PCOS & Mental Health

Mental health is one of the most important parts  of our wellbeing: wellness does not only encompass physical health, but also our mental and emotional health. Mental health can affect all aspects of our lives and oftentimes, an underlying hormone imbalance may be worsening or even catalyzing these struggles. By understanding the root cause of disease we can treat the underlying issue directly.

In this article we’ll be answering questions like:

• How do my hormones impact my mental health?
• How does my PCOS make me more likely to suffer from poor mental health?
• What emotional symptoms should I look out for?
• Could my psychiatric medication be affecting my hormonal health or catalyzing a hormone imbalance?
• How can I take charge of my mental and hormonal health?

The impact of hormones on our mental health

Mental health conditions could stem from a hormonal imbalance. Inversely, if you have a hormonal imbalance you are more likely to develop mental health conditions. Sometimes psychological symptoms are side-effects of a hormonal treatment.

Norepinephrine, dopamine, and serotonin are well known in the psychiatric field to be pertinent biochemical regulators of our mood and psychological well-being (1, 2, 3). These three neurohormones form the foundation of current biochemical mental health pharmaceutical treatments in conjunction with psychotherapy and lifestyle modifications.

Although this triad is not exclusively the only group of hormones that can lead to mental illnesses; it is important to also consider the following hormones when working with your healthcare provider.

Estrogen

Estrogen  (E1, E2 and E3) is a group of hormones that play a major role in our body’s physiology, ranging from bone health, female characteristic developments, to our emotional well-being.

Focusing on mental health, estrogen regulates neurotransmitters such as serotonin, dopamine, epinephrine, and norepinephrine, which are involved in mood regulation. Estrogen increases both production of serotonin (the “feel good” or “happy” chemical), as well as serotonin receptors in the brain. Estrogen is involved in regulation of endorphins, a group of hormones that stimulate physiological pathways associated with blocking pain and bringing a rush of euphoria and happiness. Fluctuating levels of estrogen is associated with mood swings and irritability.

Low levels of estrogen is linked to lower levels of serotonin, which can cause mood swings, depression, trouble concentrating, fatigue, and irritability. Overly high levels of estrogen along with low levels of progesterone, known as estrogen dominance, is associated with depression, irritability, fatigue, memory problems, mental fog, and anxiety as well.

Progesterone

Apart from the reproductive shifts associated with progesterone, high levels of the hormone is associated with increased amygdala sensitivity (the part of the brain associated with the fight or flight panic response) leading to a greater likelihood of anxiety, depression, insomnia, and a general glum (4). Low levels of progesterone can contribute to estrogen dominance and mood changes such as anxiety, depression, mental fog, irritability, and more.

Androgens DHEA and DHEA-S

Dehydroepiandrosterone (DHEA) and it’s sulfated form DHEA-S is the most highly concentrated hormone naturally occurring in our body. As a precursor to other hormones such as testosterone and estrogen, DHEA is essential for healthy functioning.

Low levels of DHEA and DHEA-S is associated with depression; some studies have even found positive results when treating older depressed patients with DHEA supplements (5, 6). Although DHEA supplementation tends to quickly raise natural testosterone levels, and therefore comes with a long list of side effects including hirsutism, insulin resistance, insomnia, and abnormal menses.

Further research is needed to understand the physiological effects of DHEA; efficacy of DHEA supplementation is low and the risk of drug interactions or strong side-effects are high.

Thyroid Hormones T3 (Triiodothyronine) and T4 (Thyroxine)

Although our thyroid is usually associated with metabolic disorders, the metabolism affects energy rates for our entire body. Activated by thyroid stimulating hormone (TSH) the thyroid gland releases hormones T3 and T4, which differ in the number of iodine molecules present.

T3 and T4 are mood regulators that influence the metabolic rate, and therefore can be directly associated with our energy levels and emotions.

Cortisol

Known widely as the “stress hormone”, cortisol is an essential hormone involved in our fight-or-flight response.

Due to the fast pace of modern society, oftentimes our bodies can perceive unending chronic stress; our adrenal glands can continuously release cortisol which stimulates chronic inflammation throughout the body. Besides resulting in increases in blood sugar, blood pressure, and fat storage, raised cortisol and inflammation levels are correlated with higher rates of depression, anxiety, and other mental health conditions. Serotonin is reportedly dysregulated with a consistently high level of cortisol, chronic stress and bodily inflammation (7).

The source of excessive cortisol can be an adrenal tumor, genetic disorder, or more commonly chronic stress from work, exercise, relationships, and life in general. Lifestyle modifications, such as mindfulness and meditation, can help to reduce stress and cortisol levels.

Indirect effects of our hormones on mental health

Hormonal changes often lead to fluctuations in body weight, hair thinning or excessive growth, facial acne, and other physical transformations which can contribute to our self perception, body image, and self-esteem. It is important to recognize how physical changes, due to hormonal imbalances or treatments, can affect our emotional well-being.

Furthermore, hormonal imbalances are a source of physiological stress which is felt by our insular cortex, a part of our brain that senses our internal state. Similar to feeling down or fatigued at the beginning of a bad cold, we may sense hormonal imbalances and subconsciously allow it to affect our emotional state.

How PCOS impacts your mental health

People with PCOS are 3 times more likely to experience anxiety and/or depression than people without PCOS and are more likely to report a higher severity of symptoms.

Although the exact reason for this association between conditions is unknown, many symptoms of PCOS, such as hirsutism, infertility, body weight fluctuations, and a general lack of control over one’s health and body can be frustrating and anxiety-provoking. Some studies have suggested that insulin resistance or higher androgen levels could be a factor that predisposes people with PCOS to develop mental health conditions.  

Mental health can also be impacted by our energy levels throughout the day: if we are always exhausted, it is easier to fall into patterns of anxiety and depression. Fatigue, insomnia and other sleep disturbances, and brain fog are all common symptoms of PCOS. Consider the following facts about PCOS, our circadian rhythm, and sleep quality:

• Studies have suggested that people with PCOS have elevated serum melatonin levels in the middle of the night compared to those without PCOS (melatonin levels should be highest before bedtime, and this pattern suggests poor sleep quality and a disturbed circadian rhythm). While the exact cause of this is unknown, a strong possibility is the higher levels of androgens generally seen with PCOS.
• Conversely, melatonin supplementation intended to regulate production of this hormone has been shown to decrease androgen levels and improve metabolic function for people with PCOS (8, 9).
• Many people with PCOS report daytime fatigue. In a study of 59 adolescent girls with PCOS, it was found that the aforementioned later melatonin offset is associated with circadian misalignment, which is associated with metabolic issues (10). Note that this is a small study and more research is needed to prove this relationship.
• Evidence suggests that people with PCOS have a heightened response to stress versus people without (11). Since there is a connection between sleep disturbance and heightened cortisol levels, it is possible that the tendency to have a more intense stress response impacts sleep quality at night (8).
• There is a strong relationship between sleep disturbances and insulin resistance, with evidence showing a causal relationship that can become a vicious cycle (8).

Signs you may be struggling with your mental health

1 in 4 adults experiences a mental health issue at some point in their lifetime, and hormone imbalances leave you even more likely to fall into this category. Below are common signs that it may be time to seek support:

• Anxiety
• Irritability
• Depression
• Insomnia or problems with sleeping
• Mood swings
• Difficulty concentrating
• Short-term memory lapses
• Decreased mental sharpness / brain fog
• Problems with weight or appetite
• Obsessive compulsive disorder (OCD) or compulsive thought patterns
• Feelings of hopelessness
• Thoughts of death or suicide
• *Remember that if you are struggling with debilitating stress or anxiety, you are not alone. If these feelings ever become overwhelming and you need immediate support, please text HOME to 741741 for free, 24/7 crisis counseling.

Psychiatric medication and our hormones

While imbalanced hormones can leave you more likely to experience anxiety, depression, and other mental health issues, it is also important to know that psychiatric medications can create or worsen off-kilter hormones.

That said, remember that every body is unique and for many, the benefits of these medications will outweigh the negative symptoms. This section is intended to be educational and give you a starting point if you want to discuss the impact of these medications on your hormones with your doctor. Do not make any changes to your medication regimen without consulting your care team.

Antidepressants

Selective serotonin reuptake inhibitors (SSRI), a major class of antidepressants, directly change our neurohormonal levels.

Recent studies have found that hormone replacement therapies (in which estrogen and other hormones may be supplemented) can have a reciprocal relationship with antidepressants; people taking antidepressants may be missing an underlying endocrine condition, and people treated with hormonal replacement therapy feel the effects not only physiologically but mentally as well (12). Additional studies have reported antidepressants’ interactions with estrogen receptors (13).

Anti-androgen hormonal therapies

Androgen-blocking drugs are commonly used to treat endocrinological conditions or as an oral contraceptive yet they also affect our neurohormonal levels and mental health (14).

Common anti-androgen prescriptions include cyproterone acetate (co-cyprindiol or Diane™-35, Estelle™ 35 and Ginet-84™), drospirenone (Yasmin™, Yaz™) or dienogest (Valette™).  Since hormonal fluctuations of estrogen, testosterone, and other hormones act on your brain as well as the rest of your body, blocking our androgens for physiological changes affects your mental health too. It is important to talk with your healthcare provider about the ways in which your treatments for either mental or endocrine conditions interact.

Taking back control of our mental health

Luckily, mental health struggles with PCOS is manageable. Below are potential treatment strategies:

• 1-1 therapy: If you can afford it, 1-1 talk therapy with a counselor is well-worth the time and monetary investment. You can explore a variety of treatment strategies used by different therapists such as cognitive behavior therapy (CBT). Let your care team know if you would like help finding an in-person or virtual therapist. We would love to help!
• Group therapy: If you cannot afford a personal counselor or think that you would benefit more from strong community support, group therapy may be a good option. Especially when it comes to being a parent and balancing family with life’s other responsibilities, learning from peers can be invaluable. Be sure to check out your Pollie support group and let your care team know if you would like a more counseling-focused group.
• Stress management techniques: Being a human is no walk in the park, nor is having PCOS. There’s no doubt about it: life is stressful. Stress can catalyze or worsen a mental health problem, and having techniques in your pocket that help you relax and regain clarity is important. Journaling, exercising, going on walks, baking, taking baths, cuddling with your dog, and just getting out into nature are all ideas for managing stress.
• Medication: While Pollie cannot prescribe medication yet, finding a mental health professional who can is important if your mental health is impeding your ability to properly function. Let your care team know if you think medication is the best next step for you.

Be sure to speak with your care team if you are interested in learning more about the effect PCOS can have on our mental health, or if you are interested in learning more about additional support resources.

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