PCOS, heart disease, and diabetes: What every patient needs to know
Dr. Shruthi Mahalingaiah is a physician scientist specializing in ovulation disorders, reproductive endocrinology, and infertility at the Massachusetts General Hospital in the Department of Obstetrics and Gynecology (#1 hospital in the nation for OBGYN). She is an associate professor of environmental, reproductive, and women’s health in the Department of Environmental Health at the Harvard T.H. Chan School of Public Health, and she is board certified in OBGYN and Reproductive Endocrinology and Infertility.
The menstrual cycle is a vital sign. In this Q&A, we address common questions about PCOS, persistently irregular menstrual cycles, and cardiometabolic health.
What is cardiometabolic disease and why is it important for people with polycystic ovary syndrome (PCOS) to know about?
“Cardiometabolic disease” is a broad term healthcare professionals will use to refer to certain health conditions. These conditions can include things like type 2 diabetes, obesity, non-alcoholic fatty liver disease, and more1. They are linked with greater risk for heart issues. Research from the Apple Women’s Health Study has found that people diagnosed with PCOS can tend to get conditions like prediabetes and heart disease earlier than those who aren’t diagnosed with PCOS, on average2. Having PCOS (or persistently irregular menstrual cycles) is also linked with some increased risk for cardiometabolic conditions like heart attack, hypertension, stroke, and diabetes3. It’s important that we raise awareness about both PCOS and cardiometabolic disease so we can implement risk reduction through lifestyle and behavior management and medication management, if appropriate.
Why are people with PCOS at higher risk for cardiometabolic conditions?
More research is needed to identify exact pathways that may influence risk, and to understand patterns in who or may not be affected more often or more severely. Regardless, PCOS is a “whole body” condition – not just something that causes infertility, or something that only impacts reproductive health. People with PCOS and other ovulation disorders can often experience insulin resistance, chronic inflammation, difficulty losing weight (or easy weight gain), and disruption of hormone processes in the body. These factors can all be possible contributors to why they are at greater risk overall.
Will everyone with PCOS develop diabetes or heart disease?
Not everyone with PCOS will develop cardiometabolic disease. Many factors influence someone’s individual risk. While it’s important to be aware, it’s also important to remember that increased risk doesn’t equal a guarantee of a future issue.
What are the best ways for people with PCOS to lower their risk of heart disease and metabolic syndrome?
Both lifestyle changes and medical interventions like prescription medications can help. Everyone is different, and it’s important to work with a qualified clinician to get personalized recommendations and counseling just for you. For example, as someone who treats PCOS and ovulation disorder patients, I often discuss a combination of lifestyle changes that might support ovulation health in complement to medication recommendations. Things like regular movement, staying up to date with things like preventative care, prioritizing heart-healthy meals, getting good sleep, and staying hydrated can all do wonders. However, lifestyle can’t always prevent or fix everything.
Something really important to remember is to take your medications as they’re prescribed so they can be most effective; if you’re struggling to keep up with your regimen, for whatever reason, your clinician is someone you can trust to go to for help. While you may not physically feel different skipping doses or stopping medications entirely, it’s always necessary to consult with your health care provider to discuss what is and isn’t working for you and to get their insight on what they may recommend instead. Stopping medications abruptly or not taking them as they are prescribed for you can cause serious health problems.
What screening tests are recommended for heart and metabolic risks in PCOS?
As a clinician, I rely on the patient’s individual history and physical examination to guide both diagnosis and management. I focus on the patient’s main concerns and provide ongoing education and support at follow-up appointments after starting treatment. Specific tests and screenings are going to depend on a patient’s individual risk factors, like for example their family history. I also discuss symptoms and patterns (or changes in patterns) throughout a patient’s life. For patients who potentially have PCOS, I check serum androgen levels and perform an ultrasound to assess ovarian shape (called ovarian morphology), regarding how many follicles are present. I discuss with the patient how having an ovulation disorder may affect their uterine health, fertility, and long-term risk for metabolic or cardiovascular issues. Depending on symptoms, or how long they have been present for, I may perform or provide referral for additional tests and/or consultation as well.
Do other ovulation disorders, besides PCOS, increase risk for cardiometabolic disease?
Yes, ovulation disorders and having irregular cycles can increase someone’s chances of – but not guarantee – developing heart disease, diabetes, and more. Last year, using large scale data through the Apple Women’s Health Study, my research team and I found that even women without PCOS – those with an irregular menstrual cycle, whose periods took more than five years to become regular, or who used hormones to establish a regular cycle – faced higher risks too3.
What are the current management and treatment options for reducing cardiometabolic risk in PCOS?
There are several ways people with PCOS can reduce their risk for cardiometabolic issues and take care of their overall health. For many, this starts with lifestyle habits that promote good health. Depending on an individual patient’s needs, a clinician might also recommend certain medications to help with key hormones, control blood sugar, manage body weight, or lower cholesterol. Living with PCOS can be really hard and many patients may also benefit from support groups or mental health counseling to help manage the burden.
Something to keep in mind, too, is that many PCOS patients can’t always get the type of medical care they need, when they need it. Research has found that many patients struggle to get a timely diagnosis of the condition, for example2. These types of patients are often at risk for worse health as a result, and they may not even be aware. This is all to say that if you are really struggling with PCOS symptoms, and it feels like things are getting worse, it’s not always your personal fault – you can try your best and still experience poor health.
Are there early warning signs of heart or metabolic problems women with PCOS should watch out for?
Education and awareness is key here. Some signs to look out for with PCOS include having fewer than 8 periods a year and accompanying symptoms, including things like increased facial and body hair or recent weight gain. Also, I always encourage my patients to talk to their family members to better identify family history as early as they can. This is a good practice for PCOS and beyond.
When it comes to cardiometabolic disease, always tell a clinician if you experience changes in blood pressure, shortness of breath or chest discomfort, feeling unusually thirsty or tired, or even needing to pee more often. These can all be warning signs that something larger is happening within the body and it’s important to discuss them with a clinician. Unfortunately, sometimes serious conditions and health issues can also be “silent,” so it’s important to keep up with preventive care.
Certain windows of life can also change risk even when you weren’t having symptoms before. For example, pregnancy is one of those windows. I personally experienced gestational diabetes during my pregnancy with my twins – and research has found that experiencing this is more common if you took longer to establish regular menstrual cycles early on as an adolescent4. Monitoring your menstrual cycles and knowing your own body so you can quickly identify when something is different or feels wrong is so important.
References
1: T. Eroglua, F. Caponea and G. G. Schiattarella, “The evolving landscape of cardiometabolic diseases,” The Lancet: eBioMedicine, vol. 109, 2024.
2: E. Peebles, Z. Wang, E. Dracup, C. Sarcione, C. L. Curry, K. Abrams, J.-P. Onnela, M. A. Williams, R. Hauser, B. Coull and S. Mahalingaiah, “Utilizing a digital cohort to understand the health burden and lifestyle characteristics across the life course in individuals with polycystic ovary syndrome and possible PCOS,” Frontiers in Endocrinology, vol. 16, 2025.
3: Z. Wang, A. M. Z. Jukic and D. D. Baird, “Irregular Cycles, Ovulatory Disorders, and Cardiometabolic Conditions in a US-Based Digital Cohort,” JAMA Network Open, vol. 7, no. 5, 2024.
4: Z. Wang, D. D. Baird, M. A. Williams, A. M. Z. Jukic, A. J. Wilcox, C. L. Curry, T. Fischer‐Colbrie, J. Onnela, R. Hauser, B. A. Coull and S. Mahalingaiah, “Early‐life menstrual characteristics and gestational diabetes in a large US cohort,” Paediatric and perinatal epidemiology, vol. 28, no. 38, 2024.
5: World Health Organization, “Polycystic ovary syndrome,” 7 February 2025. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome. [Accessed 16 October 2025].
