Introduction to PCOS and Its Impact on Mental Health

What is PCOS?

Polycystic Ovary Syndrome, or PCOS, is a hormonal disorder that affects women of reproductive age. PCOS can cause a range of physical and mental health symptoms that are related to hormone and neurotransmitter imbalances. Many women with PCOS experience physical symptoms related to hyperandrogenism, or overproduction of male hormones, like:

• Unwanted hair growth

• Male pattern baldness

• Irregular periods

• Weight gain

• Acne
  

PCOS is common but widely underdiagnosed. Evidence suggests it affects up to 13% of women of reproductive age, but the World Health Organization found that up to 70% of women with the disorder are undiagnosed.

Many of us are wondering why we’re experiencing these physical and mental symptoms but don’t realize that PCOS could be the culprit. There’s a strong connection between PCOS and mental health conditions like depression, anxiety, mood swings, attention-deficit/hyperactivity disorder (ADHD), and bipolar disorder.

PCOS and Mental Health

PCOS often occurs in tandem with mental health issues. Why are you more likely to experience mood swings and ongoing mental health conditions like anxiety, depression, and bipolar disorder with PCOS?

Studies suggest the link between PCOS and mental health issues stems from a few factors, including:

• Elevated male hormone levels

• Hormonal and neurotransmitter imbalances

• Chronic inflammation and pain

• Negative body image and self-esteem

• Difficulty conceiving and menstrual challenges

• Social stigma from visible symptoms

• Genetic predisposition
  

The hormonal and neurotransmitter imbalances that occur with PCOS can have a chain-reaction effect, leading even small changes in body chemistry to have real, palpable effects on your mental health, fertility, and wellbeing.

If you’ve noticed new hairs sprouting where they shouldn’t, hair thinning at an alarming rate, stubborn weight gain that isn’t easily fixed with diet and exercise adjustments, or ongoing problems with fertility, you know firsthand that these factors play a significant role in your mood, how you feel about yourself, and the way you perceive the world around you.

The result can be mood regulation issues, long-term challenges with anxiety and depression, or an increased likelihood of dealing with mood disorders like bipolar disorder. Women with PCOS are up to seven times more likely to experience moderate or severe symptoms of depression and anxiety than women without the condition [1].

Hormonal Imbalances in PCOS and Their Effects on Mood

Hormones are closely related to mental health and mood. Under ideal circumstances, they send chemical messages that help regulate your body and mind. But with PCOS, hormone levels are out of balance, and your mood and mental health may suffer as a result.

The Link Between Hormones and Mental Health

Hormones convey signals that trigger growth, sexual development, reproduction, metabolism, mood, and homeostasis. PCOS affects several hormones in your body that play a role in your mental health:

• Insulin: Women with PCOS tend to have higher insulin resistance, which leads to higher levels of insulin in the bloodstream and may be linked to PCOS depression and anxiety.
  

• Female hormones (estrogen and progesterone): Elevated estrogen and decreased progesterone levels in PCOS can lead to acne, disrupted menstrual cycles, weight gain, and fertility issues and can lead to symptoms of depression or anxiety disorders.
  

• Male hormones (testosterone): Elevated testosterone levels in women with PCOS can cause male characteristics like unwanted facial hair, acne, and male-pattern baldness, increasing risk of depression and anxiety with altered self-image.
  

• Gonadotropins (LH and FSH): Luteinizing hormone (LH) is usually elevated with PCOS, while follicle-stimulating hormone (FSH) levels may be lower, leading to ovulation issues and potentially linked to depressive episodes in bipolar disorder and mood swings.
  

• Hunger hormones (ghrelin and leptin): Levels may be lower (ghrelin) or higher (leptin) in women with PCOS, resulting in increased appetite with lower energy levels and mood swings.
  

Hormonal imbalances interfere with the chemical signals your body receives, giving these chemical messengers a large amount of influence on your mental health. When your hormones are out of sync, you might experience anxiety, depression, frequent mood swings, or other mental health issues.

How PCOS Affects the Brain and Mood

You’ve seen how hormones can contribute to mental health challenges with PCOS. Still, there’s another type of chemical messenger in your body that can affect your brain and mood with PCOS: neurotransmitters.

The word “neurotransmitter” stems from the Greek word neura, meaning nerve or nervous system, and the Latin word transmittere, meaning to pass on or send across. This is the role of neurotransmitters—they carry messages from your body’s nerve cells to regulate your heart rate, movement, mood, and energy levels. But with PCOS, neurotransmitter levels can be disrupted, leading to subtle or drastic changes to your mood.

If you have PCOS, you might have a chemical imbalance with a lower amount of dopamine, serotonin, glutamate, and other neurotransmitters in your body. These imbalances, combined with hormonal imbalances, can trigger conditions like ADHD, anxiety attacks, bipolar disorder, or depression with PCOS.

Let’s take a closer look at how PCOS influences your mood through neurotransmitter action:

• Serotonin: Regulates sleep, appetite, learning, and mood; low levels with PCOS are linked to anxiety and depression.
  

• Dopamine: Regulates motivation, mood, and sleep; decreased levels with PCOS are associated with depression, fatigue, stress, and increased ADHD or mood disorder risk.
  

• Gamma-aminobutyric acid (GABA): Regulates excitability by calming the brain; lower levels in women with PCOS can lead to mood disorders, autism, ADHD, anxiety and panic disorders, or post-traumatic stress disorder (PTSD).
  

• Glutamate: Stimulates nerve cells and regulates attention; increased levels in women with PCOS are associated with a higher risk of anxiety disorders, depression, obsessive-compulsive disorder (OCD), and PTSD.
  

• Acetylcholine: Regulates movement, sleep, focus, and involuntary functions (like heart rate and digestion); lower levels with PCOS may result in mood swings or mood disorders, like bipolar disorder and depression.

PCOS may decrease your levels of the neurotransmitters responsible for creating feelings of contentedness, calm, and relaxation, like serotonin, dopamine, and GABA. These effects are amplified with higher levels of excitatory messengers, like glutamate, that can lead to anxiety, panic attacks, migraines, and decreased pain tolerance.

Common Mental Health and Mood Disorders in PCOS

Mental health conditions like anxiety disorders and mood disorders have a strong link to PCOS. Let’s explore the connection between PCOS and mental health conditions, including anxiety disorders, depression, bipolar disorder, and ADHD.

Depression and Anxiety in PCOS

Studies show that your risk of depression and anxiety is increased up to seven-fold if you have PCOS. It’s estimated that 11-25% of women with PCOS suffer from depression, while 28-39% experience ongoing symptoms of anxiety [2].

Your risk of depression is elevated with PCOS due to imbalances and changes in the body. This includes insulin resistance, imbalances of male and female hormones, and decreased levels of neurotransmitters that are responsible for mood regulation. Poor self-image related to visible symptoms of PCOS and ongoing pain or physical symptoms can also be factors in developing depression.

PCOS and anxiety disorders are also seen frequently due to increased levels of hormones like estrogen and androgens, along with lower levels of certain neurotransmitters. Persistent feelings of worry, fear, and nervousness are common signs of anxiety, but it can also manifest in unexpected ways, like irritability, restlessness, shortness of breath, or increased muscle tension.

Bipolar Disorder and PCOS

Women with bipolar disorder are more likely to be diagnosed with PCOS than those without the disorder. Bipolar disorder is characterized by alternating mood swings between mania and depression.

PCOS may contribute to depressive and manic episodes. One study found that imbalanced gonadotropin levels (LH and FSH) were potential biomarkers in women with bipolar disorder [3]. Symptoms of mania, like impulsivity, increased energy, and decreased need for sleep, may be related to higher glutamate levels in women with PCOS.

Not every woman with PCOS will develop bipolar disorder, and not every woman with bipolar disorder will develop PCOS. While these conditions can cause similar symptoms, learning to differentiate between the two can be helpful.

• PCOS symptoms: Irregular periods, weight gain, acne, and unwanted facial hair growth. Mental symptoms like mood swings, depression, and anxiety may occur.
  

• Bipolar disorder symptoms: Severe mood swings with pronounced manic and depressive episodes lasting 4-14+ days, elevated confidence, sleep issues, and racing thoughts.
  

ADHD and PCOS

Studies indicate that women with PCOS have higher incidences of developing adult ADHD and of being diagnosed with ADHD during childhood. Scientists believe being born to a mother with PCOS is linked to ADHD due to exposure to higher androgen and sex hormone levels during development

PCOS and ADHD symptoms you may experience include:

• Difficulty focusing or paying attention with tendencies of forgetfulness and procrastination
  

• Disruptive or excessively energetic behavior with difficulties remaining still or controlling impulses
  

You can manage ADHD with PCOS with treatments, supplements, nootropics, and tweaks to your lifestyle. ADHD treatments include prescription stimulants, like methylphenidate (Ritalin) and nutritional supplements to improve cognitive function (nootropics), like L-theanine, caffeine, and creatine.

Fertility, Infertility, and Mental Health in PCOS

PCOS is the most common cause of infertility and problems with fertility—both of which can intersect with mental health issues. Because of increased androgen levels and potential ovarian cysts, PCOS is linked to issues with ovulation, menstrual irregularities, reduced egg quality, and trouble with implantation.

Impact of Infertility on Mental Health

When family planning, infertility is one of the most difficult challenges you can face with PCOS. Being unable to conceive or carry a pregnancy to term has a significant impact on your mental health and self-image.

As many as 40% of women with PCOS are diagnosed with a psychiatric condition. You may experience challenges with mental health when you’re dealing with PCOS infertility, including:

• Depression: Roughly 40% of women with PCOS experience depression, which is double the number of women without PCOS.
  

• Anxiety: Research indicates that around 36% of women struggling with infertility experience symptoms of anxiety and stress.
  

• Grief, anger, and guilt: About 45.5% of women with PCOS experience negative emotional impacts like these with infertility.
  

• Medication side effects: Fertility drugs and treatments have been associated with side effects that can include depression, mood swings, and irritability.
  

It becomes even more important to look after your health holistically when you’re struggling with PCOS infertility. You can manage mental health conditions that arise through therapy, psychiatric medications, supplements, and lifestyle changes.

PCOS and Postpartum Depression

Postpartum depression is a stark reality for many women with PCOS, especially if you experience depression and anxiety before or during pregnancy.

If you have postpartum depression, you might feel like you’re:

• Having trouble sleeping

• More anxious and irritable than usual

• Persistently feeling sad, angry, or guilty

• Struggling to bond with your baby

• Less hungry than usual
  

The same hormonal imbalances that create PCOS symptoms can lead to lingering issues with postpartum depression after childbirth. Seeking therapy or sharing your concerns with a healthcare professional can help you manage the difficulty of postpartum depression with PCOS.

Does PCOS Affect Mental Health During Pregnancy?

Studies show that a PCOS diagnosis has measurable effects on your mental health during pregnancy [4]. Women with PCOS are more likely to deal with anxiety (11.7%) and depression (8.9%) while pregnant, possibly due to fluctuations in hormones and lingering stress from fertility issues. Women with PCOS were found to experience anxiety and depression at nearly twice the rate of women without the condition during pregnancy.

Symptoms of Mood Swings and Mental Health Issues in PCOS

If you think you may be dealing with mood swings or other mental health issues along with PCOS, it’s essential to be able to recognize how these conditions may manifest.

PCOS and Mood Swings

PCOS mood swings related to hormonal and neurotransmitter imbalances or negative self-image may look or feel like unexpected shifts in mood, emotions, or outlook. Look for these symptoms:

• Sudden changes in emotion, including happy or hopeful to irritable, anxious, angry, or depressed.
  

• Emotional shifts that are more pronounced than premenstrual mood swings.
  

• Angry outbursts, trouble focusing, feeling overwhelmed, or lingering feelings of sadness or worry.

If your mood swings tend to be depressive or last longer than 4-7 days, it’s possible that PCOS depression or bipolar disorder could be an underlying issue. 

Experiencing PCOS mood swings can have far-reaching impacts on your emotional state, relationships, job, and daily life. Unpredictable mood changes can make it harder to do well at work and strain relationships. This is why treatment and healthy coping strategies are important to improving and maintaining your quality of life.

PCOS and Anxiety Attacks

PCOS anxiety or panic attacks can happen suddenly due to hormonal fluctuations, negative self-image, stress about your appearance or infertility, or other related factors. Look for symptoms like these if you think you’re experiencing an anxiety attack with PCOS:

• Shaking, dizziness, or trembling

• Intense feelings of fear, panic, or doom

• Trouble focusing or concentrating

• Fast heartbeat

• Shortness of breath

• Sweating

• Nausea
  

Anxiety attacks can be intense but are usually short-lived (between 5 and 20 minutes in most cases). Learning coping mechanisms, like meditation, grounding techniques, and positive self-talk, can help to stop an anxiety attack. You can seek treatment through therapy or medication to manage anxiety and panic attacks.

Natural Remedies for Mood Swings in PCOS

Natural remedies can be incredibly effective and offer a convenient way to treat and manage mood swings on your own, especially when used in conjunction with lifestyle changes and a good support system.

These are some of the most-studied natural remedies for mood swings in PCOS:

• Diet changes: Mood and food go hand in hand, so try adding more whole foods and grains, protein, fruits and veggies, omega-3 fatty acids, folate, and fiber to your diet to help stabilize your mood.
  

• Stress management techniques: Stress can contribute to mood swings, so managing stress with techniques like mindfulness meditation, physical activity, spending time in nature, relaxing hobbies, and deep breathing exercises can help.
  

• Supplements: Vitamins, nootropics, minerals, antioxidants, and plant extracts may be helpful in combatting mood swings with PCOS. Look for supplements like that contain effective ingredients like inositol, and vitamin D
  

• Exercise: Regular exercise can help balance hormones and neurotransmitter levels to stabilize mood swings in PCOS. Try yoga, walking, dancing, swimming, or playing a sport to help combat mood changes.
  

Treatment Options for Managing Mood Swings in PCOS

You have a range of treatment options available to you if you’re trying to manage PCOS mood swings. Medical, psychological, and holistic approaches can help you achieve wellness and better health.

Medical Interventions

• Antidepressants: Medications like selective serotonin reuptake inhibitors (SSRIs) may help alleviate depression and anxiety while treating other symptoms of PCOS, like unwanted hair growth and irregular periods, but side effects should be considered.
  

• Anxiolytics: These medications treat symptoms of anxiety but haven’t been widely studied with PCOS and should not be used long-term because they can be addictive. Clonazepam and Lorazepam are examples.
  

• Metformin: A diabetic medication commonly used for PCOS insulin resistance, it’s been shown to help regulate blood sugar, reduce androgen production, and help with anxiety, depression, and mood swings as a result.
  

Psychological Therapies

Psychological or talk therapy, including cognitive behavioral therapy (CBT), can be a valuable tool in managing PCOS depression, anxiety, and mood disorders. CBT helps you address the mental impacts of this condition on your life and helps manage anxiety, depression, and poor self-image that may accompany PCOS. You’ll learn to challenge negative self-talk and thought processes by replacing them with positive, uplifting behaviors and responses.

Support groups and group therapy are other helpful ways to deal with PCOS and related issues, like infertility or weight gain. Hearing from others who experience similar symptoms can help you feel connected and more apt to seek support. You can find groups that meet in person and a range of online and social media groups and forums to participate in.

Lifestyle and Holistic Approaches

Lifestyle changes and whole-body, holistic approaches are effective ways to deal with PCOS mood swings. Choosing healthier, whole foods and grains with vitamins, minerals, and higher levels of mood-enhancing nutritional substances, like omega-3 fatty acids and protein, offers a natural way to change your lifestyle and achieve a more stable mood.

Exercise releases endorphins and activates the “reward center” of your brain, helping even out your moods with PCOS. To get the most benefits, exercise regularly, at least 3-5 times per week. Learning meditation and mindfulness practices can help you challenge negative thought patterns and enter into a more balanced, positive mindset as you manage mood swings and other mental health challenges.

The Role of Stress and Lifestyle in Managing PCOS and Mental Health

Your lifestyle and stress levels can either help or hurt your ability to manage and take control of your mental health with PCOS.

Stress and Anxiety in PCOS

Ongoing stress can exacerbate PCOS symptoms like anxiety. Since stress is part of daily life, it is essential to find ways to mitigate it with practical techniques. We’ve talked about the value of exercise, better nutrition, mindfulness and meditation, and psychological therapy like CBT as helpful stress management techniques. 

PCOS and Fatigue

PCOS and fatigue often go hand in hand, with neurotransmitter and hormonal imbalances, insulin resistance, and depression creating a perfect storm that can leave you feeling tired more often than you should. 

If you don’t feel well-rested, even after you get plenty of sleep, you can take steps to manage fatigue by taking natural and nutritional supplements that help energize your body (like simple carbohydrates and vitamins C, D, and B12), eating more whole grains and protein for sustained energy, and adopting sleep-inducing techniques, like meditation or reading, to calm and quiet your mind before bedtime. 

How to Cope with PCOS-Related Mental Health Issues

While there's no instant solution for managing the mental health challenges associated with PCOS, developing effective coping strategies and wellness practices can significantly improve your quality of life and emotional well-being.

Coping Mechanisms for PCOS Mood Swings

There are several practical ways to cope with mood swings when you have PCOS. The best coping options are gentle tweaks to your lifestyle, eating a more balanced diet, and using proven techniques to manage stress.

• Focus on nutrition: Food plays a significant role in your mood. Choose diverse, nutrient-rich, filling foods for the best nutrition to cope with mood swings, and consider adding natural supplements with clinically proven ingredients to your regimen to combat mood swings and physical symptoms of PCOS.
  

• Improve your sleep: Poor rest paves the way for low moods, so get plenty of sleep and practice good sleep hygiene (no electronic devices before bed, limiting caffeine, etc.).
  

• Start meditating: Mindfulness and being grounded in the present moment can help enhance your mood and reduce anxiety and depression, so make time to quietly meditate each day.
  

• Get moving: Your body craves movement and releases mood-boosting neurotransmitters and hormones when you exercise, so plan to be active for at least 30 minutes, 3-5 days each week.
  

Support Systems

Holistic and lifestyle changes can be even more effective when you bring in support systems to help manage your mood swings with PCOS. For you, that might look like seeking professional help from a therapist or psychologist, joining local or online PCOS support groups, and reaching out to close friends and family for support when you’re feeling low.

How to Deal with PCOS Depression and Anxiety

Many women with PCOS experience significant challenges with depression and anxiety. While these conditions can create barriers to seeking support and making lifestyle changes, it's important to know that effective treatment options are available, and meaningful improvements in both physical and mental health are achievable with proper care and support.

Take stock of your treatment options—from therapy and medication to natural supplements and lifestyle changes—and talk with your healthcare provider to determine what’s best for you. Make lifestyle changes that feel manageable and viable to keep up with long-term. You might join a gym, stop eating fast food, or plan to cook healthy meals at home at least three nights each week.

Don’t underestimate the power of getting support when you have PCOS. Friends, family members, support groups, and professionals can help you lift the emotional burdens of managing this condition and give you greater hope for the future.

Taking Charge of Your Mental Health and PCOS

We know that PCOS and mental health are deeply connected—the challenges you may be facing can be traced to a root cause. Now that you’re armed with information about how PCOS is linked to mental health issues, you can take steps on your journey to better health and holistic wellness.

Empowerment Through Knowledge

Learning more about the condition empowers you to take control of your mental health and wellbeing with PCOS, so don’t stop reading, learning, and making lifestyle changes. New research is always being done on PCOS and its related mental health symptoms, so stay up to date and empower yourself with the knowledge to create a healthy lifestyle that mitigates the effects of PCOS.

Seeking Help

If you’re struggling with PCOS, a healthcare or mental health professional can help. Consult your doctor or mental healthcare provider if you are dealing with symptoms of mental health conditions, take advantage of existing support systems and support groups, and consider looking into PCOS fertility treatments if you’re trying to conceive.

Make Whole-Body Wellness Your Priority

Through a comprehensive approach to wellness that addresses both physical and emotional health, you can effectively manage PCOS-related mental health symptoms. Rather than viewing these challenges as inevitable, consider them as manageable aspects of your health journey that can be significantly improved with proper care and attention.

Taking care of yourself with a healthier lifestyle, treatments, nutritional support, stress management, mental health coping techniques, and therapy can be your stepping stone to a brighter future with PCOS. Make whole-body wellness your priority and step confidently into the life you’re dreaming of.