From the Guidelines
Patients with anovulation due to Polycystic Ovary Syndrome (PCOS) are at increased risk for several health complications, including endometrial hyperplasia and endometrial cancer, metabolic disorders, cardiovascular disease, infertility, and mental health issues. The risks associated with anovulation in PCOS patients are multifaceted and can have a significant impact on their quality of life and mortality. Some of the key risks include:
- Endometrial hyperplasia and endometrial cancer due to chronic unopposed estrogen exposure without the protective effects of progesterone 1
- Metabolic disorders, such as insulin resistance, type 2 diabetes, dyslipidemia, and metabolic syndrome, which can increase the risk of cardiovascular disease 1
- Infertility due to irregular or absent ovulation, which can be addressed with lifestyle modifications, hormonal contraceptives, and specific fertility treatments 1
- Mental health issues, such as depression and anxiety, which occur at higher rates in PCOS patients and can be exacerbated by the physical and emotional challenges of the condition 1
- Other potential complications, including obstructive sleep apnea and nonalcoholic fatty liver disease, which can further increase the risk of cardiovascular disease and other health problems.
The management of anovulation in PCOS patients typically includes lifestyle modifications, such as weight loss and exercise, hormonal contraceptives to regulate cycles and provide endometrial protection, and metformin to address insulin resistance. Regular screening for these complications is essential, including:
- Periodic endometrial assessment to detect any abnormal cell growth or cancer
- Metabolic screening to monitor for insulin resistance, type 2 diabetes, and other metabolic disorders
- Cardiovascular risk evaluation to assess the risk of heart disease and stroke
- Fertility treatments, such as clomiphene citrate or gonadotropins, for patients who wish to conceive 1
Overall, the risks associated with anovulation in PCOS patients are significant, and management should prioritize reducing these risks to improve quality of life and reduce morbidity and mortality.
From the Research
Risks Associated with Anovulation in PCOS
The risks associated with anovulation in patients with Polycystic Ovary Syndrome (PCOS) include:
- Increased risk of cardiovascular disease and diabetes mellitus due to hyperinsulinaemia and insulin resistance 2, 3, 4
- Metabolic syndrome, which is a cluster of conditions that increase the risk of heart disease, stroke, and type 2 diabetes 2, 4
- Infertility and subfertility due to anovulation and ovulatory disturbances 5, 2, 6
- Menstrual dysfunction, including irregular menstrual cycles and amenorrhea 5, 4
- Hirsutism and acne due to excessive androgen secretion or activity 4
- Obesity, which is a common comorbidity in women with PCOS and can exacerbate metabolic and cardiovascular risks 2, 6, 4
Long-term Health Risks
Long-term health risks in patients with PCOS demand monitoring of their general health, even after their reproductive needs have been fulfilled 5. Metabolic and cardiovascular risk prevention in women with PCOS should start as early as possible 5. The use of insulin-sensitising agents such as metformin may be beneficial in reducing the risk of type 2 diabetes and cardiovascular disease in women with PCOS 2, 3, 6.
Treatment Options
Treatment options for anovulation in PCOS include:
- Clomiphene citrate, which is still the first-line treatment in subfertile anovulatory patients with PCOS 5
- Metformin, which may improve live birth rates and ovulation in women with PCOS, although the evidence quality is low to moderate 2, 6
- Gonadotrophins and laparoscopic ovarian surgery, which are second-line options for ovulation induction in women with PCOS 5
- Aromatase inhibitors, which show promising results in improving ovulation and pregnancy outcomes in women with PCOS 5