Complications


Other health problems that have been linked to PCOS include information on prediabetes, type 2 diabetes, cardiovascular disease, metabolic syndrome and endometrial cancer. You can also learn about BMI (body mass index) and how to measure your BMI.

Coping with the symptoms of PCOS and managing the treatments can be demanding. To then learn there can be complications and added risks to your health from PCOS can be distressing.

Just being aware there are added risks is an important first step. Once you have the symptoms of PCOS under control then you can turn your mind to thinking about ways to prevent further complications.  The good news is that many of the treatments you will use for your PCOS will also help to prevent many of the complications.

What are the complications of PCOS?

Besides insulin resistance and the high levels of androgens ('male' hormones) associated with PCOS, other health issues women with PCOS may encounter include:

  • Weight gain or obesity
  • Prediabetes
  • Type 2 diabetes
  • Cardiovascular disease
  • Metabolic syndrome (generally having at least two of high blood pressure, high cholesterol, obesity, high fasting blood glucose)
  • Endometrial cancer

Weight gain & obesity

PCOS can occur in women of any weight, however, up to 75 per cent of women with PCOS are overweight or obese. This excess weight is more likely to be concentrated around the abdominal (stomach) region. This gives you an 'apple' shape. Women without PCOS tend to be a 'pear' shape, with weight concentrated around the hips, buttocks and thighs.

Being overweight, and especially having a high amount of abdominal obesity, is associated with:

  • A higher risk of insulin resistance (a state where the body doesn't use the available insulin effectively to help keep the glucose levels stable, i.e. the insulin produced is not working properly)
  • Problems with infertility
  • A higher risk of type 2 diabetes
  • A higher risk of cardiovascular disease, including high blood pressure and heart disease

Importance of waist circumference

Waist circumferenceA simple way to assess your abdominal weight is to measure your waist circumference. The recommended waist circumference is less than 80cm for adult women. 

To measure this accurately you should:

  • Place a tape measure directly on your skin, or on no more than one layer of tight clothing horizontally halfway between your lowest rib and the top of your hipbone (roughly in line with your belly button)
  • Breathe out normally
  • Take the measure
  • Make sure the tape is snug, without squeezing the skin

Below is a table of the health implications associated with each waist circumference category:

Waist circumference Health implications
80-88cm Increased risk of obesity and developing type 2 diabetes and cardiovascular disease
Greater than 88cm Substantially increased risk of developing type 2 diabetes and cardiovascular disease

Measuring your BMI

Another way to measure if you are overweight is to calculate your BMI (Body Mass Index). You calculate your BMI as your weight (in kilograms) divided by your height (in metres) squared (height x height).

For example, Sally (not her real name) weighs 90kg and is 167cm tall, will have a BMI of 32.3:

>Weight (kg)   Height (m) squared   BMI
90 ÷ (1.67 x 1.67) = 32.3

When you know what your BMI is you can look at the table below to find out which weight category you are in. You will see that Sally's BMI of 32.3 would place her in the obese category. Better health channel have a BMI calculator to help you work out your BMI if you need.

BMI score Weight category
Less than 20 Underweight
20-25 Normal weight
25-30 Overweight
Greater than 30 Obese

Your BMI is only one measure of your weight. If you are unsure if your BMI increases your risk of health problems please discuss this with your doctor.

Metabolic syndrome

Women with PCOS have a higher prevalence of 'metabolic syndrome'[1]. Metabolic syndrome is a collection of conditions (listed below) that often occur together and increase the risk of type 2 diabetes and cardiovascular disease:

  • Impaired glucose tolerance (indicating the beginnings of insulin resistance)
  • High blood pressure
  • Abdominal obesity
  • High blood cholesterol

Prediabetes & type 2 diabetes

diabetesWomen with PCOS have between four and seven times increased risk of developing prediabetes and type 2 diabetes[2] than women without PCOS. Prediabetes is the stage before type 2 diabetes. Women with PCOS are also more likely to develop diabetes earlier, e.g. in their 30s and 40s. This risk is further increased by:

  • being overweight or obese
  • having insulin resistance
  • having an immediate family member with type 2 diabetes

Women with PCOS have a higher risk of developing diabetes in pregnancy (gestational diabetes). This risk increases if you are overweight when pregnant.

Cardiovascular disease

Women with PCOS are at twice as much risk of heart disease or stroke[2]. There are a number of factors that increase the risk of cardiovascular disease such as:

  • high blood fats or cholesterol
  • high levels of 'bad' cholesterol or low density lipoprotein cholesterol which increases the risk of developing heart disease
  • high levels of inflammatory proteins which can alter the function of blood vessels and increase insulin resistance
  • high blood pressure

While being overweight can increase these risks, these risks appear to be increased in PCOS independent of the effect of obesity.

Endometrial cancer

Having the condition PCOS does not cause endometrial cancer, rather it is having very infrequent periods which may increase the risk of endometrial cancer. Chronic anovulation (lack of eggs being released regularly) leads to a lack of menstruation or shedding of the lining of the uterus (endometrium). If this happens, the endometrium can thicken which can increase the risk of abnormal cells that, as a woman ages, can develop into cancerous cells.

This risk can be greatly reduced with treatments such as the oral contraceptive pill. By improving the regularity of the menstrual cycle, the uterine lining is shed more often during menstruation.  

Adequate physical activity and having a healthy body weight can also assist in normalising periods and reducing the risk of endometrial cancer.

What you can do

If you are worried about the complications of PCOS it is helpful to:

  • Get your symptoms of PCOS under control as a first step
  • Learn about and understand your risks
  • Have your blood pressure, blood glucose and cholesterol checked regularly
  • Seek guidance and support to help with weight management if needed
  • Discuss any of your concerns with your doctor

References

  1. Ehrmann D et al. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2006 Jan;91(1):48-53

  2. Meyer C et al. Overweight women with polycystic ovary syndrome have evidence of subclinical cardiovascular disease. J Clin Endocrinol Metab. 2005 Oct;90(10):5711-6

Last updated 24 July 2017 — Last reviewed 05 March 2014

** Currently under review **

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at March 2014.

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