PCOS Diagnosis and Autoimmunity
By: Nitisha Gautam
Polycystic Ovarian Syndrome, known to many as PCOS, is an endocrine disorder that can affect between 5-10% of women between the ages of 15 and 44.[2] Among these women, a higher percentage of them find out they have PCOS in their twenties and thirties. However, PCOS can develop in women at any age after puberty. PCOS was first identified in 1935 by Stein and Leventhal, two scientists who noticed “irregular menstruation, obesity, and hirsutism” among women. [3] Currently, researchers and the general public still lack many of the answers to important PCOS questions, like its diagnosis process and long-term autoimmune effects.
For many women, the journey of their diagnosis of PCOS can be long and tedious. A patient advocate and founder Sasha Ottey of the “PCOS Challenge: The National Polycystic Ovary Syndrome Association” published an article about her PCOS journey that started with a missed period and OB/GYN visit. The multiple visits included hormone tests, files on medical history, and transvaginal ultrasounds before the OB/GYN was able to diagnose her with PCOS.[4] She was referred to an endocrinologist who told her that she needed to lose weight before she could meet the healthcare team. On top of all the stress and anxiety looming around the diagnosis, she found out that her health insurance would not cover the charges for her healthcare visits, because PCOS was not included in her plan. She was told that she would have to have diabetes with PCOS if she wanted her bills to be covered. The inefficient and economically draining process of diagnosing PCOS emphasizes the lack of support, education, and community awareness towards this common medical disorder. The Center for Disease Control and Prevention states that PCOS is a serious disorder that is “severely underdiagnosed, misdiagnosed and under-recognized by healthcare providers. Fifty percent [of cases] are going undiagnosed or misdiagnosed.” [4]
PCOS has scientifically been associated with a series of endocrine and metabolic disturbances, an example being the prevalence of autoimmune thyroiditis among the patients. In an ongoing study titled “Polycystic ovary syndrome and autoimmunity,” scientists are trying to understand whether the chemical changes that occur in women with PCOS are also associated with many autoimmune diseases in women of reproductive age.[5] In the field of reproductive care for women, conditions like preeclampsia, recurrent miscarriage, endometriosis, and fibroids have been proven to have associations with other autoimmunological processes. The study has confirmed previous evidence that PCOS has been associated with anti-ovarian autoimmunity.[5] Furthermore, the prevalence of autoimmune thyroiditis is very high among PCOS patients.
Recent studies have also revealed higher incidences of autoantibodies, like anti-histone and anti-dsDNA, and lower levels of vitamin D in PCOS patients, which can correlate with worse metabolic characteristics.[5] However, the prevalence of systemic and organ-specific autoantibodies in PCOS patients has not been proven statistically significant, and future studies can continue to “explore the mechanisms with which autoimmune diseases can be related to PCOS”.Another study delved deeper into the increased risk of type two diabetes and cardiovascular disease in PCOS patients, and how PCOS is often associated with changes to BMI levels. The study emphasizes the importance of screening for metabolic syndromes among recently diagnosed PCOS patients. HbA1c and lipid accumulation products could be important diagnosis factors associated with high metabolic risk among PCOS patients.[1] The increased secretion of autoantibodies among these patients can put them at an increased risk for type one diabetes, asthma, and thyroid disease. Among PCOS patients, looking for diabetes can help these women understand if they are at a higher risk for nonalcoholic fatty liver disease, endometrial cancer, and gallbladder disease.
All the research conducted about the intersection between PCOS diagnosis and changes to autoimmune health has been fueled in the last couple of years through a purposeful focus on the awareness of PCOS and other reproductive illnesses. Initiatives like the PCOS Challenge are focused on raising public awareness about PCOS and helping women reduce their risk for life-threatening diseases, like diabetes, cardiovascular disease, and cancer, that can result from the development of PCOS.[4] Doctors can collaborate with insurance companies to promote a more open communication and cost-efficient process to understand the symptoms and diagnosis procedures for PCOS. In terms of PCOS public policy and advocacy, the PCOS challenge has passed a legislation in the U.S. Senate on December 21, 2017 that recognizes the seriousness of PCOS and the need for further research, improved treatment and care options, and for a cure for PCOS.[4] This is a step in the right direction, we must continue to learn more about this field to provide effective and feasible treatment for women suffering from these reproductive diseases.
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[1] Glintborg, D., & Andersen, M. (2017). Medical comorbidity in polycystic ovary syndrome with special focus on cardiometabolic, autoimmune, hepatic and cancer diseases: An updated review. Current Opinion in Obstetrics & Gynecology, 29(6), 390-396. doi:10.1097/gco.0000000000000410
[2] Polycystic ovary syndrome. (2019, April 01). Retrieved April 02, 2021, from https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
[3] PCOS Case Study References. (n.d.). Retrieved April 02, 2021, from https://u.osu.edu/pcoscasestudy2018/
[4] My life with PCOS: A personal story by SASHA OTTEY. (2019, September 16). Retrieved April 02, 2021, from https://resolve.org/infertility-101/medical-conditions/polycystic-ovary-syndrome/my-life-with-pcos-a-personal-story/
[5] Petríková, J., & Lazúrová, I. (2012). Ovarian failure and polycystic ovary syndrome. Autoimmunity Reviews,11(6-7). doi:10.1016/j.autrev.2011.11.010