Download PDF
Semin Reprod Med 2008; 26(1): 045-052
DOI: 10.1055/s-2007-992924
© Thieme Medical Publishers

Mood and Sexual Function in Polycystic Ovary Syndrome

Onno E. Janssen1 , Susanne Hahn2 , Susanne Tan3 , Sven Benson4 , Sigrid Elsenbruch4
  • 1Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  • 2Praxis für Endokrinologie, Wuppertal, Germany
  • 3Division of Endocrinology, Department of Medicine, University Hospital of Essen Medical School, Essen, Germany
  • 4Institute of Medical Psychology, University Hospital of Essen Medical School, Essen, Germany
Further Information

Publication History

Publication Date:
08 January 2008 (online)

    Permissions and Reprints

ABSTRACT

Women with polycystic ovary syndrome (PCOS) fail to conform with societal norms for outer appearance. Many PCOS patients thus feel stigmatized in the sense of a loss of “feminine identity.” In addition to somatic impairment, mood disturbances such as depression and limitations in emotional well-being, quality of life, and life satisfaction, the diagnosis of PCOS also has a negative impact on sexual self-worth and sexual satisfaction. Both obesity and hirsutism are major determinants of the physical component of quality of life in affected women. However, its psychological aspect appears to be inherent and specific for PCOS. Confirmation of the diagnosis and provision of detailed information to affected women, together with the availability of interdisciplinary treatment aimed at improving PCOS-related symptoms, such as hirsutism, obesity, menstrual irregularity, and infertility, will also reduce psychological distress and improve sexual self-worth. New treatment options, including insulin sensitizers, psychological counseling, and participation in a PCOS support group, are likely to further improve life satisfaction and coping of affected women.

KEYWORDS

Polycystic ovary syndrome - quality of life - psychological disturbances - sexual satisfaction - hirsutism - obesity - hyperandrogenism

REFERENCES

  • 1 WHO .Development and Constitution of the W.H.O. Geneva. Switzerlandm; United Nations 1947
    Google Scholar
  • 2 WHO Division of Mental Health .WHO-QOL Study Protocol: The Development of the World Health Organization Quality of Life Assessment Instrument. Geneva, Switzerland; United Nations 1993
    Google Scholar
  • 3 Ferrell B, Grant M, Padilla G, Vemuri S, Rhiner M. The experience of pain and perceptions of quality of life: validation of a conceptual model.  Hosp J. 1991;  7 9-24
    PubMedGoogle Scholar
  • 4 Diamanti-Kandarakis E, Kouli C R, Bergiele A T et al.. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile.  J Clin Endocrinol Metab. 1999;  84 4006-4011
    CrossrefPubMedGoogle Scholar
  • 5 Asuncion M, Calvo R M, San Millan J L, Sancho J, Avila S, Escobar-Morreale H F. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain.  J Clin Endocrinol Metab. 2000;  85 2434-2438
    CrossrefPubMedGoogle Scholar
  • 6 Azziz R, Woods K S, Reyna R, Key T J, Knochenhauer E S, Yildiz B O. The prevalence and features of the polycystic ovary syndrome in an unselected population.  J Clin Endocrinol Metab. 2004;  89 2745-2749
    CrossrefPubMedGoogle Scholar
  • 7 Ehrmann D A. Polycystic ovary syndrome.  N Engl J Med. 2005;  352 1223-1236
    CrossrefPubMedGoogle Scholar
  • 8 Hahn S, Tan S, Elsenbruch S et al.. Clinical and biochemical characterization of women with polycystic ovary syndrome in North Rhine-Westphalia.  Horm Metab Res. 2005;  37 438-444
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Elsenbruch S, Benson S, Hahn S et al.. Determinants of emotional distress in women with polycystic ovary syndrome.  Hum Reprod. 2006;  21 1092-1099
    PubMedGoogle Scholar
  • 10 Avery J C, Braunack-Mayer A J. The information needs of women diagnosed with polycystic ovarian syndrome-implications for treatment and health outcomes.  BMC Womens Health. 2007;  7 9
    CrossrefPubMedGoogle Scholar
  • 11 Ching H L, Burke V, Stuckey B G. Quality of life and psychological morbidity in women with polycystic ovary syndrome: body mass index, age and the provision of patient information are significant modifiers.  Clin Endocrinol (Oxf). 2007;  66 373-379
    CrossrefPubMedGoogle Scholar
  • 12 Dunaif A, Thomas A. Current concepts in the polycystic ovary syndrome.  Annu Rev Med. 2001;  52 401-419
    PubMedGoogle Scholar
  • 13 Escobar-Morreale H F, Luque-Ramirez M, San Millan J L. The molecular-genetic basis of functional hyperandrogenism and the polycystic ovary syndrome.  Endocr Rev. 2005;  26 251-282
    CrossrefPubMedGoogle Scholar
  • 14 Azziz R. Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature.  J Clin Endocrinol Metab. 2006;  91 781-785
    CrossrefPubMedGoogle Scholar
  • 15 Zawadski J K, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltine FP, Merriam GR Polycystic Ovary Syndrome. Boston; Blackwell Scientific 1992: 377-384
    Google Scholar
  • 16 The Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group . Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS).  Hum Reprod. 2004;  19 41-47
    CrossrefPubMedGoogle Scholar
  • 17 Himelein M J, Thatcher S S. Polycystic ovary syndrome and mental health: a review.  Obstet Gynecol Surv. 2006;  61 723-732
    CrossrefPubMedGoogle Scholar
  • 18 Eggers S, Kirchengast S. The polycystic ovary syndrome-a medical condition but also an important psychosocial problem.  Coll Antropol. 2001;  25 673-685
    PubMedGoogle Scholar
  • 19 Kitzinger C, Willmott J. ‘The thief of womanhood’: women's experience of polycystic ovarian syndrome.  Soc Sci Med. 2002;  54 349-361
    CrossrefPubMedGoogle Scholar
  • 20 Sills E S, Perloe M, Tucker M J, Kaplan C R, Genton M G, Schattman G L. Diagnostic and treatment characteristics of polycystic ovary syndrome: descriptive measurements of patient perception and awareness from 657 confidential self-reports.  BMC Womens Health. 2001;  1 3
    CrossrefPubMedGoogle Scholar
  • 21 Trent M E, Rich M, Austin S B, Gordon C M. Quality of life in adolescent girls with polycystic ovary syndrome.  Arch Pediatr Adolesc Med. 2002;  156 556-560
    CrossrefPubMedGoogle Scholar
  • 22 Trent M, Austin S B, Rich M, Gordon C M. Overweight status of adolescent girls with polycystic ovary syndrome: body mass index as mediator of quality of life.  Ambul Pediatr. 2005;  5 107-111
    CrossrefPubMedGoogle Scholar
  • 23 Wild S, Pierpoint T, McKeigue P, Jacobs H. Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: a retrospective cohort study.  Clin Endocrinol (Oxf). 2000;  52 595-600
    Google Scholar
  • 24 Legro R S. Polycystic ovary syndrome and cardiovascular disease: a premature association?.  Endocr Rev. 2003;  24 302-312
    PubMedGoogle Scholar
  • 25 Cronin L, Guyatt G, Griffith L et al.. Development of a health-related quality-of-life questionnaire (PCOSQ) for women with polycystic ovary syndrome (PCOS).  J Clin Endocrinol Metab. 1998;  83 1976-1987
    CrossrefPubMedGoogle Scholar
  • 26 Jones G L, Benes K, Clark T L et al.. The Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (PCOSQ): a validation.  Hum Reprod. 2004;  19 371-377
    CrossrefPubMedGoogle Scholar
  • 27 Coffey S, Bano G, Mason H D. Health-related quality of life in women with polycystic ovary syndrome: a comparison with the general population using the Polycystic Ovary Syndrome Questionnaire (PCOSQ) and the Short Form-36 (SF-36).  Gynecol Endocrinol. 2006;  22 80-86
    CrossrefPubMedGoogle Scholar
  • 28 Guyatt G, Weaver B, Cronin L, Dooley J A, Azziz R. Health-related quality of life in women with polycystic ovary syndrome, a self-administered questionnaire, was validated.  J Clin Epidemiol. 2004;  57 1279-1287
    CrossrefPubMedGoogle Scholar
  • 29 Schmid J, Kirchengast S, Vytiska-Binstorfer E, Huber J. Infertility caused by PCOS-health-related quality of life among Austrian and Moslem immigrant women in Austria.  Hum Reprod. 2004;  19 2251-2257
    CrossrefPubMedGoogle Scholar
  • 30 Pekhlivanov B, Kolarov G, Kavurdzhikova S, Stoikov S. Determinants of health related quality of life in women with polycystic ovary syndrome [in Bulgarian].  Akush Ginekol (Sofiia). 2006;  45 29-34
    PubMedGoogle Scholar
  • 31 Zung W WA. Self-Rating Depression Scale.  Arch Gen Psychiatry. 1965;  12 63-70
    PubMedGoogle Scholar
  • 32 Barnard L, Ferriday D, Guenther N, Strauss B, Balen A H, Dye L. Quality of life and psychological well being in polycystic ovary syndrome.  Hum Reprod. 2007;  22 2279-2286
    CrossrefPubMedGoogle Scholar
  • 33 Elsenbruch S, Hahn S, Kowalsky D et al.. Quality of life, psychosocial well-being, and sexual satisfaction in women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 2003;  88 5801-5807
    CrossrefPubMedGoogle Scholar
  • 34 Ware Jr J E, Sherbourne C D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.  Med Care. 1992;  30 473-483
    CrossrefPubMedGoogle Scholar
  • 35 McHorney C A, Ware Jr J E, Raczek A E. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs.  Med Care. 1993;  31 247-263
    CrossrefPubMedGoogle Scholar
  • 36 Schmitz N, Hartkamp N, Kiuse J, Franke G H, Reister G, Tress W. The Symptom Check-List-90-R (SCL-90-R): a German validation study.  Qual Life Res. 2000;  9 185-193
    CrossrefPubMedGoogle Scholar
  • 37 Derogatis L R, Rickels K, Rock A F. The SCL-90 and the MMPI: a step in the validation of a new self-report scale.  Br J Psychiatry. 1976;  128 280-289
    CrossrefPubMedGoogle Scholar
  • 38 Henrich G, Herschbach P. Questions on life satisfaction (FLZ) - A short questionnaire for assessing subjective quality of life.  Eur J Psychol Assess. 2000;  16 150-159
    CrossrefPubMedGoogle Scholar
  • 39 Goldbeck L, Schmitz T G. Comparison of three generic questionnaires measuring quality of life in adolescents and adults with cystic fibrosis: the 36-item short form health survey, the quality of life profile for chronic diseases, and the questions on life satisfaction.  Qual Life Res. 2001;  10 23-36
    CrossrefPubMedGoogle Scholar
  • 40 Sonino N, Fava G A, Mani E, Belluardo P, Boscaro M. Quality of life of hirsute women.  Postgrad Med J. 1993;  69 186-189
    PubMedGoogle Scholar
  • 41 Loo W J, Lanigan S W. Laser treatment improves quality of life of hirsute females.  Clin Exp Dermatol. 2002;  27 439-441
    CrossrefPubMedGoogle Scholar
  • 42 Hahn S, Janssen O E, Tan S et al.. Clinical and psychological correlates of quality-of-life in polycystic ovary syndrome.  Eur J Endocrinol. 2005;  153 853-860
    CrossrefPubMedGoogle Scholar
  • 43 Keegan A, Liao L M, Boyle M. ‘Hirsutism’: a psychological analysis.  J Health Psychol. 2003;  8 327-345
    PubMedGoogle Scholar
  • 44 Barth J H, Catalan J, Cherry C A, Day A. Psychological morbidity in women referred for treatment of hirsutism.  J Psychosom Res. 1993;  37 615-619
    CrossrefPubMedGoogle Scholar
  • 45 Shulman L H, DeRogatis L, Spielvogel R, Miller J L, Rose L I. Serum androgens and depression in women with facial hirsutism.  J Am Acad Dermatol. 1992;  27(2 Pt 1) 178-181
    PubMedGoogle Scholar
  • 46 Coffey S, Mason H. The effect of polycystic ovary syndrome on health-related quality of life.  Gynecol Endocrinol. 2003;  17 379-386
    CrossrefPubMedGoogle Scholar
  • 47 Klassen A F, Newton J N, Mallon E. Measuring quality of life in people referred for specialist care of acne: comparing generic and disease-specific measures.  J Am Acad Dermatol. 2000;  43(2 Pt 1) 229-233
    CrossrefPubMedGoogle Scholar
  • 48 Mallon E, Newton J N, Klassen A, Stewart-Brown S L, Ryan T J, Finlay A Y. The quality of life in acne: a comparison with general medical conditions using generic questionnaires.  Br J Dermatol. 1999;  140 672-676
    CrossrefPubMedGoogle Scholar
  • 49 Yazici K, Baz K, Yazici A E et al.. Disease-specific quality of life is associated with anxiety and depression in patients with acne.  J Eur Acad Dermatol Venereol. 2004;  18 435-439
    CrossrefPubMedGoogle Scholar
  • 50 Dolte K S, Girman C J, Hartmaier S, Roberts J, Bergfeld W, Waldstreicher J. Development of a health-related quality of life questionnaire for women with androgenetic alopecia.  Clin Exp Dermatol. 2000;  25 637-642
    CrossrefPubMedGoogle Scholar
  • 51 Girman C J, Hartmaier S, Roberts J, Bergfeld W, Waldstreicher J. Patient-perceived importance of negative effects of androgenetic alopecia in women.  J Womens Health Gend Based Med. 1999;  8 1091-1095
    PubMedGoogle Scholar
  • 52 Van Der Donk J, Hunfeld J A, Passchier J, Knegt-Junk K J, Nieboer C. Quality of life and maladjustment associated with hair loss in women with alopecia androgenetica.  Soc Sci Med. 1994;  38 159-163
    CrossrefPubMedGoogle Scholar
  • 53 Paoletti A M, Floris S, Mannias M et al.. Evidence that cyproterone acetate improves psychological symptoms and enhances the activity of the dopaminergic system in postmenopause.  J Clin Endocrinol Metab. 2001;  86 608-612
    CrossrefPubMedGoogle Scholar
  • 54 Weiner C L, Primeau M, Ehrmann D A. Androgens and mood dysfunction in women: comparison of women with polycystic ovarian syndrome to healthy controls.  Psychosom Med. 2004;  66 356-362
    CrossrefPubMedGoogle Scholar
  • 55 Goldstat R, Briganti E, Tran J, Wolfe R, Davis S R. Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women.  Menopause. 2003;  10 390-398
    CrossrefPubMedGoogle Scholar
  • 56 Shifren J L, Braunstein G D, Simon J A et al.. Transdermal testosterone treatment in women with impaired sexual function after oophorectomy.  N Engl J Med. 2000;  343 682-688
    CrossrefPubMedGoogle Scholar
  • 57 Floter A, Nathorst-Boos J, Carlstrom K, von Schoultz B. Addition of testosterone to estrogen replacement therapy in oophorectomized women: effects on sexuality and well-being.  Climacteric. 2002;  5 357-365
    PubMedGoogle Scholar
  • 58 Sherwin B B, Gelfand M M, Brender W. Androgen enhances sexual motivation in females: a prospective, crossover study of sex steroid administration in the surgical menopause.  Psychosom Med. 1985;  47 339-351
    PubMedGoogle Scholar
  • 59 Paulson J D, Haarmann B S, Salerno R L, Asmar P. An investigation of the relationship between emotional maladjustment and infertility.  Fertil Steril. 1988;  49 258-262
    PubMedGoogle Scholar
  • 60 Trent M E, Rich M, Austin S B, Gordon C M. Fertility concerns and sexual behavior in adolescent girls with polycystic ovary syndrome. Implications for quality of life.  J Pediatr Adolesc Gynecol. 2003;  16 33-37
    CrossrefPubMedGoogle Scholar
  • 61 Monga M, Alexandrescu B, Katz S E, Stein M, Ganiats T. Impact of infertility on quality of life, marital adjustment, and sexual function.  Urology. 2004;  63 126-130
    CrossrefPubMedGoogle Scholar
  • 62 Wischmann T, Stammer H, Scherg H, Gerhard I, Verres R. Psychosocial characteristics of infertile couples: a study by the ‘Heidelberg Fertility Consultation Service’.  Hum Reprod. 2001;  16 1753-1761
    CrossrefPubMedGoogle Scholar
  • 63 Ragni G, Mosconi P, Baldini M P et al.. Health-related quality of life and need for IVF in 1000 Italian infertile couples.  Hum Reprod. 2005;  20 1286-1291
    CrossrefPubMedGoogle Scholar
  • 64 Himelein M J, Thatcher S S. Depression and body image among women with polycystic ovary syndrome.  J Health Psychol. 2006;  11 613-625
    CrossrefPubMedGoogle Scholar
  • 65 Ardenti R, Campari C, Agazzi L, La Sala G B. Anxiety and perceptive functioning of infertile women during in-vitro fertilization: exploratory survey of an Italian sample.  Hum Reprod. 1999;  14 3126-3132
    CrossrefPubMedGoogle Scholar
  • 66 Chiba H, Mori E, Morioka Y et al.. Stress of female infertility: relations to length of treatment.  Gynecol Obstet Invest. 1997;  43 171-177
    CrossrefPubMedGoogle Scholar
  • 67 Guerra D, Llobera A, Veiga A, Barri P N. Psychiatric morbidity in couples attending a fertility service.  Hum Reprod. 1998;  13 1733-1736
    CrossrefPubMedGoogle Scholar
  • 68 Oddens B J, den Tonkelaar I, Nieuwenhuyse H. Psychosocial experiences in women facing fertility problems-a comparative survey.  Hum Reprod. 1999;  14 255-261
    CrossrefPubMedGoogle Scholar
  • 69 Boivin J, Takefman J E, Tulandi T, Brender W. Reactions to infertility based on extent of treatment failure.  Fertil Steril. 1995;  63 801-807
    PubMedGoogle Scholar
  • 70 Fekkes M, Buitendijk S E, Verrips G H et al.. Health-related quality of life in relation to gender and age in couples planning IVF treatment.  Hum Reprod. 2003;  18 1536-1543
    CrossrefPubMedGoogle Scholar
  • 71 McCook J G, Reame N E, Thatcher S S. Health-related quality of life issues in women with polycystic ovary syndrome.  J Obstet Gynecol Neonatal Nurs. 2005;  34 12-20
    CrossrefPubMedGoogle Scholar
  • 72 Stunkard A J, Faith M S, Allison K C. Depression and obesity.  Biol Psychiatry. 2003;  54 330-337
    CrossrefPubMedGoogle Scholar
  • 73 Mannucci E, Ricca V, Barciulli E et al.. Quality of life and overweight: the obesity related well-being (Orwell 97) questionnaire.  Addict Behav. 1999;  24 345-357
    CrossrefPubMedGoogle Scholar
  • 74 Swallen K C, Reither E N, Haas S A, Meier A M. Overweight, obesity, and health-related quality of life among adolescents: the National Longitudinal Study of Adolescent Health.  Pediatrics. 2005;  115 340-347
    CrossrefPubMedGoogle Scholar
  • 75 Hashimoto D M, Schmid J, Martins F M et al.. The impact of the weight status on subjective symptomatology of the polycystic ovary syndrome: a cross-cultural comparison between Brazilian and Austrian women.  Anthropol Anz. 2003;  61 297-310
    PubMedGoogle Scholar
  • 76 Faith M S, Matz P E, Jorge M A. Obesity-depression associations in the population.  J Psychosom Res. 2002;  53 935-942
    CrossrefPubMedGoogle Scholar
  • 77 Onyike C U, Crum R M, Lee H B, Lyketsos C G, Eaton W W. Is obesity associated with major depression? Results from the Third National Health and Nutrition Examination Survey.  Am J Epidemiol. 2003;  158 1139-1147
    CrossrefPubMedGoogle Scholar
  • 78 Derogatis L R, Rose L I, Shulman L H, Lazarus L A. Serum androgens and psychopathology in hirsute women.  J Psychosom Obstet Gynaecol. 1993;  14 269-282
    CrossrefPubMedGoogle Scholar
  • 79 Cecchine R. Scrambled; a journey through polycystic ovarian syndrome.  Available at: http://scrambledthewebsite.com , Accessed February 11, 2007
    PubMedGoogle Scholar
  • 80 Matsunaga H, Sarai M. Elevated serum LH and androgens in affective disorder related to the menstrual cycle: with reference to polycystic ovary syndrome.  Jpn J Psychiatry Neurol. 1993;  47 825-842
    PubMedGoogle Scholar
  • 81 Bruce-Jones W, Zolese G, White P. Polycystic ovary syndrome and psychiatric morbidity.  J Psychosom Obstet Gynaecol. 1993;  14 111-116
    CrossrefPubMedGoogle Scholar
  • 82 Dittmar M, Heintz A, Hardt J, Egle U T, Kahaly G J. Metabolic and psychosocial effects of minimal invasive gastric banding for morbid obesity.  Metabolism. 2003;  52 1551-1557
    CrossrefPubMedGoogle Scholar
  • 83 Jalil R A, Manan W A, Bebakar W M, Halim R, Ooi G S, Othman R. Assessing changes in quality of life among obese participants in Kelantan, Malaysia.  Asia Pac J Clin Nutr. 2004;  13(Suppl) S141
    PubMedGoogle Scholar
  • 84 Mathus-Vliegen E M, de Weerd S, de Wit L T. Health-related quality-of-life in patients with morbid obesity after gastric banding for surgically induced weight loss.  Surgery. 2004;  135 489-497
    CrossrefPubMedGoogle Scholar
  • 85 Ogden J, Clementi C, Aylwin S, Patel A. Exploring the impact of obesity surgery on patients' health status: a quantitative and qualitative study.  Obes Surg. 2005;  15 266-272
    CrossrefPubMedGoogle Scholar
  • 86 Lord J M, Flight I H, Norman R J. Insulin-sensitising drugs (metformin, troglitazone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome.  Cochrane Database Syst Rev. 2003;  3 CD003053
    PubMedGoogle Scholar
  • 87 Hahn S, Benson S, Elsenbruch S et al.. Metformin treatment of polycystic ovary syndrome improves health-related quality-of-life, emotional distress and sexuality.  Hum Reprod. 2006;  21 1925-1934
    CrossrefPubMedGoogle Scholar

Onno E JanssenM.D. 

Raalandsweg 36

22559 Hamburg, Germany

Email: onno@onnojanssen.de

      >