Oral contraceptive treatment in polycystic ovarian syndrome improves mental health

Abstract

Objective: The primary objective of this study was to derive preliminary data concerning the effect of oral contraceptive (OC) therapy on mental health measures in women with polycystic ovarian syndrome (PCOS). Design: This is an interim data analyses at 24 weeks from a treatment trial that will continue for 48 weeks. Evaluations were performed at baseline and after 24 weeks of therapy. We also assessed a control sample at baseline to establish differences on variables of interest. Materials and Methods: Twelve women (M age = 24) with PCOS, identified by means of elevated free androgen levels, oligomenorrhea, and hirsutism, completed the treatment intervention. Six healthy women (M age = 31), who were normally cycling, also were assessed during the early follicular phase of the menstrual cycle for baseline comparisons only. The pre-treatment baseline and 24-week studies included indices of androgen level, PCOS-related physical signs, general and PCOS-specific emotional symptoms, and measures of cognitive function. The treated women received either continuous or cyclic OC therapy with Loestrin (norethindrone acetate, 1 mg plus ethinyl estradiol, 20 mcg). Results: At baseline, there was no difference between the treatment group and the control group with respect to IQ estimate (t = 1.21, ns) or verbal memory function (t = 1.72, ns). However, as might be expected, there were significant differences between treatment subjects and controls with respect to free androgen levels (t = 2.43, p < .03) and measures of mood disturbance (t = 2.22, p < .05) and self esteem (t = 2.01, p < .05). After 24 weeks of Loestrin treatment, subjects showed significantly decreased free androgen levels as compared with baseline (t = 2.69, p < .03). In addition, all PCOS-specific symptoms and general measures of psychological well-being showed change in the positive direction. Tests for dependent measures indicated improvement in emotional symptoms (t = 3.85, p < .01), perception of bodily hair (t = 3.63, p < .01), weight concern (t = 3.73, p < .01), and menstrual concern (t = 3.32, p < .01). There also was improvement in overall self esteem (t = 2.61, p< .05) and a trend for improvement in total mood disturbance (t = 1.87, p < .10). Finally, there was marked improvement in delayed recall on a verbal memory task (t = 3.94, p < .003). Conclusion: These findings are encouraging with respect to improvement in multiple aspects of psychological well being in concert with treatment producing hormonal regulation and diminished physical features of PCOS. The improvements in mood and self-esteem might be understood most readily as psychological responses to the changes in the physically apparent signs of androgen irregularity. There also may be psychological effects mediated by direct neural actions of the hormone intervention, and the improvement in verbal memory function may reflect this effect. These interim results justify continued investigation of the mental health effects of PCOS treatment. In particular, randomized, controlled interventions would be useful in understanding the nature of psychological change associated with treatment and to compare continuous and cyclic forms of therapy.