Polycystic Ovary Syndrome (PCOS) is often dismissed as a reproductive or cosmetic issue—a condition marked by irregular periods, acne, and weight fluctuations. But the hormonal and metabolic underpinnings of PCOS go much deeper. New findings presented at ENDO 2025, the annual meeting of the Endocrine Society, now highlight a troubling link: PCOS may significantly increase the risk of vascular events in women with thrombotic disease, and these events are occurring at increasingly younger ages.The research, presented by a team from Riverside University Health System Medical Center and supported by national health data, suggests that the combination of PCOS and thrombotic disease creates a more dangerous cardiovascular profile, one that might be going under-recognized in clinical settings.The analysis drew on records from the National Inpatient Sample (NIS), evaluating over 205,000 women hospitalized between 2016 and 2022 for thrombotic, atherosclerotic, or cerebrovascular diseases. The goal was to see how outcomes differed based on the presence or absence of comorbid PCOS. The findings were both significant and sobering:Women with both PCOS and thrombotic disease had higher stroke rates (14.81%) compared to those without PCOS (11.91%).A greater percentage of women with PCOS were under the age of 50 at the time of their vascular event compared to those without PCOS across all categories—thrombotic, atherosclerotic, and cerebrovascular.Also Read: Your Home May Look Clean, But These 8 Spots Are Dirtier Than You ThinkDespite the younger age of presentation, in-hospital mortality rates were similar between women with and without PCOS, suggesting the seriousness of these events in younger populations is not being offset by age-related resilience.Dr. Alexander Lim, DO, who presented the findings, noted, “We found that cardiovascular events in women with PCOS were more likely to occur at an earlier age. The risk tends to decrease with age, possibly due to underdiagnosis of PCOS in older women or survivorship bias.”Why Metabolic Difficulties Due To PCOS Lead Vascular Complications?To understand why PCOS might elevate vascular risk, it's crucial to look at its underlying pathology. PCOS is not just a hormonal disorder—it’s also deeply metabolic.Women with PCOS frequently exhibit insulin resistance, even if they are not overweight. This insulin resistance is a precursor to type 2 diabetes, hypertension, nonalcoholic fatty liver disease, and dyslipidemia—all conditions that significantly increase the risk of both arterial and venous thrombotic events.Despite this, clinical management of PCOS often remains centered on cosmetic symptoms (like acne and hirsutism) or fertility concerns, rather than addressing the long-term metabolic and cardiovascular consequences. This treatment gap may explain why vascular events in women with PCOS catch both patients and providers off guard.Why Current Testing May Be Failing Women?Another striking aspect of the new research is that women with PCOS who experienced recurrent thrombotic events (strokes, heart attacks, pulmonary embolisms) often showed normal results in standard coagulation tests. This was identified in a diagnostic review by a coagulation management team and later verified through a national data set analysis using TriNetX, a large health research network.Between 2013 and 2018, researchers used the TriNetX platform to analyze PCOS patients aged 15–75, excluding those with known thrombotic disorders, smoking history, or HIV. They found that thrombotic events occurred at significantly higher rates in women with PCOS compared to matched controls, even though clinical tests failed to detect abnormalities in coagulation.What this suggests is that standard coagulation assays may not be sensitive enough to detect the unique thrombotic risk profile in PCOS, raising concerns about diagnostic error or delayed interventions.This is the first large-scale study to systematically evaluate the rate and clinical presentation of thrombotic events in women with PCOS using national data and validated diagnostic algorithms like SPADE (Symptom-Disease Pair Analysis of Diagnostic Error).By comparing outcomes 90 days prior to major thrombotic events, the researchers identified consistent symptom patterns—including subtle indicators—that could serve as early warning signs for intervention. However, the precise biological mechanisms behind thrombosis in PCOS remain poorly understood.The message is clear: PCOS isn’t just a reproductive disorder—it’s a systemic, vascular-risk condition that can dramatically impact a woman’s health long before menopause. Clinicians need to think beyond fertility and skin health and recognize that young women with PCOS may be walking around with unrecognized cardiovascular vulnerabilities.For women living with PCOS, this means that a heart-healthy lifestyle—including regular cardiovascular screening, metabolic management, and awareness of symptoms like chest pain, migraines, and swelling—needs to be part of long-term care, not just pregnancy planning.