PCOS is often labeled a fertility disorder, but it's important to know about other PCOS complications like diabetes, heart disease, and more.
If and when you’ve received a PCOS diagnosis, it’s likely you were told that you would likely have fertility problems. It’s also possible your physician sputtered off a list of other scary-sounding health factors -
This is - to say the least - fairly stress-inducing. But, with proper knowledge and education we can take back control of understanding our health. There is much we can do from young adulthood to beyond middle-age to decrease our own risk for these long-term health issues.
Prevention is key when it comes to chronic health conditions. But to properly prevent, education is a must. Let’s double click into some of the most major chronic conditions associated with PCOS.
The majority of women with PCOS also have something called insulin resistance.
Insulin is a hormone secreted by our pancreas. Its job is to break down glucose (or blood sugar) into energy for our muscles, organs, and other internal functions. Being resistant to insulin means that our body's blood sugar is less responsive to the insulin our pancreas. This has 2 immediate effects:
Chronic high blood sugar is an issue because it turns into pre-diabetes and eventually type 2 diabetes if we don't do anything to stop it. And diabetes makes us much more predisposed to serious health issues like cardiovascular disease (more on that below!), nerve damage, kidney damage, and more, because having chronic high levels of blood sugar ultimately leads to cell degradation within our body.
More than half of women with PCOS develop type 2 diabetes by age 40 (5). This is a startling stat, but remember - knowledge is power! By proactively managing our hormones in our 20s and 30s, our cysters can avoid (or at least manage) insulin resistance through diet, exercise, and in some cases, medications like Metformin.
Insulin and fasting blood sugar are two key biomarkers for keeping insulin resistance under control. While accurate insulin tests generally need to be administered by a lab, you can monitor your own blood sugar daily (or even more frequently!) with blood glucose meters. This puts much of the control back in your hands through allowing you to see which foods, medications, and other lifestyle factors do well for your blood sugar versus which do not.
A hormonal health specialist will be able to provide increased support for managing your diabetes risk. That said, there are many resources for diabetes since it is such a prevalent issue in the US. If you do hit the point of being diabetic or prediabetic, or are just worried about your increased risk and want more support but seeing a specialist is not feasible for you, there are dozens of digital-based Diabetes Prevention Programs (DPPs) to choose from that are clinically-proven to help improve your blood sugar levels. Some examples of these are Livongo, Vida, Virta Health, and Omada Health. It is likely that your employer-sponsored or private health plan will cover your fee for completing these programs, but if not, consumer plans are also available.
If you have insulin resistance, prediabetes, or diabetes, you can learn more at the American Diabetes Association.
Luckily, this doesn't happen overnight (duh!) and there are a few strong indicators to keep track of to make sure you're optimizing your heart health: insulin resistance, cholesterol, and blood pressure. ⠀⠀
As mentioned above, a strong correlation between insulin resistance and cardiovascular disease (CVD) has been established: there is a correlation between carrying around excess weight intensifying insulin resistance and vice versa (3,4).
Insulin resistance contributes to generate CVD via two independent pathways: (a) atheroma plaque formation (clogged arteries) and (b) ventricular hypertrophy and diastolic abnormality (thickening of the walls of our heart's primary pumping chamber and abnormal relaxation vs. stiffening of our heart).
That said, it takes years - even decades - of insulin resistance leading to diabetes leading to more serious heart problems. Insulin and blood sugar are relatively easy biomarkers to monitor, and there are seemingly infinite tools available for managing blood sugar, prediabetes, and diabetes.
Before we dive into this one, let’s remember a key thing about cholesterol: it is needed for healthy cell building and function! Cholesterol is needed especially for hormone production, fat-soluble vitamins, and efficient digestion (1). Without it, we simply could not function.
For that reason, we like to stay away from cholesterol demonization and rather take an objective look at what most current studies are indicating:
Now that we have that sorted out - it's important to know that PCOS also puts us at risk for high LDL ("bad" cholesterol) and low HDL ("good" cholesterol). This means that for many cysters, the important ratios mentioned above may be outside of optimal range; since our LDL clogs our arteries and HDL clears them, this can leave us predisposed to CVD down the road.
While this is somewhat tied to insulin resistance and diabetes, a poor good-to-bad cholesterol ratio can also develop from imbalanced hormones independent of one specifically having insulin resistance and/or being overweight (2).
In other words: even women with either lean PCOS and/or non-insulin resistant PCOS are still at an increased risk for high cholesterol, which in time can lead to poor heart health. ⠀
Women with PCOS are also at risk of developing hypertension, or high blood pressure. High blood pressure can damage our arteries over time, restricting blood flow to our hearts.
An inactive lifestyle, sleep apnea, smoking, stress, insulin resistance, and obesity are all linked to hypertension. While we may be born with some of these predispositions to hypertension (e.g., insulin resistance and sleep apnea) there are a host of other lifestyle factors that we have control over - e.g., don't smoke! - to minimize risk.
Like testing our blood sugar, blood pressure is something that we can monitor from our own homes. This makes it a relatively easy biomarker to monitor and experiment with what works vs. what does not work for us - for example, perhaps you respond quite quickly to medication and cutting back sodium, but your morning cup of coffee (which has been shown to cause temporary spikes in blood pressure) doesn’t negatively affect you.
Estrogen dominance, or a too-high ratio of estrogen-to-progesterone, is a topic we discuss a great deal at Pollie. The reason for this is not just because of its in-the-moment annoying side effects like bloating, painful breast swelling, and heavy periods.
Here’s how we get to that point:
Keeping tabs on endometrial cancer is a tougher one to do from home. The reason behind this is that it is more highly dependent on estrogen, progesterone, and other reproductive hormones, which are more difficult to monitor yourself even with helpful at-home tests like Everlywell and Modern Fertility. This is when it makes sense to get a specialist involved for more longitudinal care and monitoring.
That said, most of these issues can lurk silently. While insulin resistance may have more noticeable effects like energy crashing after meals, heart disease risks like high cholesterol have no symptoms, and there is no way to know if it is afflicting us if we are not actively monitoring it with a qualified practitioner.
None of these chronic health conditions develop overnight and while they cannot be addressed overnight either, there are steps everyone can take today to start managing their hormones, re-balancing their bodies, and planning for tomorrow’s wellbeing.