Many people with multiple sclerosis (MS) also live with other chronic conditions (comorbidities). The most common comorbidities that occur alongside MS include depression, anxiety, hypertension (high blood pressure), and hyperlipidemia (high cholesterol) — however, some people who have MS may also experience polycystic ovary syndrome (PCOS). PCOS is an endocrine disorder, meaning it’s related to glands that secrete hormones into the blood. PCOS causes a hormonal imbalance, leading the ovaries to produce more androgens (male hormones) than they normally should.

“I now have ANOTHER new diagnosis to add: PCOS,” one MyMSTeam member wrote. Another member said, “My hair seems to be thinning, and I’m wondering if it’s my MS meds or my PCOS.”

Currently, there is no research specifically on the prevalence of PCOS among individuals living with MS, but there are some commonalities between those who develop the conditions.

What Is PCOS?

PCOS affects between 6 million and 17 million women, ages 18 to 44, in the United States, according to the Columbia School of Nursing. The condition is also among the leading causes of infertility in women, notes the Centers for Disease Control and Prevention (CDC).

Initially, health care professionals defined PCOS as the presence of cysts on the ovaries. However, they now understand that PCOS can develop with or without cysts.

This condition increases the risk of metabolic syndrome (insulin resistance syndrome) — a combination of high blood pressure, abnormal cholesterol levels, and excess body fat around the waist. Metabolic syndrome can raise a person’s risk for heart disease, type 2 diabetes, and stroke.

PCOS also causes hormonal symptoms, including:

• Irregular periods
• Lack of ovulation during a cycle
• Acne
• Thinning hair or hair loss
• Excess facial and body hair

How Are MS and PCOS Related?

The increased risk of metabolic syndrome has also been observed in people living with MS, leading some people to wonder how the two conditions may be related. Currently, there is no research specifically on the prevalence of PCOS among individuals living with MS, but there are some commonalities between those who develop the conditions.

MS Society UK reports that women of reproductive age are three times more likely to be diagnosed with MS than men. Moreover, an estimated 6 percent to 12 percent of U.S. women of reproductive age have PCOS, per the CDC. On MyMSTeam, nearly 300 members out of 185,000 report having PCOS.

Although the hormonal symptoms of PCOS do not overlap with the common signs and symptoms of MS, they do both lead to inflammation, which is typically low-grade in PCOS.

Researchers have found that MS and PCOS also share long-term health complications in women of child-bearing age. These include:

• Mental health issues — Depression and anxiety are prevalent in women with PCOS, notes the women’s health nonprofit Jean Hailes. They’re also common among people living with MS.
• Type 2 diabetes — Women with PCOS have a greater risk of developing diabetes than those without PCOS, according to research from the Endocrine Society. Type 2 diabetes also may be a risk among people who have MS.
• Hypertension — High blood pressure is 25 percent more common in people with MS than in the general population. More than 30 percent of women with PCOS are believed to have high blood pressure, according to Endocrine Connections.
• Heart disease — MS and PCOS are associated with a higher risk of heart disease. A study in JAMA Neurology found that women were affected more severely by cardiovascular disease than men. Research in the European Journal of Preventive Cardiology found that women in their 30s and 40s faced a higher risk of developing heart disease than those without PCOS.

Can MS Cause PCOS?

The cause of PCOS remains unknown. However, some evidence indicates that biological, genetic, and environmental factors all play a role in the development of this disorder. There is limited research on whether MS itself is directly linked to PCOS, but some researchers believe there may be connections between these two conditions.

Insulin Resistance

There is a strong connection between insulin resistance (prediabetes) and PCOS. In people with PCOS, insulin resistance is seen almost universally, no matter what the person’s weight is. Consequently, PCOS is considered a risk factor for insulin resistance.

Insulin resistance is also common among individuals with MS. One study found that people with multiple sclerosis have significantly higher rates of insulin resistance (22 percent) and metabolic syndrome (46 percent) compared to those without MS.

Insulin resistance occurs when cells in your liver, muscles, and fat poorly respond to insulin and can’t easily use glucose from your blood for energy. This causes your blood glucose levels to be higher than normal, leading to prediabetes. Insulin has a wide range of effects on the central nervous system (consisting of the brain and spinal cord). Among them, it affects the synaptic transmission between neurons, which is known to be abnormal in MS. One study found that insulin resistance and adiposity — a condition of having too much fatty tissue in the body — were associated with the inflammation and oxidative stress of MS itself.

Additionally, other risk factors for insulin resistance are glucocorticoid use and sleep problems. Glucocorticoids, or steroids, are widely used for the treatment of inflammation or relapses in MS. About 60 percent of people with MS report having sleep problems, which is more common than it is in the general population.

Obesity

The main factors that lead to insulin resistance in the general population are lack of physical activity and obesity. In general, women tend to accumulate more fat around the abdomen compared to men, according to HealthyWomen. Between 40 percent to 80 percent of women with PCOS are believed to be obese, according to Obesity Management.

According to Multiple Sclerosis Trust, researchers have found that people who are obese have a high risk of developing MS — in particular, women who developed obesity at a younger age. One theory is that being overweight can lead to starting puberty at a younger age, which can increase hormone levels.

Genetics

Health experts believe PCOS may have a genetic component, since it is frequently seen among family members, such as siblings or parent and child. Also, those with a family history of type 2 diabetes have a higher risk of developing PCOS.

MS is not inherited, but there is an increased risk in families with a history of MS.

Stress

Stress is also suspected to play a major role in the development of PCOS. Similarly, a person living with MS will encounter various physical, social, and emotional stressors as they cope with their condition. This stress may interact with other risk factors to lead to PCOS.

Managing PCOS in MS

Early diagnosis and treatment of PCOS, along with weight loss when applicable, may reduce the risk of long-term complications, such as type 2 diabetes and heart disease. There is no cure for PCOS and there is no screening to detect the condition, but there are many ways to help manage symptoms with at-home treatments, medications, and lifestyle changes.

Healthy Lifestyle Changes

Lifestyle approaches may be helpful in treating PCOS symptoms as well as MS symptoms, including:

• Getting plenty of rest
• Getting daily exercise and reducing body weight if overweight or obese
• Maintaining a well-balanced diet
• Eliminating processed/junk foods and sugar
• Keeping a journal to identify what (if anything) triggers symptoms
• Quitting smoking
• Practicing stress-reducing activities such as doing yoga, getting a massage, practicing deep breathing, reading, meditating, taking a bath, or going on long walks

Medications

Depending on your PCOS symptoms, your doctor may recommend various medications or treatments.

• To regulate the menstrual cycle, a doctor may recommend progestin therapy, a contraceptive pill, the patch, a shot, a vaginal ring, or a hormone intrauterine device (IUD).
• To help with ovulation, they may recommend medications such as metformin, clomiphene, letrozole, and gonadotropins.
• To help reduce excess hair growth, a doctor may prescribe birth control pills, spironolactone, eflornithine, or electrolysis.

Before taking any new medications for PCOS, talk with your neurologist to ensure that they won’t interact poorly with your MS medications. Your OB-GYN and neurology team should be in communication as well to ensure that both conditions are being managed without exacerbating the other.

Meet Your Team

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Do you have polycystic ovary syndrome with your MS? Share your experiences in the comments below or by posting on MyMSTeam.