International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Chainani EG. Int J Reprod Contracept Obstet Gynecol. 2019 Dec;8(12):4716-4720

www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789

DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20195307
Original Research Article

Awareness of polycystic ovarian syndrome among young women in

Western India
Esha G. Chainani*

Department of Obstetrics and Gynecology, D.Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India

Received: 27 July 2019

Accepted: 25 October 2019

*Correspondence:
Dr. Esha G. Chainani,
E-mail: eshachainani@hotmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Polycystic ovary syndrome (PCOS) is a complex condition characterized by elevated androgen levels,
menstrual irregularities, and/or small cysts on one or both ovaries. It is a common issue affecting more than 7% of
adult women, causing many problems including but not limited to infertility, irregular menses, hirsutism, acne and
alopecia. The primary cause of PCOS is still unknown but awareness and lifestyle modification is known to be an
efficient therapy route to relieve symptoms of this syndrome. Objective of the study was to assess the knowledge
about PCOS in young women in Navi Mumbai, Maharashtra, India.
Methods: A cross sectional study was performed on 500 women of age group 18-30 years coming to outpatient
departments of D. Y. Patil Hospital, Navi Mumbai. Written informed consent was obtained and simple random
technique was applied for selection of study participants. Pre-designed, pre-tested, semi-structured questionnaire was
used for data collection. The data collected was analyzed through percentages and frequencies using Excel. Relevant
statistical test was applied was applied and p value was calculated wherever required and considered statistically
significant when <0.05.
Results: Among 500 participants, only 38% of the women were aware of the term PCOS. 26% of the subjects were
aware about the organ system involved in this disease. Most of the people know about this disorder through friends or
relatives. 17% of the women knew about the various symptoms associated with PCOS.
Conclusions: The alarming results of present study show that very small number of young women understand what
this disease is and thus when to consult a physician. This could be why PCOS is an underrepresented and
underdiagnosed disease. This widely prevalent disease among young women should be talked about more and more
young women must be educated on this to help prevent the sequelae of this syndrome on fertility and insulin
resistance.

Keywords: Awareness, India, Polycystic ovary syndrome, Women

INTRODUCTION limited to infertility, irregular menses, hirsutism, acne

and alopecia.1
Polycystic ovary syndrome (PCOS) is a complex
condition characterized by elevated androgen levels, Changing definitions and a range of symptoms have
menstrual irregularities, and/or small cysts on one or both made the path to diagnosis for many women difficult; up
ovaries. Polycystic ovary syndrome (PCOS) is a common to 70% of women with PCOS in the community remain
condition, present in 12 - 21% of women of reproductive undiagnosed.1 In India, it is much underrepresented
age, depending on the criteria used and the population disease to the common population and not much
assessed causing many problems including but not

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discussed so many women go undiagnosed with multiple increase in a sedentary lifestyle and lack of exercise seem
worrying results. to be major factors leading to this rise. Awareness among
women is also at a low as many women do not seem to
As far as the definition of PCOS goes, the Rotterdam know about this condition and this is found as an
criteria was the most widely accepted across the world incidental finding to infertility and/or irregular menses.
and is the definition used for the guideline. It Adolescents are also showing an increase in incidence of
encompasses the National Institutes of Health definition, PCOS and the belief is that raised awareness can lead to
which generally describes women with a more severe early diagnosis and maybe even prevention of PCOS. 6
form of PCOS and requires the presence of both
hyperandrogenism and oligo/anovulation. The Rotterdam METHODS
Criteria require the presence of two of the following:
oligo/anovulation, hyperandrogenism or polycystic A cross sectional study was performed on 500 women of
ovaries on ultrasound.2 age group 18-30 years coming to Out Patient
Departments of D. Y. Patil Hospital, Navi Mumbai.
Two of the following three criteria are required for Duration of the study was 2 months from Septemer 2018
Rotterdam diagnosis of polycystic ovary syndrome: to November 2018. Written informed consent was
obtained. A simple random sampling method was used to
• Oligo/anovulation pick subjects for the study. Pre-designed, pre-tested,
• Hyperandrogenism semi-structured questionnaire was used for data
• Clinical (hirsutism or less commonly male pattern collection before knowledge awareness intervention.
alopecia) or Incomplete questionnaires were excluded from the study.
• Biochemical (raised FAI or free testosterone) The data collected was analyzed through percentages and
frequencies using Excel. Relevant statistical test was
• Polycystic ovaries on ultrasound
applied was applied and p-value was calculated where
• Other aetiologies must be excluded such as
ever required and considered statistically significant
congenital adrenal hyperplasia, androgen secreting
when <0.05.
tumours, cushing syndrome, thyroid dysfunction
and hyperprolactinaemia.
Inclusion criteria
There is a range of symptoms that women present with
• Women of age group 18-30 years, those who gave
and these can vary with age. Reproductive symptoms
written consent.
predominate in younger women. The prevalence of
metabolic features increases with age but can also occur
in overweight young women. Exclusion criteria

Hyperandrogenaemia and insulin resistance are • Women of age group of less than 18 years and more
pathophysiological features of PCOS. than 30 years.
• Women not giving written consent.
• Hirsutism and male pattern balding consistent with
hyperandrogenism Statistical analysis
• Irregular or absent menstrual cycles
• Subfertility or infertility Relevant statistical test (Chi-square) was applied and p
value was calculated where required and considered
• Psychological symptoms - anxiety, depression,
statistically significant when < 0.05.
psychosexual dysfunction, eating disorders.
RESULTS
Women are at risk if they have a genetic predisposition,
and the onset of symptoms can be triggered by
During the study interval 523 responses to the
environmental factors, particularly obesity. It is important
questionnaire were registered. 20 responses were
to be aware that some population groups have a higher
incomplete and were excluded, 3 responses were
risk of PCOS and different populations may have
excluded due to incomplete consent forms. 37.4% women
predispositions to different symptoms.
were in the age group of 18-24 years and 62.6% women
in the age group of 25-30 years (Table 1).
PCOS appears to be a particularly common endocrine
disorder in the world population under study;
Among 500 participants, only 38% of the women were
furthermore, it is associated with certain metabolic
aware of the term PCOS. 26% of the subjects were aware
abnormalities.3-5
about the organ system involved in this disease (Table 2).
India has witnessed a sudden rise in PCOS and infertility
Out of the 190 women aware of the term PCOS, the most
cases in the last couple of years and that is only the tip of
the iceberg. Lack of knowledge, rampant obesity, common presentation for PCOS was asymptomatic (n =

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 Chainani EG. Int J Reprod Contracept Obstet Gynecol. 2019 Dec;8(12):4716-4720

79) followed by irregular menses, infertility, obseity, Only 28% of the subjects are regularly involved in some
hirsutism followed by psychological disorders (Figure 1). kind of exercise. Almost 42% of the subjects were
struggling with difficulty in losing weight.
Table 1: Age group distribution.
Women were also asked about the time interval between
Age group Number of their last Obstetrician Gynecologist visit and the results
Percent (%)
(in years) patients were stacked according to their age group. Most women
18-24 187 37.4 in the age group of 18-24 years had not visited an
25-30 313 62.6 OBGYN at all and most women in the age group of 25-
30 years had visited an OBGYN in the last 6 months
Table 2: Awareness of term PCOS. (Figure 3).

Patient Number Percent (%) 160 149

143
Aware of term PCOS 190 38
140
Unaware of term PCOS 310 62
120
102
100
90 79
80 80 18-24yrs
70 61
60 25-30yrs
60
50 40 40
40 32 17 14
27 20 4 7
30
20 0
8
10 4 <6 months 6 months to > 1 year Never visited
0 1 year

Figure 3: Time interval between last OBGYN visit.

The most common self reported reason for visiting an

OBGYN in the age group 18-24 years was irregular
menses followed by pregnancy and in the age group of
25-30 was pregnancy followed by inability to conceive.
Figure 1: Symptomatology associated with PCOS. A total of 1 woman in the entire study reported coming
for a regular checkup (Figure 4).
The study participants knew about the term PCOS due to
doctors visits followed by Media/Internet sources,
250
Friends, Teachers and then family (Figure 2). 18-24yrs
198 25-30yrs
200
80 71
70
150
60 54
102
50 42
100
40 66 64
30
14 50
20 22
9 12 7
10 1.8 0 1
0
0
Pregnancy Inability to Irregular Regular Pain
conceive menses checkup abdomen

Figure 4: Most common self reported reason for

visiting an OBGYN.
Figure 2: Sources of knowledge of PCOS.
DISCUSSION
A 72% of the people did not know about the role of
lifestyle changes like diet, lack of physical activities, Polycystic ovary syndrome (PCOS) is a convergence of
stress and obesity are that are involved in the chronic multisystem endocrine aberrations, including
pathogenesis of the disorder. irregular menses, hirsutism, obesity, hyperlipidemia,

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 Chainani EG. Int J Reprod Contracept Obstet Gynecol. 2019 Dec;8(12):4716-4720

androgenization, large and polycystic-appearing ovaries, PCOS symptoms. Most participants were unaware of the
insulin resistance and infertility.7 Although PCOS is the long-term complications as hypertension, diabetes
most common hormonal disorder among reproductive age mellitus, and cardiovascular abnormality. They were
women it is the leading cause for anovulatory/ mostly unaware of its relationship to early puberty and
oligoovulatory infertility and has the potential for serious inheritance as well.
long-term health effects. PCOS is posited to be the most
common endocrine abnormality of reproductive-aged Most of the studied females did not know about the role
women in the United States.8 The absence of uniform of lifestyle changes like diet, lack of physical activities,
diagnostic criteria for PCOS and lack of any stress and obesity are that are involved in the
pulbicization, education and awareness of this disease has pathogenesis of the disorder. Even fewer females are
probably contributed to its low clinical diagnosis rate. If regularly involved in some kind of exercise. Almost 42%
the objective of heightened public interest in PCOS is of the subjects were struggling with difficulty in losing
indeed achieved through wide public service weight.
announcements or other structured media exposure, then
it could lead to a higher awareness and therefore The importance of understanding the full spectrum of
prevention of this disease complex. PCOS is as presented to different specialty clinics. Not
only is the syndrome under diagnosed but also are the
In present study only 38% of the women were aware of significant associated morbidities such as IGT and type 2
the term PCOS, 17% of the subjects who were aware diabetes.17 Women with PCOS had higher levels of
knew about the organ system involved in this disease. A luteinizing hormone and higher luteinizing
similar study by Safa showed that 50% have knowledge hormone/follicle-stimulating hormone ratios than those in
about the PCOS and in contrast to present study only 6 % the other groups.18 A study in China comparing the 833
aware about the reasons and consequences of the women with PCOS to 2732 women without PCOS
condition.9 Another survey by Ansari et al found only indicated that PCOS occurs in younger women and these
10% of their study population having knowledge of women were prone not only to menstrual problems,
PCOS. A study by Sabitha et al revealed that 76 % had hyperandrogenism, PCO and infertility but also metabolic
average knowledge about PCOS but 10% actually knew syndrome and insulin resistance.19 Different specialists
about the organ systems and pathology of the disease. 10 need to appreciate the spectrum of health problems for
Abbas et al found in there study 45 % are aware of PCOS women with PCOS that may extend beyond the specific
condition which is similar to present finding. 11 Sunanda B symptoms that precipitated the initial referral.
et al found that 76% of the samples were with average
knowledge and 10.7% with good knowledge regarding As with any questionnaire-based research, there were
polycystic ovarian syndrome.12 Gul S et al found that only some limitations with the study that should be
20 out of 177 women had any knowledge about this acknowledged. The research method relied on an un-
syndrome. 19 Out of these 20 women 11 were those who screened and unmotivated audience and their educational
had degrees in Medical Sciences.6 background was not screened which could lead to some
false negatives and positive answers not accounted for
This study also revealed that most of the study subjects and corrected in the study.
know about this disorder through their doctor followed by
media/internet. A study performed on polycystic ovarian CONCLUSION
syndrome in adolescents in Rotterdam showed that 11.5%
of the population got knowledge from a doctor and 5% The alarming results of present study show that very
learnt from the internet Jayshree et al[13], another study small number of young women understand what
shows information source 51% from doctor and 22% polycystic ovarian syndrome is and thus when to consult
form internet Pitchai et al.14 A study conducted in Sri a physician. This could be why PCOS is an
Lanka posited the most common phenotypes of PCOS underrepresented and underdiagnosed disease. This
were oligo/amenorrhea and polycystic ovaries (91.4%) widely prevalent disease among young women should be
and oligo/amenorrhea and hirsutism (48.3%).15 talked about more and more young women must be
educated on this to help prevent the sequelae of this
A two year follow up study in adoloscents showed a syndrome on fertility and insulin resistance.
statistically significant higher percentage difference in
prevalence of irregular menses (59.9%), hirsuitism Funding: No funding sources
(56.3%), acne (17.8%), obesity (17.3%), polycystic Conflict of interest: None declared
ovaries on ultrasound (47.8%) and clinical Ethical approval: Not Required
hyperandrogenism (56.1%) among those with PCOS as
against those without PCOS.16 REFERENCES

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