Skip to main content Skip to main navigation menu Skip to site footer

Correlation between phenotype and cortisol with anxiety status related to Polycystic Ovary Syndrome (PCOS)

  • Ummi Shulaeha ,
  • Andi Mardiah Tahir ,
  • Nusratuddin Abdullah ,
  • Isharyah Sunarno ,


Link of Video Abstract:


Background: Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Symptoms include irregular menstrual cycles, hirsutism, obesity, acne vulgaris, and infertility. PCOS is a stigmatized condition that affects women's identity and mental health, especially anxiety. In addition, increased cortisol is associated with increased anxiety. This study aims to determine the effect of phenotype and cortisol on anxiety status in polycystic ovary syndrome (PCOS) patients.

Methods: 40 patients diagnosed with polycystic ovary syndrome (PCOS) aged 18-40 years in Makassar. The Indonesian version of the Hamilton Anxiety Rating Scale (HAM-A) assesses anxiety. A blood sample is taken to check for cortisol (drip blood test). Cortisol levels were measured using the CMIA (Chemiluminescent microparticle Immunoassay) method. Data were analyzed using SPSS version 25.0 for Windows.

Results: The prevalence of phenotypes A, B, C, and D were 27.5%, 0%, 45%, and 45%, respectively. Phenotype C had a higher body mass index than the other phenotypes but was not significantly different. (p > 0.05). About 26.1% of patients with phenotype A were found to suffer from mild anxiety and 29.5% experienced moderate anxiety. Compared to phenotype C, 52.2% experienced mild anxiety and 35.5% experienced moderate anxiety; however, these results were not statistically significant. Higher cortisol levels were found in phenotype A compared to other phenotypes (phenotype C; 7.01±3.12 and phenotype D; 6.37±3.02) but not significantly different (p>0.05).

Conclusion: The PCOS phenotype has no relationship with the anxiety status of PCOS patients and there is no relationship between the phenotype and serum cortisol levels in PCOS patients.


  1. Yildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H. Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria. Hum Reprod. 2012;27(10):3067–3073.
  2. Sachdeva G, Gainder S, Suri V, Sachdeva N, Chopra S. Comparison of the Different PCOS Phenotypes Based on Clinical Metabolic, and Hormonal Profile, and their Response to Clomiphene. Indian J Endocrinol Metab. 2019;23(3):326–331.
  3. Witchel SF, Oberfield SE, Peña AS. Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls. J Endocr Soc. 2019;3(8):1545–1573.
  4. Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril. 2016;106(1):6–15.
  5. Cooney LG, Lee I, Sammel MD, Dokras A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2017;32(5):1075–1091.
  6. Barry JA, Kuczmierczyk AR, Hardiman PJ. Anxiety and depression in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2011;26(9):2442–2451.
  7. Brutocao 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):318–325.
  8. Bazarganipour F, Ziaei S, Montazeri A, Foroozanfard F, Kazemnejad A, Faghihzadeh S. Psychological investigation in patients with polycystic ovary syndrome. Health Qual Life Outcomes. 2013;11:141.
  9. Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010;8:41.
  10. Podfigurna-Stopa A, Luisi S, Regini C, Katulski K, Centini G, Meczekalski B, et al. Mood disorders and quality of life in polycystic ovary syndrome. Gynecol Endocrinol Off J Int Soc Gynecol Endocrinol. 2015;31(6):431–434.
  11. Muharam R, Purba JS, Hestiantoro A, Elvira SD. Profile on personality types and cortisol in polycystic ovarian syndrome. Middle East Fertil Soc J. 2018;23(3):189–194.
  12. Kurniawati EY, Hadisaputro S, Suwandono A. The Effect of Holistic Programs on Cortisol Serum Levels in Polycistic Ovarium Syndrome. Indones J Med. 2019;4(4):376–382.
  13. Neubronner SA, Indran IR, Chan YH, Thu AWP, Yong E-L. Effect of body mass index (BMI) on phenotypic features of polycystic ovary syndrome (PCOS) in Singapore women: a prospective cross-sectional study. BMC Womens Health. 2021;21(1):135.
  14. Welt CK, Carmina E. Lifecycle of Polycystic Ovary Syndrome (PCOS): From In Utero to Menopause. J Clin Endocrinol Metab. 2013;98(12):4629–4638.
  15. Carroll J, Saxena R, Welt CK. Environmental and genetic factors influence age at menarche in women with polycystic ovary syndrome. J Pediatr Endocrinol Metab. 2012;25(5–6):459–466.
  16. Hasan M, Sultana S, Sohan M, Parvin S, Rahman MA, Hossain MJ, et al. Prevalence and associated risk factors for mental health problems among patients with polycystic ovary syndrome in Bangladesh: A nationwide cross-Sectional study. PLoS One. 2022;17(6):e0270102.
  17. Chaudhari AP, Mazumdar K, Mehta PD. Anxiety, Depression, and Quality of Life in Women with Polycystic Ovarian Syndrome. Indian J Psychol Med. 2018;40(3):239–246.
  18. Azizi M, Elyasi F. Psychosomatic aspects of polycystic ovarian syndrome: A review. Iran J Psychiatry Behav Sci. 2017;11(2):e6595.
  19. Bahadori F, Jahanian Sadatmahalleh S, Montazeri A, Nasiri M. Sexuality and psychological well-being in different polycystic ovary syndrome phenotypes compared with healthy controls: a cross-sectional study. BMC Womens Health. 2022;22(1):390.
  20. Lin H, Liu M, Zhong D, Ng EHY, Liu J, Li J, et al. The Prevalence and Factors Associated With Anxiety-Like and Depression-Like Behaviors in Women With Polycystic Ovary Syndrome. Front psychiatry. 2021;12:709674.
  21. Lim AJR, Indran IR, Kramer MS, Yong E-L. Phenotypic spectrum of polycystic ovary syndrome and their relationship to the circadian biomarkers, melatonin and cortisol. Endocrinol diabetes Metab. 2019;2(3):e00047.
  22. Hashemi AH, Mozdarani H, Mozdarani S. The relationship between hormones level and body mass index with insertion and deletion (D/I) polymorphism of ACE gene in infertile patients with polycystic ovary syndrome. Bali Medical Journal. 2017;6(1):90-96.
  23. Ermanto B, Fadilah, Bowolaksono A, Asmarinah, Djuwantono T, Kekalih A, et al. Sequencing analysis of anti mullerian hormone in polycystic ovarian syndrome and primary ovarian insufficiency. Bali Medical Journal. 2023;12(2):2058-2066.
  24. Muarrofah, Santoso B, Tirthaningsih NW. Analysis of CYP17 gene polymorphism on increasing androstenedione levels in polycystic ovary syndrome women with obesity in Surabaya. Bali Medical Journal. 2013;12(3):2612-2618.

How to Cite

Shulaeha, U., Tahir, A. M., Abdullah, N., & Sunarno, I. (2023). Correlation between phenotype and cortisol with anxiety status related to Polycystic Ovary Syndrome (PCOS). Bali Medical Journal, 12(3), 3032–3036.




Search Panel

Ummi Shulaeha
Google Scholar
BMJ Journal

Andi Mardiah Tahir
Google Scholar
BMJ Journal

Nusratuddin Abdullah
Google Scholar
BMJ Journal

Isharyah Sunarno
Google Scholar
BMJ Journal