Mental health disorders are becoming more prevalent year upon year – in Australia about 1 in 6 Australians experience anxiety and 1 in 3 Americans. Symptoms that one may experience with anxiety and/or depression, could be –
A feeling of dread or doom when you wake up in the morning
Feelings of paranoia
Persistent negative though patterns
Difficulty finding joy or enjoyment in activities/relationships
Of course, seeing your healthcare provider is paramount if these kinds of symptoms become a common theme for you. Depending on the severity, sometimes medication may need to be used and other times Counselling/Therapy can be supportive to support a person to make some shifts.
For women, when navigating mental health disorders it is super important to also consider hormonal balance. Hormones have a huge part to play when it comes to our mental wellbeing and if things are not moving along in their natural flow then we can be impacted in various ways. A condition like PCOS is one such female presentation that can increase risk factors of mental health disorders, so it is well worth understanding how and why this is – and why the common approach of anti-depressants is not the only route to take and may not be the one for you when we consider the underlying factors of why a woman has PCOS in the first place. Let’s take a look!
What is PCOS?
PCOS is one of the most common causes of anovulation with about 1 in 10, or 8-13% of women of reproductive age being affected
There is a very specific criteria to diagnose a woman with PCOS – it’s not simply just about having multiple cysts on the ovaries as the name would suggest. Other criteria include irregular periods, high androgens on a blood test or symptoms such as male patterned hair growth.
Diagnosis of PCOS
The Rotterdam criteria requires the presence of 2 out of 3 - (1) oligomenorrhea/anovulation, (2) clinical/biochemical hyperandrogenism, and (3) polycystic ovaries. And the Androgen excess criteria revised this in 2006, to require The AES requires the specific presence of clinical/biochemical hyperandrogenism in combination with either oligoanovulation or polycystic ovaries.
PCOS and adolescence
It is important to note that in adolescence, these indicators can often lead to misdiagnosis because ovulation is often irregular for girls in their formative years of menstruation. It is also common for girls to have multiple cysts on the ovaries due to irregular ovulation as their hormones mature – and it is not advised nor necessary for girls to have a transvaginal ultrasound as part of diagnostic procedure. They can also fluctuate in levels of androgens as they develop, some more than others which can even itself out as they move through those formative years.
PCOS and the pill
In terms of medical treatment, the medical approach is to put girls on the oral contraceptive pill, sometimes at a very young age before their hormones have had a chance to fully develop. This appears to ‘work’ in that is seemingly provides a regular menstrual cycle. But taking the pill does not and cannot regulate your menstrual cycle. The ‘period’ you get on the pill is not a period – it is a withdrawal bleed from the synthetic hormones in the pill. An actual period happens as a result of ovulation. And the pill shuts down your entire menstrual cycle system so you are not ovulating at all. This is how the pill works. This is a problem because now these young women are not making their own oestrogen and progesterone. And they are also not addressing the underlying factors as to why they may have had the PCOS symptoms in the first place. Everything gets put on hold, so to speak and meanwhile the benefits from the natural production of the female hormones are not being received.
PCOS and mental health
Women with PCOS are at increased risk of mental health disorders, like anxiety, depression and bipolar disorder than people without. It is also associated with worse symptoms of anxiety and depression.
With anovulation being a common symptom of PCOS and therefore a lower production and/or imbalance of the hormones oestrogen and progesterone, as well as increase of testosterone and other androgens, there is potential impact on one’s ability to feel settled, to sleep well and to feel content with life.
Progesterone is known as our own inbuilt anti-anxiety hormone, whilst oestrogen is a contributor in the production of serotonin. When these hormones are not in balance they can impact on many levels that can impact our mental and emotional capacities to be in life and deal with life’s challenges and stressors.
If a woman with PCOS has a mental health disorder, it would be super supportive for her to work with a health professional that addresses the underlying factors that may be causing PCOS, instead of using a poly-pharmacy approach like the pill and then anti-depressants, which unfortunately do not address the issues at hand. Perhaps this may be suitable for a short-term approach for some women but it is certainly not ‘treating’ the condition, neither the PCOS or the anxiety/depression, etc.
Counselling & PCOS
Counselling can be super supportive for women with PCOS if they can find someone who understands the condition. Working in a strength-based capacity, whilst supporting the client to build body awareness and body connection, is paramount so she can feel empowered to take steps towards her health and hormonal balance rather than burying and ‘putting up with’ (in many cases) reversible symptoms.
Too often women are not aware of the options available to them, which much of the time requires more commitment and work on their part to take charge of their own health and make adjustments and changes that are sustainable, long-lasting and fulfilling on many levels.
Underlying factors of PCOS
There are a number of factors to consider with PCOS, which determines the approach to actual treatment. All of which point to a woman taking more notice and attention to her body and how she is looking after herself.
As a very brief summary –
Do you have insulin resistance?
If so, insulin resistance needs to be treated and reversed. This is generally done by diet factors and lifestyle factors.
Were your periods regular before taking the pill and symptoms of PCOS have only appeared post-pill?
This is a common experience for women to increase a surge in androgens post-pill, as they withdraw from pills such as Yasmin, Diane, Yaz or Brenda.
Do you have inflammation?
If you don’t have insulin resistance you may need to look at the level of chronic inflammation playing out in your body. This may mean food sensitivities like gluten and dairy intolerance and possible histamine intolerance.
See this flow chart as a support and guide to bring more understanding to your PCOS.
If you are experiencing PCOS AND have mental health concerns, be careful not to separate the two. Your body and mind are not separate systems, they are one and the same and need to be carefully nurtured to support overall health and wellbeing in all areas of life.
Anxiety and depression are not a life sentence. And neither is PCOS. Seek the appropriate support and guidance that is going to support you to address you as a whole person. Your body does not compartmentalize itself, so we would be wise to take its lead and not do this either. Bring wholesome, aware, loving support to your body and your mind, to your hormones and to every stage and phase of being a woman. You are worth every bit of detail and every bit of intricate attention to what you are experiencing, without settling for things being ‘just the way they are’.
If you would like personalized support and guidance for PCOS and/or mental health concerns – please get in touch here.