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By Maggie Markgraf (Medical Student, Class of 2027), Emily Cranmer, MS (Medical Student, Class of 2028), Uwaoma Okwu-uwa, MS (Medical Student, Class of 2028), Trinity Neal BS (Medical Student, Class of 2028), Mary Brewer, MPH (Medical Student, Class of 2028) and Yanli Zhang-James, MD, PhD

What Is PCOS?

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders affecting individuals assigned female at birth. While often discussed in the context of fertility, PCOS impacts multiple aspects of health. Key features include:

1. Oligomenorrhea or amenorrhea (associated with chronic anovulation)
2. Clinical manifestations of hyperandrogenism
3. Polycystic ovarian morphology

The clinical symptoms of this disorder are often related to androgen excess and can present in patients as hirsutism, acne, and androgenic alopecia, among others (Cussen et al.). Diagnosis can pose a challenge given the wide range of presenting symptoms and overlap with other clinical diagnoses, resulting in a significant portion of women with PCOS who can remain undiagnosed (Cussen et al, Christ et al.). Outside of androgenic symptoms, PCOS also often coexists with various neuropsychiatric illnesses such as depression and anxiety (Almhmoud et al.).

Long-term implications of PCOS extend far beyond reproductive health. A study conducted in 2014 found that, among women with PCOS, rates of hospitalizations for gynecological conditions were significantly higher than in those without (Hart et al.). Outside of reproductive or gynecological diagnoses, women with PCOS also developed late-onset diabetes, obesity, and other endocrine and metabolic conditions at higher rates than women without PCOS (Hart et al.). Among this population, the higher burden of psychiatric diagnoses poses a significant burden to patients and can impact not only quality of life, but can promote high chronic stress levels, which is a known contributor to the pathogenesis of PCOS (Almhmoud et al.). PCOS is also a known risk factor for cardiovascular disease given its association with several cardiometabolic abnormalities like diabetes, obesity, and dyslipidemia (Guan et al.).

PCOS and ADHD in Women: An Overlooked Connection

Recent research has revealed an interesting, often overlooked link between PCOS and Attention-Deficit/Hyperactivity Disorder (ADHD). While most studies focus on reproductive or metabolic features, emerging evidence suggests:

• Maternal PCOS increases risk of ADHD in offspring by an estimated 42% in some studies with slightly higher risk in mothers with comorbid obesity as well as those with other metabolic conditions (Kosidou et al.)
• Women with PCOS had increased rates of neuropsychiatric diagnoses such as depression and anxiety (Rodriguez-Paris et al.).

Are there bidirectional link between ADHD and PCOS?

Studies are now emerging showing that neurodevelopmental and endocrine diseases, such as ADHD and PCOS, can have common biological and genetic backgrounds (Plummer et al). It is not yet clear whether behavioral, neuroendocrine, or metabolic factors related to ADHD could be involved in the pathogenesis of PCOS or if the two conditions share upstream risk determinants, including intrauterine exposures or even the involvement of chronic inflammation pathways (Dubey et al).

There may be a link between current PCOS diagnosis and later development of ADHD. PCOS involves increased levels of androgens and insulin resistance, causing effects beyond the ovaries and influencing brain function. Androgens and insulin are involved in the signaling mechanisms controlling attention, impulse control, and emotions within the brain. This altered signaling in people with PCOS may increase vulnerability to problems with attention or symptoms that resemble those seen in ADHD (Dokras et al).

Conversely, ADHD might increase the likelihood of getting PCOS. Typical behaviors seen in ADHD, such as impulsivity, problems with sleep, and challenges maintaining regular eating habits, can aggravate weight gain as well as insulin resistance and hormone imbalances. Over time, these behavioral patterns could lead to PCOS development or cause it to manifest more severely. This may suggest that the metabolic components of PCOS are potentiated in the presence of ADHD through hormone or endocrine dysregulation (Herguner et al).

Cardiometabolic Considerations

PCOS is strongly associated with cardiometabolic risk. Women with PCOS are at higher risk of:

• Obesity and central fat accumulation (lipodystrophy)
• Insulin resistance and type 2 diabetes
• Dyslipidemia (abnormal cholesterol levels)
• Hypertension and cardiovascular disease
• Stroke and coronary heart disease (Guan et al.)

ADHD has also been shown to increase the risk of cardiometabolic diseases. The combination of PCOS, ADHD, and metabolic risk factors may amplify long-term health challenges. This makes early screening and monitoring essential for both mental and physical health.

Why This Matters?

The Bottom Line:

PCOS – Is More Than a Reproductive Disorder with fertility issue. Its overlaps with ADHD, metabolic dysfunction, and mental health underscore the need for holistic care.

References

• Cussen L, McDonnell T, Bennett G, Thompson CJ, Sherlock M, O’Reilly MW. Approach to androgen excess in women: Clinical and biochemical insights. Clin Endocrinol (Oxf). 2022;97(2):174-186. doi:10.1111/cen.14710
• Christ JP, Cedars MI. Current Guidelines for Diagnosing PCOS. Diagnostics (Basel). 2023;13(6):1113. Published 2023 Mar 15. doi:10.3390/diagnostics13061113
• Almhmoud H, Alatassi L, Baddoura M, et al. Polycystic ovary syndrome and its multidimensional impacts on women’s mental health: A narrative review. Medicine (Baltimore). 2024;103(25):e38647. doi:10.1097/MD.0000000000038647
• Hart R, Doherty DA. The potential implications of a PCOS diagnosis on a woman’s long-term health using data linkage. J Clin Endocrinol Metab. 2015;100(3):911-919. doi:10.1210/jc.2014-3886
• Kosidou K, Dalman C, Widman L, et al. Maternal Polycystic Ovary Syndrome and Risk for Attention-Deficit/Hyperactivity Disorder in the Offspring. Biol Psychiatry. 2017;82(9):651-659. doi:10.1016/j.biopsych.2016.09.022
• Rodriguez-Paris D, Remlinger-Molenda A, Kurzawa R, et al. Psychiatric disorders in women with polycystic ovary syndrome. Psychiatr Pol. 2019;53(4):955-966. doi:10.12740/PP/OnlineFirst/93105
• Dokras A, Stener-Victorin E, Yildiz BO, Li R, Ottey S, Shah D, Epperson N, Teede H. Androgen Excess- Polycystic Ovary Syndrome Society: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertil Steril. 2018 May;109(5):888-899. doi: 10.1016/j.fertnstert.2018.01.038. PMID: 29778388.
• Dubey, P., Thakur, B., Rodriguez, S. et al. A systematic review and meta-analysis of the association between maternal polycystic ovary syndrome and neuropsychiatric disorders in children. Transl Psychiatry 11, 569 (2021). https://doi.org/10.1038/s41398-021-01699-8
• Hergüner S, Harmancı H, Toy H. Attention deficit-hyperactivity disorder symptoms in women with polycystic ovary syndrome. Int J Psychiatry Med. 2015;50(3):317-25. doi: 10.1177/0091217415610311. Epub 2015 Oct 7. PMID: 26449924.
• Plummer JT, Gordon AJ, Levitt P. The Genetic Intersection of Neurodevelopmental Disorders and Shared Medical Comorbidities – Relations that Translate from Bench to Bedside. Front Psychiatry. 2016 Aug 22;7:142. doi: 10.3389/fpsyt.2016.00142. Erratum in: Front Psychiatry. 2016 Sep 30;7:166. doi: 10.3389/fpsyt.2016.00166. PMID: 27597832; PMCID: PMC4992686.
• Guan C, Zahid S, Minhas AS, et al. Polycystic ovary syndrome: a “risk-enhancing” factor for cardiovascular disease. Fertil Steril. 2022;117(5):924-935. doi:10.1016/j.fertnstert.2022.03.009

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