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PCOS: Causes, Clinical Features, and Its Effect on Mental Health

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Polycystic ovarian syndrome is a hormonal disorder. Patients suffering from polycystic ovarian syndrome also suffer from several mental health issues.

Medically reviewed by

Dr. Shivangini Gupta

Published At June 7, 2023
Reviewed AtJune 7, 2023

Mental health disorder is one of the burning issues of recent times. Every one out of eight people in the world is suffering from mental health-related disorders. The prevalence of mental health disorders is higher among women than men. Around 41 percent of women suffering from depressive conditions compared to 28 percent of men. Several factors like medical issues, hormonal problems, social factors, and lifestyle conditions are related to mental health. Polycystic ovarian syndrome is a gynecological condition caused by hormonal disruption. Along with gynecological conditions women suffering from polycystic ovarian syndrome often suffer from mental disorders. Understanding the pathophysiological conditions behind PCOS can be helpful in understanding mental health-related conditions.

What Is Mental Health?

The mental welling of the person helps to cope with the daily ups and downs of life. It is related to the social, medical, physical, and psychological well-being of the person. It is an integral part of our health which determines the individual ability of the person to make decisions, build relationships and shape the world they live in. Mental health can be evaluated by several factors. Lifestyle patterns, expression of emotions, and daily activities are several determinants of mental health conditions. Excessive expressions of different kinds of emotions like anxiety, depression, and fear can be suggestive of mental health disorders.

What Is PCOS?

PCOS or polycystic ovarian syndrome is a hormone characterized by the increased level of male hormones in the female body. Four out of 20 women in the world who are their reproductive age suffer from this condition. In this condition, multiple fluid-filled sacks in the ovary can be detected.

What Are the Causative Factors?

The cause of this condition is unknown. But several risk factors have been identified which may cause this disorder. These are:

Familial and Genetic Factors - Familial and genetic factors are one of the most distinctive causes of PCOS. Different genes associated with steroidogenesis are responsible for this condition. Malfunctioning associated with CYP11a, CYP21, CYP17, and CYP19 genes is related to PCOS. On the basis of phenotypic factors, PCOS can be of four types. Phenotype A and B is more associated with menstrual dysfunction and insulin resistance. PCOS phenotype C is also associated with metabolic dysfunction. It s called ovulatory PCOS. The fourth type or type D PCOS is also known as the nonhyperandrogenic type and is not related to metabolic dysfunction.

Lifestyle Factors - PCOS is very much related to lifestyle. Obesity is one of the key factors which is responsible for PCOS. Obesity is responsible for altering metabolic activity. As a result, the low-grade inflammatory pathway is activated. Which is responsible for arrays of chemical and cellular events and responsible for PCOS. Smoking, drinking, and unhealthy food habit are also associated with PCOS.

Imbalance in the hypothalamic–pituitary–ovarian (HPO) axis and metabolic dysfunctions like insulin resistance is associated with PCOS. In PCOS the level of androgen (male sex hormone) is high. The high level of androgen is responsible for elevating the level of luteinizing hormone (LH) and gonadotropin-releasing hormone (GnRH). The level of follicular-stimulating hormone (FSH) remains unchanged or slightly decreases. This causes alliteration in the ratio between luteinizing hormone (LH) and follicular-stimulating hormone (FSH). Also, the level of anti-Müllerian hormone (AMH) is increased due to these factors. As a result, the ovulatory event is altered and the amount of circulating progesterone may decrease.

Insulin resistance is responsible for high levels of sugar in the blood. This is associated with the abnormal functioning of serine or /threonine kinase (an enzyme that regulates cell functioning). These enzymes are also associated with androgen biosynthesis. The level of estrogen and androgen is regulated by the action of sex hormone globulins and DHEAS (dehydroepiandrosterone sulfate, a type of steroid). Excessive insulin level lowers the level of both of these factors. Asa result, the amount of androgen in the body is elevated.

The clinical manifestations of PCOS are:

  1. Absence of period or irregular menstrual cycle.

  2. Presence of facial hair or hair in the unusual parts of the body.

  3. Thinning or loss of hair.

  4. Weight gain and irregular eating habits.

  5. The dark appearance of various parts of the body and skin folds.

What Is the Role In Mental Health?

The amount of clinically significant psychological symptoms of mental disorders is higher in PCOS patients. Around 37 percent of women suffering from PCOS deal with mental disorders like anxiety, and depression. The occurrence of depressive symptoms among PCOS is around three times higher and anxiety symptoms are four times more prevalent. Associated with these, conditions like bipolar disorders and obsessive-compulsive disorders are also seen in PCOS patients. These factors which are associated with mental disorders are the deficiency of inhibitory neurotransmitters. A decrease in the plasma level of serotonin (5-HT), dopamine (DA), gamma-aminobutyric acid (GABA), and acetylcholine (ACh) is associated with PCOS. The cause of these psychological problems. The factors associated with these are:

Excessive Androgen Level: The high level of androgen is one of the key features of PCOS. The free testosterone present in the blood crosses the blood-brain barrier and binds with and to the androgen receptor. This is responsible for disruption in the functioning neurotransmitters and immune systems. As a result, the amount of serotonin is decreased.

Inhibition of Neural Function: In PCOS condition over- expression of GABA-A receptor is seen. This upregulation is influenced by the action of the excess level of androgen. These receptors are linked to the inhibitory function of the neurons.

Obesity: Hypothalamic-pituitary-adrenal (HPA) axis is dysregulated in obesity. This causes the overproduction of cortisol (a type of stress hormone). This impaired glucocorticoid-mediated feedback mechanism (a regulatory mechanism of hormone secretion) is responsible for depression-like symptoms.

Insulin Resistance: Insulin resistance changes the molecular mechanism of the body. This is responsible for increased oxidative stress. This is associated with a decreased level of GABA. Insulin level is also associated with a reduced amount of Cholecystokinin. This hormone is associated with alteration in the eating pattern and depressing symptoms.

Inflammation: An altered inflammatory response is a clinical feature of PCOS. In this condition, the blood level of pro-inflammatory cytokines, interleukin 1, interleukin 6, and interferon-gamma is elevated. This causes a decrease in the activity of tryptophan (a factor needed for the production of neurotransmitters). Also, the level of serotonin is decreased due to the increased reuptake mechanism.

Physical and Social Factors: PCOS is related to changes in physical appearance and lifestyle. Conditions like weight gain, loss of hair, and the presence of facial hair are associated with social and psychological complications. Also, irregular menstrual cycle and infertility is associated with mental trauma for women.


Mental health is an integral part of physical well-being. Hormonal conditions like PCOS are associated with several mental health issues. Conditions like anxiety, depression, and mood disorders are related to hormonal and metabolic dysfunction of PCOS.

Frequently Asked Questions


What Are the Symptoms of Polycystic Ovarian Syndrome?

The symptoms of polycystic ovarian syndrome are:

- Absence of period or irregular periods.

- Weight gain.

- Oily skin.

- Thinning hair or hair loss.

- Excessive hair growth on the chest, face, buttocks, or back.

- Difficulty getting pregnant.


Can PCOS Be Cured?

PCOS (polycystic ovarian syndrome) cannot be cured, but management of symptoms is possible. Treatment options vary depending on the symptoms experienced. The main treatment options are:

- Lifestyle modification.

- Medications to treat acne and hair loss.

- Medications for treating acne and hair loss.

- Birth control pills if the affected is not planning to get pregnant.


What Foods Are the Best for PCOS?

Some of the good foods for PCOS are:

- Whole grains.

- Whole fruits.

- Omega-3-rich fish like salmon.

- Leafy green vegetables and other non-starchy vegetables.

- Protein-rich legumes.

- Olive oil.


What Type of Exercise Is Best for PCOS?

The best exercises for PCOD are:

- Steady-State Cardiovascular Workouts: The exercise intensity remains in the same range as a steady-state cardiovascular workout. It helps reduce insulin resistance, improves mood, and aids in weight loss.

- Strength Training: Strength training is a form of aerobic exercise (resistance exercise) that increases the strength of a group of muscles by making these muscles work against a force or weight.

- Mind-Body Exercises: Like Tai chi, yoga, etc., which help reduce stress.

- High-Intensity Interval Training (HIIT): HIIT includes high-intensity cardio exercises in short bursts followed by rest for the same period or longer.


Is PCOS a Hormone Imbalance?

PCOS (polycystic ovarian syndrome) is a type of hormonal imbalance in which the ovaries produce excess androgen hormones. This results in an imbalance of the reproductive hormones. Due to this, those with PCOS experience unpredictable ovulation, missed periods, and irregular menstrual cycles.


Is PCOS a Lifelong Condition?

Polycystic ovarian syndrome is a lifelong condition. It can lead to long-term health risks in the future. The condition is commonly linked to heart problems, high blood pressure, obesity, uterine cancer, diabetic mellitus, anxiety, sleep apnea, and depression.


How Can One Reduce PCOS Naturally?

Some natural remedies for PCOS are:

- Diet modification - include whole grains, non-starchy vegetables, legumes, whole fruits, etc in the diet.

- Nutritional supplements.

- Probiotic supplements.

- Exercises - regular exercise improves heart health and aids in lowering insulin resistance.

- Weight management.


Can Polycystic Ovaries Be Reversed?

PCOS is not a fully reversible condition—however, treatment options help in managing the symptoms. Most of the affected can lead a normal life without many complications.


Is PCOS Temporary or Permanent?

PCOS (polycystic ovarian syndrome) cannot be cured, but management of symptoms is possible.

Some women experience PCOS symptoms after the stoppage of hormonal birth control. This is referred to as post-pill PCOS and is mostly temporary and resolves without treatment.


What Are the Ways to Lose Weight With PCOS?

Some ways in which one can lose weight with PCOS are:

- Reduce carbohydrate consumption.

- Take a high-fiber diet.

- Include high-protein food and healthy fat in one’s diet.

- Probiotic supplement.

- Limit processed food intake.

- Regular exercise.

- Adequate sleep.

- Stress management.


What Hormone Levels Are Diagnosed With PCOS?

Blood tests for FAI (free androgen index) and testosterone help detect high androgen levels.

Blood tests are used for determining hormonal changes, but these changes are not universal. Those affected with PCOS show elevated levels of:

- LH (luteinizing hormone) is a pituitary hormone essential for normal ovulation.

- Estrogen hormone. (an ovarian hormone).

- Anti-mullerian hormone (a measure of the fertility level of the ovary).

- Insulin.


What Are the Differences Between PCOD and PCOS?

Though PCOS and PCOD (polycystic ovarian disease) sounds similar, they are not the same. In PCOD, the ovaries release immature eggs, leading to hormonal imbalance and swollen ovaries. On the other hand, in PCOS, due to endocrine issues, ovaries produce androgens in excess. This changes the eggs into cysts, which build up in the ovaries but are not released.

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Dr. Shivangini Gupta
Dr. Shivangini Gupta

Obstetrics and Gynecology


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