Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder affecting women of reproductive age, accounting for approximately 75% of anovulatory infertility cases worldwide. In addition to its impact on fertility, various studies have demonstrated a significant connection between metabolic indicators such as body mass index (BMI), insulin levels, lipid metabolism, and mental health issues. Among these mental health concerns, bipolar disorder emerges as a prominent condition linked to PCOS. Research indicates that individuals diagnosed with bipolar disorder exhibit a higher incidence of PCOS compared to those without the disease. This association has been published in the Journal of Affective Disorders, highlighting an increased risk of bipolar disorder in women with PCOS.
The study conducted by Dr. Liu and colleagues recruited 72 bipolar disorder patients on long-term medication, 72 drug-naive patients, and 98 healthy controls without a family history of psychiatric disorders or prior psychiatric diagnoses. The study, carried out between March 2022 and November 2022, involved recording menstrual patterns, measuring reproductive hormone levels and metabolic indicators, and performing pelvic ultrasound examinations using a transvaginal sensor. PCOS was defined according to the Rotterdam criteria.
Liu et al. reported that drug-naive women with bipolar disorder exhibited significantly higher rates of PCOS compared to healthy controls (OR: 3.02). The drug-naive bipolar disorder patients also demonstrated a higher prevalence of oligomenorrhea (36.36% vs. 12.12%) and higher levels of anti-mullerian hormone, luteinizing hormone, and follicle-stimulating hormone. Further regression analysis highlighted those individuals undergoing long-term valproate treatment had the highest risk (OR: 3.89), with a significantly greater prevalence of PCOS observed in valproate-treated patients compared to drug-naive patients (53.3% vs. 30.6%). Younger age and the presence of insulin resistance were also associated with an increased risk of PCOS (OR 0.37 and OR 1.73, respectively).
In line with these findings, Qadri et al. reported high rates of PCOS among women with bipolar disorder, regardless of the type of medication. Women with bipolar disorder seem to exhibit both reproductive abnormalities that may contribute to fertility problems and metabolic abnormalities that could lead to long-term medical comorbidity.
Current research highlighting the increased risk of PCOS in drug-naïve bipolar disorder patients emphasizes the importance of early detection and intervention to address reproductive and metabolic abnormalities in women with bipolar disorder. The study underscores the necessity for vigilant investigation and continuous monitoring of PCOS in bipolar disorder patients. This proactive approach can contribute not only to better reproductive health outcomes but also to the overall well-being of individuals with bipolar disorder.
References
- Liu J, Teng Z, Xie H, Yuan H, Liu M, Chen J, et al. Prevalence and characteristics of polycystic ovarian syndrome in patients with bipolar disorder. Journal of Affective Disorders. 2023 Nov 1;340:387–95.
- Qadri S, Hussain A, Bhat MH, Baba AA. Polycystic Ovary Syndrome in Bipolar Affective Disorder: A Hospital-based Study. Indian J Psychol Med. 2018;40(2):121–8.