Body image and mental health in women with polycystic ovary syndrome–a cross-sectional study
Authors: Hofmann Konstantin , Decrinis Claire , Bitterlich Norman , Tropschuh Katharina , Stute Petra , Bachmann Annette 
Published: February 2025

Abstract

Purpose
Polycystic Ovary Syndrome (PCOS) is a multifaceted endocrine-metabolic condition affecting around 5–15% of women globally. Despite its prevalence and diverse impact, the psychological aspect of PCOS is often underestimated in clinical settings, leading to significant distress among affected individuals. This study aimed to explore the extent of body image perception disorders, psychological comorbidities, and their influence on the health-related quality of life (HRQOL) in women with PCOS. Additionally, we focused on measuring the impact of factors associated with PCOS, particularly obesity, to gain a more comprehensive understanding of their effects.

Methods
An online survey was distributed anonymously to gynecologists, hospitals, and women’s clinics across Austria, Germany, and Switzerland, as well as through social media platforms to connect with women with PCOS. The survey was conducted from November 14, 2023, to February 05, 2024. HRQOL, anxiety/depression levels, body image and self-esteem were assessed employing the Modified-PCOS-Questionnaire (MPCOSQ), Hospital Anxiety and Depression Scale (HADS), Multidimensional Body-Self Relations Questionnaire Appearance Scales (MBSRQ-AS) and Rosenberg Self-Esteem Scale (RSE) respectively. Identification of potential confounding variables relied on their plausibility and association with the estimate. Adjusted odds ratios and their respective 95% confidence intervals were computed through regression analysis.

Results
587 participants fully completed the questionnaire. The study participants were on average 32.5 ± 5.9 years old and had a BMI of 31.3 ± 7.8 kg/m2. In this study, 84.5% of all PCOS patients exhibited pathological scores in the MBSRQ-AS Appearance Evaluation, 83.8% in Body Areas Satisfaction, and 67.5% in Overweight Preoccupation. Half of the participants (46.7%) showed significantly poor results in the RSE, indicating low self-esteem. A notable portion of the study participants displayed elevated HADS scores, which supports a higher rate of distress in PCOS patients. (HADS-Anxiety > 8: 75.0% (440); HADS-Depression > 8: 57.6% (338). Examining the HRQOL of PCOS patients revealed that all average scores of the subscales, except for the Acne subscale and MPCOSQ-Total (3.6 ± 1:0), were situated in the lower half, indicating diminished HRQOL. The linear regression revealed that pathological values in the MBSRQ-AS, indicating impaired body image, were associated with low scores in the MPCOSQ subscales and HADS scales, suggesting impaired HRQOL and a higher rate of distress in PCOS patients. Furthermore, the multivariate analysis showed a statistically significant link between adverse body perception and HRQOL, as well as distress among PCOS patients in this study group. [multivariate HADS-Anxiety: MBSRQ-AS Body Areas Satisfaction (B: − 2.10; CI: − 3.88; − 0.33; p = 0.02) HADS-Depression MBSRQ-AS Body Areas Satisfaction (B: − 1.92; CI: − 3.59; − 0.26; p = 0.02)].

Conclusion
Our findings reveal that obesity and a negative body image are interconnected factors that adversely affect both HRQOL and mental health in women with PCOS. Healthcare professionals should recognize the negative effects of obesity and poor body image in patients with PCOS and proactively provide effective treatment options.