For anyone suffering from Polycystic Ovarian Syndrome (PCOS), it must’ve been a scary week. Not only have they been diagnosed with a fairly nasty condition — PCOS is associated with fertility issues, weight gain, irregular/painful periods, and more — but judging by recent news, they are even worse off.
According to media sites from around the world, a new study has found that people with PCOS are suffering more than we thought. If you’ve got PCOS, you’re at higher risk of mental illness. Not just that, but your kids might be getting sick as well.
But it turns out that there might not be much to worry about after all.
Big Scary Study
I’ve talked about the Big Scary Study before. This is where the media turns a fairly routine finding in epidemiology from something boring that doesn’t impact your life into a terrifying message that you should fear.
So what did this study actually do?
The researchers did what’s known as a case-control study to look at the mental health risks in women diagnosed with PCOS. They compared a very large number of women with PCOS to a similarly enormous number of ‘control’ women, and found that the PCOS sufferers were more likely to be diagnosed with a range of mental health disorders, including depression, bipolar disorder, and anxiety.
They also found that women who had PCOS were more likely to have children who were diagnosed with ADHD and autism.
Sounds scary, right?
Well, maybe not so much. There’s some important points that you may not’ve heard about.
Correlation Is Not Causation
I’m going to introduce you to a term that should be in every single media piece about this study: observational research. This is a type of research where researchers, rather than testing an intervention, just watch people — or their data — and try to draw conclusions based on their observations. In this case, the researchers looked back at the medical records of women with PCOS, but didn’t actually intervene in their lives in any way.
The important thing about observational research is that it doesn’t control for all variables — it can’t. So in a study like this, the effect might be caused by the thing that’s being studied — in this case PCOS — or it might be caused by another factor entirely. Epidemiologists do what’s known as ‘controlling for confounders’ to try and make sure that the effect is actually being caused by the thing that’s being studied. In this case, the researchers controlled for BMI, age, GP, and prior mental health diagnosis. Basically, they tried to make sure that the increased risk of mental health disorders was due to PCOS and not to the other factors.
But there’s a problem.
You see, while BMI, age, GP, and prior mental health diagnosis are important factors, they aren’t the only ones that affect mental health. We know, for example, that people who are more disadvantaged — less wealthy, less educated, non-native language speakers — are more likely to experience mental health issues. I’m sure this comes as no surprise to anyone who’s ever been poor and trying to make ends meet: that stuff can make anyone anxious and depressed.
But in this study, the researchers didn’t control for most measures of disadvantage. Remember: BMI, age, GP, mental health diagnosis. It’s likely that at least part of the relationship that you see between PCOS and mental health problems is down to a third, hidden factor. Maybe people who are poor are less able to access healthy food, something that we know is also associated with depression. Maybe taking medication for depression, something we know can cause weight gain, is also associated with a higher risk of PCOS.
Maybe, because this study only looked at diagnosis of mental health problems, what we’re seeing is that women with PCOS go to the doctor more often, and so are more likely to actually get diagnosed with their non-PCOS issues.
From this study, it’s impossible to say.
This goes double for the risks seen in kids, because ADHD and autism are highly related to environment as well. These are very complicated relationships and no one knows for sure.
It’s also worth noting that the absolute risks found in this study were not large. A difference of 4% in terms of risk of mental health issues isn’t quite as scary as most of the news stories made it sound. Moreover, one of the scariest parts of the study — the risk to kids — was not consistent and again only had a small absolute risk increase.
Not as terrifying as you might’ve heard after all.
And the worst part about all of this is that the authors said all of this in their study.
Anyone who had a look at the study, or even the abstract, would realize that it isn’t necessarily PCOS causing mental health problems. The idea that, as the Daily Mail put it, “Chronic ovarian cysts increase a woman’s risk of mental health issues — and of having children with ADHD and autism” is a great headline, but also terribly misleading for someone worried about their health.
So what do these results actually mean?
What Does This Mean To You?
If you have PCOS, try not to worry any more than you already do. These results don’t mean a huge amount to your life.
This study is really aimed at doctors and public health workers. If you’ve got patients who have PCOS, or you’re looking at an entire population of people who have the disease, the small increase in risk means a lot. It might be that we need to put more of a population focus on mental health for PCOS sufferers. It might be that doctors should start asking about mental health issues more in their consulting rooms. We haven’t found a causal link, but even if there’s just an association it’s something for doctors to watch out for in their consults.
But to you? The person suffering? It’s probably not going to mean all that much.
If you have PCOS, you might want to ask your GP about mental health issues. If you’ve got mental health issues (and ovaries), you might want to have a chat with your doctor about the possibility of PCOS.
Just don’t freak out.
Chances are that this study doesn’t mean much to your health at all.
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