When we are talking about PCOS treatment, it is probably not the correct term. It is rather “management” of PCOS. There are a lot of areas that need to be taken into account to decide on a specific treatment, approach to treat this disease. It is also important what the patient wants – what is her goal that she wants to achieve. If she would like to become pregnant, we will look at the general condition and we will try to stimulate the ovary and lead to pregnancy. We will check if she has a normal sugar level, and she does not have too high blood pressure – if those are unbalanced, we will try to normalize these parameters but first of all we would like to stimulate her ovaries. If her main concern is menstrual irregularity we can prescribe her medication to regulate her cycle. Sometimes due to high androgen levels women suffer from acne, skin problems, and excess hair growth, we can prescribe dermatological treatment and also antiandrogens medication which will decrease the level of androgens. The main concern in the case of PCOS is what the patient needs. If she already has children, I mean she has given birth to all planned children and does not wish to have more, we need to discuss long-term risks. Patients who will not be treated for PCOS, in 10-20 years there will be more likely to suffer from heart disease, high blood pressure, dyslipidemia, arteriosclerosis, hypertriglyceridemia, and diabetes. It is necessary to inform patients and make them aware from a very young age that those are the potential risks and the prophylactic measures are needed to keep a normal weight, keep a healthy diet, exercise, to do regular check ups of the endometrium, and ovaries. When we are focusing on specific problems of PCOS, we see the problem with endometrium like polyps, hyperplasia, and cancer is affecting PCOS patients more often.
Long-term problems could be because it is a state where the estrogen hormone is as a baseline and tonically raised so it can lead to continuous stimulation of the lining of the womb and it gets thickened so it can lead to heavy menstrual periods but it can also lead to some cellular changes within the lining of the womb which could be precancerous or in very very few cases it could lead to cancer as well in the long term. Again due to the same reason, due to raised estrogen (female hormone) it can sometimes lead to a breast problem which could be cancer of the breast in the long term. Again, the hormonal problem in polycystic ovary is basically related to mainly insulin resistance, so insulin is a growth hormone and and if the tissues are resistant to it, it cannot do its proper action which is to push the main energy source – glucose, into the cells, so that cells can utilize that glucose to produce energy and if the tissues and cells are resistant then as a compensatory mechanism there is more insulin secreted and because insulin is a growth hormone, it can lead to weight gain, it can lead to more hunger, it can lead to more fat deposition and because it is a stress on the carbohydrate metabolism, patient can manifest changes of carbohydrate intolerance and diabetes mellitus. So diabetes mellitus, endometrial lining of the thick lining and cancer of the womb or cancer of the breast also because the patient is overweight, they are struggling with fertility. Sometimes they have menstrual cycle problems, so their mental health gets affected and it can lead to depression, poor self-esteem and things like that. These are long-term issues.
Long-term risks from polycystic ovarian, as I said, it is a metabolic disorder. It’s a metabolic and its genesis is a metabolic disorder and the one thing that we do know with women with the Polycystic Ovarian Syndrome, is they have much, especially for those women who have a raised BMI and that’s a BMI over 26, they do have a much higher risk -I believe people have quoted 50 to 60%t – risk of developing type 2 diabetes in later life or talk about in when they’re over 50. So that is one of the big risk factors of Polycystic Ovarian Syndrome that there is a higher preponderance of them developing type 2 diabetes which is the non-insulin dependent diabetes mellitus the other risk factors with the Polycystic Ovarian Syndrome, especially for women who have irregular or absent periods, is that they also run the risk of developing endometrial cancer or endometrial hyperplasia which can lead to endometrial cancer because they’re not regularly shedding off the lining of the womb. If a doctor notices that a woman who’s not necessarily trying to get pregnant but she’s having very infrequent periods, they would normally start either on the contraceptive pill or even give progesterone tablets to induce a period at least three times a year. We also know that women with Polycystic and again this is really associated with those with raised BMI, have a higher risk of developing a cardiovascular disease later on in life and all of these have a metabolic genesis but again lifestyle changes, can reduce almost all the things I’m talking about which is the endometrial hyperplasia. If you lose weight you’re less likely to get a thickened endometrium, you’re more likely to have regular periods and therefore you risk of endometrial cancer is reduced, the developing type 2 diabetes, if you lose weight exercise and dieting again, you’re less likely to develop type 2 diabetes in later life and also reduce your risk of of cardiovascular disease.
Short term, if you’re trying to conceive, without treatment you will find it more difficult to conceive or it might take a little bit longer. Obviously, if you have distressing symptoms that are often associated with PCOS (that can be excess body weight, excess bodily hair, thinning of hair on the scalp, acne) then those symptoms can have a long term effect, impacting on your self esteem and your self confidence. These long term effects of not getting on top of your PCOS can be treated through changes in lifestyle. The long term consequences of not doing this can mean that you may in some circumstances become overweight and that can impact on your general health so your likelihood of getting diabetes or cardiovascular disease will increase in the future. Long term risks are associated predominantly with cardiovascular disease and diabetes.
