Mohsan Ali ( 4th Year MBBS Student, )
Bushra Khalid ( Final Year MBBS Student, King Edward Medical University, Lahore, Pakistan. )
Madam, Polycystic Ovary Syndrome is the most common endocrine disorder in women around the globe. It is characterized by cysts, usually in ovaries, and caused by excessive androgen production, resulting in menstrual abnormalities, hirsutism, obesity etc. It has a fairly high prevalence in middle-aged Pakistani females1 as well, and it often (75% of the time) remains undiagnosed.2 Besides, PCOS affects the women of age group 18-44 which is often considered low-risk for developing a severe COVID-19 infection, compared to the older people who are more vulnerable.3
A study by Kyrou I et al. showed that women with PCOS and multiple cardio-metabolic diseases are more likely to be suffering from Type 2 Diabetes Mellitus, Hypertension, Dyslipidaemias, Obstructive sleep apnoea and Non-alcoholic fatty liver disease. Moreover, there is a link between severe COVID-19 and certain factors such as, hyper-inflammation, low vitamin D and hyper-androgenism which are all directly associated with PCOS. Therefore, there exists an overlap between certain common features of PCOS and identified risk factors for severe COVID-19. This implies that the women with PCOS are at higher risk for developing a severe SARS-CoV-2 infection.
In this population,
l Clinicians should keep in mind the potential COVID-related implications on PCOS management as mentioned by Kyrou I et al.4
l All Doctors should be skilled to diagnose PCOS based on the signs and symptoms which can provide a provisional diagnosis, followed by Ultrasonography for a definitive diagnosis. Similarly, PCOS should be kept in mind while treating a middle-aged woman with COVID-19.
l Risk profile of COVID patients with PCOS should be assessed.
l Patients should be informed of preclinical risk for severe COVID 19 if PCOS patients have coexisting Type 2 Diabetes Mellitus and/or Hypertension.
l In case of pregnancy, closer antenatal and perinatal monitoring is required.
l Careful monitoring for potential Thromboembolic complications in PCOS patients who are at high risk for thrombosis (e.g. Treatment with oral contraceptive pills, obesity etc).
l Women with PCOS should be given a priority for immunization with highly efficacious vaccines. Furthermore, awareness regarding preventive measures against COVID-19 should be ensured.
l There should be a follow-up of PCOS patients who recover from COVID-19 in-order to manage any long term complications of the disease, if found.
Abbreviations: PCOS= Polycystic Ovary syndrome, SARS-CoV-2= Severe acute respiratory syndrome coronavirus 2.
Disclaimer: None to declare.
Conflict of Interest: None to declare.
Funding Disclosure: None to declare.
1. Akram M, Roohi N. Endocrine correlates of polycystic ovary syndrome in Pakistani women. J Coll Physicians Surg Pak. 2015; 25:22-6.
2. Wang ET, Kao CN, Shinkai K, Pasch L, Cedars MI, Huddleston HG. Phenotypic comparison of Caucasian and Asian women with polycystic ovary syndrome: a cross-sectional study. Fertil Steril. 2013; 100:214-8.
3. Mueller AL, McNamara MS, Sinclair DA. Why does COVID-19 disproportionately affect older people? Aging (Albany NY). 2020; 12:9959-81.
4. Kyrou I, Karteris E, Robbins T, Chatha K, Drenos F, Randeva HS. Polycystic ovary syndrome (PCOS) and COVID-19: an overlooked female patient population at potentially higher risk during the COVID-19 pandemic. BMC Med. 2020; 18:220.