What are the long-term and metabolic consequences of PCOS, and how are they managed?

PCOS carries long-term risks: type 2 diabetes, dyslipidaemia, metabolic syndrome, and (from unopposed oestrogen with infrequent periods) endometrial hyperplasia/cancer.

Management beyond fertility includes weight loss and lifestyle, regular withdrawal bleeds (e.g. combined pill or progestogen) to protect the endometrium, treating hirsutism, and screening for/managing diabetes and cardiovascular risk.

Clinical relevance. PCOS has lifelong metabolic and endometrial risks - managed by lifestyle, endometrial protection, and cardiometabolic screening beyond just fertility.

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Long-term consequences of PCOS

PCOS is a lifelong metabolic and gynaecological condition with important long-term risks.

Metabolic risks

• Insulin resistance -> impaired glucose tolerance and type 2 diabetes.
• Dyslipidaemia and metabolic syndrome; increased cardiovascular risk.

Endometrial risk

• Infrequent ovulation/periods -> prolonged unopposed oestrogen -> endometrial hyperplasia and increased endometrial cancer risk.

Other

• Obesity, obstructive sleep apnoea, and psychological effects (from hirsutism/subfertility).

Management (beyond fertility)

• Weight loss and lifestyle (improves all features).
• Regular withdrawal bleeds - e.g. combined oral contraceptive pill or cyclical progestogen - to protect the endometrium (ensure at least a few bleeds per year).
• Treat hirsutism (cosmetic measures, combined pill, anti-androgens).
• Screen for and manage diabetes and cardiovascular risk factors; metformin for metabolic features.