Polycystic Ovary Syndrome (PCOS) is the commonest endocrine disorder in young women, affecting up to 10% of the premenopausal population. In addition to its reproductive sequelae, PCOS is now established as a metabolic disorder, characterised by defects in insulin secretion and action. These disturbances, along with comorbidities such as obesity and dyslipidaemia, may predispose to an increased risk of cardiometabolic disease in later life. Our studies confirm a higher prevalence of surrogate risk measures for cardiovascular disease, including antioxidant capacity, complement concentration and sympathoexcitation, in women with PCOS compared to matched controls. Nevertheless, differences between groups in arterial stiffness, myocardial function and carotid intima media thickness are not apparent after adjustment for obesity. Large-scale epidemiological data confirm an increased long-term risk of type 2 diabetes and fatty liver disease but not of all-cause mortality, cancer and cardiovascular events, albeit that studies were conducted in a young population (with a low event-rate) hence longer-term data are required. These risks extend into pregnancy and include an increased risk of gestational diabetes, pre-eclampsia, prematurity and miscarriage. However, age-standardised fertility ratios are not different compared to unaffected controls, providing some reassurance to patients that fertility may be restored with appropriate treatment. More recently, data show an increased incidence of depression, anxiety, bipolar disorder and eating disorder in women with PCOS, accompanied by alterations in white matter microstructure. Furthermore, linkage analysis also found an increased risk of a recorded diagnosis of autism spectrum disorder and attention-deficit hyperactivity disorder in children born to mothers with PCOS, raising the possibility that increased exposure to androgens in utero might affect neonatal brain development. Treatments to reduce these long-term risks are thus needed urgently. In this regard, data from randomised, placebo-controlled trials of metformin on vascular function show promise, whereas lifestyle trials comparing different exercise modalities are ongoing.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes