Polycystic ovary syndrome (PCOS) is an endocrine disorder often associated with psychological problems. This study aimed to examine the relationship between hormonal imbalance and mental health outcomes, including depression, anxiety, body-image dissatisfaction, and quality of life in women with PCOS. A cross-sectional study was conducted with 120 women aged 18–40 years diagnosed with PCOS according to the Rotterdam criteria. Clinical assessments included anthropometric measurements and hormonal tests (testosterone, LH, FSH, cortisol, fasting insulin, and glucose). Psychological status was evaluated using BDI-II, GAD-7, BIDQ, and PCOSQ questionnaires. Data were analyzed using Pearson correlation and multiple linear regression. Elevated testosterone and cortisol levels were significantly associated with higher depression and anxiety scores (p < 0.01). Insulin resistance was linked to increased body-image dissatisfaction and lower quality-of-life scores. Regression analysis showed testosterone and cortisol as independent predictors of depression, cortisol and LH/FSH ratio as predictors of anxiety, and insulin resistance as a predictor of body-image dissatisfaction. Hormonal imbalance, particularly high androgens, elevated cortisol, and insulin resistance, plays an important role in psychological difficulties among women with PCOS. Integrating mental health assessment into routine PCOS care is recommended.

Polycystic ovary syndrome; hormonal imbalance; depression; anxiety; body-image dissatisfaction; insulin resistance; women's health

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