Long-Term Health Outcomes in Young Women With Polycystic Ovary Syndrome

A Narrative Review

Lowri A. Allen; Natasha Shrikrishnapalasuriyar; Dafydd Aled Rees

Disclosures

Clin Endocrinol. 2022;97(2):187-198. 

In This Article

Abstract and Introduction

Abstract

Polycystic ovary syndrome (PCOS) has long been recognized as a common disorder in young women leading to reproductive and cutaneous sequelae. However, the associated health risks are now known to extend beyond these familiar manifestations to a range of longer-term comorbidities. Here we review the evidence for an association of PCOS with adverse long-term health outcomes, discussing the pathophysiological mechanisms involved in addition to opportunities for therapeutic intervention. Cross-sectional and longitudinal studies point to an increased risk of type 2 diabetes, hypertension and dyslipidaemia, with recent data confirming that these translate to an increased risk of cardiovascular events independently of obesity. Obstructive sleep apnoea, nonalcoholic fatty liver disease and endometrial cancer are also more prevalent, while mental health disorders, notably anxiety and depression, are common but under-appreciated associations. Uncertainties remain as to whether these risks are apparent in all patients with PCOS or are confined to particular subtypes, whether risks persist post-menopausally and how risk may be affected by ethnicity. Further work is also needed in establishing if systematic screening and targeted intervention can lead to improved outcomes. Until such data are available, clinicians managing women with PCOS should counsel patients on long-term health risks and invest in strategies that limit progression to metabolic and non-metabolic morbidities.

Introduction

Polycystic ovary syndrome (PCOS) is a common endocrine disorder, affecting 5%–13% of premenopausal women.[1] The clinical manifestations of hyperandrogenism (hirsutism, acne and scalp hair loss) and menstrual disturbance are well-recognized. In contrast, the association with longer-term adverse health outcomes is less appreciated, despite a wealth of evidence pointing to an increased risk of metabolic and non-metabolic morbidities. Coupled with care that is often fragmented, this disconnect may lead to a management approach that is overly focused on symptom control, with consequent missed opportunities for prevention, screening and treatment of longer-term complications. In this review, we examine the evidence for long-term adverse health outcomes in young patients with PCOS, and consider the implications for clinical practice. We undertook this as a narrative exercise as there were insufficient studies in each area to conduct a systematic review.

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