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PCOS and HS: What’s the Connection?

Posted on November 04, 2020
Medically reviewed by
Alexa B. Kimball, M.D., M.P.H.
Article written by
Max Mugambi

Many of the symptoms of polycystic ovary syndrome (PCOS) — including hirsutism (excessive hair growth), irregular menstruation, and acne — are also common in hidradenitis suppurativa (HS). These commonalities have led researchers to draw associations between HS and PCOS.

Androgens are present in both men and women. These hormones are responsible for the development of traits that have been traditionally considered male, including baldness and facial hair. Higher androgen levels are often seen in PCOS, a hormonal disorder affecting between 5 percent and 10 percent of women between 15 and 44 years old.

Hidradenitis suppurativa affects about 1 percent of the general population and is most common in young adults and women. HS is less common in women before puberty and after menopause, which suggests a relationship to sex hormones.

To better understand the relationship between PCOS and HS, myHSteam spoke to Dr. Alexa Kimball. Dr. Kimball is a professor of dermatology at Harvard Medical School and serves as president of Physician Performance LLC and the CEO of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center.

Are PCOS and HS Related?

There is reason to believe PCOS and HS are related in some way. In addition to presenting similar signs, recent studies have found considerable overlap between the comorbidities of the two conditions — including diabetes, metabolic syndrome, and obesity. However, a study in the Australasian Journal of Dermatology noted, “There have been few formal studies to assess the relationship between hidradenitis suppurativa and polycystic ovarian syndrome.”

Similarities Between HS and PCOS

Understanding the similarities between HS and PCOS may help people living with either (or both) to better understand their conditions and manage their symptoms. HS and PCOS share several characteristics.

HS, PCOS, and Puberty

Both PCOS and HS are more common with the onset of puberty and grow less common after menopause. This has led researchers to believe that sex hormones play a role in the development of each condition.

HS, PCOS, and the Environment

Toxins, diet, geography, and socioeconomic factors have been thought to increase the risk for both PCOS and HS. Apart from affecting one’s health, environmental factors have also been thought to play a significant role in the expression of the genetic traits responsible for the disorders.

HS, PCOS, and Biological Sex

HS affects more women than men. Women are up to three times more likely than men to develop HS. PCOS only affects people with female reproductive systems.

HS, PCOS, and Weight

While both PCOS and HS have been linked to weight gain and obesity, this is not necessarily for the same reasons. It is possible that PCOS can contribute to weight gain as a result of insulin resistance. On the other hand, the severity of HS may be partly caused by excess weight — as obesity increases the area where skin rubs together and the risk of inflammation. For this reason, weight loss may not have the same effect on PCOS as it would on HS.

Hormonal Treatments for PCOS and HS

Because sex hormones are thought to play a role in the development of both PCOS and HS, hormonal treatments can be used to treat both. As Dr. Kimball explained, “One of the reasons why hormonal treatments work is probably because there is testosterone — which may be one of the links why hormonal factors come into play.”

According to Dr. Kimball, the type of treatment used for both PCOS and HS depends on various factors, including the stage of the condition, medical history, and symptoms. When deciding whether to start hormonal treatment for either PCOS or HS, Dr. Kimball advised talking to your doctor about how hormonal therapies will work with other medications you may be taking.

Hormonal Treatment for PCOS

The hallmark symptom of PCOS is irregular menstrual cycles due to hormonal imbalances. Treatment options are dependent on an individual’s goals for care. Given that women with PCOS are at increased risk for insulin resistance, high blood pressure, heart disease, obesity, and fertility challenges, treatment should be tailored to each woman’s needs. All women with PCOS should consult their doctors about the best exercise and nutrition plan for their health, and about regular monitoring for insulin resistance.

Women who are not planning on pregnancy are often offered hormonal treatment for PCOS. Birth control pills, vaginal rings, and skin patches produce a monthly bleed that simulates a menstrual period. Other birth control options, such as intrauterine devices (IUDs) and injected medications, will act specifically on the endometrial lining and keep it thin. Women with PCOS who are planning a family may be offered ovulation-induction agents to improve their chances of getting pregnant.

Hormonal treatments may also decrease excessive hair growth and acne.

Hormonal Treatment for HS

Dr. Kimball believes hormonal therapy is one of the most effective yet underutilized methods for treating hidradenitis suppurativa. “For women in mild to moderate stages of HS, hormonal rebalancing through oral contraceptives or Spironolactone can help restore and maintain favorable conditions on low medication doses for a long time,” she explained.

The Impact of PCOS and HS on Mental Health

PCOS has been linked to depression and anxiety in women. This may be a result of the various symptoms of PCOS, including weight gain, mood disturbances, negative self-image, a decline in sexual satisfaction, and the risk of developing other health conditions.

HS can also impact emotional health and quality of life. People with HS may worry about symptoms growing worse, feel self-conscious about the smell of ruptured lesions, or fear that people will misunderstand their condition. Some members of myHSteam share their experiences living with PCOS and HS:

  • “I have PCOS too. I can grow a full beard.”
  • “I have lost relationships because of this problem. I currently have a supporting and loving fiance, but I can tell that even he feels uncomfortable about it sometimes.”
  • “I am heartbroken. Because of this condition, I chose abstinence. I chose it because, with HS, sex is not as simple as it is to those without it.”
  • “I have been seriously exhausted. Lately, I have a glucose monitor that I wear for 10 days at a time. It’s annoying, honestly. It doesn’t hurt or anything; it just makes it uncomfortable to sleep on my right side.”

The combined impact of living with multiple chronic conditions can be even more difficult. However, finding the right support and interacting with others with PCOS and HS can help you understand that you’re not alone.

Find Your Support System

When you join myHSteam you gain a community of more than 16,000 people living with HS. Members offer support and share advice about living with HS and other related health conditions.

Do you have PCOS in addition to HS? Have you tried any treatments that have helped? Share your experiences in the comments below or on myHSteam.

References

  1. Hidradenitis suppurativa: Causes, features, and current treatments — The Journal of Clinical and Aesthetic Dermatology
  2. Hidradenitis suppurativa — Mayo Clinic
  3. Hidradenitis suppurativa — American Academy of Dermatology Association
  4. Polycystic ovary syndrome — Office on Women's Health
  5. Hidradenitis suppurativa and polycystic ovary syndrome — Australasian Journal of Dermatology
  6. Environmental determinants of polycystic ovary syndrome — Fertility and Sterility
  7. A to Z: Hidradenitis — The Nemours Foundation
  8. Polycystic ovary syndrome: current status and future perspective — Frontiers in Bioscience
  9. Polycystic ovary syndrome (PCOS) — Mayo Clinic
  10. Hidradenitis suppurativa — University of Rochester Medical Center
  11. Polycystic Ovarian Syndrome (PCOS) Linked to Anxiety and Depression — MGH Center for Women's Mental Health
  12. The influence of body weight on the prevalence and severity of hidradenitis suppurativa — Acta Dermato-Venereologica
  13. Can PCOS cause weight gain? — Cleveland Clinic
  14. The skin transcriptome in hidradenitis suppurativa uncovers an antimicrobial and sweat gland gene signature which has distinct overlap with wounded skin — Plos One
  15. Comorbidities and Hidradenitis Suppurativa — Hidradenitis Suppurativa Foundation
  16. Depression and Anxiety in Adults With Hidradenitis Suppurativa: A Systematic Review and Meta-analysis — JAMA Dermatology
Alexa B. Kimball, M.D., M.P.H. is CEO and president of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center. Learn more about her here.
Max Mugambi is a copywriter at MyHealthTeams with more than five years of experience writing about a diverse range of subjects. Learn more about him here.

A myHSteam Member said:

This was very helpful

posted 3 days ago

hug

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