Increased COVID-19 infections in women with polycystic ovary syndrome: a population-based study

Eur J Endocrinol. 2021 May;184(5):637-645. doi: 10.1530/EJE-20-1163.


Objective: Several recent observational studies have linked metabolic comorbidities to an increased risk from COVID-19. Here we investigated whether women with PCOS are at an increased risk of COVID-19 infection.

Design: Population-based closed cohort study between 31 January 2020 and 22 July 2020 in the setting of a UK primary care database (The Health Improvement Network, THIN).

Methods: The main outcome was the incidence of COVID-19 coded as suspected or confirmed by the primary care provider. We used Cox proportional hazards regression model with stepwise inclusion of explanatory variables (age, BMI, impaired glucose regulation, androgen excess, anovulation, vitamin D deficiency, hypertension, and cardiovascular disease) to provide unadjusted and adjusted hazard risks (HR) of COVID-19 infection among women with PCOS compared to women without PCOS.

Results: We identified 21 292 women with a coded diagnosis of PCO/PCOS and randomly selected 78 310 aged and general practice matched control women. The crude COVID-19 incidence was 18.1 and 11.9 per 1000 person-years among women with and without PCOS, respectively. Age-adjusted Cox regression analysis suggested a 51% higher risk of COVID-19 among women with PCOS compared to women without PCOS (HR: 1.51 (95% CI: 1.27-1.80), P < 0.001). After adjusting for age and BMI, HR reduced to 1.36 (1.14-1.63)], P = 0.001. In the fully adjusted model, women with PCOS had a 28% increased risk of COVID-19 (aHR: 1.28 (1.05-1.56), P = 0.015).

Conclusion: Women with PCOS are at an increased risk of COVID-19 infection and should be specifically encouraged to adhere to infection control measures during the COVID-19 pandemic.

Significance statement: Women with polycystic ovary syndrome (PCOS) have an increased risk of cardio-metabolic disease, which have been identified as a risk factor for COVID-19. To investigate whether the increased metabolic risk in PCOS translates into an increased risk of COVID-19 infection, we carried out a population-based closed cohort study in the UK during its first wave of the SARS-CoV-2 pandemic (January to July 2020), including 21 292 women with PCOS and 78 310 controls matched for sex, age and general practice location. Results revealed a 52% increased risk of COVID-19 infection in women with PCOS, which remained increased at 28% above controls after adjustment for age, BMI, impaired glucose regulation and other explanatory variables.

MeSH terms

  • Adult
  • Age Factors
  • Body Mass Index
  • COVID-19 / epidemiology*
  • Cardiovascular Diseases / epidemiology
  • Diabetes Mellitus / epidemiology
  • Female
  • Humans
  • Hypertension / epidemiology
  • Middle Aged
  • Obesity / epidemiology
  • Polycystic Ovary Syndrome / epidemiology*
  • Polycystic Ovary Syndrome / metabolism
  • Prediabetic State / epidemiology
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Testosterone / metabolism
  • United Kingdom / epidemiology
  • Vitamin D Deficiency / epidemiology


  • Testosterone