The Relationship Between PCOS And Mental Health

The overlap between physical and mental health has been well established in medical and psychological research, and the general societal understanding of how your physical and mental well-being can interact is improving. However, not everyone may know the impact that certain medical conditions can have on a person’s mental state. 

One such condition is polycystic ovary syndrome (PCOS), a condition that can affect people with ovaries. Symptoms associated with PCOS are also linked to increased mental health concerns. For this reason, learning how these conditions may interact could be helpful for anyone with a PCOS diagnosis. 

What is PCOS?

Polycystic ovary syndrome (also sometimes referred to as polycystic ovarian syndrome) is a common health condition that affects the hormone production of women and people with ovaries who have had their first menstrual period and have not yet gone through menopause (typically referred to as women of “reproductive age”). PCOS symptoms can be caused by the ovaries creating excessive amounts of androgen hormones.

Polycystic ovary syndrome gets its name from the small cysts, or fluid-filled sacs, that can form surrounding unreleased egg cells in the ovaries of people with the condition. These cysts can be visible on an ultrasound and can sometimes help women with PCOS receive a diagnosis. However, not everyone with PCOS develops these cysts, so they are not necessary for diagnosis. When cysts are present, they are often not painful and do not negatively impact physical health. 

Women with polycystic ovary syndrome are often diagnosed in their 20s and 30s if they are trying to become pregnant. Infertility is a common symptom of PCOS, and some people who have the condition without any other presenting symptoms may not realize they have PCOS until they begin trying to have a child. About 15% of people with ovaries experience PCOS. 

Symptoms of PCOS

Below are some of the most common symptoms of PCOS to look out for. However, speak to a doctor for a complete diagnostic panel. 

• Menstrual irregularities: PCOS may cause missed periods (not involving pregnancy) or heavy period bleeding.
• Hair growth/hirsutism: Some people may start growing excessive facial hair, chest hair, arm hair, or abdomen hair with PCOS. 
• Hair loss: Even if excessive hair growth is observed elsewhere, PCOS can cause thinning hair and bald patches on the head.
• Ovarian cysts: Cysts can form on the ovaries and may be painful or asymptomatic. 
• Acne: Acne may develop on the face, chest, and back and may be more challenging to treat and unresponsive to mitigation methods that work well for other kinds of acne.
• Weight gain: In some cases, PCOS causes obesity and difficulty maintaining a doctor-recommended weight.
• Acanthosis nigricans: This symptom involves darkening of the skin, especially on the neck and breasts, in the armpits and groin, and any other areas where the skin folds onto itself.
• Skin tags: People with PCOS may notice flaps of extra skin, usually on the neck or armpits.
• Infertility: PCOS is the most common cause of infertility in women and people with ovaries.

Risk factors for developing PCOS

Below are some of the most common risk factors for developing PCOS. However, anyone may develop this condition, so speak to your doctor if you notice new or worsening symptoms. 

Genetics

People whose biological relatives have or have had PCOS may have a higher chance of developing PCOS themselves. Current research indicates that the risk increases the closer one’s relative is (so a person whose mother had PCOS would be at a higher risk than a person whose aunt had the condition).

High androgen levels

Androgen hormones are responsible for some PCOS symptoms, including irregular periods, hirsutism, cyst formation, and acne. Some evidence suggests that experiencing sexual trauma or abuse at a young age could lead to increased androgen production in women and people with ovaries, potentially causing the development of PCOS. However, these experiences are not the only cause of high androgen levels.

If you are facing or witnessing abuse of any kind, the National Domestic Violence Hotline is available 24/7 for support. Call 1-800-799-SAFE (7233) or text “START” to 88788. You can also use the online chat. 

Insulin resistance

Insulin is a hormone that helps the human body turn sugars into energy. Insulin resistance is caused by the body not processing insulin correctly, which can lead to high glucose levels in the bloodstream. These elevated levels of glucose can cause a range of complications, including an increased risk of diabetes and increased production of androgens. 

Inflammation

Evidence indicates that people with PCOS also often have low-grade inflammation, though it is not currently clear if the inflammation causes PCOS or is a coincidence. A blood test can measure inflammation to assess a person’s levels of C-reactive proteins and white blood cells. 

Mental health impacts of PCOS

Because PCOS involves an imbalance in hormone production within the body, it can be common for the condition to also impact a person’s mental health. PCOS symptoms can cause a change in personal appearance, often in ways that are not viewed positively by society at large (skin tags, acne, etc.). These changes may lead to psychological distress and negatively impact a person’s self-esteem and sense of self. This situation can be one reason why people with PCOS typically rank lower on measurements of health-related quality of life. 

People with PCOS may also be more likely to develop mental health conditions than members of the general population. Research indicates that the following mental health disorders can be more common in people with PCOS:

• Anxiety disorders, including generalized anxiety disorder, social anxiety disorder, panic disorder, and phobias
• Depression (major depressive disorder)
• Eating disorders
• Bipolar disorder
• Obsessive-compulsive disorder
• Personality disorders
• Post-traumatic stress disorder (PTSD)
• Somatic symptom disorder, a mental health condition in which a person experiences physical symptoms with no clear medical cause

People with PCOS may be more prone to specific mental health symptoms as well, even if those symptoms do not rise to the level of meeting diagnostic criteria for specific psychiatric disorders. Current research has found that people with PCOS may be more likely to experience anxiety symptoms, psychotic symptoms, and symptoms of paranoia than people without PCOS. 

Caring for your mental health with PCOS

Doctors and psychologists have found that some of the mental health complications associated with PCOS may be directly linked to specific PCOS symptoms. Reducing or eliminating those symptoms might also address specific mental health concerns. For example, anxiety symptoms are often associated with menstrual irregularities, obesity, balding, excessive body hair, and infertility. Depression symptoms are more associated with acne and obesity. 

Even if treatment is effective in reducing certain symptoms associated with mental health concerns, living with PCOS may take a toll on your mental well-being. Interacting with the medical system can be stressful. If you are experiencing distress or other complicated emotions related to your experiences with PCOS, it may be helpful to talk to a therapist.

Self-confidence concerns related to PCOS and medical fatigue from seeing multiple providers may make the thought of leaving the house for an in-person appointment overwhelming. If you relate, it may be helpful to consider online therapy through a service like BetterHelp. With online therapy, you can chat with your therapist from the comfort of your home. If PCOS symptoms are impacting your physical appearance and taking a toll on your self-esteem, you can leave your camera off during online therapy sessions or communicate with your therapist via phone or in-app messaging instead. 

Research indicates that online therapy may be as effective as in-person therapy when addressing various mental health concerns, including improving self-confidence. One study found that a cohort of people who completed a course of online therapy reported increases in their sense of self-empowerment and overall self-esteem. If you are experiencing a negative sense of self or any other mental health complications related to PCOS, online therapy could be a helpful resource for you. 

Takeaway

PCOS can cause a range of symptoms that may have associated mental health impacts, including infertility, weight gain, acne, and hair growth. Because PCOS is a hormonal disorder, hormone production disruption and fluctuation can have additional adverse effects on mood and overall well-being. If you are experiencing mental health impacts related to PCOS symptoms, talking to a therapist could be beneficial. Consider contacting a provider online or in your area to get started.