Polycystic Ovary Syndrome and Mental Isolation

By: Marhamah Sohail

Polycystic ovary syndrome, or PCOS, is a condition that affects a woman’s ovaries (1). Some of the symptoms can include irregular periods, difficulties getting pregnant, excess hair growth, among others (1). PCOS is a serious condition that affects roughly 1 in 12 women (2), making an important point to talk about and consider. While the physiological and biological conditions and effects are well-understood, the mental health effects need to be discussed, which this article will talk about. Because of the complex nature of PCOS, it has psychological repercussions on a woman’s health and her overall well-being. In fact, depression, anxiety, bipolar disorder, and obsessive compulsive disorder, are all associated with PCOS (3). Not only, but PCOS is associated with worse symptoms in these areas (3), making the mental health effects an important factor to look at. This article will focus on PCOS’ relation with the mentioned mental illnesses.

Depression is characterized as “a common and serious medical illness that negatively affects how you feel, the way you think and how you act” (4). Currently, depression is the most studied mental illness in terms of PCOS, with women reporting worse than normative samples (5). Unfortunately, the link between PCOS and depression is not well understood. An example of this is how both higher androgen (a hormone) levels are not correlated to depression in women with PCOS (5). Androgen, like testosterone, is a male reproductive hormone. However, testosterone has been found to be associated with better moods (5), illustrating the confusing nature of PCOS and depression. The complicated nature of PCOS and depression, even down to the chemical level, means there are other factors that can be addressed, such as; exercise, quality of life (ie. a social determinant), bodily insecurity, or even the hormonal imbalances associated with irregular periods. The link is an important factor to consider, and a reminder that syndromes like PCOS also have severe psychological ramifications that can invade every aspect of a person’s life.

Bipolar disorder is another important mental illness associated with PCOS, as mentioned. An explanation for the high rates of bipolar disorder in women with PCOS may be antiepileptic drugs (AED) (5). AED are used for the treatment of epilepsy (6), and are frequently used to treat bipolar disorder as well (5). Unfortunately, the relationship between PCOS and bipolar disorder is also incredibly complex and at times, contradictory. While AED are presumed to “directly or indirectly promote PCOS '' (5), there have been studies concluding that this probably is not the case (5). However, the samples for these studies tend to be small and limited (5), which may be a limitation in the discussion about PCOS and bipolar disorder. Furthermore, while AEDs have not been shown to independently cause PCOS, an AED like valproate may cause higher levels of androgen, leading to bipolar disorders (5). As Himelein and Thatcher say, the relationship between PCOS and bipolar disorder needs further research and is limited by research problems that include unclear diagnostic criteria, small study samples, and control groups (5). While PCOS and bipolar disorder show the complicated effects of the syndrome, they also show how studies can sometimes limit the discussion around the psychological symptoms of women with the syndrome.

Finally, the last one we will discuss is eating disorders and body dissatisfaction. Previous studies have shown women with PCOS to experience “profound feelings of despair” (5). PCOS has many physical manifestations, and one of them is hirsutism, a condition that causes excessive body hair growth (5). This had women feeling unfeminine and insecure (5). Not only, but women with PCOS, obese or otherwise, report higher feelings of body dissatisfaction when compared to women without PCOS (5). The effects of body dissatisfaction can be immense on people with PCOS, but with women who have the syndrome, it may explain the relationship between PCOS and higher depressive symptoms (5). Not only, but there may be links to anxiety disorders as well, and clear links to eating disorders (5). Bulimia is an eating disorder that many women with PCOS suffer from, and women with bulimia are also more likely to have PCOS (5). The relationship between body dissatisfaction and eating disorders with PCOS unearth a variety of potentially causal relationships that concern depression and anxiety, further illustrating the incredibly complex nature of the syndrome.

Overall, PCOS is a syndrome that affects every aspect of a woman’s life. While physical and biological manifestations are incredibly important to discuss and study, we cannot ignore or minimize the psychological effects. As shown through this paper, PCOS is an incredibly complex syndrome that has many contradictory associations with different mental illnesses, like depression or bipolar disorder. The nature of these associations makes understanding the links even more complicated, and may mitigate the suffering that women with PCOS face in their daily lives. While academic stances on this are important, we must remember that the experiences of those with the syndrome are vital to the syndrome’s understanding. As mentioned, studies with a low sample size can contribute to a lack of understanding about PCOS, and an improvement in this area can provide us with more insight.

References

1. NHS. “Overview: Polycystic ovary syndrome.” Last modified February 1, 2019. https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/symptoms/

2. Mayo Clinic. “Polycystic ovary syndrome (PCOS).” October 3, 2020. https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439#:~:text=Polycystic%20ovary%20syndrome%20(PCOS)%20is,fail%20to%20regularly%20release%20eggs.

3. Brutocao, Claire, Feras Zaiem, Mouaz Alsawas, Allison S Morrow, M Hassan Murad, and Asma Javed. “Psychiatric Disorders in Women with Polycystic Ovary Syndrome: a Systematic Review and Meta-Analysis.” Endocrine 62, no. 2 (2018): 318–25. https://doi.org/10.1007/s12020-018-1692-3.

4. Torres, Felix. “What is Depression?” American Psychiatric Association. October 2020.https://www.psychiatry.org/patients-families/depression/what-is-depression

5. Himelein, Melissa J, and Samuel S Thatcher. “Polycystic Ovary Syndrome and Mental Health: A Review.” Obstetrical & Gynecological Survey 61, no. 11 (2006): 723–32. https://doi.org/10.1097/01.ogx.0000243772.33357.84.

6. Ochoa, G. Juan. “Antiepileptic Drugs.” Medscape. Last modified September 22, 2020. https://emedicine.medscape.com/article/1187334-overview