The Relationship Between Polycystic Ovary Syndrome (PCOS) and Depression

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder, frequently accompanied by psychological comorbidities including depression. The aim of this narrative review is to summarise the latest research regarding potential contributors to and underpinning mechanisms of this relationship.

A detailed search of the PubMed database was carried out beginning with systematic reviews and using the 'snowballing' method to identify further studies. The results yielded were assessed for quality using the GRADE framework. Depression in all studies was assessed using validated questionnaires.

The association of PCOS and depression is bidirectional and multifactorial. The role of biological factors such as hyperandrogenism, metabolic dysregulation, chronic low-grade inflammation, gut microbiome, and genetic and epigenetic factors are highlighted. Also, psychosocial contributors includingillness perception (obesity, acne and hirsutism), menstruation, infertility issues, and sexual dysfunction, as well as eating disorders have a prevalent role. The majority of the studies included were systematic reviews and cross-sectional original research studies.

Given the complex pathophysiology underpinning both diseases independently as well as in combination, despite evolving research, there is no single unifying link. However, this highlights the need for mental health risk stratification, addressing possible contributing factors, and offering the support required for patients with PCOS and depression.