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
- 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
- Sleep apnoea
Weight gain & obesity
PCOS can occur in women of any weight, however, up to 75% 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, ie 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
A 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|
|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.
Women with PCOS have a higher prevalence of 'metabolic syndrome'. 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
Women with PCOS have between four and seven times increased risk of developing prediabetes and type 2 diabetes than women without PCOS. Prediabetes is the stage before type 2 diabetes. Women with PCOS are also more likely to develop diabetes earlier, eg 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.
Women with PCOS are thought to be at higher risk of having future heart disease or stroke. 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.
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:
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
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
McCartney CR, Marshall JC. Polycystic Ovary Syndrome. N Engl J Med 2016;375:54-64
Last updated 01 May 2018 — Last reviewed 20 April 2017
** 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 April 2017.