Psychological and social concerns in PCOS.

It is remarkable that a condition that affects so many women and has such important emotional and social correlates for them appears to lack a large body of research. A ‘Medline’ search in February, 2007 revealed only 52 articles out of millions of references cited. It does seem that in the last few more people are paying attention to this important issue. Given the fact that PCOS is 1^st clinically observed around the time of puberty, medical providers can do their patients a great service by addressing these issues at this important time in a woman’s life. There is no question that the media and society in general defines cultural norms in the US.

Himelein and Thatcher (1) recently reviewed mental health issues and PCOS. The patients with PCOS seemed to have more clinical or sub-clinical depression based on their scores on standardized tests for depression. There was a poor correlation of the depression with androgen levels, amount of hirsutism, or the presence of infertility. There seemed to be a better correlation with obesity but many factors are probably involved. Some studies suggested increased indices of anxiety but data is conflicting. Body dissatisfaction is also and issue that has been addressed. Patients often find hirsutism unsettling, especially teenagers, and they may develop a negative image of themselves. Such body dissatisfaction may affect the patient as they become adults and persist. Several studies have addressed sexual satisfaction which was found to be decreased even though they had the same frequency of intercourse and sexual thoughts and fantasies. They believed their partner was less satisfied and attracted to them, but studies addressing their relationship satisfaction indices were actually higher than those without PCOS suggesting that the sexual disinterest was not affecting their romantic satisfaction. Elsenbruch et al (2,3) did studies addressing quality of life issues and found less satisfaction with sex life, more emotional distress and they felt that obesity played a major role in their quality of like issues.

It is reassuring that studies have shown that treatment of PCOS led to improvements in many of these symptoms (4). This is strong evidence that our intervention as physicians helps both physically and emotionally. Our practice recognizes this important issue with our patients. As we treat medically, we support or patients emotionally. Our practice counselor is always available.

References:

1. Himelein MJ, Thatcher SS. Polycystic Ovarian Syndrome and Mental Health: A Review. 2006. Obst. Gynecol. Survey. 61(11): 723-732.

2. Elsenbruch S, Benson S, Hahn S, Tom S, Mann K, Pleger K, Kimmig R, Janssen O. Determinants of emotional distress in women with polycystic ovary syndrome. 2006. Human Reproduction. 21(4): 1092-1099

3. Elsenbruch S, Hahn S, Kewalsky D, Offner A, Schedlowski M, Mann K, Janssen O. Quality of like, psychosocial well-being, and sexual satisfaction in women with polycystic ovarian syndrome. 2003. JCEM. 88(12): 5801-5807.

4. Hahn S, Benson S, Elsenbruch S, Pleger K, Tan S, Mann K, Schedlowski M, van Halteren W, Kimmig R, Janssen O. Metformin treatment of polycystic ovarian syndrome improves health related quality-of-life, emotional distress and sexuality. 2006. Human Reproduction. 21(7):1925-1934.