Polycystic ovary syndrome (PCOS) is the most common female hormonal disorder, yet it’s historically been underdiagnosed and under-researched. We know that the endocrine system— which makes and releases hormones that go all over the body— directly affects the brain. So why are we not more concerned about how PCOS could impact our brain health? Recent research out of the Journal of Neurology suggests we should be paying more attention to the connection between PCOS and memory loss in middle age, defined as 48-60 years of age according to the study [1].
PCOS can show up many different ways
PCOS is a common female endocrine disorder that causes unhealthy cyst growth on one or both ovaries [2]. It affects between 8% to 15% of women during their reproductive years. However, there are likely many undiagnosed cases due to symptoms being attributed to other causes. PCOS is characterized by a range of symptoms, including hyperandrogenism (in females, too much of the sex hormone testosterone), PMS, irregular periods, hirsutism, insulin resistance, obesity (though not always!), metabolic syndrome, and infertility. Additionally, women with PCOS are more likely to have depression and/or anxiety [1].
Researchers wanted to know how PCOS affects brain aging and health
Metabolic, cardiovascular, and depressive disorders are all already known to cause memory loss issues in mid-life [1]. Since each of these can be part of a PCOS diagnosis, it makes sense to study whether women with PCOS are more likely than their peers to experience memory problems. However, very few studies have researched the effects of PCOS on the brain. Researchers out of the University of California-San Francisco aimed to bridge this gap, and they released their findings in 2024.
The UCSF researchers utilized data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which started in 1983 and followed 5,000 men and women aged 18-30, for 30 years. They homed in on several offshoot studies like the CARDIA Women’s Study, which studied a subset of women in the bigger CARDIA study, and incorporated cognitive testing in addition to brain scans. The UCSF researchers considered any woman who had hyperandrogenism and infrequent periods (oligomenorrhea) to have PCOS.
The UCSF team concluded that, based on the structure and arrangement of white matter in these women’s brains (known as white matter integrity), women with PCOS were at risk of early brain aging, and thus memory loss issues. Compared to their peers without PCOS, these women consistently scored lower on tests of memory, attention, verbal skills, and mental processing speed.
How does PCOS affect memory loss?
The UCSF researchers said we can’t know for sure why PCOS is linked to memory loss in midlife. Certainly, some of the symptoms that can be part of PCOS, like diabetes and depression and metabolic syndrome, could play a role. But even women who “just” met the criteria of hyperandrogenism and infrequent periods without other PCOS symptoms were at risk of midlife cognitive problems.
Furthermore, the women with PCOS who also had diabetes and depression had only slightly more memory deficits than those with PCOS but no diabetes or depression. This suggests that multiple factors are at play concerning memory loss and its connections to PCOS.
What does this research add to what we already knew about PCOS and the brain?
Past research on mental health outcomes of women with PCOS was limited and primarily focused on younger populations. A 2007 study found “lower scores on tests of verbal fluency, verbal memory, manual dexterity, and visual-spatial learning” in women with PCOS compared to women without, even though the participants were only in their late 20s [3]. And a 2022 study found that women in their late 20s (both with and without PCOS) who had high free testosterone levels performed worse on tests of psychomotor speed and visuospatial learning [4].
In 2024, the UCSF researchers contributed valuable information to the question of how PCOS might affect perimenopausal or menopausal women’s brain health. Certainly, more research is necessary to confirm their findings, and determine how much PCOS directly affects memory loss and overall brain health, plus how to prevent it.
What can be done to lessen the cognitive effects of PCOS?
Unfortunately, there is no official cure for PCOS. The good news is that many of the effects of PCOS, including the cognitive struggles, can be lessened by eating a healthy diet, getting regular, moderate exercise, and maintaining a healthy weight. Women with PCOS should also be proactive about protecting their mental health, since anxiety and depression can increase your risk for cognitive decline.
One of the best ways to manage PCOS symptoms is to learn how to chart your cycle. Charting helps you become in tune with your body so that you can take action, rather than feeling like a victim to your PCOS. Through the vital information found in your cycle charts, medical providers trained in restorative reproductive medicine can treat your PCOS symptoms at their roots, through targeted hormonal supplementation and/or other evidence-based methods, rather than simply masking your symptoms with hormonal birth control.
References:
[1] Huddleston HG, Jaswa EG, Casaletto KB, Neuhaus J, Kim C, Wellons M, Launer LJ, Yaffe K. Associations of Polycystic Ovary Syndrome With Indicators of Brain Health at Midlife in the CARDIA Cohort. Neurology. 2024 Feb 27;102(4):e208104. doi: 10.1212/WNL.0000000000208104. Epub 2024 Jan 31. PMID: 38295344. [2]Chaudhari AP, Mazumdar K, Mehta PD. Anxiety, Depression, and Quality of Life in Women with Polycystic Ovarian Syndrome. Indian J Psychol Med. 2018 May-Jun;40(3):239-246. doi: 10.4103/IJPSYM.IJPSYM_561_17. PMID: 29875531; PMCID: PMC5968645. [3] Schattmann L, Sherwin BB. Testosterone levels and cognitive functioning in women with polycystic ovary syndrome and in healthy young women. Horm Behav. 2007;51(5):587-596. [4] Sukhapure M, Eggleston K, Douglas K, Fenton A, Frampton C, Porter RJ. Free testosterone is related to aspects of cognitive function in women with and without polycystic ovary syndrome. Arch Womens Ment Health. 2022;25(1):87-94.
