09 Jul Impact of Polycystic Ovary Syndrome (POCS) on Mental Health and Well-being of Women?

Polycystic Ovary Syndrome (POCS): A Psychologists Perspective

What is PCOS?

PCOS (Polycystic Ovary Syndrome) is a hormonal disorder in women. Interestingly, despite what the name suggests, it is not just an ovary condition.

PCOS is a common metabolic and inflammatory condition affecting up to one in 10 women of childbearing age- i.e. in technical terms childbearing age is considered from the time a female reaches puberty and commences their menstrual period to the time they reach menopause. The average women’s reproductive years are typically between the ages of 12 and 51, however, it is not uncommon for females who have PCOS to deviate from this average. In a woman with PCOS, research has found two hormones that are produced at higher levels – insulin and androgens (male-type hormones).

PCOS and the Diagnostic Criteria:

To be diagnosed with PCOS, women need to have two out of three of the following:

1. Irregular or absent periods.
2. Symptoms- acne, excess facial or body hair growth, scalp hair loss or a blood test showing high levels of androgens (testosterone and similar hormones).
3. Ultrasound- the image of ovaries showing 20 or more follicles on either ovary.

If you are unsure who you can see to be diagnosed with PCOS, a GP, gynaecologist or endocrinologist will be able to help you and will together with you explore your history around menstrual patterns and other PCOS symptoms, provide a physical examination and organise the lab and ultrasound testing.

Some Key PCOS Facts:

• PCOS is the most common hormonal disorder in women
• It’s the leading cause of female infertility
• It affects a woman physically, emotionally, and mentally
• PCOS symptoms can be greatly managed

What are the symptoms of PCOS?

PCOS is very complex and unique to each woman. It tends to present itself differently in each woman. Some of the more common symptoms of PCOS are:

• Menstrual cycle irregularities include irregular periods (more or less often), or sometimes absent periods
• Emotional challenges, including anxiety, depression, mood changes or low self-esteem
• Hirsutism which means more hair growing on the face, stomach and back
• Loss of scalp hair
• Challenges with fertility
• Challenges managing weight
• Insulin resistance- the risk of developing type 2 diabetes
• Risk factors for heart disease
• Sleep issues including sleep apnoea
• Skin issues including acne
• Poor energy levels

How does PCOS develop?

The cause of PCOS is not fully understood, however family history and genetics, hormones and lifestyle have been found to play a role.

You might have noticed from an early age that your periods may be heavier than what your peers described to you or what has been described to you during health class at school or you may have started your periods earlier than others around you which can lead you to feel different and alone throughout a really vulnerable time. You might have noticed that your cycle is very sensitive to your external environment, e.g. It might be exam time and you notice that your period hasn’t come yet which gets you worried, or you might be travelling on holiday and you also notice that there is a no show from your period. You might have noticed the extra dark hairs on your face which makes you feel really self-conscious when all you want to do is to ‘fit in’ and feel womanly. These are all valid and common reasons for you to reach out and investigate what could be going on for you.

What is the impact of PCOS on mental health?

There is evidence that women with PCOS have higher rates of depression, anxiety, low self-esteem, body dissatisfaction, and eating disorders.

Emotional challenges such as depression and anxiety may be due to hormonal changes or the symptoms experienced- excess hair growth, hair loss, acne, weight struggles and fertility challenges. These factors often have a negative effect on one’s mood and self-confidence.

Furthermore, stress can be a trigger for many PCOS symptoms. Stress can also exacerbate symptoms of PCOS. As we know whenever we are stressed, our adrenal gland produces stress hormones (cortisol). Cortisol increases blood sugar levels, which in turn increases insulin production. This has a negative impact on any insulin resistance and its symptoms such as poor energy levels, poor sleep etc. Also, when your adrenals are producing cortisol, they can lead to symptoms such as hair thinning/ loss, acne and menstrual cycle irregularities.

How has PCOS been found to impact Body Image?

Clinical research has shown that generally women living with PCOS tend to have increased body dissatisfaction compared to those without PCOS. Furthermore, several studies have indicated that the odds of having an eating disorder were higher in women with PCOS than in controls.

What do we know about PCOS, Eating Disorders, and Body Dissatisfaction?

Unfortunately for people who experience PCOS, it can mean that they have a higher predisposition to weight gain particularly around their mid-section due to the excess androgens, testosterone, and increased insulin resistance. This can lead women to experience increased body dissatisfaction.

What we know about eating disorders and how they develop is if one suffers from increased body dissatisfaction it can make them more susceptible to wanting to lose weight and dieting which we know is a risk factor for developing an eating disorder. It can also make them more preoccupied with their weight and shape, so it might make them more susceptible to checking behaviours- such as frequent weighing, repetitive checking of body parts in the mirror, comparisons to others’ bodies or avoidant behaviours such as wearing loose clothing, feeling embarrassed to show parts of their bodies and so forth. On top of all of this, it is often recommended by health professionals who often lack insight into the complexity of PCOS to ‘just lose weight’ to ‘fix’ their PCOS. This can be really debilitating and tormenting for one who suffers from PCOS and body dissatisfaction.

What then can happen is many women end up taking drastic measures to lose weight- including extreme restrictions, excessive exercise etc. Unfortunately, these types of extreme measures can then lead one to engage in binge episodes which then further reinforces the restrictive cycle and dissatisfaction with weight and shape. It can be important to understand the warning signs of disordered eating behaviours or eating disorders as well as poor body image.

How can a psychologist help with PCOS?

Currently, the best line of treatment for PCOS is through lifestyle modification- reducing stress levels as much as possible, getting quality sleep, managing emotional challenges such as anxiety and depression, working on improving body image and if diagnosed working on treating the eating disorder. It is important to have a psychologist who has a good understanding of PCOS. Research shows that women with PCOS who receive care from a number of health professionals such as doctors, dietitians, and endocrinologists – rather than just one, can have better health outcomes. Our psychologists have a special interest and understanding of PCOS symptoms management.

How can Positive Wellbeing Psychology help?

At Positive Wellbeing Psychology, our psychologists adopt a holistic approach to managing symptoms of PCOS. Our psychology practice has warm and compassionate psychologists with a special interest in women’s health and in particular PCOS. To provide an example, your healthcare team to manage symptoms of PCOS may include a GP with a special interest in women’s health, endocrinologist (hormone specialist), gynaecologist (for fertility or bleeding issues), dietitian, exercise physiologist or physiotherapist, and of course a psychologist.

It is recommended to connect with you professionals that have specific knowledge and special interest in PCOS, to help feel better supported and guided through symptoms management. Reach out to our warm and compassionate psychologists today should you currently feel unsupported or hear things like ‘just lose some weight’ by members of your care team.