Researchers from the University of Pennsylvania Medical Center (Dokras, Anuja et al.) have published a new systematic review and meta-analysis in a November 29 online report in Fertility and Sterility investigating the prevalence of anxiety disorders in women with polycystic ovary syndrome (PCOS).
They found 5 times as many women with PCOS having generalized anxiety symptoms compared with controls (prevalence - 20% vs. 4%) and a nearly sevenfold increase in the risk of generalized anxiety symptoms in women with PCOS (pooled odds ratio, 6.88). They also found studies showing a higher prevalence of social phobia in women with PCOS and showing a higher percentage of obsessive compulsive disorder in women with PCOS.
They ask clincians to begin screening all women with PCOS for both anxiety and mood disorders in order to refer them for appropriate evaluation and treatment. They also ask for more studies to help better understand why anxiety is more prevalent in women with PCOS.
Neuroendocrinology provides a nice framework to understand why anxiety is more prevalent in women with PCOS. PCOS is defined as chronic hyperandrogenic oligo-ovulation. This translates to women being contiuously stuck in the first week of their menstrual cycles due to elevated androgens, like testosterone, mucking things up in the ovary and preventing them from ovulating except once in a while. This then leads to a hormonal environment in the brain consisting of relatively normal levels of estrogen, but no progesterone. If there is no ovulation, there is no progesterone production.
Estrogen excites brain cells and brings energizing and then anxiety provoking effects and can eventually bring epileptic seizures, in women predisposed to seizures. Progesterone is relaxing, anti-anxiety in its properties and will prevent seizures. I have described estrogen and progesterone's relationship as like "yin and yang" upon the emotions.
Therefore, the brains of women with PCOS spend weeks or months bathed in "unopposed estrogen", and if their brains are, for whatever reason, sensitive to the emotonal modulating effects of estrogen and progesterone, this brings anxiety, irritability and mood volatility. The good news is that treatment with natural progesterone counters this estrogen effect and brings soothing, calming relief.