Screening for bipolar disorder in women with polycystic ovary syndrome: a pilot study

Previous reports have attributed polycystic ovary syndrome (PCOS) to valproate treatment in women with bipolar disorder and with epilepsy. However, since high rates of mood disorders have been identified in women with PCOS, we sought to investigate the hypothesis that an intrinsic association may exist between PCOS and bipolar disorder, independent of pharmacotherapy.

Seventy-eight women identified with PCOS were screened for the presence of bipolar illness using the Mood Disorders Questionnaire (MDQ), a validated self-assessment screen for bipolar disorder.

Twenty-eight percent of subjects had either a previous bipolar diagnosis or met MDQ threshold criteria for bipolar screen positivity. Ninety seven percent of previously diagnosed or MDQ screen-positive subjects had no valproate exposure before PCOS diagnosis.

Possible selection bias, lack of direct comparison with a control group, and lack of knowledge of specific diagnostic work up for PCOS, should all be considered in interpretation of these results. The MDQ as a self-report screen may be less sensitive to detect bipolar II or NOS than bipolar I disorder, and was not corroborated by a diagnostic interview.

These preliminary findings suggest a higher rate of bipolar screen positivity among women with PCOS than is expected in the general population, independent of an association with valproate. This observed link between PCOS and bipolar screen-positivity is consistent with a possible shared hypothalamic-pituitary-gonadal axis abnormality.