PCOS / PMOS

PCOS and mental health

Taking anxiety, mood and body image seriously

The emotional burden is one of the most common effects of polycystic ovary syndrome (PCOS/PMOS) and at the same time one of the most overlooked. Consultations usually focus on the cycle, the skin or the wish for a child. Anxiety, low mood and a negative body image are often not mentioned at all.

This is why the 2023 international guideline made this area a focus of its own. Women with the syndrome took part in developing the guideline, and for many of them mental health was one of the most important concerns.

How common are depression and anxiety?

A large review from 2017 shows that moderate to severe depressive symptoms occur in about 37% of women with PCOS, compared with about 14% of women without the syndrome. For anxiety symptoms the figure is about 42%, compared with about 9%. The risk is therefore about four to five times higher.

Large population studies from Australia and Sweden confirm this picture. Women with PCOS are treated more often for depression and anxiety, including in hospital. According to the available data, the burden in adolescents with the syndrome is probably even higher than in adult women.

A newer study from Taiwan, published in 2024 in the Annals of Internal Medicine, followed women with the syndrome for 16 years. The risk of a suicide attempt was about 8 times higher than in women without the syndrome. In adolescents it was about 5 times higher, and in young women about 9 times higher. A systematic review from 2025 concludes that the doctor should ask every woman with the syndrome about such thoughts. A woman who is thinking about harming herself needs help from a doctor straight away.

Why is mental health so often affected?

The reasons are many and act together. Visible symptoms such as extra hair growth, acne, hair loss or weight gain affect self-esteem every day. An irregular cycle brings uncertainty, and difficulty conceiving is one of the hardest experiences of all for many couples.

On top of this comes the path to diagnosis. Many women see different doctors over several years before someone puts the symptoms together. Quite often they are told that their symptoms are “normal” or that they only need to lose weight. This feeling of not being taken seriously adds to the burden.

Studies also suggest that the hormonal and metabolic mechanisms of the syndrome itself play a role. The link between PCOS and depression remains even when weight and hair growth are taken into account. Androgens, insulin resistance and chronic inflammation may act directly on the brain. The emotional burden is therefore not only a reaction to the symptoms, but also part of the syndrome itself.

What role does body image play?

Many women with PCOS experience their body as foreign or as an opponent. This concerns weight, skin and hair, but also the feeling that their own body “does not work properly”. A changed body image weighs on mental health: it lowers self-esteem and increases anxiety and depression. This is often the first step. Anxiety and depression then affect relationships, sexual life and the willingness to be among other people. The guideline recommends raising the topic of body image actively and offering support when needed.

How do mental health and quality of life affect each other?

Anxiety and depression do not only affect mood. They cause sleep problems and tiredness, change appetite and eating behavior, reduce the wish to exercise and sexual desire, and make weight control harder. Together with the visible symptoms of the syndrome, these problems in turn weigh on mental health and quality of life. This closes the vicious circle, in which each problem feeds the next. Treating one link in the chain, for example depression or sleep, often helps the others as well.

Sleep, eating and sexual life are described in detail in the article “PCOS and quality of life”.

How are anxiety and depression diagnosed?

The guideline gives a strong recommendation: the doctor should ask all adolescents and women with PCOS about anxiety and depressive symptoms at diagnosis. A few simple questions about the past two weeks are enough at first. If the answers raise concern, short validated questionnaires follow and, if needed, a referral to a psychotherapist.

There is no fixed interval for later checks. Important life events, fertility treatment, pregnancy, the time after the birth and new symptoms are good reasons to ask again.

How are anxiety and depression treated?

When depression or an anxiety disorder is diagnosed, psychological therapy is the first choice, especially cognitive behavioral therapy. The doctor uses medicines according to the general rules for these conditions. The guideline recommends particular caution with medicines that cause weight gain, because they can worsen other symptoms of the syndrome.

Cognitive behavioral therapy also helps with lifestyle. In a randomized trial, women who had cognitive behavioral therapy together with a lifestyle program lost more weight and had a better quality of life than women who followed the lifestyle program alone. Psychological support is therefore part of the treatment of the syndrome.

Hormonal treatment also plays a role. Some women have mood changes with certain hormonal preparations. The choice of a preparation therefore also takes mental well-being into account. On the other hand, effective treatment of hair growth, acne, the cycle and fertility often improves emotional well-being as well.

Regular exercise has a proven positive effect on mood and anxiety, regardless of weight. A clear explanation of the syndrome is just as important. A woman who understands what is happening in her body, and knows that the cause is not a lack of discipline, can cope better with the difficult phases.

The practice's approach

Sources: International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome (Monash University, ESHRE, ASRM, 2023); Teede HJ et al., Human Reproduction 2023. Cooney LG et al., High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome, Human Reproduction 2017. Hart R, Doherty DA, Journal of Clinical Endocrinology and Metabolism 2015 (population study, Western Australia). Cesta CE et al., Psychoneuroendocrinology 2016 (Swedish register study). Hsu TW et al., Suicide attempts after a diagnosis of polycystic ovary syndrome: a cohort study, Annals of Internal Medicine 2024. Wong S et al., Suicide risk in persons with polycystic ovarian syndrome: a systematic review, Annals of General Psychiatry 2025. Cooney LG et al., Cognitive-behavioral therapy improves weight loss and quality of life in women with polycystic ovary syndrome, Fertility and Sterility 2018.