Autistic Comorbidities: Polycystic Ovarian Syndrome


According to Molecular Psychiatry, autistic people with uteruses are 1.78 times more likely to have PCOS than neurotypical peers.  Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder that is common with female bodied people of reproductive age. Uterus owners with PCOS have irregular menstrual cycles or prolonged periods or excess male hormones. The ovaries could develop multiple collections of fluid and fail to release the egg. 

  • There is no known cause of PCOS. Early diagnosis and treatment paired with weight loss may reduce the risk of long term complications like type 2 diabetes and heart disease. 

Symptoms

  • Irregular periods- infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. This can be cycles that do not happen every month, they may be light then heavy, etc. 
  • Excess male hormones- Elevated male hormones can result in physical signs such as hirsutism (excess facial and body hair) and sever acne and male pattern baldness
  • Infertility- having trouble getting pregnant or holding onto a pregnancy with out miscarrying. 
  • Mood changes
  • enlarged ovaries or have many cysts
  • weight gain
  • acne or oily skin
  • male pattern baldness or thinking hair
  • skin tags
  • dark or thick skin patches on the back of the neck, in the armpits or under the breasts

Risk Factors:

  • Excess insulin- Insulin is a hormone produced by the pancreas that helps cells process glucose. Glucose is the main energy source of the body. If the cells are resistent to insulin, the blood sugar levels will rise and the pancreas will produce more insulin. Excess insulin causes more male hormone production. 
  • low grade inflammation- This term is used when white blood cells production of substances to fight infection. People with PCOS have a type of low grade inflammation that stimulates polycystic ovaries to produce male hormones which can lead to vascular and heart problems. 
  • Heredity- There is a genetic factor to PCOS
  • Excess androgen- The ovaries produce abnormally high levels of male hormones. 
  • Progesterone deficiency
  • ovarian cysts

Complications:

  • infertility
  • gestational diabetes
  • miscarriage, stillbirth or premature birth
  • non alcoholic steatohepatitis- severe liver inflammation cause by fat accumulation of the liver (fatty liver)
  • metabolic syndrome- a cluster of conditions including high blood pressure, high blood sugar and abnormal cholesterol or triglyceride levels that increase risk of cardiovascular disease
  • type 2 diabetes or prediabetes
  • depression, anxiety and eating disorders
  • abnormal uterine bleeding
  • endometrial cancer 
  • weight gain

Diagnosis

There is no specific test for PCOS. The OBGN will take a medical history. This will include mentrual periods and weight changes. 

After this, the doctor may perform:
  • a pelvic exam- The doctor visually and manually inspects reproductive tract for masses, growth and other abnormalities
  • blood tests- The blood is taken for analysis to measure hormone levels. This can also rule out other conditions that can mimic PCOS. 
  • An ultrasound- The doctor will look at the appearance of the ovaries and thickness of the uterine lining. 

Treatment

  • Based on individual symptoms experienced
  • Lifestyle changes
    • weight loss via a low calorie diet- a small reduction in weight can improve the condition
    • moderate excercise
  • Medications
    • combination birth control pills or hormonal IUD
      • Pills or IUD that contain estrogen and prgestin decrease male hormone production. Regulating hormones can lower the risk of endometrial cancer and regulate bleeding, excess hair growth and acne
    • Progestin therapy. Taking progestin for 10 to 14 days every one or two months can regulate mensural cycles and protect against endometrial cancer. This does not improve androgen levels and does not prevent pregnancy. 
  • To help ovulation
    • anti estrogen medications that stimulate the ovaries
    • breast cancer treatment that can stimulate the ovaries
    • medication to improve insulin resistance and lowers insulin levels 

IF YOU THINK YOU HAVE PCOS, PLEASE SEE A DOCTOR FOR EVALUATION

Sources:

https://www.nature.com/articles/s41380-019-0398-0

https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439#:~:text=Polycystic%20ovary%20syndrome%20(PCOS)%20is,fail%20to%20regularly%20release%20eggs.

https://www.webmd.com/women/what-is-pcos#1

https://www.healthline.com/health/polycystic-ovary-disease#what-is-pcos

https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos

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