Insulin Resistance, Hyperandrogenism, and Its Associated Symptoms Are the Precipitating Factors for Depression in Women With Polycystic Ovarian Syndrome.

Comfort Anim-Koranteng,Chike B Onyali,Aarthi Ethirajulu,Hira E Shah,Jihan A Mostafa,Almothana Alkasabera,Nitin Bhawnani

doi:10.7759/cureus.18013

Abstract

Polycystic ovarian syndrome (PCOS) is a combination of many symptoms resulting from hormonal imbalance, metabolic syndromes, hyperandrogenism, and anovulation. This paper explores the various etiopathology and mechanisms causing depression in women with PCOS and how to prevent and treat PCOS-induced depression. Women with PCOS present with multiple symptoms such as acne, hirsutism, androgenic alopecia, obesity, menstrual irregularities, infertility, and mood disturbances like depression and anxiety. Depression is the most common psychological problem faced by women with PCOS. The various pathophysiological mechanisms that lead to depression are Insulin resistance, disturbance in the hypothalamic pituitary adrenal (HPA) axis, hyperandrogenism and its clinical presentation, obesity, and infertility. Lifestyle modifications such as dietary changes and weight loss play a significant role in preventing and managing PCOS-induced depression. Cognitive behavioral therapy (CBT) and lifestyle modification have shown to be effective measures for weight loss in obese women with PCOS. Antidepressants also play a part in treating PCOS-induced depression. Over the last decade, the number of cases of depression in women with PCOS has increased. This paper provides detailed data on the fundamental causes of depression in women with PCOS to facilitate a more straightforward treatment approach.

Highlights

BackgroundEtiology of depression in women with Polycystic ovarian syndrome (PCOS)The clear-cut etiology of polycystic ovarian syndrome (PCOS)-associated depression has not been postulated yet
Women with PCOS are diagnosed clinically based on the signs and symptoms of hyperandrogenism such as acne, increased facial hair growth, and androgenic alopecia
Diagnosing depression in women with PCOS is a crucial step that should be done early in the approach, as multiple studies support PCOS is associated with depression such as this comprehensive meta-analysis that shows that women with PCOS have four times the odds of depressive symptoms than women without PCOS [2]

Summary

Introduction

The clear-cut etiology of polycystic ovarian syndrome (PCOS)-associated depression has not been postulated yet. PCOS is diagnosed when a group of symptoms consistently occur together as a result of hormonal imbalance such as obesity, anovulation leading to multiple cysts in the ovaries, infertility, increased peripheral estrogen that gets converted to androgen leading to hirsutism in young females, metabolic derangements like insulin resistance, and dyslipidemia leading to coronary artery disease [11]. It is one of the most common endocrine disorders affecting women in their reproductive age group (5-10%) and is one of the most common causes of female infertility [12]. PCOS is a condition that requires a multidisciplinary treatment strategy, as it is a heterogeneous condition presenting with reproductive, endocrine, metabolic, and psychiatric abnormalities

Physical Examination Findings in Women With PCOS

Conclusions

Disclosures

Bremer AA