“Something’s not right”

Mary, a woman in her early 20s, describes how she just hasn’t felt “right” for the past couple of years. She is tired, gains weight easily, and is self-conscious about the hair on her chin and chest. The acne on her face and back is getting worse, and her periods pretty much come whenever they want. She has been spending less time with friends and feels really down most days. She expresses frustration that her doctor just tells her to exercise more – she knows something else is going on. One of her friends was recently diagnosed with PCOS and Mary wonders if she might have it too.

What is PCOS?

Polycystic ovarian syndrome, commonly known as PCOS, is a group of related symptoms affecting females. Although there is no universally accepted way to diagnose this condition, experts estimate that between 5-18% of women may meet criteria. However, many clinicians use the Rotterdam Criteria to make a diagnosis:

• Signs of high androgen levels 
  • Excessive hair on face, chest, back
  • Male pattern hair loss 
  • Excessive acne
  • High measured levels of androgen hormones in the blood
• Menstrual cycle abnormalities
  • Irregular periods
  • No periods at all
• Polycystic ovaries
  • Many follicles seen on the ovaries during ultrasound

Many, but not all, people with PCOS will also experience fertility challenges, insulin resistance, high cholesterol, and obesity. They may also be at increased risk for endometrial cancer. In addition, the association between depression, anxiety, and PCOS is well documented in up to 50% of people with PCOS. 

How can PCOS affect mental health?

Up to 50% of people with PCOS may also experience depression, anxiety, and/or bipolar disorder.  There are many possible contributing factors to the increased risk of mental health concerns in this population:

• Stress from managing a chronic condition 
• Dealing with fertility challenges
• Insulin resistance
• High androgen levels
• Concerns about physical manifestations of PCOS, like excessive hair or hair loss, acne, and weight challenges 
• Increased levels of inflammation  
• Genetic factors 

How can I treat depression/anxiety if I have PCOS?

There are two ways to think about managing depression and anxiety symptoms in people with PCOS. First, addressing the physical manifestations of PCOS can be quite helpful:

• Many symptoms of PCOS can significantly improve by changes to diet and exercise
• Hormonal contraceptives (like birth control pills, patches, rings, implants, or IUD)
• Diabetes medications (like insulin, metformin, and other medications)
• Other medications that target acne and hair loss as well

If depression and anxiety don’t improve with the methods above, then it could be helpful to look into other treatments:

• Support groups can be very useful places to discuss the challenges associated with PCOS
• Therapy with a provider who is familiar with PCOS can also be helpful
• Patients may also consider treatment with antidepressant medications, which can improve both depression and anxiety symptoms

Talking to your doctor about PCOS and mental health

If you have concerns about PCOS and your mental health, reach out to your doctor first! Tell them your concerns and some of the specific things you have noticed. In addition, academic institutions, such as the Center for Women’s Mental Health, often have good information. A reproductive psychiatrist may be able to help you find the right medications. Although being diagnosed with PCOS can cause a lot of stress and anxiety, there are many ways to get support throughout diagnosis and treatment.