Women with polycystic ovary syndrome (PCOS) are at a significantly increased risk of contracting COVID-19 than women without the condition, according to research led by the University of Birmingham. The study investigators are now calling for healthcare policy to specifically encourage women with PCOS to adhere to COVID-19 infection control measures while the global pandemic continues.
"Given the high prevalence of PCOS, these findings need to be considered when designing public health policy and advice as our understanding of COVID-19 evolves,” said first author, Dr Anuradhaa Subramanian, of the University of Birmingham.
Women with PCOS have an increased risk of cardiometabolic disease, such as type 2 diabetes, non-alcoholic fatty liver disease, and high blood pressure, all of which have been identified as risk factors for COVID-19.
"Before the onset of the COVID-19 pandemic, women with PCOS consistently report fragmented care, delayed diagnosis and a perception of poor clinician understanding of their condition,” said co-author, Dr Michael O'Reilly, of the Royal College of Surgeons of Ireland. “Women suffering from this condition may fear, with some degree of justification, that an enhanced risk of COVID-19 infection will further compromise timely access to healthcare and serve to increase the sense of disenfranchisement currently experienced by many patients."
To investigate whether the increased metabolic risk in PCOS translates into an increased risk of COVID-19 infection, the team carried out a population-based closed cohort study in the UK during the first wave of the pandemic between January and July 2020.
Using UK GP patient records, the study included 21,292 women with PCOS and 78,310 female 'controls' without PCOS matched for age and general practice location. The results revealed a 51% increased risk of contracting COVID-19 in women with PCOS, compared to those of the same age and background of those without PCOS.
A 26% increased susceptibility to COVID-19 infection in the PCOS cohort persisted, even after adjustment for individual cardio-metabolic risk factors known to cluster within PCOS, which have recently been directly linked to increased COVID-19 susceptibility, including obesity, impaired glucose regulation and hypertension.
The research, ‘Increased COVID-19 infections in women with polycystic ovary syndrome: a population-based study’, published in the European Journal of Endocrinology, showed that incidence of COVID-19 in women with PCOS was almost twice the rate than in women without PCOS (18.1 cases per 1,000 person years in women with PCOS, compared to 11.9 cases per 1,000 person years in women without PCOS).
Joint senior author Dr Krish Nirantharakumar of the University of Birmingham's Institute of Applied Health Research, said that COVID-19 shielding strategies for women with PCOS should also carefully consider the need to protect mental health: "The risk of mental health problems including low self-esteem, anxiety and depression is significantly higher in women with PCOS, and advice on strict adherence to social distancing needs to be tempered by the associated risk of exacerbating these underlying problems.”
Professor Arlt, who leads DAISy-PCOS—a large Wellcome Trust-funded research program on metabolic health and 'male' hormones in women with PCOS, added: "Women with PCOS have recently been highlighted as an overlooked and potentially high risk population for contracting COVID-19. However, our study does not provide information on the risk of a severe course of the COVID-19 infection or on the risk of COVID-19 related long-term complications of COVID-19 and further research is required."
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