Covid-19 increases risk of death in pregnant women 1:14
(CNN) -
In July 2020, when her family tested positive for covid-19, Breanna Aguilar did not belong to any group considered high risk for serious illness.
She is 31 years old, a pet sitter and former fitness teacher who once ran a half marathon.
In most measurements, she was healthy.
When Aguilar contracted COVID-19, he lost his sense of taste, had mild fevers and muscle weakness.
He could barely keep food down in his stomach, but he gained about 15 kilos.
Later, she developed pelvic pain, cystic acne, breast tenderness, headaches, mental confusion, and extreme fatigue.
It's been months since then, but he says the low energy, chronic pain and brain fog - long-lasting COVID-19 symptoms - remain and that he can't even take a 15-minute walk without needing a break.
Also, she now has to deal with insulin resistance, and take various medications to keep that and her hormone levels under some control.
His doctor told him that he will probably have to deal with the consequences of COVID-19 for the rest of his life.
advertising
Breanna Aguilar and her 7-year-old dog, Gambit.
Covid-19 vaccines provide protection to pregnant and lactating women and their newborns, study says
Women with polycystic ovary syndrome
More than a year after the pandemic, a study found that some women have a higher risk of contracting COVID-19 compared to others in their age group and gender.
These women, often young and generally healthy like Aguilar, have an underlying condition not mentioned on any covid-19 comorbidity list: polycystic ovary syndrome, or PCOS.
PCOS, which affects 1 in 10 women of "childbearing age," is an imbalance of reproductive hormones that can lead to irregular menstrual cycles, elevated androgen levels, and ovarian cysts.
But it can also be accompanied by a host of other health problems, nearly all of which resemble covid-19 comorbidities.
“The impact of SOP is completely underestimated.
It is seen as a reproductive problem that is not clinically relevant.
But this is completely wrong… Patients should be viewed as a high-risk population, 'says Dr Wiebke Arlt, Director of the Institute for Metabolism and Systems Research at the University of Birmingham (UK).
More than half of people with PCOS develop diabetes before their 40s, and up to 80% are overweight.
They are at increased risk for insulin resistance, heart disease, and endometrial cancer, a cancer that begins in the uterus.
Additionally, many have high blood pressure and low vitamin D levels. These PCOS complications have also been associated with a potentially increased risk of severe COVID-19.
Women, the main affected by unemployment in Mexico during the pandemic: 5 points to explain this problem
Women with PCOS should be a potentially high-risk group, says expert
Despite how common polycystic ovary syndrome is, as well as the serious complications it can bring with it, health experts say that it has long been overlooked, misunderstood, and under-researched. that makes patients have to advocate for themselves or even convince professionals to get treatment.
And because little research has been done on whether women with PCOS are at higher or long-term risk for more severe COVID-19 symptoms, some fear the same will happen to public health policy around the pandemic.
"My advice would be to include women with PCOS as… a potentially high-risk group," says Dr. Katherine Sherif, chief of Women's Health in the Jefferson University Department of Medicine and a leading syndrome expert. polycystic ovary.
However, he warns: “We are working on a very large system that is full of silences.
No one is going to jump in and say, 'Oh well, don't forget PCOS.'
"If Anthony Fauci said, 'Look at high-risk groups like PCOS,' people might pay more attention," he says.
Why does PCOS go unnoticed?
According to Arlt and Sherif, part of the reason PCOS goes unnoticed in general and as far as covid-19 is concerned is because it is often dismissed as a women's health issue, an ovarian hindrance.
Over the past year, we know of numerous pre-existing health conditions that put a person at higher risk for covid-19 disease, but polycystic ovary syndrome is not one of them.
For Arlt, coauthor of the first large study published in February in the journal
E
uropean Journal of Endocrinology, the SOP name is a misnomer.
It is not an ovarian disorder, Arlt said, but a "lifelong metabolic disease" and should be treated as such when assessing vulnerability for COVID-19.
"The higher the metabolic risk, the higher the risk of contracting COVID-19," says Arlt.
“People looked at obesity and type 2 diabetes, and hypertension and heart disease, but they didn't look at PCOS consistently before we did.
Because they just don't consider it a metabolic risk factor.
That is something we would like to change.
The pandemic exacerbates the gender gap in the US 2:51
'Something in the SOP is driving this'
Arlt and researchers from the University of Birmingham in the UK found that women with PCOS were 51% more likely to have confirmed or possible COVID-19 infection than women without the syndrome.
Based on primary care records from January to June 2020, they identified more than 21,000 PCOS patients and a control group of more than 78,000 without it, matched for age and location.
The researchers then "wanted to understand whether the increased incidence of COVID-19 was just due to PCOS, or was it also due to underlying risk factors that women with PCOS have," lead author Anuradhaa Subramanian tells CNN.
In other words, if a woman has polycystic ovary syndrome and type 2 diabetes, which of the two factors increases the risk of covid-19?
According to the study, in a fully adjusted model that took into account several risk factors, women with PCOS still had a 28% increased risk of confirmed or suspected COVID-19 infection.
Subramanian says the results did not surprise her.
However, "it gave us more certainty ... that it is not just the risk factors associated with PCOS, but that there is something about PCOS that drives it," he said.
However, as the data came from primary care databases, the researchers were unable to analyze whether PCOS patients had more severe or long-term symptoms of Covid-19.
In addition, polycystic ovary syndrome is not a disorder with universal characteristics and covid-19 may or may not have an impact, or a different level of risk depending on the person.
There are many questions for which we do not yet have definitive answers, says Dr. Anuja Dokras, director of Penn Medicine's Polycystic Ovarian Syndrome Center.
"We need to get this information now that (covid-19) has lasted for a full year," says Dokras.
"It is affecting so many people that it would be good to review this literature and order it, because they are confounding factors."
In search of answers
So far, the fact that people with PCOS have more serious complications from COVID-19 is anecdotal, so some women are left to speculate about how COVID-19 affects the syndrome.
In Aguilar's case, she was diagnosed with polycystic ovary syndrome after being exposed to COVID-19, even though she probably had it for years but did not recognize the symptoms.
"I had some of these underlying symptoms, my body was able to handle them to some degree for most of my life, and then getting COVID really knocked out all my body's defenses and the ability to regulate anything," he says. said his doctor.
But you still don't know why or if your symptoms will one day improve.
Kris Nealon has also spent much of the last year searching for answers.
She was diagnosed with polycystic ovary syndrome at age 12, and the disorder has caused her to struggle with her weight and insulin resistance.
These factors, he says, made him fear that he could have severe symptoms of COVID-19 and that he might even require hospitalization.
So last summer he did what most did during the pandemic: Googled it.
He recalled searching for '' should I be concerned… about insulin resistance COVID? '
or 'PCOS COVID?' ».
Nealon found no answers.
He caught COVID-19 in October and says his symptoms were mild.
But when it turned into muscle and joint pain, extreme fatigue, depression, insomnia, and mental confusion, she did what they recommended: talk to her doctor.
Poor sleep would nearly double the risk of sexual dysfunction in women, study finds
Use multiple doctors
Kris Nealon and her husband John Mattie.
In Nealon's case, he spoke to several.
Having lived with PCOS for more than half her life, she was aware of the complications and wanted to know how this might affect her long-term COVID-19 symptoms.
He comments that the GP for his long-term symptoms said that his only covid-19 comorbidity was his weight.
“He has been kind and understanding, but… you can see him saying: 'Woman problems, don't worry.
These are your lungs, '"he adds.
He told her that polycystic ovary syndrome is linked to anxiety and depression, and asked if that could be related to fatigue and insomnia from covid-19.
He also asked about his heart, explaining that PCOS and covid-19 can cause complications.
But aside from suggesting that losing weight might help, Nealon recalled that his doctor told him it “had nothing to do with PCOS.
He said, 'No, it's your ovaries and so on.'
After COVID-19, Nealon also noticed that his PCOS symptoms "went crazy."
He says he had extreme pain in his lower abdomen.
An ultrasound showed that her fallopian tubes "suddenly looked very worrying" and that she had a ruptured ovarian cyst.
She went to her gynecologist, the doctor who first diagnosed her with polycystic ovary syndrome, and asked, "Does this have anything to do with (that) I just had COVID?"
He says his doctor replied, "No, there is no literature on this."
And it's true, there wasn't.
Weeks after Nealon tested positive, Allison Roach and Chitra Gotluru, two Florida International University medical students, finished their journal article exploring the potentially increased risk women with PCOS have of suffering from PCOS-related morbidity. covid-19.
There was no data set for patients with both diagnoses, they said.
The risk is 'obvious but not proven'
Roach and Gotluru's research, published in the March issue of the journal Obstetrics and Gynecology, shows that the potentially higher risk for PCOS patients comes down to "comorbidities, androgens, and lipotoxicity."
People with PCOS tend to have higher levels and sensitivity to androgens, the male sex hormones.
This could "directly affect susceptibility to COVID-19," wrote Roach and Gotluru.
Androgens function as a "gateway," in very simple terms, to letting COVID-19 through, says Roach.
In addition, it is common for people with PCOS to have chronic inflammation, that is, an immune system that is in an almost constant state of fighting damage.
Impaired insulin regulation and obesity can lead to a toxic accumulation of fatty acids in tissues, known as liptoxicity, which can damage organs.
This can also trigger the secretion of immune signaling cells called cytokines.
Although cytokines are a vital part of the body's immune response, too much of them can cause what's known as a cytokine storm.
Adding to this a COVID-19 infection can lead to increased cytokine secretion, which can trigger one of these storms and cause the immune system to attack the body's cells, not just the pathogen.
And there is research to suggest this can happen "whether you're overweight or not," Gotluru tells CNN.
For Sherif, from Jefferson University, the risk that PCOS patients have more severe symptoms of COVID-19 is "obvious but not proven."
Obvious because "If testosterone increases inflammation, what if… men who are in the hospital with covid complications and have high testosterone levels, it makes sense that it would put women with PCOS more at risk."
This is not yet proven, he says, because so little research exists.
An expert tells you why children should be vaccinated against covid-19 2:24
'This is independent of obesity'
Based on his own research on PCOS and heart disease, Sherif says, "What's important for people to understand is that this is independent of obesity."
"It's the high insulin and high testosterone that give them a higher risk of covid compared to weight-matched controls," he says.
So you have two women who weigh 100 kilos.
The one with the polycystic ovary syndrome is more likely to be diabetic or to have sleep apnea, or to get covid ».
Without that data, some doctors and researchers say it's something that PCOS patients should be aware of, but without panicking.
If you get COVID-19, it's important to tell your doctor that you have PCOS and that you are taking medication, Gotluru notes.
"Let your provider know ... there is research about PCOS that is concerning and that you would like to be careful," he adds.
The search for answers does not end
Meanwhile, women like Aguilar and Nealon continue to search for answers.
Nealon says his doctors have yet to make a connection between the consequences of COVID-19 and his polycystic ovary syndrome.
It does not surprise him.
"That's right, only with polycystic ovary syndrome, and even more so with the addition of covid," says Nealon.
"You go to a doctor with a list of symptoms and they say 'you are fat' or 'you are thinking too much'".
For his part, Aguilar says that having to constantly educate the people in his life is exhausting, in addition to his two new diagnoses.
“A lot of people like to talk about the survival rate being so high and the mortality rate so low, but what they don't take into account is the degree to which lives are changing due to the diseases that are arising after this. , or simply the long-term symptoms that are so debilitating, ”emphasizes Aguilar.
"It's hard to beat."
Covid-19 Women Syndrome