The link between PCOS and depression

Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects women of reproductive age (between puberty and menopause). This condition affects about 8-13% of women in their reproductive age. There are three features associated with PCOS: hyperandrogenism, ovulatory dysfunction, and the presence of cysts in the ovaries. A woman is diagnosed with PCOS when she has two of these three features. Hyperandrogenism refers to an excessive production of male hormones like testosterone. Ovulatory dysfunction involves a lack of ovulation or irregular ovulation. And cysts are fluid-filled sacs present in the ovary of a woman in place of healthy eggs.1,2

Symptoms of PCOS

Being a syndrome, PCOS is diagnosed when certain symptoms occur together. The symptoms of PCOS usually appear without a trigger and they may change with time. These symptoms vary depending on the feature of PCOS a woman has.

Symptoms of hyperandrogenism include

• Acne

• Oily skin

• Excessive growth of facial and body hair (hirsutism)

• Hair thinning

• Male-pattern baldness

Symptoms of ovulatory dysfunction include 

• Irregular periods

• Absent periods

• Lack of ovulation

• Infertility 

There are also certain complications common with PCOS

• Obesity

• type 2 diabetes

• high blood pressure

• high cholesterol

• heart disease

• endometrial cancer

• Psychological disturbances like anxiety, depression and a negative body image.1 

The Link between PCOS and depression 

Depression is one of the complications of having PCOS. Depression affected as high as 66.1% of women with PCOS in a previous study.3 Researchers are still studying the connection between PCOS and depression to discover the causes and possible treatments. However, multiple factors likely contribute to causing depression among women with PCOS. These include:

• Physical Appearance 

The symptoms and complications of PCOS such as excessive hair growth on the face and body, scalp hair loss, obesity, acne, and irregular periods may serve as a source of stress, low self esteem, social phobia, and depression to a woman with PCOS.4

• Stress 

Women with PCOS are at risk of having high stress levels. Stress is seen as one of the causes of hormonal imbalances observed in PCOS. Stress is also one of the major contributors to depression generally as well as among women with PCOS.5 

• Obesity 

As high as 60% to 80% of women with PCOS have obesity. And studies have shown links between obesity and depression or the risk of depression among women with PCOS who have obesity. This suggests that obesity plays a role in causing depression among many women who have PCOS.5

Obesity has been associated with an increased production of the stress hormone cortisol. And high levels of cortisol may result in the development of depression. Additionally, obesity may affect self-perception and self-image, which can contribute to depression among women with PCOS.6

• Infertility 

Ovulatory dysfunction due to PCOS accounts for about 75% of the cases of infertility in women. Infertility alone can be associated with depression in women. About 40% of women with infertility showed symptoms of depression in a previous study. Hence, it is no surprise that infertility can be a source of psychological burden to a woman with PCOS, especially if she has always wanted children. Social pressures to have children and ethnic or religious beliefs may also contribute to placing a psychological burden on women with PCOS and infertility.5,6

• Insulin resistance 

Insulin resistance has been linked to depression in previous studies although how this happens is still being studied by researchers. Insulin resistance has been observed in up to 75% of women with PCOS, and it may play a role in the development of PCOS. Insulin resistance has also been linked to depressive symptoms among women with PCOS. Insulin resistance alters the levels of hormones such as cortisol and neurotransmitters such as serotonin, adrenaline, and noradrenaline. These alterations may contribute to the development of depression in PCOS.5,6

• Socioeconomic factors

There are many socioeconomic factors that contribute to depression among women with PCOS such as marital status, concerns about childbirth, and the cost of managing a chronic condition and any future complications These may increase stress and contribute to depression among women with PCOS.4

Treatment Options for Depression in PCOS

There is no one drug used to treat PCOS. treatment of PCOS generally focuses on addressing unwanted symptoms or complications of the condition according to the affected woman’s desires. There are various treatment options available for depression in PCOS. However, more research is required to develop more treatments for depression in PCOS.

• Developing healthy lifestyle habits. 

This includes a healthy diet, exercise, weight management and quitting unhealthy practices like smoking

• Acupuncture. 

This treatment has shown positive benefits in the treatment of PCOS and PCOS associated depression.

• Psychological intervention: 

Techniques such as mindfulness-based stress reduction, cognitive behavioral therapy, and motivational interviewing may be used for depression in PCOS.6

References

1. Polycystic ovary syndrome [Internet]. [cited 2024 Nov 20]. Available from: https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome 

2. Dybciak P, Raczkiewicz D, Humeniuk E, Powrózek T, Gujski M, Małecka-Massalska T, et al. Depression in polycystic ovary syndrome: a systematic review and meta-analysis. Journal of Clinical Medicine [Internet]. 2023 Oct 10 [cited 2024 Nov 20];12(20):6446. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10607337/ 

3. Madhuri V, Koteswaramma CH, Snehika A. Prevalence of depression and anxiety among polycystic ovarian syndrome patients: a cross-sectional study. International Journal Of Community Medicine And Public Health [Internet]. 2023 Jun 29 [cited 2024 Nov 20];10(7):2566–70. Available from: https://www.ijcmph.com/index.php/ijcmph/article/view/11275 

4. Almeshari WK, Alsubaie AK, Alanazi RI, Almalki YA, Masud N, Mahmoud SH. Depressive and anxiety symptom assessment in adults with polycystic ovarian syndrome. Depression Research and Treatment [Internet]. 2021 Apr 17 [cited 2024 Nov 20];2021:6652133. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8075703/ 

5. Gnawali A, Patel V, Cuello-Ramírez A, Kaabi ASA, Noor A, Rashid MY, et al. Why are women with polycystic ovary syndrome at increased risk of depression? Exploring the etiological maze. Cureus [Internet]. 2021 Feb 22 [cited 2024 Nov 20];13(2):e13489. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7990040/

6. Xing L, Xu J, Wei Y, Chen Y, Zhuang H, Tang W, et al. Depression in polycystic ovary syndrome: Focusing on pathogenesis and treatment. Front Psychiatry [Internet]. 2022 Aug 31 [cited 2024 Nov 20];13. Available from: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.1001484/full  Assessed and Endorsed by the MedReport Medical Review Board