Women with polycystic ovary syndrome, a hormone disorder and the leading cause of infertility in the US, are twice as likely as other women to be hospitalized, and show a greater risk of a number of diseases, with a “particular propensity to develop metabolic and cardiovascular disorder,” a large retrospective cohort study suggests.
In the analysis of 2,566 women with a diagnosis of polycystic ovary syndrome (PCOS), who were compared with 25,660 age-matched women without the diagnosis, those with the hormone disorder had a heightened risk of developing:
- Heart disease
- Mental health conditions
- Reproductive disorders
- Cancer of the lining of the uterus.
The study, published in the Journal of Clinical Endocrinology & Metabolism, compared rates of hospital admission. Co-author Dr. Roger Hart – of the University of Western Australia and Fertility Specialists of Western Australia, both in Perth, Australia – says the results call for more attention to the overall medical care of women with this fertility problem:
“Our study indicates women who have PCOS have twice as many hospital admissions as women without the condition. Additional health care resources should be directed to address the risks facing this population.”
The study paper describes typical features of polycystic ovary syndrome, including menstrual irregularity, hyperandrogenism (high levels of male hormone, causing hirsutism and acne) and polycystic ovarian morphology (multiple cysts in the ovaries) – with “significant reproductive implications for women.”
The reproductive health effects include increased risks of “anovulatory infertility, miscarriage and pregnancy-related complications.”
“PCOS has profound implications for a women’s reproductive health as well as [for] her long-term risk of chronic illness,” Dr. Hart says.
Hospitalization due to PCOS, between the years 1997 and 2011, enabled the researchers to identify the 2,566 women with the disorder, and to extract further medical records data on their hospital admissions for non-reproductive health issues at the same hospital in the state of Western Australia.
In the retrospective cohort study, the hospitalization patterns for the women, from 15 years of age, were compared with those of women who had not been in hospital with a PCOS diagnosis, by using data links to state-wide electoral roll information.
In addition to a list of hospital admissions unrelated to reproductive health, the “women who had PCOS were more likely to have miscarriages, ectopic pregnancies or other gynecological conditions such as irregular menstrual periods and endometriosis,” the researchers say. Women who had PCOS also had a “higher rate of endometrial cancer” (affecting the lining of the uterus).
The association with higher rates of hospital admissions also took in a long list of reasons unrelated to obstetrics and gynecology or injury, including the following conditions (with percentages of women admitted in each group given for those with a diagnosis of PCOS versus those without the disorder):
- Adult onset diabetes – 12.5% versus 3.8%
- Obesity – 16.0% versus 3.7%
- Hypertensive disorder (high blood pressure) – 3.8% versus 0.7%
- Ischemic heart disease (narrowing of coronary arteries) – 0.8% versus 0.2%
- Cerebrovascular disease (affecting blood supply to the brain, e.g., stroke) – 0.6% versus 0.2%
- Arterial blood vessel disease – 0.5% versus 0.2%
- Venous blood vessel disease – 10.4% versus 5.6%
- Asthma – 10.6% versus 4.5%
- Stress/anxiety – 14.0% versus 5.9%
- Depression – 9.8% versus 4.3%
- Licit and illicit drug-related admissions – 8.8% versus 4.5%
- Self-harm – 7.2% versus 2.9%.
The authors say the study population included only a quarter of the women reaching an age of 40 years, so the absolute number of women with metabolic and cardiovascular conditions was low.
“It would be expected,” they say, “that as the women with PCOS age, their metabolic risk will increase.”
The authors say their findings of a greater association with cardiovascular factors for women with PCOS are at odds with a consensus statement on the risk agreed so far by international experts (from the European Society of Human Reproduction and Embryology).
Contrary to this background, their study “suggested significant associations with the cardiovascular endpoints of late onset diabetes (even when controlling for obesity), obesity, hypertensive disorder, ischemic heart disease (although low due the age of the groups studied), and cerebrovascular disease.”
The authors conclude their findings:
“This unique study suggests that PCOS has profound implications for women with regard to reproductive function in the short term, and in the longer-term, the risk of chronic illness, and health care resources should be directed accordingly to mitigate against these risks.”
The Endocrine Society, which publishes the journal this study appears in, has issued 2013 clinical guidelines that recommend all women and teens diagnosed with PCOS are screened for heart disease risk factors and diabetes.
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