Polycystic ovary syndrome (PCOS) is the most common reproductive condition affecting women. It is not only a reproductive disorder, but a disorder that affects women through their lifespan. Women with PCOS have been established to be at a higher risk of cardiovascular conditions, type 2 diabetes, non-alcoholic fatty liver disease, obstructive sleep apnoea, and certain types of gynecological cancer. In addition to these conditions, women with PCOS are also at a higher risk of developing mental health conditions such as anxiety, depression and eating disorder. It is important to understand what the specific risk factors are for these mental health conditions among women with PCOS, so that interventions can be developed targeted towards these high-risk patients. In this study using CPRD Aurum of women with PCOS, we establish case and control patients with and without each of the three mental health conditions (anxiety, depression and eating disorder) of interest. We then assess the association between a range of risk factors [such as age, body mass index, ethnicity, deprivation, smoking status, PCOS symptoms such as oligo/anovulation (menstrual irregularity), hairloss, excess hair growth, acne, other concurrently presented chronic health conditions (as mentioned above), prescriptions of combined oral contraceptives (for management of PCOS symptoms) and other concurrent diagnosis of mental health conditions] and the risk of developing each of the mental health outcomes.
The diagnosis of polycystic ovary syndrome (PCOS) has evolved over time. In UK, women with PCOS are diagnosed using the Rotterdam criteria, which is met when women have two of the following symptoms: symptomatic presentation of androgen excess (such as hormonal acne, hirsutism and hairloss), anovulation and polycystic ovaries. It has been recently established that PCOS should be considered more than just a reproductive disorder, but a disorder that affects women through their lifespan in multiple ways. Women with PCOS have been established to be at a higher risk of cardiovascular conditions, type 2 diabetes, non-alcoholic fatty liver disease, obstructive sleep apnoea, and certain types of gynecological cancer. In addition to these conditions, women with PCOS are also at a higher risk of developing common mental health conditions such as anxiety, depression and eating disorder. It is important to understand what the specific risk factors are for these mental health conditions among women with PCOS, so that interventions can be developed targeted towards these high-risk patients. In this nested case control study using CPRD Aurum, we establish a cohort of women with PCOS, followed by establishing case and control patients with and without each of the three mental health conditions (anxiety, depression and eating disorder) of interest. We match the case and control patients for age (+/- 1 year) and the practice they are registered with. We then assess the association between a range of risk factors [such as age, body mass index, ethnicity, deprivation, smoking status, PCOS symptoms such as oligo/anovulation (menstrual irregularity), hairloss, hirsutism, acne, comorbidities (as mentioned above), prescriptions of combined oral contraceptives (for management of PCOS symptoms) and other concurrent diagnosis of mental health conditions] and the odds of developing each of the mental health conditions using conditional logistic regression models.
Primary outcome:
Composite common mental health outcome (including anxiety, depression and eating disorder)
Secondary outcomes (Individual components of the composite outcome:
(1) anxiety
(2) depression
(3) eating disorder
All of the above mentioned outcomes will be ascertained using a consolidated list of Snomed CT codes attached in the appendix.
Anuradhaa Subramanian - Chief Investigator - University of Birmingham
Anuradhaa Subramanian - Corresponding Applicant - University of Birmingham
Krishnarajah Nirantharakumar - Collaborator - University of Birmingham
Nicola Adderley - Collaborator - University of Birmingham
Patient Level Index of Multiple Deprivation