Long-term health consequences in women with polycystic ovary syndrome

Ageing and the menopause

The phenotype of women with PCOS appears to ameliorate with ageing as indicated by the increase in frequency in the regularity of menstrual cycles, decrease in serum androgen levels, and decrease in insulin resistance (37).

The PCOS menopausal phenotype remained poorly defined and the current diagnostic criteria cannot be used after the menopause. Longitudinal data provide evidence that control women tend to have worsening of some of their metabolic parameters to a range seen in the PCOS subjects over time, whereas women with PCOS have more components of the metabolic syndrome starting at an early age (insulin resistance, abnormal lipid levels, hypertension, obesity) and therefore have a longer exposure to these adverse car­diovascular risk factors (83). Whether the increased cardiovascular risk in reproductive life translates into an increased cardiovascular morbidity and mortality in later life for women with PCOS remains to be unravelled as current data remains conflicting (1, 83). In women who maintain high androgen levels even after menopause, the cardiovascular risk remains increased and can adversely af­fect these women's risks of cardiovascular disorders later on in life. Further longitudinal data is essential to follow up in women with PCOS to determine their lifetime risks of metabolic and cardiovas­cular diseases.

Cancer risks in women in PCOS

Women with PCOS share many of the risk factors associated with the development of endometrial cancer including obesity, hyperinsulinism, diabetes, and abnormal uterine bleeding (52). Young women with endometrial cancer are found to be more likely to be nulliparous and infertile, have higher rates of hirsutism, and have a slightly higher chance of oligomen orrhoea (84). Therefore, the Royal College of Obstetricians and Gynaecologists has recom­mended it is good clinical practice that women with irregular men­strual cycles should receive treatment with progestogens to induce a withdrawal bleed at least every 3- 4 months as they are at higher risks of endometrial hyperplasia and cancer later on in life.

Women with PCOS do not have a significant increase in their risk of developing breast cancer compared to those without PCOS (relative risk 0.88; 95% CI 0.44-1.77) based on systematic review (85). A small number of studies have addressed the possibility of an association between PCOS and epithelial ovarian cancer risk and the overall data appear reassuring (86-88). Finally, there does not appear to be an association of PCOS with breast or ovarian cancer. Therefore, no additional surveillance is required beyond that of rou­tine screening for breast and ovarian cancer.