The association between PCOS and risk of suicide

Written by Francesca Hearn-Yeates, PhD Student at the Centre for Reproductive Health, University of Edinburgh, and Dr Sinead Rhodes, Senior Research Fellow at the Centre for Clinical Brain Sciences, University of Edinburgh.

Polycystic ovary syndrome, known as PCOS, is a highly common condition, yet one that we still know relatively little about. PCOS is a condition associated with abnormal hormone levels, leading to symptoms including irregular periods, excessive hair growth, acne, and weight gain. It is estimated to affect around 1 in 10 women (or those assigned female at birth) in the UK.

A recent study into PCOS has been discussed in the media looking at the association between a diagnosis of PCOS and risk of suicide. The Guardian and The Daily Mail have both published articles about the study.

The first issue here is that a common (understandable) misconception of PCOS, that it is diagnosed by cysts on the ovaries (a trap that The Guardian fell into). Although women with PCOS can have cysts on their ovaries, so can lots of other women, and these cysts are not necessarily an issue, many of us carry on never knowing we have them. In fact, the ‘cysts’ they identified in the ovaries of women when they named it ‘polycystic ovary syndrome’ are not cysts at all! More recent research has identified that they are in fact ‘paused’ follicles (pre-egg cells).

Now, I know you are thinking, what on earth do you mean by ‘paused follicles’ but let me explain. Usually, during the menstrual cycle, various hormones fluctuate, and these fluctuations cause the follicles in the ovaries to mature into egg cells. Once they have matured, the hormones in the next stage of the menstrual cycle will prompt them to move down the Fallopian tube and into the uterus. However, in people with PCOS their hormones do not always behave as they should, meaning they do not always go through a full hormone/menstrual cycle. Their hormones can cause the follicles in the ovaries to grow but they never get the hormonal trigger to send them off down the Fallopian tube. As a result, they get a build-up of ‘paused’ follicles in the ovaries, which under the microscope can look a bit like cysts!

So, onto the media coverage of the studies. Both The Guardian and The Daily Mail articles did a good job of picking out the key results from the study into the association between PCOS and suicide risk and mentioning the methodology used. However, The Guardian incorrectly stated that data was used from ‘8,960 women and girls’, rather than 18,960, which could downplay how much impact this study could have. The Daily Mail states that ‘a third of infertility cases are linked to PCOS’ without any reference to where they sourced this data. Not referencing where they have sourced this information means we do not know if it is a valid statement. Additionally, this could lead PCOS patients reading the article to worry about their fertility, without providing any supporting evidence or websites for further information.

A key aspect of this study is that it is looking at population data, taking the population who have been diagnosed with PCOS and comparing their suicide risk to the rest of the population. Therefore, it cannot be stated whether this is a cause-and-effect relationship, or simply a correlation. A correlation would mean that although there is an association between PCOS and suicide risk, there could be a third factor (or many other things, such as lifestyle or environmental factors) that are influencing both PCOS and suicide risk, rather than the two having a direct impact on each other. These limitations are touched upon in The Guardian article, but no potential cautions are mentioned by The Daily Mail.

Both articles were successful in conveying the primary take-home messages from the study. The Guardian finished by highlighting the importance for further research into PCOS and with links to helplines for those struggling with mental health. This is a really important part of an article on such a sensitive topic.