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Androgen Excess- Polycystic Ovary Syndrome Society: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome
Open accessAbstract
Objective To formulate clinical consensus recommendations for screening depression, anxiety, health-related quality of life (HRQoL), and disordered eating symptoms in women with polycystic ovary syndrome (PCOS) and review prevalence based on phenotypes and ethnicity, changes over time, etiology, and impact of treatment.Design Systematic reviews and preparation of position statement.Setting Not applicable.Patient(s) Women with PCOS and controls screened using validated tools.Intervention(s) None.Main outcome measure(s) Depressive symptoms, anxiety symptoms, disordered eating, and HRQoL scores.Result(s) Several studies demonstrate that women with PCOS have an increased prevalence of higher depression and anxiety scores and higher odds of moderate and severe depressive and anxiety symptoms compared with controls. Obesity, hyperandrogenism, and fertility have a weak association with these symptoms. HRQoL scores are consistently reduced in PCOS, with infertility and weight concerns having the most significant impact. Some studies suggest an increased prevalence of disordered eating in women with PCOS compared with controls. The few studies that have evaluated the impact of PCOS-related treatments (lifestyle interventions and pharmacotherapy) show no detrimental effect or some improvement in depressive and anxiety symptoms and HRQoL scores.Conclusion(s) In women with PCOS, screening for depressive and anxiety symptoms should be offered at the time of diagnosis and screening for disordered eating should be considered. Further research is required across PCOS phenotypes, in longitudinal cohorts and on impact of therapy on depressive and anxiety syptoms, HRQOL, and disordered eating.
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“PCOS is associated with increased co-morbidities including obesity, infertility, pregnancy complications, depression and anxiety, metabolic syndrome, diabetes, reproductive cancers and cardiovascular disease [3, 7, 8, 10–13].”
From Challenges in diagnosis and health care in polycystic ovary syndrome in Canada: a patient view to improve health care (2023) · cites this paper as [8]
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“Individuals with PCOS experience significant impacts on their quality of life related to irregular menstrual cycles, heavy menstrual bleeding, infertility, hirsutism, acne, obesity, and cardiometabolic disease risk [3, 8, 15].”
From Challenges in diagnosis and health care in polycystic ovary syndrome in Canada: a patient view to improve health care (2023) · cites this paper as [8]
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“In addition, they experience decreased psychological and emotional well-being, anxiety, depression, eating disorders, negative self-image and impaired sexual function [8, 16–19].”
From Challenges in diagnosis and health care in polycystic ovary syndrome in Canada: a patient view to improve health care (2023) · cites this paper as [8]
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“Depression and anxiety in those affected by PCOS are also risk factors for eating disorders [8, 18, 61–63].”
From Challenges in diagnosis and health care in polycystic ovary syndrome in Canada: a patient view to improve health care (2023) · cites this paper as [8]
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“This is concerning given the established evidence of increased depression, anxiety, eating disorders and other mental illnesses in those affected with PCOS [3, 8, 57–59].”
From Challenges in diagnosis and health care in polycystic ovary syndrome in Canada: a patient view to improve health care (2023) · cites this paper as [8]
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“In addition, women with PCOS have an increased prevalence of mental health disorders, and an increased psychosocial and economic burden attributable to anxiety, depression, and eating disorders.2,7,28, 29, 30”
From Increased Prevalence of Adverse Health Outcomes Across the Lifespan in Those Affected by Polycystic Ovary Syndrome: A Canadian Population Cohort (2024) · cites this paper as [7]
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“In particular, the prevalence of depression and anxiety in those with PCOS has been reported to be markedly elevated, with a 30%-50% prevalence and an odds ratio of 1.4 to > 2.5 in those with PCOS.7,29,32,127,128”
From Increased Prevalence of Adverse Health Outcomes Across the Lifespan in Those Affected by Polycystic Ovary Syndrome: A Canadian Population Cohort (2024) · cites this paper as [7]
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“In addition, depression and anxiety can impede an individual’s ability to follow challenging recommendations such as diet-lifestyle interventions to target body weight.”
From Challenges in diagnosis and health care in polycystic ovary syndrome in Canada: a patient view to improve health care (2023) · cites this paper as [8]
In the citing paper
“The prevalence of depression and depressive symptoms is higher in PCOS [67] and PCOS is also associated with more severe symptoms of depression [68].”
From Providing lifestyle advice to women with PCOS: an overview of practical issues affecting success (2021) · cites this paper as [67]
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Flagged first, then by citations
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Cited by
Sorted by citations
Joham, A. E., Norman, R. J., Stener-Victorin, E., Legro, R. S., Franks, S., Moran, L. J., Boyle, J., & Teede, H. J. (2022) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(22)00163-2 · Cited by 838
Self-citationStener-Victorin, E., Teede, H., Norman, R. J., Legro, R., Goodarzi, M. O., Dokras, A., Laven, J., Hoeger, K., & Piltonen, T. T. (2024) · Nature Reviews Disease Primers · doi:10.1038/s41572-024-00511-3 · Cited by 495
Self-citationAnimal Models to Understand the Etiology and Pathophysiology of Polycystic Ovary Syndrome
Stener‐Victorin, E., Padmanabhan, V., Walters, K. A., Campbell, R. E., Benrick, A., Giacobini, P., Dumesic, D. A., & Abbott, D. H. (2020) · Endocrine Reviews · doi:10.1210/endrev/bnaa010 · Cited by 391
Self-citationLifestyle management in polycystic ovary syndrome – beyond diet and physical activity
Cowan, S., Lim, S. S., Alycia, C., Pirotta, S., Thomson, R. L., Gibson‐Helm, M. E., Blackmore, R., Naderpoor, N., Bennett, C., Ee, C., et al. (2023) · BMC Endocrine Disorders · doi:10.1186/s12902-022-01208-y · Cited by 318
Epigenetic inheritance of polycystic ovary syndrome — challenges and opportunities for treatment
Stener‐Victorin, E., & Deng, Q. (2021) · Nature Reviews Endocrinology · doi:10.1038/s41574-021-00517-x · Cited by 227
Self-citation
Metadata
- Authors
- Dokras, A., Stener-Victorin, E., Yildiz, B. O., Li, R., Ottey, S., Shah, D., Epperson, N., & Teede, H.
- Affiliations
- University of Pennsylvania (US)
- Peking University (CN)
- Monash Health (AU)
- Corresponding author
- Dokras, Anuja
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2018-05
- Volume
- 109
- Issue
- 5
- Pages
- 888-899
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2804217905
- Cited by
- 285
- References
- 92
- Citations by year
- 2026: 34 · 2025: 35 · 2024: 42 · 2023: 40 · 2022: 42 · 2021: 26 · 2020: 27 · 2019: 28 · 2018: 11
- FWCI
- 24.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Monash University Research Portal (Monash University) (submittedVersion, other-oa)
- Funders
- Novo Nordisk Fonden (NNF18OC0033992)
- National Institute of Mental Health (P50MH099910)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Keywords
- polycystic ovary syndrome, depression, anxiety, health-related quality of life, disordered eating, screening, prevalence, PCOS phenotypes, ethnicity, obesity, hyperandrogenism, infertility, weight concern, lifestyle intervention, pharmacotherapy
- MeSH terms
- Androgens, Anxiety, Feeding and Eating Disorders, Depression, Female, Humans, Polycystic Ovary Syndrome, Quality of Life, Societies, Medical
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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