Are Bipolar II Disorder and PCOS Common in Women of Reproductive Age?
Yes, both conditions are common in women of reproductive age, with PCOS affecting up to 15% of reproductive-age women and showing a particularly strong association with bipolar disorder—women with PCOS face approximately double the risk of bipolar disorder compared to women without PCOS. 1, 2
Prevalence of PCOS
- PCOS affects up to 15% of women in the reproductive age, making it one of the most common endocrine disorders in this population 1
- Secondary amenorrhea (a common PCOS manifestation) affects approximately 3-4% of women in the general population, with PCOS being one of the most frequent underlying causes alongside functional hypothalamic amenorrhea, ovarian failure, and hyperprolactinemia 3
- PCOS accounts for approximately 20-35% of cases of secondary amenorrhea and about 3% of primary amenorrhea cases 3
Prevalence of Bipolar Disorder in Women with PCOS
- The pooled prevalence of bipolar disorder specifically in women with PCOS is 4% (95% CI, 2-5%), based on a meta-analysis of 73,102 women with PCOS 2
- Women with PCOS have approximately 2-fold increased odds of bipolar disorder (pooled OR 2.06; 95% CI, 1.61-2.63) compared to women without PCOS 2
- Individual studies report bipolar disorder prevalence in PCOS populations ranging from 0% to 27%, reflecting significant heterogeneity across populations 2
- A separate meta-analysis confirmed elevated risk, showing women with PCOS are more likely to have a clinical diagnosis of bipolar disorder (OR 1.78; 95% CI, 1.43-2.23) 1
The Bidirectional Relationship
- Women with bipolar disorder also show high prevalence of PCOS even before diagnosis or treatment of the psychiatric condition, suggesting shared pathophysiological mechanisms rather than purely medication-induced effects 4
- Common metabolic and immune disorders—including hypothalamic-pituitary-adrenal axis dysfunction, chronic inflammation, gut microbial alterations, adipokine disturbances, and circadian rhythm disruption—are observed in both BD and PCOS, potentially explaining the comorbidity 4
- Valproate, a common mood stabilizer for bipolar disorder, can trigger or exacerbate PCOS, including worsening hirsutism, creating a treatment-related pathway for the association 5, 6
Other Psychiatric Comorbidities in PCOS
Beyond bipolar disorder, women with PCOS face elevated risk of multiple psychiatric conditions:
- Depression: OR 2.79 (95% CI, 2.23-3.50) 1
- Anxiety: OR 2.75 (95% CI, 2.10-3.60) 1
- Obsessive-compulsive disorder: OR 1.37 (95% CI, 1.22-1.55) 1
- A nationwide cohort study found significantly increased incidence of newly diagnosed depressive disorder (HR 1.296), anxiety disorder (HR 1.392), and sleep disorder (HR 1.495) following PCOS diagnosis 7
Clinical Implications
- Screening for psychiatric disorders, including bipolar disorder, in women with PCOS is warranted to allow early intervention 1
- The temporal relationship appears bidirectional, with PCOS potentially increasing risk of subsequent psychiatric diagnoses and bipolar disorder increasing vulnerability to PCOS 4, 7
- Women with bipolar disorder of reproductive age require careful mood stabilizer selection, as valproate carries the highest teratogenic risk in pregnancy and can worsen PCOS features 8
- The association persists across all follow-up durations (0-1 years, 1-5 years, ≥5 years), indicating a sustained rather than transient relationship 7