PCOS and Getting Older
By Samuel Thatcher, MD, Ph.D.
Q. I've never actually been diagnosed with PCOS. But after reading what I have on the subject, I'm really starting to wonder whether this may have been the cause of all my past fertility problems. My question to you is that since I'm now no longer trying to conceive (I had a tubal ligation done after our last child), and if indeed I am correct on my assumption and this is PCOS, how will it continue to affect me as I get older? I am now 33.5 years old.
A. First, I agree that a good case could be made for your diagnosis of PCOS. One of the most pressing issues about PCOS is that are its long term consequences. We virtually know nothing about this at present and the scattered reports tend to be conflicting.
There are several things we think we know for sure. PCOS is clearly associated with an increased risk of type 2 diabetes. Continued vigilance on fasting glucose levels, possibly even insulin levels may be a reasonable idea. Much of type 2 diabetes is weight related. It has been difficult to separate out the adverse effects of weight from other medical conditions.
PCOS patients also tend to have abnormal lipoid profiles and yearly monitoring with lifestyle, and possible medical intervention when appropriate. There is a real question about heart attacks and heart disease. It seems that the risk with PCOS should be much higher than it actually is. This is still an issue that requires a considerable amount of research. Both diabetes and heart disease may be preventable in part and successfully treated when identified in the formative stages.
There is a clear association of PCOS with cancer of the uterine lining (endometrium). This is markedly reduced and possible reversed with cycles regulation or regular bleeding. Others cancer such as ovarian and breast do not seem to be increased. Childbearing and oral contraceptive use is protective against ovarian cancer. Family history is most important issue with breast cancer. Routine mammogram and self-examination are strongly suggested. Colon cancer risk rise with obesity.
Cycles tend to become more regulate after age 35. It is possible that the menopausal transition is easier with PCOS. Hip fracture and osteoporosis are very significant health risks to postmenopausal women. Bone density is greatest and fracture risk appears reduced with PCOS.