Lack of ovulation results in infertility and may cause abnormal overgrowth of the endometrium (the lining of the uterus). This overgrowth (“hyperplasia”) is due to a lack of progesterone to counteract the effects of estrogen and can lead to irregular bleeding, and if not corrected long-term, may induce abnormal, sometimes, precancerous changes in the endometrium. Excess androgens may result in increased body hair, acne and in some cases, even male-pattern balding. Other health concerns include obesity and associated features, such as sleep apnea, a condition that involves obstruction of the airway during sleep.
Some women with PCOS may have abnormal metabolic changes:
- Carbohydrate intolerance as suggested by an abnormal glucose tolerance test which can evolve into diabetes (type 2).
- Increased blood levels of bad lipids (total and LDL cholesterol, and triglycerides), and decreased blood levels of good lipids (HDL cholesterol), a pattern that is considered a risk factor for heart disease in the future.
However, there is no good quality, prospective data to confirm whether PCOS itself contributes separately to other lifestyle factors that are known to increase the risk of heart disease. Nevertheless, women with PCOS should be monitored with periodic assessment, including blood tests for cholesterol and sugar levels, and if indicated, a biopsy of the uterine lining.
In addition, the symptoms and signs of PCOS may change from adolescence to menopause. In adolescence, infrequent periods, male pattern of hair growth, and overweight are common worries; in reproductive-age women, infertility due to lack of ovulation is an added concern; and, in more mature women, obesity, abnormal blood lipids and type 2 diabetes, and abnormal uterine lining are health issues. Obesity is present in 30-75% of women with PCOS and there is also a tendency for body fat to be distributed around the abdomen, increasing the waist-to-hip ratio. Obesity is associated with more marked disturbances in androgens and metabolic changes when compared to normal-weight women with PCOS.