RESEARCHERS have identified the potential contributors and underlying mechanisms of the bidirectional, multifactorial association between polycystic ovary syndrome (PCOS) and depression.
PCOS and Depression
PCOS is a common endocrine disorder, frequently accompanied by psychological comorbidities including depression. It affects 4–21% of women of reproductive age worldwide and can be characterised by ovarian malfunction, insulin resistance, androgen excess, disequilibrium of the gonadotrophins, and low-grade chronic inflammation.
Depression is more prevalent in PCOS compared with controls without the condition. A 2023 systematic review found that the probability of depression in patients with PCOS is more than 2.5 times higher than in healthy controls.
Underlying Mechanisms
The association between PCOS and depression is bidirectional, researchers reported.
They highlighted the role of several biological factors implicated in the association: hyperandrogenism, metabolic dysregulation, chronic low-grade inflammation, gut microbiome, and genetic and epigenetic factors.
Psychosocial factors, including illness perception, menstruation, infertility issues, sexual dysfunction, and eating disorders also play a prevalent role in the multifactorial relationship, the study concluded.
Patient Care
Researchers noted that, due to the complex pathophysiology behind both PCOS and depression (independently and in combination), no single unifying link has yet been identified.
They emphasised the need for mental health risk stratification, addressing the possible contributing factors identified, and offering the required support to patients with PCOS and depression.
Impacts on Daily Life
Researchers highlighted the public health implications of the association between PCOS and depression.
More than half of patients with PCOS report work-related problems, including missing work and poor quality of output.
The management of PCOS, including its pregnancy-related complications, also carries a significant economic burden in the USA, costing an estimated 8 billion USD annually.
Combined with depression and anxiety, an additional 4 billion USD is incurred, researchers have previously reported.
The authors therefore emphasised the importance of the potential benefits of early screening for psychological sequelae in patients with PCOS.
References
Karampela AI, Druce M. The relationship between polycystic ovary syndrome (PCOS) and depression. Clin Endocrinol. 2026;DOI:10.1111/cen.70124.
Helvaci N, Yildiz BO. Polycystic ovary syndrome as a metabolic disease. Nat Rev Endocrinol. 2025;21(4):230-244.
Dybciak P et al. Depression in polycystic ovary syndrome: a systematic review and meta-analysis. J Clin Med. 2023;12(20):6446.
Huddleston HG et al. Productivity loss due to polycystic ovary syndrome and its relationship to race, mental health and healthcare delivery indices. F&S Reports. 2024;5(2):157-163.
Riestenberg C et al. Health care-related economic burden of polycystic ovary syndrome in the United States: pregnancy-related and long-term health consequences. JCEM. 2022;107(2):575-585.
Yadav S et al. Direct economic burden of mental health disorders associated with polycystic ovary syndrome: systematic review and meta-analysis. eLife. 2023;DOI:10.7554/eLife.85338.
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