Relationship Between PCOS and Anxiety

Introduction:

Mental health and psychological disorders are among the most burning issues of modern times. Around 28 percent of the global population is suffering from depression, and around 26 percent of the global population is suffering from anxiety-related disorders. Approximately 41 percent of women suffer from depressive disorders compared to 28 percent of men. The predominance of psychological disorders among women can be attributed to hormonal factors. Polycystic ovarian syndrome is one of the most common gynecological problems which may cause hormonal imbalance. Around 4 to 20 percent of females of reproductive age suffer from this condition. Among many side effects, depression and anxiety are common in women suffering from PCOS. Understanding the pathophysiology behind psychological problems can help irradicate such problems.

What Is PCOS?

PCOS, or polycystic ovarian syndrome, is a condition characterized by the increased level of male hormones in the body. 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. However, several risk factors have been identified which may cause this disorder. These are:

1. Familial and Genetic Factors - Familial factor is one of the most distinctive features of PCOS. Different genes associated with steroidogenesis are responsible for this condition. Malfunctioning associated with CYP11a, CYP21, CYP17, and CYP19 genes is related to PCOS.

2. Lifestyle Factors - PCOS is very much related to lifestyle. Obesity is one of the key factors which is responsible for PCOS. Obesity is responsible for altering metabolic functions, which causes PCOS. Smoking, drinking, and unhealthy food habits are associated with PCOS.

These two factors are responsible for defects in the hypothalamic-pituitary-ovarian (HPO) axis. Due to the effect of these factors, 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). As a result, ovulatory events may decrease, and the amount of circulating progesterone may decrease. Insulin resistance is a crucial factor for hormonal imbalance. In insulin resistance, the amount of sugar in the blood is high, and the production of insulin is increased. 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. Also, increased insulin level lowers the level of sex hormone binding globulin, which disrupts the body's androgen level regulatory mechanism. Excessive insulin also decreases the level of DHEAS (dehydroepiandrosterone sulfate, a type of steroid), which regulates the amount of estrogen and androgen in the female body. Hormonal imbalance in PCOS causes dysregulation in the release of the egg (ovulation) during the menstrual cycle. This condition is known as anovulation. This causes the development of small cysts like structures in the ovary. These factors are responsible for infertility associated with PCOS.

What Are the Clinical Features?

Hormonal imbalance in PCOS causes dysregulation in the release of the egg (ovulation) during the menstrual cycle. This condition is known as anovulation. This causes the development of small cysts like structures in the ovary. These factors are responsible for infertility associated with PCOS. The clinical symptoms of PCOS are:

1. Amenorrhea - Absence of period, irregular, periodic cycle, and irregular period are the most common clinical presentations.

2. Hirsutism - Abnormal hair growth in unusual body parts of the female body, like arms and chest, can be seen. The presence of facial hair is also commonly seen. Thickening of hair in hands and legs can also be seen.

3. Alopecia - Thinning hair and excessive hair loss are also associated with this.

4. Acanthosis Nigricans - This clinical condition is characterized by the dark appearance of skin in the skin folds areas, specifically in the armpits, groin, and neck.

5. Skin Tags - Skin growth or skin tags can also be found.

6. Mental Disorders - Mental disorders like anxiety, depression, and restlessness can be seen in patients.

What Is the Cause of Anxiety?

The amount of clinically significant psychological symptoms of mental disorders is higher in PCOS patients. Around 37 percent of women suffering from PCOS complain of psychological disorders like anxiety and depression. The key factor associated with mental disorders is the deficiency of inhibitory neurotransmitters. Decrease in the amount of serotonin (5-HT), dopamine (DA), gamma-aminobutyric acid (GABA), and acetylcholine (Ach). The cause of these psychological problems. The factors associated with these are:

1. Excessive Androgen Level - The high level of androgen is one of the key features of PCOS. The free testosterone in the blood crosses the blood-brain barrier and binds with and to the androgen receptor. It also disrupts the function of neurotransmitters and immune systems.
2. Obesity - The hypothalamic-pituitary-adrenal (HPA) axis is dysregulated in obesity. This causes vast 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.
3. Insulin Resistance - Insulin resistance changes the molecular mechanism of the body. An elevated level of cortisol, decreased level of serotonin (5-HT), and elevated sympathetic nerve activity are observed in such cases. All these factors are responsible for anxiety, depression, and psychological problems.
4. Inflammation - Altered inflammatory action is one of the main features of PCOS. The level of pro-inflammatory substances like interleukin 1, interleukin 6, and interferon-gamma is high. These factors are associated with increased stress. The high level of tumor necrosis factor-alpha and interferons decreases the amount of serotonin and dopamine. The inflammatory cytokines are associated with a decrease in the activity of tryptophan (a factor needed for the production of neurotransmitters) and increased serotonin reuptake by various mechanisms. These phenomena are related to increased mental stress. Thus, stress caused by inflammatory substances may cause anxiety.
5. Physical and Social Factors - PCOS is associated with alteration of physical appearance, like weight gain, the appearance of hair in various unwanted parts of the body, and loss of hair. These factors are psychologically stressful for a girl. Moreover, irregularities associated with the menstrual cycle also cause mental trauma. One of the most important factors is infertility. Motherhood is an important event in women’s life. Failure to be pregnant can be stressful and may cause social stigma.

Conclusion:

Polycystic ovarian syndrome is a global problem. Various factors like genetics, familial history, and hormones play important roles in the onset of this hormonal disorder. Psychological side effect associated with PCOS can be severe and is multifactorial. Identifying such symptoms at an early stage can be helpful to overcome the problems. Psychological counseling, medications, increase physical activity, and treatment of PCOS is important to overcome such mental disorders.