Mental Health and Emotional Well-being in Subfertile Rural Indian Women with PCOS

Mental Health and Emotional Well-being in Subfertile Rural Indian Women with PCOS | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mental Health and Emotional Well-being in Subfertile Rural Indian Women with PCOS Dr.Seema Pandey, Dr.Lokendra BahadurYadav This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7769847/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To explore the emotional & mental well-being, including body image concerns, in women and individuals with PCOS using a questionnaire-based study. Materials and Methods: This observational study was done at a tertiary fertility unit in India. All women with PCOS, as defined by the Rotterdam criteria (2023), who attended a tertiary care centre between January 2023 and July 2025, were included. Individuals with concurrent known endocrine concerns were excluded from the study cohort. Results: Out of 2000 PCOS patients, 86.8% perceived themselves as attractive or better, indicating a generally positive self-image, though 30.8% felt inferior about their body shape. Despite this, 45.4% expressed feeling "fat and shapeless" and 7.3% "too skinny," reflecting a bimodal dissatisfaction. Poor sleep was reported by 26.8%, 56.8% experienced social discomfort, and 36.3% felt life was meaningless. Emotional reactivity was high, with 64.3% crying easily. Suicidal ideation was reported by 20.5%, indicating significant psychological distress. Despite body image concerns, 73.9% prioritized treatment for menstrual irregularities over physical appearance. These findings highlight the complex interplay between physical symptoms and psychological well-being in women with PCOS. Conclusions: Upon reviewing the responses provided by the female PCOS patients undergoing the treatment of infertility, it became evident that a significant number of patients struggle with feelings of inferiority and emotional instability due to PCOS and infertility, which can negatively impact their outlook and treatment results. Polycystic ovary syndrome (PCOS) Depression Anxiety Stress Mental health Figures Figure 1 Figure 2 Figure 3 Introduction Polycystic ovary syndrome (PCOS) is a complex reproductive endocrinological disorder that affects 6–20% of women worldwide, which persists throughout the reproductive lifespan [ 1 ]. At the same time, hormonal imbalance results in various clinical manifestations such as oligomenorrhea or amenorrhea, hirsutism, acne and infertility [ 2 ], the Insulin resistance (IR) and hyperinsulinemia (HI) leads to various metabolic derangements like diabetes, obesity, higher dyslipidaemia, etc. The disease is diagnosed using the modified Rotterdam criteria 2023, according to which at least two of the following parameters must be present: oligo-ovulation/anovulation, hyperandrogenism, and polycystic ovaries on ultrasound (PCOM) [ 3 ]. Once diagnosed, the condition is managed with a combination of lifestyle modifications (diet, exercise, and mental health), hormonal pills, anti-androgen therapy, metformin, ovulation induction, and artificial reproductive techniques if required [ 4 ]. Hyperandrogenism is the foremost manifestation, marked by an overproduction of androgens originating from the ovaries. These symptoms, like hirsutism, acne and alopecia, may create body image issues leading to anxiety and depression. However, PCOS per se increases the chances of getting anxiety and depression disorders. The hormonal imbalances characteristic of PCOS can contribute to mood disturbances, amplifying the risk of depressive symptoms and anxiety disorders [ 5 ].These symptoms often diminish their sense of femininity and physical satisfaction, leading to sexual dysfunctions and overall mental health and ultimately leading to a poor quality of life [ 6 , 7 ]. Beyond the physiological factors, the emotional toll of managing a chronic condition, coupled with societal pressures and potential fertility concerns, can further contribute to the heightened prevalence of depression and anxiety among those with PCOS. Recognizing and addressing these mental health issues is critical to promoting a comprehensive approach to PCOS treatment [ 8 ]. Emotion regulation refers to the influence individuals exert on the production, experience, and expression of emotions [ 9 ]. This process encompasses not only changing emotions themselves but also other psychological factors such as cognition, behaviour, and social interactions [ 10 ]. Therefore, it is essential to provide effective emotional management to treat these psychological and emotional issues in PCOS patients. To effectively address the psychological distress and emotional challenges faced by women with PCOS, there is an urgent need to develop feasible, patient-friendly intervention programs that focus on enhancing mental well-being and improving body image, leading to a holistic approach toward these women. The primary objective of this study was to comprehensively examine and analyzed the clinical manifestations, along with the physical, mental health and emotional well-being aspects of quality of life in sub-fertile women with PCOS in the rural Indian population. Material and Methods This was an observational study conducted from January 2023 to July 2025 among women aged 18–40 years diagnosed with PCOS, included based on the Rotterdam criteria 2023. A total of 2200 participants were enrolled in the study. The research was carried out in rural Indian sub-fertile populations to assess the symptoms of mental health and emotional well-being in individuals diagnosed with polycystic ovarian syndrome (PCOS). Inclusion Criteria Women of reproductive age (18–40) who are diagnosed with polycystic ovarian syndrome according to modified Rotterdam criteria 2023 and had the chief complaints of Subfertility for more than one year, belonging to the rural area and were in regular follow-up. These women were assessed on the following grounds- Psychological - anxiety, depression, and body image dissatisfaction Physical - hirsutism and acne Reproductive - irregular menstrual cycles and infertility Metabolic - insulin resistance, metabolic syndrome, prediabetes, and type 2 diabetes disorders. Exclusion Criteria Women who have crossed their reproductive age (> 40 years), including postmenopausal women, might introduce confounding variables related to hormonal changes associated with menopause and Co-existing endocrine disorders (e.g., thyroid dysfunction, Cushing's syndrome). Severe psychiatric illnesses already under treatment were excluded from the study. The study was approved by the Medical Ethics Committee of the Hospital (VPIMS/IEC/098/2023). All patients gave informed consent to use the questionnaire for clinical data in this study. Questionnaires For data collection, a self-constructed questionnaire was used during the first visit for consultation at our centre. The questionnaire, which had been meticulously validated by professionals, consisted of a total of 10 questions, in Hindi language. These questions were designed to assess the participants' physical consciousness and their anxious and depressing thoughts, providing a comprehensive view of their mental and emotional well-being. Statistical analysis The statistical analysis was performed using SPSS (Version 25.0; IBM,) and Microsoft Office Excel 2016 was used, respectively, for data collection and analysis. Categorical variable frequencies with percentages and continuous variable means were reported using descriptive statistical approaches. Results Baseline characteristics of Patients A total of 2,200 patients were included in the study, with a mean age of 27.60 years (range, 18–38 years), who were undergoing the treatment of infertility. Out of 2,200 patients, 104 patients were excluded due to a lack of follow-up, and 96 patients were excluded for missing data. A total of 2000 patients were included in the study (Fig. 1). The mean weight was 65.77 kg, and the mean height was 153.61 cm, resulting in an average BMI of 28.7 kg/m², which falls within the overweight range, consistent with the high prevalence of obesity-related PCOS in rural populations. The mean of Modified Ferriman-Gallwey (mFG) score was 3.3, indicating mild hirsutism in most patients.Oligomenorrhea was reported in 75% of cases, confirming menstrual irregularity as a predominant feature. Acanthosis nigricans, a marker of insulin resistance, was seen in 20% of participants, highlighting a significant proportion with metabolic involvement. Mean age at menarche was 12.87 years, which is within the normal range, suggesting that menstrual irregularity developed post-puberty. ( Table-1 ) Physical Consciousness of Patients (n = 2000) (%) The following questions and their answers are discussed in the paragraphs below. Do you think you look good? Out of 2000 patients, 1368(68.4%) felt Good, 368(18.4%) felt they looked very good, only 70(3.5%) considered themselves Average looking, and 194(9.7%) felt they didn't look good at all. A strong majority (86.8%) perceive themselves as attractive or better, indicating a generally positive body image in this population, with an inferiority Complex about Body Shape. Out of 2000 patients, 1384 (69.2%) felt comfortable with their body shape, while 613 (30.8%) felt inferior about their body shape. If so, how do you feel about this? 946 (47.3%) Patients felt "I am alright,146 (7.3%) felt "I am so skinny," reflecting concerns about being underweight, and 908 (45.4%) felt "I am so fat and shapeless," expressing strong dissatisfaction and negative body image. This bimodal pattern reflects body dissatisfaction and internal conflict, which are common in appearance-related issues. ( Figure-2) Anxious and depressing thoughts: Sleep Quality: Out of (n = 2000) Patients, 1464 (73.2%) were sleeping well, while 536 (26.8%) experienced poor sleep quality. More than one-quarter of the participants suffered from poor sleep, which is a well-recognized indicator of anxiety, depression, and body dissatisfaction. Comfort in Crowded Places (Social Discomfort): Out of 2000 Patients, 864 (43.2%) felt comfortable in crowded places, whereas 1136 (56.8%) felt discomfort. Over half of the participants experienced unease in social settings, suggesting elevated social anxiety, particularly among those with heightened appearance concerns or body image dissatisfaction. Sense of Meaningless Life: Out of 2000 Patients, 726 (36.3%) had a sense of meaninglessness in life, while 1274 (63.7%) did not share this perception. Over one-third of respondents expressed feelings of hopelessness or purposelessness, which are often associated with body image dissatisfaction and depressive symptoms. Emotional Reactivity (Crying Easily): 1286 (64.3%) expressed their emotional reactivity in the form of crying easily whenever they felt any discomfort in their surroundings, while 714 (35.7%) had no such problem. Nearly two-thirds of respondents displayed heightened emotional sensitivity, which is often linked to body dissatisfaction and anxiety-related symptoms and Subfertility. Thoughts of Ending One's Life (Suicidal Ideation): Out of 2000 Patients, 410 (20.5%) reported experiencing suicidal thoughts, while 1590 (79.5%) did not. It has been observed that approximately one in five Patients experienced suicidal ideation, reflecting a considerable mental health burden. Consistent with PCOS-related body image issues, Anxiety and Depression. (Figure-3) Physical Appearance vs. Menstrual Irregularities Despite feeling all the dissatisfaction regarding their body image, anxiety issues, when it came to prioritizing the treatment, 1478 (73.9%) of our PCOS women chose the therapy for their menstrual irregularities over physical health first and 522 (26.1%) women wanted to feel physically better first. The majority report menstrual irregularities rather than general physical health problems, aligning with reproductive-focused distress common in women with PCOS. Out of 2000 patients, 1246(62.3%) had Infertility, 532 (26.6%) had Irregular periods, and 222 (11.1%) had Physical Health issues. Over 60% prioritize infertility concerns above period regulation or general health, underscoring the psychological weight associated with infertility—even eclipsing concerns about physical wellness. The majority report menstrual irregularities and infertility rather than general physical health problems, aligning with reproductive-focused distress common in women with PCOS. Social expectations and stigma surrounding infertility may heighten emotional burden and contribute to suicidality, anxiety, or hopelessness in affected women ( Fig. 3 ). Discussion PCOS is characterised by intricate features, rendering its diagnosis challenging. Polycystic Ovary Syndrome (PCOS) significantly influences the mental and emotional well-being of affected women [ 11 , 12 ].The chronic nature of the disorder, coupled with its physical manifestations such as obesity, hirsutism, acne, and menstrual irregularities, can contribute to low self-esteem and body image dissatisfaction. Emotional stress often arises from infertility concerns, which is a frequent and distressing complication of PCOS [ 13 ]. The present study highlights a significant impact of mental health concerns among women with Subfertility and PCOS, with notable effects on their emotional, social, and potentially financial well-being. In our study, Social discomfort was evident in more than half of the participants, reflecting heightened social anxiety and avoidance tendencies. This observation may be linked to body image dissatisfaction, which is directly related to their perception of femininity [ 14 ]. PCOS women with fertility challenges often perceive themselves as socially stigmatized, particularly in cultures where fertility is strongly tied to social identity and marital expectations. Social withdrawal can, in turn, intensify feelings of isolation and hopelessness, further impairing mental health [ 12 ]. In our study, women with PCOS followed the same trend as more than half of the participants, n = 1136(56.8%) experienced unease in social settings, suggesting a higher prevalence of social anxiety. Chronic emotional distress has been associated with poor sleep, reduced treatment adherence, hormonal imbalance, and impaired decision-making, which can further hinder fertility prospects [ 15 ]. It is well evident in our study where Out of (n = 2000) Patients, 536 (26.8%) experienced poor sleep quality (Figure-3). Women with PCOS are reported to have a higher prevalence of anxiety, depressive symptoms, and emotional distress, which may be further exacerbated by negative body image, poor sex life, social stigma and isolation. Poor sleep quality, mood swings, and irritability are common, and many patients experience a sense of hopelessness or helplessness regarding their condition [ 16 ]. Over one-third of respondents n = 726 (36.3%) experienced feelings of hopelessness or a lack of purpose, and felt that their life was meaningless, while, 1274 (63.7%) women did not share this sentiment despite facing the same challenges. 1286(64.3%) and 714(35.7%) felt like crying over little things. This emotional reactivity is often associated with body dissatisfaction and anxiety-related symptoms. Thoughts of ending One's Life (Suicidal Ideation): Approximately one in five participants (410/2000 = 20.5%) expressed suicidal ideation, indicating a substantial mental health burden. In line with previous body image research, suicidal thoughts tend to be more prevalent among individuals experiencing significant appearance-related distress, dissatisfaction and infertility [ 17 ]. The outcomes derived from our study align with a study published in 2024, where they found a positive correlation between mental and emotional well-being and various symptoms of PCOS, like weight gain, hirsutism, and menstrual irregularity [ 18 ].Moreover, the challenges associated with PCOS extend beyond its primary symptoms, incorporating distressing elements such as coexisting conditions like diabetes, and complex complications like miscarriage and infertility. The intricate nature of managing and treating these multifaceted aspects significantly contributes to the overall stress experienced by women [ 18 ]. A study by Begum and colleagues emphasised the importance of addressing poor health-related quality of life (HRQOL) in PCOS patients beyond conventional treatment for physical symptoms. This approach involved utilizing interviews and open-ended questions to allow patients to express concerns related to their QOL[ 19 ].The findings underscored the intricate interplay of physical, psychological, and social aspects in a woman's life, shedding light on their discomfort, which in turn had notable mental repercussions [ 20 ]. The psychological burden is often compounded in rural populations, where awareness and access to mental health support are limited, leading to delayed interventions and increased psychosocial impact. Addressing the mental and emotional aspects of PCOS through counselling, lifestyle modifications, and support groups is crucial for improving overall quality of life and treatment outcomes [ 21 ]. Integrating mental health screening and support into fertility care is, therefore, not optional but essential. Women undergoing ART or living with PCOS should receive psychological counselling, stress-reduction support, and body image interventions as part of comprehensive, person-centred care. Improving emotional well-being not only enhances quality of life but may also improve clinical outcomes in fertility treatment [ 22 , 23 ]. Improving mental and emotional well-being in women experiencing Subfertility or PCOS requires a multidimensional approach that addresses psychological, social, and lifestyle factors. Psychological interventions such as cognitive behavioural therapy (CBT) and mindfulness-based stress reduction (MBSR) have been shown to reduce anxiety, depressive symptoms, and emotional reactivity by enhancing coping skills and resilience [ 24 , 25 ]. Social support is another crucial protective factor; involving partners and family members in counselling sessions, encouraging participation in peer support groups, and fostering community-based awareness programs can reduce isolation and stigma. Lifestyle modifications—including regular physical activity, balanced nutrition, and improved sleep hygiene—play a key role in boosting self-esteem, regulating mood, and enhancing overall well-being [ 26 ]. Furthermore, ensuring accessible and affordable mental health services within fertility clinics can address psychological distress early. In contrast, public health policies aimed at reducing stigma and financial burden can provide long-term societal support. Integrating these strategies within a holistic, multidisciplinary care model is likely to improve not only emotional health but also treatment outcomes and quality of life for women affected by these conditions. Conclusion Polycystic Ovary Syndrome (PCOS) significantly affects the emotional and mental well-being of sub-fertile women in rural India. Beyond its clinical manifestations, the condition contributes to heightened psychological distress, low self-esteem, and social isolation due to infertility-related stigma and limited awareness. This study underscores the urgent need for holistic, multidisciplinary management strategies that extend beyond medical management to include lifestyle modifications and comprehensive mental health support, counselling, and community-based education, ultimately leading to social empowerment, particularly in underserved rural settings. Addressing the emotional and psychological dimensions of PCOS is also essential for improving the overall quality of life and reproductive outcomes in this vulnerable population. Abbreviations PCOS Polycystic Ovary Syndrome IR Insulin resistance HI Hyperinsulinemia PCOM polycystic ovaries on ultrasound SPSS Statistical package for social sciences BMI Body Mass Index mFG Modified Ferriman–Gallwey Score HRQOL Health-related quality of life QOL Quality of life ART Assisted Reproductive Technology CBT cognitive behavioural therapy MBSR Mindfulness-based stress reduction Declarations Conflict of interest : The authors have no conflict of interest. Funding Statement: Not associated Ethics statement; Ethical approval was obtained from the institutional Ethics committee of Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, India, with the reference number ((VPIMS/IEC/098/2023). Informed consent : All patients provided informed consent for their clinical Data to be used in this study Availability of data and material; All Data available upon request from the Corresponding Author Informed Consent to Participate and Consent to Publish: Informed consent for both participation and publication was obtained from all participants. All Participant was above age 18 year. Acknowledgements; Authors acknowledge the Vivekananda Polyclinic and Institute of Medical Sciences, for providing facilities and support during the study. Author contributions SP conceptualized and designed this study. SP, LBY were involved in data collation and project administration. SP and LBY conducted data analysis and data collection and project administration. SP, LBY wrote the original draft and edited and reviewed the manuscript. References Deswal R, Narwal V, Dang A, Pundir CS. The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. 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Impact of cognitive-behavioral therapy and mindfulness-based stress reduction in mitigating test anxiety and enhancing academic achievement among vocational education students at Nigerian universities. BMC Med Educ. 2025;25(1):578. Goyal M, Singh S, Sibinga EM, Gould NF, Rowland-Seymour A, Sharma R, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357–68. Yadav M, Diet. Sleep and Exercise: The Keystones of Healthy Lifestyle for Medical Students. JNMA J Nepal Med Assoc. 2022; 60(253). Tables Tables 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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08:43:40","extension":"html","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":87274,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7769847/v1/7a7a4cf5b24493a28f60871d.html"},{"id":96242416,"identity":"41ac0484-1a34-40d6-b752-cc3c0f92bbd8","added_by":"auto","created_at":"2025-11-19 07:12:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36604,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart showing the enrolment of Patients\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7769847/v1/076bb020aa6a2c0d3f886887.png"},{"id":95902789,"identity":"18bb5513-a511-4a3d-8011-91be059c0b0e","added_by":"auto","created_at":"2025-11-14 08:43:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":62743,"visible":true,"origin":"","legend":"\u003cp\u003eCharacteristics of Physical Consciousness of PCOS patients\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7769847/v1/c54f5001b059d7a3f5af0879.png"},{"id":95902790,"identity":"4af07a9e-903c-4c13-bdf0-e0a4cdd26485","added_by":"auto","created_at":"2025-11-14 08:43:40","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":95177,"visible":true,"origin":"","legend":"\u003cp\u003eCharacteristics of Anxiety and Depression thoughts of PCOS patients\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7769847/v1/63c9d7c7a7eeb2f02064b184.png"},{"id":103404065,"identity":"7fc1e456-3ac4-4fcb-b8ed-e12643b6bc5b","added_by":"auto","created_at":"2026-02-25 09:44:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":689556,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7769847/v1/5d526800-b4d6-4d39-b18d-88d6ccc45f7c.pdf"},{"id":95902786,"identity":"8fc45d9f-c97f-4e3f-a022-42a16c16e531","added_by":"auto","created_at":"2025-11-14 08:43:40","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18253,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7769847/v1/8b7e14ab8791241bdf20c988.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mental Health and Emotional Well-being in Subfertile Rural Indian Women with PCOS","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePolycystic ovary syndrome (PCOS) is a complex reproductive endocrinological disorder that affects 6\u0026ndash;20% of women worldwide, which persists throughout the reproductive lifespan [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. At the same time, hormonal imbalance results in various clinical manifestations such as oligomenorrhea or amenorrhea, hirsutism, acne and infertility [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], the Insulin resistance (IR) and hyperinsulinemia (HI) leads to various metabolic derangements like diabetes, obesity, higher dyslipidaemia, etc. The disease is diagnosed using the modified Rotterdam criteria 2023, according to which at least two of the following parameters must be present: oligo-ovulation/anovulation, hyperandrogenism, and polycystic ovaries on ultrasound (PCOM) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Once diagnosed, the condition is managed with a combination of lifestyle modifications (diet, exercise, and mental health), hormonal pills, anti-androgen therapy, metformin, ovulation induction, and artificial reproductive techniques if required [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHyperandrogenism is the foremost manifestation, marked by an overproduction of androgens originating from the ovaries. These symptoms, like hirsutism, acne and alopecia, may create body image issues leading to anxiety and depression. However, PCOS per se increases the chances of getting anxiety and depression disorders. The hormonal imbalances characteristic of PCOS can contribute to mood disturbances, amplifying the risk of depressive symptoms and anxiety disorders [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].These symptoms often diminish their sense of femininity and physical satisfaction, leading to sexual dysfunctions and overall mental health and ultimately leading to a poor quality of life [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBeyond the physiological factors, the emotional toll of managing a chronic condition, coupled with societal pressures and potential fertility concerns, can further contribute to the heightened prevalence of depression and anxiety among those with PCOS. Recognizing and addressing these mental health issues is critical to promoting a comprehensive approach to PCOS treatment [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEmotion regulation refers to the influence individuals exert on the production, experience, and expression of emotions [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This process encompasses not only changing emotions themselves but also other psychological factors such as cognition, behaviour, and social interactions [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Therefore, it is essential to provide effective emotional management to treat these psychological and emotional issues in PCOS patients.\u003c/p\u003e\u003cp\u003eTo effectively address the psychological distress and emotional challenges faced by women with PCOS, there is an urgent need to develop feasible, patient-friendly intervention programs that focus on enhancing mental well-being and improving body image, leading to a holistic approach toward these women.\u003c/p\u003e\u003cp\u003eThe primary objective of this study was to comprehensively examine and analyzed the clinical manifestations, along with the physical, mental health and emotional well-being aspects of quality of life in sub-fertile women with PCOS in the rural Indian population.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003eThis was an observational study conducted from January 2023 to July 2025 among women aged 18\u0026ndash;40 years diagnosed with PCOS, included based on the Rotterdam criteria 2023. A total of 2200 participants were enrolled in the study. The research was carried out in rural Indian sub-fertile populations to assess the symptoms of mental health and emotional well-being in individuals diagnosed with polycystic ovarian syndrome (PCOS).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eInclusion Criteria\u003c/h2\u003e\u003cp\u003eWomen of reproductive age (18\u0026ndash;40) who are diagnosed with polycystic ovarian syndrome according to modified Rotterdam criteria 2023 and had the chief complaints of Subfertility for more than one year, belonging to the rural area and were in regular follow-up. These women were assessed on the following grounds-\u003c/p\u003e\u003cp\u003ePsychological - anxiety, depression, and body image dissatisfaction\u003c/p\u003e\u003cp\u003ePhysical - hirsutism and acne\u003c/p\u003e\u003cp\u003eReproductive - irregular menstrual cycles and infertility\u003c/p\u003e\u003cp\u003eMetabolic - insulin resistance, metabolic syndrome, prediabetes, and type 2 diabetes disorders.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eExclusion Criteria\u003c/h3\u003e\n\u003cp\u003eWomen who have crossed their reproductive age (\u0026gt;\u0026thinsp;40 years), including postmenopausal women, might introduce confounding variables related to hormonal changes associated with menopause and Co-existing endocrine disorders (e.g., thyroid dysfunction, Cushing's syndrome). Severe psychiatric illnesses already under treatment were excluded from the study.\u003c/p\u003e\u003cp\u003e The study was approved by the Medical Ethics Committee of the Hospital (VPIMS/IEC/098/2023). All patients gave informed consent to use the questionnaire for clinical data in this study.\u003c/p\u003e\n\u003ch3\u003eQuestionnaires\u003c/h3\u003e\n\u003cp\u003eFor data collection, a self-constructed questionnaire was used during the first visit for consultation at our centre. The questionnaire, which had been meticulously validated by professionals, consisted of a total of 10 questions, in Hindi language. These questions were designed to assess the participants' physical consciousness and their anxious and depressing thoughts, providing a comprehensive view of their mental and emotional well-being.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe statistical analysis was performed using SPSS (Version 25.0; IBM,) and Microsoft Office Excel 2016 was used, respectively, for data collection and analysis. Categorical variable frequencies with percentages and continuous variable means were reported using descriptive statistical approaches.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eBaseline characteristics of Patients\u003c/h2\u003e\u003cp\u003eA total of 2,200 patients were included in the study, with a mean age of 27.60 years (range, 18\u0026ndash;38 years), who were undergoing the treatment of infertility. Out of 2,200 patients, 104 patients were excluded due to a lack of follow-up, and 96 patients were excluded for missing data. A total of 2000 patients were included in the study (Fig.\u0026nbsp;1). The mean weight was 65.77 kg, and the mean height was 153.61 cm, resulting in an average BMI of 28.7 kg/m\u0026sup2;, which falls within the overweight range, consistent with the high prevalence of obesity-related PCOS in rural populations. The mean of Modified Ferriman-Gallwey (mFG) score was 3.3, indicating mild hirsutism in most patients.Oligomenorrhea was reported in 75% of cases, confirming menstrual irregularity as a predominant feature. Acanthosis nigricans, a marker of insulin resistance, was seen in 20% of participants, highlighting a significant proportion with metabolic involvement. Mean age at menarche was 12.87 years, which is within the normal range, suggesting that menstrual irregularity developed post-puberty. (\u003cb\u003eTable-1\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePhysical Consciousness of Patients (n = 2000) (%)\u003c/h3\u003e\n\u003cp\u003eThe following questions and their answers are discussed in the paragraphs below.\u003c/p\u003e\u003cp\u003eDo you think you look good? Out of 2000 patients, 1368(68.4%) felt Good, 368(18.4%) felt they looked very good, only 70(3.5%) considered themselves Average looking, and 194(9.7%) felt they didn't look good at all. A strong majority (86.8%) perceive themselves as attractive or better, indicating a generally positive body image in this population, with an inferiority Complex about Body Shape. Out of 2000 patients, 1384 (69.2%) felt comfortable with their body shape, while 613 (30.8%) felt inferior about their body shape.\u003c/p\u003e\u003cp\u003eIf so, how do you feel about this? 946 (47.3%) Patients felt \"I am alright,146 (7.3%) felt \"I am so skinny,\" reflecting concerns about being underweight, and 908 (45.4%) felt \"I am so fat and shapeless,\" expressing strong dissatisfaction and negative body image. This bimodal pattern reflects body dissatisfaction and internal conflict, which are common in appearance-related issues. (\u003cb\u003eFigure-2)\u003c/b\u003e\u003c/p\u003e\n\u003ch3\u003eAnxious and depressing thoughts:\u003c/h3\u003e\n\u003cp\u003eSleep Quality: Out of (n\u0026thinsp;=\u0026thinsp;2000) Patients, 1464 (73.2%) were sleeping well, while 536 (26.8%) experienced poor sleep quality. More than one-quarter of the participants suffered from poor sleep, which is a well-recognized indicator of anxiety, depression, and body dissatisfaction. Comfort in Crowded Places (Social Discomfort): Out of 2000 Patients, 864 (43.2%) felt comfortable in crowded places, whereas 1136 (56.8%) felt discomfort. Over half of the participants experienced unease in social settings, suggesting elevated social anxiety, particularly among those with heightened appearance concerns or body image dissatisfaction. Sense of Meaningless Life: Out of 2000 Patients, 726 (36.3%) had a sense of meaninglessness in life, while 1274 (63.7%) did not share this perception. Over one-third of respondents expressed feelings of hopelessness or purposelessness, which are often associated with body image dissatisfaction and depressive symptoms. Emotional Reactivity (Crying Easily): 1286 (64.3%) expressed their emotional reactivity in the form of crying easily whenever they felt any discomfort in their surroundings, while 714 (35.7%) had no such problem. Nearly two-thirds of respondents displayed heightened emotional sensitivity, which is often linked to body dissatisfaction and anxiety-related symptoms and Subfertility. Thoughts of Ending One's Life (Suicidal Ideation): Out of 2000 Patients, 410 (20.5%) reported experiencing suicidal thoughts, while 1590 (79.5%) did not. It has been observed that approximately one in five Patients experienced suicidal ideation, reflecting a considerable mental health burden. Consistent with PCOS-related body image issues, Anxiety and Depression. \u003cb\u003e(Figure-3)\u003c/b\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePhysical Appearance vs. Menstrual Irregularities\u003c/h2\u003e\u003cp\u003eDespite feeling all the dissatisfaction regarding their body image, anxiety issues, when it came to prioritizing the treatment, 1478 (73.9%) of our PCOS women chose the therapy for their menstrual irregularities over physical health first and 522 (26.1%) women wanted to feel physically better first. The majority report menstrual irregularities rather than general physical health problems, aligning with reproductive-focused distress common in women with PCOS.\u003c/p\u003e\u003cp\u003eOut of 2000 patients, 1246(62.3%) had Infertility, 532 (26.6%) had Irregular periods, and 222 (11.1%) had Physical Health issues. Over 60% prioritize infertility concerns above period regulation or general health, underscoring the psychological weight associated with infertility\u0026mdash;even eclipsing concerns about physical wellness. The majority report menstrual irregularities and infertility rather than general physical health problems, aligning with reproductive-focused distress common in women with PCOS. Social expectations and stigma surrounding infertility may heighten emotional burden and contribute to suicidality, anxiety, or hopelessness in affected women \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePCOS is characterised by intricate features, rendering its diagnosis challenging. Polycystic Ovary Syndrome (PCOS) significantly influences the mental and emotional well-being of affected women [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].The chronic nature of the disorder, coupled with its physical manifestations such as obesity, hirsutism, acne, and menstrual irregularities, can contribute to low self-esteem and body image dissatisfaction. Emotional stress often arises from infertility concerns, which is a frequent and distressing complication of PCOS [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe present study highlights a significant impact of mental health concerns among women with Subfertility and PCOS, with notable effects on their emotional, social, and potentially financial well-being. In our study, Social discomfort was evident in more than half of the participants, reflecting heightened social anxiety and avoidance tendencies. This observation may be linked to body image dissatisfaction, which is directly related to their perception of femininity [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePCOS women with fertility challenges often perceive themselves as socially stigmatized, particularly in cultures where fertility is strongly tied to social identity and marital expectations. Social withdrawal can, in turn, intensify feelings of isolation and hopelessness, further impairing mental health [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our study, women with PCOS followed the same trend as more than half of the participants, n\u0026thinsp;=\u0026thinsp;1136(56.8%) experienced unease in social settings, suggesting a higher prevalence of social anxiety. Chronic emotional distress has been associated with poor sleep, reduced treatment adherence, hormonal imbalance, and impaired decision-making, which can further hinder fertility prospects [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. It is well evident in our study where Out of (n\u0026thinsp;=\u0026thinsp;2000) Patients, 536 (26.8%) experienced poor sleep quality (Figure-3).\u003c/p\u003e\u003cp\u003eWomen with PCOS are reported to have a higher prevalence of anxiety, depressive symptoms, and emotional distress, which may be further exacerbated by negative body image, poor sex life, social stigma and isolation. Poor sleep quality, mood swings, and irritability are common, and many patients experience a sense of hopelessness or helplessness regarding their condition [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Over one-third of respondents n\u0026thinsp;=\u0026thinsp;726 (36.3%) experienced feelings of hopelessness or a lack of purpose, and felt that their life was meaningless, while, 1274 (63.7%) women did not share this sentiment despite facing the same challenges. 1286(64.3%) and 714(35.7%) felt like crying over little things. This emotional reactivity is often associated with body dissatisfaction and anxiety-related symptoms.\u003c/p\u003e\u003cp\u003eThoughts of ending One's Life (Suicidal Ideation): Approximately one in five participants (410/2000\u0026thinsp;=\u0026thinsp;20.5%) expressed suicidal ideation, indicating a substantial mental health burden. In line with previous body image research, suicidal thoughts tend to be more prevalent among individuals experiencing significant appearance-related distress, dissatisfaction and infertility [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe outcomes derived from our study align with a study published in 2024, where they found a positive correlation between mental and emotional well-being and various symptoms of PCOS, like weight gain, hirsutism, and menstrual irregularity [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].Moreover, the challenges associated with PCOS extend beyond its primary symptoms, incorporating distressing elements such as coexisting conditions like diabetes, and complex complications like miscarriage and infertility. The intricate nature of managing and treating these multifaceted aspects significantly contributes to the overall stress experienced by women [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA study by Begum and colleagues emphasised the importance of addressing poor health-related quality of life (HRQOL) in PCOS patients beyond conventional treatment for physical symptoms. This approach involved utilizing interviews and open-ended questions to allow patients to express concerns related to their QOL[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].The findings underscored the intricate interplay of physical, psychological, and social aspects in a woman's life, shedding light on their discomfort, which in turn had notable mental repercussions [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe psychological burden is often compounded in rural populations, where awareness and access to mental health support are limited, leading to delayed interventions and increased psychosocial impact. Addressing the mental and emotional aspects of PCOS through counselling, lifestyle modifications, and support groups is crucial for improving overall quality of life and treatment outcomes [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIntegrating mental health screening and support into fertility care is, therefore, not optional but essential. Women undergoing ART or living with PCOS should receive psychological counselling, stress-reduction support, and body image interventions as part of comprehensive, person-centred care. Improving emotional well-being not only enhances quality of life but may also improve clinical outcomes in fertility treatment [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eImproving mental and emotional well-being in women experiencing Subfertility or PCOS requires a multidimensional approach that addresses psychological, social, and lifestyle factors. Psychological interventions such as cognitive behavioural therapy (CBT) and mindfulness-based stress reduction (MBSR) have been shown to reduce anxiety, depressive symptoms, and emotional reactivity by enhancing coping skills and resilience [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSocial support is another crucial protective factor; involving partners and family members in counselling sessions, encouraging participation in peer support groups, and fostering community-based awareness programs can reduce isolation and stigma. Lifestyle modifications\u0026mdash;including regular physical activity, balanced nutrition, and improved sleep hygiene\u0026mdash;play a key role in boosting self-esteem, regulating mood, and enhancing overall well-being [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Furthermore, ensuring accessible and affordable mental health services within fertility clinics can address psychological distress early. In contrast, public health policies aimed at reducing stigma and financial burden can provide long-term societal support. Integrating these strategies within a holistic, multidisciplinary care model is likely to improve not only emotional health but also treatment outcomes and quality of life for women affected by these conditions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePolycystic Ovary Syndrome (PCOS) significantly affects the emotional and mental well-being of sub-fertile women in rural India. Beyond its clinical manifestations, the condition contributes to heightened psychological distress, low self-esteem, and social isolation due to infertility-related stigma and limited awareness. This study underscores the urgent need for holistic, multidisciplinary management strategies that extend beyond medical management to include lifestyle modifications and comprehensive mental health support, counselling, and community-based education, ultimately leading to social empowerment, particularly in underserved rural settings. Addressing the emotional and psychological dimensions of PCOS is also essential for improving the overall quality of life and reproductive outcomes in this vulnerable population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003ePCOS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePolycystic Ovary Syndrome\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eIR\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInsulin resistance\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eHI\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHyperinsulinemia\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003ePCOM\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epolycystic ovaries on ultrasound\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eSPSS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStatistical package for social sciences\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBody Mass Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003emFG\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eModified Ferriman\u0026ndash;Gallwey Score\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eHRQOL\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHealth-related quality of life\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eQOL\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eQuality of life\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eART\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAssisted Reproductive Technology\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eCBT\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ecognitive behavioural therapy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eMBSR\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMindfulness-based stress reduction\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e: The authors have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement:\u003c/strong\u003e Not associated\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement;\u003c/strong\u003e Ethical approval was obtained from the institutional Ethics committee of Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, India, with the reference number ((VPIMS/IEC/098/2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e: All patients provided informed consent for their clinical Data to be used in this study\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material;\u003c/strong\u003e All Data available upon request from the Corresponding Author\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent to Participate and Consent to Publish:\u003c/strong\u003e Informed consent for both participation and publication was obtained from all participants. All Participant was above age 18 year.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors acknowledge the Vivekananda Polyclinic and Institute of Medical Sciences, for providing facilities and support during the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSP conceptualized and designed this study. SP, LBY were involved in data collation and project administration. SP and LBY conducted data analysis and data collection and project administration. SP, LBY wrote the original draft and edited and reviewed the manuscript.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDeswal R, Narwal V, Dang A, Pundir CS. The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. J Hum Reprod Sci. 2020 Oct-Dec;13(4):261\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAljefri YE, Alahmadi RA, Alajmi RS, Alkhamisi TA, Maaddawi HA, Alraddadi AA et al. Cutaneous Manifestations and Hormonal Changes among Polycystic Ovary Syndrome Patients at a Tertiary Care Center. Cureus. 2021;13(12).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRotterdam ESHRE, ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl Wattar BH, Fisher M, Bevington L, Talaulikar V, Davies M, Conway G, et al. Clinical Practice Guidelines on the Diagnosis and Management of Polycystic Ovary Syndrome: A Systematic Review and Quality Assessment Study. J Clin Endocrinol Metab. 2021;106(8):2436\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrutocao C, Zaiem F, Alsawas M, Morrow AS, Murad MH, Javed A. Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine. 2018;62(2):318\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYin X, Ji Y, Chan CLW, Chan CHY. The mental health of women with polycystic ovary syndrome: a systematic review and meta-analysis. Arch Womens Ment Health. 2021;24(1):11\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang G, Liu X, Zhu S, Lei J. Experience of mental health in women with Polycystic Ovary Syndrome: a descriptive phenomenological study. J Psychosom Obstet Gynaecol. 2023;44(1):2218987.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlmhmoud H, Alatassi L, Baddoura M, Sandouk J, Alkayali MZ, Najjar H, et al. Polycystic ovary syndrome and its multidimensional impacts on women's mental health: A narrative review. Med (Baltim). 2024;103:25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ede Jes\u0026uacute;s G\u0026oacute;mez RM, Cornu-Labat MA. Emotional regulation or affective regulation? Front Psychol. 2024;15:1429361.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhan F, Govender N, Thandar Y. The current landscape of mental health challenges in women with PCOS: a narrative review. Curr Psychol 2025 Feb 14:1\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eConte F, Banting L, Teede HJ, Stepto NK. Mental health and physical activity in women with polycystic ovary syndrome: a brief review. Sports Med. 2015;45(4):497\u0026ndash;504.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDewani D, Karwade P, Mahajan KS. The Invisible Struggle: The Psychosocial Aspects of Polycystic Ovary Syndrome. Cureus. 2023;15(12).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNorman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ovary syndrome. Lancet. 2007;370(9588):685\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHofmann K, Decrinis C, Bitterlich N, Tropschuh K, Stute P, Bachmann A. Body image and mental health in women with polycystic ovary syndrome-a cross-sectional study. Arch Gynecol Obstet. 2025;312(1):177\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRooney KL, Domar AD. The relationship between stress and infertility. Dialogues Clin Neurosci. 2018;20(1):41\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChaudhari 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\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarmer B, Lee S, Rizvi A, Saadabadi A, Suicidal Ideation. 2024 Apr 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan\u0026ndash;. PMID: 33351435.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLigocka N, Chmaj-Wierzchowska K, Wszołek K, Wilczak M, Tomczyk K. Quality of Life of Women with Polycystic Ovary Syndrome. Med (Kaunas). 2024;60(2):294.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBegum RF, Vellapandian C, Mohan S. Examining symptom and quality of life in polycystic ovarian syndrome: a web-based cross-sectional study. Future Sci OA. 2024;10(1):2430878.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTaghavi SA, Bazarganipour F, Hugh-Jones S, et al. Health-related quality of life in Iranian women with polycystic ovary syndrome: a qualitative study. BMC Womens Health. 2015;15(1):111.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChadha C, Kataria J, Chugh P, Choudhary A. Quality of life in young adult females with PCOS. Indian J Physiother Occup Ther. 2019;1:40\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCowan S, Lim S, Alycia C, Pirotta S, Thomson R, Gibson-Helm M, et al. Lifestyle management in polycystic ovary syndrome - beyond diet and physical activity. BMC Endocr Disord. 2023;23(1):14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoivin J, Griffiths E, Venetis CA. Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. BMJ. 2011;342:d223.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNwadi CL, Edeh NI, Ugwunwoti EP, Nwokike FO, Nneji OS, Anamezie RC, et al. Impact of cognitive-behavioral therapy and mindfulness-based stress reduction in mitigating test anxiety and enhancing academic achievement among vocational education students at Nigerian universities. BMC Med Educ. 2025;25(1):578.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoyal M, Singh S, Sibinga EM, Gould NF, Rowland-Seymour A, Sharma R, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYadav M, Diet. Sleep and Exercise: The Keystones of Healthy Lifestyle for Medical Students. JNMA J Nepal Med Assoc. 2022; 60(253).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Polycystic ovary syndrome (PCOS), Depression, Anxiety, Stress, Mental health","lastPublishedDoi":"10.21203/rs.3.rs-7769847/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7769847/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo explore the emotional \u0026amp; mental well-being, including body image concerns, in women and individuals with PCOS using a questionnaire-based study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e This observational study was done at a tertiary fertility unit in India. All women with PCOS, as defined by the Rotterdam criteria (2023), who attended a tertiary care centre between January 2023 and July 2025, were included. Individuals with concurrent known endocrine concerns were excluded from the study cohort.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOut of 2000 PCOS patients, 86.8% perceived themselves as attractive or better, indicating a generally positive self-image, though 30.8% felt inferior about their body shape. Despite this, 45.4% expressed feeling \"fat and shapeless\" and 7.3% \"too skinny,\" reflecting a bimodal dissatisfaction. Poor sleep was reported by 26.8%, 56.8% experienced social discomfort, and 36.3% felt life was meaningless. Emotional reactivity was high, with 64.3% crying easily. Suicidal ideation was reported by 20.5%, indicating significant psychological distress. Despite body image concerns, 73.9% prioritized treatment for menstrual irregularities over physical appearance. These findings highlight the complex interplay between physical symptoms and psychological well-being in women with PCOS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eUpon reviewing the responses provided by the female PCOS patients undergoing the treatment of infertility, it became evident that a significant number of patients struggle with feelings of inferiority and emotional instability due to PCOS and infertility, which can negatively impact their outlook and treatment results.\u003c/p\u003e","manuscriptTitle":"Mental Health and Emotional Well-being in Subfertile Rural Indian Women with PCOS","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-14 08:43:35","doi":"10.21203/rs.3.rs-7769847/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"126b4114-b61b-4076-92f5-5a9f06610416","owner":[],"postedDate":"November 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-25T09:43:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-14 08:43:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7769847","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7769847","identity":"rs-7769847","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}