Is there a link between psychiatric and reproductive system disorders in women?

By Pooja Toshniwal PahariaReviewed by Lily Ramsey, LLMApr 20 2023

In a recent study published in the journal JAMA Network Open, researchers performed a meta-analysis to assess the co-occurrence of reproductive and psychiatric disorders among women.

Disorders associated with the female mental well-being and reproductive tract commonly co-exist; however, the precise cause of the co-occurrence is not clear. Probable causes include non-intrinsic or external-type factors that interfere with the reproductive system, including psychotropic-type medications, psychosocial causes like reproductive disorders impacting relationships and life quality, and stress affecting reproductive functions and the menstrual cycle. Moreover, the overlap could originate from genetic causes.

Study: Association Between Mental Health and Reproductive System Disorders in Women. Image Credit: fizkes / Shutterstock

About the study

In the present meta-analysis, researchers determined the association between female reproductive and psychiatric functions.

The PubMed database was searched for observational-type and peer-reviewed studies (population-level cross-sectional and case-control studies), including reproductive-age females aged between 13.0 and 55.0 years, published from January 1980 to December 2019, evaluating the prevalence of mental health disorders among females with genital tract dysfunction, and reproductive disorders among women with mental dysfunction.

The primary study measures and outcomes were reproductive and psychiatric disorders among females. Data analysis was performed between January and December 2022. Random-effects modeling was performed to calculate the odds ratios (ORs). In addition, I2 statistics were used to assess heterogeneity, and the Egger test was used to evaluate bias in the included studies.

Psychiatric disorders included psychotic disorders, affective disorders, behavioral syndromes, anxiety, neurodevelopmental disorders, and personality disorders, and those diagnosed using the International Classification of Diseases, ninth and tenth revision (ICD-9,10) codes, Diagnostic and Statistical Manual of Mental Disorders, Fourth and Fifth Editions (DSM-IV, V) criteria.

Reproductive disorders included inflammatory and non-inflammatory disorders of the female reproductive tract, ovarian dysfunction, and those diagnosed using ICD criteria. The data extracted included authors, sample sizes, interventions, outcomes, and findings of the included studies. The team excluded reproductive and mental health disorders stemming from events (such as surgery, trauma, and infection) to account for probable confounding.

In addition, mental health disorders that arise from physical trauma, substance use, sexual dysfunction, infertility, childbirth, and the utilization of non-natural reproduction methods, were excluded. Likewise, reproductive disorders arising from distinctive environmental factors, such as sexually transmitted infections (STIs), medications, or surgeries, were excluded from the analysis.

Results

Initially, 1,197 relevant studies were selected, of which 941 records were excluded, and 256 records were assessed for full-text eligibility. Subsequently, the team excluded 206 records, which included 72 off-topic abstracts, 20 records published in foreign languages, 59 studies assessing irrelevant outcomes, 43 studies with outcomes documented as frequencies rather than risks, and 12 studies with outcomes documented as mean and standard deviation values.

As a result, 50 and 31 records satisfied the eligibility criteria for the qualitative (systematic review) and quantitative (meta-analysis) evaluations, respectively. The diagnosis of reproductive disorders was related to a 2.0- to 3.0-fold increase in the probability of having psychiatric disorders (lower limit and upper limit OR values of 2.0 and 2.9, respectively).

Polycystic ovary syndrome (PCOS) was related to an increased likelihood of depression, with OR values of 1.7 and 2.6 for population-level studies and clinical-type studies, respectively. Similar results were obtained for anxiety, with OR values of 1.7 and 2.9 for the corresponding study types, respectively. In addition, chronic-type pelvic pain (CPP) was related to anxiety and depression, with OR values of 2.3 and 3.9, respectively. Only a few studies have examined risks for other types of reproductive tract disorders among females having poor mental health or in reverse relationships.

PCOS symptomatology includes hormonal imbalance, infertility, hirsutism, and the use of medications, which themselves can deteriorate mental well-being; however, genetic factors may also be involved. Previous studies have reported that all types of chronic pain can give rise to depressive symptoms; however, the distinct association between CPP and depression has not been well-characterized.

Conclusions

Overall, the study findings showed a two- to three-fold more significant likelihood of psychiatric disorders among females having reproductive dysfunction. In addition, in disorder pairs that have been well represented in scientific literature, the probability of affective-type psychiatric disorders among females with CPP and PCOS was two- to four-fold greater than that in women with no such disorders.

However, information on several other disorder pairs was scarce. The study findings must be interpreted cautiously due to the compromise of evidence caused by a high degree of heterogeneity in the included studies, study designs, analytical decisions, methodological issues, and non-uniformity in the underlying mechanisms of the diverse comorbid conditions. The relationships between female mental health and the reproductive system remain largely unclear, warranting further research.