PCOS is linked to higher rates of depression, anxiety disorders, and other mental health conditions.
Hormonal imbalances, insulin resistance, and infertility are some of the ways PCOS can directly affect mood and emotional well-being.
With the right combination of support, it’s possible to manage both PCOS and your mental health.
Polycystic ovary syndrome (PCOS) is an endocrine disorder. It affects up to 13% [1] of reproductive-aged people assigned female at birth (AFAB). PCOS is characterized by irregular periods, excess androgens, and ovarian cysts. But PCOS doesn’t only affect your body. PCOS and mental health also have a deeply interlinked relationship.
The mental health impacts of PCOS are very real. But with the right support, it’s possible to manage both the physical and emotional challenges that can arise.
The connections between PCOS and mental health
Living with PCOS can affect your mental health in different ways. For example, people with PCOS are much more likely to live with mental health conditions, especially depression.
There are many direct biological links between PCOS and mental health.
Examples of these links include:
Hypothalamic-pituitary-ovarian (HPO) axis: The HPO axis is the system that controls hormone production and menstrual cycles. One of the main features of PCOS is a dysfunction of the HPO axis, which can directly contribute to the risk of depression.
Hormone imbalances: Because of the HPO axis dysfunction, people with PCOS often face hormonal imbalances, particularly excess androgens. One common theory states that excess androgens can directly cause depression and other mental health conditions, although research is limited [2].
Metabolic pathways: People with PCOS are significantly more likely to face metabolic syndromes like insulin resistance. Research has shown [3] that insulin resistance leads to brain changes and is a risk factor for depression.
Infertility: Up to 80% of people with PCOS [4] face infertility. Just knowing about this risk can significantly affect mental health for many people with PCOS. The risk of depression, especially, is high in people facing infertility, with and without PCOS.
Menstrual abnormalities: One of the symptoms of PCOS is irregular, heavy, or painful periods. This can be a significant risk factor for mental health. Physical discomfort and pain are highly linked with emotional distress. Irregular periods can also mean hormonal imbalances that directly impact mood.
Obesity: Up to 60% [5] of people with PCOS also live with obesity, which is highly linked with depression and other mental health conditions.
Co-occurring health conditions: PCOS often comes along with other physical health challenges like metabolic conditions and endometriosis. These health conditions are also linked with depression.
Physical changes and stigma: PCOS can sometimes lead to physical changes like facial-hair growth. If the person identifies as a woman, this can sometimes lead to lower self-esteem because of the stigma around how women “should” present in society.
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How PCOS can impact your emotional well-being
Research has found links between PCOS and many specific mental health conditions. Some examples include:
Depression
Depression is the mental health condition that’s most commonly associated with PCOS. People with PCOS are up to eight times more likely [6] to develop depression. The biological changes that come along with PCOS can directly contribute to depression.
Anxiety
People with PCOS are also more likely to experience higher levels of anxiety [7]. Some studies [8] have found that people with PCOS tend to have higher levels of stress hormones like cortisol, which could raise the risk of anxiety. But we need more newer research to be able to explain the relationship fully.
PMDD (premenstrual dysphoric disorder)
PMDD is a depressive disorder characterized by a persistently low mood that depends on your menstrual cycle. Since people with PCOS often have heavy periods, they often have worse premenstrual symptoms. This includes mood changes and depression.
Attention-deficit hyperactivity disorder (ADHD)
Smaller studies [9] have found that people with PCOS tend to have more severe ADHD symptoms. In addition, people who are born to mothers with PCOS are also more likely to live with ADHD [10]. We need more research to fully understand the relationship between PCOS and ADHD.
Eating disorders
Research shows [11] that people with PCOS face a higher risk of developing an eating disorder. The relationship could be due to a few different things. Depression, which is highly linked with PCOS, is a risk factor for eating disorders.
When mental health worsens PCOS symptoms
PCOS can directly cause mental health conditions — especially depression — through biological avenues. But PCOS and mental health can also have a two-way relationship and get locked in a vicious cycle.
For example, if you live with PCOS-related insulin resistance, you’re more likely to experience depression. And living with depression can make you less likely to engage in healthy lifestyle choices. Things like exercising, getting enough restful sleep, or eating a healthy diet might feel too challenging. This can then worsen your PCOS symptoms.
Stress also plays a role. People who live with mental health conditions are naturally more likely to experience more stress. And being under a lot of stress can lead to hormonal changes — especially increases in cortisol levels. This can make the hormonal imbalances of PCOS even worse.
Finding relief from mental health challenges with PCOS
Navigating both mental health and PCOS together can be complicated. But with the right support, it’s possible to manage both.
Talk to your doctor about PCOS treatment
Your first step should be to talk to your primary care provider about treating PCOS. PCOS directly leads to mental health challenges, so it’s important to address that underlying cause.
Unfortunately, PCOS (like many health conditions that only affect AFAB people) is highly misunderstood. Reports show [12] that it’s undiagnosed (and therefore untreated) in up to 70% of cases. So, it may help to find a provider who specializes in this condition.
Manage stress levels
Stress accounts for one of the direct relationships between PCOS and mental health challenges. In addition to PCOS treatment, it’s also important to learn how to manage your stress levels in healthy ways.
Understand what causes stress for you, and make sure you’re implementing strategies in your daily life to keep your stress down.
Practice self-care
Try to keep up with self-care — especially when it concerns your body. This can look like prioritizing restful sleep, eating nourishing foods, and moving your body. These things can’t replace PCOS treatment, but they can be helpful for both PCOS and your mental health.
Self-care can also mean addressing the emotional side of PCOS. For example, you might journal about your feelings or join a support group for people with PCOS.
See a reproductive psychiatrist
A reproductive psychiatrist may also be able to help. These psychiatrists don’t treat PCOS directly. But they specialize in mental health conditions that are linked with reproductive organs (like PCOS). They’re more likely to be familiar with PCOS symptoms and the way it interacts with mental health.
Psychiatrists can prescribe medications to help you manage your mental health that are also safe to take with PCOS. Reproductive psychiatrists are also more familiar with issues like infertility.
Talk to a therapist
If you live with PCOS, a therapist can help you cope with the emotional weight of managing a chronic health condition.
Therapists — especially those who are familiar with the impact of PCOS — can provide a space to process your feelings of grief or low self-esteem. They can also help you work through the challenges of infertility or body-image changes. If you also live with a mental health condition, a therapist can develop a treatment plan that addresses all your unique needs.
When supporting someone coping with both PCOS symptoms and their mental health, it’s important to emphasize physical well-being as much as mental well-being. Things like getting enough sleep, exercising, and eating healthy can help both areas.
Halee Fullerton, PMHNP-BC
Clinical reviewer
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The mental health effects of PCOS are very real. PCOS can feel overwhelming because it affects both your body and mind. But you don’t have to manage it without help. Addressing PCOS with your primary care provider, caring for your stress levels, and working with a therapist and/or psychiatrist can all help you feel better.
At Rula, we’re here to help you feel better. Rula makes it easy to find a licensed therapist or psychiatric provider who takes your insurance. That way, you don’t have to choose between great care and a price you can afford.
Rula patients pay about $15 per session with insurance, and 93% say they feel better after getting care through Rula. We have 21,000+ providers, and appointments are available as soon as tomorrow. We’re here to help you take the next step — wherever you are in your mental health journey.
References
- Polycystic ovary syndrome https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
- Plasma androgens and the presence and course of depression in a large cohort of women https://pmc.ncbi.nlm.nih.gov/articles/PMC7881099/
- Insulin resistance and the risk of incident depression: the role of age, glycemic status, and adiposity in a prospective cohort study https://pubmed.ncbi.nlm.nih.gov/40896368/
- Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice https://pmc.ncbi.nlm.nih.gov/articles/PMC4642490/#:~:text=INTRODUCTION,mandatory
- Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society https://www.sciencedirect.com/science/article/pii/S0015028208039095
- Why are Women With Polycystic Ovary Syndrome at Increased Risk of Depression? Exploring the Etiological Maze https://pmc.ncbi.nlm.nih.gov/articles/PMC7990040/
- Anxiety and Depression in Women with Polycystic Ovary Syndrome https://pmc.ncbi.nlm.nih.gov/articles/PMC9319705/
- Cortisol and polycystic ovarian syndrome - a systematic search and meta-analysis of case-control studies https://pubmed.ncbi.nlm.nih.gov/33818258/
- Attention deficit-hyperactivity disorder symptoms in women with polycystic ovary syndrome https://pubmed.ncbi.nlm.nih.gov/26449924/
- Association between polycystic ovary syndrome and risk of attention-deficit/hyperactivity disorder in offspring: a meta-analysis https://pmc.ncbi.nlm.nih.gov/articles/PMC8841975/
- Increased Odds of Disordered Eating in Polycystic Ovary Syndrome: a Systematic Review and Meta-Analysis https://pmc.ncbi.nlm.nih.gov/articles/PMC7918293/
- Up to 70% of women with PCOS remain undiagnosed https://www.va.gov/iowa-city-health-care/stories/up-to-70-of-women-with-pcos-remain-undiagnosed/
Saya Des Marais
Saya graduated with her Master in Social Work (MSW) with a concentration in mental health from the University of Southern California in 2010. She formerly worked as a therapist and motivational interviewing trainer in community clinics, public schools, mental health startups, and more.
Her writing has been featured in FORTUNE, GoodRX, PsychCentral, and dozens of mental health apps and therapy websites. Through both her clinical work and her personal OCD diagnosis, she’s learned the importance of making empathetic and accurate mental health content available online.
She lives in Portland, Oregon but you can find her almost just as often in Mexico or in her birthplace, Tokyo.
Halee Fullerton, PMHNP-BC
Halee is a psychiatric nurse practitioner with experience treating children, adolescents, and adults. She has worked in outpatient community health with children/adolescents as well as inpatient substance use disorder treatment. She currently sees patients via outpatient telehealth. Before becoming a psychiatric nurse practitioner, she worked in emergency rooms, medical-surgical units, long-term care facilities (including Alzheimer/dementia units) and the intensive care unit.
She chose a career in mental health because she wanted to help people and to contribute to breaking down stigma around mental health. She is especially passionate about working with people who are navigating substance use disorders, depressive disorders, and anxiety/trauma-related disorders. She has three labradoodles that she adores.
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