PCOS and COVID-19 risk update

Earlier this week, on 9th March 2021, a new study was published from the University of Birmingham that has shown a ‘significantly increased risk of COVD-19’ in those with PCOS. 

In a very simplified way, this study looked at GP records of women from January – June 2020 and compared the rates of COVID-19 infection in those with PCOS and those without. Overall the study found a ‘51% increased risk of contracting COVID-19 in women with PCOS’. Even after accounting for individual secondary cardio-metabolic risk factors such as obesity, diabetes and hypertension, there was still an increased risk of 26% compared to those without PCOS.

Understandably this has caused concern and anxiety in the community as we are still in the midst of the pandemic and not everyone has been vaccinated. Verity has reached out to the research team behind the study to find out more and what this means for us as PCOS patients. Joint senior author Professor Wiebke Arlt, Director of the University of Birmingham’s Institute of Metabolism and Systems Research and lead of the DAISy-PCOS study has taken the time to answer some of our questions.

Question: Can you clarify if it’s the likelihood of catching COVID that is increased or if it’s catching and developing symptoms/complications that increases; or possibly both? Do you know how many had severe covid or if the death rate increased?

Answer: Our paper looks at the likelihood of catching COVID. The paper is based on a primary care database, thus it can analyse all women for whom the GP entered a diagnosis of suspected/confirmed COVID into the medical records. This means that all women recorded were definitely symptomatic. However, our study cannot answer whether the women with PCOS had a more severe course of disease as we did not have access to hospital data.

As you may remember, there was no widespread testing available during the first wave of COVID last year and many patients were only tested for COVID when admitted to hospital. Our paper covers the period of January to June 2020 when not many patients had access to testing, this is why we treated suspected and confirmed COVID cases as one group.

Question: Do you know if there is an increased risk of long covid symptoms?

Answer: We do not know this yet but we will definitely look at this going forward. As our study is based on a primary care database, it will require GPs to record a diagnosis of Long Covid before we can capture it and this process is increasingly underway but not complete yet. Thus, we will have an answer to this question, but this will be only later in the year.

Question: Have you found any other correlations in the analysis e.g. does it affect particular ethnicities or age groups within the cohort more?

Answer: Unfortunately, we did not have access to ethnicity data, which we would have been very interested in. We also would have been very interested in looking at the impact of age, but most women with PCOS had relatively similar ages, this did not allow for a more detailed analysis.

Question: Even after individual co-morbidity risk factors were accounted for you found an increased prevalence. Do you know why this was the case or does this require further research?

Answer: This definitely requires further research. We believe it is likely that androgen excess and insulin resistance might be the culprits, but this is a hypothesis at present. Both are present with high prevalence in women with PCOS. We adjusted risk for various factors and when we adjusted for hirsutism, there was a significant step down in risk, which indicates an important role for androgens. However, androgens in the blood were not systematically measured in the women in the study, thus we cannot prove whether the 28% increase in risk of covid after adjusting for all listed factors is due to androgen excess. We know through previous research that androgen excess is linked to insulin resistance, the higher the androgens, the poorer the body cells respond to insulin, which is a metabolic risk factor.

Question: Does this research mean that PCOS should be added to the underlying conditions vaccine priority group?

Answer: We think that PCOS should be considered as an additional metabolic risk factor like others in the vaccination algorithm, e.g. obesity, type 2 diabetes, hypertension etc. However, our data cannot prove, as per above, whether the course of the disease is more severe, which would be the hardest argument to make to convince public health authorities to add PCOS to the list.

Question: Do you have any advice to offer the community around managing their risk for catching COVID-19? Understandably this research has caused anxiety for some.

Answer: Stay calm, follow social distancing guidelines, do not take unnecessary risks whilst we are still under lockdown and facing high infection levels. Talk to your GP so that they can assess your overall metabolic risk including PCOS and help to make sure you are vaccinated as soon as possible. If invited to your vaccination, please attend!

As more research is done we will continue to update the community and would like to take this time to say thank you to Professor Wiebke Arlt and her team for both conducting the study and taking time out of their busy schedules to answer our questions.

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