Thread by @DaisyPcos

A new research study in @bmj_latest doi.org/10.1136/bmj.m3… finds the risk to die early (<70yrs) increases with irregularity & length of women’s #menstrualcycle irregularity, with premature mortality mostly due to #cardiovasculardisease. What's it mean for women with #PCOS? 1/13

PCOS affects 10% of women worldwide & irregular menstrual cycles are a common symptom. Many of the women in this study likely have PCOS. Understandably, the higher rates of premature mortality reported will be worrying to women with PCOS. But what causes period irregularity? 2/13

Increased levels of male hormones #androgens are a cause of irregular periods (see: doi.org/10.1177/204201…; doi.org/10.1210/en.201…) and also impact on pancreatic beta cell function (doi.org/10.2337/db20-0…) causing #insulinresistance 3/13

Women with #PCOS have an increased risk of #type2 #diabetes, #hypertension & #fattyliverdisease and these risks increase with increasing severity of androgen excess (see doi.org/10.1371/journa…). What about cardiovascular disease in PCOS? 4/13

Diabetes, high #bloodpressure & #fattyliver disease are major risk factors for #cardiovascular disease (see: doi.org/10.1530/EJE-17…), which was identified as the major cause of the increased premature death risk seen in the BMJ study - a chain-like effect 5/13

Irregular menstrual cycles in themselves are not likely to increase premature mortality risk, but the UNDERLYING causes of irregularity, such as male hormone excess in women with PCOS, might do. #PCOS needs to be recognized by medics as a lifelong #metabolic disorder 6/13

Our #WellcomeTrust funded @daisypcos research programme led by @WiebkeArlt @IMSR_UoB investigates the link between androgen excess and metabolic disease to identify new biomarkers & therapies for women with #PCOS. PCOS is common & profoundly affects many women’s lives 7/13

Biomarkers (see: doi.org/10.1210/jc.201…; doi.org/10.1210/jc.201…) are urgently needed to help determine which women are most likely to develop #diabetes, #hypertension #fattyliverdisease & #cardiovasculardisease. This enables earlier interventions 8/13

Women with irregular menstrual cycles should see their GP to be assessed for a PCOS diagnosis; with possible further #endocrinologist & #gynaecologist specialist advice. Women with PCOS should be regularly assessed for metabolic risk conditions e.g. #diabetes & #hypertension 9/13

Maintaining a #healthylifestyle & #healthyweight is especially important for women with #PCOS. We should acknowledge the extra support & assessment some will need to achieve this. Alongside new research, #publicengagement is also vital to reduce stigma & misinformation 10/13

The BMJ study doi.org/10.1136/bmj.m3… is of high quality. However, we note authors used hirsutism (= increased male pattern body hair growth) as sole defining feature of PCOS. Not all with PCOS exhibit hirsutism whereas 90%+ show male hormone excess, not measured here 11/13

Comparison between those with irregular periods who have normal or high levels of male hormones should provide a more definitive answer on increased risk of premature mortality & #PCOS. We continue to advocate for further research on the lifelong metabolic nature of PCOS 12/13

Give @daisypcos a follow for future updates from our group, as well as comments on new #PCOS research from others. We invite you to further explore information at daisypcos.com & we are actively recruiting volunteers (UK&Ireland) for #PCOS research, see website🌼13/13