Psychiatric Complications in Women with Polycystic Ovary Syndrome Most Often Linked to Menstrual Irregularities

Polycystic ovary syndrome (PCOS), a hormone imbalance that causes infertility, obesity, and excessive facial hair in women, can also lead to severe mental health issues including anxiety, depression, and eating disorders.

A study supervised by Columbia University School of Nursing professor Nancy Reame, MSN, PhD, FAAN, and published in the Journal of Behavioral Health Services & Research, identifies the PCOS complications that may be most responsible for psychiatric problems. While weight gain and unwanted body hair can be distressing, irregular menstrual cycles is the symptom of PCOS most strongly associated with psychiatric problems, the study found.

 “We were surprised to find that menstrual abnormalities in women with PCOS was the strongest predictor for mental health issues, particularly when there are so many other symptoms—like beard growth and infertility—that can make a woman feel unfeminine,” says senior author Nancy Reame, the Mary Dickey Lindsay Professor of Disease Prevention and Health Promotion at Columbia Nursing. “The study findings suggest that we can’t treat PCOS effectively unless we pay close attention to any signs of mental distress.”

The study evaluated psychological symptoms in 126 women diagnosed with PCOS. Participants completed surveys using a standard tool for evaluating mental health, the Brief Symptom Inventory (BSI), and their responses were compared with those of adult women in the general population and of adult women undergoing outpatient psychiatric care. While small, and not a randomized controlled trial, the study offers insight into the psychiatric manifestations of different PCOS symptoms, Reame says. Body hair and menstrual problems most strongly predicted anxiety, while obesity was most strongly associated with hostility, the study found.

In addition, the study found that for all nine mental health disorders measured by the BSI, the women with PCOS had significantly higher levels of psychological distress than the general population. For more than half of those disorders, the women with PCOS had distress levels statistically similar to those of the female psychiatric patients.

“When we compared participants with women in the general population, we found significantly higher scores on all of the symptoms evaluated and on corresponding psychological distress measures, particularly for anxiety, depression, somatization (the conversion of psychological distress to physical symptoms), and interpersonal sensitivity,” says lead author Judy McCook, PhD, RN, professor of nursing at East Tennessee State University.

PCOS is estimated to Affect 6 to 17 million women aged 18–44 in the U.S. It is one of the most common causes of infertility. There’s no single test to diagnose PCOS, and there’s no cure. The disorder is typically characterized by an excess production of the hormone testosterone, irregular ovulation, and cysts, or fluid-filled sacs, in the ovaries.

The paper is titled: “Differential Contributions of Polycystic Ovary Syndrome (PCOS) Manifestations to Psychological Symptoms”; it was published online in January 2014. The other authors are: Beth Bailey, PhD; Stacey Williams, PhD; and Sheeba Anand, MD (all from East Tennessee State University). The research was partially funded by the NIH Contraception and Infertility Loan Repayment Program. The authors declare no financial or other conflicts of interest.