Polycystic Ovary Syndrome, simply referred to as PCOS, is a hormonal disorder that impacts women who are of reproductive age. While the cause of PCOS is not well known, we do know that it causes enlarged ovaries with small cysts on the outer edges. Health experts believe a combination of genetic and environmental factors are at play with this disorder.
The effects of PCOS are still being studied, but we know that those with the disorder can experience a wide range of mental health concerns, from anxiety and depression to eating disorders and low self-esteem. Continue reading this blog to figure out how PCOS may be impacting you mentally and emotionally, and what you can do to cope.
Anchor Therapy is a counseling center in Hoboken, NJ with mental health therapists specialized in helping children, teens, adults, couples, and families with anxiety, depression, relationship issues, trauma, life transitions, and more. Anchor Therapy is accepting new clients and is now providing in-person sessions and teletherapy sessions to residents of New Jersey, New York, and Florida.
What is PCOS?
PCOS is a hormonal issue that can occur during a woman’s reproductive years. If you have PCOS, your menstrual cycle may last for days on end, or you may not have periods very often. Having few menstrual periods or having periods that are not regular are common signs of PCOS.
Another common sign is having periods that last for many days or for longer than what is typical of a period. A period usually lasts from four to eight days, but it varies person-to-person. For example, some people may experience periods that last two to seven days. Irregularities with your menstrual cycle may make getting pregnant difficult.
It is also possible that you have too much androgen, a group of sex hormones that develop and maintain masculine characteristics, in your body. High levels of androgen can come along with unwanted physical signs and symptoms, such as hirsutism or excessive facial and body hair. In some cases, you may experience severe hormonal acne along your jawline, chest, and back. Male-pattern baldness can occur as well.
With PCOS, your ovaries may be bigger and may not work the way they are supposed to work. You likely have many follicles containing immature eggs that develop around the edge of the ovary.
PCOS can come along with many complications, including the following:
Infertility (Check out our blog “How Infertility Can Impact Your Mental Health”)
Gestational diabetes
Pregnancy-induced high blood pressure
Miscarriage(s) (Read our blog “5 Common Emotions Felt While Pregnant If You Previously Experienced A Miscarriage”)
Premature birth
Sleep apnea (View our blog “Unlock the Secrets of Quality Sleep: A Therapist’s Perspective on Sleep Hygeine and Insomnia”)
Depression (Take our Depression Quiz)
Anxiety (View our blog to take our Anxiety Quiz “Do I Have Anxiety? Take The Quiz and Learn 5 Instant Calming Tips”)
Low self-esteem (Read our blog “Do You Understand Your Self-Esteem?”)
Eating disorders (Check out our blog “Cultivating Good Mental Health for Intuitive Eating”)
Type 2 diabetes or prediabetes
Nonalcoholic steatohepatitis (severe liver inflammation triggered by fat buildup in the liver)
Metabolic syndrome (e.g., high blood pressure, high blood sugar, unhealthy cholesterol or triglyceride levels, etc.)
Obesity commonly occurs alongside PCOS and can worsen complications of the disorder.
What is the psychological burden of PCOS?
PCOS is a complex disorder and, like with any other health condition, it can impact your psychological well-being. The psychological burden of PCOS is not one to ignore, and it can trigger many emotional and mental health challenges.
Some of the primary psychological burdens of PCOS include:
Depression
Women with PCOS are at a higher risk of developing depression. According to research, women with PCOS have up to eight times higher prevalence of depression compared to the respective control groups. This is often due to a combination of factors, specifically hormonal imbalances.
Those with PCOS experience elevated androgen levels and the physical manifestation of this includes weight gain, acne, and hair loss. The visible consequences of PCOS may lead to shame, feelings of inadequacy, and low self-esteem.
PCOS is a chronic condition and has a lifelong nature. Therefore, many women often feel hopeless when it comes to controlling or managing their symptoms. This sense of deep frustration can create a taxing emotional burden that impacts many areas of your life, from interpersonal relationships to career performance.
Anxiety
Anxiety is another mental health concern commonly seen in women with PCOS. Women with PCOS are six times more likely to develop moderate to severe anxiety than women without the disorder according to a study.
This anxiety can form due to many reasons, such as:
Experiencing body image issues (Check out our blog “The Hidden Impact of Body Image on Your Well-Being”)
Uncertainty about future fertility
Worries about long-term health complications (e.g., diabetes, heart disease, etc.)
Women with PCOS may experience anxiety over how people perceive them, particularly if they have visible signs of PCOS, like excessive facial or body hair or severe acne. These symptoms can be quite unpredictable and when you couple this with hormonal fluctuations, you can experience increased feelings of unease, nervousness, and restlessness. This can cause your anxiety to be ongoing, furthering its impact on your physical symptoms as well.
Body image concerns
As previously mentioned, PCOS leads to visible physical changes which can impact your body image and self-esteem.
Some physical symptoms of PCOS include the following:
Excessive hair growth (hirsutism)
Acne
Weight gain or difficulty losing weight
Thinning hair or hair loss (androgenic alopecia)
Darkening of the skin (acanthosis nigricans)
Skin tags
These physical changes are often stigmatized in society, and can lead women with PCOS to feel less attractive or feminine. As a result, some women with PCOS may avoid social interactions (e.g., swimming, exercising in public, etc.) or intimate relationships where their body is exposed.
Negative body image may dominate your thoughts and interactions. Along with the emotional burdens of PCOS, you may be carrying around large feelings of shame, embarrassment, or inadequacy. For support, read our blogs “Cognitive Behavioral Therapy (CBT) for Negative Self-Talk” and “How to Overcome Body Image Issues.”
Infertility-related stress
One of the most emotionally distressing effects of PCOS is infertility since it may impact many women who are wishing to conceive. Irregular ovulation or a lack of ovulation can cause many women with PCOS to struggle to get pregnant.
For women who have always envisioned being mothers, you may experience grief, sadness, and frustration. You may have always seen a future where you could conceive naturally and have a healthy, happy pregnancy; however, reality is now coming to the forefront. For support with this, check out our blog “Grieving A Life That Never Was.”
Society and personal expectations may also be placing a lot on you since womanhood and fertility are often viewed as one. This can cause a deep sense of inadequacy or failure. From failed attempts at conception to the stress of fertility treatments, you may experience emotional turmoil.
Impact on relationships
PCOS can strain intimate and social relationships. The physical manifestations of PCOS and emotional struggles linked to the disorder can create barriers in romantic relationships, especially regarding sexual intimacy.
As a woman with PCOS, you may withdraw from physical intimacy due to the following reasons:
Body image issues
Feelings of unattractiveness
Fear of rejection (Read our blog “Why Am I Terrified of Rejection?”)
If you are struggling with this, you may find support in working with a sex and relationship therapist at Anchor Therapy. For more information, check out our blog “What to Expect in Sex Therapy.”
Additionally, fertility issues can cause tension within a relationship. For instance, you may want to do one specific fertility treatment while your partner thinks the other option is better. Or, you and your significant other may experience different levels of emotional investment in the life transition of becoming a parent.
While your family members and friends likely mean well, it is possible that they do not know the full scope of PCOS, leading you to feel isolated.
Eating disorders and disordered eating
Research shows that women with PCOS are three to six fold more likely to have an eating disorder. Weight gain and insulin resistance come along with PCOS, making women with PCOS more likely to develop disordered eating behaviors.
Even with rigorous dieting and exercise, it may be hard for a woman with PCOS to lose weight. Understandably, frustration will build from this which can lead to emotional eating, binge eating tendencies, or restrictive eating patterns.
The metabolic challenges of PCOS are made worse by the pressure to conform to societal beauty standards. This can make it hard to have a healthy relationship with food. Controlling your weight and managing your PCOS symptoms is difficult and some women will develop clinical eating disorders to cope in an unhealthy way.
Cognitive and attention issues
Some studies have shown that women with PCOS may experience a range of cognitive and attention issues, such as scoring lower on cognitive tests that measure attention, memory, verbal abilities, and processing speed. Some tests even report that women with PCOS have lower white matter integrity in the brain which may indicate early brain aging.
These cognitive and attention issues can be linked to the hormonal imbalances that come along with PCOS, specifically elevated androgen levels and insulin resistance that can impact brain functioning.
Women with PCOS often report:
Brain fog
Forgetfulness
Difficulty focusing
These challenges can:
Affect job performance
Make academic success more difficult
Make everyday tasks hard to complete
Dealing with cognitive and attention issues related to your PCOS can worsen the stress you are already facing.
How to emotionally deal with PCOS
PCOS can very clearly impact your physical health, but it may not be so obvious as to how the disorder affects your mental and emotional welfare. There are emotional coping strategies out there that can help women manage the stress, frustration, and psychological burdens that come along with being diagnosed and living with PCOS.
First, it is important to acknowledge and validate your emotions. In other words, feel your feelings. If you feel sad, angry, or frustrated over having PCOS, that is okay. Many women experience some form of grief once they find out they have PCOS, specifically in relation to their health, fertility, and even body image.
Suppressing your emotions will only lead to emotional distress over time. Processing your emotions is a way to come to terms with your PCOS diagnosis and can reduce feelings of isolation and loneliness.
If you have been diagnosed with PCOS, it is important to educate yourself about the condition (just as you are doing by reading this article!). Knowing the symptoms and treatment options of PCOS can make you feel more in control over your health and reduce any feelings of hopelessness and confusion. Many women report feeling empowered once they know more about their condition. Understanding what is happening in your body can help alleviate your anxiety and the emotional burden of feeling out of control. Contrastingly, if you are struggling with health anxiety, check out our blog “3 Ways to Overcome Health Anxiety.”
When you educate yourself about PCOS, you will come to find out that there is not just one single solution to all of your PCOS-related concerns. Managing PCOS symptoms often includes a multifaceted approach of diet, exercise, lifestyle modifications, and sometimes medication. Like anything, progress may be slow. Therefore, it is important to set realistic goals for yourself instead of aiming for perfection. For example, if your PCOS has caused you to gain weight, it is not realistic to state that you want to lose 20 pounds in one month. Instead, you can set a healthy, sustainable goal of losing one to two pounds a week.
If feelings of anxiety, depression, or emotional distress become overwhelming, seeking help from a therapist who specializes in women’s issues is important. Several forms of talk therapy, including the evidence-based Cognitive Behavioral Therapy (CBT), can help treat this.
A fertility therapist can offer a safe space for you to explore your deeper emotional challenges while offering coping strategies and emotional support.
Working with a licensed mental health counselor when dealing with PCOS offers several benefits, including:
Emotional validation and support
Managing depression and anxiety
Improving body image and self-esteem
Coping with reproductive challenges
Addressing food-related issues
Improving relationship dynamics
Challenging negative thoughts and addressing self-blame
Creating a safe space for grief and acceptance
Reducing feelings of isolation
Supporting long-term mental health
Many women with PCOS feel misunderstood; however, working with a therapist can counter these feelings by providing emotional connection and understanding.
Victoria Scala
is the Social Media Manager, Intake Coordinator, and Community Engagement Director at Anchor Therapy in Hoboken, New Jersey. She is a graduate of the Honors College of Rutgers University-Newark and is currently studying Clinical Mental Health Counseling at the graduate level. In her roles, Victoria is committed to managing the office’s social media/community presence and prioritizing clients' needs.
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