Eating Disorders in Women with PCOS

Recently, during our September National Network Seminar, Professor Leah Brennan, Dr. Jillian Tay, and Jessica Cox discussed polycystic ovary syndrome (PCOS) and eating disorders, and what this means for care and research.

You can watch the session on our Hub’s Seminar Series page. In the meantime, here’s a quick overview:

Why does this matter?

- PCOS is the most common endocrine disorder among women of reproductive age, affecting approximately 1 in 8 worldwide. An estimated 70% go undiagnosed.
- PCOS impacts multiple systems, including reproductive, skin, and cardiometabolic health, along with a significant mental health burden.

Links with mental health and eating disorders

-       Women with PCOS report higher rates of depression and anxiety, which clearly affect their quality of life.

-       The risk of an eating disorder is higher, especially for bulimia nervosa and binge eating disorder. Evidence for anorexia nervosa is less consistent, and there is limited data on other eating disorders.

-       Biological mechanisms might play a role in the connection between PCOS and mental health. For instance, hyperandrogenism and insulin resistance can impact stress pathways, potentially affecting mood and eating behaviour.

What the guidelines say

-       The 2023 International PCOS Guideline standardizes diagnostic criteria and enhances recommendations on psychological assessment.

-       Lifestyle intervention is recommended for everyone with PCOS, regardless of weight. There is no single best diet or exercise approach.

-       Clinicians are encouraged to use non-stigmatising language, seek consent before discussing weight, and focus on health behaviours over numbers on a scale.

-       Screening and treatment for depression and anxiety are supported by more substantial evidence than for eating disorders, reflecting gaps in the literature.

Care considerations raised by the panel

-       Many women report poor healthcare experiences and limited emotional support during diagnosis and care. Collaborative, patient-centered care is crucial.

-       For individuals with PCOS and a history of disordered eating, referrals to dietitians and psychologists can assist in customising lifestyle advice and lowering the risk of relapse.

-       Any decision should include input from a multidisciplinary team and mental health professionals.

Evidence gaps and current work

-       Methods to evaluate eating disorders in PCOS differ significantly, and tools lack validation in this group.

-       There is limited research on transgender and gender-diverse people.

-       Little is known about the lived experience of PCOS and eating disorders. Jessica Cox’s ongoing qualitative study is gathering these perspectives to inform integrated models of care.

Key takeaway

PCOS and eating disorders overlap in ways that impact identification, treatment, and lived experience. A weight-inclusive, collaborative approach, along with improved measurement and lived experience research, will help advance care and policy.