Cardio vascular risks of PCO long term ill defects

 

Long-Term Risks and Interventions

Dyslipidemia is one of the most common metabolic disorders seen in PCOS patients (up to 70% prevalence in a US PCOS population) .

It is associated with insulin resistance and hyperandrogenism in combination with environmental (diet, physical exercise) and genetic factors. Various abnormal patterns include decreased levels of HDL, elevated levels of triglycerides, decreased total and LDL levels, and altered LDL quality .

 

To assess cardiovascular risk and prevent disease in patients with PCOS, the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society recommend the following monitoring activities :

Waist circumference and BMI measurement at every visit, using the National Health and Nutrition Examination Survey method.

A complete lipid profile based using the American Heart Association guidelines (Fig. or sooner if weight gain occurs.

A 2-hour post-75-goral glucose challenge measurement in PCOS women with a BMI greater than 30 kg/m²_, or alternatively in lean PCOS women with advanced age (40 years), personal history of gestational diabetes, or family history or type 2 diabetes.

Blood pressure measurement at each visit. The ideal blood pressure is 120/80 or lower. Prehypertension should be treated because blood pressure control has the largest benefit in reducing cardiovascular diseases.

Regular assessment for depression, anxiety, and quality of life.

Treatment of Hyperandrogenism and PCOS

Treatment depends on a patient’s goals. Some patients require hormonal contraception, whereas other desire ovulation induction. In all cases where there is significant ovulatory dysfunction, progestational interruption of the unopposed estrogen effects on the endometrium is necessary.

This may be accomplished by periodic luteal function resulting from ovulation induction, progestational suppression via contraceptive formulations, or intermittent administration of progestational agents for endometrial or menstrual regulation. Interruption of the steady state of hyperandrogenism and control of hirsutism usually can be accomplished simultaneously.

 

Patients desiring pregnancy are an exception, and for them effective control of hirsutism may not be possible. Treatment regimens for hirsutism are listed in Table. The induction of ovulation and treatment of infertility are discussed