So when we talk about, comorbidities, I like to describe what’s happening at the hormonal level to explain the signs and the symptoms that we have with PCOS.
What happens basically is an increase of male hormones as well as an increase of insulin. Those are the two main hormonal dysregulation and that is brought with the genetics factors but also with the lifestyle. So if you have increased androgen, you have all the signs and symptoms that we see with increased male hormones, like hirsutism, acne, increase lipids can be present also. And you can have anovulation, which means you don’t have regular secretions of the progesterone each month. Also, if you have increased insulin, you can have the anovulation and you can have the increase of metabolic problem like diabetes, high blood pressure and cardiovascular disease. It really affects the mental health, by creating more problem with self-esteem, depression, anxiety, also eating disorders like anorexia and bulimia.
So now we’ll discuss the other diseases linked with PCOS. One of the first ones is diabetes or intolerance to glucose that we can see in 60 to 70% of patients. And there is four more times to have diabetes in America if you have PCOS. The other one is increased lipids, as we can see in 70% of patients. And also if you have a combination of high blood pressure, diabetes, obesity, mostly abdominal obesity and increased lipids, it’s what we call a metabolic syndrome, which is present in 43 to 46% of patients. And metabolic syndrome is really linked with an increased risk of cardiovascular disease. Other factor as well can affect cardiovascular disease. And your doctor will ask you: exercise, family history, if you smoke or vape, alcohol consumption, your stress.
One of the major risks that we want to prevent is endometrial cancer. In patients that have PCOS, we know that it’s also common to have really prolonged and heavy bleeding when you don’t have regular bleeding. Why is that? If I go back to the cycle, the first part of the cycle, it’s where your estrogen goes really high and prepare the layers where the embryo will implant. The layers we call endometrium. So it’s getting thicker and thicker. And when you have ovulations around mid-cycle, progesterone is secreted, and it helps to stabilize those layers.
If there is pregnancy, progesterone will still be produced eventually by the placenta, and they won’t have any bleeding. But if there’s no pregnancy progesterone will go lower and it will induce what we call a withdrawal bleeding where you shed that endometrium. If you don’t have ovulations, and you don’t have the progesterone, it means that you always have those proliferation of the endometrium. So it’s getting thicker, thicker and thicker. And it can eventually start to bleed uncontrolled and heavily. As well, we can have irregular cells or even cancer that develop in those layers. So if any suspicions, your health care provider will talk to you about getting a sample of the cells of those, of that endometrium, to be checked and make sure there’s no abnormal cells. But any patients who have really irregular cycles, heavier bleeding, obesity, or a family history, need to have that sample done. If you have polycystic ovary syndrome, you have six times a chance to have endometrial cancer. When I explain all that to patients, I like to have an analogy with the lawn. It’s like you have your lawn and you put fertilizer on it. The fertilizer is like the estrogen. So it grows and grows and grows. And if at some point you don’t, you don’t stop, you can have some weeds or abnormal cells. The progesterone would be like the lawn mower. And you go and you go over it and get rid of those layers.
