should PCOS be recognized as COVID-19 risk factor ?

More than a year after the outbreak of the pandemic, one study found that some women are more likely to contract “Covid-19” than others.
These women, who are often young and healthy, suffer from an underlying condition not mentioned in any list of COVID-19 comorbidities (PCOS).

PCOS, which affects about 10% of women of “reproductive age” is an imbalance in reproductive hormones that can lead to irregular periods, high androgen levels, and ovarian cysts. But it can also come with a host of other health problems, almost all of which overlap with the illnesses associated with COVID-19.

Dr. Webeck Arlt, director of the Institute of Metabolism and Systems Research at the University of Birmingham in the UK, said: “PCOS is completely underestimated in terms of its impact. It's kind of seen as a reproductive problem that is not clinically relevant. But that's totally wrong”.
More than half of women with PCOS develop diabetes before their 40s, 80% of them are overweight and have a higher risk of insulin resistance, heart disease, and endometrial cancer ( cancer that begins in the uterus) and many of them have high blood pressure and low levels of vitamin D.

Despite how common Polycystic ovary syndrome is, as well as the dangerous complications that can come with it, researchers say the disease has long been overlooked and misunderstood.

With so little research looking at whether women with Polycystic ovary syndrome are more likely to have corona virus or long-term symptoms, some fear the same could happen with public health policy around this pandemic.

“My recommendation is to include women with Polycystic ovary syndrome as being in a high-risk group,” said Dr. Catherine Sheriff, chair of women's health in the Jefferson University Department of Medicine and an expert in PCOS.

“If Anthony Fauci said you have to look at the high-risk groups of women with PCOS, people might pay more attention to that group,” Sharif noted.

Over the past year, we knew several pre-existing health conditions that put women’s health at greater risk of severe corona virus, but PCOS is not one of them.

For the researcher (Arlt) the name PCOS is a misnomer.

It's not an ovarian disorder, Arlt said, but a “lifelong metabolic disease” and should be treated as such when considering its vulnerability to COVID-19.

“The stronger the metabolic risk, the more likely to get COVID-19,” Arlt explained.

Arlt noted that people had looked at “obesity, type 2 diabetes, high blood pressure, heart disease, but they haven't systematically looked at PCOS before that. Because they don't see it as a metabolic risk factor,” it's “something we'd like to change”

Arlt and researchers at the University of Birmingham found that women with Polycystic ovary syndrome had a 51 % higher chance of developing a confirmed or suspected COVID-19 infection compared to uninfected women.

Using primary care records from January to June 2020, the researchers identified more than 21,000 PCOS patients and a control group of more than 78,000 without them, matched for age and location.

“The researchers wanted to understand whether the increased incidence of COVID-19 is solely caused by PCOS or is it also due to the underlying risk factors that women with PCOS have,” lead author Anuradha Subramanian told CNN.

In a fully adjusted model that took into account a variety of risk factors, women with Polycystic ovary syndrome still had a 28% increased risk of developing a confirmed COVID-19 infection, according to the studies.

Subramanian noted that “the results gave us more confidence.. it's not just about the risk factors associated with Polycystic ovary syndrome, but something in PCOS is driving this.”

But because the data was pulled from primary health care databases, the researchers were unable to look at whether PCOS patients had more severe or long-lasting COVID-19 symptoms.

What's more, PCOS is not a one-size-fits-all disorder, and COVID-19 may have a different effect or level of risk, and it may not have a different effect or level of risk depending on the person.

There are a lot of questions that we don't have definitive answers to yet, says Dr. jhon lehman, director of the PCOS Center at oxford university .

                                    Danger ‘obvious but not proven'

The research by Texas University medical students nicole and amanda, published in the March issue of Obstetrics and Gynecology, shows that the greatest potential risks for PCOS patients are “comorbidities, androgen and lipid toxicity.”

Women with PCOS often have higher levels of androgens and male sex hormones.

This may “directly affect susceptibility to COVID-19,” nicole and amanda  wrote, adding that androgens act as a “gateway”, to allow entry to “Covid-19”.
Also Poor insulin regulation and obesity can lead to a buildup of toxic fatty acids in tissues, known as lipotoxicity, which can lead to organ damage, this may lead to the release of immune signaling cells called cytokines, and while cytokines are a vital part of the body's immune response, too many of them can cause what is known as a cytokine storm.

Adding “Covid-19” infection to this condition may cause an increase in cytokine secretion, which may lead to the release of one of these storms and cause the immune system to attack the body’s cells, not just the pathogen.

Gutluru told CNN there was research to suggest this could happen “whether or not the patient is overweight.”

For Dr.spencer of Jefferson University, the risk of “Covid-19” symptoms being more severe for PCOS patients is “clear but not proven.”

This has not been proven, says Dr.spencer, because there is little research.

Based on her own research on PCOS and heart disease, DR.SPENCER said, “It's important for people to understand that this has nothing to do with obesity.”

She explained that high insulin and high testosterone bring their risks to a greater risk of contracting Covid-19 compared to weight controls.

“So, if you have two women who weigh 100 kilos, a woman with PCOS will be more likely to have diabetes or sleep apnea or to have the disease because of Covid-19,” she added.

Without this data, some clinicians and researchers say this is something PCOS patients should be aware of, and if they contract COVID-19, it is important for women to tell their doctor that they have PCOS and the medications they are taking.