The Effects of PCOS on Mental Health

Written by Aziza Sobh, Registered Psychotherapist

Aziza is a Registered Psychotherapist and Founder of Day by Day Psychotherapy, based in Burlington, Ontario. She is committed to supporting adolescents, adults, and couples navigate a wide range of challenges. With an academic background in Kinesiology and Psychology, Aziza integrates a holistic approach into her practice.

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“Why do I feel like this?” If you have ever asked yourself that while navigating life with PCOS, you are far from alone. The mood swings, the stress, and the low self-esteem are not just random or imagined. They are part of a much bigger, often overlooked picture. PCOS does not just affect your body; it can take a serious toll on your mental health. Beneath the physical symptoms lies a hidden struggle. Anxiety, depression, and emotional burnout are too often left unspoken. It is time to break the silence and shed light on the mental and emotional weight of living with PCOS.

The biological connection: How hormones shape mental health

To say that women with Polycystic Ovarian Syndrome (PCOS) struggle with depression is an understatement. Clinical depression is, unfortunately, all too common among women living with PCOS, resulting from a complex interplay of biological, psychological, and social factors unique to this condition.

But what exactly is clinical depression, and what does it look like? Also known as Major Depressive Disorder (MDD), it is a serious mood disorder characterized by persistent feelings of sadness, hopelessness, low self-worth, and a loss of interest or pleasure in activities. For women with PCOS, depression is rarely just a standalone diagnosis. It often stems from the underlying hormonal and metabolic disturbances, as well as the emotional and social challenges associated with the condition.

Among the biological mechanisms driving depression in PCOS, hormonal imbalances are at the forefront. Androgens, which are male hormones such as testosterone, are often elevated in women with PCOS. At the same time, estrogen and progesterone levels can be disrupted. Together, these hormonal shifts profoundly affect the brain’s chemistry, particularly in systems responsible for regulating mood, emotion, and cognitive function.

Androgens and brain chemistry

Elevated androgens can interfere with serotonin production and receptor sensitivity. Serotonin is a key neurotransmitter responsible for feelings of well-being, emotional stability, and resilience to stress. Reduced serotonin levels are strongly associated with depression, anxiety, and irritability. At the same time, excess androgens may disrupt dopamine pathways, the brain’s system for motivation, pleasure, and reward processing. When dopamine signaling is impaired, it can lead to low motivation, fatigue, and an inability to experience joy, a symptom known as anhedonia, commonly seen in depression.

Additionally, high androgen levels may amplify the body’s stress response by increasing cortisol production. Cortisol, known as the stress hormone, when chronically elevated, contributes to anxiety, sleep disturbances, and mood instability, all of which commonly accompany depressive states.

Estrogen, progesterone, and their influence on mood

The menstrual irregularities often seen in PCOS reflect deeper disturbances in estrogen and progesterone, two hormones critical for brain function and emotional well-being. Estrogen supports serotonin production and receptor activity, enhances dopamine transmission, and has anti-inflammatory effects within the brain. When estrogen levels are low or fluctuate unpredictably, as they often do in PCOS, mood can suffer. Many women experience lowered emotional resilience, cognitive fog, and increased vulnerability to depression. Progesterone, particularly in its neurosteroid form known as allopregnanolone, enhances the calming effects of GABA (gamma-aminobutyric acid), a neurotransmitter that promotes relaxation, reduces anxiety, and helps regulate sleep. Disruptions in progesterone levels in PCOS can reduce GABA activity, leaving individuals more prone to anxiety, insomnia, and irritability.

The combination of elevated androgens, disrupted estrogen and progesterone levels, and resulting imbalances in neurotransmitters like serotonin, dopamine, and GABA create a perfect storm for emotional and mental health challenges. Over time, this biological imbalance increases susceptibility to clinical depression, generalized anxiety disorder, mood swings, poor stress tolerance, irritability, and sleep disturbances—a mental health burden that often goes unrecognized but is very real for those living with PCOS.

Insulin resistance and inflammation

Many women with PCOS experience insulin resistance and low-grade chronic inflammation, two interconnected biological factors that have been increasingly linked to depression and altered brain function. Insulin resistance disrupts the body’s ability to regulate blood sugar and energy metabolism, while chronic inflammation interferes with neurotransmitter activity and brain signaling. Together, these imbalances may contribute to mood disorders, cognitive difficulties, and broader mental health challenges in women with PCOS.

It is important to note that insulin resistance affects a significant number of women with PCOS, even those who are not overweight. Insulin resistance occurs when the body’s cells become less responsive to insulin, forcing the pancreas to produce more to maintain normal blood glucose levels. Beyond its role in metabolism, research shows that insulin plays a critical role in brain signaling, neuroplasticity, and the regulation of key neurotransmitters, particularly serotonin, dopamine, and glutamate, all of which are essential for mood regulation and cognitive function.

In a 2019 study titled Insulin Resistance is Associated with Depression Risk in Polycystic Ovary Syndrome, researchers found that: “Insulin resistance has a strong and independent association with depression in PCOS and may serve as a physiologic mediator. Findings corroborate a growing body of evidence linking insulin resistance to depressed mood. The association between insulin resistance and depressed mood warrants further investigation to elucidate mechanisms and identify potential therapeutic targets” (Greenwood et al., 2019).

In addition to insulin resistance, many women with PCOS exhibit signs of chronic low-grade inflammation, a condition that can also impact brain health. Chronic inflammation can cross the blood-brain barrier and disrupt brain chemistry by reducing serotonin production, increasing oxidative stress, and activating microglia, the brain’s immune cells, all of which have been linked to depression and other mood disorders. A 2021 review titled PCOS and Depression: Common Links and Potential Targets emphasized the need to further explore these biological pathways, highlighting shared factors such as elevated cortisol, androgen imbalances, vitamin D deficiency, altered neurotransmitter activity, monoamine oxidase (MAO) changes, and disrupted insulin-like growth factor-1 (IGF-1) signaling as contributing to both PCOS and depression (Kolhe et al., 2021).

Together, insulin resistance and chronic inflammation create an internal environment that not only affects physical health but significantly increases vulnerability to depression, anxiety, and cognitive difficulties in women living with PCOS.

Psychological and social factors

PCOS is not just an internal health battle. It is a condition that can visibly affect a woman’s outward appearance, often with significant emotional consequences. Symptoms such as acne, hirsutism (excess facial or body hair), hair thinning, and weight gain can severely impact body image and self-perception. In a society already saturated with unrealistic beauty standards, these visible symptoms can leave women with PCOS feeling as though their bodies set them apart in undesirable ways. This often leads to persistent feelings of embarrassment, shame, and inadequacy, which, over time, erode self-esteem and confidence. Social situations such as dating, public events, or even professional opportunities can become sources of anxiety, avoidance, or complete withdrawal.

Numerous studies highlight this reality. Research shows that women with PCOS are significantly more likely to experience body image dissatisfaction compared to women without the condition, with up to 70-80% reporting moderate to severe dissatisfaction with their appearance.

The emotional toll of fertility struggles

One of the most distressing aspects of PCOS is the challenge it poses to fertility. Irregular or absent menstrual cycles and hormonal imbalances frequently lead to difficulties conceiving, which can be devastating for those who dream of having children. The emotional burden of fertility treatments, repeated disappointment, and the uncertainty of the future can trigger deep grief, frustration, and a profound sense of hopelessness.

For many women, fertility struggles also strain romantic relationships and fuel feelings of isolation, especially when peers seem to conceive effortlessly. Research shows that women with PCOS and infertility report 2 to 3 times higher rates of depression than women facing infertility from other causes. Additionally, up to 60% of women with PCOS experience significant anxiety when confronted with fertility challenges.

Unfortunately, it is not only the individual who suffers. Couples navigating PCOS-related infertility often experience higher rates of relationship strain, sexual dissatisfaction, and emotional withdrawal. Issues with fertility tied to PCOS extend far beyond medical complications. They ignite deep psychological distress, grief, and identity crises. Numerous studies confirm that PCOS-related infertility contributes to increased depression, anxiety, and low self-esteem, regardless of weight or physical appearance.

Beyond statistics and clinical terms, the emotional reality for many women sounds painfully familiar: “Every month feels like a reminder that my body isn’t doing what it’s supposed to.” Many describe the emotional rollercoaster of tracking ovulation, clinging to hope, only to face disappointment month after month, a cycle that chips away at both emotional resilience and self-worth.

Social comparison and stigma in the age of social media

In today’s world of social media and filtered perfection, the visible symptoms of PCOS, especially those related to weight and appearance, often expose individuals to unsolicited comments, judgment, and stigma. Social comparison becomes inevitable as women compare themselves to seemingly “perfect” bodies and “effortless” lifestyles that dominate their social feeds.

Fertility struggles are especially difficult in this context. Seeing friends or influencers announce pregnancies and celebrate motherhood can serve as a painful reminder of one’s ongoing struggle, intensifying feelings of depression, isolation, and defeat.

A large survey conducted by Gibson-Helm et al. (2018) found that women with PCOS frequently reported feeling “different” and “unfeminine” due to visible symptoms, often resulting in avoidance of dating, intimacy, and social situations. Over time, external judgment can become internalized, causing women to adopt negative beliefs about themselves, viewing their bodies as defective, unattractive, or not feminine enough.

This internalized stigma can lead to avoidance of social situations or relationships out of fear of rejection. It is also associated with an increased risk for depression, anxiety, and eating disorders, further compounding the psychological burden of living with PCOS.

What does it look like to experience depression?

Depression, particularly in the context of PCOS, is not simply “feeling sad.” It infiltrates nearly every aspect of a woman’s life: internally, emotionally, physically, and socially.

Internally, women often grapple with persistent feelings of worthlessness, hopelessness, and guilt—emotions that can stem from body image struggles, fertility challenges, and hormonal imbalances described earlier. Over time, this internal dialogue erodes self-confidence and emotional resilience.

Emotionally, depression presents as more than sadness. Many women report ongoing feelings of emptiness, irritability, and even emotional numbness, where joy and motivation feel inaccessible. These emotional struggles often feel overwhelming and unrelenting, affecting daily functioning. These intense emotional states are not confined to the mind; they manifest physically. Fatigue, changes in appetite, sleep disturbances, and a general lack of energy are common. Everyday tasks, even those that once felt routine, can suddenly feel exhausting or impossible.

Externally, depression deeply affects relationships. Combined with the physical and emotional symptoms of PCOS, women may begin to withdraw from family, friends, and even romantic partners. Unfortunately, this often happens at a time when support is most needed. The overwhelming nature of depression can make it difficult to reach out, creating a cycle of isolation that only deepens emotional pain.

The impact also extends to work and education. Difficulty concentrating, reduced productivity, and even absenteeism are common among individuals struggling with depression.

When simply getting through the day feels like living in “survival mode,” fulfilling academic or professional responsibilities can feel nearly impossible.

Depression in the context of PCOS is not just about low mood. It is a complex, multi-layered struggle that affects how a woman feels about herself, how she connects with others, and how she functions in the world.

Conclusion

In summary, the higher rates of clinical depression among women with PCOS are not the result of a single factor, but rather a complex, interconnected web of biological, psychological, and social challenges. Hormonal imbalances, visible physical symptoms, fertility struggles, chronic health uncertainty, social stigma, and underlying inflammation and metabolic issues all contribute to the emotional toll of this condition.

Importantly, clinical depression in women with PCOS is not simply a reaction to physical symptoms. It is a deeply rooted, multifaceted mental health condition that demands attention. Understanding the how, what, when, where, and why of this connection highlights the urgent need for a more holistic approach to care. True, effective management of PCOS must extend beyond addressing physical symptoms. It must always include comprehensive, compassionate mental health support.

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Aziza Sobh, Registered Psychotherapist

Aziza Sobh is a Registered Psychotherapist and the Founder of Day by Day Psychotherapy, a private practice offering counselling services to individuals aged 13 and older, as well as couples. Holding a dual degree in Kinesiology and Psychology, Aziza is passionate about advancing the understanding of the interplay between mental and physical health. With aspirations to pursue a doctorate degree, her work is focused on raising awareness of the long-term impact of mental health concerns on physical well-being, especially in women.