Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-76fb5796d-vfjqv Total loading time: 0 Render date: 2024-04-25T11:03:43.772Z Has data issue: false hasContentIssue false

7 - Long-term health consequences of polycystic ovary syndrome

Published online by Cambridge University Press:  29 September 2009

By
Eleni Kousta  and
Stephen Franks
Edited by
Gabor T. Kovacs  and
Robert Norman
Eleni Kousta
Affiliation:
Greece
Stephen Franks
Affiliation:
Imperial College London
Gabor T. Kovacs
Affiliation:
Monash University, Victoria
Robert Norman
Affiliation:
University of Adelaide
Get access

Summary

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder to affect women of reproductive age (Franks 1995). Although its first description occurred almost 70 years ago (Stein and Leventhal 1935), there has been no universal agreement about its definition. Recently, the European Society for Human Reproduction and Embryology and the American Society for Reproductive Medicine (ESHRE/ASRM) achieved a new consensus regarding the definition of PCOS (The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group 2004). This is now defined as the presence of any two of the following three criteria: (1) polycystic ovaries; (2) oligo- and/or anovulation; and (3) clinical or biochemical evidence of hyperandrogenism. This revised definition provides an international framework for the clinical assessment of PCOS and for future research and collaboration.

The clinical and biochemical features of the syndrome are heterogeneous and the combination and degree of expression of these features vary between individuals. In the last few years, it has become clear that PCOS is not simply a combination of hyperandrogenemia and anovulation, but has important long-term health implications (Franks 1995, Dunaif 1997, The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group 2004). Although disagreement about diagnostic criteria has, up to now, made it difficult to compare epidemiological studies of long-term health risks, it is now well accepted that PCOS has been associated with metabolic disorders (hyperinsulinemia and insulin resistance, impaired pancreatic beta cell function and increased risk of type 2 diabetes, obesity, hyperlipidemia) and increased risk factors for cardiovascular disease.

Type
Chapter
Information
Polycystic Ovary Syndrome , pp. 81 - 101
Publisher: Cambridge University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abbott, D. H., Dumesic, D. A., and Franks, S. (2002) Developmental origin of polycystic ovary syndrome: a hypothesis. J. Endocrinol. 174:1–5.CrossRefGoogle ScholarPubMed
Andersen, P., Seljeflot, I., Abdelnoor, M., et al. (1995) Increased insulin sensitivity and fibrinolytic capacity after dietary intervention in obese women with polycystic ovary syndrome. Metabolism 44:611–616.CrossRefGoogle ScholarPubMed
Anttila, L., Karjala, K., Penttila, R. A., Ruutiainen, K., and Ekblad, U. (1998) Polycystic ovaries in women with gestational diabetes. Obstet. Gynecol. 92:13–16.CrossRefGoogle ScholarPubMed
Arslanian, S. A., Lewy, V. D., and Danadian, K. (2001) Glucose intolerance in obese adolescents with polycystic ovary syndrome: roles of insulin resistance and beta-cell dysfunction and risk of cardiovascular diseaseJ. Clin. Endocrinol. Metab. 86:66–71.Google ScholarPubMed
Asunción, M., Calvo, R. M., Millan, San J. L., et al. (2000) A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J. Clin. Endocrinol. Metab. 85:2434–2438.Google ScholarPubMed
Austin, M. A., Breslow, J. L., Hennekens, C. H., et al. (1988) Low-density lipoprotein subclass patterns and risk of myocardial infarction. J. Am. Med. Assoc. 260:1917–1921.CrossRefGoogle ScholarPubMed
Balen, A. (2001) Polycystic ovary syndrome and cancer. Hum. Reprod. Update 7:522–525.CrossRefGoogle ScholarPubMed
Balen, A. H., Conway, G. S., Kaltsas, G., et al. (1995) Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum. Reprod. 10:2107–2111.CrossRefGoogle ScholarPubMed
Bass, K. M., Newschaffer, C. J., Klag, M. J., and Bush, T. L. (1993) Plasma lipoprotein levels as predictors of cardiovascular death in women. Arch. Intern. Med. 153:2209–2216.CrossRefGoogle ScholarPubMed
Birdsall, M. A., Farquhar, C. M., and White, H. D. (1997) Association between polycystic ovaries and extent of coronary artery disease in women having cardiac catheterization. Ann. Intern. Med. 126:32–35.CrossRefGoogle ScholarPubMed
Blackburn, R., Giral, P., Bruckert, E., et al. (2001) Elevated C-reactive protein constitutes an independent predictor of advanced carotid plaques in dyslipidemic subjects. Arterioscler. Thromb. Vasc. Biol. 21:1962–1968.CrossRefGoogle ScholarPubMed
Burghen, G. A., Givens, J. R., and Kitabchi, A. E. (1980) Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease. J. Clin. Endocrinol. Metab. 50:113–116.CrossRefGoogle ScholarPubMed
Christian, R. C., Dumesic, D. A., Behrenbeck, T., et al. (2003) Prevalence and predictors of coronary artery calcification in women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 88:2562–2568.CrossRefGoogle ScholarPubMed
Colilla, S., Cox, N. J., and Ehrmann, D. A. (2001) Heritability of insulin secretion and insulin action in women with polycystic ovary syndrome and their first degree relatives. J. Clin. Endocrinol. Metab. 86:2027–2031.Google ScholarPubMed
Conway, G. S., Jacobs, H. S., Holly, J. M., and Wass, J. A. (1990) Effects of luteinizing hormone, insulin, insulin-like growth factor-1 and insulin-like growth factor small binding protein 1 in the polycystic ovary syndrome. Clin. Endocrinol. (Oxf.) 33:593–603.CrossRefGoogle ScholarPubMed
Coulam, C. B., Annegers, J. F., and Kranz, J. S. (1983) Chronic anovulation syndrome and associated neoplasia. Obstet. Gynecol. 61:403–407.Google ScholarPubMed
Dahlgren, E., Friberg, L. G., Johansson, S., et al. (1991) Endometrial carcinoma: ovarian dysfunction – a risk factor in young women. Eur. J. Obstet. Gynecol. Reprod. Biol. 41:143–150.CrossRefGoogle ScholarPubMed
Dahlgren, E., Johansson, S., Lindstedt, G., et al. (1992a) Women with polycystic ovary syndrome wedge resected in 1956 to 1965: a long-term follow-up focusing on natural history and circulating hormones. Fertil. Steril. 57:505–513.CrossRefGoogle ScholarPubMed
Dahlgren, E., Janson, P. O., Johansson, S., Lapidus, L., and Oden, A. (1992b) Polycystic ovary syndrome and risk for myocardial infarction, evaluated from a risk factor model based on a prospective population study of women. Acta Obstet. Gynecol. Scand. 71:599–604.CrossRefGoogle Scholar
Diamanti-Kandarakis, E., Kouli, C. R., Bergiele, A. T., et al. (1999) A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J. Clin. Endocrinol. Metab. 84:4006–4011.CrossRefGoogle ScholarPubMed
Diamanti-Kandarakis, E., Spina, G., Kouli, C., and Migdalis, I. (2001) Increased endothelin-1 levels in women with polycystic ovary syndrome and the beneficial effect of metformin therapy. J. Clin. Endocrinol. Metab. 86:4666–4673.CrossRefGoogle ScholarPubMed
Dunaif, A. (1997) Insulin resistance and the polycystic ovary syndrome: mechanism of action and implications for pathogenesis. Endocr. Revi. 18:774–800.Google ScholarPubMed
Dunaif, A. and Finegood, D. T. (1996) Beta-cell dysfunction independent of obesity and glucose intolerance in the polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 81:942–947.Google ScholarPubMed
Dunaif, A., Graf, M., Mandeli, J., Laumas, V., and Dobrjansky, A. (1987) Characterization of groups of hyperandrogenic women with acanthosis nigricans, impaired glucose tolerance, and/or hyperinsulinemia. J. Clin. Endocrinol. Metab. 65:499–507.CrossRefGoogle ScholarPubMed
Dunaif, A., Segal, K. R., Futterweit, W., and Dobrjansky, A. (1989) Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 38:1165–1174.CrossRefGoogle ScholarPubMed
Ehrmann, D. A., Sturis, J., Byrne, M. M., et al. (1995) Insulin secretory defects in polycystic ovary syndrome: relationship to insulin sensitivity and family history of non-insulin-dependent diabetes mellitus. J. Clin. Invest. 96:520–527.CrossRefGoogle ScholarPubMed
Ehrmann, D. A., Barnes, R. B., Rosenfield, R. L., Cavaghan, M. K., and Imperial, J. (1999) Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 22:141–146.CrossRefGoogle ScholarPubMed
Eisner, J. R., Barnett, M. A., Dumesic, D. A., and Abbott, D. H. (2002) Ovarian hyperandrogenism in adult female rhesus monkeys exposed to prenatal androgen excess. Fertil. Steril. 77:167–172.CrossRefGoogle ScholarPubMed
Escobedo, L. G., Lee, N. C., Peterson, H. B., and Wingo, P. A. (1991) Infertility-associated endometrial cancer risk may be limited to specific subgroups of infertile women. Obstet. Gynecol. 77:124–128.Google ScholarPubMed
Fernandez-Castaner, M., Biarnes, J., Camps, I., et al. (1996) Beta-cell dysfunction in first-degree relatives of patients with non-insulin-dependent diabetes mellitus. Diabet. Med. 13:953–959.3.0.CO;2-V>CrossRefGoogle ScholarPubMed
Ferrannini, E., Natali, A., Bell, P., et al. (1997) Insulin resistance and hypersecretion in obesity: European Group for the Study of Insulin Resistance (EGIR). J. Clin. Invest. 100:1166–1173.CrossRefGoogle Scholar
Ferri, C., Pittoni, V., Piccoli, A., et al. (1995) Insulin stimulates endothelin-1 secretion from human endothelial cells and modulates its circulating levels in vivo. J. Clin. Endocrinol. Metab. 80:829–835.Google ScholarPubMed
Festa, A., D'Agostino, R. Jr., Howard, G., et al. (2000) Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation. 102:42–47.CrossRefGoogle Scholar
Folsom, A. R., Pankow, J. S., Tracy, R. P., et al. (2001) Investigators of the NHBLI Family Heart Study: association of C-reactive protein with markers of prevalent atherosclerotic disease. Am. J. Cardiol. 88:112–117.CrossRefGoogle ScholarPubMed
Franks, S. (1995) Polycystic ovary syndrome. N. Engl. J. Med. 333:853–861.CrossRefGoogle ScholarPubMed
Franks, S. (2001) Are women with polycystic ovary syndrome at increased risk of cardiovascular disease? Too early to be sure, but not too early to act!Am. J. Med. 111:665–666.CrossRefGoogle ScholarPubMed
Freeman, D. J., Norrie, J., Caslake, M. J., et al. (2002) C-reactive protein is an independent predictor of risk for the development of diabetes in the West of Scotland Coronary Prevention Study. Diabetes 51:1596–1600.CrossRefGoogle ScholarPubMed
Furberg, A. S. and Thune, I. (2003) Metabolic abnormalities (hypertension, hyperglycemia and overweight), lifestyle (high energy intake and physical inactivity) and endometrial cancer risk in a Norwegian cohort. Int. J. Cancer. 104:669–676.CrossRefGoogle Scholar
Gambineri, A., Pelusi, C., Manicardi, E., et al. (2004) Glucose intolerance in a large cohort of mediterranean women with polycystic ovary syndrome: phenotype and associated factors. Diabetes 53:2353–2358.CrossRefGoogle Scholar
Goldzieher, J. W. and Green, J. A. (1962) The polycystic ovary. I. Clinical and histologic features. J. Clin. Endocrinol. Metab. 22:325–338.CrossRefGoogle ScholarPubMed
Guzick, D. S., Talbott, E. O., Sutton-Tyrrell, K., et al. (1996) Carotid atherosclerosis in women with polycystic ovary syndrome: initial results from a case-control study. Am. J. Obstet. Gynecol. 174:1224–1229; discussion 1229–1232.CrossRefGoogle ScholarPubMed
Hamilton-Fairley, D., Kiddy, D., Watson, H., Paterson, C., and Franks, S. (1992) Association of moderate obesity with a poor pregnancy outcome in women with polycystic ovary syndrome treated with low dose gonadotrophin. Br. J. Obstet. Gynaecol. 99:128–131.CrossRefGoogle ScholarPubMed
Hardiman, P., Pillay, O. C., and Atiomo, W. (2003) Polycystic ovary syndrome and endometrial carcinoma. Lancet 361:1810–1812.CrossRefGoogle ScholarPubMed
Harris, M. I., Hadden, W. C., Knowler, W. C., and Bennett, P. H. (1987) Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in US population aged 20–74 yr. Diabetes 36:523–534.CrossRefGoogle Scholar
Holte, J., Bergh, T., Berne, C., Berglund, L., and Lithell, H. (1994) Enhanced early insulin response to glucose in relation to insulin resistance in women with polycystic ovary syndrome and normal glucose tolerance. J. Clin. Endocrinol. Metab. 78:1052–1058.Google ScholarPubMed
Holte, J., Bergh, T., Berne, C., Wide, L., and Lithell, H. (1995) Restored insulin sensitivity but persistently increased early insulin secretion after weight loss in obese women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 80:2586–2593.Google ScholarPubMed
Holte, J., Gennarelli, G., Wide, L., Lithell, H., and Berne, C. (1998) High prevalence of polycystic ovaries and associated clinical, endocrine, and metabolic features in women with previous gestational diabetes mellitus. J. Clin. Endocrinol. Metab. 83:1143–1150.CrossRefGoogle ScholarPubMed
Ibañez, L., Dimartino-Nardi, J., Potau, N., and Saenger, P. (2000) Premature adrenarche: normal variant or forerunner of adult disease?Endocr. Rev. 21:671–696.Google ScholarPubMed
Kahn, S. E., Prigeon, R. L., McCulloch, D. K., et al. (1993) Quantification of the relationship between insulin sensitivity and beta-cell function in human subjects: Evidence for a hyperbolic function. Diabetes 42:1663–1672.CrossRefGoogle ScholarPubMed
Kelly, C. C. J., Lyall, H., Petrie, J. R., et al. (2001) Low grade chronic inflammation in women with polycystic ovarian syndrome. J. Clin. Endocrinol. Metab. 86:2453–2455.CrossRefGoogle ScholarPubMed
Kelly, C. J. G., Speirs, A., Gould, G. W., et al. (2002) Altered vascular function in young women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 87:742–746.CrossRefGoogle ScholarPubMed
Kiddy, D. S., Sharp, P. S., White, D. M., Scanlon, M. F., et al. (1990) Differences in clinical and endocrine features between obese and non-obese subjects with polycystic ovary syndrome: an analysis of 263 consecutive cases. Clin. Endocrinol. (Oxf.) 32:213–220.CrossRefGoogle ScholarPubMed
Kiddy, D. S., Hamilton-Fairley, D., Bush, A., et al. (1992) Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin. Endocrinol. (Oxf.) 36:105–111.CrossRefGoogle ScholarPubMed
King, H., and Rewers, M. (1993) Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults: WHO Ad Hoc Diabetes Reporting Group. Diabetes Care 16:157–177.CrossRefGoogle ScholarPubMed
Knochenhauer, E. S., Key, T. J., Kahsar-Miller, M., et al. (1998) Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J. Clin. Endocrinol. Metab. 83:3078–3082.Google ScholarPubMed
Kousta, E., White, D. M., and Franks, S. (1997) Modern use of clomiphene citrate in induction of ovulation. Hum. Reprod. Update. 3:359–365.CrossRefGoogle ScholarPubMed
Kousta, E., Cela, E., Lawrence, N. J., et al. (2000) The prevalence of polycystic ovaries in women with a history of gestational diabetes. Clin. Endocrinol. 53:501–507.CrossRefGoogle ScholarPubMed
Kousta, E., Lawrence, N. J., Godsland, I. F., et al. (2003) Insulin resistance and beta-cell dysfunction in normoglycaemic European women with a history of gestational diabetes. Clin. Endocrinol. 59:289–297.CrossRefGoogle ScholarPubMed
Kuczmarski, R. J., Flegal, K. M., Campbell, S. M., and Johnson, C. L. (1994) Increasing prevalence of overweight among US adults: The National Health and Nutrition Examination Surveys, 1960 to 1991. J. Am. Med. Assoc. 272:205–211.CrossRefGoogle ScholarPubMed
Kuller, L. H., Tracy, R. P., Shaten, J., and Meilahn, E. N. (1996) Relation of C-reactive protein and coronary heart disease in the Multiple Risk Factor Intervention Trial nested case-control study. Am. J. Epidemiol. 144:537–547.Google ScholarPubMed
Laitinen, J., Taponen, S., Martikainen, H., et al. (2003) Body size from birth to adulthood as a predictor of self-reported polycystic ovary syndrome symptoms. Int. J. Obes. Relat. Metab. Disord. 27:710–715.CrossRefGoogle ScholarPubMed
Legro, R. S., Kunselman, A. R., Dodson, W. C., and Dunaif, A. (1999) Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J. Clin. Endocrinol. Metab. 84:165–169.Google ScholarPubMed
Legro, R. S., Kunselman, A. R., and Dunaif, A. (2001) Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am. J. Med. 111:607–613.CrossRefGoogle ScholarPubMed
Legro, R. S., Bentley-Lewis, R., Driscoll, D., Wang, S. C., and Dunaif, A. (2002) Insulin resistance in the sisters of women with polycystic ovary syndrome: association with hyperandrogenemia rather than menstrual irregularity. J. Clin. Endocrinol. Metab. 87:2128–2133.CrossRefGoogle ScholarPubMed
Lerman, A., Edwards, B. S., Hallett, J. W., et al. (1991) Circulating and tissue endothelin immunoreactivity in advanced atherosclerosis. N. Engl. J. Med. 325:997–1001.CrossRefGoogle ScholarPubMed
Lewy, V. D., Danadian, K., Witchel, S. F., and Arslanian, S. (2001) Early metabolic abnormalities in adolescent girls with polycystic ovarian syndrome. J. Pediatr. 138:38–44.CrossRefGoogle ScholarPubMed
Manson, J. E., Colditz, G. A., Stampfer, M. J., et al. (1990) A prospective study of obesity and risk of coronary heart disease in women. N. Engl. J. Med. 322:882–889.CrossRefGoogle ScholarPubMed
Mather, K. J., Kwan, F., and Corenblum, B. (2000a) Hyperinsulinemia in polycystic ovary syndrome correlates with increased cardiovascular risk independent of obesity. Fertil. Steril. 73:150–156.CrossRefGoogle ScholarPubMed
Mather, K. J., Verma, S., Corenblum, B., and Anderson, T. J. (2000b) Normal endothelial function despite insulin resistance in healthy women with the polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 85:1851–1856.Google ScholarPubMed
Mather, K. J., Mirzamohammadi, B., Lteif, A., Steinberg, H. O., and Baron, A. D. (2002) Endothelin contributes to basal vascular tone and endothelial dysfunction in human obesity and type 2 diabetes. Diabetes 51:3517–3523.CrossRefGoogle ScholarPubMed
Norman, R. J. and Clark, A. M. (1998) Obesity and reproductive disorders: a review. Reprod. Fertil. Dev. 10:55–63.CrossRefGoogle ScholarPubMed
Norman, R. J., Masters, S. C., Hague, W., et al. (1995) Metabolic approaches to the subclassification of polycystic ovary syndrome. Fertil. Steril. 63:329–335.CrossRefGoogle ScholarPubMed
Norman, R. J., Masters, S., and Hague, W. (1996) Hyperinsulinemia is common in family members of women with polycystic ovary syndrome. Fertil. Steril. 66:942–947.CrossRefGoogle ScholarPubMed
Norman, R. J., Davies, M. J., Lord, J., and Moran, L. J. (2002) The role of lifestyle modification in polycystic ovary syndrome. Trends Endocrinol. Metab. 13:251–257.CrossRefGoogle ScholarPubMed
O'Meara, N. M., Blackman, J. D., Ehrmann, D. A., et al. (1993) Defects in beta-cell function in functional ovarian hyperandrogenism. J. Clin. Endocrinol. Metab. 76:1241–1247.Google ScholarPubMed
Orio, F. Jr., Palomba, S., Cascella, T., et al. (2004) Early impairment of endothelial structure and function in young normal-weight women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 89:4588–4593.CrossRefGoogle ScholarPubMed
O'Sullivan J. B. (1995) The interaction between pregnancy, diabetes and long-term maternal outcome. In Reece, E. A. and Coustan, D. R. (eds.) Diabetes Mellitus in Pregnancy, 2nd edn pp.389–398. New York: Churchill Livingstone.Google Scholar
Palmert, M. R., Gordon, C. M., Kartashov, A. I., et al. (2002) Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 87:1017–1023.CrossRefGoogle ScholarPubMed
Paradisi, G., Steinberg, H. O., Hempfling, A., et al. (2001) Polycystic ovary syndrome is associated with endothelial dysfunction. Circulation 103:1410–1415.CrossRefGoogle ScholarPubMed
Pierpoint, T., McKeigue, P. M., Isaacs, A. J., Wild, S. H., and Jacobs, H. S. (1998) Mortality of women with polycystic ovary syndrome at long-term follow-up. J. Clin. Epidemiol. 51:581–586.CrossRefGoogle ScholarPubMed
Pirwany, I. R., Fleming, R., Greer, I. A., Packard, C. J., and Sattar, N. (2001) Lipids and lipoprotein subfractions in women with PCOS: relationship to metabolic and endocrine parameters. Clin. Endocrinol. (Oxf.) 54:447–453.CrossRefGoogle ScholarPubMed
Reaven, G. M. (1988) Banting Lecture 1988: Role of insulin resistance in human disease. Diabetes 37:1595–1607.CrossRefGoogle ScholarPubMed
Reaven, G. (2002) Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease. Circulation 106:286–288.CrossRefGoogle ScholarPubMed
Redberg, R. F., Rifai, N., Gee, L., and Ridker, P. M. (2000) Lack of association of C-reactive protein and coronary calcium by electron beam computed tomography in postmenopausal women: implications for coronary artery disease screening. J. Am. Coll. Cardiol. 36:39–43.CrossRefGoogle ScholarPubMed
Rice, S., Christoforidis, N., Gadd, C., et al. (2005) Impaired insulin-dependent glucose metabolism in granulosa-lutein cells from anovulatory women with polycystic ovaries. Hum. Reprod. 203:373–381.CrossRefGoogle Scholar
Ridker, P. M., Hennekens, C. H., Buring, J. E., and Rifai, N. (2000) C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N. Engl. J. Med. 342:836–843.CrossRefGoogle ScholarPubMed
Robinson, S., Chan, S. P., Spacey, S., et al. (1992) Postprandial thermogenesis is reduced in polycystic ovary syndrome and is associated with increased insulin resistance. Clin. Endocrinol. (Oxf.) 36:537–543.CrossRefGoogle ScholarPubMed
Robinson, S., Kiddy, D., Gelding, S. V., et al. (1993) The relationship of insulin insensitivity to menstrual pattern in women with hyperandrogenism and polycystic ovaries. Clin. Endocrinol. (Oxf.) 39:351–355.CrossRefGoogle ScholarPubMed
Robinson, S., Henderson, A. D., Gelding, S. V., et al. (1996) Dyslipidaemia is associated with insulin resistance in women with polycystic ovaries. Clin. Endocrinol. (Oxf.) 44:277–284.CrossRefGoogle ScholarPubMed
Rose, G. (1981) Strategy of prevention: lessons from cardiovascular disease. Br. Med. J. (Clin. Res. Edn) 282:1847–1851.CrossRefGoogle ScholarPubMed
Sagle, M., Bishop, K., Ridley, N., et al. (1988) Recurrent early miscarriage and polycystic ovaries. Br. Med. J. 297:1027–1028.CrossRefGoogle ScholarPubMed
Shoupe, D., Kumar, D. D., and Lobo, R. A. (1983) Insulin resistance in polycystic ovary syndrome. Am. J. Obstet. Gynecol. 147:588–592.CrossRefGoogle ScholarPubMed
Solomon, C. G., Hu, F. B., Dunaif, A., et al. (2001) Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus. J. Am. Med. Assoc. 286:2421–2426.CrossRefGoogle ScholarPubMed
Speert, H. (1949) Carcinoma of the endometrium in young women. Surg. Gynaecol. Obstet. 88:332–336.Google ScholarPubMed
Stein, I. F. and Leventhal, M. L. (1935) Amenorrhea associated with bilateral polycystic ovaries. Am. J. Obstet. Gynecol. 29:181–191.CrossRefGoogle Scholar
Talbott, E. O., Guzick, D., Clerici, A., et al. (1995) Coronary heart disease risk factors in women with polycystic ovary syndrome. Arterioscler. Thromb. Vasc. Biol. 15:821–826.CrossRefGoogle ScholarPubMed
Talbott, E. O., Clerici, A., Berga, S. L., et al. (1998) Adverse lipid and coronary heart disease risk profiles in young women with polycystic ovary syndrome: results of a case-control study. J. Clin. Epidemiol. 51:415–422.CrossRefGoogle ScholarPubMed
Talbott, E. O., Guzick, D. S., Sutton-Tyrrell, K., et al. (2000) Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women. Arterioscler. Thromb. Vasc. Biol. 20:2414–2421.CrossRefGoogle ScholarPubMed
Taponen, S., Martikainen, H., Jarvelin, M. R., et al. (2003) Hormonal profile of women with self-reported symptoms of oligomenorrhea and/or hirsutism: Northern Finland birth cohort 1966 study. J. Clin. Endocrinol. Metab. 88:141–147.CrossRefGoogle ScholarPubMed
Taponen, S., Martikainen, H., Jarvelin, M. R., et al. (2004) Metabolic cardiovascular disease risk factors in women with self-reported symptoms of oligomenorrhea and/or hirsutism: Northern Finland Birth Cohort 1966 Study. J. Clin. Endocrinol. Metab. 89:2114–2118.CrossRefGoogle ScholarPubMed
Tarkun, I., Arslan, B. C., Canturk, Z., et al. (2004) Endothelial dysfunction in young women with polycystic ovary syndrome: relationship with insulin resistance and low-grade chronic inflammation. J. Clin. Endocrinol. Metab. 89:5592–5596.CrossRefGoogle ScholarPubMed
The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum. Reprod. 19:41–47.
Toprak, S., Yonem, A., Cakir, B., et al. (2001) Insulin resistance in nonobese patients with polycystic ovary syndrome. Horm. Res. 55:65–70.Google ScholarPubMed
Toscano, V., Bianchi, P., Balducci, R., et al. (1992) Lack of linear relationship between hyperinsulinaemia and hyperandrogenism. Clin. Endocrinol. (Oxf.) 36:197–202.CrossRefGoogle ScholarPubMed
Verma, S., Buchanan, M. R., and Anderson, T. J. (2003) Endothelial function testing as a biomarker of vascular disease. Circulation 108:2054–2059.CrossRefGoogle ScholarPubMed
Vrbikova, J., Cifkova, R., Jirkovska, A., et al. (2003) Cardiovascular risk factors in young Czech females with polycystic ovary syndrome. Hum. Reprod. 18:980–984.CrossRefGoogle ScholarPubMed
Wang, J. X., Davies, M. J., and Norman, R. J. (2001) Polycystic ovarian syndrome and the risk of spontaneous abortion following assisted reproductive technology treatment. Hum. Reprod. 16:2606–2609.CrossRefGoogle ScholarPubMed
Weerakiet, S., Srisombut, C., Bunnag, P., et al. (2001) Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in Asian women with polycystic ovary syndrome. Int. J. Gynaecol. Obstet. 75:177–184.CrossRefGoogle ScholarPubMed
Weiderpass, E., Persson, I., Adami, H. O., et al. (2000) Body size in different periods of life, diabetes mellitus, hypertension, and risk of postmenopausal endometrial cancer (Sweden). Cancer Causes Control. 11:185–192.CrossRefGoogle Scholar
White, D. M., Polson, D. W., Kiddy, D., et al. (1996) Induction of ovulation with low-dose gonadotropins in polycystic ovary syndrome: an analysis of 109 pregnancies in 225 women. J. Clin. Endocrinol. Metab. 81:3821–3824.Google ScholarPubMed
Wild, R. A., Painter, P. C., Coulson, P. B., Carruth, K. B., and Ranney, G. B. (1985) Lipoprotein lipid concentrations and cardiovascular risk in women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 61:946–951.CrossRefGoogle ScholarPubMed
Wild, S., Pierpoint, T., McKeigue, P., and Jacobs, H. (2000) Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: a retrospective cohort study. Clin. Endocrinol. (Oxf.) 52:595–600.CrossRefGoogle ScholarPubMed
Willis, D. S., Watson, H., Mason, H. D., et al. (1998) Premature response to luteinizing hormone of granulosa cells from anovulatory women with polycystic ovary syndrome: relevance to mechanism of anovulation. J. Clin. Endocrinol. Metab. 83:3984–3991.Google ScholarPubMed
Wilson, P. W., Abbott, R. D., and Castelli, W. P. (1988) High density lipoprotein cholesterol and mortality: The Framingham Heart Study. Arteriosclerosis 8:737–741.CrossRefGoogle ScholarPubMed
Yildiz, B. O., Yarali, H., Oguz, H., and Bayraktar, M. (2003) Glucose intolerance, insulin resistance, and hyperandrogenemia in first degree relatives of women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 88:2031–2036.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×