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Polycystic Ovary Syndrome Increases Risk of CVD and Type 2 Diabetes

Women diagnosed with Polycystic Ovary Syndrome are at an increased risk of type 2 diabetes and cardiovascular disease….

Polycystic ovary syndrome (PCOS) is a condition that affects women whose sex hormones are imbalanced. This imbalance may result in menstrual cycle changes, ovarian cysts, infertility issues, and other conditions. Women with PCOS are also at a significantly higher risk of becoming diabetic and having a cardiovascular disease. When these two conditions are placed together, it is referred to as a "cardiometabolic disease" (CMD). If women with PCOS were regularly screened, increased prevention of CMD would be possible; however, this is not the case since PCOS is difficult to diagnose. Approximately 18% of women are diagnosed with PCOS at a reproductive age, and among these woman, "70% remain undiagnosed in primary care." Of the females that are diagnosed with PCOS, not many are screened for diabetes since the main goal of treatment is usually to focus on infertility and hirsutism issues.

From the statistics, it can be seen that there is a need for "evidence-based guidelines on screening, diagnosis and interventions" to prevent and decrease the rise of CMD in patients with PCOS. Currently, all that is suggested in the US is that women be screened for type-2 diabetes if they have PCOS and a BMI of ≥25 kg/m.

There are three major sets of criteria used to diagnose PCOS; these include: The NIH 1990 Criteria, the Rotterdam 2003 Criteria, and the AES Criteria. Although the Rotterdam criteria covers a larger variety of phenotypes in regards to patients with CMD and insulin resistance, the phenotypes the NIH criteria focuses on, androgen excess and irregular ovulation/menstrual cycles, are more likely to be associated with CMD. Alternatively, the AES Criteria consists of using an ultrasound to diagnose PCOS, however, hyperandrogenism must be present in order to get this diagnosis. Due to the limited access of equipment primary care settings contain, it is difficult to diagnose women for PCOS using the AES Criteria. Furthermore, since the clinical features associated with PCOS are inconsistently defined, this adds to the overall difficulty for diagnosis.

In conclusion, there are three interconnected steps that need to be taken in order to prevent the increased incidence of CMD among female patients with PCOS; 1) Improve the detection of PCOS in women during primary care visits; 2) Determine a "universally accepted definition" of PCOS; 3) Standardize diabetes screening and CVD risk assessment protocols in women with PCOS. Currently, general practitioners and researchers are working hard to better diagnose and manage/prevent the complications linked to PCOS so that these women are no longer at a disadvantage.

Tomlinson JA, Pinkney JH, Evans P, Millward A, Stenhouse E. Screening for Diabetes and Cardiometabolic Disease in Women With Polycystic Ovary Syndrome. British Journal of Diabetes and Vascular Disease. 2013;13(3):115-123.