Eating, Sleeping and Sexual Function Disorders in Women With Polycystic Ovary Syndrome (PCOS)

A Systematic Review and Meta-Analysis

Aneesa Thannickal; Claire Brutocao; Mouaz Alsawas; Allison Morrow; Feras Zaiem; Mohammad Hassan Murad; Asma Javed Chattha


Clin Endocrinol. 2020;92(4):338-349. 

In This Article

Abstract and Introduction


Purpose: We aim to evaluate the association of PCOS with eating, sleeping and sexual function disorders.

Methods: A comprehensive search including MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through 01 August 2018 was conducted for studies reporting the prevalence of any eating, sleep or sexual function disorders in patients with PCOS. Independent reviewers selected studies and extracted data. A random-effects model was utilized to generate pooled odds ratio (OR) and 95% confidence intervals (CI) for binary outcomes, and mean difference (MD) and 95% CI for continuous outcomes.

Results: We included 36 studies reporting on 349,529 patients. Compared to women without PCOS, women with PCOS were more likely to have bulimia nervosa (OR 1.37; %CI, 1.17 to 1.60), binge eating (OR 2.95; 95%CI, 1.61 to 5.42), or any eating disorder (OR 1.96; 95% CI 1.18 to 3.24); but not anorexia nervosa (OR 0.92; 95%CI, 0.78 to 1.10). Women with PCOS were more likely to have sleep disorders like hypersomnia (OR 4.39; %CI, 1.07 to 18.07) and obstructive sleep apnoea (OR 10.81; %CI, 2.39 to 48.83). Women with PCOS had lower sexual satisfaction as measured on a visual analogue scale (MD −29.67; 95% CI, −36.97 to −22.37), but no difference in Total Female Sexual Function Index (MD −0.06; 95% CI, −0.51 to 0.38).

Conclusion: PCOS can be associated with an increased risk of eating and sleeping disorders as well as decreased sexual satisfaction. Screening for these disorders in women with PCOS may allow early intervention and improve quality of life.


Polycystic ovary syndrome (PCOS) is the most common endocrine and metabolic disorder in women, affecting up to 10% of females. It is characterized by hyperandrogenism dysfunction and menstrual irregularity.[1] Common features of PCOS include hyperinsulinemia and insulin resistance, which place women at an increased risk for cardiovascular disease and diabetes mellitus.[2] Phenotypically, the presentation of PCOS is variable, though there is a strong correlation with obesity, hirsutism and subfertility.[2,3] Obesity and insulin resistance have been shown to contribute to both reproductive and psychological symptoms observed in women with PCOS.[4–6] Despite the prevalence of PCOS, much remains unknown about this complex disorder.

Women with PCOS are at increased risk for several cardio-metabolic comorbidities including early cardiovascular disease, nonalcoholic fatty liver disease, lipid disorders and diabetes mellitus.[7,8] Anecdotally, women with PCOS appear to have difficulty with diet and weight management. Lifestyle modifications are first-line management for treatment of PCOS in overweight or obese women,[2] and weight loss has been shown to improve menstrual regularity, cardio-metabolic risk factors and androgen excess.[2,8–11] Despite the association between PCOS and obesity, along with the role of diet and weight loss in treatment, limited data exist on the best intervention to achieve sustainable lifestyle modifications.

Several psychological comorbidities are associated with PCOS. Substantial data demonstrate decreased health-related quality of life in women with PCOS.[12–14] Moreover, several recent studies have demonstrated increased frequency of both depression and anxiety in these women.[15,16] However, little data exist regarding eating patterns and attitudes or potential comorbid eating disorders in women with PCOS. Studies have reported an increased frequency of PCOS among women with anorexia nervosa or bulimia nervosa, but these results have not been substantiated in large cross-sectional studies.[17–19] Studies also vary in findings regarding eating attitudes in women with PCOS, though some report greater concerns about weight and dieting.[20,21] It has also been suggested that hyperandrogenism and polycystic ovaries might contribute to bulimic behaviour by influencing food cravings and impulsivity.[22]

PCOS is also associated with an increased risk of obstructive sleep apnoea (OSA), placing these women at a further increased risk for long-term cardio-metabolic disorders.[23] Obesity commonly underlies these diagnoses, and it is reasonable that each condition contributes to the development of the other.[23,24] Like PCOS, OSA is associated with depressive disorders; it is plausible that this could contribute to decreased quality of life in PCOS patients.[25] There is a lack of evidence regarding practice guidelines in screening these women for OSA or other sleep disorders, making a better understanding of its prevalence essential.

Finally, there appears to be an association between obesity and sexual dysfunction in women.[26] Given the correlation of PCOS and obesity, it is conceivable that PCOS patients might have increased rates of sexual dysfunction. Additionally, it is well known that sexual dysfunction is a frequent issue in patients with affective disorders, such as depression and anxiety seen at increased rates in PCOS patients.[27] However, little data exist regarding the prevalence of sexual function disorders in women with PCOS. As a potential contributor to quality of life, it is important to understand the prevalence of sexual function disorders in women with PCOS.

The primary objective of this systematic review and meta-analysis is to assess the association of eating, sleep and sexual function disorders with PCOS.