This article explores the complex connection between PCOS and our mental health and well-being. It covers research on mood and anxiety disorders and how much of its prevalence can be attributed to existing biological mechanisms as well as cultural norms and expectations that are a result of our PCOS diagnosis.

Let’s talk about PCOS and our mental health.

Mahima Moses is currently 20 years old and a student of psychology and anthropology, has always been interested in exploring the experiences of women and their lived realities in an intersectional manner i.e. understanding of the female body and its interactions with society at large.

I’ve often heard myself and other women use the apology- “I’m sorry, I’m on my period”- to explain certain behaviours that might be considered uncharacteristic or ‘irrational’ by those around us. Although this apology might be used jokingly in certain contexts, it reveals a very real phenomenon that many women experience when they’re on their period. There is a reason why most period tracking apps we use also have a separate section attributed to tracking our emotions. The reason for this is that there is a clear correlation between our period and our low moods when we are menstruating.

“I’m PMSing right now” is another phrase we hear. Premenstrual syndrome, premenstrual dysphoric disorder and premenstrual exacerbation are serious conditions that impact one’s mood, especially in the week or so before their periods. Common moods experienced are- heightened feelings of anger, irritability, anxiety and sadness that might manifest in crying and increased sensitivity. This is what women with ‘normal’ menstrual cycles experience. What then happens to women with PCOS who have irregular periods and frequent hormonal fluctuations as their norm? 

To reiterate, PCOS is a serious medical condition experienced by a staggeringly large number of young women. It is characterized by cysts on the ovaries, irregular periods and heightened androgen levels in the female body along with a plethora of other signs and symptoms. The major hormones involved in a female person’s reproductive cycle are estrogen and progesterone. Fluctuations in both adversely influence the serotonin levels- an essential neurotransmitter that regulates moods, sleep cycles and one’s appetite.

Let’s break this down. When we speak of moods- we refer to one’s feelings or their state of mind at any particular time. Everyone experiences different types of moods- positive or negative in nature. In the context of menstruation, low moods that give rise to negative emotions are a dominant feature. Mood disorders however, are less common and are intense and long-lasting mental states that have the potential to impair one’s ability to function ‘normally’. Most widely known mood disorders are those of depression and bipolar disorder. Disorders of mood, anxiety, somatic and eating are highly prevalent in persons struggling with PCOS as well.

Medical health researchers and practitioners are yet to establish a strict cause and effect relationship between PCOS and mental disorders. However, what most go by are multiple legitimate  hypotheses and prevalence rates that state a clear relation between both variables. Some state a connection between insulin resistance and sex hormone imbalances– particularly higher levels of androgens (common symptoms for those with PCOS), that affect the secretion of certain hormones leading to side effects of prolonged stress and depression in the individual. What researchers have noticed through their studies on this matter is that women with PCOS markedly report lower levels of the neurotransmitter- serotonin, which as we earlier stated, are instrumental in regulating one’s moods. 

The above neurobiological symptoms are not the sole contributor to the comorbidity of PCOS and mental illnesses. While hormonal and neurotransmitter imbalances exacerbate one’s mental well-being, they do not negate or supersede other contributors to the development of mental illnesses such as past traumatic experiences, insecurities, fears, socio economic conditions and other phenomena that lead to illnesses such as depression and anxiety. 

In addition, the perception of one’s body and prevailing cultural standards of beauty also have an impact on our mental health. We are aware of the physical manifestation of this disorder in the form of acne, dark spots and patches, weight gain, excessive hair growth both on the body and the face- all of which are considered to be clear aberrations of what the ideal female body is supposed to look like. Women are constantly expected to conform to the standard of fair, unblemished skin with luscious hair and a slender frame. The reality of the situation is that women with PCOS do not meet most of these standards. This can culminate to extreme body dysphoria, low self-esteem, low confidence and a hatred for one’s body and ultimately one’s self- all of which heavily contribute to or can be the source of one’s deepest fears and despair. Prescribed medication to treat both the physical and mental condition of the woman can also increase the occurrence of all of the above physical reactions to the disorders.

Being diagnosed with a chronic illness such as diabetes, high blood pressure or in this case even PCOS is a major stressor in the lives of women as well and definitely impacts not only the physical but emotional and mental health. Many societies and cultures additionally lay the expectation on women to procreate and fulfil their obligations of providing children to their families. This can be a source of immense emotional and physical stress for the woman in question, particularly if they fail to meet this societal expectation and are shamed for the same. Some women may have to undergo medical treatment that correct the levels of certain hormones that are secreted, all of which have physical and mental side effects. This lonely journey is filled with stress, anxiety, pressure, disappointment and frustration.

My personal journey is also rife with the above circumstances. I was 16 when I was first diagnosed with PCOS and 19 when I was diagnosed with clinical depression and anxiety. When the psychiatrist asked me when I first started feeling this way prominently, I drew the parallel between my PCOS journey and my mental health journey. I am in no way stating that PCOS was the sole cause for my mental illness. I am however, bringing light to the correlating timelines- where fluctuating neurobiological mechanisms could have increased the intensity of my low mental state and helped me recognize that this was when my mental condition markedly became worse and began to impair my ability to function. Medication for both these conditions has also affected my weight, acne, appetite, sleep and menstrual cycle. 

Well-meaning people immediately offer us solutions to both conditions which are predominantly medication, exercise and diet. However, what many don’t understand is that mentally ill individuals experience extremely low levels of motivation and lose interest or the capability to engage with even the most basic daily activities. Therefore, it is immensely difficult for exhausted individuals with low levels of energy and motivation to partake in these activities. And so this unfortunate, seemingly punishing cycle continues. 

There is a dire lack of conversation on this issue which can be owed in part to the fact that these are two stigmatized topics, particularly in the Indian framework- issues of the female body and mental health, at play here. The journey of the Indian woman and her sexual or reproductive experiences is often lonely, something personal that she must deal with in secret. With no one to talk to about this very physical manifestation of the diagnosis of PCOS accompanied with serious changes in one’s mental wellbeing can be an alarming phenomenon to experience alone. It is extremely essential then for us as women, to take charge and build a strong support system amongst ourselves. A support group that encourages women to share their stories and come up with joint, realistic strategies in tackling their conditions. Furthermore, we should check up on each other’s progress non-judgmentally and help one another through both the highs and lows that are a part of our collective journeys. Living with PCOS is an extremely hard reality to bear alone. So let’s do our best to be there for each other with empathy, kindness and unconditional support.

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