Women with PCOS Face Increased Mental Health Risks

Aled Rees, MBBCh, PhD

A study in the UK looked at mental health outcomes for women with polycystic ovary syndrome (PCOS) and their children. The results suggest that women with PCOS are at increased risk of psychiatric disorders and their children are more likely to develop attention deficit hyperactivity disorder (ADHD) and autism.

PCOS is one of the most common causes of infertility among women, affecting as many as 5 million (6% to 12%) of American women of reproductive age, according to the CDC. However, infertility is just one aspect of the condition. Women with PCOS can also develop other serious health problems including heart disease and diabetes. However, less is known about the direct effects of PCOS on mental health.

“The effects of PCOS on mental health is under-appreciated,” one of the study authors, Aled Rees, MBBCh, PhD, FRCP, of Cardiff University in Cardiff, United Kingdom, told MD Magazine.

The study drew from the Clinical Practice Research Datalink, a UK governmental database of anonymized primary care records.

PCOS patients were matched to 2 control sets of non-PCOS patients by age and body mass index. The second control set was also matched by history of prior mental health disorders, including depression, anxiety, bipolar disorder, schizophrenia, eating disorder, autism, ADHD. Of 16,986 eligible participants, 16,938 (99.7%) and 16,355 (96.3%) patients were matched with control counterparts for control sets 1 and 2 respectively.

The study’s primary endpoint was incidence of depressive disorder, anxiety, bipolar disorder, schizophrenia, eating disorder, ADHD, and autism spectrum disorder (ASD) in cases and controls.

In the first control set, 23.1% of patients with PCOS had been diagnosed previously with depression compared to 19.32% of controls. Patients with PCOS were also more often previously diagnosed with anxiety (11.55%, 9.32% for controls) and bipolar disorder (3.16%, 1.45% for controls).

The authors reported an increased incidence of depression and anxiety when comparing patients and controls matched for a prior history of mental health disorder (control set 2).

“Our work shows that screening for mental health disorders should be considered during clinical assessments,” said Rees.

Secondary outcomes for the study were the incidence of ADHD or ASD in the children of mothers with PCOS. In control set 1 there were 8,962 children born to patients with PCOS compared to 8,885 born to the controls. For the second control group, there were 8,695 births to women with PCOS and 8,973 to controls.

In control set 1 the respective rate of ADHD was 4.81 per 1000 patient years (pky) for mothers with PCOS versus 3.32 pky in controls, and the rate of ASD was 5.82 pky versus 3.92 pky. For control set 2, the rate of ADHD was 6.00 pky versus 3.54 pky, respectively, and the rate of ASD was 4.44 pky versus 3.90 pky.

Rees advises caution in interpreting results relating to secondary outcomes. “Whilst our findings have suggested that there may be a slightly increased risk of disorders such as autism and ADHD in children born to mothers with PCOS, it is important to recognize that the actual number of children affected was very low.”

However, the authors conclude that women with PCOS are at increased risk of being diagnosed with mental health disorders and their children face increased risk of ADHD and ASD.

“Further research is needed to determine which components of the syndrome might be driving this increased risk, and indeed whether all patients with PCOS are at increased risk or only some,” said Rees.

The authors anticipate further research to “investigate if genetic factors that contribute to the risk of PCOS also contribute to the risk of mental health disorders, which may help to reveal new biological pathways implicated in these conditions, and lead to new treatments.”

The study, “Polycystic ovary syndrome is associated with adverse mental health and neurodevelopmental outcomes,” was published in The Journal of Clinical Endocrinology & Metabolism.