PCOS and Post-COVID-19 Symptom Severity

Key Points

• Many individuals with PCOS also experience insulin resistance and elevated blood sugar levels, increasing their risk of developing type 2 diabetes.
• Metabolic disorders like diabetes can lead to dysfunction in multiple body systems and weaken the immune system, making the body more vulnerable to infections.
• Research suggests that chronic inflammation, a common feature of metabolic conditions, may be a risk factor for developing long COVID.

Polycystic ovary syndrome (PCOS) is an endocrine syndrome, with markers of metabolic conditions, that is characterized by a group of symptoms that includes ovarian cysts, irregular periods, infertility, acne, difficulty losing weight and hirsutism in females. It's estimated PCOS affects 7 percent to 10 percent of females within the range of childbearing age in the United States.

Many people with PCOS struggle with insulin resistance and elevated blood sugar levels, which often leads to an increased risk of developing type 2 diabetes.

"Because the body's cells become insensitive to insulin, the blood glucose levels don't drop normally, and this causes the pancreas to release more and more insulin in order to lower it," said Renee Trewella, B.S.N., a registered nurse in Baton Rouge, Louisiana. "The blood glucose remains elevated."

It's no secret heightened blood sugar levels and insulin resistance can produce long-term effects on one's health. Side effects of prolonged insulin resistance include increased hunger and thirst, higher triglyceride levels, headaches and slow healing, according to Cleveland Clinic. Additionally, complications from metabolic disorders such as diabetes can lead to dysfunction of multiple body systems, including ones that affect sexual function.

They are associated with chronic inflammation, which can provoke a host of additional negative health impacts.

"Chronic inflammation leads to a weakened immune system, which makes the body more vulnerable to infections," Trewella said.

Immunity has been an ongoing concern in the minds of many since March 2020, the beginning of the global COVID-19 pandemic, and rightfully so. COVID has claimed millions of lives worldwide, and many who've survived initially mild cases have suffered long past the initial infection, a condition known as long COVID.

With all the evidence indicating diabetes is a major risk factor for severe COVID-19 infection, it would make sense to assume metabolic conditions in general should be observed for how they affect COVID sufferers. This is especially important since many people are unaware that they even have a metabolic condition.

Examining the links between metabolic conditions, inflammation and long COVID

Long COVID is a collection of symptoms that may be present in COVID sufferers for weeks, months and even years after their initial infections. In June 2022, it was estimated that about 7.5 percent of U.S. adults who've had COVID-19 were still struggling with long COVID symptoms, according to the Centers for Disease Control and Prevention (CDC).

"Long COVID is a still poorly understood syndrome that can result in some people following initial COVID-19 infection," said William Li, M.D., a researcher and the New York Times bestselling author of "Eat to Beat Your Diet:Burn Fat, Heal Your Metabolism, and Live Longer."

"There is a large constellation of more than 100 signs and symptoms that are part of long COVID, ranging from brain fog to rapid heart rate to extreme fatigue, breathing difficulty, gut problems, and even stroke and heart attack," he added. "Recently, a new sign was added to the pantheon of problems associated with long COVID, and that's 'blue legs,' a problem of nerves cutting off circulation."

Though research into long COVID's causes and risk factors is ongoing, some studies indicate a mechanism by which long COVID wreaks havoc on the bodies of sufferers is through chronic inflammation. That's something that those with metabolic conditions are already at higher risk for.

"Many metabolic conditions, including metabolic syndrome and diabetes, are characterized by inflammation in the body," Li said. "This baseline inflammation may be one risk factor for developing long COVID. People with diabetes also have suppressed immunity, which may make it harder to completely clear the coronavirus from the body, making it possible for the virus to persist.

"In addition, diabetes damages the lining of blood vessels, called the endothelium, and my research group discovered that the SARS-CoV-2 can infect and also damage this lining, leading to a double-whammy to people with diabetes when they get COVID-19."

When we think about these connections, diabetes being a major risk factor for severe COVID makes sense. It isn't a stretch to hypothesize that people with PCOS are at an elevated risk as well, since PCOS puts sufferers at an increased risk of developing type 2 diabetes due to the already present insulin resistance and inflammation that can result.

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How can you prevent long COVID if you have a metabolic condition such as PCOS or diabetes?

If you're at a higher risk of developing severe COVID-19 or long COVID because of a metabolic issue such as PCOS or diabetes, prevention may be on your mind.

Of course, the best way to prevent COVID complications is to avoid catching it in the first place. But at this point, that may feel unrealistic. Managing your metabolic condition symptoms with a holistic health plan, including mental health management—which will in turn improve immunity and decrease inflammation—is another great place to start.

"Having a collaborative provider and healthcare team is crucial to controlling the stress associated with PCOS," Trewella said. "One of the first recommendations I'd like to give is to find and establish care with a therapist. Mental health can make a huge impact in how we begin to regulate ourselves and they can also help us have a readiness for acceptance and change."

Additionally, some medications typically used to treat diabetes can be used in those with other conditions that cause insulin resistance. Metformin, for example, isn't just for diabetics and prediabetics and can be prescribed to people with PCOS or other conditions that cause elevated blood sugar.

If you do catch COVID, new evidence supports metformin as a component of preventive treatment against complications.

"A clinical study of more than 1,000 people recently showed that treatment of acute COVID-19 with Paxlovid and the old diabetes medication called metformin can lower the risk of developing long COVID by 41 percent," Li said. "This is one of the first important clinical studies revealing a way to lower the risk of long COVID."

[Editor's note: Paxlovid is the brand name for a prescription medicine used to treat mid- to moderate coronavirus disease 2019. It is FDA-approved and contains the antivirus medications nirmatrelvir and ritonavir.]

The takeaway

Every system of the body is interconnected, so knowledge of how these systems are related is important—how they work together, how they can inadvertently work against each other and everything in between. In the same way that some have mild COVID-19 symptoms that they write off as a common cold, many people don't pay much attention to their metabolic condition symptoms for years if they ever have any at all in the first place.

Since conditions like PCOS, which can result in insulin resistance, are more common than you think, it's important to stay on top of your regular physicals and blood sugar screenings so you can anticipate and prevent long-term COVID-19 complications.