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Women with polycystic ovaries ‘need mental health screening’

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Women with polycystic ovaries are more likely to suffer from mental health problems and should be routinely screened for mental health issues, according to a new large-scale study.

The study by researchers at Cardiff University suggests all women with Polycystsic Ovary Syndrome – known as PCOS – should have their mental health assessed as part of medical check-ups.

“Screening for mental health disorders should be considered during clinical assessments”

Aled Rees

Researchers assessed the mental health history of more than 17,000 women diagnosed with the common condition, which sees raised male hormone levels cause a range of distressing symptoms including infertility, irregular periods, excessive facial and body hair, and acne.

They found women with PCOS were more likely to be diagnosed with mental health disorders, including depression, anxiety and bipolar disorder.

The findings, which were presented at the Society for Endocrinology annual conference in Harrogate, back up previous research showing the condition may negatively affect mental health.

The study followed women with PCOS from diagnosis and routine follow-up appointments for at least six month and compared results with unaffected women matched for age, body mass index and geographical.

Nearly a quarter of women with PCOS – 23.1% – were found to have depression compared with 19.3% in the control group.

The proportion with anxiety was 11.5% compared with 9.3% of women who did not have PCOS, while the rate of bipolar disorder was 3.2% compared to 1.5%.

The study also found children born to mothers with PCOS were at greater risk of developing attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder.

“Further research is needed to confirm the neurodevelopmental effects of PCOS”

Aled Rees

High levels of testosterone during pregnancy have previously been linked to increased risk of neurodevelopmental disorders in children.

The research team said the findings confirmed women with PCOS should be screened for mental health disorders to ensure early diagnosis and treatment and ultimately improve their quality of life.

Study lead Dr Aled Rees said the effect of PCOS on mental health was generally “under-appreciated”. “Our work shows that screening for mental health disorders should be considered during clinical assessments,” he said.

Dr Rees and his team said they now hoped to investigate if genetic factors that contribute to the risk of PCOS also contribute to the risk of autism and ADHD.

“Further research is needed to confirm the neurodevelopmental effects of PCOS, and to address whether all or some types of patients with PCOS are exposed to mental health risks,” he added.

Abstract: Polycystic ovary syndrome is associated with adverse mental health and neurodevelopmental outcomes: a retrospective, observational study

Thomas Berni1, Christopher Morgan2, Ellen Berni1, Aled Rees3

1School of Mathematics, Cardiff University, Cardiff, United Kingdom, 2Pharmatelligence, Cardiff, United Kingdom, 3Neurscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom

Background: Polycystic ovary syndrome (PCOS) is characterised by hyperandrogenism, oligo/amenorrhoea and subfertility but the effects on mental health outcomes are unclear. Offspring neurodevelopment might also be influenced by gestational androgen exposure.

Aims: To determine if (i) there is an association between PCOS and psychiatric outcomes, and (ii) rates of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are higher in the offspring of mothers with PCOS.

Methods: Data were extracted from the Clinical Practice Research Datalink. Patients with a diagnosis of PCOS (2000-2014) were matched to two control sets (ratio 1:1) by age, BMI and primary care practice. Control set 2 were additionally matched on prior mental health status. Primary outcomes were the incidence of depression, anxiety and bipolar disorder. Secondary outcomes were the prevalence of ADHD or ASD in offspring. Rates of progression to each primary outcome were compared using Cox proportional hazard models. Prevalence of ADHD and ASD in offspring were compared using logistic regression.

Results: 16,986 eligible PCOS patients were identified; 16,938 (99.7%) and 16,355 (96.3%) were matched to control sets 1 and 2 respectively. Compared to control set 1, baseline prevalence was 23.1% versus 19.3% for depression (p<0.001), 11.5% versus 9.3% for anxiety (p<0.001) and 3.2% versus 1.5% for bipolar disorder (p<0.001). The hazard ratio for time to each endpoint was 1.26 (95% CI 1.19-1.32; p<0.001), 1.20 (1.11-1.29 p<0.001), and 1.21 (1.03-1.42; p<0.001) for cohort 1 and 1.38 (1.30-1.45 p<0.001), 1.39 (1.29-1.51 p<0.001) and 1.44 (1.21-1.71) for cohort 2. The odds ratio for ASD and ADHD in offspring were 1.54 (1.12-2.11) and 1.64 (1.16-2.33) for cohort 1, and 1.76 (1.27-2.46) and 1.34 (0.96-1.89) for cohort 2.

Conclusions: PCOS is associated with psychiatric morbidity and increased risk of ADHD and ASD in the offspring. Screening for mental health disorders should be considered during assessment.

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