Many women with polycystic ovary syndrome (PCOS) notice changes in their mood, emotional wellbeing, or ability to cope, often long before they receive any psychological support. Feeling low, anxious, emotionally overwhelmed, or persistently tired is very common in PCOS and is not a personal failing.
Research consistently shows that PCOS is linked to significantly higher rates of anxiety and depression as well as a lower overall quality of life. These mental health challenges are not incidental. They are closely linked to the biological, hormonal, and psychosocial features of PCOS, as well as the lived experience of managing a long-term condition.
In this article, I explain why PCOS can have such a strong impact on mood, why anxiety and depression are more common, and when it may be important to seek support.
Is anxiety or depression more common in women with PCOS?
Yes. Multiple studies and meta-analyses show that women with PCOS experience significantly higher levels of depression and anxiety compared with women without PCOS. This finding has been replicated across different populations and age groups, including adolescent girls with PCOS.
Women with PCOS also report a lower quality of life, with psychological distress closely linked to both hormonal factors and PCOS-related symptoms such as acne, excess hair growth, weight gain, and fertility difficulties.
These mental health difficulties are therefore a recognised and integral part of the condition, rather than secondary or coincidental.
Why does PCOS affect mental health and mood?
PCOS impacts mental health through multiple interacting pathways, including biological, hormonal, neuroendocrine, and psychosocial mechanisms.
Insulin resistance and inflammation
Insulin resistance is a common feature of PCOS. It can lead to chronic low-grade inflammation and oxidative stress, both of which are associated with an increased risk of anxiety and depressive symptoms.
Insulin resistance also contributes to ongoing metabolic stress, creating a self-perpetuating cycle that worsens both physical symptoms (such as fatigue and weight gain) and psychological wellbeing.
This metabolic strain is closely linked to persistent fatigue, which itself has a significant impact on mood, emotional resilience, and coping capacity.
Elevated androgens and brain chemistry
Raised androgen (male-associated hormone) levels, such as testosterone, are central to PCOS. Research suggests that elevated androgens may affect neurotransmitter systems involved in mood regulation, including serotonin and GABA signalling.
These neurotransmitters play a key role in emotional balance, anxiety regulation, and stress response, and disruption within these systems is an important biological pathway underlying mood disturbances in PCOS.
Neuroendocrine dysregulation
PCOS is also characterised by disrupted communication between the brain and ovaries, known as neuroendocrine dysregulation. This involves altered signalling between the hypothalamus, pituitary gland, and ovaries.
As a result, luteinising hormone (LH) levels are increased and the LH-to-FSH ratio is higher than normal. This drives excess androgen production and disrupts ovulation. This dysregulation represents a fundamental pathophysiological change in PCOS and contributes indirectly to psychological distress.
Psychosocial and lived-experience factors
In addition to biological pathways, the emotional impact of PCOS is shaped by lived experiences associated with the condition.
Key contributors include:
- Body image and self-esteem difficulties related to symptoms such as hirsutism, acne, hair loss, and weight gain
- Fertility concerns, as PCOS is a leading cause of anovulatory infertility
- Chronic stress and coping burden associated with managing a complex, lifelong condition
Research shows that women with PCOS may use more emotion-focused coping strategies and have lower psychological resilience, both of which are associated with higher levels of anxiety and depression.
Why do I feel so tired all the time with PCOS?
Persistent fatigue is very common in PCOS and is closely linked to insulin resistance, inflammation, and metabolic stress.
When the body is under ongoing physiological strain, both physical energy and emotional capacity are reduced. Fatigue can increase irritability, reduce motivation, and make coping with symptoms feel overwhelming, further impacting mood and mental wellbeing.
When should I seek help for my mental health?
If you have been feeling persistently low, anxious, or emotionally distressed for more than two weeks, it is important to seek support.
Speaking with your GP or specialist can help you access talking therapies and, where appropriate, pharmacological treatment options. Early intervention can help prevent symptoms from becoming more entrenched and support both mental and physical wellbeing.
About the author
Dr Sarah Jane Khalid is a Counselling Psychologist, Coach and certified Meditation Teacher with experience across the NHS, charitable organisations and private practice. She specialises in stress, low self-esteem, workplace challenges and women’s mental health, using evidence-based approaches including CBT, mindfulness, ACT and Compassion Focused Therapy.
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