In This article

• PMOS (previously known as PCOS) is common and associated with a high burden of depressive and anxiety symptoms
• Depression prevalence ranges from about 26% to over 40% depending on assessment methods
• Rates may be even higher in low- and middle-income countries
• Lifestyle interventions, particularly exercise, can improve mood but are adjunctive
• Routine mental health screening should be standard in PMOS care

In 2026, endocrine researchers endorsed a change for the condition previously known as Polycystic Ovary Syndrome or PCOS. The new name is Polyendocrine Metabolic Ovarian Syndrome or PMOS. While the term PCOS focuses on ovarian cysts as the primary component of the disorder, the new name reflects a more nuanced understanding of the condition which is associated with a wide range of reproductive, metabolic, dermatologic and mental health symptoms.

PMOS is the most commonly diagnosed endocrine disorder in women of reproductive age, affecting about 1 in 8 women worldwide.  Mood and anxiety disorders are among the most common comorbid conditions in women with PMOS; however, many are not aware of the psychiatric symptoms that may accompany this disorder.

Psychiatric Comorbidity in PMOS

Mood and anxiety disorders are among the most common comorbid conditions in women with PCOS/PMOS. A recent meta-analysis including 35 studies and 5,857 women (3,610 with PCOS/PMOS and 2,247 controls) examined the prevalence of depressive and anxiety symptoms.  The prevalence of depressive symptoms in women with PMOS versus controls varied depending on the assessment tools used:

• Beck Depression Inventory: 42.11% (95% CI: 32.6–52.2) vs. 13.62% (95% CI: 8.4–21.5; p < 0.001)
• Hospital Anxiety and Depression Scale: 28.90% (95% CI: 20.7–38.8) vs. 15.80% (95% CI: 11.3–21.7; p = 0.010)
• Patient Health Questionnaire: 26.50% (95% CI: 8.0–59.9) vs. 9.10% (95% CI: 1.8–35.1; p = 0.255)

In general, individuals with PCOS/PMOS were 2-3 times as likely to report depressive symptoms as those without the disorder.  The prevalence of anxiety symptoms, measured using HADS, was also higher in the PCOS/PMOS group compared to controls: 48.25% (95% CI: 36.1–60.6) vs. 31.40% (95% CI: 18.8–47.4; p = 0.098)

A previous meta-analysis including 57 studies (172,040 patients with PCOS/PMOS) also observed that women with PCOS/PMOS were more likely to have a clinical diagnosis of depression (odds ratio (OR), 2.79; 95% CI, 2.23-3.50), anxiety (OR, 2.75; 95% CI, 2.10-3.60), and obsessive compulsive disorder (OCD) (OR, 1.37; 95% CI 1.22-1.55), 

Overall, these findings support a higher burden of depressive symptoms in women with PMOS, with a similar trend observed for anxiety disorders. 

Findings from Low- and Middle-Income Countries

A separate meta-analysis focusing on low- and middle-income countries (LMICs) demonstrated even higher prevalence rates of depression and anxiety in those with PCOS/PMOS:

• Depression: 51% (95% CI: 43–59; I² = 97%)
• Anxiety: 45% (95% CI: 36–54; I² = 96%)

The highest prevalence of depressive symptoms and anxiety was observed:

• Among women aged 20–25 years (depression: 63%, anxiety: 56%)
• In studies conducted in India (depression: 55%, anxiety: 51%)

PMOS and Other Psychiatric Disorders

In a systematic review and meta-analysis of 11 studies, including 73,102 women with PCOS/PMOS and 340,724 controls without the disorder, researchers observed that In women with PCOS/PMOS, the odds of bipolar disorder ranged from 0.98 and 8.78, compared to individuals without this disorder.  Pooling all of the studies, the researchers estimated that women with PCOS/PMOS had about a twofold increase in risk for bipolar disorder compared to women without the disorder. 

In one small study, the prevalence of PCOS/PMOS was estimated to be about 30% in drug-naïve patients with bipolar disorder (compared to approximately 10% in the general  population). In this study, the risk was even higher, rising to 53% in those who had received long-term treatment with valproic acid. 

Emerging evidence suggests associations between PMOS and other psychiatric conditions, including attention-deficit/hyperactivity disorder (ADHD), eating disorders and schizophrenia; however, these associations are less consistent and require further investigation.

Lifestyle Interventions for PMOS and Depressive Symptoms

Lifestyle interventions remain a cornerstone of PMOS management, primarily targeting metabolic and reproductive outcomes. However, there is growing evidence that these interventions also carry mental health benefits.

A 2026 meta-analysis of randomized controlled trials found that structured exercise significantly reduced depressive symptoms in women with PCOS/PMOS. While larger studies are needed, these findings suggest that exercise may serve as a useful adjunctive treatment.

Patients with PMOS, as well as symptoms of depression and anxiety, should be counseled that:

• Regular physical activity may improve mood and reduce anxiety
• Healthy lifestyle changes can enhance overall quality of life
• These strategies complement, but do not replace, evidence-based treatments for major depressive or anxiety disorders

Clinical Implications

While much of the diagnosis and management of PMOS focuses on physical symptoms and fertility concerns, it is essential to consider a broader range of symptoms that also includes mental health conditions:

• In those with PMOS, routine screening for depression and anxiety should be incorporated into endocrine and reproductive care settings
• Screening is especially critical in LMICs, where mental health services may be limited
• Interventions should be culturally tailored and address stigma, fertility concerns, and body image issues

Bottom Line

Women with PMOS are at substantially increased risk for depression and anxiety, with prevalence estimates approaching 30–50% or higher in many studies and in certain populations. For psychiatric providers, PMOS should be considered a meaningful risk factor when evaluating women of reproductive age. Routine screening, early identification, and integrated treatment approaches are essential. While lifestyle interventions such as exercise can improve mood symptoms, they should be viewed as adjunctive to standard psychiatric care, not as substitutes for evidence-based treatments.

Resources for Clinicians and Patients

For clinicians:

• International Evidence-based Guideline for the Assessment and Management of PCOS Monash University
• PCOS Practice Tools Based on the best available evidence and was co-designed with health professionals, and aims to assist in the delivery of evidence-based care
• Endocrine Society Patient and Clinician Library on PCOS
• ASRM: PCOS is Now PMOS — Understanding the Name Change

For patients:

• PCOS Awareness Association Resources Includes a “talking to your doctor” checklist
• NICHD PCOS Resources
• AskPCOS app and multilingual guideline resources (PCOS.Together) Available in Arabic, Mandarin, Spanish, French, and more
• Multidisciplinary care models may improve both psychiatric and reproductive outcomes

—Ruta Nonacs, MD PhD