Review of Related Literature and Studies
This chapter presented the literature and studies which have direct bearing to the present study. These were taken from research journals, books and electronic sites. The reviewed literature and studies enriched the researchers with the variables of the study and provided the framework of the study.
Capability to Conceive Child
According to Hailes (2020), polycystic ovarian syndrome, or PCOS, is a common hormonal condition in women. Women with PCOS struggle to become pregnant and are at higher risk of developing complications during pregnancy. However, by managing the symptoms, many women with PCOS can be pregnant and could have a healthy baby. Having PCOS can increase the risk of some complications during pregnancy, such as: miscarriage, high blood pressure induced by the pregnancy, gestational diabetes, pre-mature birth. Women with PCOS also have a higher likelihood of needing a caesarean delivery because the babies might be larger than expected for their gestational age. Babies born to women with PCOS have a greater risk of dying around the time of delivery and of being admitted to a new born intensive care unit. There is a small probability of women diagnosed of polycystic ovarian syndrome to bear child, some physician call it as a miracle if you are able to conceive a baby. PCOS mostly happen during child bearing age or sometimes it happened after conceiving how many children (Hailes, 2020).
Hirsutism
Hirsutism is broadly defined as excessive hairiness, the common clinical used of the term referred to women with excess growth of terminal hair in a male pattern (Griffing, 2020). Regardless of the etiology, hirsutism can produce mental trauma and emotional anguish. Even mild cases of hirsutism may be viewed by the patient and others as a presumptive loss of femininity, in some severe cases, hirsutism can be a serious cosmetic problem. The major objectives in the management of hirsutism are to rule out a serious underlying medical condition and to devise a plan of treatment (Griffing, 2020). Hirsutism is the medical term refers to the presence of excessive terminal (coarse) hair in androgen-sensitive areas of the female body (upper lip, chin, chest, back, abdomen, arms, and thighs). It is different from virilisation, which refers to the concurrent presentation of hirsutism with a broad range of signs suggestive of androgen excess, such as ambiguous external genitalia, increased muscle mass, acne, balding, deepening of the voice, breast atrophy, amenorrhea/oligomenorrhoea, and increased libido, varying with age (Pasquali, 2014). All these signs and symptoms may differ in their clinical presentation according to the patient’s age.
In the study conducted by Gade (2014), defines that Polycystic Ovary Syndrome (PCOS) is a common disorder seen in 5-10% of premenopausal women. The common symptoms are oligo-/amenorrhea, obesity, hirsutism, and acne and the ovaries appear polycystic by ultrasonography, hyperandrogenemia is usual present, and increased total testosterone combined with low sexhormone-binding globulin (SHBG). The main pathophysiology accompanying PCOS is hyperinsulinemia leading to further hyperandrogenism. The concurrent hirsutism is not only a cosmetic issue but the cause of emotional distress. Hirsutism is objectively classified by the Ferriman-Gallwey scoring system, in which the presence of black hair is scored in nine body areas on an arbitrary scale, however its use in clinical practice is limited. Medical treatment of hirsutism focuses on anti-androgenic hormones, mostly in oral contraceptives (OC). The evidence for using metformin in the long-term treatment of hirsutism is sparse. It would be valuable to know the extent of these effects from the women’s perspective, which may affect the women’s quality of life, as low self-esteem and higher rates of depression are associated with the severity of the PCOS condition. This study aimed to obtain self-assessment of the effect of treatment on hirsutism. The information gathered about the women’s medical and mechanical treatment of hirsutism as well as other factors such as co-morbidity, which may influence on the result of the treatment.
In the study written by Khomami et al., (2015), describes that polycystic ovary syndrome (PCOS), a common complex disorder among reproductive-aged women, characterized with hyperandrogenism, ovulatory dysfunction and polycystic ovary morphology, affects 8–18% of women during their reproductive years. Although the exact pathogenesis of PCOS has remained a mystery, it is considered as a polygenic trait that is likely caused by the interaction of genetic and environmental factors. In addition to irregular menses, hirsutism and infertility, women with PCOS may display a number of metabolic and cardiovascular abnormalities and several psychological disorders such as depression, anxiety, marital and social problems and sexual functioning impairment. While the underlying causes of these non-reproductive health-related complications are mainly unknown, they do negatively affect the quality of life (QoL) of women diagnosed with PCOS. Mood disorders, low sexual satisfaction, weight gain, acne, hair loss, pain, infertility and menstrual irregularity have all been mentioned as factors which decrease QoL of women suffering from PCOS. It has also been shown that lifestyle management strategies to manage these factors can improve the QoL of affected women. It is highly recommended that assessment of women with PCOS include not only reproductive and metabolic assessment, but also their health-related QoL (HRQoL) assessment. HRQoL refers to the “physical, psychological and social domains of health seen as distinct areas that are influenced by a person’s experiences, beliefs, expectations and perceptions”. The diminished QoL often faced by women diagnosed with PCOS may be the result of symptoms that are currently causing issues as well as the fear of possible disorders in future. It is not clear which aspects of PCOS have the strongest influence on HRQoL in affected women although negative impacts have been shown to result from hirsutism, acne, hyperandrogenism, metabolic disturbances, menstrual irregularity, obesity and infertility. Further, it is likely that various traditions, cultural-gender identity, religions and ethnicity influence the impact of these factors on HRQoL of women affected by PCOS in various societies.
In the study of Demir et al., (2011) defined polycystic ovary syndrome (PCOS) as a genetically complex endocrine disorder of uncertain etiology, it is a common cause of anovulatory infertility, menstrual dysfunction and hirsutism. Both the presence and severity of hyperandrogenism, menstrual irregularities and infertility are heterogeneous in PCOS. There is no distinct biochemical abnormality or unique phenotype that allows PCOS-related hyperandrogenism to be distinguished from other forms and there is difficulty in introducing generally accepted diagnostic criteria for PCOS. Currently, the diagnosis of PCOS is based on the following criteria from the 2003 Rotterdam Consensus: (i) oligoanovulation; (ii) clinical evidence of hyperandrogenism and/or biochemical hyperandrogenaemia; and (iii) polycystic ovary appearance on ultrasound. In 1961 Ferriman and Gallwey described a scoring system to determine the degree of hirsutism. The density of terminal hairs at 11 different body sites was scored: upper lip, chin, chest, upper back, lower back, upper abdomen, lower abdomen, arm, forearm, thigh and lower leg. For each of these areas, a score from 0 (absence of terminal hairs) to 4 (extensive terminal hair growth) was assigned. Hair growth over the forearm and lower leg was noted to be less sensitive and modifications of the Ferriman–Gallwey method have excluded scoring of these areas. Subsequent studies have shown that three body areas, the buttocks/perineum, sideburns and the neck/lower jaw, contributed more substantially to the total hirsutism score than the nine body areas in the modified Ferriman–Gallwey (mFG) scoring system; however, the mFG system remains the most widely used method for visually scoring excess terminal body or facial hair growth in the assessment of hirsutism. Androgen levels and hirsutism scores have been evaluated in many previous studies, but a relationship between clinical hirsutism and the severity of hyperandrogenism has not been demonstrated.
Impact of PCOS
This is one of the identified subscales of determining the Quality of life of the millennial as identified in the development and preliminary validation of PCOS disease specific to quality of life scale which is more sensitive in assessing the impact of PCOS. Impact of PCOS in the quality of life can be measure in four domains, which are the physical state, psychological status, social interaction and environmental relationship (William, 2018).
In the study conducted by Tabassum, (2021), defined that polycystic ovary syndrome (PCOS) is a major endocrine disorder in young age women affecting their health-related quality of life (HRQOL) and their mental well-being as well. Moreover, this develops into lifelong health condition that continues far beyond the young ages and affects around 5 million young age population in the United States of America. In India, PCOS has been reported to vary between racial counterparts with an estimated prevalence of 9.13% in adolescents. The major changes in physical appearance, obesity, along with menstrual irregularity have been found to be the main contributing factor of psychological dilemma. PCOS negative impact is always underestimated and dominates on women’s life and may lead to a risk for serious anxiety and psychological disorder. Importantly, the psychological burden greatly varies with the change in geographical areas and societal perceptions (Barnard et al., 2007). These patients may experience characteristics of PCOS as stressful and may be at higher risk for depression and anxiety disorders and even this may lead towards suicidal tendency. Clinically, PCOS is characterized by either oligoovulation or anovulation and hyperandrogenism that may cause infertility, and other related metabolic disorders. This progresses to increased risk of reproductive issues like infertility endometrial cancer, gestational as well as mental disturbances. However, novel treatments and therapies can then be targeted toward improving those problems, which are most important for the individual concerned. Recently, increased importance has been given on understanding the impact of PCOS symptoms and in particular about the feminine identity and thus their treatment from the patients’ perspective for the better quality of life (QOL). HRQOL is a self-perceived health status as a consequence of any disease that is measured by health status questionnaires. Therefore, HRQOL questionnaires like Short Form Health Survey-36 (SF-36) for PCOS, was used to understand the impact of PCOS and evaluating individual patients’ health status and monitoring and comparing disease burden. The SF-36 scale leaves out important detrimental issues linked to PCOS patients such as physical and emotional symptoms associated with menses. PCOS questionnaire has reasonable internal reliability, good test-retest reliability, good concurrent and discriminated validity, and a reasonable factor analysis making PCOS questionnaire a useful and promising tool for HRQOL in PCOS cases. At present, there is a paucity of information related to PCOS among women of the reproductive age group in India, in particular, North India. Thus, considering these factors into account, this prospective study was planned to compare socioeconomic status (SDS) and association of age, body mass index (BMI), education level and marital status between PCOS and healthy control cases among the women in the reproductive age group visiting the department of gynaecology and obstetrics of tertiary care hospital.
In the study conducted by Mohammed (2020), suggested that the most common endocrine disorder seen during reproductive age of women is polycystic ovary syndrome (PCOS) with high rate of infertility. As per the new Rotterdam criteria formulated by the European Society for Human Reproduction & Embryology and the American Society for Reproductive Medicine, PCOS is characterized by the presence of two of the three features of oligo/anovulation, hyperandrogenism or polycystic ovaries on ultrasound with exclusion of other etiologies such as congenital adrenal hyperplasia, androgen secreting tumors, Cushing syndrome, thyroid dysfunction and hyperprolactinemia (Teede et al., 2018). The other common clinical features of PCOS include: hirsutism, moderate to severe acne, irregular menses, obesity and metabolic syndrome (Elghblawi, 2007). Studies have reported an association of PCOS with multiple endocrinal, reproductive and even metabolic risks that reduces quality of life through the life cycle of the affected female (Dokras et al., 2011). Metabolic risks include impaired glucose tolerance, type II diabetes mellitus, dyslipidemia, breast cancer and cardiovascular complications which are mainly age-related existence of hypertension, and subtle endothelial and vascular changes. Reproductive risks include infertility, endometrial and ovarian cancer (Daniilidis and Dinas, 2009). In addition, PCOS patients are more likely to develop psychiatric disorders including depression and anxiety (Asdaq and Yasmin, 2020). Some reports have proposed that poor body image and enhanced body weight due to PCOS are contributory factors for mood disorders in these patients (Barry and Kuczmierczyk, 2011). A study showed a fall in quality of life in patients with PCOS probably due to PCOS induced obesity and infertility (Amiri et al., 2018). Some of the eating disorders like anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) produces changes in the body image. The most common ED is BED, a 2% prevalence is reported in general public that increases to about 20% in adults seeking weight loss (Cossrow et al., 2016). Since both, BED and PCOS, has been associated with diabetes mellitus, obesity, and hypertension (Dokras, 2013), it is worthwhile to investigate the status of BED in patients with PCOS. There is an independent relationship found between depression and eating disorder (ED) (Hudson et al., 2007) with an occurrence of major depression in 32% of BED patients. Also, there are individual reports of prevalence of BED and depression in PCOS, however, the data on the co-existence of BED and depression in PCOS patients is not yet reported. Hence, this study was designed to explain the association of polycystic ovary syndrome (PCOS) with eating disorder, specifically, BED and depression as well as to determine the impact of these features on quality of life among women in Riyadh, Saudi Arabia.
Infertility
Infertility is the act of not able to conceive a child due to health condition (Khalid, 2020). According to Khalid (2020), symptoms of infertility in women include abnormal periods, which bleeding is heavier and lighter than usual. Infertility is a disease in which the ability to get pregnant and give birth to a child is impaired or limited in some way. For heterosexual couples (man and woman), this is usually diagnosed after one year of trying to get pregnant (but may be diagnosed sooner depending on other factors). For heterosexual couples, one third of causes of infertility are due to a male problem, one third are due to a female problems, and one third are due to combination or unknown reasons. When the cause of the infertility is found to come from the female partner, it’s considered female infertility or “female factor” infertility. A common condition, female infertility is an inability to get pregnant and have a successful pregnancy. This is typically diagnosed after a woman has tried to get pregnant (through unprotected sex) for 12 months without a pregnancy. There are many treatment options for infertility, including medications to correct hormonal issues, surgery for physical problems and in vitro fertilization (IVF). There are many possible causes of infertility. However, it can be difficult to pinpoint the exact cause, and some couples have “unexplained” infertility or “multifactorial” infertility (multiple causes, often both male and female factors). Some possible causes of female factor infertility can include: Problems with the uterus: This includes polyps, fibroids, septum or adhesions inside the cavity of the uterus. Polyps and fibroids can form on their own at any time, whereas other abnormalities (like a septum) are present at birth. Adhesions can form after a surgery like a dilation, curettage, and problems with the fallopian tubes. The most common cause of “tubal factor” infertility is pelvic inflammatory disease, usually caused by chlamydia and gonorrhea. Problems with ovulation: There are many reasons why a woman may not ovulate (release an egg) regularly. Hormonal imbalances, a past eating disorder, substance abuse, thyroid conditions, severe stress and pituitary tumors are all examples of things that can affect ovulation. Problems with egg number and quality: Women are born with all the eggs they will ever have, and this supply can “run out” early before menopause. In addition, some eggs will have the wrong number of chromosomes and cannot fertilize or grow into a healthy fetus. Some of these chromosomal issues (such as “balanced translocation”) may affect all of the eggs. Others are random but become more common as a woman gets older. Many factors can increase a woman’s risk of female infertility. General health conditions, genetic (inherited) traits, lifestyle choices and age can all contribute to female infertility. Specific factors can include: age, hormone issue that prevents ovulation, abnormal menstrual cycle, obesity, underweight, having a low body-fat content from extreme exercise, endometriosis, structural problems (problems with the fallopian tubes, uterus or ovaries), uterine fibroids, cysts, tumors. autoimmune disorders (lupus, rheumatoid arthritis, Hashimoto’s disease thyroid gland conditions), and sexually transmitted infections (STIs).
In the study by Joham (2015), defines Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting reproductive-aged women, with a prevalence of 6%–21%, depending on the diagnostic criteria applied and population studied. The etiology of PCOS is underpinned by both insulin resistance and hyperandrogenism, while the diagnosis is based on oligo- or anovulation, hyperandrogenism (clinical or biochemical), and polycystic ovaries on ultrasound. Clinically, PCOS is characterized by reproductive (hyperandrogenism, menstrual irregularity, oligo- or anovulation, infertility), metabolic (dyslipidemia, type 2 diabetes [T2DM], cardiovascular risk factors), and psychological features (depression, anxiety, and lower quality of life) and represents a major health burden. Women with PCOS have higher rates of obesity and central adiposity compared to women without PCOS. A recent systematic review and meta-analysis of 21 studies reported a pooled prevalence of 61% (range between 6% and 100%) for overweight or obesity in women with PCOS compared with controls, with considerable heterogeneity between studies. Both the prevalence and clinical expression of PCOS are strongly influenced by weight. Obesity exacerbates the reproductive and metabolic features of PCOS, worsens infertility independent of PCOS and decreases response to assisted reproductive technology (ART). There are limited data exploring the impact of body mass index (BMI) on fertility in community-recruited PCOS populations. Therefore, it is important to explore the interaction between PCOS, BMI, and fertility and treatment outcomes. While infertility is well described in PCOS, it was unable to find any published data examining the natural history data on infertility prevalence or on use of fertility treatment in PCOS in community-based Caucasian populations. Most infertility and PCOS data is based on selected populations managed in hospital or fertility clinics. A study by Wild et al. retrospectively followed a cohort of 786 women from the United Kingdom with PCOS diagnosed over 30 years ago. The women with PCOS were identified from hospital records and compared with 1060 women without PCOS. In this selected population, using macroscopic or microscopic evidence of polycystic ovaries with or without ovarian dysfunction, 66% of women reported infertility, 24% had ovulation induction with clomiphene citrate, and 17.5% had persisting involuntary infertility, compared with 6%, 1%, and 1.3% of those without PCOS.24 BMI three decades ago was lower overall and there was no analysis of an interaction between PCOS, BMI, and infertility in the study. A recent Swedish birth register analysis reported on pregnancy outcomes in singleton pregnancies in women with PCOS, noting increased nulliparity compared with women without PCOS, despite higher maternal age and increased use of ART (13.7% compared with 1.5% of women without PCOS). There is limited data on the natural history of fertility in PCOS and the likely health and economic burden of PCOS, infertility, and fertility therapies. Greater insight is needed into the natural history of fertility and the key predictors of infertility, including the impact of BMI and the use of fertility hormones and in-vitro fertilization (IVF) in PCOS. Using the large, prospective, community-based Australian Longitudinal Study on Women’s Health (ALSWH), it aimed to explore self-reported PCOS status, infertility (defined as trying unsuccessfully for 12 or more months to become pregnant), use of fertility hormones, and IVF and to examine the relationships between infertility, PCOS status, and BMI.
According to the study of Legro (2002), defines polycystic ovary syndrome (PCOS) as the most common, perhaps least understood endocrine disorder of women. Over the 60 years since PCOS was first recognized as a common entity, clinicians have entertained the notion that PCOS is a genetic disease. However, the exploration of the genetics of PCOS has been hampered by several factors. First, PCOS is associated with infertility and low fecundity. Thus, it is rare to find large pedigrees with multiple affected women with whom to perform linkage analysis. Second, assigning phenotypes to premenarchal girls and postmenopausal women is not straightforward, a problem that also limits the use of pedigrees. Third, there has been an ongoing debate over disease phenotypes. The larger the number of distinct phenotypes within the affected category, the more complex the genetic analysis and the greater the likelihood that investigators using different diagnostic criteria will arrive at different conclusions. Fourth, although a male phenotype has been postulated, there are no rigorously established clinical or biochemical features that can be used to identify PCOS males. This makes formal segregation analysis as well as genetic linkage studies more difficult. Fifth, the lack of animals that spontaneously develop a PCOS-like phenotype, especially mice, precludes the use of powerful tools of genetic mapping. The diagnosis of PCOS has traditionally been based on the historical variables of oligomenorrhea and hirsutism; biochemical markers such as circulating total or bioavailable androgens and gonadotropin levels; or the ultrasound image of the ovaries. The criteria that emerged from the 1990 National Institutes of Health-National Institute of Child Health and Human Development (NICHD) conference identified PCOS as unexplained hyperandrogenic chronic anovulation, making it in essence a diagnosis of exclusion. The “consensus” definition did not include the polycystic ovary morphology found on ultrasound of multiple 2- to 8-mm subcapsular preantral follicles. The rationale for not incorporating ovarian morphology in the diagnostic criteria is that polycystic ovaries are distinct from PCOS; ≤30% of an unsolicited population may have polycystic ovaries on ultrasound examination, and many of these women have normal androgen levels and regular menstrual cycles. The consensus definition also did not include insulin resistance, a common but not invariable finding in PCOS. However, insulin resistance may be a key factor in the pathophysiology of PCOS, exacerbating an underlying metabolic abnormality. The associated compensatory hyperinsulinemia can affect hypothalamic control of gonadotropin secretion and appetite, stimulate adrenal and ovarian androgen secretion, and suppress circulating levels of sex hormone-binding globulin, thus increasing the pool of bioavailable androgens.
In the study conducted by Navid (2018), defines Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine diseases that affects 6–21% of reproductive age women. A woman's life is very much affected by PCOS, due to several features characterizing PCOS (hirsutism, acne, obesity, menstrual disturbances, anovulation, and infertility). Infertility is prominent in PCOS and affects 40% of women with the disease. There is clear evidence that infertility and its treatments are associated with psychological disorders and poor quality of life moreover, the relationship between PCOS and psychiatric disorders is specific. PCOS may lead to various psychological consequences, including decreased mental health, lower self-efficacy, impaired marital and social adjustment, decreased quality of life, and poor sexual functioning. Psychologically, symptoms of PCOS in many women can lead to reductions in quality of life and may be the cause of distress. Previous studies showed PCOS is linked to depression and anxiety, emotional disorders, eating disorders, and health-related quality of life. One of the indicators affecting the health of women is marital satisfaction. Since PCOS has an association with sex hormone disorders, it can have an effect on the marital and sexual satisfaction of married women. Marital satisfaction refers to a status in which couples feel happy and are satisfied with being together. When the marital relationship is in trouble, it can lead to problems in the social relationships of couples. On the other hand, one of the protective factors against the burdens of infertility is social support. Women with PCOS who experience hirsutism and acne have often expressed that they feel “unfeminine” and “different”. Also, these women have lower social performance and diminished mental health compared to the general population. In summary, both appearances of hyperandrogenism and hirsutism may have psychological consequences for patients with PCOS. The literature indicated that there is a lack of knowledge about the relationship between PCOS and the psychological aspects of infertile women, this study was designed to compare marital satisfaction and perceived social support in infertile women with and without PCOS.
In the study conducted by Naguib (2020), determines that polycystic ovarian syndrome (PCOS) is one of the most common causes of female infertility affecting 5%–20% of women of reproductive age. As per the modified Rotterdam’s Criteria 2003, diagnosis includes 2 out of 3 of the following: chronic anovulation, hyperandrogenism (clinical or biochemical), and polycystic ovarian morphology as seen on ultrasound (US). Traditionally, infertility treatment of anovulatory PCOS starts with clomiphene citrate (CC), a selective estrogen receptor modulator. Reasons for its popularity include low cost, oral administration, relatively few side effects, minimal ovarian monitoring, and relative safety of the drug. This leads to an ovulation rate of 75%–80% with a conception rate up to 40% in patients using timed intercourse. Recently, aromatase inhibitors have been shown to increase pregnancy and live birth rates compared with CC, however, CC remains a mainstay of therapy. Patients are often started on CC/intrauterine insemination (IUI). Patients who fail to respond to CC with IUI undergo ovulation induction using exogenous gonadotropins, human menopausal gonadotropin (HMG), as a second-line treatment, along with IUI. Gonadotropins cause a transient increase in follicle-stimulating hormone to initiate and maintain dominant follicle growth, resulting in a 20% pregnancy rate per cycle. However, there is a significantly increased incidence of multiple gestations along with a higher risk of ovarian hyperstimulation syndrome. In-vitro fertilization (IVF), with or without intracytoplasmic sperm injection (IVF/ICSI), is the last step in treating infertile women with PCOS. Using single-embryo transfers, IVF treatment can result in higher pregnancy rates per cycle with a significant reduction in the incidence of multiple pregnancies. Over the last 2 decades, IVF success rates for women younger than 40 years of age have nearly doubled. However, the success rates of HMG with IUI have not changed. It has been postulated that after unsuccessful cycles using CC and timed intercourse, pregnancy should be achieved using IVF methods, bypassing gonadotropins. With consideration to the rising costs of IVF as well as a couple’s desire to achieve pregnancy as soon as possible, we explored the most efficient and cost-effective way to obtain at least 70% live-birth rate in (PCOS) patients who fail the first-line treatment for infertility with CC and timed intercourse. We believe that a 70% live birth rate is an acceptable mark and thus each protocol below was designed with the goal of providing a 70% rate by the final intervention.
In the study conducted by Taghayi (2021), states that Polycystic ovary syndrome (PCOS) is the most common endocrine disease affecting women of childbearing age. The prevalence of PCOS is estimated at 4.4-19.5 percent in Iran. PCOS has many of the symptoms of pain, inconvenience, and unpredictability, with features that are culturally considered as non-feminine and undesirable such as hirsutism, acne, and amenorrhea. Since PCOS often occurs at the same age as men and women seek to find a sexual partner, it is possible that self-confidence in one’s appearance and psycho-sexual issues may cause serious problems in these women who may feel undesirable. Women with PCOS may feel that they are less attractive to their partner and that their partner is less satisfied with their relationship. It showed that sexual and marital satisfaction in couples with PCOS is affected by the symptoms associated with PCOS such as acne, a higher BMI than their peers, and infertility. However, sample was a limited number of patients with PCOS and without considering a control group. Sexual satisfaction is defined as individuals’ perceptions of their pleasurable sexual behavior and is an individual need associated with human, social, and societal health. Sexual dissatisfaction affected individuals’ health and reduce their ability to perform daily activities and be creative. It also affected their health and well-being; for example, research shows that the incidence of heart attacks is significantly decreased in men who experience sexual satisfaction in their marital life. Similarly, women find that sexual satisfaction reduces migraine and the incidence of headache, premenstrual syndrome, and chronic arthritis. Anxiety, lower abdominal pain, an inability to concentrate, and even an inability to perform common tasks is other reported consequences of failure to satisfy sexual needs in men and women. Satisfaction of an individual’s sexual needs is therefore an important factor in physical and mental health and strengthens family life. Because of the high prevalence of PCOS and its sexual and psychological sequels as well as the social consequences of sexual dissatisfaction, the aim of this study is to evaluate sexual and marital satisfaction in couples with PCOS compared with a control group. The findings are intended to assist in screening sexual and marital satisfaction in patients with PCOS and setting treatment goals in clinic and primary care.
Marital Status
In the study conducted by Tabassum (2020), shares that according to the World Health Organization (WHO), polycystic ovary syndrome (PCOS) affected 116 million (3.4%) women worldwide in 2012 and the centre for disease control and prevention reported the most common causes of female infertility among US women at reproductive age. It comprises around 6 to 12% (around 5 million) populations. In addition, PCOS has been reportedly high among Indian women similar to their Caucasian counterparts, with an estimated prevalence of around 9.13%-22.5% in Indian adolescents. No proper published statistical data are available on the prevalence of PCOS in India. Thus, PCOS is the major endocrine disorder among women in reproductive age suffering from anovulation or oligoovulation and hyperandrogenism without any other underlying condition. The major risk factors in PCOS women are the increased risk of psychological and reproductive problems including depression, anxiety, suicidal thoughts, infertility, endometrial cancer, and gestational problems. On the other hand, PCOS cases may cause psychological morbidity and have a significant negative impact on health-related quality of life (HRQOL) in women at reproductive age. PCOS cases have a greater predisposition to obesity and more adversely affect the HRQOL mainly due to infertility consequences. The level of hyperandrogenism and its related clinical symptoms seriously overweight against performing daily work, as well as social activities and affecting HRQOL in young patients.Currently, the due importance is given for understanding the effect of PCOS symptoms and treatment for HRQOL in PCOS cases. The variability of PCOS symptoms makes it important to understand the QOL from each patient’s prospects. Furthermore, novel treatments and therapies can then be targeted toward improving psychosocial problems, which are most important for the concerned individual. Psychological alterations due to infertility and cosmetic problems in PCOS cases are receiving greater attention for improving HRQOL. Moreover, compromised QOL and mood alterations including depressive symptoms, compromised sexual satisfaction, and feminine identity are among the major concerns in PCOS cases. Earlier, different investigators in the urban population reported various studies. However, the existence of PCOS cases and its effects on HRQOL in the young population have been least reported in diverse populations of north India. Thus, this is also of utmost importance to find out the demographics of PCOS and its related HRQOL for improving psychosocial understanding regarding disease treatment and better medical policy implementation in a particular population.
In a comparative study conducted by Life (2013), PCOS is associated with an increase in subfertility, ectopic pregnancy and early pregnancy loss (EPL). Potential causes are an altered endometrial environment and subsequent reduction in implantation success due to the hyperinsulinemic environment and concurrent hyperandrogenism. The rates of infertility and EPL have been estimated to be 15 times and three times greater, respectively, than women of similar demographics; however, it is unclear as to whether body mass index (BMI) or the use of fertility treatment (ovulation induction and/or in vitro fertilization (IVF)) had a role to play in the higher rates observed (Joham, et al., 2015).
Millennial
Millennial or also called the generation Y, were born between the year of 1982 to 2000, (U.S Census Bureau, 2019). They have surpassed the baby boomers to become the largest living generation in the world, (Abella, 2019). As expected by their birth years, the millennial generation makes the fastest growing segment of the workplace, as companies compete of available talent employers simply ignore the needs, desires, and attitudes of this vast generation. According to Kane (2019), that millennial grew with the advancement of technology and they rely on it to perform their jobs better. Generation Y have been labeled as well as Family Centric with the willingness to trade high pay for fewer billable hours. Millennial are goal oriented, they have been nurtured and pampered by their parents who did not want to make mistakes of the previous generation.
Survey data has shown that millennials strongly prefer to have a holistic approach to health, 90% of millennials stated that they want mental and emotional health support, adequate sleep and positive family relationships. Research also shows that millennials have been experiencing more anxiety than previous generations. According to a Welltok survey report contradicts a common assumption about millennials whish is that they are mainly concerned with convenience and are much less interested in accessing primary care service. According 93% of millennials states that they want a provider relationship however, 85% feel otherwise and expresses that providers only care about them when they are sick. Women with polycystic ovarian syndrome have shown dissatisfaction with health care providers, diagnostic processes and initial treatment of PCOS and they tend to seek information through alternative sources. Information acquired in the internet has significantly affected the patient-physician relationship, allowing medical information whether factual or not to be acquired by patients paves way to reshaping their healthcare perspective. Patient dissatisfaction with health care providers in regards with polycystic ovarian syndrome raises questions of responsibilities of academic institutions to properly and adequately train and maintain clinicians and government agencies competence in order to sufficiently support scientific investigation focusing in this field. (Hoyos, et al., 2020). Millennial became the largest generation of living adult, and by 2020, nearly half of the workforce was dominated by this generation, making millennial health and how they consume healthcare an important issue in the healthcare landscape of the country. With the exception of family, millennial value health the most, prioritizing the well-being and mental health (Nermoe, 2018). According to American Psychological Association, this generation is the most stressed-out and heavily focus on healthy living than any of the other generation. This particular generation believed that health is the gateway to success, pursuing good health can make them successful and improved the quality of life in reducing stress and feel happy (Adamo, 2015) . Millennials achievement for having quality of life would be like winning a lottery due to its complexity and broad concept.
In the study conducted by Tom (2013), stated that human disease is often complex, as are treatments. Thus, effective communication between healthcare providers and patients is ever more important in our efforts to improve healthcare as is a basic level of health knowledge by patients and it is founded upon adequate health knowledge and health literacy. Large percentage of Americans have low health literacy skills, which restricts their acquisition of health knowledge about where young adult Americans acquire their health knowledge and the extent of their actual depth of understanding. In the past most Americans received the majority of their health education in high school yet in the 21st century health knowledge can now be acquired from many non-school sources, and particularly from the internet and other media. As health topics are being presented with increasing frequency on TV and web programs, the population is inundated with health-related information such as advertisements for drugs to treat diseases, to lose weight and to have greater energy. Although many adult Americans use the Internet to search for health information including the Millennials, it is unclear what the impact of this mix of sources of health-related information has been on health knowledge acquisition among young adults and how it will impact their health care in the future. Numerous assessments of adolescents’ health behaviors have been made, and mass media has been shown to be an effective tool to change health behavior in adolescents. However, quantitative studies to assess clinically relevant health knowledge among young adults have not been reported. Prior to the explosion of media-based health information, health education classes in middle and high school were the primary sources of health information to the public. The curricula in the US has been based upon theory that learning is hierarchical and that acquisition of content is a necessary base structure upon which comprehension, application and synthesis are sequentially built. Some assessments of the use of the internet for health information have been performed yet this does not inform to the level of working health knowledge by the users. The present study was undertaken in an effort to learn the level of clinically related health knowledge possessed by 18 year old American high school students. In this context clinically relevant refers to knowledge that can be directly linked to physical health. Thus our goal is distinct from assessments of school health programs in the US over the past two decades which have placed increasing emphasis on promotion of healthy behaviors. As the instruments for assessment of these programs are not appropriate for our study we developed a health knowledge survey appropriate for high school seniors because high school is the last period of formal health education for most Americans. The survey we developed focuses on two domains of clinically relevant health knowledge, namely health content, which encompasses factual information, and health application, namely the ability to use health information in real-world situations.
Mood
Mood refers to emotional response of the women diagnosed of PCOS, it may vary from calm, fear, anger, or joy depending on the situation of the individual (Olfson, 1995). Women are at their greatest lifetime risk for mood disorders during their childbearing years (Weissman and Olfson, 1995). Mood, or affective, disorders include unipolar depression and bipolar disorder (American Psychiatric Association, 2000).
In the study of Stopa (2015), polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of childbearing age. It is estimated that 5–10% of women suffer from PCOS. It was firstly described in 1935, by Stein and Leventhal as a group of symptoms consisting of hirsutism, amenorrhea, enlarged ovaries and obesity; the term ‘‘polycystic ovary syndrome’’ was later introduced even though the name Stein–Leventhal syndrome is still accepted. PCOS is characterized by menstrual disturbances like amenorrhea (or most often oligomenorrhea), hyperadrogenism (including hirsutism) or acne and very often by obesity. PCOS is also a common cause of chronic anovulation and infertility. All these annoying symptoms may be the cause of psychological problems, impaired sexual functioning, depression and marital and social maladjustment. The prevalence of depression among women with PCOS is very high and varies from 28% to 64%, including different kind of feeling sick, depressed mood, melancholy, sadness, regardless of the cause of this disorder. The symptoms of depression include: depressed mood, loss of interest and the ability to enjoyment, energy reduction leading to intensified fatigue and loss of activity. Other common symptoms include poor concentration and attention, low self-esteem, sleep disturbances, loss of appetite, thoughts, trends and even suicide attempts. Anxiety is another common disturbance in women suffering from PCOS, varying from 34% to 57%. Multiple factors contribute to the high prevalence of depression and anxiety in women with PCOS. The most likely reason of psychological complications is physical symptoms experienced by patients with PCOS. Additionally, PCOS has clinical implications across the lifespan and is relevant to related family members with an increased risk for metabolic conditions reported in first-degree relatives. Long term adverse health problems including increased risk of insulin resistance, obesity, type 2 diabetes, hypertension, dyslipidemia, inflammation and subclinical cardiovascular disease. Diagnosis of PCOS includes a heterogeneous group of women patients with regular ovulatory cycles with relatively normal weight as well as in women with fully developed clinical symptoms: the impact on psychosocial functioning largely is concerned among the second group of women. The diagnosis of PCOS is based on the Rotterdam 2003 criteria that include the presence of two out of three of the following features: oligo/anovulation, clinical and/or biochemical hyperandrogenism and polycystic ovaries by gynecological ultrasound. It is estimated that PCOS affects 5–15% of women and is a leading cause of infertility by the lack of ovulation – affects approximately 73% of women with difficulty in getting pregnant. Causes of PCOS are not so far fully explained. The exact etiology of PCOS remains unclear, but it is believed to result from complex interactions between genetic, behavioral and environmental factors. It is believed that the most important role is played by genetic factors. In most cases of PCOS, an autosomal dominant inheritance is found. The occurrence of PCOS depends on the coexistence of predisposing factors, such as tissue insulin resistance, impaired secretion of GnRH and dopamine receptors dysfunction. The environmental factors associated with the disclosure of PCOS are weight gain and obesity. Clinical symptoms depend not only on the hormonal profile but also on the sensitivity of target tissues to steroid hormones and the coexistence of obesity. This multifactorial pathogenesis explains the diversity and unequal degree of severity of clinical symptoms. A role of CYP 17 gene (located on chromosome 10q 24.3) is suggested for PCOS appearance. CYP 17 gene codes cytochrome P-450c-17 alpha structure is involved in steroidgenesis. Hyperinsulinemia, often found in PCOS, stimulates ovaries and adrenals to androgens production, which are responsible for excess additional symptoms such as hirsutism, acne, seborrhea, hair loss and in extreme cases lowering voice and body structure changes. Dyslipidemia is another metabolic disorder, often present in the course of PCOS. It is characterized by the elevated LDL, cholesterol, triglycerides level and low levels of HDL. Some pathological conditions such as diabetes type 2 and cardiovascular and/or respiratory tract disease, could be responsible for further PCOS complications. Lastly, it is believed that oxidative stress plays an important role in the pathogenesis of PCOS. It is not entirely clear whether oxidative stress affects the development of PCOS, whether it is only a secondary condition as a result of hyperglycemia and insulin resistance. It is believed that oxidative stress in PCOS is related to the risk of heart disease. The clinical symptoms occurring in women with the recognition of PCOS are the consequences of hyperandrogenism, anovulation and metabolic disorders. The purpose of the review is to elucidate the impact of these symptoms in PCOS patients on the mood disorders.
A study conducted by Michael (2014), polycystic ovary syndrome (PCOS) is a common endocrine disorder among females of reproductive age, and typical symptoms include hyperandrogenism, anovulation, irregular menstrual periods, and infertility. Although not formally part of the diagnosis for PCOS, females with PCOS also frequently present with co-occurring obesity and depressive symptoms. Excess body weight among youth with PCOS has been independently related to increased risks for metabolic syndrome and type 2 diabetes mellitus. Moreover, depressed females with PCOS have been shown to have greater insulin resistance and BMI than non-depressed females with PCOS. Depression among clinical samples has also been shown to increase risk for non-compliance to a medical treatment regimen. Participation in regular physical activity has been shown to contribute to weight loss and reduce symptoms of depression, yet research on physical activity as a therapeutic tool for youth with PCOS is lacking. Using self-report methods, youth with PCOS have been shown to participate in structured physical activities less often and at a lesser intensity than BMI-matched youth without PCOS. However, an overall, objective picture of physical activity, structured and unstructured, among youth with PCOS is missing. Knowledge about how often youth with PCOS initiate a physical activity bout and how long the bout of physical activity is sustained could provide key information for providers about how to appropriately prescribe and tailor activity interventions. Furthermore, understanding the role of obesity and depression in physical activity initiation and duration should also not be ignored because both are often comorbid with PCOS and proven barriers to physical activity engagement. The present study included pilot data on a unique sample of youth with PCOS who completed ambulatory monitoring of physical activity as part of a larger-scale behavioral lifestyle intervention. The primary aim of the current study was to examine physical activity patterns among youth with PCOS using novel methodology that samples physical activity in youths’ natural environment and provides real-time, objective physical activity monitoring. The secondary aim was to examine BMI and depressive symptoms as independent predictors of physical activity in youth with polycystic ovary syndrome (PCOS). Based on previous research, we hypothesized that there will be an inverse relationship between BMI and physical activity outcomes. Additionally, we hypothesized that higher ratings of depressive symptoms, as measured by self-report and parent report, would predict lower total physical activity and shorter durations of continuous physical activity bouts.
In the study by Głowińska, (2016) states that polycystic ovary syndrome (PCOS) is the most common endocrinopathy, affecting women in the reproductive age. PCOS is diagnosed in approximately 5–10% of the female population. The diagnostic criteria include hyperandrogenism, ovulatory disorders, and the presence of ovarian cysts on ultrasound. Diversity of the diagnostic criteria results in a significant patient heterogeneity in terms of concomitant symptoms such as hirsutism, acne, excess weight, or obesity. Due to its complex nature, PCOS may be accompanied by a number of problems, manifesting over the course of a patient’s life and causing considerable stress. PCOS is treated as a risk factor for infertility, metabolic syndrome, and cardiovascular diseases. Prospective studies in perimenopausal women with PCOS have demonstrated higher incidence of type II diabetes. According to various authors, PCOS patients are more likely to suffer from mood disorders and increased anxiety. Most studies on the mental functioning of the affected women are comparative, estimating the incidence of mood disorders and anxiety level in PCOS patients and healthy controls. The results unequivocally indicate that depressive disorders are 4–5 times more frequent among PCOS patients, and that the vast majority of the investigated women present with mild or moderate symptoms of depression and slightly elevated anxiety levels. The main cause behind this remains unclear, with androgen levels, hirsutism, obesity, insulin resistance, and infertility among the suggested reasons. Interestingly, obesity and infertility treatment, which have been identified as strong risk factors for depression in studies unrelated to PCOS, do not appear to differentiate the group of PCOS patients in terms of risk for mood disorders, according to preliminary reports. A recent study conducted on a relatively large sample of women (n = 301) has reported the suspected role of insulin resistance as a risk factor for depression in PCOS patients. However, the results are not consistent with previous publications. Reports evaluating the influence of the body mass index (BMI) on the risk for depression also present conflicting results. Several studies on the quality of life in PCOS patients have been published. Their results led to believe that factors influencing the risk for mood disturbance and anxiety in the context of PCOS symptoms may include patient resources, i.e. internal mental disposition as well as environmental support. Concurrent analysis of the relevant medical and psychological factors and an attempt to describe the mechanisms of developing mood and anxiety disorders in PCOS patients, rather than attempting to identify a single factor, appears to be a promising method.
Polycystic Ovarian Syndrome
Polycystic Ovary Syndrome (PCOS) is a condition that affects a woman’s hormone levels (John Hopkins Hospital, 2022). Women with PCOS produce higher-than-normal amounts of male hormones (John Hopkins Hospital, 2022. This hormone imbalance causes their body to skip menstrual periods and make it harder for them to get pregnant. For instance, PCOS can disrupt the menstrual cycle, leading to fewer periods, acne, hair growth, weight gain and dark skin patches are often symptoms of the condition. The article shows that hormones imbalances can affect a woman’s health in many ways. PCOS can increase the risk of infertility, metabolic syndrome, sleep apnea, endometrial cancer and depression. PCOS is a long term disease with greater chances of other comorbidities like type II diabetes linked with it, so lifestyle modification is the crucial and simple approach for implementation in women with PCOS. Studies revealed that changes in the lifestyle, including diet, exercise and attitude have a positive impact on body weight, insulin resistance, and testosterone levels (Moran et al., 2011). Many women are often not immediately diagnosed with PCOS and it is important for physicians to look for the hallmark signs of PCOS, such as menstrual cycle irregularity, hirsutism, infertility and a family history. It is important to note that outside of these criteria, women with PCOS often experience other conditions that can affect their short-and long-term physical and mental health. Decreased quality of life from mood disturbances, decreased sexual satisfaction, weight gain, acne vulgaris, and alopecia have all been documented (Hahn et al., 2005) Although it is important to treat the short term disturbance for women, research shows that it is important to think about the future of women with PCOS, as many of them will develop metabolic syndrome (Caliskan 2005). Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an abnormal amount of androgens, male sex hormones that are usually present in women in small amounts. The name polycystic ovary syndrome describes the numerous small cysts (fluid-filled sacs) that form in the ovaries. However, some women with this disorder do not have cysts, while some women without the disorder do develop cysts. Ovulation occurs when a mature egg is released from an ovary. This happens so it can be fertilized by a male sperm. If the egg is not fertilized, it is sent out of the body during your period. In some cases, a woman doesn’t make enough of the hormones needed to ovulate. When ovulation doesn’t happen, the ovaries can develop many small cysts. These cysts make hormones called androgens. Women with PCOS often have high levels of androgens. This can cause more problems with a woman’s menstrual cycle. And it can cause many of the symptoms of PCOS.
According to the study of Lenhart (2014), it defined PCOS as one of the most common disorders of the endocrine system affecting women of reproductive age. The exact cause of PCOS as of today is still unknown; however, it is often associated irregularities in metabolic process and hormone levels which may be due to a combination of several factors such as but not limited to insulin resistance, obesity, and changes in hormone production. With PCOS, the hormone androgen which are prominent in males but can also be detected in females but in small amount tend to have increased level which is significantly higher than normal. These increased levels of the hormone androgens inhibit the production of progesterone which is a significant factor for a normal menstrual cycle. Usually, the hormone estrogens are at a normal level. Underdeveloped egg follicles are a result of abnormal increase of the androgens and decrease of the hormone progesterone. Due to these abnormal changes of hormone levels, ovulation cannot occur and these immature follicles as a result turn into small cysts in the ovaries. Approximately 5-10% of women are being affected because of PCOS in the span of their childbearing age, however, around 30% of women exhibits the characteristics which are prominent with this syndrome. Polycystic Ovarian Syndrome is known as the most common endocrine disorder among pre-menopausal women.
In a study conducted by the Women’s Hospital School of Medicine (2021), polycystic ovary syndrome (PCOS) is one of the leading causes of female infertility, affecting around 5% of women with a child-bearing age in China. Vitamin D insufficiency in women is associated with lower live birth rates in women with PCOS. The Evidence of the vitamin D treatment efficacy is still however inclusive.
In the study conducted by Zehravi (2021), defined polycystic ovarian syndrome as the most well-known endocrine condition among women of this generation (PCOS). Symptoms such as hyperandrogenism, insulin resistance, and irregular menstrual periods are all traits associated with PCOS. There is also an increase chance of having problems such as infertility, insulin resistance, and type 2 diabetes. The PCOS board hopes to avoid misunderstandings as well as restore fertility, reduce body weight and insulin levels, control excessive hair growth on the body or scalp, and re-establish the regular feminine cycle. One of the most common metabolic modulators is insulin sensitizers, but their effectiveness showed to be intermittent. Insulin resistance and thiazolidinediones is central to the pathophysiology of polycystic ovarian syndrome having nearly similar efficacy with metformin. In the management of PCOS, statins and incretins are newer therapies with obvious metabolic targets. Vitamin D, acarbose, and myoinositol are just a few of the reciprocal and optional clinical treatments that have been proved to be useful in the treatment of PCOS. The number of viable methods for dealing with PCOS-related infertility has increased as well. Despite the fact that clomiphene citrate (CC) has long been the gold standard for ovulation induction in the event of ovulatory infertility, aromatase inhibitors can induce ovulation with results that are nearly identical to or better than those reported with CC, aromatase inhibitors can cause ovulation with results that are nearly identical to or better than those reported with CC. Ovarian incitement conventions that intelligently utilize gonadotropins, gonadotropin-delivering hormone rivals, the approach of ovarian boring, and assisted conceptive advancements with in vitro oocyte development indicate an expanding level of therapeutic progress. Based on the researcher, polycystic ovary syndrome (PCOS) is the major endocrine related disorder in young age women. Physical appearance, menstrual irregularity as well as infertility are considered as a sole cause of mental distress affecting health-related quality of life (HRQOL). This study concluded that PCOS clinically characterized by either oligoovulation or anovulation and hyperandrogenism that may cause infertility, and other related metabolic disorders. This progresses to increased risk of reproductive issues like infertility endometrial cancer, gestational as well as mental disturbances.
According to the study conducted by Woodward (2020), revealed that up to 15% - 20% of women are affected by polycystic ovarian syndrome and is characterized by obesity, visceral fats, dyslipidemia, insulin resistance and reproductive and cardiometabolic complications. The Rotterdam criteria states that for women to be diagnosed with polycystic ovarian syndrome that woman must be present with two of the three signs/symptoms which are chronic anovulation/oligomenorrhea, hyperandrogenism and polycystic ovaries in the absence of diseases that promote these symptoms. The researchers have used quantitative measurements in the conduct of the study to determine if increased physical activity and supervised training helps in reducing cardiovascular risk for women with PCOS. According to the researchers, it has been posited that as a rule of thumb at least 30 participants should be overall sufficient in the conduct of the feasibility study. In addition, sample sizes between 24 and 50 have been recommended for calculation of a standard deviation of an outcome. Furthermore, the study has stated that its limitation is that some self-monitoring in terms of lifestyle for physical activity group may not be as reliable or replicable.
Quality of Life
The term QOL was coined in the United States after World War II (Vendegodt, 2009). At first it meant “the good life,” and was limited to having or not having typical consumer goods. Good QOL meant affluence – having a car, a house of one’s own or other commodities. It was a “have” category. The concept gradually evolved and its range widened to encompass life satisfaction, realisation of one’s needs and aspirations and modifying one’s environment in order to cope with it better. In other words, the QOL concept gradually moved from “have” to “be.” In those days, high quality of life was reserved for the healthy. Only a healthy society – the argument went – can produce material and cultural goods and enable people to use them and achieve the high level of development which is the mark of better quality of life. Attention was paid to the process of QOL assessment. Finally, general QOL began to be defined as an individual’s appraisal of his/her own life situation within a specific time span (Gałuszko, 1997). In other words, it is the appraisal of a fragment of one’s life which takes place between the human subject on the one hand and the factors which have an impact on him/her from the external environment and the internal environment (his/her own body) on the other hand. Observer ratings are viewed as additional, complementary information. One must remember that these ratings are not free of subjectivity in the perception of reality. The importance which people ascribe to various aspects of life partly depends on the role the respondent is playing in the diagnostic process and the respondent’s profession. Physicians pay more attention to the somatic state and to physical complaints which may reduce quality of life. Psychologists and the patient’s family pay more attention to psychosocial dimensions. The subjective source – direct appraisal of one’s situation by the interested party – is now considered the most important and most valid source of information. So what are the determinants of one’s appraisal of one’s quality of life. Everyone takes several factors into consideration when appraising their quality of life. Some of these factors are objective, others are subjective. External factors which are important for both healthy and unhealthy people include the economic situation, education, place of residence, work, family relations, and social relations. Appraisal of the life situation is mutable and depends on the respondent’s personality, which has been shaped by former experience and social status .Temperament, which is largely genetically determined, also affects the appraisal of one’s quality of life.
Researchers have paid attention to aspects of health other than biological and strictly medical since the mid-twentieth century. It has drew attention to this problem in the following words: “We can treat the cancer patient, prolong his life for months or even years, but treating prolongation of life as a measure of medical success is the critical issue” (Burchenak, 1949). This leads to the most difficult question of all: who wants to live in pain deprived of his most basic functions, completely dependent on the environment. As interest in bio-psycho-social issues increased it became necessary to define and identify the criteria of evaluation of QOL in patients. Many studies of QOL began to appear in the medical sciences in response to the shift toward a more holistic understanding of human nature, in which subjective states were also important. These subjective factors definitely affect the patient’s life situation. From the medical perspective, not only is objective improvement of health very important but also the subjective quality of life. The QOL concept began to appear in the medical sciences in the 1970s. Before that, attempts had been made to identify the various dimensions of QOL but not to associate these dimensions with QOL directly. For example, these dimensions were included in the definition of health formulated by the World Health Organisation’s (WHO) in 1949. According to this definition, health was a state of complete psychological and social wellbeing. Later QOL was defined as the individual’s experience of his/her own life situation in the context of his/her culture and value system, and also with respect to his/her goals, expectations and standards (World Health Organisation, 1996). The authors of this definition also point out that QOL is a capacious concept and that it can be modified by many factors relating to physical health, psychological state, level of independence, and social relations, as well as personal beliefs and their relations with significant aspects of the external environment. Researchers began to refer to this definition and to equate good quality of life with subjective wellbeing, which they divided into cognitive wellbeing (judgement of life) and affective wellbeing (subjective happiness). Then they began to link quality of life, thus defined, with other variables (socio-demographic, personality and economic, life events etc.). Efforts to define QOL more precisely finally led to the development of a new quality of life concept which could be applied in the medical sciences, health-related quality of life (HRQL). Schipper and collaborators introduced this concept to the medical sciences towards the end of the twentieth century and defined it as “the functional effect of illness and its treatment perceived (experienced) by the patient”. HRQL has four aspects: physical state – somatic experience and motor fitness, psychological state, social situation, and economic conditions (Schipper et al., 1996).
These four basic dimensions are widely considered to be sufficient for the evaluation of basic components of QOL. In the broad sense, QOL means subjective appraisal of one’s happiness and satisfaction with life.
In the study conducted by Ferrer (2020), Polycystic ovary syndrome (PCOS) is one of the most common chronic endocrinopathies affecting between 5 and 10% of reproductive age women. Clinical manifestations of this syndrome such as obesity, infertility, hirsutism, biochemical and hormonal disturbances has been widely described. Yet, these symptoms are often related to deterioration in the woman’s self-esteem and self-image and may affect their health-related quality of life (HRQoL), particularly in relationship with psychosocial domains. HRQoL is a multidimensional concept widely used in medical research, but its usage in routine medical practice is increasing. It is defined as “individual’s perception of their own life in the context of their cultures and believes, and their personal goals and concerns”. Important areas such as physical health, psychological health, level of independence and social relationships are included in HRQoL evaluation. Over the past years, there has been a growing tendency to incorporate assessment of HRQoL in clinical studies and routine clinical management of PCOS. Consequently, several investigations conducted over the world have shown associations between HRQoL and the presence of PCOS. Women with PCOS may be at a higher risk of low HRQoL. However, several of the previous studies have focused on series of women with PCOS or evaluated the effect of an intervention (lifestyle or medical treatments) on HRQoL of women with PCOS without adequate control. Therefore, the interpretation and generalization from these studies is challenging, due to relatively small sample sizes, heterogeneities between study populations, tools evaluating HRQoL, or the inadequate control of confounding. The impact of potential confounders such as age, body mass index (BMI), educational level or even professional activity upon HRQoL in PCOS women is uncertain as they may not have been properly evaluated. Besides, there are differences in PCOS symptoms presented across geographical locations and between differing race and ethnic groups. Moreover, the Rotterdam ESHRE/ASRM definition recognizes four different phenotypes of this syndrome, but whether there are differences in the HRQoL between the different phenotypes has never been analyzed. It is also important to know more about HRQoL in women suffering from this common problem in order to develop strategies and interventions to enhance their HRQoL. Therefore, the goal of this work was to compare the HRQoL of adult women with PCOS -and its phenotypes- and controls. We hypothesize that women with PCOS, especially those with anovulatory phenotype, would show worse HRQoL compared to women without PCOS.
In the study conducted by University of Derby (2016), stated that polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders amongst women, estimated to affect one out of 10 women. Symptoms include infertility, obesity, alopecia, acne, hirsutism and menstrual irregularities. Women with the syndrome are also more likely to experience co-morbid physical and psychological conditions such as diabetes, heart disease, endometrial cancer and also depression and anxiety. PCOS has also been found to have a negative impact on quality of life. This thesis aimed to further understanding, and improves quality of life of women with PCOS in the UK. To achieve this, the thesis aimed to investigate and identify how women with PCOS in the UK perceive and define their quality of life and to further understanding of the day-to-day experience of living with PCOS. Moreover, in order to measure quality of life, it aimed to develop and validate a UK disease-specific quality of life measure for women with PCOS. It also aimed to identify, develop and test a pilot intervention to increase quality of life in women with PCOS. To achieve these aims a mixed-methods approach was taken employing a variety of data generation and collection methods including: photovoice, online Skype™ interviews; LimeSurvey and Qualtrics. The findings of this thesis emphasise that PCOS has a negative impact on quality of life; encompassing psychological, social, environmental, and physical domains of quality of life. Women with PCOS who experienced the symptoms of infertility, hirsutism, weight, alopecia, skin discolouration, skin tags and mood swings had significantly lower scores of overall quality of life than those women who did not experience the symptoms. In addition, those women with PCOS who had a diagnosis of anxiety and/or depression had reduced quality of life. The dissemination of these findings will enable health care professionals to better understand the experience of living with PCOS and its impact on quality of life. Moreover, this thesis identifies many areas for future research which will enable a better understanding of the impact of PCOS on quality of life. Finally, this thesis makes recommendations for clinical practice which include improvement of support from health care professionals for women with PCOS in order to help them better manage their symptoms, and therefore improve their overall quality of life.
Synthesis and Gap
Elicited from the review of related literature that the researchers gathered related to polycystic ovarian syndrome and quality of life. It was found that quality of life has four domain factors which are physical health, psychological stage, level of independence as well as personal beliefs in the relations with the environment. Similarly some studies explore quality of life and how it was affected by means of health condition. There are some studies that present how polycystic ovarian syndrome affects the quality of life and determine factors contributing to the effects of PCOS in the life of the respondents. Some studies have presented common symptoms of polycystic ovarian syndrome which are irregular periods, excess body hair, weight gain, acne or oily skin, infertility, depression or mood swings, and male-pattern baldness or thinning hair. Moreover, the quality of life is affected when there is a domain that is affected by health condition, environmental situation, psychological status and social relationship. The researchers have explored many foreign studies and literature about the quality of life of millennial diagnosed of Polycystic ovarian syndrome. Though several studies have been conducted in different counties and states, no study have been published about polycystic ovarian syndrome and its effect to the quality of life focusing of women diagnosed of PCOS and living in Dapitan City province of Zamboanga del Norte. Also previous studies have look into the effect of polycystic ovarian syndrome in the quality of life using the PCOS-QOL scale that determines the impact of PCOS and its subscale which are the infertility, hirtuism and mood, but no certain studies have focused on the millennial generation as the respondents and how it affect to their life. Thus, this present study aims to determine the effect of polycystic ovarian syndrome to the quality of life and its subscale which are the infertility, hirtuism and mood focusing on the millennial generation diagnosed of Polycystic ovarian syndrome that lives within the city of Dapitan province of Zamboanga del Norte.