Abstract
To the Editor
Polycystic ovarian syndrome (PCOS) is an endocrine disorder characterized by infertility, obesity, menstrual dysfunction, acne, hirsutism and hyperandrogenism. The prevalence of PCOS in the Australian population is approximately 5.6% (Avery et al., 2019).
Previous research has established that women with borderline personality disorder (BPD) have higher prevalence rates of PCOS symptoms (Rausch et al., 2015; Roepke et al., 2010) including a higher proportion of ovarian cysts (Roepke et al., 2010) and higher androgen levels (Rausch et al., 2015) measured in saliva, hair and serum compared with mentally healthy controls.
The physical symptoms of PCOS have been shown to exacerbate a range of mental health symptoms (Rausch et al., 2015). Characteristic symptoms of PCOS like hirsutism, irregular menstruation and infertility are often considered to challenge conventional views of femininity. Hirsutism and resultant poor self-image may elevate psychological distress, hostility and irritability and lead to a reduced quality of life. Elevated androgen levels have been associated with increased impulsivity and anger expression, high trait anger scores plus negative mood (Rausch et al., 2015). More extreme fluctuations in estrogen levels may also be associated with increased BPD symptoms through modulating a range of neurotransmitter systems and ultimately influencing mood.
Ms A. is a 31-year-old woman with a history of childhood sexual and emotional abuse. She was diagnosed with PCOS at 25 following the medical termination of an unplanned pregnancy. Since then, she been struggling to become pregnant. Her mental health symptoms have worsened due to the stress associated with fertility treatments. Each failed in vitro fertilization treatment causes increased depression and a worsening of BPD symptoms.
The above case and recent research illustrate that the physical symptoms of PCOS may serve to exacerbate the mental health symptoms of BPD, not only through impacting physical appearance and body image or the ability to conceive, but also through the impact of dysregulated estradiol/androgen gonadal hormone levels on mood and BPD symptoms.
Footnotes
Author Contributions
T.T. created the main concept, and T.T., E.M. and J.K. drafted the manuscript. All authors provided critical revisions to the manuscript.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Informed Consent
Informed consent was obtained from the patient for publication of this letter to the editor.
