PCOS–A Rising Condition Affecting 1 in 5 Women and the Missing Piece in Its Care

There’s no one-size-fits-all treatment for PCOS—especially when mental health is left out.
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The global rate of polycystic ovary syndrome (PCOS) has been on the rise year after year, with up to 21 percent of women affected. This condition is accompanied by severe long-term complications as women age, including infertility, diabetes, heart disease, and mental health challenges.
Yet when PCOS is mentioned, it’s often reduced to acne, irregular periods, or weight gain. That narrow view can delay care. PCOS runs deeper than hormones and cycles—it’s a full-body condition that demands full-body care.

Links to Mood

PCOS has been associated with a higher risk of mental health and cognitive difficulties, including symptoms that overlap with attention-deficit/hyperactivity disorder.
A meta-analysis involving approximately 31,000 women confirmed that PCOS is also associated with depression, anxiety, and decreased quality of life.

“The increased prevalence of mental health disorders in women with PCOS may be partly explained by hormonal imbalances,” Mpho Tshukudu, an integrative and functional nutritionist, said in an interview with The Epoch Times.

Women with PCOS often have elevated levels of androgens—male hormones such as testosterone—which can influence brain function. They may also have problems with how their bodies process tryptophan, a nutrient needed to make serotonin, the feel-good brain chemical. Excess tryptophan increases inflammation and raises the risk of depression.
Insulin resistance—a common feature of PCOS—may interfere with neurotransmitters such as dopamine, serotonin, and gamma-aminobutyric acid, also known as GABA. Disruption of these brain chemicals can impair mood regulation and reduce the brain’s energy availability, contributing to anxiety and depression, Tshukudu said.

Altered Body Image

Body image struggles and disordered eating behaviors are also common with PCOS. Higher androgen levels may increase appetite and emotional lability, while insulin resistance can lead to blood sugar crashes that fuel intense carbohydrate cravings. When these physiological drivers combine with social pressure to be thin and the stigma surrounding weight, it can lead to patterns of binge eating or cycles of restriction and overeating.

“I’ve worked with many women in their 20s and 30s who have been diagnosed with PCOS,” Yasi Ansari, a registered dietitian who specializes in eating disorders, said.

“Often, they’ve been told to drastically change their diet or lose weight, which can feel overwhelming and confusing. That emphasis on weight can trigger disordered eating and harm their relationship with food and their body.”

Hormonal fluctuation can also cause symptoms such as acne and excessive hair growth in a male-like pattern, which may affect self-esteem.

Treat the Whole Person

Ansari emphasized that treatment should be both individualized and integrative, with care plans designed to address the full spectrum of a person’s physical and mental health needs.

There are numerous opportunities to enhance care, according to Dr. Licy Yanes Cardozo, a physician-scientist and practicing endocrinologist at the University of Mississippi Medical Center. A comprehensive, multidisciplinary team approach is essential for managing PCOS effectively over the long term, she stated.

“Addressing mental health should be a priority in the care of women with PCOS,” Cardozo said.

Tshukudu noted that mental health is often overlooked or insufficiently addressed in current PCOS treatment plans.

While guidelines recommend including mental health professionals, psychologists and psychiatrists are not always part of the care team. Ansari noted that the focus tends to remain on hormonal health—weight, fertility, insulin resistance, and the menstrual cycle—often managed by gynecologists, endocrinologists, and dietitians.

Research has shown that addressing mental health directly can make a real difference. For example, a mindfulness-based stress reduction program helped women with PCOS reduce their level of worry and anxiety in a study of Iranian participants. The women took part in eight 90-minute sessions twice a week that helped them focus on reducing stress. The study measured their worries before, right after, and one month after the program. Women who participated in the program had much less worry than those who didn’t. Their worry scores dropped significantly and remained lower a month later.
Additionally, findings from a systematic review suggested improvements in anxiety and depression in women with PCOS who engaged in exercise.

Modify Diet

“When I give nutritional guidance, I focus on practices that support energy levels, nourishment, and well-being, without centering everything around weight,“ Ansari said. ”The goal is for clients to feel no shame or pressure to restrict any foods or food groups.”

No matter a person’s weight or age, improved nutrition and regular physical activity are considered the first line of treatment for PCOS.

While there’s no single PCOS diet, eating patterns such as the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets have shown promise. The Mediterranean diet emphasizes fruits, vegetables, whole grains, nuts, olive oil, and moderate amounts of fish and poultry. It’s known for its heart-healthy benefits and anti-inflammatory effects. The DASH diet focuses on eating lots of fruits, vegetables, whole grains, lean proteins, and low-fat dairy while limiting salt, sugar, and saturated fat.
Diets that include plenty of low-glycemic fruits and vegetables, small amounts of low-fat dairy, fish rich in omega-3 fatty acids, lean meats, healthy fats, legumes, whole grains, and moderate alcohol appear to help improve PCOS.
While more common dietary plans have been studied, specialized approaches such as intermittent fasting and meal replacements haven’t been thoroughly researched yet. However, early findings suggest they could offer additional ways to improve metabolic health in women with PCOS.
To reduce inflammation, stabilize blood sugar, and support mental well-being, Tshukudu recommends the following strategies. Importantly, inflammation in PCOS causes the body’s cells to respond less to insulin, making blood sugar harder to control.
  • Eat a wide variety of fruits, vegetables, whole grains, legumes, raw nuts, seeds, fermented dairy, lean meats, herbs, and spices. These foods are rich in fiber, prebiotics, and phytonutrients, which support gut health and help regulate blood sugar.
  • Choose lower-glycemic carbs and high-quality fats and proteins as they help improve satiety, stabilize blood sugar, and reduce inflammation. Build balanced meals and include healthy snacks as needed.
  • Include omega-3s from oily fish such as salmon, mackerel, sardines, and herring, as well as from plant sources such as chia seeds, flaxseeds, walnuts, spirulina, and chlorella.
  • Drink plenty of fluids such as filtered water and unsweetened herbal or fruit teas to support digestion and stay hydrated.
  • Minimize ultra-processed and sugary foods, which are often high in energy but low in fiber, vitamins, and minerals. These foods are less satiating, can lead to overeating, and often displace healthier whole foods—negatively affecting blood sugar, hormonal balance, and weight.

Vary Lifestyle Interventions

Because PCOS affects so many aspects of health, from hormones and metabolism to mood and cognition, care should be broad and multidisciplinary.

In addition to focusing on quality nutrition, Tshukudu also emphasized the importance of other lifestyle factors.

Sleep problems are common in PCOS, with many experiencing poorer sleep quality and increased daytime sleepiness. In teens, there are often changes in circadian rhythms, including later sleep timing and longer melatonin release at night.

Practices such as deep breathing, yoga, time in nature, and creative hobbies—such as knitting or painting—may help reduce stress and support emotional regulation, Tshukudu said.

Finally, incorporate a mix of aerobic exercise, strength training, and gentle practices such as Pilates. Physical activity improves insulin sensitivity, balances sex hormones, lowers inflammation, and can reduce symptoms of anxiety and depression.

Zena le Roux
Author
Zena le Roux is a health journalist with a master’s in investigative health journalism and a certified health and wellness coach specializing in functional nutrition. She is trained in sports nutrition, mindful eating, internal family systems, and applied polyvagal theory. She works in private practice and serves as a nutrition educator for a UK-based health school.