HPA/HPG axes dysfunction: assessing the interrelations between diminished ovarian reserve and mental health

Abstract Diminished ovarian reserve (DOR), characterized by a premature decline in follicle quantity and quality, is increasingly prevalent among reproductive-aged women. Notably, DOR is strongly linked to mental health concerns, as affected women face substantially increased risks of anxiety and depression; however, this comorbidity remains overlooked clinically. Central to this relationship are the hypothalamic‒pituitary‒gonadal (HPG) and hypothalamic‒pituitary‒adrenal (HPA) axes, which act as key mediators linking ovarian dysfunction to psychological disturbances. This review synthesizes the current understanding of how DOR interacts with mental health via these two axes, highlights the severity of their interconnected effects, and summarizes relevant evidence and therapeutic approaches, aiming to inform comprehensive clinical management of DOR and its associated mental health challenges.