The link between PCOS and mental health


If you are affected mentally by PCOS, don’t worry, there are steps you can take to help improve your emotional wellbeing. — AFP

Polycystic ovary syndrome (PCOS) is a hormonal disorder experienced by women.

The symptoms often manifest around puberty.

Studies have found that anywhere between 27% to 50% of women with PCOS report being depressed, compared to around 19% of women without PCOS.

Polycystic ovaries have a large number of harmless follicular cysts that can go up to 8mm in size.

In PCOS, these sacs are often unable to release an egg, which means that ovulation does not take place.

Although more than half of women who have PCOS do not display any symptoms, the condition is commonly associated with the following:

  • Irregular periods – most commonly, prolonged or infrequent periods
  • High levels of male sex hormones (androgens)
  • Small collections of fluid, called follicular cysts, on the ovaries
  • Insulin resistance, leading to elevated blood sugar levels

Nearly two-thirds of women who suffer from PCOS are insulin-resistant.

And for some reason, a higher percentage of women with both PCOS and insulin resistance also suffer from depression.

One theory is that insulin resistance can affect the body’s way of producing hormones in the long term, resulting in depression and stress.

Related factors

Some patients with PCOS report feeling frustrated and anxious about their ability to become pregnant, their weight, and their excess body and facial hair, as well as a sense of lacking control over their health and bodies.

Two important influencing factors are the person’s values and the culture they live in, as these can have a strong impact on which symptoms of PCOS they find distressing.

Women with PCOS who have anxiety or depression may also have lower levels of certain neurotransmitters such as serotonin.

Serotonin is a chemical messenger within the nervous system that is associated with positive feelings.

It plays a key role in a person developing depression or anxiety.

While women with PCOS face an increased risk for depression and anxiety, one study showed that such women who also have low levels of serotonin and other neurotransmitters, report more symptoms of depression and anxiety.

Hormone levels may also play a role in the development of PCOS, and researchers have been looking into this factor.

Some women with PCOS have insulin resistance, resulting in higher levels of insulin in the bloodstream.

A greater level of insulin resistance increased the risk for depression in some studies, although others found no difference.

Hence, more research is needed to determine the actual situation.

Androgens, which includes testosterone, are usually elevated in many women with PCOS.

Only one study has looked at the association between testosterone levels and mental health.

It found that the level of testosterone in the body had no effect on the symptoms of depression and anxiety.

Higher levels of DHEA (dehydroepiandrosterone) – another androgen – may be associated with increased risk for depression and anxiety in people with PCOS.

But this association was only found in one study and more research is needed.

Treatment options

There are a few types of treatments to consider for those with both PCOS and mental health issues:

> Anti-depressants

A doctor can prescribe anti-depressant drugs for patients who want to try medication for their depression, but the side effects may not be so desirable.

Anti-depressants that belong to a group known as selective serotonin reuptake inhibitors (SSRIs), such as sertraline and escitalopram, can cause high levels of a hormone called prolactin to be released.

High prolactin levels interfere with the normal production of other hormones, such as oestrogen and progesterone.

This can lead to irregular periods or cause ovulation to stop.

> Supplements and medications

Women with PCOS may also be prescribed supplements or medications for anti-anxiety or insulin aids.

Although no studies have been done on the treatment of people with PCOS with such medications specifically, they may help to improve symptoms of depression in these patients.

Metformin, a diabetes drug, may also help with anxiety symptoms.

Key supplements for PCOS patients include omega-3 fatty acid from fish oil.

It can be taken in combination with vitamin D, which may also help decrease symptoms of depression and anxiety in these patients.

> Lifestyle changes

Switching to low-calorie diets and adding exercise to one’s routine can help alleviate symptoms of depression.

However, they do not help with anxiety.

In general, staying fit and eating healthy can help improve one’s mental health.

This is facilitated by the release of dopamines (the “feel-good” hormone), the pleasure of making new friends or working out in a group, the reassurance of discipline, and the sense of achievement when you make it to your fitness goals.

Women with PCOS who reported exercising regularly had fewer symptoms of anxiety and depression.

With at least 150 minutes of moderate exercise each week, they were able to decrease their feelings of depression.

> Alternative therapies

Alternative therapies can be a great add-on to treatments for dealing with depression and anxiety brought on by PCOS.

Patients with PCOS can try acupuncture, mindfulness practices, yoga, breathing exercises and meditation to relieve their anxiety.

Women with PCOS who see an increase in facial hair may feel uncomfortable and want to seek treatment to remove it.

Laser hair treatment is a safe and lasting hair-removal procedure, which can help patients feel more confident about their appearance.

Getting the right amount of nutrition from your diet and correcting hormonal imbalances should be a priority as well.

Eating the right foods that we know are good for us can have a positive mental effect, as we are fortifying our bodies with a good diet.

Basically, mental and self-care are really essential.

PCOS patients should not ignore their symptoms and leave them untreated.

Women who are diagnosed with PCOS and feel depressed, anxious or notice other changes in their mood, can talk to their healthcare provider about possible treatment options.

Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist, and a functional medicine practitioner. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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