Studies of PCOS & Hormones
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Q:  Studies of PCOS & Hormones

Hi Dr.Phelps: I was diagnosed with PCOS and Diabetes Type II 4 years ago. I was diagnosed Bipolar this past January. My endocrinologist was saying in relation to the PCOS and Diabetes that if one hormone is out of balance it effects all the others. Then I read the articles in this site about Metabolic Syndrome which is a part of PCOS and wondered if there is a very high incidence of Bipolar disorder in women who have PCOS. I know there is some interest in insulin resistance and Bipolar disorder but are they looking at any of the other hormones, ie. testosterone, andesteindione? Just curious?


Dear Diana -- 
Funny you should ask as I was just reading a study that did look.
McIntyre  In a group of women with bipolar disorder, 18 on Depakote and 20 on lithium, here's what they found.  Don't worry about the units for most of these tests if they don't mean much to you, just compare the Depakote and lithium columns.  (A "p value" of 0.05 means the difference could have appeared by chance one time in 20 such tests.  A  "p value" of 0.001 means the difference could have appeared by chance one time in 1000 tests -- so a value of 0.001 means this is extremely likely to be a "true" difference between the blood test results in the two groups.)   

Lab test Normal range for lab results On Depakote On Lithium significance level, Lithium vs. Depakote
Estrogen 0-210 pmol/L 828 370 p=0.001
Free testosterone <3.1 pmol/L 5.07 1.99 p=0.04
Androstenedione 1.7-10.5 nmol/L 9.1 7.2 p=0.05
DHEAS 3.2-9.7 nmol/L 6.53  4.55 p=0.05

What do these numbers mean? 

Estrogen itself is dramatically higher in the group taking Depakote.  Now before we go drawing conclusions, first we need to study a group of women going onto Depakote.  This study only compared the two groups.  Maybe there's something different about the women, and that's why one group got Depakote and the other was getting lithium (that step was done, before the study even started, because the doc' was choosing the medication based on the woman's needs; so maybe they were different already somehow).  Maybe that difference is the cause of these numbers above, not Depakote.  To know about this we need a group of women just starting Depakote, and then watch to see if the numbers shift similarly.  

There is such a study looking at some of these hormones.Rattya  It doesn't make a neat picture, as testostone levels did also go up in that study, but many of the other values reported went up in the Rattya study and down in the McIntyre study, or vice versa.  

So, too early to know anything for sure.  The trend however seems to suggest increased testosterone, and increased estrogen.  I'm particularly interested in the estrogen part, as I think that may play a significant role in keeping women symptomatic.  This is an area to keep watching.  I'm glad you are. 

Dr. Phelps

Published May, 2003


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