'Everything's from the inside out with PCOS': Exploring women's experiences of living with polycystic ovary syndrome and co-morbidities through Skype™ interviews

Understanding barriers and facilitators to lifestyle management in people with polycystic ovary syndrome: A mixed method systematic review

Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting 10-13% of reproductive-aged women. Lifestyle management through diet and physical activity changes can improve reproductive, metabolic, and psychological comorbidities. The aim of this systematic review is to understand the barriers and facilitators to lifestyle changes from the perspective of people with PCOS and health care professionals (HCP) using the theoretical domains framework and capability, opportunity, motivation, and behavior model. Six databases were systematically searched for qualitative, quantitative, and mixed-methods studies to 22nd September 2022. Quantitative outcomes from quantitative and mixed-methods studies were narratively synthesized and all studies were thematically analyzed. Sixty-eight papers met the eligibility criteria. HCP education on lifestyle management in PCOS was viewed by all to be inadequate, impacting the quality of care and health outcomes. Lifestyle advice delivered by a multidisciplinary team, including dietitians, was identified as a key component for change. All agreed that there was a need for individualized and PCOS-specific lifestyle advice. Weight stigma was identified as negatively impacting both those in larger and smaller bodies with PCOS, reducing the quality of care and affecting self-perception and mental health. People with PCOS perceived that lifestyle management was overly focused on weight loss and fertility, independent of their own personal motivations and goals. Systemic changes, including increasing HCP education on lifestyle management and multidisciplinary collaboration, focusing on lifestyle advice that meets individual needs, and reducing the use of weight-centric care are necessary for long-term sustainable changes and improvements in health outcomes in people with PCOS.

Challenges experienced by those with polycystic ovary syndrome in healthcare interactions: a qualitative evidence synthesis

Studies report interaction difficulties between patients with polycystic ovary syndrome (PCOS) and healthcare professionals (HCP). This systematic review and qualitative evidence synthesis aimed to collate and synthesize the existing peer-reviewed literature investigating challenges for people with PCOS when interacting with HCP. Medline, PsycInfo, EMBASE, All EBM and CINAHL were searched from 1990 to September 2022. Study risk of bias (RoB) was performed and all textual data relevant to challenging interactions between patients with PCOS and HCP were extracted and analysed using thematic synthesis. Of the 6353 studies identified, 28 were included. Two were appraised as high, four as moderate and 22 as low RoB. Four analytic themes were derived illustrating that interactions were challenging when: (i) medical information (PCOS, its management) was not shared in the best way; (ii) information provision and deliberation opportunities were insufficient to achieve outcomes that mattered to patients; (iii) interactions prompted but did not support patient activation; and (iv) health system-level barriers (e.g. policies and guidelines) were present or made worse by HCP behaviour. Future research should examine methods for the implementation and evaluation of established frameworks for sharing medical information and supporting patient agency in the context of PCOS care.

Exploring the Experiential Journey of Women with PCOS Across the Lifespan: A Qualitative Inquiry

Introduction

Peri-postmenopausal women with the chronic condition polycystic ovary syndrome (PCOS) remain at cardiometabolic risk and/or subsist with established comorbidity while continuing to manage persistent PCOS signs and symptoms, such as hirsutism. Thus, PCOS transcends the reproductive years, yet there is sparse scientific literature on the peri-postmenopausal years of women with PCOS.

Purpose

To explore how peri-postmenopausal women's perceptions about PCOS have changed over the lifespan since their PCOS diagnosis.

Methods

A cross-sectional survey with one qualitative question was conducted via Research Electronic Data Capture (REDCap) among women with PCOS aged ≥43 years, who were all recruited from PCOS-specific Facebook pages. Of the 107 women completing the survey, 72 substantively answered the qualitative question. The qualitative responses were analyzed using the steps of reflexive thematic analysis. Themes were interpreted and discussed through the lens of the bioecological conceptual model.

Results

Respondents were 47.6 (±4.1) years of age, primarily White (87.5%), employed full time (65.3%), and married (75%) with children (68%). Four overall themes were identified: 1) dismissal 2) information desert, 3) PCOS experience over the lifespan, and 4) mindset.

Conclusion

The study findings illustrated the unique healthcare needs among peri-postmenopausal women with PCOS. Further research is needed to further explore their healthcare concerns and psychosocial needs followed by studies that develop and assess interventions that promote symptom and adaptive coping strategies across their lifespan.

The effectiveness of psychological interventions for reducing poor body image in endometriosis, PCOS and other gynaecological conditions: a systematic review and meta-analysis

Gynaecological conditions (e.g., endometriosis, PCOS) result in bodily changes that negatively impact body image. Psychological interventions (e.g., CBT, psychoeducation) have shown promise in reviews with the general population for alleviating body image concerns. This systematic review and meta-analysis aims to provide asynthesis of the impact of psychological interventions for reducing body image concerns for individuals with gynaecological conditions. Electronic databases were searched for relevant psychological intervention studies with body image outcomes. Twenty-one eligible studies were included in the systematic review (ten were included in a random-effects meta-analysis). Studies included participants (N = 1483, M = 71.85, SD = 52.79) with a range of gynaecological conditions, ages (Mage = 35.08, SD = 12.17) and cultural backgrounds. Most included studies reported at least one positive effect with the meta-analysis indicating psychological interventions were moderately superior to control conditions for reducing body image concerns (SMD -.41, 95% CI [-0.20 -0.62]). However, there was a high risk of bias and moderate heterogeneity. Results suggest psychological interventions may hold promise for reducing body image concerns among individuals gynaecological conditions in the short term. Further, preliminary support was found for the use of theory-guided psychological interventions delivered in group settings in particular, with further research needed on optimal intervention length and particular psychotherapeutic approach.

Developing a Novel Web-Based Self-Management Support Intervention for Polycystic Ovary Syndrome: Mixed Methods Study With Patients and Health Care Professionals

BACKGROUND

Polycystic ovary syndrome (PCOS) represents a significant global health burden requiring urgent attention. This common chronic endocrine and cardiometabolic condition affects around 1 in 10 women and individuals assigned female at birth, with significant adverse effects on well-being, quality of life, and mental health, as well as serious and complex long-term health consequences. International guidelines for best health care practice recommend the provision of comprehensive cognitive behavioral interventions to support self-management and improve health outcomes for those living with PCOS. Web-based health interventions have the potential to meet this need in an accessible and scalable way.

OBJECTIVE

We aim to identify barriers to self-management and psychological well-being in women with PCOS and adapt a web-based self-management program to provide a prototype digital support intervention for them.

METHODS

We adapted an existing support program (HOPE) for PCOS using the antecedent target measure approach. We conducted qualitative interviews with 13 adult women living with PCOS, 3 trustees of a patients with PCOS advocacy charity, and 4 endocrinologists to identify "antecedents" (barriers) to self-management and psychological well-being. Framework analysis was used to identify potentially modifiable antecedents to be targeted by the novel intervention. At a national conference, 58 key stakeholders (patients and health professionals) voted for the antecedents they felt were most important to address. We used research evidence and relevant theory to design a prototype for the PCOS intervention.

RESULTS

Voting identified 32 potentially modifiable antecedents, relating to knowledge, understanding, emotions, motivation, and behaviors, as priorities to be targeted in the new intervention. A modular, web-based prototype HOPE PCOS intervention was developed to address these, covering six broad topic areas (instilling HOPE for PCOS; managing the stress of PCOS; feeding your mind and body well; body image, intimacy, and close relationships; staying healthy with PCOS; and keeping PCOS in its place).

CONCLUSIONS

We identified barriers to self-management and psychological well-being in women with PCOS and used these to adapt a web-based self-management program, tailoring it for PCOS, which is a comprehensive group intervention combining education, empowerment, lifestyle management, peer support with cognitive behavioral tools, and goal-setting (to be delivered by peers or codelivered with health care professionals). The modular structure offers flexibility to adapt the program further as new clinical recommendations emerge. The intervention has the potential to be delivered, evaluated for feasibility, and, if effective, integrated into health care services. Self-management interventions are not designed to replace clinical care; rather, they serve as an additional source of support. The HOPE PCOS program conveys this message in its content and activities. Future research should evaluate the prototype intervention using primary outcomes such as measures of psychological well-being, self-management self-efficacy, depression, anxiety, and PCOS-related quality of life. They should also assess the intervention's acceptability, scalability, and cost-effectiveness.

A Review on Acupuncture Efficiency in Human Polycystic Ovary/Ovarian Syndrome

Objectives

Human Polycystic Ovary/Ovarian Syndrome (PCOS), a frequent endocrine pathophysiology among women of fertile age, is associated with woman's lifespan endocrine, metabolic and psychological implications. Long-term usage side effects of allopathic strategies and their low efficacy made complementary medicine treatments a relevant subject for these patients. The main aim of this work is to review the efficiency of the acupuncture treatment reported in the latest studies on literature regarding PCOS patients.

Methods

A comprehensive literature search, in English language, about the use of acupuncture on the management of PCOS, was conducted in October 2020 using EBSCO, Cochrane, PubMed, Medline, Embase, databases for randomised and non-randomised controlled trials between 2015 and 2020 (09/2015-10/2020), following the PRISMA protocol.

Results

This research led us to an analysis, according to PICOS, of six final papers selected among 178 in total. The articles addressed distinct aspects of the PCOS condition, diverse acupuncture techniques and different main and secondary outcomes in agreement to the respective main objective. According to this review, acupuncture seems to be useful for the treatment of this debilitating and chronic health condition which affects millions of women worldwide, many of them part of the workforce in their community.

Conclusion

Despite of the display of these positive results addressing acupuncture treatments to manage PCOS major symptoms - whether they are reproductive, metabolic, or mental health features - more research is urgent. Randomized, double blinded controlled trials with improved quality design and following STRICTA and/or CONSORT recommendations are necessary to engage acupuncture as a standardized and scientific validated technique in PCOS condition.

The Psychosocial Impact of Polycystic Ovary Syndrome

Polycystic ovary syndrome is a common endocrine disorder affecting 5–20% of women in association with metabolic disorders and insulin resistance. Patients with PCOS are also at increased risk of developing cardiovascular sound aspects of polycystic ovaries and metabolic complications, a psychosocial impact that exists, which is poorly known, assessed and treated. The delay, sometimes long, for diagnosis and its announcement has a strong impact on the feelings and life projects of these patients. Psychological co-morbidities such as depression, anxiety, eating disorders as well as a decrease in self-esteem and quality of life are frequently described in these patients and must, therefore, be screened and treated.

The double-edged sword of PCOS and gender: exploring gender-diverse experiences of polycystic ovary syndrome

Background: Past research on polycystic ovary syndrome (PCOS), a chronic endocrine condition, has focused on the experiences of cisgender women. Aims: The purpose of the present study was to address the knowledge gap about gender-diverse individuals by exploring their lived experiences with PCOS and to better understand if and how their gender identity affected their experience of PCOS. Methods: To explore this, we recruited nine non-binary people and one transgender man with a PCOS diagnosis for qualitative interviews. Results: Three overarching themes emerged: PCOS as a burden, PCOS as an occasion, and PCOS as a benefit. While some aspects of PCOS created an additional burden for our participants, other symptoms such as excess body and facial hair could be empowering and affirming, revealing a positive aspect of this chronic condition. Conclusion: This study is the first to describe the lived experiences of gender-diverse individuals with PCOS, uncovering burdens as well as some benefits. Future research in this population may reveal not only the particulars of what PCOS is like for them but also more generalizable insights into the highly gendered perception and treatment of PCOS.

Bridging the Information Gap in Polycystic Ovary Syndrome: A Narrative Review with Systematic Approach

Polycystic ovary syndrome (PCOS) is a complex endocrinopathy with wide-ranging implications for affected individuals. Literature has shown that patients with PCOS are dissatisfied with the health information provided to them and that healthcare professionals lack adequate knowledge. In this narrative review with systematic approach, we explored the unmet information needs in PCOS care for both patients and healthcare professionals. A comprehensive search of databases yielded 41 relevant studies, predominantly of observational and qualitative design. Adults and adolescents with PCOS desire wide ranging health information and express a keen desire for weight management guidance. Importantly, discussions surrounding weight should be addressed knowledgeably and without weight bias. Therefore, healthcare professionals should facilitate access to comprehensive evidence-based resources. Lack of information drives PCOS-related online searches. Referral to support groups that promote individual agency in the self-management aspects of PCOS can furthermore guide patient resource acquisition. Patients prefer guidance from professionals that understand the psychosocial complexity of PCOS and can empathize with experiences of stigmatization or even marginalization depending on the cultural context of the individual. The findings informed the 2023 International Evidence-Based PCOS Guideline, recommending patient-centered communication, evidence-based information resources, and culturally sensitive approaches to optimize PCOS care.

Capability, Opportunity, and Motivation-Identifying Constructs for Increasing Physical Activity Behaviours in Women with Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is the commonest endocrinopathy in reproductive-aged women. Because increased adiposity is pivotal in the severity of PCOS-related symptoms, treatment usually incorporates increasing energy expenditure through physical activity (PA). This study aimed to understand the reasons why women with PCOS engage in PA/exercise, which could support the development of targeted behavioural interventions in this at-risk population. Validated questionnaires were administered for self-reported PA levels, quality of life, mental health, illness perception, sleep quality, and capability, opportunity, and motivation (COM) for PA. Using categorical PA data, outcomes were compared between groups; ordinal logistic regression (OLR) was used to identify whether COM could explain PA categorisation. A total of 333 participants were eligible; favourable differences were reported for body mass index, depression, mental wellbeing, self-rated health, illness perception, and insomnia severity for those reporting the highest PA levels. COM scores increased according to PA categorisation, whilst OLR identified conscious and automatic motivation as explaining the largest PA variance. The most active participants reported favourable data for most outcomes. However, determining whether health is protected by higher PA or ill health is a barrier to PA was not possible. These findings suggest that future behavioural interventions should be targeted at increasing patient motivation.

Development of the First Health-Related Quality of Life Questionnaires in Arabic for Women With Polycystic Ovary Syndrome (Part III): Scoring System Interpretation

BACKGROUND

Our team developed the first highly reliable, validated, easily comprehensible, and self-administered polycystic ovary syndrome quality of life (PCOSQOL)-42 and PCOSQOL-47 questionnaires for unmarried and married women with polycystic ovary syndrome (PCOS), respectively. Using such scales needs a scoring system that covers the responses to each item per domain and overcomes the missing responses. we developed a scoring system for PCOSQOL-42 and PCOSQOL-47 to interpret the items' responses at any similar population.

METHODS

The scoring was inspired by the 5-point Likert scale that was used during the creation of PCOSQOL-42 and PCOSQOL-47, where each item represents the woman's experience in the last two weeks before seeking consultation, i.e., Never=5 or no effect, on the health-related quality of life (HRQOL), (Seldom=4), (Quite often=3), (Very often=2), and (Always=1 or the maximal effect on the QOL). The sum of the total points in each item per domain was evaluated. Then we divided the results by the number of the items that had been scored only to get the final domain score as a (mean ± SD). The ultimate or final score per the questionnaire was gained from the sum of individual domain scores divided by the number of domains that had been evaluated. Ultimately, the first interval values (from 1 to < 3 points) represent marked effects on HRQOL; second interval values (from 3 to < 4 points) represent the marginal effect on HRQOL; third interval values (from 4 to < 5 points) represent the minimal effect on HRQOL; fourth interval (5 points) represents no effect on HRQOL.

RESULTS

The lower the score, the greater the negative impact on HRQOL. Although all domains in both questionnaires showed a marked reduction in HRQOL, women in either cohort were more concerned with their body image dissatisfaction and psychological distress induced by PCOS than their reproductive concerns. The mean score calculated for the questionnaire had a greater negative impact than the emotions subscale and was similar to the subscale for infertility. All mean points per item and domain values indicate a marked effect (< 3 points) on QOL using PCOSQOL-42 and PCOSQOL-47. All values referred to a marked reduction in PCOSQOL-47 points, whether item or domain-wise.

CONCLUSIONS

The current scoring system provides an easy way to interpret the responses in both questionnaires and overcome the missing responses in any item per domain. There was a marked impact on all domains of HRQOL using both questionnaires, with a special impact on body image and psychological concerns. The responses of women in either cohort to the sexual and reproductive items were extremely high, reflecting the scope of this problem in the life of women with PCOS.

Features of dynamics of identity in women with polycystic ovarian syndrome and their socio-demographic determinants

With a significant prevalence of polycystic ovary syndrome (PCOS), the question of its impact on the identity of women, the specifics of such identity, as well as its dynamics remain debatable.The aim. To study the features of identity dynamics in women with PCOS and the socio-demographic factors that determine these features.Research methods. A retrospective cohort study was conducted using the SEI-test methods and the Russian language versions of the Life Line, Twenty Statements Test methods on a sample of 110 women of reproductive age (58 women with PCOS, 52 women without PCOS; two surveys during the year).Results. Had been shown that women diagnosed with PCOS show fewer signs of an identity crisis than women without such diagnosis, but their identity is more variable. Such women are less likely to characterize themselves with the help of concepts related to gender and family spheres in favor of personality traits. An analysis of the influence of socio-demographic factors showed that their identity determines a greater number of external factors than in women without PCOS. The ego-identity of such women depends on marital status and place of residence.Conclusion. The identity of women diagnosed with PCOS is more variable, but shows fewer signs of a crisis. It seems necessary to take into account the presence or absence of children when planning further research. The results obtained can be used in the consultation of women with PCOS.

Polycystic Ovary Syndrome (PCOS) and Non-Suicidal Self-Injury (NSSI): A Community-Based Study

Polycystic Ovary Syndrome (PCOS) is an endocrine condition that has been associated with atypical emotional regulation strategy use as well as elevated levels of depression, anxiety, self-harm and suicidal ideation. Despite the existence of clinical screening guidance for this population, there is still little to no understanding of how non-suicidal self-injury and suicidal ideation and intention manifest in women with PCOS and how this might differ from women without PCOS. Within this cross-sectional investigation, women with and without a diagnosis of PCOS (n = 418) completed validated metrics of emotion dysregulation, rumination and non-suicidal self-injury (NSSI), as well as self-reported indices of previous suicidal ideation and future suicidal intention. Group comparisons indicated that women with, relative to those without, PCOS reported significantly greater metrics across all variables. Moreover, serial mediation analyses were conducted to test the ideation-to-action framework of suicide in women with PCOS, with the positive relationship between a PCOS diagnosis and future suicidal intention being explained through the indirect pathway of increased emotion dysregulation, recent suicidal ideation and NSSI. Our findings call to action the need for international screening for suicide intention and self-harm in women with PCOS.

'I'm usually being my own doctor': women's experiences of managing polycystic ovary syndrome in Canada

BACKGROUND

Polycystic ovary syndrome (PCOS) is a complex, chronic condition characterized by anovulation, polycystic ovarian morphology and hyperandrogenism that requires lifelong management. To reduce the risk of comorbidity and to manage symptoms, lifestyle management and pharmaceuticals such as oral contraceptives are the most common forms of treatment and should be tailored to the individual patient. The literature to date has shown PCOS patients to experience widespread dissatisfaction with the amount and quality of information they receive from providers, along with lower levels of trust in physicians. Little is known about the lived experiences of women managing PCOS in Canada, across age groups.

METHODS

In-depth remote interviews explored women's lived experiences managing PCOS and the barriers and facilitators they encountered in their management journeys. Data were analyzed using thematic analysis and interpretive description methodology.

RESULTS

Twenty-five in-depth, telephone interviews conducted with participants (aged 18-63 y) across Canada revealed participants lacking sufficient information and guidance from physicians, especially in primary care. Areas in need of more guidance included lifestyle management and mental health. Lack of empathy and weight bias among physicians were also perceived by participants. Older participants received little guidance on treatment options postmenopause. Loss of trust and withdrawal from seeking medical care were prominent themes, along with greater self-reliance on self-management, including self-educating and self-experimenting with treatments.

CONCLUSIONS

Most women in this study were frustrated with the level of involvement and information provision from their doctors. Key recommendations are identified for the provision of care to younger and older patients with PCOS. Improved education for physicians may be needed to improve the quality of healthcare provision for PCOS.

What can be done to improve polycystic ovary syndrome (PCOS) healthcare? Insights from semi-structured interviews with women in Canada

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common and perplexing condition affecting metabolic, reproductive, cardiovascular, and psychological health in women. Previous studies point to widespread dissatisfaction and frustration in women with the information and care they receive. Studies have found delays with the diagnosis of PCOS and gaps in knowledge in physicians regarding the diagnosis and management of PCOS. Little has been heard from women on what they think can be improved with PCOS care, especially in Canada. This qualitative study explores women's experiences navigating the healthcare system and their insights on what could be improved based on their lived experiences.

METHODS

Twenty-five participants were interviewed remotely over the phone by the first author between October and December 2018.Interviews were semi-structured and in-depth. Data were analyzed using thematic analysis and interpretive description methodology.

RESULTS

Twenty-five in-depth interviews conducted with participants across Canada (ages 18-63) revealed three overall areas in need of improvement. First, women emphasized a need for greater knowledge and awareness of PCOS in primary care physicians (PCPs) as well as the need for the medical community to prioritize women's health. Second, participants advocated for greater PCOS awareness and de-stigmatization in the general community and in women and girls, and any individuals with female reproductive systems. Third, participants brought up several needed resources, such as the need for more PCOS research to be funded and undertaken, more PCOS specialists and experts to be available, credible doctor-provided information (e.g., pamphlets, websites), and age-specific support groups and mental health supports to be available. Participants were generally unaware of existing PCOS organizations and brought up the need for established PCOS organizations to aid in the training and retraining of doctors and local awareness-building in communities.

CONCLUSIONS

Participants believed that PCPs in Canada needed to be well-versed on how to diagnose and manage PCOS to prevent delays in diagnosis and provide easier access to care. Further, greater awareness and de-stigmatization in the general community are needed so women can identify symptoms early and have access to support from those around them. Overall, PCOS may be an overlooked and under-prioritized condition, both in the Canadian healthcare system and general community.

Mental Health and PCOS Information-Sharing: Interviews with Health Care Providers in a Low-Income Urban Community

Polycystic ovary syndrome (PCOS) is a female metabolic-endocrine disorder typically characterized by menstrual dysfunction, hyperandrogenism, and/or polycystic ovaries. While comorbidity with poor mental health is often observed, it is less understood if women of color are given information on PCOS, mental health, or both by healthcare providers. This paper examines the information-sharing practices of healthcare providers serving a low-income, predominantly Latino/Hispanic municipality in Southeast Los Angeles, CA. Of 65 providers identified across 27 clinics in the service area, four participated in one-on-one semi-structured interviews. Four themes relating to PCOS and mental health information were identified using content analysis. Results suggest that information-sharing on PCOS is limited to symptomatic patients and varies by provider specialization. Poor mental health as a side effect of PCOS is not elaborated on during patient-provider interactions within the explored service area. Implications and directions for further research are discussed, including mixed methods approaches for contextual information on PCOS among women of color and recommendations for improving communication among healthcare providers.

"I felt like she didn't take me seriously": a multi-methods study examining patient satisfaction and experiences with polycystic ovary syndrome (PCOS) in Canada

Background

Polycystic ovary syndrome (PCOS) is a common and complex condition affecting metabolic, reproductive, cardiovascular, and psychological health in women. Previous studies point to widespread dissatisfaction and delays with the diagnosis of PCOS and a lack of information provision by doctors, with few studies on Canadian populations. This multi-methods study explored the perceptions and experiences of PCOS diagnosis in Canada using an online-distributed survey and follow-up, in-depth, semi-structured phone interviews.

Methods

The online questionnaire was completed by 296 women aged 18–60 with a self-reported diagnosis of PCOS. The survey measured time to diagnosis, number of doctors seen, and information provided. Descriptive statistics, Chi-square tests, Fisher’s exact tests, and Spearman’s rank correlations were used to analyze the sample characteristics and correlations between the demographic factors and the outcome measures. Twenty-five follow-up interviews were held over the phone and analyzed using thematic analysis and interpretive description methodology.

Results

Survey respondents were dissatisfied with the information provided about PCOS (66%), lifestyle management (34%), and medical therapy (38%) at the time of diagnosis. Approximately 34% of respondents waited for more than 2 years and 41% saw 3 or more doctors before attaining diagnosis. Many did not receive any information about lifestyle management (42%) or medical therapy (28%). Interview participants encountered doctors who lacked sufficient knowledge on PCOS to diagnose, chronically dismissed concerns, and did not provide necessary medical information about the condition. Women described benefitting from self-advocation to receive the care they needed from doctors, and self-educating about PCOS using materials they could find online. Younger interview participants whose symptoms began in adolescence would often not understand the significance of symptoms until much later in life, contributing to delayed diagnoses.

Conclusions

Greater education on PCOS for physicians, particularly in primary care, is needed to prevent delayed diagnoses and ensure that patients are provided with reliable medical information about their condition. Greater awareness of PCOS may be necessary for the general population to help women identify symptoms, especially for adolescents and their parental figures.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01630-3.

Sleep Disruption and Depression, Stress and Anxiety Levels in Women With Polycystic Ovary Syndrome (PCOS) During the Lockdown Measures for COVID-19 in the UK

Background: Lockdown measures have been enforced globally in response to the COVID-19 pandemic. Given the comorbidity burden in women with polycystic ovary syndrome (PCOS), these lockdown measures may have a particularly negative impact on sleep health, quality of life (QoL), and depression/stress levels in this population. The aim of this study was to explore whether such potential problems were present in women with PCOS during the COVID-19 lockdown in the UK. Methods: UK women with PCOS were recruited through social media into a cross-sectional study during the COVID-19 lockdown. The study survey was delivered online, and included demographic and COVID-19 relevant questions, as well as validated questionnaires/scales, namely the Insomnia Severity Index (ISI), Depression Anxiety and Stress Scale (DASS-21), and PCOSQOL questionnaire. Results: Three hundred and thirty-three women with PCOS [median age: 30.0 (9.0) years] were recruited. Participants were dichotomized based on responses regarding the impact of COVID-19 restrictions on their sleep [negative (N = 242) vs. no/positive (N = 91) impact]. No differences were noted between groups regarding age, time since PCOS diagnosis, body mass index, or number of comorbidities. Based on the ISI, 44.2% of participants reporting a negative impact on sleep exhibited at least moderately severe clinical insomnia. Compared to those who reported no/positive effect on sleep, the participants reporting a negative impact on sleep also reported poorer QoL, based on the total PCOSQOL score, with a greater impact of PCOS and poorer mood in the corresponding PCOSQOL domains. Based on the DASS-21, the latter also had statistically higher depression and stress levels compared to the former. Finally, for this cohort significant inverse correlations were noted between the ISI and PCOSQOL scores (total and domain scores), whilst the DASS-21 and ISI scores were positively correlated (all p-values <0.001). Conclusion: The majority of recruited UK women with PCOS reported that the COVID-19 lockdown had a negative impact on their sleep, which was also associated with impaired QoL and higher depression/stress levels. Whilst further research is required, women with PCOS should be considered a vulnerable population that may experience an adverse impact on sleep, QoL and mental health well-being due to lockdown measures during the COVID-19 pandemic.

Médicalisation et autonomie des femmes affectées par le syndrome des ovaires polykystiques

Le syndrome des ovaires polykystiques (SOPK) est un trouble endocrinien répandu qui affecte environ 10% des femmes en âge de procréer. Bien qu’il soit principalement connu pour ses effets sur la fertilité, le SOPK est considéré comme un facteur de risque pouvant mener au diabète de type 2. Il est également associé à des conditions comme les cancers hormono-dépendants, les troubles psychiatriques ou encore les maladies cardio-vasculaires. La volonté de prévenir les conditions associées pourrait pousser à une plus grande médicalisation des femmes atteintes par le SOPK, notamment par d’éventuels dépistages. Cet article examine les facteurs potentiels pouvant contribuer à la médicalisation de ces femmes et la manière dont leur autonomie pourrait être affectée par ce phénomène. Entre autres, l’article met en évidence comment la médicalisation façonne des représentations collectives et individuelles par rapport aux notions de santé, de maladie et de traitement. Dans une perspective relationnelle de l’autonomie, il attire l’attention sur l’importance de reconnaitre comment la médicalisation influence ces représentations et l’impact potentiel que cela pourrait avoir sur les femmes. Encourager la démédicalisation du SOPK par une approche visant à soutenir la santé pousse à interroger ces représentations et fait partie des pistes de solution permettant de favoriser l’autonomie des femmes affectées par le SOPK. Il devient alors possible non seulement de contrôler la maladie, mais aussi de soutenir la santé, voire de faire les deux selon la situation individuelle.

Implementation of the polycystic ovary syndrome guidelines: A mixed method study to inform the design and delivery of a lifestyle management program for women with polycystic ovary syndrome

AIM

The 2018 evidence-based polycystic ovary syndrome (PCOS) guidelines recommend lifestyle management as first-line treatment. This study aims to understand the preferred intervention characteristics of a PCOS lifestyle program from the perspectives of women with PCOS to inform the translation of the guidelines into practice.

METHODS

Women with self-reported PCOS residing in Australia took part in semi-structured interviews (n = 20) and an online survey (n = 286). The survey and interview schedule were developed using the template for intervention description and replication checklist.

RESULTS

Women want to take part in a lifestyle program (94.6%) and use government-subsidised sessions to attend (83%). Sessions of 45 to 60 minutes (75%) costing less than AUD$50 are preferred (60%). Topics of most interest related to sustainable daily physical activity (58%), overcoming non-hungry eating (54%), PCOS-specific diets (51%) and how to overcome barriers to behaviour change (45%). A delivery mode that combines online and in-person support is preferred (53%). Women are in need of long-term professional lifestyle support (6-12 months) that provides evidence-based, PCOS-specific, personalised prescription. Multidisciplinary support from a range of PCOS-trained professions is also preferred to address women's physical, psychological and emotional needs.

CONCLUSION

Women with PCOS are willing to take part in lifestyle programs that are low cost, long term, evidence based, PCOS-specific and provide practical strategies for nutrition and physical activity changes. Future online and in-person PCOS programs are strongly recommended to incorporate these findings to improve program engagement and patient satisfaction.

"The whole package deal": experiences of overweight/obese women living with polycystic ovary syndrome

BACKGROUND

Polycystic Ovary Syndrome (PCOS) is a common female reproductive disorder with multiple manifestations. There are relatively few qualitative studies exploring the nature of living with PCOS despite its high prevalence. Qualitative research can enhance clinical practice via the provision of patient insights into the experience of living with their condition.

METHODS

We conducted two focus groups and three semi-structured interviews of Australian overweight/obese women with PCOS aged 18-46 years between March and April 2017 who were recruited through social media advertising. Interviews and focus groups were audio recorded and transcribed verbatim. Thematic analysis was applied to the data, using the method of constant comparison.

RESULTS

Ten women contributed data from two focus groups and two semi-structured interviews. Five themes emerged from the data: complexity of the condition with its multiple manifestations, difficulties with delayed diagnosis and lack of information provided after diagnosis, negative experiences on social media and online forums and the need for support, frustration over lack of a "cure"; and the impact of symptoms and concern about long-term sequelae.

CONCLUSIONS

Living with PCOS appears to generate a significant degree of anxiety about the future, dissatisfaction with current treatment models, and loss of feminine identity. Gaps in timely diagnosis, information and support provision need to be addressed. This includes supporting weight management as a fundamental concern for women with PCOS.

Evaluation of women knowledge and perception about polycystic ovary syndrome and its management in Jordan: A survey-based study

OBJECTIVES

Polycystic ovary syndrome (PCOS) is a common metabolic and endocrine disorder in females in their reproductive-age and is associated with clinical complications. The aim of this study was to evaluate the knowledge and perception of women in Jordan about PCOS, its symptoms, diagnosis and treatment.

METHODS

A descriptive, cross-sectional study that was designed in order to assess female knowledge, and perceptions about PCOS in Jordan. The study was carried out through a validated questionnaire and 227 was the number of recruited female participants.

RESULTS

The result showed that the participants had inadequate knowledge about PCOS. The major sources of information were physician and family (n = 77, 34%), 205 participants were aware that irregular or absence of menstrual cycle is a symptom of PCOS (90.3%). More than half of participants (55.9%) believe that PCOS patients have low body image. The educational level and marital status factors were significantly associated with participants' knowledge about PCOS (P-value = .008 and .004, respectively).

CONCLUSION

The result of this study concluded that women have insufficient knowledge about PCOS and its complication. There is a need to enhance the knowledge and perception in female population in Jordan by developing education using different sources.

Women with Polycystic Ovary Syndrome: A Marginalized Population in the United States

The National Institutes of Health has identified polycystic ovary syndrome (PCOS) as a major public health problem for women in the United States and recommends establishing multidisciplinary programs to improve the awareness of the public and health care providers regarding management for women with PCOS. This article argues that individuals with PCOS are marginalized due to the syndrome's misleading name; its underrepresentation in research; lack of culturally and gender-sensitive standards of care; debates about the contraceptive mandate; and stigmatization due to symptoms that do not conform to dominant social constructs of beauty, femininity, and womanhood. The article directs readers to key publications on the assessment and treatment of patients with PCOS, discusses a case study that illustrates the role of a social worker in treating an adolescent with PCOS as part of a multidisciplinary team, and emphasizes the importance of integrating behavioral health in the treatment of patients with PCOS.

Body image, personality profiles and alexithymia in patients with polycystic ovary syndrome (PCOS)

Aim: Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic disorder. It affects women's physical well-being and leads to great psychological distress. Indeed, women with PCOS show a compromised quality of life as well as impaired emotional well-being. The aim of this study is to assess personality characteristics, body image and alexithymia in women with PCOS. Materials and methods: A total of 59 women with PCOS and 38 healthy controls were administered the Toronto Alexithymia Scale (TAS), the Body Uneasiness Test (BUT) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Results: The PCOS group showed higher values of alexithymia and a higher body uneasiness. They also showed higher values on many clinical, content and supplementary scales of the MMPI-2. Discussion: It seems that physical appearance and bodily function have a central place in the minds of women with PCOS, as well as in their relationships. However, it is a body they find it hard to feel and with which they mostly feel uncomfortable. Their approach to the outside world seems to be characterized by a certain degree of immaturity, anger, hostility and distrust. Low self-esteem also seems to be connected to a certain tendency toward introversion and withdrawal. This leads to problems in social, professional and intimate relationships.

Threats to Feminine Identity as the Main Concern of Iranian Adolescents with Polycystic Ovary Syndrome: A Qualitative Study

PURPOSE

Polycystic Ovary Syndrome (PCOS) is a prevalent hormonal disorder in adolescents; this study seeks to elaborate the main concerns of adolescents with PCOS.

DESIGN AND METHODS

This qualitative content analysis was conducted on 15 adolescents with PCOS using purposive sampling in 2018. Semi-structured in-depth interviews were held for data collection, and data saturation occurred when no new data were being obtained. Data were analyzed concurrently with data collection.

RESULTS

Fifteen adolescents with PCOS aged 13-19 years were enrolled into the study. Thirteen were single and two were married. The data analysis led to the extraction of "threats to feminine identity" as the main theme of this research, which was then divided into two categories: 1) concerns about attractiveness, with subcategories including fashion-related stress and the loss of physical beauty 2) concerns about femininity, with subcategories including the underlying issues of worrying about future marriage prospects, anxiety about infertility in the future and stress about menstrual abnormalities.

CONCLUSION

According to the results of this study, attractiveness and threat to femininity is the main concern of adolescents with PCOS that should be further considered in the management of their treatment.

IMPLICATIONS FOR PRACTICE

Understanding the main concerns of adolescents with PCOS can help healthcare professionals better manage this disease in this population subgroup.

The benefits and harms of receiving a polycystic ovary syndrome diagnosis: a qualitative study of women's experiences

STUDY QUESTION

What are the benefits and harms of receiving a polycystic ovary syndrome (PCOS) diagnosis in a community sample of women, including impact on psychosocial wellbeing, lifestyle choices and behaviour?

SUMMARY ANSWER

Although some women benefit considerably from the diagnosis, such as through increased awareness and reassurance, women with minimal symptoms may experience more harm than benefit, including long-lasting anxiety and altered life plans.

WHAT IS KNOWN ALREADY

Disease labels can validate symptoms and play a vital role in understanding and coping with illness; however, they can also cause harm by evoking illness schemas about severity and permanence. Regarding PCOS, the diagnostic criteria have expanded over time to include women with milder phenotypes (such as those without signs of androgen excess). This has occurred despite limited investigation of the benefits and harms of the diagnosis and has increased the number of women diagnosed.

STUDY DESIGN SIZE DURATION

Semi-structured interviews were conducted face-to-face or by telephone with 26 participants from April-July 2018 to explore women's experiences with the diagnosis, including the benefits and harms of receiving the diagnosis and the impact on their life.

PARTICIPANTS/MATERIALS SETTING METHODS

In total, 26 women in the community self-reporting a diagnosis of PCOS (reporting mild to severe symptoms) made by a medical doctor, aged 18-45 years and living in Australia were recruited through social media. Data were analysed thematically using Framework analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

The study identified a range of both positive and negative effects of a PCOS diagnosis in the immediate, short and long-term, which were influenced by symptom severity, expectations and experience. For women with previously unexplained and bothersome symptoms, it was a relief to receive a diagnosis, and this resulted in an increased understanding about the importance of a healthy lifestyle. By contrast, women with milder symptoms often reported feeling shocked and overwhelmed by the diagnosis, consequently experiencing anxiety about the associated long-term risks. The majority of women, regardless of symptom severity, experienced prolonged worry and anxiety about infertility, resulting for some in risk taking with contraception, unintended pregnancies, pressure to conceive early or altered life plans. With time, many women developed positive coping strategies and perceived the diagnosis to be valuable, including those who felt they had experienced minimal benefit or even harm.

LIMITATIONS REASONS FOR CAUTION

PCOS diagnosis was self-reported and the sample was highly educated.

WIDER IMPLICATIONS OF THE FINDINGS

Fear of infertility was salient for many women, underscoring the need for accurate information, counselling and reassurance of fertility potential. Given the risk of significant consequences, health professionals should use a tailored approach to PCOS diagnosis to increase the benefits of appropriate and timely diagnosis for women affected by significant symptoms, while reducing the harms of unnecessarily labelling healthy women for whom the benefits of a diagnosis are small.

STUDY FUNDING/COMPETING INTERESTS

The study was funded by the University of Sydney Lifespan Research Network and an NHMRC Program Grant (APP1113532). B.W.M. reports consultancy for ObsEva, Merck, Merck KGaA and Guerbet. No further competing interests exist.

TRIAL REGISTRATION NUMBER

N/A.

'I drew the parts of my body in proportion to how much PCOS ruined them': Experiences of polycystic ovary syndrome through drawings

Polycystic ovary syndrome is a chronic endocrine disorder associated with persistent physical symptoms and psychological and lifestyle repercussions. Eighty-nine participants (83 females, 6 non-binary) aged 19-43 years described their experiences of polycystic ovary syndrome through drawings and personal accounts. Four descriptive themes were identified: awareness of visible and invisible symptoms, misshapen self and body, limitations and barriers and resignation. Taken together, participants described a condition with all-encompassing effects: much more than symptom management alone. Findings support the use of drawings as an appropriate method with this population and suggest continuing need for supports for individuals with polycystic ovary syndrome.

Medical conditions, pregnancy perspectives and contraceptive decision-making among young people: an exploratory, qualitative analysis

OBJECTIVE

To explore perspectives on family planning among young people who perceive they are infertile or will have difficulty carrying a pregnancy to term owing to medical conditions or procedures.

METHODS

This exploratory analysis examined pregnancy plans and contraceptive behavior among 12 young adults with a diagnosed medical condition or who had undergone a medical procedure associated with impaired fertility, and who had discussed fertility with a healthcare provider. We utilized data from a larger study investigating prospective pregnancy intentions and plans among 50 young (ages 18-24) women and their male partners (n=100).

RESULTS

Medical conditions included endometriosis, polycystic ovary syndrome, and lupus. For some, medical conditions/procedures led to use of no or less effective contraception; perceived risk for pregnancy was low, though seven participants had previously experienced pregnancies. Participants also described how medical conditions altered their timelines for pregnancy and overall desire for children; for example, one participant described continuing an unplanned pregnancy because she feared it would be her only chance to parent.

CONCLUSION

This exploratory analysis suggests that among young people, medical issues perceived to affect fertility and pregnancy may influence pregnancy planning and contraceptive behavior. Young people may lack knowledge about fertility and the impact of a medical condition; thus it is critical that providers clarify the difference between anticipated difficulty conceiving and complete infertility. Tailored contraceptive care is needed for young adults with medical conditions that may affect fertility to ensure they have the necessary information to make informed family planning decisions.

IMPLICATIONS

Medical conditions known to affect fertility may influence young people's family planning desires and behaviors. Understanding how young adults process information about medical conditions' impact on their fertility and change or make plans in response is important in order to best meet their family planning needs.

Measures of health-related quality of life in PCOS women: a systematic review

Introduction

Polycystic ovary syndrome (PCOS) is associated with biochemical and hormonal disturbance and adverse cosmetic, reproductive, metabolic, and psychological consequences, resulting in reduced health-related quality of life (HRQoL). Various generic and specific questionnaires have been used for assessing different dimensions of HRQoL in PCOS women. The purpose of this systematic review was to identify those general and specific instruments and to determine the factors that affect HRQoL in PCOS women.

Materials and methods

The research strategy involved general and specific terms in relation to PCOS women and their QoL. A review was performed on studies that were published between 1945 to 2017 and that were indexed in MEDLINE, ISI Web of Science, and Scopus. A narrative synthesis of the data was provided.

Results

In total, 52 studies (9 qualitative and 43 quantitative) were included in the review. The analysis indicated that 3 specific and 5 general instruments were used to measure the QoL in PCOS women. Of these, the 36-Item Short Form Health Survey (SF-36) and the Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (PCOSQ) were used most frequently. All studies assessed different aspects of QoL in PCOS women and found that PCOS had negative effects on QoL in this population.

Conclusion

The PCOSQ and the SF-36 were used most frequently for the assessment of QoL in PCOS women. Perhaps using either a specific questionnaire solely or a specific questionnaire in conjunction with a generic measure would be more appropriate when measuring QoL in PCOS women. However, both questionnaires showed that they are able to capture different aspects of QoL in PCOS women and to identify areas that can help to improve QoL in these women.

The Polycystic Ovary Syndrome Quality of Life scale (PCOSQOL): Development and preliminary validation

Polycystic ovary syndrome is an endocrine disorder amongst women, which can negatively impact quality of life. Research proposes that a more sensitive PCOS quality of life measure is needed. This study aims to develop and initially validate a quality of life scale for women with the condition in the United Kingdom. Women with PCOS (n = 714) took part in the development and initial validation of the 35-item polycystic ovary syndrome quality of life scale (PCOSQOL)(α = .95). Subscales include Impact of PCOS (α = .95), Infertility (α = .95), Hirsutism (α = .97) and Mood (α = .89). The PCOSQOL scale represents aspects of quality of life important to women with PCOS and may be more sensitive for use in the clinical and research settings.

Suitability of the National Health Care Surveys to Examine Behavioral Health Services Associated with Polycystic Ovary Syndrome

The National Institutes of Health, Office of Disease Prevention, has described polycystic ovary syndrome (PCOS) as a major public health problem for women in the USA. This study examines the suitability of the National Health Care Surveys, collected by the Centers for Disease Control and Prevention, to understand patient demographics and behavioral health services associated with PCOS-related medical visits. Data were from the 2005-2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. PCOS-related medical visits were identified using the International Classification of Diseases, 9th Revision, Clinical Modification code 256.4. Items on mental health and health education ordered or provided did not meet the National Center for Health Statistics criteria necessary to produce reliable national estimates (i.e., at least 30 unweighted records and a relative standard error <30%). Findings underscore the need to strengthen national surveillance to further understand behavioral health care for patients with PCOS.

La bioéthique, l’art et le syndrome des ovaires polykystiques : propos impressionniste visant à réhabiliter les corps tabous et les ovaires blâmés

La bioéthique pousse à une prise de responsabilité de l’être humain face aux problèmes qu’il se crée tandis que l’art inspire un réenchantement dans le but de donner un sens différent au monde mécanique et technoscientifique d’aujourd’hui. La santé n’échappe pas à cette vision rigide et les croyances qui y sont reliées sont présentées dans un conte paradigmatique et absurde où la santé devient l’objet de la rationalité instrumentale et scientifique de la biomédecine. Suite à cette contextualisation, il devient plus aisé de comprendre le parcours frustrant décrit par les femmes atteintes du syndrome des ovaires polykystiques (SOPK) dans le contexte de leurs soins. La biomédecine conçoit le SOPK de façon biologique et individuelle oubliant l’apport d’une vision plus globale. À l’opposé de la biomédecine, des approches préventives cherchant l’amélioration de l’état de santé et non le traitement de la maladie, offrent une perspective plus holistique du soin. Dans ce contexte, l’art est conçu comme une façon originale de se souvenir des valeurs oubliées: une plus grande sensibilité et humanité, un rapport à la santé qui est respectueux de la vie, une créativité dans le contexte du soin. La démarche devient un geste moral et beau appelant non plus à lutter contre un mal, mais à prendre soin de la santé dans l’amour et la paix, ouvrant alors de nouvelles possibilités pour améliorer la qualité de vie des femmes concernées et donc produire un plus grand bien.

"Less Than A Wife": A Study of Polycystic Ovary Syndrome Content in Teen and Women's Digital Magazines

BACKGROUND

Polycystic ovary syndrome (PCOS) is a major public health problem that affects women's physical and mental health. According to the US National Institutes of Health Office of Disease Prevention, there is a need to improve public awareness of the syndrome among health care providers and the public. Women's magazines are a type of "edutainment" that publish health content in addition to beauty, fashion, and entertainment content. These media have the potential to expose primarily female readers to content on PCOS and influence readers' beliefs and attitudes about women with PCOS.

OBJECTIVE

The objective of this study was to explore how digital (online) teen and women's magazines portray women with PCOS.

METHODS

We used data from the Alliance for Audited Media to identify popular digital teen and women's magazines with circulation rates ≥1,000,001. We also included magazines with circulation rates 100,001-1,000,000 directed toward racial and ethnic minority readers. A search of magazine websites over a 1-month period in 2015 yielded 21 magazines (eg, Glamour, Cosmopolitan en Español, Essence, and O, The Oprah Magazine) and 170 articles containing "PCOS" and "polycystic ovary syndrome." Textual analysis using a grounded theory approach was used to identify themes.

RESULTS

Articles depicted PCOS symptoms as a hindrance to women's social roles as wives and mothers and largely placed personal responsibility on women to improve their health. To a lesser extent, women were depicted as using their personal experience with PCOS to advocate for women's health. Experiences of Latina and African American women and adolescents with PCOS were absent from women's magazine articles.

CONCLUSIONS

The findings can inform health education programs that teach women to be critical consumers of PCOS-related content in digital women's magazines. Future research on PCOS content in digital teen and women's magazines can help researchers, patients, and consumer groups engage with the media to increase public awareness of PCOS.