Explore how polycystic ovary syndrome (PCOS) influences women’s thinking and find solutions to boost physical and mental wellbeing.
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How PCOS is linked to cognitive decline in women

Explore how polycystic ovary syndrome (PCOS) influences women’s thinking and find solutions to boost physical and mental wellbeing.

When considering the vital organs that are most affected by polycystic ovary syndrome (PCOS), the brain is rarely the first that comes to mind. However, recent research from Neurology suggests otherwise. A study tracked women with and without PCOS for thirty years. The average age of the subjects was 54.7 years old. By the thirtieth year, those with PCOS exhibited lower performance on a Stroop exam, which gauges how quickly the brain reacts to congruent and incongruent stimuli. They also performed more poorly in a category fluency test, which requires recalling words within a given category.

In addition, the women with PCOS exhibited lower white matter fractional anisotropy. The study suggests that, at midlife, women with PCOS may experience a decline in cognitive function and white matter integrity. This hormonal condition, which affects seven to ten percent of women of childbearing age, often coexists with other chronic conditions that increase the risk of cognitive decline. As a result, undergoing weight loss, the first-line treatment against PCOS complications may be necessary to minimise such risks.

To illustrate, there is a strong link between PCOS and insulin resistance, which results in diabetes. According to Fertility and Sterility, 65 to 70 percent of women with PCOS have insulin resistance and hyperinsulinemia, marked by excessively high insulin levels. Prolonged hyperinsulinemia is said to have a direct negative effect on cognitive function by reducing the amount of insulin receptors in the blood-brain barrier, thus decreasing insulin transported to the brain.

In severe cases, decreased brain glucose can lead to seizures or irreversible brain damage. Notably, 70 to 80 percent of women who grapple with insulin resistance are obese. A weight management programme may be vital in preventing worsening cognitive risks, as even a modest five percent weight reduction can yield significant improvements in insulin sensitivity and other PCOS-related complications.

Weight loss for PCOS and brain health

Previous research has indicated alterations in brain function among women with PCOS, including memory, executive functioning, and the prevalence of depressive symptoms and anxiety. While PCOS is incurable, nutrition is the first intervention for managing cognitive symptoms associated with the condition.

When devising a weight loss strategy for people with PCOS, it’s essential to consider a nutrient-rich diet that can be followed long-term without a sense of deprivation. A healthy diet helps keep blood sugar within the normal range; with insulin levels in check, the brain efficiently utilises glucose for energy, enhancing learning, memory, and function. For instance, studies have found that fiber-filled diets can reduce insulin resistance in PCOS patients and potentially lower blood pressure to protect against vascular dementia caused by reduced blood flow to the brain.

Explore how polycystic ovary syndrome (PCOS) influences women’s thinking and find solutions to boost physical and mental wellbeing.
Credit. Midjourney

Another way to enhance blood flow to the brain and improve PCOS symptoms is through exercise. A systematic review found that regular exercise improved waist-to-hip ratios of PCOS women, a key predictor of diabetes. Moreover, a study published in BMC Women’s Health found that physically active women with PCOS were significantly less depressed than their more sedentary counterparts. Given that depression can impair key cognitive areas like attention and decision-making, engaging in moderate-level exercise for 150 minutes per week may significantly contribute to improving both PCOS and overall brain health.

Addressing inequalities in female healthcare, such as the imbalanced emphasis on pregnancy in women’s diets or the lack of clear definitions of women’s mental health, is imperative. This unfortunate reality needs to change, particularly given the interconnectedness of diets, depression, anxiety, hormonal conditions like PCOS, and cognitive enhancement. By shifting the focus towards a more expansive and compassionate definition of women’s health — one that examines the interplay of various conditions — and creating avenues for sustainable diet and exercise routines, women can take control of their physical and mental well-being.

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Journal reference

Huddleston, H. G., Jaswa, E. G., Casaletto, K. B., Neuhaus, J., Kim, C., Wellons, M., … & Yaffe, K. (2024). Associations of Polycystic Ovary Syndrome With Indicators of Brain Health at Midlife in the CARDIA Cohort. Neurology102(4), e208104. https://doi.org/10.1212/WNL.0000000000208104