Both psychiatric disorders and disorders of the reproductive system are common in women of reproductive age. Often, they co-occur. “There is a lot of overlap between these two disease classes—but very little research into why that is,” says Nina Zaks, MS, Clinical Research Scientist in the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai.
She wanted to learn more about that overlap. Together with Magdalena Janecka, PhD, Assistant Professor, Psychiatry, and Genetics and Genomic Sciences, and other colleagues, she spearheaded a systematic review and meta-analysis to probe the association between mental health and reproductive system disorders in women. Their paper was published in JAMA Network Open in April.
The analysis revealed some interesting patterns—and shone a light on how much more remains to be discovered.
Psychiatric and Reproductive System Disorders: Increased Odds
Nina Zaks, MS
The analysis included 50 qualitative and quantitative studies, each of which explored co-occurring psychiatric diagnoses and reproductive system disorders. The research team cast a wide net, considering a range of psychiatric diagnoses including depression, anxiety, psychosis, and neurodevelopmental disorders such as autism. On the reproductive system side, the team looked into diagnoses such as inflammatory diseases of the female pelvic organs, non-inflammatory disorders of the genital tract, and ovarian dysfunction.
The overlap between the disease classes, they found, is significant. In women with polycystic ovary syndrome (PCOS) and chronic pelvic pain, for instance, the odds of affective disorders were approximately 1.7 to almost four times greater than in women without the disorders. But the team also showed that the overlap between many other psychiatric and reproductive disorders simply has not been studied yet, revealing a considerable gap in knowledge, with potentially serious implications for women’s health.
Overall, the literature shows that women with reproductive system disorders have two to three times the odds of having psychiatric disorders compared to women without those conditions. “We see comorbidity between psychiatric and reproductive disorders everywhere we look,” Dr. Janecka says. “Despite that, there is so much about that comorbidity that has not yet been studied. It’s an urgent research priority to address this.”
Looking for Links in Mental Health and the Reproductive System
What can account for the overlap? Unfortunately, most studies in this area don’t dig into the possible causes, according to the researchers.
Scientists have suggested a number of possible explanations for the association between reproductive system and mental health disorders. For example, stress and quality of life factors associated with mental illness could affect menstrual cycles and reproductive function. Psychiatric medications might interfere with reproductive function. It’s also possible that some underlying genetic causes contribute to both types of disorders.
Though much more research is needed, there are reasons to suspect biological causes for the connection, at least in some cases. “From a mechanism standpoint, it makes sense. Many psychiatric diagnoses present differently between females and males, possibly due to a hormonal component,” Dr. Janecka notes. “Better understanding this connection will provide us with some insight into these mechanisms, while also improving quality of life for patients.”
Polycystic Ovary Syndrome: PCOS and Depression
Magdalena Janecka, PhD
Among the studies that Dr. Janecka’s team analyzed, the largest portion focused on PCOS. Those studies showed that women with PCOS have an increased rate of depression, anxiety disorders, and bipolar disorder.
PCOS is relatively common, affecting as many as 5 to 10 percent of women of reproductive age. The condition is associated with symptoms such as infertility, obesity, acne, and excessive hair growth. One explanation for the increased risk of psychiatric diagnoses in women with PCOS is that those symptoms interfere with quality of life or body satisfaction and self-esteem. However, some emerging evidence suggests that is only part of the story, the researchers found.
The studies suggest that obesity and infertility appear to exacerbate psychiatric symptoms in women with PCOS, but don’t fully explain them. Indeed, genetic factors may play a role in both conditions. In a twin study, for instance, researchers found that the risk of depression was higher not only in people with PCOS, but also in the twin who did not have the syndrome. That implies a possible genetic cause that might increase the risk of both conditions.
Chronic Pelvic Pain
Another subset of the research the team examined focused on chronic pelvic pain. The condition affects one in seven women in the United States. In some cases, the pain can be traced to problems such as endometriosis. But for many women, the cause of their chronic pelvic pain remains elusive.
Unsurprisingly, chronic pelvic pain is associated with significantly higher rates of depression, the researchers found. Physical pain may not be the only explanation, however. “A number of studies showed that women who had chronic pelvic pain had an increased rate of childhood sexual trauma,” Ms. Zaks says. “This might point toward an environmental explanation for the increased rate of psychiatric diagnoses.”
Psychiatric Research at Mount Sinai and Beyond
Learning more about the shared mechanisms might help researchers better understand the development of both psychiatric and reproductive system disorders and could point to new directions for treatment.
The findings also suggest that physicians should do more to screen for and treat co-occurring disorders. “It may be that if you address a patient’s reproductive problems, psychiatric treatments may be more successful,” Dr. Janecka says.
The two researchers plan to continue exploring some of these associations in greater detail, but they hope they won’t be the only ones to dig deeper. “We know this association exists, and we know there’s a gap in the research. The data are there, just waiting to be studied,” Ms. Zaks says.
“One of the main things that struck us is how little is known,” Dr. Janecka adds. “This is just the starting point.”