Mood And Anxiety Disorders In Women With PCOS

What is important to note is that PCOS is a lifestyle problem, the symptoms of which can be easily controlled by simple daily modifications

–Dr. Ritu Sethi, Senior Consultant Gynecologist, Cloudnine Group of Hospitals, Sector 14, Gurgaon

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. Alarmingly, the incidence is on the rise these days and is reaching epidemic proportions. PCOS is characterized by ovulatory dysfunction, the presence of polycystic ovaries, and increasing levels of male hormones, obesity, and fertility problems.

What is now of concern is that in addition to reproductive and metabolic concerns, PCOS is also associated with psychological disorders, such as anxiety, depression, bipolar disorder, social phobia, and even suicidal thoughts. Several studies have indicated that the prevalence of anxiety and depression in women with PCOS is significantly higher than in non-PCOS women of the same age.  Women with PCOS have higher depression scores and a higher risk of depression.

A recent systematic review and meta-analysis in the Journal of Neuropsychiatric Disease and Treatment further explore the association between anxiety, depression, and PCOS. Women with PCOS were nearly three times as likely to report anxiety symptoms compared to women without PCOS. Similarly, women with PCOS were more likely to have depressive symptoms compared to women without PCOS.

Can PCOS affect mental health?

Yes, it can. PCOS is a major contributor to mental health issues in women due to the abnormality of hormones. Testosterone, which is present in abnormally high levels in women with PCOS, besides causing the physical appearance of these women like the growth of facial hair in a male pattern, acne, thinning or loss of scalp hair, oiliness of the skin, also causes psychological problems like irritability, aggressive behavior, and depression.

We as a society are obsessed with perfect faces, perfect bodies and anything short of perfection is considered as unworthy. PCOS which causes hormonal imbalances, especially in females who are obese, have unwanted facial hair and acne-prone oily skin leading to a feeling of loss of feminity also reports to have higher incidences of low self- esteem and disturbed interpersonal relationships which cause anxiety and panic attacks leading to depression.

PCOS often causes menstrual irregularities and difficulty in conceiving. This is because the high levels of male hormones(testosterone) prevent the release of the eggs from the ovaries which leads to difficulty in conceiving.PCOS is nowadays a leading cause of infertility. Many of these patients often need assisted reproductive techniques to get pregnant.

These treatments can be physically, financially, and emotionally draining for the couple and causes more stress, and further adds to anxiety for the couple and their families causing sleep disorders, insomnia, and feeling of hopelessness. In women with infertility with   PCOS,   stress levels seem to be higher due to added effects of negative body image along with psychosocial effects associated with infertility.

This feeling of hopelessness may even lead to binge eating, further aggravating obesity and the subsequent symptoms of PCOS. Thus, PCOS patients are trapped in a vicious cycle of hormonal imbalance and loss of self -esteem

What can you do?

What is important to note is that PCOS is a lifestyle problem, the symptoms of which can be easily controlled by simple daily modifications. Once the hormonal imbalances get corrected by simple measures like exercise, dietary restrictions, and modifications, the psychological manifestations like anxiety, depression, mood swings, and binge eating get automatically controlled.

  • Daily exercise of 30-40 minutes leads to release of endorphins( happy hormones released during exercise) which leads to mood upliftment and sense of well – being .
  • Yoga and meditation also keep negativity at bay
  • Dietary restrictions like avoiding foods with a high glycemic index like bakery products, sugary drinks, rice, less saturated fats, and eating unprocessed foods, whole grain cereals leads to less release of insulin in the body which causes decreased levels of testosterone.
  • Loss of weight by exercise and simple dietary changes leads to increased self-esteem due to more acceptance by peers and societal approval leads to decreased psychological problems. The addition of supplements like omega fatty acids and Vitamin D also are known to be mood uplifting
  • The role of a supportive family also goes a long way is controlling the psychological symptoms of PCOS.

Hence women with PCOS are more prone to anxiety and depression with a higher prevalence of moderate to severe anxiety and depression than those without  PCOS.  Routine assessment for anxiety and depression in women with PCOS and early intervention can help reduce the negativity these women harbor and can help improve the quality of life of these women.

Loss of sleep, poor self-esteem leading to worthlessness and frustration and even suicidal thoughts are intricately linked with the delicate balance of hormones which is severely disturbed in those women who are not paying enough attention to their health.

It is important that women should learn to relax, keep stress at bay and notice the subtle signs the body is signaling before it snowballs into mental health issues.

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