Women's Health Implications of Polycystic Ovary Syndrome

Abstract

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder of unknown etiology which affects approximately 12% of women. Principal features of PCOS are anovulation resulting in irregular or absent menstruation, excessive androgens (male sex hormones) and ovaries with multiple follicles (polycystic ovaries). PCOS has been associated with a variety of health complications of reproductive, metabolic, and psychological nature. Although PCOS is predominantly diagnosed in women of reproductive age, this syndrome influences health across the entire life span. The clinical presentation of PCOS changes during life and is determined by factors including genetic predisposition, underlying endocrine and metabolic abnormalities, environmental influences and demographics. This thesis presents our investigations into the adverse health implications of PCOS. We investigated several general health problems associated with PCOS, and sought for specific characteristics of PCOS patients that determine the individual health risk profile. We studied several cohorts of women with PCOS who underwent extensive standardized investigation of metabolic and endocrine characteristics. We demonstrated that Dutch PCOS patients are indeed prone to develop medical conditions, such as gestational diabetes, diabetes and metabolic syndrome. All investigated health problems were consistently more profound in the obese PCOS patients. Importantly, we found that the majority of PCOS patients already present with an unfavorable cardiovascular risk profile at the young mean age of 29 years. Moreover we presented data that linked preconceptional markers to the development of gestational diabetes. In addition we proposed a novel step wise screening program for abnormalities of glucose metabolism in women with PCOS. Finally we demonstrated that PCOS patients with a poor chance to conceive with the conventional treatment algorithm, can be identified based on age, duration of infertility and BMI. In conclusion we demonstrated that the diagnosis of PCOS per se implies a predisposition for several general health risk factors that may eventually result in disease. The individual health risk profile of a women with PCOS is determined by several characteristics, of which BMI seems to play the most important role. The results presented in this thesis may help to improve future PCOS patient health care as it gives direction to a patient tailored treatment and screenings approach.