Andrea M. Braverman, PhD
Associate Director of the Educational Core, Clinical Associate Professor of Psychiatry & Behavioral Medicine, Thomas Jefferson University
Executive Director of PCOS Challenge, Inc.
Mental and emotional wellness should be included in the health care and management of women and girls with polycystic ovary syndrome (PCOS). Having a chronic condition is challenging for anyone’s mental health, especially if battling a mysterious illness or one perceived to have established control over one’s body. This is the case for many women and girls who have PCOS, 50% of whom have not been diagnosed as they struggle with symptoms such as absent, irregular, or heavy and painful menstrual periods; excessive facial and body hair; severe acne; unwanted hair loss; rapid weight gain and/or difficulty losing weight; subfertility and infertility; or even life-threatening diseases such as diabetes, non-alcoholic fatty liver disease, and endometrial cancer.
PCOS is the most common endocrine (hormone) disorder in women but, despite its prevalence, the disorder is poorly understood by many, including some within the healthcare community. This condition is usually diagnosed if two or three of the following symptoms are present:
- irregular or absent menstruation
- hyperandrogenism, characterized by symptoms such as increased facial and/or body hair, acne, hair loss, or elevated androgens (such as testosterone) in the blood
- polycystic ovaries (multiple immature follicles) shown on ultrasound.
PCOS is also a diagnosis of exclusion where other disorders with similar symptoms such as non-classic adrenal hyperplasia or a pituitary tumor should be ruled out. Despite what the name polycystic ovary syndrome may suggest, PCOS is not just a disorder of the reproductive system and does not go away after reproductive years or a hysterectomy. PCOS and its comorbid conditions can affect other organs and systems in the body including the brain, skin, liver, pancreas, blood vasculature, and more. The complex interactions between genetics, hormones, and environment also influence mental health in those with PCOS.
In a recent conversation with PCOS Challenge Founder and Executive Director Sasha Ottey, Dr. Andrea Braverman, PCOS Challenge Health Advisory Board member, shares insights about how living with PCOS can affect a woman’s mental health.
Sasha Ottey: What is polycystic ovary syndrome (PCOS) and why is it important to public health?
Andrea Braverman: PCOS is a disorder involving a problem with a woman’s hormones and is often characterized by small cysts on her ovaries. PCOS is an important public health issue because untreated PCOS can lead to many other serious medical and mental health problems.
What is the connection between PCOS and mental health?
PCOS has been associated with women having higher rates of depression, anxiety, and other mental health challenges The difficulty in receiving a diagnosis as well as its accompanying challenges – higher rates of diabetes, heart disease, infertility, hirsutism (excessive hair growth), weight gain – may also contribute to a woman with PCOS having a vulnerability to feelings of depression and anxiety.
What should parents of girls with PCOS or PCOS symptoms be aware of regarding psychosocial health in teens?
Teens are exceptionally aware of issues related to body image and mood. Some of the symptoms of weight or excess hair can start a cycle of self-blame or negative self-image that are hard to change as they grow into adulthood. Adding to that, teens are just beginning to learn about their bodies and information that they receive about their bodies can leave them vulnerable to feeling judged or dismissed. Women need to be supported in being their own advocates for their health care and have their concerns and fears addressed respectfully and fully.
What are signs that one may be experiencing depression or anxiety?
Depression is often experienced as persistent low mood (feeling blue and down) that doesn’t go away. Symptoms include feelings of hopelessness/helplessness, poor concentration, poor appetite, oversleeping, isolating oneself, and loss of interest in general are just some. Anxiety is often experienced as excessive or unrelenting worry. Symptoms include having persistent negative thoughts.
Studies show higher incidence of bipolar disorder in women with PCOS. Describe bipolar disorder and how to get help.
Bipolar disorder used to be known as manic depression because many who live with it experience fluctuations between mania and depression. Episodes of hypomania (abnormally and persistently elevated, expansive, or irritable mood and increased activity/energy) instead of a full-blown manic episode are now considered to be characteristics of bipolar II disorder. Women with bipolar disorder need treatment and support from professional psychiatric and psychological help.
How do PCOS fertility issues affect mental health?
Any chronic condition affects mental health. There is no current “cure” for PCOS and women must struggle with their symptoms on a daily basis. The sheer weight of the continual battle often has its impact on a woman’s mental health. Family and friends also provide support but can suffer from support “burnout” for both the medical and mental health issues.
What advice do you have for couples whose relationships are impacted by the effects of negative body image, low libido, and mood disorders that are often associated with PCOS?
Don’t be afraid to talk about how negative body image, low libido, and mood disorders impact your relationship. The first step is the desire to create positive changes and the second is to agree upon what those changes are. Seek out professional help for strategies to support the mutual goals that come out of those talks if you feel you are stuck and just spinning your wheels. Talk, read, and listen to others who struggle with the same issues to destigmatize the experience and not feel like you are the only one.
Body image issues and eating disorders are more prevalent in PCOS. What is the connection?
Women live in a world with many images and messages about how their bodies should look. The vast majority of these messages and images set an ideal that is unattainable. If women with PCOS struggle with maintaining their desired weight, this adds to the endless feedback loop of feeling their bodies are not what they should be. An increased vulnerability to eating disorders may result from the need and desire to take control over a body that is not cooperating or, quite frankly, betraying her expectations. Eating-disordered thoughts may mistakenly feel like control.
Studies show increased risk of suicide in PCOS. Are there ways to self-identify being at high risk for suicide?
It is important to pay attention to what those thoughts are. Is there a general sense of just wishing you wouldn’t wake up so you wouldn’t have to deal with stuff any longer? Or are the thoughts moving toward ideas of how to take your own life. Once thoughts begin to move to toying with ideas of a plan or seeing that you are engaging in risky behaviors is the time to reach out to your support system and to get professional help.
When and how should one seek help for mental health disorder?
It is important to distinguish between seeking help for emotional challenges when you believe you may have depression or anxiety that is impacting you on a daily basis and seeking out help to learn more coping strategies or for identifying self-punishing or defeating behaviors or thoughts. In the first case, you should seek out help immediately if you are experiencing trouble managing to get through the day. This is a situation when the feelings of depression or anxiety just won’t let up. In the second case, seeking out help proactively is a very positive step for working hard to take care of yourself. New coping strategies and insight can prevent sliding into a negative cycle and can also add to good self-image and enjoyment in life.
How can families, friends, and other supporters help girls and women who are struggling with mental health issues and PCOS?
Families, friends, and other supporters can help most by validating the experiences and the burden of coping and managing the symptoms of PCOS for the women with PCOS whom they love. Listening and reflecting back their experience is a powerful tool for these women to feel understood and heard. Encouraging their loved ones to keep on top of their medical care and proactively practice their own self-care is important.
How can healthcare providers and medical professionals better identify mental health disorders in women with PCOS and provide support?
Healthcare and medical providers can best identify mental health disorders by creating time in their consults to ask questions and have time for their patients to share their experiences. Many women are reluctant to share mental health concerns for fear of judgment or lack of interest from their providers. Adding quick assessment tools may also help set the tone that these concerns are important and allows for providers to follow up on the answers their patients give.
What are the best strategies for improving and managing mental health in women and girls with PCOS?
Best strategies for improving and managing mental health is for women with PCOS to make this a priority. Women often put themselves low on their “to do” list. Have plans and goals for how you are going to take care of yourself. Write them down. Tell someone who will gently hold your feet to the fire to make sure you are working on those goals. Make them doable. Make them reasonable. Tune into the negative self-talk and talk back at it. Get your village behind you – no person is an island and no person can do it all. Keep on learning new tricks and avoiding the old tricky stuff that trips us up.
- What steps have you taken to manage both your mental and physical health—especially when the physical condition is a contributing factor to your mental health condition?
Sasha Ottey, is Founder and Executive Director of PCOS Challenge, Inc. Sasha started the organization after she was diagnosed with PCOS and experienced great dissatisfaction with the availability of support resources for women with the condition. Since its programs started in 2009, PCOS Challenge, Inc. has grown to 50,000 members worldwide including its online and offline support groups. PCOS Challenge is innovative in its multimedia approach to support. It produces the national award-winning cable television show PCOS Challenge, a health series that follows ten women with polycystic ovary syndrome as they have their lives transformed by naturopathic and allopathic medical experts and coaches. Its website, PCOSChallenge.com, has been called the “Facebook for women with PCOS” by its members, and its popular PCOS Challenge radio show features internationally-recognized PCOS experts, New York Times best-selling authors, and real-life stories from women with PCOS. The organization also provides offline support networks, webinars, and educational products. Sasha is a Clinical and Research Microbiologist with a Bachelor’s degree in Clinical Laboratory Science from Howard University and a Master’s in Health Administration from the University of Phoenix. Prior to founding PCOS Challenge, Sasha was a contract research microbiologist at the National Institutes of Health (NIH).
Andrea M. Braverman, PhD
Andrea Braverman, PhD, is a Clinical Associate Professor with a joint appointment in the Department of Obstetrics and Gynecology and Psychiatry and Behavioral Medicine at Thomas Jefferson University. Dr. Braverman is the Associate Director for the Educational Core for OB/Gyn. She is a health psychologist with a specialty in medical health management and infertility counseling. She received her M.A., M.S., and Ph.D. in psychology from the University of Pennsylvania. Dr. Braverman has published numerous articles and lectured internationally. She is a member of the Health Advisory Board for PCOS Challenge: The National Polycystic Ovary Syndrome Association. Dr. Braverman received the Timothy Jeffries Memorial award in 2011 for outstanding contributions as a health psychologist from the American Psychological Association.