这种病医生难以诊断，还可能让你控制不住暴饮暴食｜科学60秒

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Rachel Feltman: Polycystic ovary syndrome, or PCOS, affectsin the U.S. alone. But in spite of how common PCOS is, it’s also quite poorly understood. Many people with the condition remain undiagnosed as they grapple with irregular periods, changes in their hair growth and body composition, acne and even infertility. If and when they do manage to get a diagnosis, they’re often told to focus on lifestyle changes like weight loss to mitigate symptoms. Now some researchers are pushing back against this generalized advice, which they say isn’t just unhelpful but sometimes actively harmful.

In a recent meta-analysis researchers showed that people with PCOS have a higher prevalence of eating disorders than their peers—regardless of their body mass index, or BMI, a common though flawed measurement based on a person's height and weight.

For Scientific American’s Science Quickly, I’m Rachel Feltman. I’m joined today by Laura Cooney, a co-author in the recent study. She’s an associate professor in the Division of Reproductive Endocrinology and Infertility at the University of Wisconsin School of Medicine and Public Health.

Laura, thank you so much for joining us today.

Laura Cooney: Thank you so much. It’s great to be here.

Feltman: So let’s start with something basic: What is PCOS, and how has our understanding and definition of it changed in recent years?

Cooney: Yeah, so PCOS is actually incredibly common—it impacts probably about 10 percent, at a minimum, of women in the reproductive ages. And what’s really difficult is it’s a complex disorder with lots of different kind of criteria. So not all women with PCOS are the same, which has made it hard over the years for us to both diagnose PCOS and to do, you know, appropriate studies on it.

The three current criteria are irregular periods, any evidence of elevated androgen—so this could be blood levels of testosterone, or it could be abnormal hair growth on the face or other parts of the body—and then [a] very specific ultrasound finding, where there’s lots of follicles on the ovaries. This is one of the more complicated things for patients to understand because the name is “polycystic,” but it’s not really that they have a lot of cysts on their ovaries; it’s just that they have a lot of follicles, and each of those follicles has an immature egg. But if they’re not getting their periods, they’re not ovulating and releasing those eggs.

So those are the three criteria, and to be diagnosed with PCOS you have to have two out of those three.

Feltman: And so what prompted you to investigate the link between PCOS and disordered eating specifically?

Cooney: So this has actually been a long-standing interest of mine: really looking at PCOS and sort of the broad spectrum of mental health, including depression or anxiety.

So we had done a study showing high levels of moderate to severe depression and anxiety in women with PCOS, and because, you know, mood disorders like depression and anxiety are so closely linked to eating disorders, you know, body image, so many other factors that could be an issue in women with PCOS, it was really a logical next step to kind of look at eating disorders.

We had done an initial analysis, but there weren’t a lot of studies for us to look at, but [we] did kind of find [a] suggestion of elevated eating disorders in PCOS. This study was actually really driven by the 2023 international PCOS guidelines. And so they had done meta-analyses on a lot of different topics looking at PCOS. And so I was tasked to do the meta-analysis looking at PCOS and eating disorders. And then we were going to use this to kind of inform the guidelines, you know, in terms of screening women with PCOS and thinking about how to incorporate eating disorders into day-to-day management of PCOS.

Feltman: And what did you find in this most recent study?

Cooney: This was a study that, as I said, was a meta-analysis, so we included multiple different cross-sectional studies comparing the rates of eating disorders in women with PCOS compared to women without PCOS. And we looked both at overall eating disorders, disordered eating, as well as specific kind of diagnoses of eating disorders, like bulimia nervosa, binge-eating disorder and anorexia nervosa.

And we found that in women with PCOS, they had increased odds of, you know, overall eating disorders, as well as specifically bulimia, binge-eating disorder and disordered eating. We did not find an increase in anorexia in this population.

Feltman: What do we know about why that connection might exist?

Cooney: It’s really difficult. You know, I think a lot of people assume that the connection is just related to, you know, BMI—so overweight, obesity. Women with PCOS do have higher weights—rates of overweight and obesity than women without PCOS. But one of the interesting things we were able to do in this study is that...[full transcript]