PCOS Complications: Let’s Simplify the Complexity!

What are the Complications of PCOS?

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder common among women of reproductive age. In PCOS, the ovaries produce an abnormal amount of androgens, (male hormones) which are usually produced in women, but only in smaller amounts. 

As a result of this hormonal imbalance, the ovaries are unable to release eggs (ovulation), which causes irregular menstrual cycles, and other PCOS symptoms such as unwanted facial hair, acne, hair loss, weight gain, and infertility.

The exact cause of this hormonal imbalance in PCOS is unknown, but there are some factors that play a major part in causing PCOS. PCOS risk factors or contributing agents include excess androgen levels, insulin resistance, low-grade inflammation, genetics, etc.

PCOS cannot be cured and needs to be managed life-long with treatment methods and lifestyle changes. So what happens if PCOS is left untreated? If PCOS goes undiagnosed and untreated for a long, there are high chances of developing PCOS complications including:

Infertility

PCOS is the most common cause of infertility. In PCOS, the excess amount of androgens produced in a woman’s body interferes with the formation and release of eggs from the ovaries. 

Unpredictable ovulation results in irregular menstrual cycles and can also lead to infertility. It may be difficult to get pregnant with PCOS, but it is not impossible. Infertility in PCOS is treatable with lifestyle changes, medications, and surgery.

Endometrial Cancer

The endometrium is the lining of your uterus or womb, which is shed every month through menstruation in non-pregnant women. Endometrial cancer starts in the cells of the endometrium and is the most common type of uterine cancer. 

In individuals with a normal menstrual cycle, estrogen causes the thickening of the endometrium in preparation for a potential pregnancy. When there is no pregnancy, the thickened endometrium will shed and bleed with each menstrual cycle.

In PCOS, there is no ovulation, the endometrial lining is not shed and is exposed to higher amounts of estrogen. This causes the endometrium to grow thicker than normal and increases the chance of the development of cancer cells.

Normalising your menstrual cycle plays an important role in managing PCOS and preventing the development of endometrial cancer.

Type 2 Diabetes

Prediabetes and Type 2 Diabetes are two of the most common long-term complications of PCOS. Normally, your body digests the food you eat and breaks it down into glucose (sugar). Insulin helps to transport this glucose from the bloodstream into muscle and fat cells, where the glucose is converted into energy. Thus, insulin helps regulate blood sugar levels.

Women with PCOS may develop insulin resistance, which means their cells do not respond to insulin in a normal way. This leads to increased blood glucose levels, which can trigger the pancreas to produce more insulin to stabilise the blood glucose level. Over time, a gradual and consistent increase in blood glucose levels can lead to Type 2 Diabetes.

Metabolic Syndrome

Metabolic syndrome is a cluster of risk factors that occur together and increase the risk of heart disease. The insulin resistance and obesity commonly associated with those who have PCOS may increase their chances of developing metabolic changes such as:

• Increased abdominal weight
• Low level of high-density lipoprotein (HDL) or “good cholesterol”
• Increase in the level of triglycerides
• High blood sugar levels
• High blood pressure

Heart Disease

Now, as we know, your body produces more androgens in PCOS. The androgen levels, insulin resistance, and increased insulin levels trigger weight gain predominantly in the abdominal region since this is where men tend to carry their weight.

This belly fat, also called visceral fat surrounds the internal organs and poses serious health issues such as heart disease. 

The high insulin levels associated with PCOS also increase the risk for high triglycerides, inflammatory markers, high blood pressure, and atherosclerosis. These factors can increase your risk of a heart attack and stroke.

Pregnancy-Related Complications

In pregnant women with PCOS, pregnancy complications are also seen. During pregnancy, PCOS may increase chances of:

• Gestational Diabetes: This can be due to increased insulin resistance.
• Pregnancy-Related High Blood Pressure: This condition usually occurs in the second half of the pregnancy. If untreated, it can lead to pre-eclampsia. 
• Pre-eclampsia: There can be a sudden increase in blood pressure in a pregnant woman after the 20th week of pregnancy. 
• Preterm Birth: This refers to the birth of the baby before 37 weeks of pregnancy. It may be because of developing preeclampsia.
• Caesarean Delivery: This may be due to the larger size of the baby for their gestational age, complications during labour and delivery, and the risk to mother and infant due to vaginal birth. 

Apart from these complications, untreated PCOS may also result in: 

• Sleep disorders such as sleep apnoea
• Mental health problems such as depression and anxiety
•  Inflammation and damage to the liver, a condition called nonalcoholic steatohepatitis. 

How to Prevent PCOS Complications?

It is a fact that PCOS cannot be cured and needs to be managed. PCOS cannot be prevented either. However, even if you have PCOS, the complications can be effectively prevented by taking a few precautionary measures.

1. Have a balanced diet that includes food that is low in carbohydrates, and high in fibre, protein, and healthy fats. This can help control your blood sugar levels. This, in turn, helps to manage insulin resistance and the excess insulin and androgen levels that lead to PCOS and its complications.
2. Exercise regularly for at least 30 minutes a day, 5 days a week. This can help keep your body active, maintain a healthy body mass index, and prevent the amplification of PCOS symptoms.
3. Keep a check on your weight with diet and exercise. If you are obese or overweight, losing even 10% of your body weight may help normalise hormone levels, make your menstrual cycle more predictable, and prevent PCOS complications. 
4. Get your health assessed regularly. Consulting your doctor at least once a year and getting blood tests done to know the status of your risk factors can help you take preemptive action against PCOS complications.