Hello everyone,
I hope you are well. Today we touch on a very sensitive topic: mental health. I will try to stay on the science side as much as possible as I recognise mental health is an incredibly personal topic.
This week’s question
Is PCOS linked to Anxiety?
If you think that this article might trigger unwanted anxiety or depressive feelings, please consider skipping it. If you are experiencing suicidal thoughts and/or any mental health distress, please know it's essential to contact your GP for help. Additionally, the Samaritans Helpline (116 123 or Text SHOUT to 85258) can offer support whenever needed.
I experienced anxiety for the first time in my life in November, and it was very scary. Not having control over my mind was new to me, and I can’t imagine how hard it must be for those suffering from anxiety/depression for a long time. I attribute this to losing my dad to cancer a few years back and not dealing with it properly at the time. Whilst going through this period of anxiety, my cycle lengthened a bit so I wondered if it was linked to my PCOS.
Is PCOS linked to Anxiety?
<Incoming rant> On top of dealing with irregular periods, weight gain, acne and the other conditions PCOS puts us at risk of, we also need to worry about our mental health. The most recent data shows that women with PCOS are up to six times more likely to develop anxiety and up to four times more likely to develop depression symptoms. The prevalence of anxiety symptoms is 42% in women with PCOS compared to 8.5% in women without PCOS.
🎉 Great news (ironic).
So, it does seem that anxiety is linked to PCOS. The mechanisms underlying the association of PCOS with anxiety and depression are poorly understood. For this reason, the Androgen Excess-Polycystic Ovary Syndrome Society in 2018 issued a call to action to make mental health with PCOS a research priority.
What do we know so far?
1. Coping with stress
Many studies suggest that high-stress levels are at the root of the mood and anxiety problems observed in women with PCOS. Having to deal with annoying symptoms and the fear of infertility automatically means we experience more stress. Excess hair and weight gain also puts us at a higher risk of image issues.
There are different ways of dealing with stress: Passive coping mechanism - trying to avoid or reduce unwanted emotions and Active coping methods - striving to resolve the problem. A fascinating study showed that women with PCOS tend to chose more passive coping mechanisms when they find themselves in stressful situations. Choosing passive ways of dealing with stress has been associated with higher incidences of anxiety.
In addition, we seem to have lower levels of ego-resiliency, which is the ability to respond to life circumstances in a flexible way: “This characteristic provides individuals with the necessary emotional, motivational, and cognitive resources for controlling their behaviour and adapting to changing circumstances.”
This is of course a generalisation, as everyone is different. For example, I consider myself pretty resilient but I can notice a tendency to pick up my phone in uncomfortable situations to avoid certain thoughts. As a women with PCOS, knowing that this is seen in research, it’s interesting and it gives me food for thought.
2. Insulin resistance
There hasn’t been any correlation between insulin resistance and anxiety. However, insulin resistance has been found to have a direct relationship with depression. A recent study to assess this association in women with PCOS showed that for each 1 unit increase in insulin resistance (HOMA-IR measurement), there was a 6% increased odds of having a positive depression screen.
A reason why this might be the case is that insulin plays a role in the dopamine pathway. Impairments in insulin signalling can lead to disruptions in dopamine signalling, further affecting the brain's reward and motivation mechanisms which can lead to symptoms of depression.
3. Hormonal Imbalance
Certain hormones can influence our mood. We all have experienced the irritability before our period:
Estrogen has the ability to induce higher levels of serotonin (happiness hormone), hence why in our first part of the cycle we tend to be happier. If we don’t ovulate, our levels of Estrogen and Testosterone will be unbalanced and could have an effect on our mood and anxiety
Thyroid hormones: Feelings of anxiety, restlessness, irritability, and nervousness are common symptoms of an overactive thyroid (hyperthyroidism). On the other end, an underactive thyroid can cause symptoms like fatigue and feelings of depression
4. Vitamin D deficiency
Recent research has found a possible link between vitamin D deficiency and depression in the general population. Vitamin D deficiency in women with PCOS has been reported to be anywhere between 30-70%. If you are experiencing depressive symptoms, testing your Vitamin D might be a good idea. Vitamin D is an essential nutrient for a lot of other functions in the body which affect PCOS. I have a whole article on this here.
There has not been any strong correlation between anxiety and obesity or high androgens.
Mental Health Support
I want to share some of the things that helped me whilst going through an anxiety period:
“You should not believe everything you think”. Our brain constantly comes up with thoughts and scenarios as a way of keeping us alive and safe. However, not all of these are true. I am ashamed to think I had to turn 29 to find this out.
I found that ACT (Acceptance and Commitment Therapy) principles help. I would recommend reading The Happiness Trap. It gave me a lot of tools to deal with my thoughts and how I experienced anxiety. I believe it to be an incredible tool for life.
Talking: I found that talking about these emotions with other people really helped as most of us experience periods of mental heath distress at a certain point in our lives.
Meditation: I often struggled to get into meditation as my mind is always racing, but the Waking up app changed that for me. Sam Harris’s guided courses are truly exceptional in training you to calm down.
Therapy: I believe therapy should be one of those things that everyone should do from time to time, irrespective of a mental health diagnosis. No one teaches us to deal with life, and I think therapists and psychologists can help guide our thinking and offer us tools to deal with difficult situations.
Samaritans: I believe these services are life-saving. If you are ever in a dark place, give them a ring (116 123 or Text SHOUT to 85258).
Lastly, I want to say that regardless of why anxiety or other mental health issues happen, we need to give it proper care. As we would go to a doctor when our arm is broken, I believe seeing mental health professional should be as easy and common. Breaking through the stigma will help everyone get the care they deserve. Sending you a lot of love for those suffering or those that have family who are going through mental health problems.
See you next Sunday,
Francesca
1 Sources
Cooney, L. G., & Dokras, A. (2017). Depression and anxiety in polycystic ovary syndrome: Etiology and treatment. Current Psychiatry Reports, 19(11). https://doi.org/10.1007/s11920-017-0834-2
Cooney, L. G., Lee, I., Sammel, M. D., & Dokras, A. (2017). High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction (Oxford, England), 32(5), 1075–1091. https://doi.org/10.1093/humrep/dex044
Dokras, A., Stener-Victorin, E., Yildiz, B. O., Li, R., Ottey, S., Shah, D., Epperson, N., & Teede, H. (2018). Androgen Excess- Polycystic Ovary Syndrome Society: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertility and Sterility, 109(5), 888–899. https://doi.org/10.1016/j.fertnstert.2018.01.038
Dybciak, P., Humeniuk, E., Raczkiewicz, D., Krakowiak, J., Wdowiak, A., & Bojar, I. (2022). Anxiety and depression in women with polycystic ovary syndrome. Medicina (Kaunas, Lithuania), 58(7), 942. https://doi.org/10.3390/medicina58070942
Disclaimer: We are all so unique in our own ways so this information is for educational purposes only. In my communications, I summarise research data and bring in my own experience. This shouldn’t be viewed as medical advice at any point. Please further consult your healthcare provider about your health needs.