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Can PCOS cause Mental Health Issues?

PCOS, or Polycystic Ovary Syndrome, is a common hormonal condition in which women have high levels of male hormones (called androgens) and small cysts on their ovaries. It can affect fertility and cause other health issues like diabetes or heart disease.

It's important to understand how PCOS affects your mental health because it could lead to other problems if not treated properly.



Hormonal imbalance and ovarian malfunction are hallmarks of the condition polycystic ovary syndrome (PCOS), which typically manifests around puberty. In women, the incidence can range from 5.6% to 21.3%, and in teenage girls, it can be as high as 6%. The population investigated and the diagnostic standards applied are relevant to this disparity. PCOS can cause a multitude of co-morbidities, including hypertension, diabetes, dyslipidemia, and mental health disorders.


PCOS and Mental Health


Estrogen appears to exert an antipsychotic effect. When levels decline, the emergence of psychotic symptoms is facilitated. PCOS women, might, therefore, be vulnerable to psychosis because they are exposed to long durations of high levels of unopposed estrogen as a result of infrequent ovulation. When they do ovulate, their estrogen levels decline, mirroring the postpartum state. This could explain why women with PCOS are more susceptible to psychotic symptoms. Women with psychosis often show menstrual irregularity or amenorrhea, attributable to the hyperprolactinemia induced by the use of antipsychotic drugs.


Infertility is another symptom of PCOS, which has been linked to severe psychological stress and lowers the quality of life for those who have it. Reduced sexual satisfaction and low self-esteem may have contributed. However, a person's ethnic origin, religious convictions, and desire for children all play a significant role in infertility and psychological stress.


HPO axis disturbance in PCOS


An underlying imbalance in the hypothalamic-pituitary-ovarian (HPO) axis feedback processes serves as the basis for the diagnosis of PCOS. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation is another proposed reason for the development of depression. These two pathways can be changed by any type of stress. Corticotropin-releasing hormone and elevated cortisol are two stress hormones that have been associated with depression in the general population.


The metabolic pathway and depression


Metabolic syndrome is common in PCOS women. Long-term effects of PCOS and metabolic syndrome include cardiovascular disease, diabetes, sleep apnea, and depression. Depression might reduce motivation to modify lifestyle practices, resulting in worsened symptoms and severe metabolic decline. Obesity and insulin resistance have both been linked to an increased risk of depression in the general population. This metabolic pathway may be a contributing factor to depression in PCOS women.


Obesity


One possible cause of depression in this population is obesity, which affects up to 60% of women with PCOS. Obesity and depression are linked in a complex way. Obesity is thought of as an inflammatory state because weight increase activates the inflammatory pathways. Inflammation and depression have an inverse association in the general population. The HPA axis, which plays a role in the emergence of depression, becomes dysregulated as a result of obesity. Additionally, a physical characteristic that differs from conventional ideals might exacerbate depressive symptoms and affect a woman's sense of her own identity.


Insulin Resistance


Insulin resistance affects up to 70% of PCOS women, and they have a greater rate of diabetes mellitus than healthy young women. Even when BMI is taken into consideration, studies demonstrate that insulin resistance is widespread in women with PCOS.

Elevated cortisol is assumed to be the biochemical route implicated in the development of PCOS via insulin resistance. This, in turn, increases the sympathetic nervous system and inflammatory indicators. Insulin resistance has also been linked to lower levels of serotonin in the brain. As a result, insulin resistance may be a reason for depression in women with PCOS, and treating aberrant insulin levels may help to prevent the development of depression.


Infertility


Among the various causes of infertility in women. PCOS-related ovulatory dysfunction accounts for 75% of all cases. Regardless of the source, the prevalence of depression in infertile people is between 7% and 26%, depending on the demographic. Infertility can thus have a role in the development of depression. However, studies that included only infertile women or omitted all infertile women found that depression levels in women with PCOS remained greater.

Depression adds to the global disease burden, and if the process is identified, preventative actions for these high-risk women can be implemented. There have also been evident menstrual abnormalities linked to depression.


How can exercise combat issues as challenging as depression and anxiety?


There are several causes, some chemical and some behavioural. Therapeutic exercises called relaxation techniques are designed to help patients reduce stress and anxiety on the physical, mental, and emotional levels.

Stress is reduced through breathing exercises. Even without formal meditation and deliberate breathing exercises, yoga's mild muscle stretches can lower stress. Yoga with "full service" is even better.

What deep breathing exercises do is as follows:

1. To make the most of your diaphragm, inhale slowly and deeply while pushing your stomach out.

2. Pause for a moment before breathing.

3. As you exhale, remind yourself to relax.

4. Focus on taking slow, deep breaths as you go through the entire procedure five to ten times.

Box Breathing

While there are many various ways to practise deep breathing, box breathing can be particularly beneficial for relaxing. Box breathing is a breathing technique that can be used before, during, or after stressful events to help people control their stress. Four easy steps are involved in box breathing. Its name is meant to aid the patient in picturing a box with four equally sized sides as they carry out the exercise. This exercise can be used in a number of situations and is not beneficial in a quiet setting.

Step 1: Take a four-count inhalation through your nose.

Step 2: Continue to hold your breath for four counts.

Step 3: Exhale for four counts.

Step 4: Continue holding your breath for a count.

In order to fit each person, the step length can be changed (e.g., Each step takes place in 2 seconds as compared to 4 seconds.



In particular, the amygdala, which is necessary for emotion regulation, and the prefrontal cortex, which is required for executive functioning and decision-making, have been shown to be negatively impacted by chronic stress. As a result, it is beneficial to have relaxation techniques as coping mechanisms to offer patients in order to lessen stress.


Conclusion


If you have polycystic ovary syndrome, then it's likely that your mental health will be affected by it too. It's important to understand how PCOS affects your mental health because it could lead to other problems if not treated properly. If you have any concerns about your PCOS symptoms, talk to your doctor right away!


References

  1. Doretto L, Mari FC and Chaves AC (2020) Polycystic Ovary Syndrome and Psychotic Disorder. Front. Psychiatry 11:543.doi: 10.3389/fpsyt.2020.00543

  2. Gnawali A, Patel V, Cuello-Ramírez A, et al. (February 22, 2021) Why are Women With Polycystic Ovary Syndrome at Increased Risk of Depression? Exploring the Etiological Maze. Cureus 13(2): e13489. DOI 10.7759/cureus.13489

  3. Norelli SK, Long A, Krepps JM. Relaxation Techniques. [Updated 2021 Sep 6].Publishing;2022Jan https://www.ncbi.nlm.nih.gov/books/NBK513238/



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