With polycystic ovary syndrome (PCOS) being the leading cause of infertility and hormonal imbalances in women worldwide, it is quite puzzling why this condition has not been further studied and understood. While some of the physical symptoms of this condition have been briefly studied, the psychological effects of PCOS are overlooked by healthcare professionals [1]. Whether women are trying to conceive or just take care of their health, PCOS can be an ongoing struggle for many, affecting their daily lives.

What is PCOS?

PCOS is a condition in women that can cause an imbalance of reproductive hormones. This imbalance can cause a plethora of different health issues, such as: 

• Infertility 
• Irregular menstrual cycles 
• Cysts on the ovaries
• Fluctuated weight gain and loss 
• Acne and unwanted hair growth
• Mental health issues 
• Increased levels of testosterone and other androgens 

There are four main types of PCOS that women can be diagnosed with, each with a different subset of symptoms and treatments [2].

The Psychological Effects of PCOS

The psychological effects of PCOS have largely been glossed over and most women go years without a diagnosis or, more often, get misdiagnosed. In fact, according to the National Institutes of Health, less than 0.1% of funding is allocated towards PCOS research, despite it being the leading cause of many health issues in women [3]. 

• The Development of Eating Disorders:

• • Many women diagnosed with PCOS, especially the insulin-resistant type, can struggle with their weight, as well as the correct types of food to eat to manage their symptoms. But with that comes the increased risk of developing an eating disorder.
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  • Healthcare professionals who treat women with PCOS often disregard underlying hormonal issues and immediately put their patients on a diet. Whether it be a restriction or an introduction to new foods, it can all be overwhelming. In fact, a study published in the Indian Journal of Psychological Medicine found that PCOS can cause changes in eating patterns, which can increase the risk of developing an eating disorder [4]. 

• Struggles with Body Image:

• • Along with fluctuations in one’s weight, issues such as unwanted facial hair and darkness in different parts of the body, also known as hirsutism, can be a source of struggle for many women. These symptoms are usually due to the elevated presence of androgens as a result of certain types of PCOS. Chaudhari, et al, concluded that women who had these symptoms not only suffered from low self-esteem, but their attempts to cover up excessive hair growth and darkness in and of itself was stressful, and overall, it was reported that they experienced a lower quality of life [4].

• Increased Risk of Anxiety and Depression 

• • A study in the Neuropsychiatric Disease and Treatment Journal found that women diagnosed with PCOS are three times more likely to be diagnosed with anxiety [5]. Issues relating to fertility, one’s menstrual cycle, and other physical manifestations of PCOS all significantly increase the risk of developing anxiety and depression. Women with PCOS are even at a greater risk of developing other conditions such as diabetes and endometriosis, a condition where the tissue that lines the uterus begins to grow outside of it due to hormonal imbalances [6]. In fact, a study done by the Department of Obstetrics and Gynecology in China found that the imbalance of hormones due to PCOS can cause other issues in the body, one of which is the disruption of the normal lining of the uterus [7]. All of these conditions that can result due to PCOS all increase stress on the body and the overall well-being of women who are diagnosed with these conditions. 
  • The same study dives deeper and explains that chemical imbalances due to PCOS are also directly correlated to the risk of developing depression and/or anxiety. The hypothalamic–pituitary–adrenal axis, or the HPA axis, was found to be disrupted due to PCOS. The HPA axis is responsible for the body’s reaction to stress, so when stress levels are elevated, the signaling that is required for the HPA axis to function is disrupted. (Figure 1). 

• The maintenance of the HPA axis is necessary for homeostasis, which is disrupted by PCOS due to changes in androgens and cortisol levels. A study found that when androgen and stress levels are elevated, it leads to the overactivation of the HPA axis since it relies on feedback inhibition. This increase in the overactivation of the HPA axis further causes imbalances in hormone levels, further disrupting homeostasis in the body [8]. 

Where do we go from here?

Healthcare professionals have frequently neglected the very real and debilitating symptoms of PCOS. Too often, birth control is used as a band-aid solution, or the symptoms are ignored in younger women. The lack of research and funding towards PCOS has been detrimental to improving diagnoses and the quality of life of those who are diagnosed. Though there are different types of PCOS, all of its symptoms and diagnoses are often lumped together without providing individualized solutions to each patient. 

Dr. John Nestler, the chair of the department of internal medicine at Virginia Commonwealth University, explains that the little funding that does go into PCOS research mostly focuses on understanding why women with PCOS struggle with fertility and ignores the plethora of other symptoms and effects that PCOS can have [9]. 

Most women either go years with their symptoms being ignored, or they are only diagnosed with PCOS when they are much older and trying to conceive. Though there is not a direct cure for PCOS, the symptoms can be managed when found earlier. Care should be holistic. There are a lot of mental stresses that come with PCOS, ranging from imbalances in hormones to struggles with body image and the development of various other disorders, and healthcare workers must take those concerns into account when developing treatment plans for their patients. 

References:

1. Center for Disease Control and Prevention. (2020, March 24). PCOS (Polycystic Ovary Syndrome) and Diabetes. https://www.cdc.gov/diabetes/basics/pcos.html
2. El Hayek, S., Bitar, L., Hamdar, L. H., Mirza, F. G., & Daoud, G. (2016). Poly Cystic Ovarian Syndrome: An Updated Overview. Frontiers in physiology, 7, 124. https://doi.org/10.3389/fphys.2016.00124
3. Levinson, A. (2019, March 19). Raising Awareness and Requesting Funding for PCOS – The #1 Infertility Diagnosis. Reproductive Medicine Associates. https://www.rmact.com/fertility-blog/raising-awareness-and-requesting-funding-pcos
4. Chaudhari, A. P., Mazumdar, K., & Mehta, P. D. (2018). Anxiety, Depression, and Quality of Life in Women with Polycystic Ovarian Syndrome. Indian journal of psychological medicine, 40(3), 239–246. https://doi.org/10.4103/IJPSYM.IJPSYM_561_17
5. Blay, S. L., Aguiar, J. V., & Passos, I. C. (2016). Polycystic ovary syndrome and mental disorders: a systematic review and exploratory meta-analysis. Neuropsychiatric disease and treatment, 12, 2895–2903. https://doi.org/10.2147/NDT.S91700
6. Nunez, Kristen. (2021, February 1). How to Tell the Difference Between Endometriosis and Polycystic Ovarian Syndrome. Healthline. https://www.healthline.com/health/womens-health/endometriosis-vs-pcos
7. Qian, Xue-ya, Wu, Hao et al. (2012, February 13). Is There A Relationship between Polycystic Ovary Syndrome and Endometriosis? Journal of Reproduction and Contraception. https://doi.org/10.1016/S1001-7844(12)60013-3
8. Pasquali R. (2012). The hypothalamic-pituitary-adrenal axis and sex hormones in chronic stress and obesity: pathophysiological and clinical aspects. Annals of the New York Academy of Sciences, 1264(1), 20–35. https://doi.org/10.1111/j.1749-6632.2012.06569.x
9. Parker, S. (2015, 26 June). When Missed Periods Are a Metabolic Problem. The Atlantic. https://www.theatlantic.com/health/archive/2015/06/polycystic-ovary-syndrome-pcos/396116/