The hormonal and metabolic disturbances associated with polycystic ovary syndrome (PCOS) are a risk factor for a variety of health conditions. However, in the absence of long-term studies targeting their health endpoints across life, the evolution of morbidity and mortality within the PCOS population remains poorly understood. One common pathology that accompanies PCOS is polycystic ovarian morphology (PCOM), characterised by the presence of 12 or more follicles on at least one ovary; this symptom also exacerbates some of the cardiometabolic risks posed by PCOS. In a landmark study spanning several decades, Nir Kugelman and colleagues tracked and compared the observed patterns of comorbidity, mortality, and hormonal profiles of PCOS patients with and without PCOM in a Canadian academic clinic. The study, recently published in JAMA Network Open, offers a nuanced view into the relationship between PCOM and a wide breadth of health endpoints. GlobalData epidemiologists forecast that the total prevalent cases of PCOS in Canada are expected to remain stable in the near future, only slightly decreasing from nearly 606,000 to 605,000 between 2025 and 2031. However, PCOS remains a highly prevalent disorder in need of further exploration for its role in long-term health outcomes.
In a prospective cohort study, Kugelman and colleagues measured the trends in morbidity and mortality among 1,089 women over 18 enrolled for endocrinology care between 1987 and 2005 for PCOS. Follow-ups with patients were conducted until 2024, with a total of 894 enrollees remaining after lost contact. For analysis, patients were further refined to 340 participants, 189 of whom were diagnosed with PCOM through transvaginal sonography compared to 151 PCOS patients with PCOM. Participants from both groups were analysed for the presence of morbidity and mortality attributed to multiple comorbid conditions, in addition to clinical indicators of their hormonal profiles. While there was no statistically significant indicator of mortality between cohorts, there were notable bifurcations in comorbidity prevalence. Non-insulin dependent diabetes showed a prevalence of 34.4% among patients with PCOM compared to 23.80% among those without it. Other comorbidities, namely hypertension, anxiety, gout, and osteoporosis, showed notably higher risk associations in the PCOM cohort, but below the threshold of statistical significance. Hormonal and metabolic profiles of women with PCOM, however, showed higher rates of androgen disturbance and insulin resistance.
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The analysis performed by Kugelman and colleagues represents an important step in understanding the long-term health implications of PCOS’ clinical subtypes. It also invites further exploration from other scholars to perform similar analyses in other populations, ideally using larger cohorts. As scholarship on PCOS’ chronic health outcomes expands, clinical practitioners have an opportunity to better tailor care towards the prevention, early detection, and treatment of its associated comorbidities. Given the high prevalence of PCOS among women of childbearing age, as well as commonly associated cardiovascular and metabolic comorbidities, these efforts could yield promising results in mitigating the disease burden of myriad chronic conditions.