Neurocognitive profiling in Polyendocrine Metabolic Ovarian Syndrome (PMOS): A minireview of current evidence
DOI:
https://doi.org/10.55184/ijpas.v78i03.610Keywords:
Polycystic ovary syndrome (PCOS), Polycystic Ovarian Syndrome, Neurocognition, Cognition, HyperandrogenismAbstract
Background: Polyendocrine metabolic ovarian syndrome (PMOS) or polycystic ovary syndrome (PCOS) is a common long-term heterogeneous endocrine disorder characterized by hyperandrogenism, insulin resistance, and ovulatory dysfunction. Evidence suggests that hormonal and metabolic disruptions inherent to PCOS may also impair neurocognitive functioning. Objective: This mini-review aims to consolidate existing evidence regarding the cognitive profile of women with PCOS and the impact of hormonal treatments on these outcomes. Methods: A comprehensive search was conducted in Web of Science, Scopus, and PubMed for studies published through February 2026 that examined cognitive domains in patients with PCOS. Results: PCOS women demonstrated lower performance in executive functioning, attention, visuospatial ability, and verbal memory than healthy controls. Although hypergonadism was expected to be associated with improved male-favoring cognitive tasks, it appears "decremental" to both male- and female-favoring domains in patients with PCOS. The results of pharmacological interventions to modulate testosterone levels in patients with PCOS and cognitive performance are mixed. Some studies have shown significant cognitive improvement using anti-androgens or oral contraceptives, whereas others have shown no significant cognitive gains despite reduced testosterone levels. However, neuroimaging studies have correlated these cognitive deficits with structural and functional brain changes, including reduced brain volumes in the frontal and parietal cortices, decreased white matter integrity, and aberrant functional connectivities. Conclusion: Significant cognitive dysfunction is observed in patients with PCOS in addition to reproductive and endocrine problems. Hyperandrogenism and insulin resistance are associated with impaired cognitive function. Clinical management should evolve beyond reproductive health to include the systematic assessment and treatment of neurocognitive and mental health symptoms.
References
El Hayek S, Bitar L, Hamdar LH, Mirza FG, Daoud G. Poly Cystic Ovarian Syndrome: An Updated Overview. Front Physiol. 2016;7:124. DOI: 10.3389/fphys.2016.00124
Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al. Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism. 2013;98(12):4565–92. DOI: 10.1210/jc.2013-2350
Barnard L, Balen AH, Ferriday D, Tiplady B, Dye L. Cognitive functioning in polycystic ovary syndrome. Psychoneuroendocrinology. 2007;32(8-10):906–14. DOI: 10.1016/j.psyneuen.2007.06.010
Sherwin BB. Estrogen and cognitive functioning in women: lessons we have learned. Behav Neurosci. 2012;126(1):123–7. DOI: 10.1037/a0025539
Harvey PD. Domains of cognition and their assessment . Dialogues Clin Neurosci. 2019;21(3):227–37. DOI: 10.31887/DCNS.2019.21.3/pharvey
Courvoisier DS, Renaud O, Geiser C, Paschke K, Gaudy K, Jordan K. Sex hormones and mental rotation: an intensive longitudinal investigation. Horm Behav. 2013;63(2):345–51. DOI: 10.1016/j.yhbeh.2012.12.007
Hausmann M, Slabbekoorn D, Van Goozen SH, Cohen-Kettenis PT, Gunturkun O. Sex hormones affect spatial abilities during the menstrual cycle. Behav Neurosci. 2000;114(6):1245–50. DOI: 10.1037//0735-7044.114.6.1245
Janowsky JS, Chavez B, Orwoll E. Sex steroids modify working memory. Journal of cognitive neuroscience. 2000;12(3):407–14.
Halari R, Hines M, Kumari V, Mehrotra R, Wheeler M, Ng V, et al. Sex differences and individual differences in cognitive performance and their relationship to endogenous gonadal hormones and gonadotropins. Behav Neurosci. 2005;119(1):104–17. DOI: 10.1037/0735-7044.119.1.104
Hampson E. Variations in sex-related cognitive abilities across the menstrual cycle. Brain Cogn. 1990;14(1):26–43. DOI: 10.1016/0278-2626(90)90058-v
Epting LK, Overman WH. Sex-sensitive tasks in men and women: a search for performance fluctuations across the menstrual cycle. Behav Neurosci. 1998;112(6):1304–17. DOI: 10.1037//0735-7044.112.6.1304
Harness A, Jacot L, Scherf S, White A, Warnick JE. Sex differences in working memory. Psychol Rep. 2008;103(1):214–8. DOI: 10.2466/pr0.103.1.214-218
Guoqing Z, Fang S, Lihui D, Bing Y, Qiaoling P, Yingting W, et al. Cerebral white matter lesions and silent cerebral infarcts in postmenopausal women with polycystic ovary syndrome. Gynecol Endocrinol. 2016;32(8):655–8. DOI: 10.3109/09513590.2016.1149812
Rees DA, Udiawar M, Berlot R, Jones DK, O’Sullivan M, O’Sullivan M. White Matter Microstructure and Cognitive Function in Young Women With Polycystic Ovary Syndrome. Journal of Clinical Endocrinology and Metabolism. 2015. DOI: 10.1210/JC.2015-2318
Lai W, Li X, Zhu H, Zhu X, Tan H, Feng P, et al. Plasma luteinizing hormone level affects the brain activity of patients with polycystic ovary syndrome. Psychoneuroendocrinology. DOI: 2020;112:104535.
Lujan M, Mergler R. Cognitive function in women with polycystic ovary syndrome (PCOS): impact of reproductive and metabolic factors. Fertility and sterility. 2015;104(3):e129.
Jarrett BY, Vantman N, Mergler RJ, Brooks ED, Pierson RA, Chizen DR, et al. Dysglycemia, Not Altered Sex Steroid Hormones, Affects Cognitive Function in Polycystic Ovary Syndrome. J Endocr Soc. 2019;3(10):1858–68. DOI: 10.1210/js.2019-00112
Castellano CA, Baillargeon JP, Nugent S, Tremblay S, Fortier M, Imbeault H, et al. Regional Brain Glucose Hypometabolism in Young Women with Polycystic Ovary Syndrome: Possible Link to Mild Insulin Resistance. PLoS One. 2015;10(12):e0144116. DOI: 10.1371/journal.pone.0144116
Soleman RS, Kreukels BPC, Veltman DJ, Cohen-Kettenis PT, Hompes PGA, Drent ML, et al. Does polycystic ovary syndrome affect cognition? A functional magnetic resonance imaging study exploring working memory. Fertil Steril. 2016;105(5):1314–21 e1. DOI: 10.1016/j.fertnstert.2016.01.034
Fahs D, Salloum D, Nasrallah M, Ghazeeri G. Polycystic Ovary Syndrome: Pathophysiology and Controversies in Diagnosis. Diagnostics. 2023;13(9):1559.
Bulsara J, Patel P, Soni A, Acharya S, editors. A review: Brief insight into Polycystic Ovarian syndrome2021.
Ibanez L, Oberfield SE, Witchel S, Auchus RJ, Chang RJ, Codner E, et al. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence. Horm Res Paediatr. 2017;88(6):371–95. DOI: 10.1159/000479371
Dewailly D, Robin G, Peigne M, Decanter C, Pigny P, Catteau-Jonard S. Interactions between androgens, FSH, anti-Müllerian hormone and estradiol during folliculogenesis in the human normal and polycystic ovary. Human reproduction update. 2016;22(6):709–24.
Mehrabadi S, Sadatmahalleh SJ, Kazemnejad A, Moini A. Association of acne, hirsutism, androgen, anxiety, and depression on cognitive performance in polycystic ovary syndrome: A cross-sectional study. Int J Reprod Biomed. 2020;18(12):1049–58. DOI: 10.18502/ijrm.v18i12.8026
Venkateshan SS, Oinonen KA. Facial emotion recognition accuracy in women with symptoms of polycystic ovary syndrome: Reduced fear and disgust perception. Womens Health (Lond). 2025;21:17455057251359761. DOI: 10.1177/17455057251359761
Sukhapure M, Eggleston K, Douglas K, Fenton A, Frampton C, Porter RJ. Free testosterone is related to aspects of cognitive function in women with and without polycystic ovary syndrome. Arch Womens Ment Health. 2022;25(1):87–94. DOI: 10.1007/s00737-021-01158-9
Schattmann L, Sherwin BB. Testosterone levels and cognitive functioning in women with polycystic ovary syndrome and in healthy young women. Horm Behav. 2007;51(5):587–96. DOI: 10.1016/j.yhbeh.2007.02.007
Brunetti R, Del Gatto C, Delogu F. eCorsi: implementation and testing of the Corsi block-tapping task for digital tablets. Front Psychol. 2014;5:939. 10.3389/fpsyg.2014.00939
Schattmann L, Sherwin BB. Effects of the pharmacologic manipulation of testosterone on cognitive functioning in women with polycystic ovary syndrome: a randomized, placebo-controlled treatment study. Horm Behav. 2007;51(5):579–86. DOI: 10.1016/j.yhbeh.2007.02.002
Franik G, Krysta K, Witkowska A, Dudek A, Krzystanek M, Madej P. The impact of sex hormones and metabolic markers on depressive symptoms and cognitive functioning in PCOS patients. Gynecol Endocrinol. 2019;35(11):965–9. DOI: 10.1080/09513590.2019.1613359
Dinsdale NL, Chizen DR, Crespi BJ. Diagnosis, pelvic pain, and medication mediate cognitive empathic abilities among women with endometriosis or polycystic ovary syndrome. Journal of Endometriosis and Pelvic Pain Disorders. 2023;15(2):64–71. DOI: 10.1177/22840265231178334
Kumari S, Manna S, Marwah S, Ahluwalia H, Panwar S. Oral contraceptive treatment improves cognitive performance in polycystic ovarian syndrome (PCOS) patients. Arch Womens Ment Health. 2025;28(6):1527–34. DOI: 10.1007/s00737-025-01628-4
Li G, Hu J, Zhang S, Fan W, Wen L, Wang G, et al. Changes in Resting-State Cerebral Activity in Women With Polycystic Ovary Syndrome: A Functional MR Imaging Study. Front Endocrinol (Lausanne). 2020;11:603279. DOI: 10.3389/fendo.2020.603279
Alur-Gupta S, Dokras A, Cooney LG. Management of polycystic ovary syndrome must include assessment and treatment of mental health symptoms. Fertil Steril. 2024;121(3):384–99. DOI: 10.1016/j.fertnstert.2024.01.018
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Soumen Manna, Saloni Kumari
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
