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Original Article
58 (
3
); 149-156
doi:
10.1055/s-0042-1750359

Awareness of Polycystic Ovarian Syndrome among College Going Females in Gurgaon: A Cross-Sectional Study

School of Medical and Allied Sciences, G. D. Goenka University, Gurgaon, Haryana, India
Address for correspondence Renuka Jakhar, MPT, BPT, School of Medical and Allied Sciences, G. D. Goenka University, Village Alipur, P. O. Ghamroj, Tehsil Sohna, Gurgaon 122103, Haryana, India (e-mail: renuka.jakhar@gdgu.org).
Licence
This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Disclaimer:
This article was originally published by Thieme Medical and Scientific Publishers Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

Objectives

Women not only take care of family members, they are also source of power and symbol of progress in a society. At the same time, physical and mental well-being of women relies on healthy lifestyle and adequate reproductive health knowledge. With growing incidence of polycystic ovarian syndrome (PCOS), it is crucial to increase awareness about the disease among women at an early age in life. The present survey investigates awareness level of college going females about PCOS.

Materials and Methods

428 females were recruited from 3 colleges in district Gurgaon, Haryana, India, based on convenience sampling. The respondents filled a self-completion questionnaire containing sociodemographic details, menstrual cycle details, and questions related to PCOS.

Statistical Analysis

Descriptive statistics was used to calculate frequency and percentage of variables. Pearson's chi-square test of independence was used to identify factors associated with awareness of PCOS. A p-value of < 0.05 was considered to be statistically significant.

Results

The mean ±SD age of respondents was 19.9 ± 1.7 years (range = 18–24 years). Only 78 females (18.22%) had heard about PCOS. Being knowledgeable was significantly associated with mother's education (p = 0.001), length of menstrual cycle (p = 0.022), and family history of PCOS (p < 0.001).

Conclusion

The present study indicates awareness of PCOS among college going females was very poor. There is an urgent need of increasing awareness about PCOS among young adult college going females not only for prevention, early diagnosis, and treatment of the disease but also to prevent its long-term consequences.

Keywords

polycystic ovarian syndrome
infertility
menstrual irregularities
hirsutism
anxiety
awareness

Introduction

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in females of reproductive age with prevalence of 8 to 13% on basis of diagnostic criteria used across different parts of the world.1 It is a complex disorder with reproductive, metabolic, and psychological features. Reproductive features include elevated levels of luteinizing hormone, reduced levels of follicle-stimulating hormone along with increased androgens, and insulin levels which results in menstrual irregularities (oligomenorrhea or amenorrhea).2 Increased production of androgens and underproduction of estrogens by the ovaries result in formation of multiple tiny cysts on ovaries, hirsutism, acne, and alopecia.2,3 During pregnancy, females with PCOS are at increased risk of gestational diabetes and spontaneous abortion in first trimester of pregnancy.2,4 Metabolic features include insulin resistance (IR) compensated by hyperinsulinemia, impaired glucose intolerance test, and dyslipidemia. Anovulation combined with hyperinsulinemia promotes proliferation of endometrial cells which further increases the risk of endometrial carcinomas. Females with PCOS have increased risk of type 2 diabetes, metabolic syndrome, and cardiovascular diseases (CVDs).2,4 There is a four to seven times higher risk of heart attack in females diagnosed with PCOS than females who do not have PCOS in the same age group.2 Psychological features include loss of femininity, body dissatisfaction, anxiety, depression, eating disorders, and suicidal attempts.3 IR and increased androgen production are identified as key pathophysiological elements for PCOS development; the exact cause is still unrecognized. Moreover, clinical presentation significantly depends on environmental factors, lifestyle, genotype, and ethnic background.4,5 As per Rotterdam criteria, diagnosis is based on presence of two out of three criteria—hyperandrogenism, oligoovulation, or anovulation, and presence of multiple cysts on ovaries—after exclusion of the diseases like thyroid disease (thyroid-stimulating hormone), hyperprolactinemia, nonclassic congenital adrenal hyperplasia, Cushing disease, androgen producing tumors, and hypogonadotropic hypogonadism.6

The aim of the present survey was to evaluate awareness of PCOS among college going females in Gurgaon, Haryana, India.

Materials and Methods

Strengthening The Reporting of OBservational Studies in Epidemiology statement is used to report the study.

Study Design

It is a cross-sectional survey. Data collection was done in February, March, and April 2021. College going females were recruited from three colleges in Gurgaon district, namely, Government College for Girls, Sector 14, Government College, Sector 9, and Nirankari Baba Gurubachan Singh Memorial (NBGSM) College, Sohna.

Sample

Inclusion criteria were females above 18 years available in campus at time of data collection and willing to participate in the study. Convenient sampling was used.

Questionnaire Development and Validation

A self-completion questionnaire was constructed and questions primarily focused on awareness related to disease. Gynecologist was approached for content validity on basis of desired outcome. A pilot study was undertaken on 10% of the sample size. Simple split-half method was used to assess reliability of the questionnaire by applying Spearman–Brown prophecy coefficient formula. The reliability value of the tool was 0.89, and hence the questionnaire was found to be good. The first set included six questions related to sociodemographic details (age, area of living, type of family, religion, mother education, and father education). Second set included six questions of personal details (age of menarche, dysmenorrhea, number of pads used in a day, days of menstrual flow, length of menstrual cycle, and family history of PCOS) followed by third question whether they have ever heard about PCOS. If yes, then what was the source of information. Question 4 was about anatomical knowledge of disease while questions 5 to 11 were multiple choice (with more than one correct answer) on sign/symptoms, causes/risk factors, diagnosis, long-term complications, psychological complications, treatment, and preventive measures of PCOS. After obtaining written informed consent, study objectives and time required to fill the questionnaire were explained to respondents. They were informed that they can refuse to participate and can withdraw from study anytime without any loss/penalty. Confidentiality and privacy was assured by keeping the document in sealed envelope and locked cabinets separately until analysis.

Sample Size

Cochran formula for infinite population was used and minimum sample size was calculated to be 385. A total of 424 participants were needed after accounting for attrition rate of 10%. A total of 428 females were recruited.

Statistical Analysis

Data analysis was done in May and June 2021. Missing data was given 0 input values. Descriptive statistics were performed to determine knowledge of PCOS. Data was first entered into Microsoft Excel spreadsheet. It was then coded and transferred into SPSS. Statistical analysis was done using IBM's Statistics version 23. Descriptive statistics was used to calculate frequency and percentage of variables. Pearson's chi-square test of independence was used to identify factors associated with awareness of PCOS. A p-value of < 0.05 was considered to be statistically significant.

Results

A total of 428 students completed the questionnaires. ►Table 1 shows sociodemographic details of participants. Mean age of students was 19.97 years (standard deviation = 0.08 years). Most females were 18 to 20 years of age (69.63%). Majority of respondents were from rural area (52.34%) followed by suburban area (29.21%) and urban area (18.46%). Note that 53.27% of participants had joint family while remaining 46.73% were from nuclear family. All females were Hindu except 2.80% who were Muslim. Note that 78.74% females' mothers were educated up to graduation and 87.15% females' fathers were graduate. ►Table 2 shows 70.79% had age of menarche from 14 to 16 years of age and 53.04% had dysmenorrhea. Most of the females had 2 to 4 days of menstrual flow (54.67%) using 2 to 4 pads in a day (92.29%). Among the participants, length of menstrual cycle was < 21 days in 13.79%, 21 to 35 days in 74.53%, and > 35 days in 4.91%; amenorrhea was found in 1.17% and 5.61% females had no fix date for menses. Out of these 428, there were 2 females already diagnosed with PCOS and 5 had sisters diagnosed with PCOS.

Table 1 Sociodemographic characteristics of participants
Variables Frequency (n = 428) Percent
Age (in years)
18 to 20 298 69.63
21 to 23 108 25.23
> 24 22 5.14
Area of living
Rural 224 52.34
Suburban 125 29.21
Urban 79 18.46
Type of family
Joint 228 53.27
Nuclear 200 46.73
Religion
Hindu 416 97.20
Muslim 12 2.80
Mother education
None 65 15.19
Up to graduation 337 78.74
Postgraduation 26 6.07
Father education
None 16 3.74
Up to graduation 373 87.15
Postgraduation 39 9.11
Table 2 Personal details of participants
Variables Frequency (n = 428) Percent
Menarche age (in years)
11 to 13 113 26.40
14 to 16 303 70.79
17 to 19 12 2.80
Dysmenorrhea
Absent 201 46.96
Present 227 53.04
Pads used in a day
2 to 4 395 92.29
5 to 7 33 7.71
Days of menstrual flow
2 to 4 234 54.67
5 to 7 183 42.76
> 8 11 2.57
Menstrual cycle (in days)
< 21 59 13.79
21 to 35 319 74.53
> 35 21 4.91
Amenorrhea 5 1.17
Randomly, no fix date 24 5.61
Family history of PCOS
Absent 423 98.83
Present 5 1.17

Abbreviation: PCOS, polycystic ovarian syndrome.

Table 3 indicates only 78 females (18.22%) heard about PCOS while 350 (81.78%) had never heard the name. Sources of information were Internet (7.71%), friend (5.14%), doctor (2.34%), family (1.17%), and women health and hygiene session in college (1.87%). Seventy-three girls (17.06%) were aware that it is a disease of the ovary.

Table 3 Respondents' knowledge of PCOS
Knowledge Frequency (n = 428) Percent
Heard about PCOS 78 18.22
Didn't heard about PCOS 350 81.78
Source of knowledge
Doctor 10 2.34
Friend 22 5.14
Family 5 1.17
Internet 33 7.71
Health and hygiene session in college 8 1.87
Knowledge of anatomical part
It's a disease of ovary 73 17.06

Abbreviation: PCOS, polycystic ovarian syndrome.

Note that 10.05% respondents knew that irregular or absent menses and facial acne are sign/symptoms of PCOS while 9.81 and 6.78% knew about weight gain and abnormal hair growth, respectively (►Table 4). Note that 9.11% females identified hormone imbalance as cause/risk factor for PCOS while 7.71 and 7.48 identified physical checkup and ultrasound scan are diagnostic tools, respectively (►Tables 5 and 6). ►Table 7 conveys only 5.14% could recognize ovarian cancer as long-term consequence, whereas ►Table 8 presents depression (7.01%) followed by anxiety (5.37%) was identified as psychological complication. Lifestyle modification as a treatment was recognized by maximum respondents (3.50%) (►Table 9) and most of the participants marked fiber-rich diet along with exercise as preventive measure (8.18%) (►Table 10).

Table 4 Awareness of signs/symptoms of PCOS
Signs/symptoms Frequency (n = 428) Percent
Irregular or absent menses 43 10.05
Facial acne 43 10.05
Abnormal hair growth 29 6.78
Reduced fertility 13 3.04
Weight gain 42 9.81
Frontal hair loss 11 2.57
Pelvic pain 25 5.84
Out of control eating 6 1.40
Stress 24 5.61
Anxiety 24 5.61
I don't know 5 1.17

Abbreviation: PCOS, polycystic ovarian syndrome.

Table 5 Awareness of causes/risk factors of PCOS
Causes/risk factors Frequency (n = 428) Percent
Insulin resistance 15 3.50
Weight gain 19 4.44
Hormone imbalance 39 9.11
Physical inactivity 20 4.67
I don't know 11 2.57

Abbreviation: PCOS, polycystic ovarian syndrome.

Table 6 Awareness of diagnosis of PCOS
Diagnostic methods Frequency (n = 428) Percent
Menstrual history 25 5.84
Physical checkup 33 7.71
Blood test 15 3.50
Ultrasound scan 32 7.48
I don't know 13 3.04

Abbreviation: PCOS, polycystic ovarian syndrome.

Table 7 Awareness of complications related to PCOS
Complications Frequency (n = 428) Percent
Diabetes 10 2.34
Endometrial cancer 11 2.57
Ovarian cancer 22 5.14
Increased androgens 8 1.87
Cardiovascular disease 6 1.40
I don't know 27 6.31

Abbreviation: PCOS, polycystic ovarian syndrome.

Table 8 Awareness of psychological complications of PCOS
Psychological complications Frequency (n = 428) Percent
Anxiety 23 5.37
Depression 30 7.01
Snoring 10 2.34
Binge eating disorder 7 1.64
Walking unrefreshed from sleep 17 3.97
I don't know 24 5.61

Abbreviation: PCOS, polycystic ovarian syndrome.

Table 9 Awareness of treatment options for PCOS
Treatment Frequency (n = 428) Percent
Lifestyle modifications 15 3.50
Laparoscopic ovarian drilling surgery 11 2.57
Hormone replacement therapy 9 2.10
Cognitive behavioral therapy 2 0.47
I don't know 2 0.47

Abbreviation: PCOS, polycystic ovarian syndrome.

Table 10 Awareness of preventive measures of PCOS
Preventive measures Frequency (n = 428) Percent
Fiber-rich diet 35 8.18
Exercise 35 8.18
Meditation 27 6.31
Weight loss 15 3.50
I don't know 8 1.87

Abbreviation: PCOS, polycystic ovarian syndrome.

Tables 11 and 12 reveal being knowledgeable of PCOS was significantly associated with the mother's education (p = 0.001) and menstrual cycle (p = 0.022). There was also a statistically significant association between knowledge of PCOS and presence of family history of PCOS (p < 0.001).

Table 11 Association between sociodemographic characteristics of participants and knowledge of PCOS
Variables Knowledgeable (n = 78) Not knowledgeable (n = 350) Test statistic p-Value
Age (in years)
18 to 20 55 243 x2 = 1.350 0.509
21 to 23 21 87
> 24 2 20
Area of living
Rural 39 185 x2 = 2.314 0.314
Suburban 20 105
Urban 19 60
Type of family
Joint 41 187 x2 = 0.019 0.89
Nuclear 37 163
Religion
Hindu 77 339 Fisher's exact 0.703
Muslim 1 11
Mother education
None 4 61
Up to graduation 64 273 x2 = 13.632 0.001a
Postgraduation 10 16
Father education
None 1 15
Up to graduation 66 307 x2 = 4.217 0.121
Postgraduation 11 28

Abbreviation: PCOS, polycystic ovarian syndrome.

a p < 0.05.

Table 12 Association between personal details of participants and knowledge of PCOS
Variables Knowledgeable (n = 78) Not knowledgeable (n = 350) Test statistic p-Value
Menarche age (in years)
11 to 13 17 96 x2 = 1.103 0.576
14 to 16 59 244
17 to 19 2 10
Dysmenorrhea
Absent 42 159 x2 = 1.815 0.178
Present 36 191
Pads used in a day
2 to 4 72 323 x2 = 0.000 0.995
5 to 7 6 27
Days of menstrual flow
2 to 4 36 198 x2 = 2.887 0.236
5 to 7 40 143
> 8 2 9
Menstrual cycle (in days)
< 21 9 50 Fisher's exact = 10.839 0.022a
21 to 35 55 264
> 35 10 11
Amenorrhea 0 5
Randomly, no fix date 4 20
Family history of PCOS
Absent 73 350 Fisher's exact < 0.001a
Present 5 0

Abbreviation: PCOS, polycystic ovarian syndrome.

a p < 0.05.

Discussion

The present survey was to assess awareness of college going females about PCOS. The study reveals 18.22% females had heard the name of disease. This study is in line with the study conducted in Bhopal city by Gupta et al which indicated 21.6% girls were aware of PCOS.7 In contrast, Rawat et al during a study among adolescent girls in Dehradun found that only 1.06% participants had knowledge on PCOS.8 Also, study conducted by Jena et al in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar reported only 2.79% and by Sharma et al among rural and urban population of Punjab indicated only 3.30% participants knew about the disease.9,10 Chainani did a survey in D.Y. Patil Hospital, Navi Mumbai and concluded 38% females and Patel et al did a survey in Indore city and reported 41% females heard about the disease.11,12 Another study carried in gynecology outpatient department at a tertiary care hospital by Kaundal revealed 43.4% females heard about PCOS.13 Salama and Elbana at Nursing Institute of Benha Teaching Hospital and Nursing Institute of Health Insurance Hospital, Egypt revealed that most of the adolescents had inadequate knowledge and only 6.3% of studied population had adequate knowledge.14 Pramodh reported 38% female Emirati students at Zayed University, Dubai campus were aware of PCOS.4 In a population-based cross-sectional survey conducted all over Saudi Arabia by Alessa et al, 56.7% Saudi females had knowledge about PCOS.15 In a study done by Mohamed at Faculty of Nursing at Minia University in Egypt only 7.3% students had good knowledge about the disease.16 Rao et al, in a cross-sectional study at Texas Woman's University which is multiethnic university, concluded only 4% of women and 2.1% of the men said that they knew everything about PCOS.17

Gurgaon is the fourth most populated district of Haryana state. Growth rate of population here was 73.1% during 2001 to 2011 against 19.9% for Haryana state as a whole. District Gurgaon had 425 large and medium industrial units in 2010. It has corporate offices of more than 60 multinational companies, industrial units of 35 multinational companies, and 582 small-scale/micro small-medium industrial units.18 Gurgaon, The Millennium City, is home to the best companies in the country and in the world like Google, TCS, Microsoft, IBM, Airtel Bharati, etc. Besides, there are more than 10 universities and more than 50 colleges/institutes in district Gurgaon. Therefore, women seeking best higher education, superior training, and professional growth are heading toward Gurgaon city from all over the nation. Undoubtedly, women play a crucial role in making a family, progress of society, and nation building. Carrier-oriented females postpone marriage and delay pregnancy. As per information provided by “The PCOS Society India” approximately 70% of females with PCOS face difficulties in conceiving, may take longer duration, and need medical help for becoming pregnant. Hence, family planning before 35 years of age is recommended.19 Young females need to be empowered with knowledge about the disease which has increasing incidence especially in urban areas. It is of utmost importance to identify the gaps in knowledge and awareness of PCOS among young college going females in Gurgaon district which is going through phenomenal transformations in industry and urbanization since the last two to three decades. Thus, this study was undertaken to assess awareness level of PCOS among college going females in district Gurgaon.

As it is evident from studies conducted in different parts of India, level of awareness about the disease can be as low as 1.06% and as high as 43.4%. Also, there is large difference in perception of the disease among women across the world. Level of awareness depends upon the population studied, health care background in education, higher level of education, cultural differences, level of parents' education (especially mothers' education level), family history of PCOS, and sources of information available. Conducting the surveys assessing awareness level of PCOS in different regions of the country will help in identifying the target areas and target population to increase the awareness level. Also, these surveys will help in developing most suitable tool to educate such population.

PCOS is a complex disorder involving hypothalamus-pituitary-ovarian axis. It results in metabolic changes, hormonal imbalances, and IR. It disturbs females' physiological functioning, physical appearance, mental health, and self-perception which in turn affect her family life and social life. A female may need to visit dermatologist, endocrinologist, gynecologist, dietician, psychiatrist, and physical therapist depending upon the symptoms. Management of the disease requires a multidisciplinary team with good communication among all its members.

Sometimes diagnosis of the disease take years and females are dissatisfied with the treatment. Not addressing all the components of the disease at the same time further extends time in getting complete relief from all symptoms and increases cost effectiveness. Most of the females are driven to long-term physiological and psychological complications due to lack of knowledge about risk factors/causes and all the treatment options available. There is also lack of awareness about preventive measures and multidisciplinary approach for management of PCOS. Since this is a lifelong disease there is need to educate females at an early age of life.

Quality of life is remarkably lower in females with PCOS as compared with healthy females. Weight gain, stress, and anxiety present in these females are also risk factors for chronic illness like diabetes and CVDs.20 Maximum number of females with PCOS report difficulty conceiving as the most significant concern.21 Females also have reported lack of counseling and care during the treatment.22

Educational programs to increase awareness of the disease should be made mandatory in curriculum. Screening of PCOS in schools/colleges/universities and all types of educational institutes and primary health care centers is extremely important. PCOS awareness workshops and support groups should be established on regional levels. Health professionals should be encouraged for educating patients and their family members for long-term consequences and also motivating them for regular follow-ups. National level public advertisements on television, radio, Internet, newspaper, and magazines that are easily accessed and understood by individuals are required urgently. Young females should also be encouraged for regular physical exercises, participation in sports activities, avoiding sugar containing drinks and frequent fast food consumption, stress management through meditation, and discussion with health care professionals about their reproductive health.

Conclusion

Prevention of this common chronic condition and its consequences relies on increasing awareness at an early age of life. The present study indicates awareness of PCOS among college going females to be very poor. Although females were aware that irregular or absent menses, facial acne, weight gain, and abnormal hair growth are symptoms of PCOS but increasing awareness for all other symptoms is also needed. Internet was the most common source of information followed by friends. Very few girls could identify diabetes, increased androgens, CVD, and endometrial cancer as long-term complications along with risk of ovarian cancer.

Prior Presentation

This study was virtually presented at the 4th International Conference on Multi-Disciplinary Research Studies and Education (ICMDRSE 2021), 29-30 June, 2021, Kuala Lumpur, Malaysia.

Ethical Approval

This survey was reviewed and approved by Research Ethical Committee at School of Medical and Allied Sciences, G. D. Goenka University (GDGU/SoMAS/REC/Approvals/2020/01).

Author Contributions

R.J. contributed in the conception of survey, collection, analysis, and interpretation of data; and drafted the manuscript. E.D.S. revised it critically for intellectual content. R.D. read and approved the final manuscript.

Acknowledgments

The authors thank the principals and staff members of all colleges for their support. They are also grateful to all participants who took part in the survey.

Conflict of Interest

None declared.

Funding

None.

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