When it comes to COVID-19, we are not all equally at risk. Health factors associated with a higher chance of catching COVID-19 include older age, underlying conditions like diabetes, chronic respiratory disease or cardiovascular disease, and higher weight. One risk factor that is not as widely known is polycystic ovary syndrome (PCOS), a common endocrinological condition affecting one in 10 women of 'childbearing' age.
In a study published in May 2021, researchers at the University of Birmingham found that women with PCOS are at a significantly increased risk (52%) of contracting COVID-19 compared to women without PCOS.
Dr Christina Papadopoulos, GP at the digital healthcare provider Livi, tells R29 that conditions commonly found alongside PCOS are obvious factors in this. "PCOS is a complex disorder that is associated with an increased risk of cardiometabolic disease, such as type 2 diabetes, obesity, non-alcoholic fatty liver disease and high blood pressure. All of these conditions are known to be risk factors in themselves for COVID-19."
However, when the researchers accounted for BMI and diabetes in the study they still found an increased risk associated with those who had PCOS. "In our study we compared the risk to women who had a similar body weight [but not PCOS]," explains Professor Wiebke Arlt, director of the Institute of Metabolism and Systems Research at the University of Birmingham. "And beyond that, we found that there is still significantly increased risk." The study found that women with PCOS but no other underlying health conditions like diabetes still have an increased risk (28%) of catching COVID.
The theory behind this continued risk is to do with androgens ('male' hormones). "PCOS is characterised by an excess of androgen," explains Papadopoulos. "There is already strong evidence that men are more predisposed to COVID-19 than women, and although the exact mechanism for this is still being investigated, it is likely that male sex hormones are implicated in increasing the susceptibility to contracting COVID-19."
Expanding on this, Arlt points out the link between increased androgens and insulin resistance, which is another COVID-19 risk factor. "That means, with the same body weight, a woman with PCOS will have higher insulin resistance, because the androgens in the adipose tissue increase the insulin resistance of the body. That's an additional risk factor, so it's therefore completely logical for us why women with PCOS are at higher risk than women with comparable weight or comparable diabetes."
Arlt adds that the increased COVID-19 risk is proportional to weight. If you have PCOS, you are probably at a slightly higher risk than someone without PCOS in your weight category. This increases significantly the higher the weight.
When the research was first published, Arlt and her colleagues were pushing for PCOS to be identified as a COVID-19 risk factor in and of itself. That has not yet happened. "There’s been lots of interest in the [paper] and obviously we voiced this to relevant bodies but so far they haven't been put in a special risk category." She adds: "That's in line with what we usually experience: not a great interest is taken by public health in women-specific conditions."
To a certain degree, this is down to simple sexism, she says. "Women are more than 50% of the world's population and their problems are taken less seriously I would say in general." The fact that women with PCOS are considered to belong to an age and sex group that is at lower risk of severe COVID-19 also plays a part, adds Papadopoulos, though while "most women with PCOS are diagnosed in their 20s and 30s, it can happen at any age after puberty and before menopause."
The main barrier to progress that Arlt identifies is the name of the condition. "The name [polycystic ovary syndrome] wrongly reflects that it would be a disease of the ovaries and has something to do just with ovaries, but that's completely wrong." The impact on the ovaries is a symptom of PCOS, not the cause: the ovaries are reacting to the insulin resistance and to the high androgens in the blood, which is why they become irregular.
Instead, Arlt believes the name should reflect the fact that PCOS is a metabolic disorder that affects the whole body. This would help not only with public perception but with perception and treatment in the medical field. "Due to the name, the majority of people who look after patients with PCOS are often gynaecologists and not routinely endocrinologists or metabolic health consultants."
As yet, no links between PCOS and long COVID or severe COVID have been found, as the researchers are waiting for the study population to be big enough.
In the meantime, the advice for people with PCOS is to be mindful of the risks, be risk-averse by wearing a mask and maintaining distance and, if you haven’t already done so, get vaccinated. As Arlt puts it: "Don't panic, but be considerate as you're at slightly higher risk."