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Alan R. Jacobs MD PCAlan R. Jacobs MD PC
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Anxiety and PCOS

March 11, 2022 Menstrual-Related Neurological Disorders
Illustration by Marta Pucci. Photo courtesy of helloclue.com

There are many research studies that have investigated and found that anxiety is significantly more prevalent in women with Polycystic Ovarian Disorder (PCOS) compared to women with normal ovulatory menstrual cycles (e.g Steroids 2012, Endocrine 2018).

The 2012 study found anxiety symptoms increased with an odds ratio of 6.88.  The 2018 study found anxiety disorders increased with an odds ratio of 2.75.

These and other studies ask clinicians to begin screening all women with PCOS for anxiety 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 continuously 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 even bring epileptic seizures, in women predisposed to seizures.  On the other hand progesterone is relaxing, anti-anxiety in its properties and can even prevent seizures.  I have described the relationship between estrogen and progesterone as like “yin and yang” upon many women’s emotions.  

Therefore, the brains of women with PCOS spend weeks or months bathed in “unopposed estrogen,” and if their brains are, for various reasons, sensitive to the emotional modulating effects of estrogen, this brings anxiety, irritability and mood volatility.   

The good news is that treatment with natural progesterone is safe and counters this estrogen effect and brings soothing, calming relief to women with PCOS who suffer from anxiety.

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