Women who suffer from a chronic ovarian cyst condition are more vulnerable to mental health issues than others, a new large study confirms.
The new study also found that women who get these cysts are significantly more likely to have children with autism or ADHD.
Polycystic ovarian syndrome, which can be painful and cause infertility, affects between four and 12 percent of in the US, making it one of the most common heath issues faced by young women in particular.
Although the Cardiff University study confirms the link between mental health for both women and their children, but the relationship is complex and the researchers remain uncertain which condition may underlie which.
Women who have polycystic ovarian syndrome develop liquid filled sacs on their ovaries due to an excess of the male hormone and are at greater risk for mental illness, the study found
No one knows exactly what causes ovarian cysts, and, in fact, often women do not even realize that they have them.
A cyst – a catch-all term for any time that tissue forms a small sac full of liquid – on an ovary occurs when a follicle that should break open and deposit an egg fails to do so, and instead fills with liquid.
More often than not, cysts are small, go unnoticed, and are completely benign.
Though polycystic ovary syndrome (PCOS) is named for and identifiable by cysts, it is distinct from an occasional ovarian cysts because of its underlying causes and possible complications. PCOS is actually an endocrine, or hormonal, condition.
Women with PCOS have higher levels of the male hormone, androgen, than most, and for this reason are more likely to have irregular periods, facial hair, acne and even infertility.
PCOS is also more common among obese women, but each condition seems to feed the other. PCOS can make a woman’s body over-produce insulin, which can catalyZe weight gain, but some women actually develop the ovarian condition after gaining weight.
The interaction of the ovaries, obesity and the endocrine system makes it difficult for scientists to parse out how the individual conditions are influencing mental health in women with PCOS and its impact on the way their children’s’ brains develop if they become pregnant.
To assess the link, the Cardiff researchers examined the mental health records of 17,000 women who had been diagnosed with PCOS.
They matched this group with women who did not have PCOS, pairing each subject by age and body mass index.
They found that women with PCOS were ‘significantly’ more likely to have any one or a combination of multiple mental health disorders, including depression, anxiety, bipolar disorder or an eating disorder.
These higher rates of mental health issues, the authors noted, were consistent with what other studies conducted in Taiwan and Australia have found.
But depending on the particular type of mental health disorder, the suspected relationships it between psychology and PCOS varied widely.
‘It’s difficult to be certain what may drive the increased risk of mental health disorders,’ said study co-author Dr Aled Rees.
‘Certainly, hormonal effects may play a role. Other factors may include concerns in relation to body weight, fertility, hair growth and menstrual disturbance among others,’ he added.
Obesity alone has been linked to a 25 percent higher risk of depression, but even when they compared similarly obese women in the PCOS and non-PCOS groups, those with the cystic ovary condition were still more likely to be depressed.
RISK FACTORS FOR POLYCYSTIC OVARIAN SYNDROME
Polycystic ovarian syndrome (PCOS) affects between eight and 12 percent of American women.
The condition is marked by chronic ovarian cysts, which are fluid-filled sacs that can form if a follicle fails to deposit an egg.
While any woman can get ovarian cysts, those with PCOS also have elevated levels of the male hormone, androgen.
Scientists do not know what causes this endocrine abnormality, but it often coincides with obesity and insulin resistance.
Yet, like many aspects of PCOS, obesity contribute to the development of PCOS, or the relationship may go in the opposite direction, such that PCOS causes weight gain.
This, the study authors speculate, may be related to distress instigated by other symptoms of PCOS.
Because PCOS can cause women that suffer the disease to grow more facial hair, experience acne so they may be more prone to feeling less attractive, a phenomenon that may in turn make them more vulnerable depression as well.
When it comes to eating disorders, PCOS probably increases risks for over-eating or obsessive control over portions via its effects on insulin and menstrual cycle irregularity.
Other research has also established links between insulin resistance – which is common among women with PCOS – and depression. Much like the connection between PCOS itself and obesity, insulin resistance and depression, too, seem to feed into one another, rather than one causing the other.
PCOS was also found to increase the risk of a woman suffering from high anxiety on its own, and women with both eating disorders and PCOS were also more prone to anxiety.
These links echo previous findings, but the Cardiff researchers aimed to explore PCOS’s connection to other mental disorders as well.
According to the authors, their sample was not substantial enough to establish clear relationships to the cyst condition and schizophrenia, autism, bulimia, tics or personality disorders, but there was an undeniable association with bipolar disorder.
Women with PCOS were definitively more likely to have bipolar disorder, but previous work has suggested that the relationship between the two may go in the opposite direction.
That is to say that bipolar disorder may predate PCOS, as a particular drug prescribed to treat bipolar disorder, called valproate (which is also used to treat epilepsy), is thought to increase the risks of developing ovarian cysts.
The authors of the new study wrote: ‘Valproate therapy could, at least in part, explain this association.’
Although it is not entirely clear how the drug may cause cysts, several studies have found that women who take it are significantly more likely to have multiple ovarian cysts as well as other symptoms of PCOS.
The Cardiff researchers also suspected that the ways that the hormonal imbalances in a woman with PCOS might change the chemistry of the environment in her uterus, which could influence the way a fetus’s brain might develop, if she got pregnant.
Children whose mothers had suffered from the cystic disorder were more likely to be born with autism spectrum disorder or ADHD than other children were.
‘This is in agreement with the observations of [a previous study that] reported respectively increased risks of 59 percent and 42 percent, of a similar magnitude to our data,’ the Cardiff team wrote.
Building upon that and other previous research, they hypothesized that greater levels of the male hormone in a mother’s womb may alter the way that a fetus’s brain develops.
The relationships between PCOS and both a woman’s mental health and the brain development of a fetus she might someday carry are undeniably complicated, and interwoven with many confounding factors.
‘Further research is needed to determine which components of the syndrome might be driving the increased risk of mental health disorders, and indeed whether all patients with PCOS are at increased risk or only some,’ said Dr Rees.
He also hopes in the future to ‘investigate if genetic factors that contribute to the risk of PCOS also contribute to the risk of mental health and neurodevelopmental disorders, which may help reveal new biological pathways implicated in these disorders, and lead to new treatments,’ he added.
But the large study further confirms that the three come hand-in-hand and ‘support international guidelines which recommend screening for mental health disorders as part of the comprehensive clinical care for women with this condition,’ the authors concluded.