Polycystic ovarian syndrome (PCOS) has seemed like the fad diagnosis. It’s one of those situations where it suddenly seems that everyone seems to be diagnosed with it and you think it can’t possibly be that common. Well, it’s not a fad. Between 5-10% of women have been diagnosed with PCOS and many may be undiagnosed. So you probably do know someone that has it, even if it’s not public knowledge. Anywhere from 1-4% of the population (both women and men) suffer from bipolar disorder. Unfortunately, the two overlap more than can be attributed to coincidence.
PCOS is mainly characterized by hormonal imbalance, specifically related to androgens. These are typically thought of as the male hormones like testosterone, but everyone has the same hormones. Women have testosterone and men have estrogen and everyone has them at varying levels. The problem comes in when humans with ovaries have abnormally high levels of androgens.
Locally, the high levels of androgens released by the ovaries can cause numerous cysts and problems with egg release. This can lead to irregular periods and problems with fertility.
Apart from the reproductive organs, symptoms of PCOS can include:
- Excess hair growth in places like facial hair, on the back, chest, even fingers and toes
- Weight gain
- Hair loss in places you may actually want hair
- Skin tags
- Sleep apnea
- Anxiety and depression
Psychological issues are a major factor in PCOS. Almost 60% of people with PCOS reportedly have at least one mental illness. It’s hypothesized that the cause is the consistent hormonal changes and abnormalities. It’s also not out of the question that simply dealing with the other symptoms can cause psychological stress.
The link between PCOS and bipolar disorder is a messy one.
Multiple studies have shown a link between PCOS and the drug valproic acid/valproate (Depakote). Valproate is an anticonvulsant, one of several used to treat bipolar disorder as a mood stabilizer. It is also used to treat epilepsy. One study showed that 43% of the women receiving valproate for epilepsy had polycystic ovaries. That’s more than four times the average rate. It’s also twice as likely to occur in patients taking valproate than other anticonvulsant drugs like lamotrigine (Lamictal).
In bipolar disorder, one study found that 47% of patients taking valproate had PCOS compared to the 13% of patients who were not.
The link does not stop there.
Women with bipolar disorder are almost twice as likely to have irregular menstrual cycles than healthy controls. While medications can cause irregularities, irregular periods often occur before a patient is even diagnosed with bipolar disorder.
There is also the similarity of metabolic disorders. Patients with bipolar disorder are twice as likely to have metabolic syndrome than those without it. The rate of metabolic syndrome among patients with PCOS is about 50%. Metabolic syndrome or insulin resistance can come with serious consequences such as heart disease, high blood pressure, bad cholesterol, stroke and diabetes.
Both PCOS and bipolar disorder show increased levels of stress and high cortisol. This could be due to a dysfunction in what’s called the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis is responsible for stress response. Cortisol is released to handle stress. Then the body is supposed to calm itself down when the stressor no longer exists. When there is a problem with this cycle, like there is in bipolar disorder and PCOS, the cortisol sticks around. High cortisol levels can lead to many cognitive problems and depressive symptoms. The hormone imbalance could also be what leads to hyperandrogenism in PCOS.
All of this is a bit of a chicken and egg question. There is no conclusive evidence that either disorder causes the other. They simply have significant similarities. It’s possible this is due to genetic overlay. The real issue is that both need to be treated and one problem should never be treated inside a box. You are a whole person, not just a summation of your disorders.
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Photo credit: eLife – the journal