I have polycystic ovarian syndrome, also known as polycystic ovary syndrome or PCOS. The “scary” things about PCOS that doctors have shared with me are the potential for subfertility, hirsuitism (hairiness), and central obesity. Recently, I got more curious about PCOS and started doing my own digging, only to find that a mustache is the least scary part of having PCOS. There are a lot of health risks associated with PCOS, but there are also some simple ways to lower your risk. Most of these have never been mentioned to me by a doctor, so I hope this information will help you advocate for yourself or a loved one.
You’ll note that a lot of these problems are seen in PCOS patients independent of obesity. Unfortunately, fat bias is a thing in the medical community. Don’t let any medical professional blame the scale for all the problems you experience as a PCOS patient. Excess weight, metabolic syndrome, hyperandrogenism (manliness), and diabetes are all potential outcomes, not causes, of PCOS. (This isn’t an excuse to throw in the towel, of course. It is important for women with PCOS to stay fit and eat well so that excess weight and glucose intolerance don’t exacerbate their condition.)
Problems associated with PCOS:
- The β-cells (or beta cells) of the pancreas, which store and release insulin, are dysfunctional in women with PCOS, independent of obesity and glucose intolerance.  This is the cause of insulin resistance (and thus a contributor to diabetes and metabolic syndrome) in women with PCOS. Insulin resistance and high homocysteine levels are more prevalent in PCOS patients, whether obese or non-obese, than in the general population.  Increased insulin, in turn, causes increased androgen production , which predisposes PCOS patients with high free testosterone to central obesity. 
- Subfertility in women with PCOS is the result of anovulation (not releasing an egg), but can be treated with weight loss, inositol (which your body synthesizes anyway), Metformin, etc. Don’t let anyone stress you out about this; having PCOS does not mean you can’t have kids.
- There is a strong correlation between PCOS and Hashimoto’s autoimmune thyroiditis. Autoimmune thyroiditis occurs at about 3 times the rate in women with PCOS. 
- There is a strong correlation between PCOS and non-alcoholic fatty liver disease (which can be a precursor to liver cancer), even in thin patients with PCOS. This risk of hepatosteatosis (fatty liver) in women with PCOS is approximately 66%. 
- There is a strong association between PCOS and risk of cardiovascular disease. 
- PCOS patients have higher serum homocysteine, on average, and it’s associated with all manner of bad things, including cardiovascular problems. 
- Endothelial disfunction, a marker of atheroslcerotic disease (plaque in your arteries), is found in women with PCOS independent of the amount or location of fat deposits, but not in non-PCOS women with the same level of cardiorespiratory fitness. 
- The risk for atherosclerosis, based on cholesterol and blood pressure measurements, can be evident as early as age 30 in PCOS patients, regardless of BMI. 
- And lastly, a curious fact: One 1984 paper cites a fivefold prevalence of PCOS among women with partial (or “focal”) seizures.  Subsequent studies by the same researcher supported the association, but more evidence is needed.  The anti-seizure medication valproate might be the reason for this coincidence, but it’s not clear.  (Note: There is no reason to think that PCOS causes seizures. Dopamine-related weirdness could potentially explain both.)
How to lower your risk:
Exercise and eat right.
Specifically, do some body weight exercises or strength training. Cardio is not your friend here. Maintaining muscle tissue is harder than maintaining fat stores, so your basal metabolic rate will be higher the more muscle you have.
Talk to your doctor about these supplements:
None of this is voodoo that I pulled out of my ass, promise. These are all chemicals that your body either produces already or requires you to consume. Since we don’t fully understand where things go awry in PCOS, I’ve listed multiple homocysteine-reducing options.
- Inositol for increased insulin sensitivity and related benefits, including reproductive  (Bonus benefit: This tastes like powdered sugar!)
- B-vitamin complex for lower homocysteine and liver health 
- Vitamin D3 + calcium to lower blood pressure 
- Vitamin K2 for strong bones and to help prevent atherosclerosis 
- Betaine for cardiovascular health and to reduce the risk of fatty liver disease 
- Choline for liver health and to lower homocysteine 
- Melatonin at night for liver health and to sleep soundly 
- Creatine for liver health and to reduce homocysteine 
If you’re interested in doing you own research, you can find scientific papers on “PCOS and _______,” where the blank is: anovulation, hyperandrogenism, hyperinsulinemia, hyperhomocysteinemia, insulin resistance, type II diabetes mellitus, type I diabetes, metabolic syndrome, autoimmune thyroiditis, Hashimoto’s, chronic lymphocytic thyroiditis, hepatosteatosis, fatty liver disease, non-alcoholic fatty liver disease, acanthosis nigricans, endothelial dysfunction, cardiovascular disease, homocysteine, HPA axis, dopamine, prolactin, anti-Müllerian hormone, 17-hydroxyprogesterone, Pentraxin-3, pancreatic β-cell, vitamin B12, folic acid, vitamin D, zinc, etc.