PCOS And Mental Health

Introduction

Polycystic ovarian syndrome (PCOS) is a real challenge for an individual’s health during their childbearing years. It currently affects 4-20% of people assigned female at birth (AFAB) during this period worldwide.¹ In addition, its interference with many aspects of people AFAB’s health, including not only physical and reproductive health but also mental health, makes it a difficult condition for both the affected people as well as their families.¹

What is PCOS?

We must understand the criteria for diagnosing PCOS in order to understand its effect on people AFAB's health. It took the whole 20th century to include people AFAB with polycystic ovaries in addition to the primary definition of PCOS, which included a rise in the androgen hormones, either clinically or through laboratory investigations, as well as the prolonged loss of ovulation cycles in people AFAB. The laboratory diagnosis includes a raised androgen level, especially free testosterone (male sex hormones) due to the reduction in its binding proteins that would eliminate its effect. In addition, low levels of female hormones, oestrogen and progesterone, are recorded.² 

Symptoms

The clinical diagnosis reflects the changes in the internal environment of the body by affecting the hormones that are found in the blood. 

People AFAB’s gynaecological stability is affected regarding the amount, duration, and frequency of the menstrual cycle, resulting in irregularities, an increase or a complete halt of menstruation (amenorrhoea). This is due to the suppression of ovulation, which is the ability of the ovary to release an ovum, as seen in the PCO definition. Individuals may also encounter difficulty getting pregnant due to the absence of an ovum for fertilisation.³

The physical appearance of a person AFAB is possibly altered, in the form of weight gain or signs related to masculinity, known as hirsutism. These later signs appear as overgrowth of body and facial hair, thinning of hair on the head, and acne (oil pockets) formation within the skin.⁴ With PCOS, higher levels of androgen hormones found in the blood are typically converted to male sex hormones. The rise of these sex hormones can then run interference with the brain responding adequately to the female sex hormones, resulting in failure to ovulate.⁵

These androgens also enhance the storage of fat by adipose tissues as well as the resistance of tissues to use glucose under the effect of insulin, causing obesity as well as possible type 2 diabetes mellitus, respectively.⁶

Hormonal changes affect mood

The rising level of free testosterone, especially when there is a mild increase in PCOS cases, has been independently associated with high levels of aggression, anxiety, and hostility. This was separate from depression, which may have another common cause related to body weight. However, this was not the case in people AFAB who were not overweight. This leads us to consider the hormonal and physical effects as two independent factors of mood changes in some cases.^7-9

The burden of chronic pain

Pain is a common physiological attribute in people AFAB during the ovulation cycle. This results from the stretch of the core and surface cells of the ovary to release the ovum. However, the degree of pain in PCOS is much higher according to some studies. Those studies suggested severe pain on top of ovarian malfunctioning and worsening of PCOS after exposure to stress, like that of anovulation. This highlights the effect of retaining the ovum inside the ovary and the failure of its release in PCOS, causing pressure on the ovarian cells and surrounding ligaments and tissues.¹⁰

Furthermore, the change in the frequency and amount of menstrual bleeding can cause more pain, especially with deficiencies of magnesium and vitamin D3, which antagonises the effect of calcium in potentiating muscle contractions. This results in higher sensitivity to pain in PCOS than in other people AFAB. Additionally, the psychological trauma and depression accompanying these changes may worsen the pain.¹¹

Increased rates of depression and anxiety

People AFAB with PCOS showed more susceptibility to depression, anxiety, bipolar disorder as well as compulsive obsession due to the stressful experience of changing their physical appearance.⁷ The human body overcomes this by reflex secretion of higher levels of cortisol in the body that inhibit the higher centres from secreting their normal hormones that affect mood and ovulation, in turn giving more space for the androgens to exert their variation effect.⁸

Understanding the effect of PCOS on mental health

The pain receptors in the brain can change their sensitivity to pain in response to different factors, including female sex hormones. As a result, the degree of pain response to the lowest pain level may be exaggerated in PCOS due to the effect on such pain receptors within the brain areas associated with emotions and memory. Examples of these areas are the amygdala, hippocampus, and insula. This would explain the rising crescendo pattern of pain that people AFAB with PCOS experience on each cycle.¹² 

If you’re worried about your or your loved one’s mental health

Medical support usually includes painkillers with some hormonal replacement for the deficient oestrogen and progesterone to balance the unopposed androgenic effect. However, mental health care is a must despite the high expense and how much medical coverage is needed for people AFAB for their variable symptoms. This support would include awareness sessions for the suffering people AFAB as well as their families in order to create an emotionally healthy environment to include these individuals.¹³

Conclusion

PCOS is a psychophysical disorder among the most common gynaecological disorders. Nevertheless, it is still managed easily if we consider the psychosocial impact in eliminating the effects of such disturbance. This would alleviate the burden on medical care and ease its role in controlling such disorders, being hormonal in nature.