Taking back control of PCOS health risks

For many, reproductive hormonal imbalances display as not-so-fun “superficial” symptoms: weight gain, male-pattern hair loss, hirsutism (irregular hair growth), and painful periods, to name a few. But what about the chronic conditions like PCOS, endometriosis, and other imbalances can cause? We’ll be taking a look at that today with a discussion of long-term health effects of PCOS. 

Fear mongering no more 

If and when you’ve received a PCOS diagnosis, it’s likely you were told that you would likely have fertility problems. It’s also possible your physician sputtered off a list of other scary-sounding health factors - 

50% risk of developing diabetes by the age of 40. 

4x-7x higher risk of heart attack than other women your age.

3x higher risk of developing endometrial cancer. 

3x higher risk of anxiety and depression. 

This is - to say the least - fairly stress-inducing. But, with proper knowledge and education we can take back control of understanding our health. There is much we can do from young adulthood to beyond middle-age to decrease our own risk for these long-term health issues. 

Prevention is key when it comes to chronic health conditions. But to properly prevent, education is a must. Let’s double click into some of the most major chronic conditions associated with PCOS. 

Insulin resistance and diabetes

The majority of women with PCOS also have something called insulin resistance.

Insulin is a hormone secreted by our pancreas. Its job is to break down glucose (or blood sugar) into energy for our muscles, organs, and other internal functions. Being resistant to insulin means that our body's blood sugar is less responsive to the insulin our pancreas. This has 2 immediate effects:

• First, our bodies get tired, because they aren't efficiently using the energy that we are eating.
• Second, over time insulin resistance can tire out our pancreas from producing high levels of this hormone. Over time this can lead to hyperglycemia, or high blood sugar, because all of that glucose that should be getting sent to our muscles and organs just continues to float around in our blood. ⠀

When this happens repeatedly, we develop “chronic” high blood sugar. 

Chronic high blood sugar is an issue because it turns into pre-diabetes and eventually type 2 diabetes if we don't do anything to stop it. And diabetes makes us much more predisposed to serious health issues like cardiovascular disease (more on that below!), nerve damage, kidney damage, and more, because having chronic high levels of blood sugar ultimately leads to cell degradation within our body. 

More than half of women with PCOS develop type 2 diabetes by age 40 (5). This is a startling stat, but remember - knowledge is power! By proactively managing our hormones in our 20s and 30s, our cysters can avoid (or at least manage) insulin resistance through diet, exercise, and in some cases, medications like Metformin. 

Insulin and fasting blood sugar are two key biomarkers for keeping insulin resistance under control. While accurate insulin tests generally need to be administered by a lab, you can monitor your own blood sugar daily (or even more frequently!) with blood glucose meters. This puts much of the control back in your hands through allowing you to see which foods, medications, and other lifestyle factors do well for your blood sugar versus which do not. 

A hormonal health specialist will be able to provide increased support for managing your diabetes risk. That said, there are many resources for diabetes since it is such a prevalent issue in the US. If you do hit the point of being diabetic or prediabetic, or are just worried about your increased risk and want more support but seeing a specialist is not feasible for you, there are dozens of digital-based Diabetes Prevention Programs (DPPs) to choose from that are clinically-proven to help improve your blood sugar levels. Some examples of these are Livongo, Vida, Virta Health, and Omada Health. It is likely that your employer-sponsored or private health plan will cover your fee for completing these programs, but if not, consumer plans are also available.  

If you have insulin resistance, prediabetes, or diabetes, you can learn more at the American Diabetes Association.

Heart disease

We now know that there’s a high correlation of insulin resistance with PCOS, which can lead to diabetes. But did you know that PCOS also puts you at higher risk for heart disease?⠀

Luckily, this doesn't happen overnight (duh!) and there are a few strong indicators to keep track of to make sure you're optimizing your heart health: insulin resistance, cholesterol, and blood pressure.  ⠀⠀

INSULIN RESISTANCE

As mentioned above, a strong correlation between insulin resistance and cardiovascular disease (CVD) has been established: there is a correlation between carrying around excess weight intensifying insulin resistance and vice versa (3,4).

Insulin resistance contributes to generate CVD via two independent pathways: (a) atheroma plaque formation (clogged arteries) and (b) ventricular hypertrophy and diastolic abnormality (thickening of the walls of our heart's primary pumping chamber and abnormal relaxation vs. stiffening of our heart).

That said, it takes years - even decades - of insulin resistance leading to diabetes leading to more serious heart problems. Insulin and blood sugar are relatively easy biomarkers to monitor, and there are seemingly infinite tools available for managing blood sugar, prediabetes, and diabetes.

CHOLESTEROL

Before we dive into this one, let’s remember a key thing about cholesterol: it is needed for healthy cell building and function! Cholesterol is needed especially for hormone production, fat-soluble vitamins, and efficient digestion (1). Without it, we simply could not function. 

For that reason, we like to stay away from cholesterol demonization and rather take an objective look at what most current studies are indicating:

• Maintaining a favorable HDL/Total Cholesterol ratio is more important than keeping our total count low. HDL stands for high-density lipoprotein, or “good” cholesterol; Total Cholesterol is a measure of our HDL + LDL ( low-density lipoprotein, or “bad” cholesterol). So, this ratio means that we are keeping the ratio of good-to-bad cholesterol under control. Higher is better here. 
• Triglyceride/HDL ratios. Similar to LDL, triglycerides are not our BFF. Another helpful calculation is to monitor triglyceride levels compared to our “good” HDL cholesterol. 

Now that we have that sorted out - it's important to know that PCOS also puts us at risk for high LDL ("bad" cholesterol) and low HDL ("good" cholesterol). This means that for many cysters, the important ratios mentioned above may be outside of optimal range; since our LDL clogs our arteries and HDL clears them, this can leave us predisposed to CVD down the road. 

While this is somewhat tied to insulin resistance and diabetes, a poor good-to-bad cholesterol ratio can also develop from imbalanced hormones independent of one specifically having insulin resistance and/or being overweight (2).

In other words: even women with either lean PCOS and/or non-insulin resistant PCOS are still at an increased risk for high cholesterol, which in time can lead to poor heart health.  ⠀

BLOOD PRESSURE

Women with PCOS are also at risk of developing hypertension, or high blood pressure. High blood pressure can damage our arteries over time, restricting blood flow to our hearts.

An inactive lifestyle, sleep apnea,  smoking, stress, insulin resistance, and obesity are all linked to hypertension. While we may be born with some of these predispositions to hypertension (e.g., insulin resistance and sleep apnea) there are a host of other lifestyle factors that we have control over - e.g., don't smoke! - to minimize risk.

Like testing our blood sugar, blood pressure is something that we can monitor from our own homes. This makes it a relatively easy biomarker to monitor and experiment with what works vs. what does not work for us - for example, perhaps you respond quite quickly to medication and cutting back sodium, but your morning cup of coffee (which has been shown to cause temporary spikes in blood pressure) doesn’t negatively affect you. 

Endometrial cancer

Estrogen dominance, or a too-high ratio of estrogen-to-progesterone, is a topic we discuss a great deal at Pollie. The reason for this is not just because of its in-the-moment annoying side effects like bloating, painful breast swelling, and heavy periods. 

When not balanced out by sufficient progesterone levels, excess estrogen can also lead to long-term health issues like endometrial cancer. 

Here’s how we get to that point:

• Progesterone is responsible for proper shedding of our uterus each month and ovulation (the release of an egg) is what catalyzes this shedding - or our period - to occur. 
• However, anovulatory cycles can still occur for women with PCOS. This means our bodies still have a period to shed our uterus lining - often catalyzed by a drop in estrogen - even if we have not ovulated.
• Since women with PCOS often have anovulatory cycles and are predisposed to chronic lower levels of progesterone, they are at a double disadvantage. Even if either a “real” or anovulatory period occurs, low levels of progesterone mean that PCOS bodies are prone to building up endometrial tissue over time.
• Due to low progesterone and irregular periods, the endometrium becomes thick. In some cases its cells can become abnormal, indicating a precancerous condition called endometrial hyperplasia. If left untreated, endometrial hyperplasia can lead to endometrial cancer (6).

Keeping tabs on endometrial cancer is a tougher one to do from home. The reason behind this is that it is more highly dependent on estrogen, progesterone, and other reproductive hormones, which are more difficult to monitor yourself even with helpful at-home tests like Everlywell and Modern Fertility. This is when it makes sense to get a specialist involved for more longitudinal care and monitoring. 

Empower yourself with knowledge 

There is a lot of fear mongering out there about PCOS. Our goal is to de-bunk this at Pollie. While all of the conditions discussed in this article are indeed serious, we can work to offset our genetic predisposition through preventative measures like lifestyle changes and medication.

That said, most of these issues can lurk silently. While insulin resistance may have more noticeable effects like energy crashing after meals, heart disease risks like high cholesterol have no symptoms, and there is no way to know if it is afflicting us if we are not actively monitoring it with a qualified practitioner. 

None of these chronic health conditions develop overnight and while they cannot be addressed overnight either, there are steps everyone can take today to start managing their hormones, re-balancing their bodies, and planning for tomorrow’s wellbeing. 

Sources

1. High Blood Cholesterol. NIH National Heart, Lung, and Blood Institute.
2. Carmina, E, Nasrallah, MP, Guastella, E, Lobo, RA. Characterization of metabolic changes in the phenotypes of women with polycystic ovary syndrome in a large Mediterranean population from Sicily. Clin Endocrinol (Oxf). 2019; 91: 553– 560.
3. Cardiovascular Diabetology 17, 122 (2018)).
4. PLoS One. 2012;7(12):e52036. doi: 10.1371/journal.pone.0052036. Epub 2012 Dec 28.
5. Polycystic Ovary Syndrome and Diabetes. Centers for Disease Control (CDC).
6. PCOS and Endometrial Cancer Risk. Everyday Health.

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