The association between body image and well-being in polycystic ovary syndrome: a mixed-methods study
Broughton, Sophie Armeni, Eleni Chu, Agatha Yee, Amanda Ling Jie Manta, Aspasia Baig, Shams Ali Blendis, Ella Kempegowda, Punith
Broughton, Sophie
Armeni, Eleni
Chu, Agatha
Yee, Amanda Ling Jie
Manta, Aspasia
Baig, Shams Ali
Blendis, Ella
Kempegowda, Punith
Abstract
Objective: To examine body image (BI) concerns in women with polycystic ovary syndrome (PCOS) by comparing perceptions with normative data, assessing links with psychological distress, clinical features, disordered eating, and quality of life (QoL), and identifying body image cut-offs that predict psychological risk.
Design: Mixed-methods observational study conducted in the United Kingdom (June 2023-October 2024).
Methods: Women with PCOS (n = 171) completed validated questionnaires assessing BI (Multidimensional Body-Self Relations Questionnaire-Appearance Scale), depression, anxiety, disordered eating, and QoL; 41 also participated in semi-structured interviews. Moderation by ethnicity and socioeconomic status (SES) was examined.
Results: Women with PCOS reported greater BI-distress than normative data, driven by elevated body mass index (BMI) and hirsutism. Poorer BI was linked to higher depression, anxiety, disordered eating, and reduced QoL. ROC-analyses identified self-classified weight scores (SW) ≥ 4.25 as the cut-off for depression and overweight preoccupation (OP) ≥ 2.88 for anxiety. In adjusted models, higher SW scores predicted nearly 5-fold greater depression risk, while elevated OP scores conferred a 4-fold higher anxiety risk and doubled disordered eating risk. Together with BMI, OP and SW predicted most PCOS-QoL domains, with the strongest effects in weight-related QoL. Socioeconomic deprivation amplified OP effects on disordered eating, while ethnicity showed minimal influence. Qualitative findings echoed these results, with weight gain, hirsutism, negative diagnostic experiences, and social withdrawal emerging as key distress drivers.
Conclusion: BI concerns are central to psychological morbidity and reduced QoL in PCOS. Establishing OP and SW cut-offs enables early risk stratification, while acknowledging that SES influences may support equitable, patient-centred care.
MIDER Authors
Affiliations
Sandwell and West Birmingham NHS Trust; Royal Free Hospital NHS Foundation Trust; University of Birmingham; South Tees Hospitals NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust
Date
2026-02-09
Type
Article
Collections
Citation
Broughton S, Armeni E, Chu A, Yee ALJ, Manta A, Baig SA, Blendis E, Kempegowda P. The association between body image and well-being in polycystic ovary syndrome: a mixed-methods study. Eur J Endocrinol. 2026 Feb 4;194(2):233-241. doi: 10.1093/ejendo/lvag023.