Adverse Long-term Metabolic and Endometrial Consequences in Women with Polycystic Ovarian Syndrome: A Report of Two Cases.

BACKGROUND: Little prospective data exist on associations between polycystic ovary syndrome (PCOS) and long-term metabolic disorders/endometrial malignancy in women. We report the cases of 2 obese, infertile women with PCOS who experienced long-term adverse metabolic and endometrial consequences. CASE: The first woman developed type 2 diabetes and hypertension after a 10-year history of PCOS and subsequent endometrioid carcinoma after having PCOS for 16 years. The second woman was first diagnosed with endometrial atypical hyperplasia, which failed to respond to high-dose progestin treatment, and then was diagnosed with PCOS after a 10-year history of oligomenorrhea. Laboratory testing revealed dyslipidemia and impaired glucose tolerance. Both women had a family history of diabetes. The second woman was administered oral contraceptives and metformin. Her endometrial atypia regressed and insulin sensitivity improved after 6 months of treatment. CONCLUSION: PCOS may be associated with long-term adverse metabolic and endometrial consequences. Timely diagnosis and appropriate monitoring and management should be emphasized in order to prevent these women from adverse long-term complications. Oral contraceptives in combination with metformin reversed endometrial atypical hyperplasia in the obese, progestin-resistant woman with PCOS. Further clinical studies may be needed to confirm the effectiveness of such treatment on endometrial atypia in obese, progestin-resistant women for fertility sparing.