Polycystic ovary syndrome (PCOS), also known as Stein-Leventhal syndrome (Evans and Riley, 1958), stands as one of the prevalent heterogeneous female disorders that affect the endocrine system and is characterized via a combination of features such as excessive androgen levels, menstrual irregularities, along ovarian dysfunction (Azziz et al., 2016). According to the WHO 2025, this disorder affects approximately 6–13 % of women of reproductive age, with up to 70 % of instances going untreated. The dermatological manifestations associated with hyperandrogenism, such as hirsutism, acne, and androgenic alopecia, can induce significant emotional distress, potentially elevating the incidence of depression and anxiety within this demographic (Dokras et al., 2012; Veltman-Verhulst et al., 2012). Nonetheless, discerning the extent to which these mental health outcomes are directly linked to PCOS as opposed to obesity, prevalent among this patient cohort and inherently linked to negative mental health repercussions, including depressive and anxiety disorders, remains challenging (Burke and Storch, 2015; Dawes et al., 2016). The likelihood of depression may be particularly augmented in individuals exhibiting metabolically unhealthy obesity, characterized by insulin resistance (IR) and increased abdominal fat, in contrast to metabolically healthy, weight-matched counterparts (Jokela et al., 2014).

Additionally, community-based investigations indicate that the correlation between obesity and depression is more pronounced among women than men (Luppino et al., 2010). Prior research has concentrated predominantly on the susceptibility to depressive and anxiety disorders in individuals with PCOS; however, hyperandrogenism may also affect the incidence of diverse mental health disorders, including schizophrenia (Markham, 2012). A recent population-based cohort investigation did not establish a heightened risk of schizophrenia (or bipolar disorder) among women diagnosed with PCOS, although an elevated risk of depressive disorders, anxiety disorders, and sleep disturbance was corroborated (Hung et al., 2014). Other investigations have indicated a potential increase in the risk of eating disorders, particularly binge-eating disorder, among women with PCOS (Lee et al., 2017).

Attention-deficit hyperactivity disorder (ADHD) has also been associated with hyperandrogenism and obesity in adults, albeit with a moderate effect size (Mueller et al., 2010; Nigg et al., 2016). More recently, research has expanded to assess the impact of prenatal androgen exposure on neurodevelopmental outcomes in offspring of mothers with PCOS. Early gestational exposure to androgens significantly influences brain development (Hines, 2008) Female rhesus monkeys subjected to in utero androgen exposure exhibit heightened male-typical behaviors, while ADHD and autism spectrum disorder (ASD) are diagnosed more frequently in males than females (Baron-Cohen et al., 2011; Rucklidge, 2010). These findings imply that prenatal androgen exposure could play a role in the development of ADHD and ASD.

Women with PCOS were found to have mild but noticeable cognitive impairments on a variety of tests. They also displayed changes in white matter microstructure, specifically in the corpus callosum, which were characterized by an increase in tissue volume percentage and a decrease in axial diffusivity. Crucially, these changes take place apart from other variables like age, education, and body mass index, suggesting a particular impact linked to metabolic and hormonal abnormalities associated with PCOS. All things considered, these results imply that PCOS may make women more susceptible to changes in the brain linked to cognitive decline (Rees et al., 2016).

Most recently, Kosidou et al., in a matched case-control study, discovered that maternal PCOS was associated with a 59 % increase in the odds of ASD in offspring, further intensified by concurrent obesity (Kosidou et al., 2016). Although these studies necessitate validation, they imply that PCOS could signify a novel risk factor for neurodevelopmental disorders later in life. This review article seeks to outline the multifaceted contributors to PCOS, highlight its association with brain-specific complications.