Mental health in women with polycystic ovary syndrome

Polycystic Ovary Syndrome (PCOS) is the most common hyperandrogenic condition in women. It is associated with several adverse health outcomes as subfertility, obesity, the metabolic syndrome, and skin issues. PCOS can be viewed as a naturally occurring model of the activating effect of androgens on women. There are significant differences in mental disorders and behaviour between men and women. The effects of androgens are a potential contributor to those differences. The overarching question in this thesis is whether women with PCOS differ from women without PCOS in terms of quality of life, psychiatric morbidity, personality, and sexual health.

We first conducted a clinical study of women with PCOS and age-matched controls who were thoroughly examined using structured interviews, biochemical analyses, and questionnaires (study I, II and IV). In study IV, we also used an independent cohort of women with PCOS and controls matched for age and BMI. Second, we used a register linkage of several nationwide Swedish registers (study III).

In study I, we found that depressive disorder, anxiety disorders, and eating disorders were more common in PCOS than controls. In women with PCOS, recurrent depression and social phobia were associated with higher Body Mass Index (BMI). In study III, we confirmed that depressive and anxiety disorders are more common among women with PCOS, and furthermore found increased prevalence of almost all studied diagnoses with the exception of alcoholism and anorexia nervosa. In a sibling analysis, both brothers and sisters of PCOS probands had more autism spectrum disorders than controls, and sisters had more anxiety, depression, and schizophrenia spectrum disorders.

In study II, we found that a larger proportion of women with PCOS are dissatisfied with their sex life than controls, and that arousal and lubrication are special areas of concern. Total sexuality correlated with testosterone in women with PCOS, but not in controls. In controls total sexuality correlated with higher psychological wellbeing, which it didn’t do in PCOS. Total psychological wellbeing was lower in women with PCOS compared to controls.

In study IV, we found that women with PCOS scored higher on several anxious personality traits are higher, and lower on the personality trait ‘socialization’, than controls regardless of whether they were matched on BMI or not.

Taken together, we found that PCOS has significant effects on mental health including increased risks of several psychiatric disorders, psychological wellbeing, personality, and also sexual health. Some of these differences might be due to a direct or indirect effect of androgens, while other might be due to secondary effects such as subfertility, and comorbid conditions.

List of scientific papers

I. Mattias Månsson, Jan Holte, Kerstin Landin-Wilhelmsen, Eva Dahlgren, Anette Johansson, Mikael Landén. 2008. Women with polycystic ovary syndrome are often depressed or anxious – A case control study. Psychoneuroendocrinology. 33, 1132-1138.
https://doi.org/10.1016/j.psyneuen.2008.06.003

II. Mattias Månsson, Kajsa Norström, Jan Holte, Kerstin Landin-Wilhemsen, Eva Dahlgren, Mikael Landén. 2010. Sexuality and psychological wellbeing in women with polycystic ovary syndrome compared with healthy controls. European Journal of Obstetrics & Gynecology and Reproductive Biology. 155, 161-165.
https://doi.org/10.1016/j.ejogrb.2010.12.012

III. Carolyn E. Cesta, Mattias Månsson, Camilla Palm, Paul Lichtenstein, Anastasia N. Iliadou, Mikael Landén. 2016. Polycystic Ovary syndrome and psychiatric disorders: Co-morbidity and heritability in a nationwide Swedish cohort. Psychoneuroendocrinology. 73, 196-203.
https://doi.org/10.1016/j.psyneuen.2016.08.005

IV. Mattias Månsson, Kerstin Landin-Wilhelmsen, Eva Dahlgren, Elisabet Stener-Victorin, Mikael Landén. 2022. Personality traits in women with polycystic ovary syndrome in two Swedish cohorts. [Submitted]