ABSTRACT
UNLABELLED: Although physical symptoms of polycystic ovary syndrome (PCOS) are increasingly recognized by practicing clinicians, little attention has focused on psychological correlates of this frequent endocrine disorder. This review of medical and psychological literature indicates that PCOS is associated with several mental health problems, including depression and anxiety, body dissatisfaction and eating disorders, diminished sexual satisfaction, and lowered health-related quality of life. Although the causal direction of these relationships has not been established, it is clear that effective and comprehensive treatment of women with PCOS must encompass careful attention to psychological symptomatology. Recommendations for the assessment of specific mental health problems, management of related physical concerns, and treatment of obesity among women with PCOS are presented. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to explain that, in addition to physiologic changes, women with polycystic ovary syndrome (PCOS) have various mental health problems and lowered health-related quality of life issues and state that treatment must address these concerns.
Subject(s)
Mental Health , Polycystic Ovary Syndrome/psychology , Quality of Life , Affective Symptoms/psychology , Body Image , Female , Humans , Infertility, Female/etiology , Infertility, Female/psychology , Obesity/etiology , Obesity/psychology , Personal Satisfaction , Polycystic Ovary Syndrome/physiopathology , Self Concept , SexualityABSTRACT
Common features of polycystic ovary syndrome (PCOS), including hyperandrogenism, ovarian dysfunction and obesity, can be highly distressing. We compared 40 women with PCOS to women with infertility but not PCOS, and to women with neither PCOS nor infertility, on measures of depression and body image. Women with PCOS reported higher depression scores and greater body dissatisfaction (p < .001) than comparison group women. Body image was strongly associated with depression overall, even after controlling body mass. Among women with PCOS, body dissatisfaction measures and education explained 66 percent of the variance in depression, suggesting explanations of the PCOS-depression link should consider the role of potentially mediating psychosocial variables.
Subject(s)
Body Image , Depression/epidemiology , Polycystic Ovary Syndrome/psychology , Adult , Depression/etiology , Depression/psychology , Female , Health Surveys , Humans , Hyperandrogenism , Obesity , Southeastern United States/epidemiologyABSTRACT
OBJECTIVE: To analyze pregnancy complications and outcome in patients with polycystic ovary syndrome (PCOS) treated with metformin. DESIGN: Single center retrospective case analysis. SETTING: Private regional nonurban referral subspecialty practice. PATIENT(S): After 7 months of average metformin use, 188 patients with PCOS (average infertility: 27 months) achieved 237 pregnancies. INTERVENTION(S): Of pregnancies established, metformin alone was used before conception in 124/237 (52%), oral fertility agents (CC or letrozole) in 81 (34%), gonadotropin therapy in 7 (3.0%), assisted reproduction in 17 (7.2%), and other fertility-promoting regimens in 8 (3.4%). MAIN OUTCOME MEASURE(S): Analysis of prepregnancy health parameters (weight, blood pressure, glucose tolerance, fasting and stimulated insulin levels) and pregnancy outcomes (miscarriage, pregnancy length, hypertension, gestational diabetes, weight gain, birth weight, sex ratio, congenital malformations, and breastfeeding success). RESULT(S): Metformin appears to decrease the rate of spontaneous abortion. The co-morbidities of PCOS including obesity, insulin resistance, and glucose sensitivity served as indicators of increased risk for pregnancy complications, especially gestational diabetes. No increase in pregnancy-induced hypertension was evident. Prematurity was increased. Neither PCOS nor metformin use appears to increase the rate of congenital anomaly. PCOS did not affect lactation. CONCLUSION(S): PCOS or its co-morbidities are associated with poorer pregnancy outcome. Implications and interventions are discussed.
Subject(s)
Infertility, Female/drug therapy , Metformin/therapeutic use , Polycystic Ovary Syndrome/drug therapy , Pregnancy Complications/drug therapy , Pregnancy Outcome , Adolescent , Adult , Female , Humans , Infant, Newborn , Infertility, Female/epidemiology , Male , Polycystic Ovary Syndrome/epidemiology , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/prevention & control , Pregnancy Outcome/epidemiology , Retrospective StudiesABSTRACT
OBJECTIVE: To evaluate the influence of obesity, fertility status, and androgenism scores on health-related quality of life in women with polycystic ovary syndrome (PCOS). DESIGN: Cross-sectional, correlational. SETTING: Private reproductive endocrinology practice in two southeast U.S. cities. PARTICIPANTS: Convenience sample of 128 women with PCOS, half of whom were attempting to conceive in addition to being treated for PCOS. Most were White (97%), married (78%), with a mean age of 30.4 years (SD +/- 5.5). MAIN OUTCOME MEASURES: The Health-Related Quality of Life Questionnaire (PCOSQ) for women with polycystic ovary syndrome. A laboratory panel and clinical measures, including body mass index, waist-to-hip ratio, and degree of hirsutism. RESULTS: The most common health-related quality of life concern reported by women with PCOS was weight, followed in descending order by menstrual problems, infertility, emotions, and body hair. CONCLUSIONS: The psychological implications of PCOS are easily underestimated and have been largely ignored. Nursing has a pivotal role in recognizing these concerns and implementing therapy to improve quality of life in women with PCOS.
