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Emerging risk factors for COVID-19 include age, gender, hypertension, diabetes and obesity. Recently, some clinical evidence and studies have suggested a possible association between PCOS and COVID-19.
The studies say that women suffering from polycystic ovary syndrome (PCOS) or polycystic ovarian disease (PCOD) could be at increased risk of COVID-19 infections compared to women without PCOS. This article will discuss how and why it could be possible. Read on to know more.
COVID-19 And Women Suffering From PCOS
According to a study published in the European Journal Of Endocrinology, women with PCOS are at a 28 per cent increased risk of getting infected by COVID-19 compared to women without the condition. The result was calculated after adjusting the age, BMI and hazard risk. 
Without the aforementioned adjustments, the analysis had shown that PCOS women are at 51 per cent higher risk of COVID-19 among women without PCOS.
Why PCOS Patients Are At Increased Risk Of COVID-19?
As of today, COVID-19 has affected around 124 million people worldwide, with 70.1 million recovered cases and 2.72 million deaths. Many published studies have shown that laboratory-confirmed COVID-19 cases are more prevalent in males in several countries compared to females.
Though the cause is multifactorial, the effect of androgen hormone is considered one of the primary reasons for the sex-specific differences in the infection rate.
Androgen is mainly referred to as a male hormone that governs the development and maintenance of male traits and their reproductive activities. 
The hormone is, however, present in both males and females, but its principal function is to stimulate testosterone and androstenedione, two of the several male sex hormones.
PCOS is an endocrine disorder in which the levels of androgens (male hormone) spike up, instead of estrogen (female hormone). This leads to hyperandrogenism and ovarian dysfunction, causing infertility in some without proper diagnosis and treatments.
As the androgen hormone is considered the key factor for the risk of COVID-19 infection, it can be said that PCOS women can become more exposed to the illness, considering that other factors such as obesity in PCOS women could also be the cause.
1. Insulin resistance
PCOS is linked to metabolic disorders such as insulin resistance and diabetes. Insulin is a hormone that helps manage glucose levels in the body, along with controlling the metabolism of proteins and lipids.
Insulin resistance is developed when the body doesn't respond to insulin, causing non-utilisation of glucose in the blood for energy, resulting in increased blood glucose. The excess of glucose starts interfering with the immune cells such as B cells, macrophages and T cells, leading to a decrease in immune functions.
Dysfunction of the immune system due to insulin resistance, which started due to PCOS can finally say why women with PCOS are getting highly affected with coronavirus. 
A study has shown that soon after the emergence of coronavirus, among the people who were ventilated, the ratio of obese patients was high, followed by an increased mortality rate among these people. 
Another study has also highlighted the fact that during the previous pandemic of H1N1 infection or swine flu, the severity of the condition was high in obese people. 
Around 38-88 per cent of women with PCOS are found to be overweight or obese. The close links between obesity, PCOS and COVID-19 can conclude, that PCOS women are more susceptible to COVID-19 due to being overweight or obese.
3. Vitamin D deficiency
Vitamin D deficiency is linked to PCOS and COVID-19 infection in many ways. Vitamin D is an essential vitamin that may help prevent respiratory infections of COVID-19 by its immune-boosting property and reducing inflammatory cytokines leading to pneumonia.
In around 67-85 per cent of women with PCOS, a high deficiency of vitamin D has been observed. 
The lack of vitamin D can cause immune dysfunction, increased inflammatory cytokines and increased risk of comorbidities like diabetes, insulin resistance and obesity, all complications for PCOS.
Therefore, it can be said that vitamin D deficiency could be linked with PCOS and increased complications and death rate due to COVID-19.
4. Gut microbiota
Gut dysbiosis or dysfunction of the gut microbiota is associated with health conditions such as PCOS.
PCOS and gut health go hand in hand. Women with PCOS are often found with gut dysbiosis. However, if the sugar levels are well managed and the digestive system is taken care of in PCOS, gut health can be improved.
Alteration in the composition of the gut microbiome can affect the immune system, the primary system of the body that protects us from infections and thus, make us prone to infections such as COVID-19.
The use of probiotics to maintain the balance of intestinal microbiota can help boost immunity and prevent the risk of COVID-19.
Insulin resistance can increase the production of androgens in women with PCOS. Obesity and overweight can worsen insulin resistance and thereby, enhance androgen production. This may cause dysfunction of the immune system due to the endocrine-immune axis, which can then, increase the risk of COVID-19 in PCOS women.