Reconsidering Trauma in the Pathogenesis and Management of Polycystic Ovary Syndrome: Link Between PCOS and Trauma

Abstract

Polycystic ovary syndrome (PCOS) has always been described as an endocrine–metabolic condition; new research compels us to take into account its psychosexual aspects. In addition to genetic susceptibility and insulin resistance, trauma, especially emotional maltreatment throughout childhood, has been closely linked to the onset of PCOS. Depression, anxiety and negative childhood experiences, such as physical and sexual abuse, are considerably more common among women with PCOS. This connection might be mediated by hypothalamic–pituitary–adrenal (HPA) axis dysregulation, which is frequently seen in post-traumatic stress disorder (PTSD). The co-occurrence of PCOS and trauma-related psychopathology points to a bidirectional interaction in which psychological distress and endocrine imbalance worsen one another. Therefore, regular mental health screening and trauma-informed care have to be incorporated into PCOS treatment. In addition to improving long-term reproductive and mental health outcomes, acknowledging the psychosocial aspects of PCOS may open up new channel for holistic management.

PCOS, or polycystic ovarian syndrome, is a hormonal condition that is becoming more and more common in women worldwide. A variety of symptoms, such as acne, weight gain and irregular periods, are its defining characteristics. Numerous studies have linked stress and trauma as possible triggers for PCOS, even though medical science identifies insulin resistance, genetics and inflammation as the main causes. The prevalence of the psychiatric disorders analysed was considerably higher among women with PCOS than among those without the condition. Women with PCOS reported having adverse childhood experiences, and there was a significant correlation between depression and PCOS. ¹ Child maltreatment (subtypes of abuse and neglect) was assessed in relation to women’s reproductive health outcomes, specifically PCOS, in a sample of psychiatrically healthy women. PCOS was substantially linked to emotional abuse, which was the most common form of child maltreatment (31.6%). Additionally, physical violence was linked to PCOS. ² The meta-analysis comprised six studies, five of which reported anxiety rates and six of which showed depression rates. Patients with PCOS had a larger percentage of participants with anxiety symptoms than women without PCOS. Women without PCOS were less likely to experience depressed symptoms than those with PCOS. ³ Abuse throughout childhood is thought to play a role in the development of PCOS in women, and it has also been linked to abnormal hypothalamic–pituitary–adrenal (HPA) axis activity. Systemic inflammation, which is linked to insulin resistance and the aetiology of PCOS, can be exacerbated by long-term stress and emotional trauma. ⁴ Those who reported emotional abuse in addition to physical and/or sexual abuse were diagnosed with PCOS. ⁵

According to studies, women with PCOS are more prone to suffer from sadness and anxiety, two conditions that are frequently associated with post-traumatic stress disorder (PTSD). This implies that the two conditions can have a bidirectional relationship in which each could make the other worse. Healthcare professionals should be aware of this possible link between PCOS and PTSD since it may affect treatment strategies and patient care in general. Women with PCOS who have suffered trauma should receive mental healthcare as part of a complete treatment approach, as treating both illnesses at the same time may be important for the best results.