Written by: Brynn Legros
Edited by: Shruti Shaji
Polycystic ovarian syndrome, known as PCOS, is an endocrine disorder that affects regular hormone secretion and regulation. It impacts the lives of millions of those assigned female at birth, which is estimated to account for about ten percent of women worldwide (Alur-Gupta et al., 2024). Symptoms of PCOS include irregular menstrual cycles, ovarian cysts, excess androgen which causes an increase in body hair and masculine features, weight gain, hair loss and headaches as well as acne and infertility. These symptoms present mostly physically and can be clearly identified by providers. However some of the most common and under-lying negative effects of PCOS are comorbid symptoms of depression and anxiety. This proposes a problem for many individuals who deal with this diagnosis since many are undertreated for mental health symptoms associated with PCOS.
PCOS can manifest into a variety of mental health conditions. Some of the most common forms of mental health issues that affect these individuals are depression and anxiety. Individuals with PCOS have an almost six-fold increase in chance of experiencing moderate to severe depression symptoms (about 36% odds compared to 14.2% odds for a control group without PCOS) (Alur-Gupta et al., 2024). As for anxiety, individuals with PCOS have a much higher risk of developing anxiety compared to general population studies. The prevalence of anxiety among patients with PCOS is about 76% compared to a 3.7% of combined lifetime prevalence across all genders, ages and global status (Alur-Gupta et al., 2024).
So what is causing these symptoms in PCOS patients, and how can we find a solution to this problem? One of the hypothesized major contributing factors of anxiety and depression among these individuals is body image distress. PCOS affects those assigned female at birth and often manifests in symptoms that present physically such as weight gain, facial hair growth, acne, and hair loss. These symptoms can dramatically change the way a person looks, often negatively impacting the way these individuals feel about themselves and their bodies. The manifestations of PCOS “make patients feel the loss of female characteristics and attraction, thereby reducing their self-esteem and physical satisfaction and negatively affecting their mental health” (Tzalazidis & Oinonen, 2020; Weiss & Bulmer, 2011, as cited in Yin et al., 2020 ). Unfortunately, there is not much research that takes into account the possible physiological or biological factors of polycystic ovarian syndrome that could contribute to the presentation of anxiety and depression within these individuals, but it is clear that PCOS can create a gender dysphoric experience for those who are affected. Fortunately, there are several options for treatment that can help with these symptoms.
In a meta-analysis study done by Dr. Alur-Gupta in 2024, it was found that lifestyle changes like adjustments in diet and fitness and use of contraceptives can counteract symptomatic weight gain or other irregularities in hormone secretion in patients, increasing self confidence and lowering depression scores among individuals with PCOS. However, one of the most common and efficient forms of treatment is CBT or cognitive behavioral therapy (Kodipalli, A., & Devi, S. (2021)). This therapy has the goal of identifying negative thoughts and changing the way that these negative life events can be rethought in a positive way. Patients usually complete about ten weeks of CBT sessions alongside the use of serotonin reuptake inhibitors which work together to reduce overall symptoms of depression and anxiety. In a societal context, we can also bring awareness to the way that PCOS symptoms present and stay mindful that just because someone looks different, that their gender identity and social identity are still valid and should be respected.
References:
Yin, X., Ji, Y., Chan, C.L.W., & Chan, C.H.Y. The mental health of women with polycystic ovary syndrome: a systematic review and meta-analysis. (2020). Arch Womens Ment Health, 24, 11–27. https://doi.org/10.1007/s00737-020-01043-x
Alur-Gupta, S.,Dokras, A., & Cooney, L.G. (2024). Management of polycystic ovary syndrome must include assessment and treatment of mental health symptoms. Fertility and Sterility, 121(3), 384-399. https://doi.org/10.1016/j.fertnstert.2024.01.018
Kodipalli, A., & Devi, S. (2021). Prediction of PCOS and Mental Health Using Fuzzy Inference and SVM. Front. Public Health, 9. https://doi.org/10.3389/fpubh.2021.789569
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