Like many health conditions affecting women and people with ovaries, PCOS had historically been misconstrued as a problem with the lady parts. Polycystic Ovary Syndrome remains under-diagnosed, its mechanisms under-researched and its impact under-estimated. This is despite it being a relatively common condition, estimated to affect 8-13% of people with ovaries.
Ova-looked
The name, Polycystic Ovary Syndrome, often leads people to think of cysts in the ovaries, overshadowing its broader impact on overall health. While research and treatment have traditionally focused on PCOS’ effects on the reproductive system and fertility, these are just surface indicators of a deeper hormonal imbalance that affects much more than just the ovaries.
It’s now understood that PCOS has implications for metabolism, insulin, mental health, sleep, and weight. While fertility and pregnancy risk is certainly an important aspect of PCOS, the focus has started to shift away from it being a reproductive condition, and towards it being a chronic condition requiring ongoing management.
Mysteries of the heart
While the evidence was mounting about PCOS’ links to other health conditions, including diabetes, obesity and metabolic syndrome, its role in heart health remained a mystery. Was heart disease a direct result of PCOS, or did the condition just heighten the risks?
This is a pretty subtle distinction but an important one. Researchers explored three key questions: Do people with PCOS have a higher risk of heart disease than those without it? If they do, is it because PCOS directly harms the heart somehow? Or does PCOS just affect things like weight, diabetes, or mental health, which then lead to heart problems?
While everyone should be concerned about their heart health generally, if PCOS does make hearts particularly achey-breaky, it’s important for people with PCOS and their doctors to understand, so they can take preventative measures and be alert for signs.
Doctors suspected that PCOS and heart disease were linked, but couldn’t figure out the exact connection. While many studies have looked at PCOS and cardiovascular events like heart attack and strokes, some found an association and others didn’t
However, this isn’t too surprising, given the vast range of experiences people can have with PCOS, and the huge number of things that can go wrong with hearts. People who join research studies might have a more severe form of the condition, or might have a different average age, ethnicity or socioeconomic status. Cardiovascular events as a category encompasses everything from heart attacks to burst blood vessels to blood clots to peripheral vascular disease. Different studies have looked at different kinds of cardiovascular events in different kinds of people, and used different methods to draw conclusions, so it’s not surprising they came to different conclusions.
Cystematic review
“We performed a systematic review for the 2023 PCOS Guidelines, and we did show a significant association between PCOS and cardiovascular disease” says Dr Jillian Tay, a researcher who has studied PCOS for many years. “In the systematic review we are only examining associations. So we can say that they are linked, but we cannot tell what is the underlying cause.”
International PCOS Guidelines are updated and published every few years by a group of dedicated endocrinologists, healthcare workers, and patient advocates. As part of the most recent guidelines, Dr Tay and her team have looked into the issue of PCOS and heart health by analysing and comparing all of the studies that have been conducted on the topic so far, in a kind of super-study.
“This has been highlighted as a priority by women with PCOS and healthcare professionals worldwide, that it should be a priority of research focus” she states.
“For composite cardiovascular disease, which includes all types of heart attack, cardiovascular death and strokes, the risk for women with PCOS is higher by up to 70%. For ischaemic heart disease, which includes angina and myocardial infarction or heart attack, it’s a 50% higher risk. For heart attack it’s 2.5 fold risk, so 250% higher. For stroke it’s 70% higher. So the risk is extremely high.”
Young at heart
Her research shows that this increased risk affects even very young people. After menopause, those with PCOS no longer face a higher cardiovascular risk than others. This could be because they’ve had years to manage their condition by the time they reach their 50s, It be because other age-related factors become more significant than PCOS over time. Hormones might also play a role.
The takeaway is that young women with PCOS can’t afford to ignore heart health until they’re older—they’re at a greater risk of heart disease while they’re still young.
Dr Tay notes that “We cannot correctly tease out whether this is due to obesity, a complication of diabetes, or if it’s just PCOS. We do not know. But is it important to know the underlying mechanism? We already know that women with PCOS have significantly higher risk of getting type 2 diabetes, obesity and hypertension, all risk factors associated with cardiovascular disease.”
“Women with PCOS need to be screened early for all of these risk factors so they can get treatment earlier”
Ova and done
This advice might sound like a broken record, but it’s actually a catchy classic tune that might save your life.
Go to the doctor if you feel any symptoms like pain in the chest, shoulders or neck, shortness of breath, fatigue, dizziness, cold sweats, or unexplained indigestion.
Eat a healthy diet based on fruits, vegetables, complex carbs, and lean proteins.
Regular exercise keeps your heart on its toes. Keep an eye on your blood sugar and cholesterol levels, and don’t hesitate to seek medical advice to manage these effectively.
Mental health and good sleep are incredibly important, so make sure you prioritise yourself.
Finally, avoid smoking and keep the drinking to a minimum.
