Going over last week’s material, and I see it says women with PCOS, lupus, and diabetes have similar rates of heart disease to men. What they have in common is they are all associated with increased iron levels. I’m curious about this because many of the women I know of that have been diagnosed with PCOS tend to lean more towards anemia. Potentially because the anemia isn’t iron deficiency related. But there are so many I can’t believe none of them are. What is the connection between PCOS and increased iron levels?

Dr. Amy Nett:  Okay, so as you mentioned though, you’re right. Anemia is not always due to iron deficiency and a lot of times if you see someone, particularly with lupus, for example, it could actually be anemia of chronic disease. And then remember that functional B12 or folate deficiency can also cause anemia. So just because you see anemia in terms of the hemoglobin and hematocrit, it certainly doesn’t mean that it’s due to iron deficiency. So then your question, what’s the connection between PCOS and increased iron levels? Well in PCOS, you generally have decreased menstruation. Women are generally menstruating with less frequency and there may be more scanty blood flow. We also see insulin resistance in PCOS, which seems to be related to iron overload. There is, there’s a question of whether or not there is enhanced erythropoiesis due to androgen excess, but probably less likely of the soluble transferrin receptor isn’t increased. And there could be other mechanisms. I don’t always know if we understand anything; when there’s an association, we may not always know why. But there does seem to be an association between PCOS and increased iron levels and those are at least some of the reasons we probably do see that association.