RCOG’s new guideline looks at the long term health problems with polycystic ovarian syndrome PCOS. There isn’t very much that’s new, but I think that generally we aren’t very good at following these women up, so I’m doing a general summary. The biggest risk is with diabetes, both gestational and type 2 if you don’t want to read on…
- Type 2 Diabetes (T2DM). This risk is independent of obesity, but is exacerbated by obesity.
- Gestational diabetes. There is double the risk.
- Sleep apnoea if they are also obese. Interestingly sleep apnoea further worsens insulin resistance and CPAP improves it.
- Cardiovascular risk.
- Endometrial cancer – if oligomenorrheic or amenorrhoeic.
Managing these risks.
When a woman presents with PCOS, if she has any other risk factors (as below), she needs screening with an OGTT. Fasting glucose and HbA1c aren’t accurate enough (but you can use an HbA1c of over 6.5 if you can’t get an OGTT). The other risk factors are:
- Age > 40
- BMI > 25
- A history of gestational diabetes
- A family history of T2DM
Women with PCOS need an OGTT at 24 – 28/40