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I’ve always struggled with anxiety.

I remember being in middle school, lying wide awake in my bed listening to the sound of my parents snoring down the hall as my brain raced through a thousand “what ifs” or replayed the events of the day, beating myself up for choices I didn’t make.

At several times in my life, my stress and anxiety would get so bad that it would become debilitating. Sometimes I’d run on 2 to 3 hours of sleep for days on end until I was finally so physically tired that I could ignore intrusive thoughts and actually fall asleep.

But 4 years ago, after I got passed for a promotion at work, something new happened: I stopped getting my period.

At first, I ignored this new symptom. To be honest, not dealing with cramps and other period-related unpleasantness kind of felt like a relief at first — at least I didn’t have one more thing making me miserable.

Until I reached 3 months with no period.

I took several pregnancy tests over those 3 months. Each confirmed that I wasn’t pregnant.

Suddenly it was inescapable. I knew that something was up with my health. So, I went to the doctor, and after a series of tests, I received a diagnosis of polycystic ovarian syndrome (PCOS).

PCOS is a hormonal disorder that affects as many as 5 million people with uteruses of reproductive age in the United States.

Sometimes, people with PCOS are insulin resistant, and they have higher levels of androgens, such as testosterone. This can lead to symptoms like:

  • irregular periods
  • acne
  • weight gain
  • hair loss
  • ovarian cysts
  • anovulation (when the body stops ovulating)

Doctors still don’t really know what causes PCOS, but there seems to be evidence that genetics and environmental factors (like stress) play a role.

It also turns out that it’s actually not that unusual for people with PCOS to also experience anxiety or depression, like I do. In fact, it’s not even all that unusual for people to experience their first PCOS symptoms during a time of high stress.

“Many women first experience symptoms of PCOS in the midst of anxiety-inducing change, severe stress, or trauma,” says Dr. Leela Magavi, a psychiatrist and the regional medical director for Community Psychiatry.

“I have evaluated patients who present with hair loss and acne vulgaris with PCOS after the loss of a loved one, relationship, or job, or due to other financial and environmental stressors,” she says.

This is partly because when we’re stressed, our whole body is affected, explains Dr. Catherine Monk, a psychologist and professor of medical psychology in the department of psychiatry and in obstetrics and gynecology at Columbia University.

We don’t sleep as well, we eat differently. All that change makes us more aware when something else goes wrong.

“There’s just going to be overall more awareness of the body, and that could be why symptoms get noticed,” she explains.

But, Monk adds, it could also be because the stress hormone, cortisol, affects inflammation, and that can amplify symptoms.

Research has found that anxiety (and depression) are more common among people with PCOS.

A 2016 research review of six studies found that people with PCOS were nearly three times as likely to report anxiety symptoms as those without this condition.

Of course, the relationship between PCOS and anxiety isn’t clear — but doctors think that the relationship between the two could at least be partly due to the symptoms themselves.

“Many people with PCOS experience significant social anxiety, generalized anxiety, and panic attacks due to physical manifestations of PCOS,” Magavi says. “Some also struggle with infertility, which can lead to anticipatory anxiety related to whether they will be able to have children and build their family.”

This was certainly true for me.

I was 28 at the time of my diagnosis and hadn’t yet considered having children, but getting the diagnosis immediately made me reconsider things.

Would I be able to have a baby? Should I speed up my timeline for trying to get pregnant in case this turns into a long-term fertility issue?

“Several women have illustrated their journey with PCOS as essentially ‘theft of their womanhood,’” Magavi says. “Women cry to me, explaining that they feel ostracized and stigmatized. Some women tend to compare themselves with other women who do not have PCOS, and can feel frustration about the day-to-day emotional and physical stressors that they endure due to this syndrome.”

There’s also the reality that you’re going to live the rest of your life with a condition that can be managed but never cured.

“Like a lot of diagnoses,” Monk says, “the diagnosis itself can come with anxiety.”

PCOS is associated with increased risk of:

  • heart disease
  • diabetes
  • stroke
  • sleep apnea
  • endometrial cancer

There’s also research suggesting that children born to people with PCOS have a greater chance of developing anxiety as they get older too.

I wasn’t ready to have a child just yet, but I knew I wanted to one day, so I started looking into my options and prioritizing my reproductive health. This gave me something to focus on, and helped ease some of my anxiety about the future.

But by far the best thing I did was prioritize self-care — something I wasn’t naturally good at doing.

I started taking a lunch break from my workday and practicing work-life balance. I started going for walks with my husband and dog. I started prioritizing sleep and routines, and activities that made me happy.

“I tell all my patients to be good to themselves, practice moderation in life, and find what helps them reset,” says Dr. Carter Owen, a PCOS and fertility expert with CCRM Fertility. According to Owen, this may look like:

  • getting exercise
  • practicing meditation
  • getting massages or acupuncture
  • walking in nature
  • counseling
  • joining a support group

Finding what works for you can take time. And while it takes some trial and error, your mental health is worth the effort.

Simone M. Scully is a writer who loves writing about all things health and science. Find Simone on her website, Facebook, and Twitter.