If you’ve heard of polycystic-ovarian syndrome (PCOS), you’ve probably heard the statistic that goes with it: “1 in 10 women of child-bearing age are affected with PCOS.” It’s the first result that comes up in Google when you search for PCOS, and one that made me feel terrified of its prevalence but comforted by being a part of such an overwhelming community.
PCOS is a hormonal disorder that can be characterized by symptoms like cystic ovaries, irregular periods, weight gain, hirsutism, acne, hyperandrogenism, insulin resistance, infertility, and even depression and anxiety. It’s a whopper of an illness and appears in everyone differently. One person (like me) may have significant hirsutism on their face, neck, and chest, while another may show no external symptoms at all. I have been told by many healthcare professionals that I have a “classic case” of PCOS, meaning that my body displays the most common and visible signs of the illness. I was diagnosed when I was 16, and in the years since I have found the best methods for treating it so that I am able to live a fulfilling life. The most significant treatment for me has been having mental health interventions like going to a therapist, alleviating stress, and creating a support network of people who will stand by me even during the most difficult times. As much as I am grateful for my access to this kind of help, it hasn’t always been easy.
Before I was diagnosed with PCOS, I was considered an angry child. I’ve never been someone to remain quiet when I or those I love have been wronged, and this often resulted in fearsome rows with authority figures in my life. Growing up in the South African Indian community, this kind of behavior was considered extreme, ungrateful, and disrespectful, and tended to be met with its own brand of volatility in return. This made for a lonely childhood, one where I didn’t have any adult figures to turn to when I needed someone to hear my struggles. I was also raised as a girl, and even though I now identify as nonbinary, this meant that difficult emotions like anger were considered dangerously unfeminine – like too much of it had the power to undo your womanhood entirely. So much of femininity has to do with controlling our emotions, lest we are deemed hysterical.
But after my PCOS diagnosis, things changed. The doctor had warned my parents that mood swings were a common symptom of the illness, and that they would need to take this into consideration moving forward. There was no suggestion for therapy or counseling, or mention of a compassionate support network. He wrote out my prescription for The PilI and sent me on my way. I will admit that, at first, I thought this might mean positive changes for the way my community dealt with my moods. I thought that they might be more interested in listening to me because I basically had a permission slip saying that I was officially Struggling™. Looking back, I am surprised at how naive I was.
Things got worse. Where my emotions were once met with hostility and punishment, those were replaced with being told that it was just my PCOS talking and that whatever I was feeling did not need to be taken seriously. I mentioned how lonely my childhood was, right? After the diagnosis, it got even lonelier. Nothing I felt mattered unless I showed easy emotions like happiness and excitement, and even then, these were mostly met with relief and assertions that my medication was finally working. It was frustrating, and still is, because I am sorry to report that this reaction to my emotions has not changed in the 10 years since my diagnosis.
Anxiety is a common symptom of PCOS, and often, anger is linked to anxiety although researchers are still unsure of how this relationship works. In a 2018 study on the anxiety-anger relationship in adolescent girls diagnosed with PCOS, researchers suggest that anger in PCOS patients may come down to three key factors: childhood traumas, chronic anxiety, and daily stress. They suggest that hyperandrogenemia may also be a culprit, explaining that “testosterone is released in response to perceived challenges of social status, often followed by an increase in aggressive behaviors and physiological activation.” There is still a lot more work that needs to be done in assessing the relationship between PCOS, anxiety, anger and aggression, but it is clear from this study that social and environmental factors are of exceptional importance in understanding how PCOS may elevate anger.
There are two ways to look at this; either we can think of anger as symptomatic of PCOS and therefore inevitable, incurable, and unworthy of intervention, or, we can take seriously, the social factors that make that anger possible. We know that we live in a world where femininity is expected to look a certain way; women are supposed to be quiet, kind, caring, and submissive. They are supposed to be effortlessly thin and hairless with clear skin and long, thick hair. They are often told that they are overly emotional when they express anything other than poise. It would make sense then that having PCOS, an illness that has often been characterized as a “loss of womanhood”, would lead those diagnosed with the condition to feel like they are fighting a losing battle every moment of their lives. For me, waking up every day is nightmarish. Even though I identify as nonbinary, I look in the mirror and immediately perceive how I have failed at femininity. I have a hairy face, hyperpigmentation, acanthosis nigricans from my insulin resistance, and hair that falls out in clumps. I know that when I go out into the world, I will be met with stares from total strangers, and even if that doesn’t happen, I expect it to because of how I have been conditioned to believe it. I am angry. I am sad. Just because I have a diagnosis saying that these emotions are probable, does not mean that they matter any less.
If you have PCOS, I want you to know this: your anger is valid, no matter what it stems from. Whether it’s because of how you are treated because of your PCOS or because you are having a rough day, you deserve to feel that anger and be supported by those around you without being dismissed. I am lucky that after years of searching, I have finally found healthcare professionals who take my mental health seriously when treating my PCOS. I hope that one day, this will be normal for all chronic illnesses.