Mental health disorder is one of the burning issues of recent times. Every one out of eight people in the world is suffering from mental health-related disorders. The prevalence of mental health disorders is higher among women than men. Around 41 percent of women suffering from depressive conditions compared to 28 percent of men. Several factors like medical issues, hormonal problems, social factors, and lifestyle conditions are related to mental health. Polycystic ovarian syndrome is a gynecological condition caused by hormonal disruption. Along with gynecological conditions women suffering from polycystic ovarian syndrome (PCOS) or polyendocrine metabolic ovarian syndrome (PMOS) often suffer from mental disorders. Understanding the pathophysiological conditions behind PCOS/PMOS can be helpful in understanding mental health-related conditions.
What Is Mental Health?
The mental welling of the person helps to cope with the daily ups and downs of life. It is related to the social, medical, physical, and psychological well-being of the person. It is an integral part of our health which determines the individual ability of the person to make decisions, build relationships and shape the world they live in. Mental health can be evaluated by several factors. Lifestyle patterns, expression of emotions, and daily activities are several determinants of mental health conditions. Excessive expressions of different kinds of emotions like anxiety, depression, and fear can be suggestive of mental health disorders.
What Is PCOS/PMOS?
PCOS/PMOS or polycystic ovarian syndrome/polyendocrine metabolic ovarian syndrome is a hormone characterized by the increased level of male hormones in the female body. Four out of 20 women in the world who are their reproductive age suffer from this condition. In this condition, multiple fluid-filled sacks in the ovary can be detected.
What Are the Causative Factors?
The cause of this condition is unknown. But several risk factors have been identified which may cause this disorder. These are:
Familial and Genetic Factors - Familial and genetic factors are one of the most distinctive causes of PCOS/PMOS. Different genes associated with steroidogenesis are responsible for this condition. Malfunctioning associated with CYP11a, CYP21, CYP17, and CYP19 genes is related to PCOS/PMOS. On the basis of phenotypic factors, PCOS/PMOS can be of four types. Phenotype A and B is more associated with menstrual dysfunction and insulin resistance. PCOS/PMOS phenotype C is also associated with metabolic dysfunction. It is called ovulatory PCOS/PMOS. The fourth type or type D PCOS/PMOS is also known as the nonhyperandrogenic type and is not related to metabolic dysfunction.
Lifestyle Factors - PCOS/PMOS is very much related to lifestyle. Obesity is one of the key factors which is responsible for PCOS/PMOS. Obesity is responsible for altering metabolic activity. As a result, the low-grade inflammatory pathway is activated. Which is responsible for arrays of chemical and cellular events and responsible for PCOS/PMOS. Smoking, drinking, and unhealthy food habit are also associated with PCOS/PMOS.
Imbalance in the hypothalamic–pituitary–ovarian (HPO) axis and metabolic dysfunctions like insulin resistance is associated with PCOS/PMOS. In PCOS/PMOS the level of androgen (male sex hormone) is high. The high level of androgen is responsible for elevating the level of luteinizing hormone (LH) and gonadotropin-releasing hormone (GnRH). The level of follicular-stimulating hormone (FSH) remains unchanged or slightly decreases. This causes alliteration in the ratio between luteinizing hormone (LH) and follicular-stimulating hormone (FSH). Also, the level of anti-Müllerian hormone (AMH) is increased due to these factors. As a result, the ovulatory event is altered and the amount of circulating progesterone may decrease.
Insulin resistance is responsible for high levels of sugar in the blood. This is associated with the abnormal functioning of serine or /threonine kinase (an enzyme that regulates cell functioning). These enzymes are also associated with androgen biosynthesis. The level of estrogen and androgen is regulated by the action of sex hormone globulins and DHEAS (dehydroepiandrosterone sulfate, a type of steroid). Excessive insulin level lowers the level of both of these factors. Asa result, the amount of androgen in the body is elevated.
The clinical manifestations of PCOS/PMOS are:
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Absence of period or irregular menstrual cycle.
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Presence of facial hair or hair in the unusual parts of the body.
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Thinning or loss of hair.
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Weight gain and irregular eating habits.
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The dark appearance of various parts of the body and skin folds.
What Is the Role In Mental Health?
The amount of clinically significant psychological symptoms of mental disorders is higher in PCOS/PMOS patients. Around 37 percent of women suffering from PCOS/PMOS deal with mental disorders like anxiety, and depression. The occurrence of depressive symptoms among PCOS/PMOS is around three times higher and anxiety symptoms are four times more prevalent. Associated with these, conditions like bipolar disorders and obsessive-compulsive disorders are also seen in PCOS/PMOS patients. These factors which are associated with mental disorders are the deficiency of inhibitory neurotransmitters. A decrease in the plasma level of serotonin (5-HT), dopamine (DA), gamma-aminobutyric acid (GABA), and acetylcholine (ACh) is associated with PCOS/PMOS. The cause of these psychological problems. The factors associated with these are:
Excessive Androgen Level: The high level of androgen is one of the key features of PCOS/PMOS. The free testosterone present in the blood crosses the blood-brain barrier and binds with and to the androgen receptor. This is responsible for disruption in the functioning neurotransmitters and immune systems. As a result, the amount of serotonin is decreased.
Inhibition of Neural Function: In PCOS/PMOS condition over- expression of GABA-A receptor is seen. This upregulation is influenced by the action of the excess level of androgen. These receptors are linked to the inhibitory function of the neurons.
Obesity: Hypothalamic-pituitary-adrenal (HPA) axis is dysregulated in obesity. This causes the overproduction of cortisol (a type of stress hormone). This impaired glucocorticoid-mediated feedback mechanism (a regulatory mechanism of hormone secretion) is responsible for depression-like symptoms.
Insulin Resistance: Insulin resistance changes the molecular mechanism of the body. This is responsible for increased oxidative stress. This is associated with a decreased level of GABA. Insulin level is also associated with a reduced amount of Cholecystokinin. This hormone is associated with alteration in the eating pattern and depressing symptoms.
Inflammation: An altered inflammatory response is a clinical feature of PCOS/PMOS. In this condition, the blood level of pro-inflammatory cytokines, interleukin 1, interleukin 6, and interferon-gamma is elevated. This causes a decrease in the activity of tryptophan (a factor needed for the production of neurotransmitters). Also, the level of serotonin is decreased due to the increased reuptake mechanism.
Physical and Social Factors: PCOS/PMOS is related to changes in physical appearance and lifestyle. Conditions like weight gain, loss of hair, and the presence of facial hair are associated with social and psychological complications. Also, irregular menstrual cycle and infertility is associated with mental trauma for women.
Conclusion:
Mental health is an integral part of physical well-being. Hormonal conditions like PCOS/PMOS are associated with several mental health issues. Conditions like anxiety, depression, and mood disorders are related to hormonal and metabolic dysfunction of PCOS/PMOS.
