Cardiometabolic problems
PCOS is a complex disorder, often associated with conditions such as obesity, insulin resistance, type 2 diabetes and hypertension [3]. Obesity related to PCOS is linked to increased insulin resistance and hyperandrogenism; as a result, women with PCOS have a significantly higher prevalence of glucose intolerance, type 2 diabetes and metabolic syndrome. For example, the prevalence of type 2 diabetes is four times higher in women with this syndrome [4].
Cardiometabolic diseases, which are common in women with PCOS, share significant overlap with the risk factors predisposing to severe COVID-19. These comorbidities indicate that this population is potentially at risk of developing severe disease.
Hyperandrogenism
A great deal of evidence indicates that, compared to women, men have a greater predisposition to developing a severe form of the disease, regardless of age [5]. The molecular mechanisms facilitating this male predisposition to severe COVID-19 are thought to be linked to the role of angiotensin-converting enzyme 2 (involved in the regulation of blood pressure), which is activated by viral proteins and acts as one of the key mediators of viral entry into host cells [6].
Furthermore, the expression and activity of the enzyme may be influenced by male sex hormones (androgens). A preliminary observation was recently published regarding the high frequency of hair loss in men hospitalised for COVID-19, suggesting that androgens could be involved in the severity of COVID-19 [7].
Therefore, there is a potential association between androgens and the severity of COVID-19. This hypothesis also becomes relevant in the context of PCOS, as women with this syndrome present with hormonal imbalance with hyperandrogenism. Further research is needed to clarify the potential links between COVID-19 outcomes and factors such as circulating androgens in male and female patients.
Chronic inflammation
The severity of COVID-19, in some cases, also appears to be linked to excessive release of pro-inflammatory cytokines in infected lung tissue (a cytokine storm syndrome) [8]. Indeed, data suggest that this syndrome can trigger hyper-inflammatory reactions leading to respiratory failure.
Moreover, the activation of pro-inflammatory pathways is also considered to promote the pathogenesis and cardiometabolic complications of PCOS, particularly when associated with central obesity (i.e. characterised by excess abdominal fat). It is recognised that women with PCOS and obesity exhibit marked dysfunction of adipose tissue and dysregulation of inflammatory factor secretion, resulting in a chronic pro-inflammatory state [9]. Some of these factors are also involved in the synthesis of ovarian androgens. The receptor for these androgens also plays a role in immunity linked to COVID-19 [10].
Therefore, it is likely that the chronic inflammation associated with PCOS is related to the hyper-inflammation linked to COVID-19.
Vitamin D status
Since the start of the pandemic, some studies have established links between low vitamin D levels and the severity of COVID-19, due to the fact that the pandemic rapidly spread across various countries in the Northern Hemisphere at a time when vitamin D levels are at their lowest (reduced sunlight exposure, onset of winter).
Furthermore, existing data indicate that vitamin D deficiency may contribute to acute respiratory distress syndrome, whilst COVID-19 mortality increases with age and cardiometabolic comorbidity, both of which also show positive associations with lower vitamin D levels [11].
However, data from various studies are contradictory, with some claiming a link between low vitamin D levels and the risk of developing COVID-19 [12] and others finding no correlation [13].
Nevertheless, vitamin D modulates immune responses and may regulate the activity of inflammatory factors and suppress the pro-inflammatory cytokine response [14]. Thus, the potential role of low vitamin D levels in the severity of COVID-19 and the development of an associated cytokine storm syndrome warrants further research.
In particular, a growing body of evidence supports an inverse association between vitamin D and the severity of multiple manifestations of PCOS, including hyperandrogenism, infertility, insulin resistance and cardiometabolic diseases [15]. Data from a meta-analysis indicate that vitamin D supplementation in women with PCOS could significantly reduce circulating total testosterone levels, whilst increasing total antioxidant capacity [16]. Overall, these data suggest that women with PCOS who have low vitamin D levels may be at risk of developing a more severe form of COVID-19. Taking a PCOS supplement based on vitamin D could therefore help.
Our vitamin D pregnancy, in drop form, is perfectly suited to every woman and is very helpful for restoring vitamin D levels.
