PCOS & Mental Health: Can PCOS Cause Depression & Anxiety?

What is PCOS?

PCOS stands for polycystic ovary syndrome. This is a common hormonal and metabolic condition that affects around 10% of the female population¹. The main symptoms are irregular or loss of periods, acne, hair growth or loss and difficulty getting pregnant. However, we know from listening to the experiences of women with PCOS, this condition has far reaching effects on almost every part of your body.

Can PCOS affect your mental health?

PCOS and mental health are closely linked. International guidance has shown that PCOS mental health issues are under-recognised and common². 

The reason for this link is unclear, but there are certainly many issues related to PCOS which can affect your mental health³. These can include:

• A long wait until diagnosis and the feeling dismissed about your symptoms
• Myths that PCOS is simply a condition that affects your ovaries, when it’s so much more
• Societal and cultural expectations about femininity and fertility placing added pressure on women with PCOS
• Self esteem and body image concerns due to the symptoms of PCOS like acne or hair growth
• Hormonal changes and fluctuations associated with PCOS
• Mood side effects due to hormonal medications or birth control used to manage PCOS

With all this to contend with, both you and your healthcare professional should be aware of how PCOS impacts mental health and ways to manage it.

PCOS and depression 

Can PCOS cause depression? The cause of depression is complex and often due to many factors. But if you have PCOS, you are at least two and a half times more likely to suffer from depression as someone without PCOS^4,5. And not only that, but if you do have PCOS and depression, the depression is more likely to be more severe. 

Depression rates may be higher in PCOS due to the hormonal imbalance with increased levels of androgens and cortisol in PCOS⁶. High levels of both these hormones have been found in people with major depression^5,7. 

Women with PCOS acne have higher rates of depression in PCOS⁸, which further supports that higher levels of androgens could be linked to mood changes.

PCOS and anxiety 

Research studies have shown that around 37% of those with PCOS will suffer from anxiety at some point⁹. This is two and a half times more likely than someone with PCOS. 

PCOS and mood swings 

PCOS mood swings can be caused by insulin resistance and hormonal surges trying to help you release an egg each month. 

Insulin resistance makes it more difficult for your body to regulate chemicals in the brain which can affect your mood, especially if your blood sugar levels go up and down¹⁰.

In PCOS, your body finds it harder to ovulate, and some people will have surges of lutenizing hormone (LH) and oestrogen more frequently than people who don’t have PCOS⁶. LH and oestrogen fluctuations can cause mood swings.

PCOS and self esteem

Some of the symptoms of PCOS can have an impact on your self esteem and body image. This includes acne, unwanted hair growth (hirsutism), hair loss and difficulty managing your weight. 

The fact that PCOS can be associated with low self esteem shows that society is not supportive or understanding of the condition, and emphasises the pressure women face to meet a “cultural norm” (that frankly shouldn’t exist as we’re all uniquely beautiful).

Learning how to manage your PCOS symptoms can help with self esteem, but more importantly, it’s about learning to love yourself.

PCOS and fertility issues 

70-80% of people with PCOS can struggle to get pregnant¹². This is mainly due to the fact that you don’t ovulate as regularly or as often with PCOS, but you can optimise your fertility in other ways to help.

Dealing with fertility issues is tough. It can often feel like you are completely alone and everyone else around you is pregnant. It’s no wonder that people may feel depression, anxiety, anger and frustration¹³.

The good news is that treatment for PCOS fertility issues is successful, with medications alone leading to a baby in 70% of cases.

How to treat mental health issues with PCOS 

We know that having PCOS can cause mental health issues. So let’s learn about how to manage your mental health and overall wellbeing.

Lifestyle changes

Exercise is proven to reduce the risk of anxiety and depression in the population¹⁴ and to improve depression in women with PCOS¹⁵. Any exercise you enjoy is beneficial, whether that’s dancing, rock climbing, spin classes or throwing around heavy weights, move your body in a way you enjoy.

Diet is a great way to control your PCOS symptoms and your overall wellbeing and mental health. However, I absolutely hate the idea of “going on a diet” for PCOS, especially as those with PCOS are at higher risk of disordered eating(11). This is not about the scales, this is about nourishing your body. Whole and nutritious foods support your hormonal health, while a variety of fruit and veg can improve your gut microbiome which may be implicated in PCOS symptoms.

Sleep is incredibly important for hormonal balance but sleep is also affected by PCOS. Practising sleep hygiene and prioritising good sleep can help improve your wellbeing.

Therapy

Therapy is the number one recommended treatment for PCOS mental health¹¹. Cognitive behavioural therapy (CBT) is particularly good for body image and low self esteem¹⁸.

Accessing therapy is easy, you don’t even need to see a doctor. BetterHelp is one of the world’s largest online therapy platforms. Research shows that online, virtual or tele therapy are appointments are effective treatments¹⁹, and they also mean therapy can fit easily into your life.

BetterHelp matches you to a therapist who suits you and your needs, which is so important when you are already dealing with the stigma PCOS can face. Finally, a membership with BetterHelp means that you can access therapy and lifestyle coaching long term as research has shown that the positive effects on body image and self esteem can wear off after therapy sessions finish¹¹.

What’s more, if you access BetterHelp via The Lowdown, you can get 25% of your first month’s subscription using this link.

Medication

Medication can be used to treat the symptoms of PCOS which overall, may improve mental health. These may include metformin, spironolactone, hormonal contraceptives or newer medications such as Ozempic or Mounjaro^11,20.

Medications can be specifically used for PCOS mental health treatment. These include:

• Hormonal birth control which can help to reduce androgens and hormonal fluctuations throughout your cycle
• Anti-depressants. Although guidance states that these should only be used if therapy hasn’t worked or you are feeling suicidal¹¹. There needs to be a balance of using anti-depressants against the side effects they cause, such as weight gain and sexual problems which are already features of PCOS¹¹.

When to speak to a doctor

If you’re facing problems with your mental health, it’s important to not face it alone. Please reach out and speak to someone, whether it’s a healthcare professional, a trusted friend or through a PCOS support community.

If you have thoughts of harming yourself or thoughts of suicide, you must call for help.

In the UK call the Samaritans on 116 123 or 111 option number 2.

In the US call or text the National Suicide and Crisis Lifeline on 988.

These are available 24/7 365 days a year.

Your doctor is there to support you through everything PCOS has to offer, and if you struggle to get an appointment, or want longer appointments with someone who really understands, you can always book to speak with a Lowdown doctor.