Cited by 82Ovarian function and disordersEating Disorders and BehaviorsHypothalamic control of reproductive hormones

Polycystic ovary syndrome: a brain disorder characterized by eating problems originating during puberty and adolescence

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Steegers-Theunissen, Régine P. M., Wiegel, Rosalieke E., Jansen, Pauline W., Laven, Joop S. E., Sinclair, Kevin D.·2020·International Journal of Molecular Sciences

Abstract

Polycystic ovary syndrome (PCOS) is an endocrine condition associated with reproductive and psychiatric disorders, and with obesity. Eating disorders, such as bulimia and recurrent dieting, are also linked to PCOS. They can lead to the epigenetic dysregulation of the hypothalamic-pituitary-gonadal (HPG) axis, thereby impacting on ovarian folliculogenesis. We postulate that PCOS is induced by psychological distress and episodes of overeating and/or dieting during puberty and adolescence, when body dissatisfaction and emotional distress are often present. We propose that upregulated activation of the central HPG axis during this period can be epigenetically altered by psychological stressors and by bulimia/recurrent dieting, which are common during adolescence and which can lead to PCOS. This hypothesis is based on events that occur during a largely neglected stage of female reproductive development. To date, most research into the origins of PCOS has focused on the prenatal induction of this disorder, particularly in utero androgenization and the role of anti-Müllerian hormone. Establishing causality in our peripubertal model requires prospective cohort studies from infancy. Mechanistic studies should consider the role of the gut microbiota in addition to the epigenetic regulation of (neuro) hormones. Finally, clinicians should consider the importance of underlying chronic psychological distress and eating disorders in PCOS.

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Authors
Steegers-Theunissen, R. P. M., Wiegel, R. E., Jansen, P. W., Laven, J. S. E., & Sinclair, K. D.
Affiliations
  • Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, 3000 CA Rotterdam, The Netherlands
  • Erasmus MC (NL)
  • University of Nottingham (GB)
Corresponding author
Sinclair, Kevin D.
Venue
International Journal of Molecular Sciences
Publisher
MDPI AG
Published
2020-11-03
Volume
21
Issue
21
Pages
8211
ISSN
1422-0067 (ISSN-L)
OpenAlex
W3094851791
Cited by
82
References
144
Citations by year
2026: 10 · 2025: 13 · 2024: 24 · 2023: 15 · 2022: 12 · 2021: 7 · 2014: 1
FWCI
1.25
Type
journal article
Language
en
Open access
Locations
  • International Journal of Molecular Sciences (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • RePub (Erasmus University Rotterdam) (submittedVersion)
Funders
  • ZonMw (636320005)
  • Biotechnology and Biological Sciences Research Council (BB/R007985/1)
  • the National Institute of Environmental Health Sciences, USA (1R01ES030374-01A1)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
Keywords
polycystic ovary syndrome, eating disorders, bulimia nervosa, puberty, adolescence, hypothalamic-pituitary-gonadal axis, epigenetic dysregulation, psychological distress, body dissatisfaction, ovarian follicle development, gut microbiota, female reproductive development
MeSH terms
Adolescent, Adolescent Behavior, Psychology, Adolescent, Feeding and Eating Disorders, Brain Diseases, Child, Female, Humans, Polycystic Ovary Syndrome, Puberty, Risk Factors, Age of Onset

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