Polycystic ovary syndrome (PCOS) is a disorder known for its various complications in young women. Apart from menstrual and fertility problems it can give rise to mental health issues. Accordingly, it is a heterogeneous disorder with an increased risk of depression, anxiety and bipolar disease.  Worst cases can lead to obsessive compulsive disorder. Disordered eating is a common psychiatric issue in PCOS.  Although PCOS doesn’t have a specific cause,  environmental and genetic factors may be contributing to it. In this condition your body has defects in the endocrine system like insulin resistance and high androgen secretion. Family history may be linked to these problems. In addition, environmental factors like sedentary habits and improper eating habits add to the PCOS mental health issues.

What causes mental health issues in PCOS?

            Obesity, acne, scalp hair thinning, menstrual irregularity, and subfertility are common features of PCOS. These symptoms in a female lead to psychological impairment. The various contributing factors for PCOS mental health issues are:

  • Reproductive concerns
  • Androgen Excess
  • Metabolic disturbances
  • Excess body hair
  • Obesity
  • Chronic stress
  • Physical appearance in young girls: Psychosocial problems arise in adolescents due to obesity, excessive body hairs and changes in physical appearances. 

Fertility issues

     Ovulatory dysfunction, menstrual irregularities and inability to conceive causes emotional disturbances in PCO women. 40% of women with PCOS and infertility suffer from mental issues. Women with PCOS often show social withdrawal and eating disorders. Anxiety disorders are more common in infertile females with PCOS. These women are at higher risk of major depressive disorders leading to suicide attempts.

Obesity related

  Obesity can psychologically affect women from adolescence to older age groups. In this age group females are more concerned  about physical appearance and body satisfaction. Unfortunately obesity impairs the social life of a young female. Sleep disturbances and eating disorders are early manifestations in a young female. Emotional disturbances interfere in their social and intellectual development. 

Body image

       In addition to obesity these women also suffer from acne and hirsutism which contribute to their body dissatisfaction. Greater psychotic symptoms are seen in these young individuals. 

Chronic stress

  PCOS can cause metabolic derangements and reduce your immune function. Psychological changes along with these endocrine changes bring in an inflammatory status. In the long term this inflammation gives rise to disorders like cardiovascular problems, diabetes and cancer.  Inflammatory changes in the body can alter your emotions resulting in mood disorders. Any condition in your body which is inflammatory has a neurological aspect as well. Chemicals causing inflammation are also found in mental disorders.  Often you have an increased heart rate and feel restless. Additionally insulin resistance in PCO causes an early diabetes and obesity precipitates this disorder.

Inflammation & Sickness behaviour

       In addition to the various symptoms of PCOS you may feel sick due to the nature of this disease.Changes in your brain cells allow the chemicals of inflammation to enter inside and affect your alert system.  Since your body harbors many chemical mediators of inflammation you may exhibit depressed mood, sleep disturbances and pain sensitivity. Other features of sickness behavior are fatigue, social withdrawal and depression. Daytime sleepiness and breathing problems during sleep are some of the additional features. 

Visceral fat

PCOS women tend to be obese and have high BMI. As a result their body organs also gain more fat which is called visceral fat. Since fat tissue converts the female hormone into androgen, they gain more male hormones in their body. Due to this women may show aggressive behaviour and exaggerated response to anger.  Visceral fat is more metabolically active than subcutaneous fat and is more harmful to PCO women. 

What are the mental health issues seen in PCOS?

       PCOS patients often do not report psychological problems. Commonly, they discuss endocrine and fertility issues. If you are facing any mood disorder it is alway better to inform your doctor. You may attribute the anxiety disorders to menstrual irregularities or infertility. But, this may have a different underlying cause. Subsequently these problems become a greater psychosocial issue. Common presentation of mental disease in PCOS are

  • Mood changes
  • Sleep disturbances 
  • Depression 
  • Bipolar disorder 
  • Anxiety disorders
  • Binge eating disorders 
Mental Health Issues in PCOS

Mood Changes in PCO women

              PCOS related infertility problems have a higher risk of mood and anxiety disorders.  Obese Women with PCOS have higher chances of depression, but lean women also suffer from this problem. Clinical features of high androgen levels affect quality of life.  Women with androgenic features like facial  and excess body hair suffer from severe depression. Ovulatory disorder causes anxiety problems in women. More commonly they present with mood disorders of varying degrees. Obesity and metabolic changes like insulin resistance and abnormal lipid levels are the contributory factors. If you are suffering from PCOS it is better to discuss with your doctor about all these underlying problems. In extreme cases women may suffer from social phobia, obsessive compulsive disorders and panic disorder.

Sleep disorders

Often, PCO women report more daytime sleepiness and fatigue. Other common complaints are difficulty in falling asleep. You may also suffer from disordered breathing in sleep. Treatment for sleep disorder in these women may be effective to reduce fatigue and mood swings. Good amount of sleep will reduce the inflammatory changes in PCOS.

Gender orientation in PCOS women

Gender identity issue in individuals with PCOS is an evolving term. Because of the social acceptability, many women are open to discuss it recently. Insurance coverage of these issues make them go for gender conversion. Gender orientation and the right to choose gender is allowed in many countries.

Genetic mutations in certain enzymes affect androgen metabolism.  Although they have the chromosomes of a male, they are brought up as a female. These female born individuals may develop male organs following puberty.

PCO women accumulate male hormone androgen in their body due to defects in metabolism. Over years these women develop into male configuration like hoarseness of voice, facial hair and changes in musculature.

Deviation from womanhood

Due to accumulation of androgen women with PCOS are at risk of disruption of womanhood. As adolescents with PCOS grow up, menstrual irregularity makes them feel abnormal. They relate feminism  to menstruation and get a sense of inability. Additionally, fear of inability to bear children threatens their womanhood. With passing years of development androgenic features like facial and body hair makes them feel physically unattractive. Imbalance of sexual hormones may negatively impact their sexual functions. Acne and alopecia alters their female identity and self esteem. Reproductive role of women with PCOS is severely affected by ovulatory dysfunction and infertility. These changes in a woman discomforts her psychologically and reduces quality of life. These women are at risk of mental health problems like depression, obsessive-compulsive disorders and aggressive behaviour.

Treatment of PCOS

             Treatment for PCOS depends on your problems and complaints. Based on the symptoms your doctor will advise any of these treatment:

  • Weight loss 
  • Exercises
  • Smoking cessation
  • Metformin : Insulin sensitizing agent, improves menstrual abnormalities and reproductive abilities.
  • Oral contraceptives: Regularize menstrual irregularities
  • Anti-androgen compounds
  • Fertility treatments : Ovulation induction with Clomiphene, Letrozole with or without Metformin
  • Stress management
  • Psychotherapy

Addressing PCOS mental health issues

Improving the lifestyle can have a positive effect on psychosocial issues in PCO women.

Weight Loss: 

  • Helps induce ovulation and eventual pregnancy 
  • Reduce the possibility of developing chronic diseases 
  • Indirectly affect mood 
  • Improves metabolic and menstrual cycle abnormalities 
  • Significantly reduces visceral fat mass 
  • May reduce inflammation associated with mood changes

Exercise

  • Regular exercise without weight loss can improve ovulation 
  • Improvement in insulin sensitivity as there is increase in muscle mass
  • Exercise can contribute to overall weight loss and more importantly, to visceral fat reduction 
  • Women following regular exercise have  body image satisfaction, thus improvement in psychological functions
  • Exercise also improves inflammatory profiles in obese 
  • Training young adolescents in a regular exercise regime may prevent development of PCOS in later life.

Diet Changes

  • Changes in diet can affect physiological parameters and mood.
  • Low carbohydrate diet improves symptoms of depression. It stabilizes blood sugar level and reduces inflammation.
  • High protein diet improves brain function.

Stress and Mood Management

  • Cognitive behavior therapy
  • Psychotherapy 
  • Drugs
  • Smoking cessation 

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