Danielle O'Laughlin, PA-C, MS: Navigating Long-Term Risks, Family Planning in PCOS

Polycystic ovary syndrome (PCOS) carries a high prevalence among women—estimated at approximately 1 in 10 and increasing over time.¹ But an exacerbation of that high prevalence rate for clinicians who manage patients with PCOS is the multitude of ways by which it can impact them long-term—and how it may alter lifestyle decisions and behaviors.

In an interview with HCPLive during the American Academy of Physician Associates (AAPA) 2024 Conference & Expo in Houston, TX, this week, Danielle O’Laughlin, PA-C, MS, a physician associate in Mayo Clinic’s division of community internal medicine, geriatrics and palliative care, discussed her session presentation on PCOS management in the primary care setting.

O’Laughlin discussed the matter of navigating treatment in a patient with PCOS who may be interested in bearing children. As she explained, the issue may be as heterogenous as the condition itself—but the sentiment of treatment is fairly consistent.

“A lot of times, our treatment and our education is focused on, 'Okay, let's reduce your risk factors’,” O’Laughlin said. “You need to have regular menstrual periods so that you can ovulate on a regular basis, so you can get pregnant. So to do that, we want to make sure that you don't have impaired fasting glucose or diabetes, we want to make sure we're preventing all the things that we can.”

Weight loss in patients who are overweight may help restore menstrual regulation, O’Laughlin said; diet and exercise are common recommendations for PCOS, as may be metformin.²

Another recourse may be recommending birth control to affected patients prior to their attempts to get pregnant, O’Laughlin said.

“And then sometimes we have to jump to ovulation induction—whether we're using medications or we're referring for that, but there's lots of options,” O’Laughlin said. “It just depends on how long have they been trying to get pregnant, when do they want to get pregnant and where they're at on that spectrum.”

O’Laughlin additionally discussed the matter of long-term outcome risks in patients with PCOS, which can range from metabolic disease like diabetes, hormonal effects like early menopause onset or endometrial cancer,³ and even psychological burdens.

“I will say that if in today's life phase, you don't want to be on birth control, that's fine. We can do the things to get you pregnant and that sort of thing,” she said. “But long term, we need to have some plan to protect the endometrium. That might be birth control…that's going to reduce the risk of endometrial hyperplasia and then reduce their risk of endometrial cancer.”

From the risk of metabolic diseases, behavior modification in exercise, sleep and diet are primary topics. But regarding psychological effects, the matter may be diverse: O’Laughlin said anxiety, depression, eating disorders and psychosexual dysfunction are more common in women with PCOS.

“This is a disease process that has different risks at different parts of your life,” O’Laughlin said. “And we can do a lot to prevent that and monitor those (risks). They need to know education for the pre-family planning, the family planning stage, or the post-family planning stage, depending on where they're at.”

References

1. ^{Deswal R, Narwal V, Dang A, Pundir CS. The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. J Hum Reprod Sci. 2020;13(4):261-271. doi:10.4103/jhrs.JHRS_95_18}
2. ^{Johnson NP. Metformin use in women with polycystic ovary syndrome. Ann Transl Med. 2014;2(6):56. doi:10.3978/j.issn.2305-5839.2014.04.15}
3. ^{Kunzmann K. PCOS status linked to menopause age onset. Contemporary OB/GYN. Published March 28, 2024. https://www.contemporaryobgyn.net/view/pcos-status-linked-to-menopause-age-onset}