PCOS May Lead To Early Death – Early Diagnosis Is Needed

Pelvic discomfort may serve as an indicative sign of PCOS. A recent study proposes that women affected by PCOS (polycystic ovary syndrome) might encounter an elevated risk of premature mortality, with heart disease, lung infections, and diabetes among the potential contributors.

New research, presented in an abstract at ENDO 2023, the Endocrine Society’s yearly conference on June 18, indicates that individuals with polycystic ovary syndrome (PCOS) face a 47 percent higher likelihood of premature death compared to those who do not have the condition.

“The data showed that women with PCOS died about one year earlier than other women,” said coauthor Terhi Piltonen, MD, PhD, of University of Oulu and Oulu University Hospital in Oulu, Finland.

Dr. Piltonen emphasized the importance of enhancing PCOS treatment to mitigate associated health risks that may lead to shortened lifespans.

PCOS May Lead to Increased Risk of Death From Heart Disease and Diabetes

Polycystic Ovary Syndrome (PCOS) serves as an encompassing term used to characterize a cluster of symptoms linked to elevated levels of testosterone and other reproductive hormones known as androgens.

Statistics from the Centers for Disease Control and Prevention (CDC) suggest that PCOS affects approximately 6 to 12 percent of women within their reproductive years, although it is widely believed that this condition often goes undiagnosed. Furthermore, the CDC underscores that PCOS is a lifelong condition that continues to influence women even after their childbearing years.

Notably, PCOS stands as a prevalent cause of infertility among women and amplifies the risk of developing diabetes and cardiovascular conditions.

How Experts Connected PCOS to Early Death

To investigate a potential association between PCOS and an elevated risk of premature mortality, researchers leveraged data from the Finnish Care Register for Health Care, employing ICD codes, which are utilized by healthcare providers to document diagnoses and symptoms.

The study encompassed records of more than 80,000 women, with nearly 10,000 diagnosed with PCOS and over 70,000 forming the control group. These participants were carefully matched based on their birth year and geographical location.

Over the course of the study, spanning from 1969 to 2019, it was observed that 1,003 women from the control group and 177 women with PCOS had passed away.

Notable findings from the study included:

• Women diagnosed with PCOS exhibited a 47 percent higher risk of overall mortality when compared to their counterparts without PCOS.
• The relative risk of succumbing to cardiovascular disease was 67 percent higher among women with PCOS, while the risk of mortality attributed to tumors was 38 percent greater.
• Women with PCOS faced a threefold increased risk of mortality due to diabetes and lung infections.

“This is the first study to show cause-specific mortality in PCOS,” Piltonen said.

“Because only the abstract is available, I’m unable to comment on the study design and quality of the study, but in terms of the findings, I am not surprised in the least,” said Fatima Daoud Yilmaz, MD. She is an obstetrician and gynecologist at Stony Brook Medicine in New York. She also wasn’t part of the study made.

“It’s becoming more and more clear that PCOS is not just a disorder of the female reproductive system or something that exclusively affects the female reproductive system, but rather, it’s a metabolic disturbance, like diabetes or thyroid issues,” Dr. Daoud explained.

The general public may view PCOS as a reproductive issue, but that couldn’t be further from the truth, she says. “It is absolutely a whole-body issue. Given the comorbidities that we frequently see with PCOS, the findings make sense,” she said.

Understanding the Elevated Risk for Women Suffering from PCOS

It’s crucial to grasp that the heightened risk discussed in the study pertains to relative risk rather than absolute risk, as clarified by Daoud. To illustrate this concept, consider the following scenario: In a study, if two individuals from a control group of 100 pass away, and three individuals with a specific condition in a group of 100 also pass away within the same timeframe, this implies that individuals with the condition face a 50 percent higher risk of mortality compared to those without the condition.

“That doesn’t mean these findings are insignificant, but they also shouldn’t frighten women with PCOS into thinking that their absolute risk of dying is 47 percent,” Daoud said.

Findings Didn’t Consider BMI or Weight

The study findings pique our interest, but to establish their relevance, we require additional contextual information, remarked Dr. Sun Kim, MD, an associate professor of medicine and an endocrinologist at Stanford Health Care in Palo Alto, California. (Dr. Kim was not affiliated with the research.)

One notable shortcoming of the study is the absence of data pertaining to the participants’ weight or Body Mass Index (BMI), a crucial factor, as noted by Dr. Kim.

“Having overweight or obesity generally worsens symptoms of PCOS and is associated with other cardiometabolic abnormalities, including increased glucose, dyslipidemia, hypertension, nonalcoholic fatty liver disease (NAFLD), and sleep apnea, to name a few, which can increase risk for morbidity and mortality,” she added.

Increased Risk of Death Could Also be Linked to Other Factors

Kim clarified that women with PCOS are not a homogenous group. While those diagnosed with PCOS are typically considered to have higher insulin resistance compared to their counterparts without the condition, some can also display insulin sensitivity. Kim explained, “In most cases, higher weight is correlated with increased insulin resistance.”

Insulin resistance refers to a situation where the body needs a greater amount of insulin to regulate blood sugar levels, a condition prevalent in individuals with prediabetes and type 2 diabetes.

Kim pointed out that among women with PCOS, those who exhibit the most pronounced insulin resistance and associated cardiometabolic abnormalities are likely at the highest risk for early mortality.

“We know, for example, that individuals with nonalcoholic fatty liver disease (NAFLD), regardless of PCOS, are at high risk for cardiovascular disease. Women with PCOS may also be at higher risk for NAFLD,” she said.

One question raised by Kim is whether women with PCOS face an elevated risk of cardiovascular disease, as mentioned in the abstract, and whether this risk is attributable to NAFLD or insulin resistance.

“The current study may be comparing women with PCOS (who are more likely to be insulin resistant and with cardiometabolic abnormalities) with women without PCOS who may be insulin sensitive,” she said.

“There have been other published studies that have shown no increase in early death in women with PCOS,” says Kim. The findings of the current study may also need to be interpreted with further caution, she advised.

How Can Women With PCOS Best Protect Their Health?

“Women with PCOS should have a full evaluation of their cardiometabolic risk at diagnosis and have that reviewed regularly,” said Kim. If being overweight has become an issue, weight loss may help improve insulin sensitivity and also generally improve cardiometabolic abnormalities as well, she added.

Due to the potential coexistence of various health conditions in women with PCOS, Daoud suggests adopting a collaborative healthcare approach.

For instance, managing conditions like high blood pressure and cholesterol can typically fall under the purview of your primary care physician, while an endocrinologist would be the most suitable choice for addressing any emerging diabetes concerns, according to her.