Polycystic ovary syndrome (PCOS) and COVID-19: an overlooked female patient population at potentially higher risk during the COVID-19 pandemic

Abstract

Background: In women of reproductive age, polycystic ovary syndrome (PCOS) constitutes the most frequent endocrine disorder. Women with PCOS are considered to typically belong to an age and sex group which is at lower risk for severe COVID-19. Main body: Emerging data link the risk of severe COVID-19 with certain factors such as hyper-inflammation, ethnicity predisposition, low vitamin D levels, and hyperandrogenism, all of which have known direct associations with PCOS. Moreover, in this common female patient population, there is markedly high prevalence of multiple cardio-metabolic conditions, such as type 2 diabetes, obesity, and hypertension, which may significantly increase the risk for adverse COVID-19-related outcomes. This strong overlap of risk factors for both worse PCOS cardiometabolic manifestations and severe COVID-19 should be highlighted for the clinical practice, particularly since women with PCOS often receive fragmented care from multiple healthcare services. Comprehensively informing women with PCOS regarding the potential risks from COVID-19 and how this may affect their management is also essential. Conclusion: Despite the immense challenges posed by the COVID-19 outbreak to the healthcare systems in affected countries, attention should be directed to maintain a high standard of care for complex patients such as many women with PCOS and provide relevant practical recommendations for optimal management in the setting of this fast moving pandemic.

Investigating the Potential for Ultraviolet Light to Modulate Morbidity and Mortality From COVID-19: A Narrative Review and Update

“…Other related risk factors include: gender (male) ( 118 , 119 ), age (older) ( 120 ) and ethnicity ( 121 ). However, women with polycystic ovarian syndrome may be a sub-population at-risk of COVID-19, due to their increased risk for cardiometabolic comorbidities ( 122 ). Younger adults with obesity may also be at increased risk compared to those people of a similar age not living with obesity ( 123 ).…”

Renin-Angiotensin System overactivation in polycystic ovary syndrome, a risk for SARS-CoV-2 infection?

“…Women with polycystic ovary syndrome share features of metabolic syndrome, including insulin resistance [ 34 ] and obesity [ 35 ], with a high proportion going on to develop type 2 diabetes [ 36 ]. Therefore, the cardio-metabolic diseases commonly seen in women with PCOS overlap with risk factors predisposing to severe COVID-19 disease [ 37 ]. Further, case reports of pregnant woman with polycystic ovary syndrome (PCOS) infected by SARS-CoV-2 [ 38 ] suggest PCOS as a high-risk factor for COVID-19.…”

Potential impacts of COVID-19 on reproductive health: Scientific findings and social dimension

“…There is currently inadequate information on ovarian function in women infected with COVID-19 virus ( Pal and Banerjee, 2020 ). One of the few reports published on this issue discussed the association between a common ovarian dysfunction in women, namely, polycystic ovary syndrome (PCOS), and the incidence of severe COVID-19 infection and/or symptoms ( Kyrou et al, 2020 ). The value of this study is ascribed to the fact that PCOS may account for about 10%–15% of endocrine disorders in women ( Teede et al, 2018 ), and that about 75% of women suffering PCOS also have obesity and other pre-existing health problems such as type 2 diabetes and hypertension.…”

“…Given the ability of the sex steroid hormones to modulate the expression and activity of ACE-2 in many tissues such as adipose tissue, myocardium, and kidney, women with POCS are highly likely to suffer severe adverse symptoms of COVID-19. Specifically, women with POCS usually have high concentrations of circulating androgens, which are strongly suggested to facilitate COVID-19 entry ( La Vignera et al, 2020 , Kyrou et al, 2020 ). Women suffering any comorbidities accompanying ovarian dysfunction should be made aware of the hazards of COVID-19 infection.…”