PCOS and autism: Is there a link?

Polycystic ovary syndrome (PCOS) is a hormonal condition that impacts women of reproductive age and can cause irregular periods and infertility. Autistic spectrum disorders (ASD), or autism, is a group of neurodevelopmental conditions that affects both males and females. It is characterized by challenges with social interaction and communication, but can present very differently from person to person. So, you might be wondering how these two completely different conditions, PCOS and autism, could be connected.

Research looking at the link between PCOS and autism is still evolving, but as studies progress, the link between the two is becoming clearer. In this article we’ll explore the science behind PCOS and autism and help you to understand how they may be related, and what that could mean for you.

What is PCOS?

PCOS affects 8–13% of reproductive—aged women. Symptoms can differ from person to person and fluctuate over time but generally they consist of:

• Irregular or absent periods
• Infertility
• Acne
• Weight gain
• Signs of high androgen (testosterone) levels: excessive hair growth on the body or face, hair thinning, and male pattern baldness.

PCOS is also linked to several chronic conditions such as type 2 diabetes, high blood pressure, heart disease and endometrial cancer. People with PCOS are also more likely to suffer from mental health disorders like anxiety and depression. 

What is autism?

Autistic spectrum disorder (ASD), or autism, is described by the World Health Organization (WHO) as a “diverse group of conditions related to development of the brain”. While autism affects different people in different ways, it is characterized by some degree of difficulty with social interactions and communication. Other signs of autism include:

• Atypical patterns of behavior
• Repetitive or restricted behavior
• Difficulty making eye contact
• Sensory issues eg. Aversion to certain clothing or food textures
• Difficulty with unexpected change 
• Delayed language, movement, or cognitive skills
• Anxiety or excessive worry

Autism occurs on a spectrum, some people with autism can live independently while others may have severe disabilities and need life—long care. Autism is more common in males but it still affects approximately 1% of girls. Signs of autism in females can be different to the typical symptoms we see in males and a 2017 meta—analysis found that girls were more likely to go undiagnosed. This could mean that the rates of autism in girls and boys are actually much more similar than current data tells us.

The connection between PCOS and autism

Can PCOS cause autism?

Autism is a complex and diverse condition, and the search for what causes it is ongoing. Currently, it is believed that there is no single cause for autism, rather, both genetic and environmental factors are likely to contribute.

One theory that researchers are exploring is how certain hormones might influence fetal brain development during pregnancy. Many factors can impact a baby’s development in the womb, including maternal hormone levels, nutrition, infections, and exposure to toxins such as alcohol and cigarette smoke. 

Recent research suggests that there could be a link between PCOS and autism. A systematic review and meta—analysis by Katsigianni et al. found that women with PCOS were 1.66 times more likely to have a child with ASD compared to women without PCOS. Similarly, a large population based study in Sweden found that the chance of having a child with ASD increased by 59% if the mother had PCOS. 

Researchers currently believe that this increased risk may be due to elevated levels of androgen hormones in women with PCOS during pregnancy. High androgen levels are thought to impact how the baby’s brain develops during pregnancy, potentially increasing their risk of developing ASD.

It’s important to remember though, that the chances of having a child with autism, even if you have PCOS, is still very low, and many other factors will likely play a part. More, large scale research is needed to confirm this connection and to look at other contributing factors.  

Does having autism mean you will have PCOS?

Just like there is thought to be an increased risk of having a child with ASD if you have PCOS, there is also an increased chance of having PCOS if you have autism. Both conditions have a hereditary element, meaning they often run in families, and both are believed to be linked to elevated exposure of androgen hormones in the womb. This could help explain why women with autism are twice as likely to have PCOS as those without. 

Managing PCOS and autism

Navigating PCOS and autism can be challenging, each condition presents with a different list of symptoms and affects daily life in different ways. But, by taking a holistic approach to your overall health, a combination of medical treatment, lifestyle adjustments, and mental health support can make a big difference to your physical and mental well—being.   

Medical management:

• Hormonal therapies, like the oral contraceptive pill, can help regulate your menstrual cycle and reduce the symptoms of excess androgens.
• Metformin can be used to manage insulin resistance which is common in PCOS as well as used to help ovulation and improve fertility.

Lifestyle management:

• Healthy diet to help maintain a healthy BMI and stable blood sugar levels can improve PCOS symptoms and protect against the development of associated chronic diseases.
• Regular exercise can help to manage PCOS symptoms as well as promote positive mental health.
• Stress—reduction practices like yoga, meditation and breathing exercises can help reduce stress and improve emotional well—being in both PCOS and autism.
• Personalized care plans especially for children and teenagers with autism can help them to cope with challenging situations. 

Mental Health support:

• Cognitive Behavioral Therapy (CBT) can be helpful for both PCOS and autism as both conditions are associated with an increased risk of being diagnosed with a mental health disorder like anxiety or depression.
• Autism—informed counseling can help develop coping mechanisms for social and sensory challenges.
• Joining PCOS and autism support groups to connect with others facing a similar situation, share resources and build a community.

Why this matters:

You might be asking yourself, why establishing a link between autism and PCOS matters. Understanding the potential link between PCOS and autism could help women to better understand their bodies and seek appropriate care. It can also help highlight gaps in research and the importance of addressing them, which could lead to improved prevention, diagnosis and treatment of these conditions in the future. 

Frequently asked questions

What should I do if I suspect I have PCOS?

If you suspect that you have PCOS then it is important to seek advice from your healthcare provider. They will be able to take a personalized look at your health and discuss if any further investigations or treatments are needed.

What should I do if I suspect I have autism?

Many women are not diagnosed with autism until adulthood, so if you think you have autism but were not diagnosed as a child then you’re not alone. If you have any concerns that you may have autism, reach out to your healthcare provider. They can discuss your concerns, guide you on the best next steps, and, if needed, refer you to a neurodevelopmental expert. 

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Can managing PCOS symptoms help me with autism related challenges? 

Management for PCOS symptoms is usually directed at minimizing hormonal imbalance or treating a physical issue. But, treatment can help improve overall health like improving mood regulation or energy levels and thus help with some challenges women with autism often face. For example, lifestyle changes like improved nutrition and regular exercise can reduce inflammation and stabilize hormones, which might indirectly support emotional and mental well-being. 

Final verdict

The link between autism and PCOS is still not fully understood and more research is still needed in this area. However, women with autism are more likely to have PCOS than women without autism and mothers with PCOS have a higher chance of having a child with ASD. It is important to keep in mind that the risk of having a child with autism remains very small, even if you have PCOS. Autism is believed to develop due to a combination of various factors, many of which we don’t yet fully understand.

References

“Autism Spectrum Disorder - Symptoms and Causes.” Mayo Clinic, www.mayoclinic.org/diseases-conditions/autism-spectrum-disorder/symptoms-causes/syc-20352928.

Brutocao, Claire, et al. “Psychiatric Disorders in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis.” Endocrine, vol. 62, no. 2, July 2018, pp. 318–25. https://doi.org/10.1007/s12020-018-1692-3.

Cherskov, Adriana, et al. “Polycystic Ovary Syndrome and Autism: A Test of the Prenatal Sex Steroid Theory.” Translational Psychiatry, vol. 8, no. 1, July 2018, https://doi.org/10.1038/s41398-018-0186-7.

Katsigianni, Maria, et al. “Maternal Polycystic Ovarian Syndrome in Autism Spectrum Disorder: A Systematic Review and Meta-analysis.” Molecular Psychiatry, vol. 24, no. 12, Mar. 2019, pp. 1787–97. https://doi.org/10.1038/s41380-019-0398-0.

Kosidou, K., et al. “Maternal Polycystic Ovary Syndrome and the Risk of Autism Spectrum Disorders in the Offspring: A Population-based Nationwide Study in Sweden.” Molecular Psychiatry, vol. 21, no. 10, Dec. 2015, pp. 1441–48. https://doi.org/10.1038/mp.2015.183.

Loomes, Rachel, et al. “What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis.” Journal of the American Academy of Child & Adolescent Psychiatry, vol. 56, no. 6, Apr. 2017, pp. 466–74. https://doi.org/10.1016/j.jaac.2017.03.013.

Maenner, Matthew J., et al. “Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020.” MMWR Surveillance Summaries, vol. 72, no. 2, Mar. 2023, pp. 1–14. https://doi.org/10.15585/mmwr.ss7202a1.

“Signs and Symptoms of Autism Spectrum Disorder.” Autism Spectrum Disorder (ASD), 16 May 2024, www.cdc.gov/autism/signs-symptoms/index.html.

World Health Organization: WHO. Autism. 15 Nov. 2023, www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders.

World Health Organization: WHO and World Health Organization: WHO. Polycystic Ovary Syndrome. 28 June 2023, www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome.

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