Risks in Polycystic Ovary Syndrome that Affect Quality of Life | Bhattacharjya & Amaresha

by Astha G Bhattacharjya, Anekal C Amaresha *

Many women of reproductive age suffer from the endocrine-gynecological condition known as polycystic ovarian syndrome/disease (PCOS/PCOD). Currently, there is no effective treatment and there are only medications available to alleviate the suffering due to this condition. Medically, in the allopathic system of medicare, it is considered a ‘lifestyle disease’ and clinicians typically recommend leading a healthy lifestyle for prevention of PCOS/PCOD. Women with PCOS/PCOD have issues in terms of extreme pain during the menstruating phase, weight gain and menstrual irregularities which lead to poor quality of life. In various indigenous and other systems of medicine, many remedies are offered.

This study aims to explore body-appreciation and the quality of life among women who face the risk of PCOS/PCOD. As many as 79 percent of the participants in this online study were found to have moderate to high risk of PCOS/PCOD. The body appreciation and quality of life scores were found to be lower among the participants. Overall, however, the conclusion was, that there is no significant difference between body-appreciation and quality of life for women with PCOS/PCOD and those without. The participants in this particular did have higher levels of risk for PCOS/PCOD. It is obvious from this small study that large studies with longitudinal designs are required to establish the causal factors or predictors of PCOS/PCOD and its relation with body appreciation and quality of life.

MAJORITY OF ENDOCRINE disorders affecting women of reproductive age are caused by polycystic ovary disease (PCOD), which affects five to ten percent of women in the West. A wide variety of symptoms are present in various combinations in women with PCOS/PCOD (Varghese Joy, Saji S and Radhakrishnan, 2018). These include insulin resistance, hirsutism, sub-fertility or infertility, anovulation, weight gain or obesity, acne vulgaris, oligomenorrhea, menorrhagia, androgenic alopecia, as well as amenorrhea, oligomenorrhea, menorrhagia, and menorrhagia (Varghese Joy, Saji S and Radhakrishnan, 2018). Expanding research also links metabolic disorders and illnesses like PCOS to an increased risk of endometrial cancer, type 2 diabetes, cardiovascular disease, dyslipidaemia, and hypertension.

Due to the wide range of symptoms, PCOS/PCOD has been difficult to diagnose (Varghese Joy, Saji S and Radhakrishnan, 2018). This cross-sectional, online survey included 204 women (18-25 age group) and the data was collected using Body Appreciation Scale-2 and WHO Bref Quality Of Life (WHOQOL BREF) scale. Factors related to PCOS/PCOD were calculated, using symptoms in the WHO protocol. Many studies have been conducted on this. Convenience and snowball sampling were used to collect the data via questionnaires (google forms) using social media.

The current study is a cross-sectional, descriptive research, which explores body appreciation and quality of life among women at risk of PCOS/PCOD. It also studies the association of demographic profiles of women at risk and not at risk with study variables, body appreciation and quality of life. The study was conducted from August 2022 to October 2022. The respondents were from urban and rural settings, who are able to comprehend English.

Semi-structured questions were used. The symptoms of PCOD were calculated by using questions such as, ‘Have you gained weight?’, ‘Do you have irregular menstrual cycle?’, ‘Do you have oily skin’, ‘Do you have hair loss?’, ‘Do you have acne’, ‘Do you have abnormal hair growth’, ‘Do you have dark skin patches?’ (Cronin, Guyatt, Griffith, et. al., 1998).

To measure the risk factor for PCOD affecting quality of life, the QOL (Quality Of Life) scale by WHO (World Health Organisation) was used. The WHOQOL-BREF domain scores have a strong correlation (0.89 or above) with the WHOQOL-100 domain scores (calculated on a four- domain structure). Test-retest reliability, internal consistency and Discriminant Validity of WHOQOL-BREF domain scores were all favourable (T, 1998). The WHOQOL-100 was developed using a unique cross-cultural approach. The WHOQOL development method has several unique features. The WHOQOL-BREF domain scores have a strong correlation (0.89 or above). Cronbach’s alpha coefficient for the whole WHOQOL-BREF scale was 0.896. WHOQOL-BREF domain scores demonstrated good Discriminant Validity, Content Validity, Internal Consistency and Test—retest Reliability (T, 1998). The range of the correlations between item/facet and its domain was 0.53 to 0.78, and for inter-domain was 0.51 to 0.64 (all p < 0.01) (T, 1998). The measure involved a collaborative approach to international instrument development (Bullinger, Kuyken, Orley, Hudelson and Sartorius,1994).

To measure body image issues, the scale that was used is Body Appreciation Scale. It examines three aspects of a body (body acceptance, respect for one’s body, and resistance to media-imposed appearance ideals). The questionnaire has ten items that are rated on a 5-point Likert scale (1 = Never, 5 = Always). It has been used in the Indian context before, which means it can be used for this research. Avalos, Tylka, & Wood-Barcalow came up with the scale and it is being used to measure the body image issues that women suffering from PCOD or at the risk of PCOD go through. In this study, the reliability of the scale was calculated equal to 0.91, using Cronbach’s alpha coefficient (Barcalow, Tylka, Avalos; 2005). The Discriminant Validity of the scale managed well to discriminate between the fit and dysmorphic groups (Barcalow, Tylka, Avalos; 2005). The items displayed improved reliability for latent levels of body appreciation that were 2 SD or less from the mean level (BA) (Zarate, Marmara, Hosking, & Potoczny, 2021).

The Poly-Cystic Ovarian Syndrome is more commonly mistaken as PCOD (a polycystic disorder). PCOS is a specific disorder of the endocrine system while PCOD is a disorder due to hormonal imbalance (not necessarily of the endocrine system). Health-related research on quality of life says that PCOS/PCOD significantly lowers HRQoL, with body weight problems and BMI (body-Mass Index) serving as mediators (Kaczmarek, Haller, Yaron, 2016). Additionally, other studies on patients with high BMI has shown that women with PCOS/PCOS had a higher likelihood of experiencing depressive symptoms (Dokras, Clifton, Futterweit, Wild, 2012).

Literature review shows that most research is done on PCOS but PCOD is studied lesser. Many more studies have been conducted on body image and quality of life with PCOS than for PCOD,

 hence there is a need for such studies. Even research available on PCOS is insufficient and with so little research data available, it is difficult to have a thorough grasp of the psychological difficulties that PCOS/PCOD patients experience (Kaczmarek, Haller, Yaron, 2016). Their is almost no research on the ‘pain’ suffered and women’s level of tolerance. Through this study, only the effects of PCOD on quality of life and body image issues that women face can be looked at.

Research has been done on topics like evaluating outcomes and complications of pregnancy in women with PCOS/PCOD where it was found that women with PCOS/PCOD had a higher risk of gestational diabetes and pregnancy-induced hypertension. This seemed to be independent of their BMI (Wang, Zhao, Zhao, Ding, et. al., 2013). Also, women suffering from PCOS/PCOD are at a higher risk of suffering through pregnancy-induced hypertension than those not suffering from PCOS/PCOD (Kashyap, Claman, 2000).

Research on awareness about PCOS/PCOD was found to be low among people between 18-30 age group (Shenoy & Brundha, 2016). Social anxiety of women with PCOS/PCOD and anxiety regarding interpersonal relationships were also studied, the age group was 22 to 45 years (Kamathenu, Velayudhan, Krishna, Nithya, 2021). Study to determine the complications associated with PCOS/PCOD, like depression, anxiety and reduced health-related quality of life (HRQOL) was done with the conclusion of depression and anxiety as chronic recurrent disorder among women (Varghese Joy, Saji S and Radhakrishnan, 2018).

A total of 204 (N) responses were collected. The data was coded and edited in Jamovi 2.0

descriptive statistical tests (mean, median, standard deviation and range) and differential statistical tests (One Way ANOVA and One Way ANOVA Kruskal Wallis) were conducted. One-way ANOVA and One-way ANOVA (Kruskal Wallis) tests were used after checking normality of the scales which were Body Appreciation Scale (BAS-2) and WHO Quality Of Life Scale, respectively. The normality of data was also checked, which was the Levels of Risk of PCOD scores. The level of PCOD scores were checked by referring to Development of a Health-Related Quality-of-Life Questionnaire (PCOSQ) for Women with Polycystic Ovary Syndrome (PCOS), from where the symptoms were measured and calculated as the symptoms were already collected from the respondents.

Results

Table 1: Socio-demographic profile of participants

Table 1 shows the socio-demographic profile of respondents. Majority were educated up to PG (47.1%) level. Most respondents were students (50.5%) and these respondents were majorly from middle-level economic status (57.6%). In the urban population (54.4%), most were single (93.6%). Most formed a part of a heterosexual population (88.2%) and most did not use substance (82.8%). Most women did not regularly exercise (88.7%) and the majority did have a family history of PCOD (83.8%).

Table 2: Body image with Levels of risk of PCOD

Table 3: WHOQOL BREF with Levels of Risk of PCOD

Table 2 and 3 show differences between levels of risk for PCOD for body appreciation and quality of life. No significant difference was found in body appreciation (p=0.86) and quality of life with levels of risk of PCOD. Under WHOQOL BREF domains were found: physical domain (low- 0.87, moderate- 0.77, severe- 0.81), psychological domain (low- 0.90, moderate- 0.85, severe- 0.89), social relationship domain (low- 0.81, moderate- 0.84, severe- 0.87), environmental domain (low- 0.87, moderate- 0.88, severe- 0.89).

However, if one looked at the proportion of participants with moderate to severe-level risk, it was quite high and 163 out 204 participants were found to score high risk (that is 79%). When looking at body appreciation and quality of life, mean and median responses were low, respectively, which meant irrespective of the risk of PCOD, all respondents had low levels of body appreciation and quality of life. The average age of participants with the risk of PCOD was 22. The major finding in the study was that out of 204 participants, 163 are at moderate to severe levels of risk of developing PCOD. Even though the study found that there is no significant difference between the levels of risk of PCOD and body appreciation, it could be seen how the average score of body appreciation was quite low for levels of risk. This signifies how all participants sufferred from body image issues, which is also a major concern for people suffering from PCOD/PCOS which is seen in a lot of studies. In a study it was discovered that patients with menstrual abnormalities, infertility, and obesity had more negative body images than subjects who were fertile, had regular menstrual cycles, or were of a healthy weight after calculating PCOS scores (Bazarganipour, Ziaei, Montazeri, 2013).

There was no significant difference found between Quality of Life and the levels of risk of PCOD. This means, quality of life was not affected by the levels of risk of PCOD, but people without PCOS/PCOD were found to have lower than average quality of life scores. There have been articles that state otherwise and say physical, social, and emotional health are more negatively impacted in PCOS cases, which overall lowers the quality of life (Tabassum, Jyoti, Sinha, Dhar, Akhtar, 2021).

There have been studies that talk about a rise in PCOS/PCOD cases in the last decade (Deswal, Narwal, Dang, Pundir, 2020). There are many reasons for this and a variety of genetic and environmental variables are significant contributors to PCOS development.

The limitation of this study is that more study is required in this area. For more reliability, another study could have been done as then, the change over a period of time could be seen. Rather than conducting an online survey with just 204 participants, more participants from different backgrounds can be included and then screened to evaluate the risks of PCOD.

To improve quality of life and reduce the risk of PCOD, better lifestyle changes need to be inculcated in daily life. Social workers can spread awareness about the importance of leading a healthy lifestyle and adopting exercise, yoga, and healthy eating habits in their daily lives. Researchers can conduct more studies on the topic of PCOD, with variables like body image issues and quality of life and many other issues, so that it brings more perspective and awareness among people and changes are made accordingly. Therapists, social workers, counsellors, and psychologists can get a better understanding of the disease and how they can handle and provide intervention in such cases.

Conclusion

The aetiology of PCOS is unknown, treatment is only focused on symptom control. Polycystic Ovarian Syndrome is comparatively more serious than the disease itself. In this study, it was found that the levels of risk of PCOD are not associated with quality of life and body appreciation. But when further exploration was done, the proportion of the population having moderate to severe risk of developing PCOD was 79%, which is quite high and even the body appreciation and quality of life was found to be poor.

More studies can be conducted systematically on PCOD so that people diagnosed with it can get better and more specialised treatment for both mental and physical health. Since this ailment still has no known treatment or permanent cure, the standard course of action following recommendations for lifestyle changes and supplemental advice is symptomatic treatment using a variety of substances, such as oral antidiabetics, contraceptives, antiandrogens, etc. There is a good likelihood that other authorised uses will be used as repurposing agents, which could have a positive impact on PCOS.

There has been record of yoga and meditation helping people but that has not been confirmed yet due to lack of research. This study focuses on body image and quality of life of people which are generally highly affected by the disease. The search for innovative therapeutics follows a little easier path. Although, there is still much to learn and investigate in order to better understand the aetiology, addressing the mechanism with the appropriate drug is a solution. It would be easier for counsellors, social workers, psychologists and psychiatrists to provide intervention to their clients if and when more studies are conducted in this area.

This study was approved by the Sociology and Social Work department of Christ University, Bangalore. Informed consent was sought from the participants before voluntary participation. The study proposal and related documents were approved by the Ethics Committee of the Department of Sociology and Social Work. Confidentiality was ensured by keeping the data confidential, as it was collected digitally and is password protected. Explanation was given to the participants about their right to withdraw from the research to avoid discomfort.

Keywords: Women, Polycystic Ovarian Disease (PCOD), Body Appreciation, Quality of Life, Mental Health, Risk Factors

(Authors:Astha G Bhattacharjya, Postgraduate Student of Social Work
Department of Sociology and Social Work, Christ (Deemed to be University) Email: astha.bhattacharjya[at]msw.christuniversity.in ; Anekal C Amaresha, Associate Professor of Social Work, Department of Sociology and Social Work, Christ (Deemed to be University) Email: amaresha.c[at]christuniversity.in )

References

• Aba Y A and Åžik B A (2022, September). Body image and sexual function in women with polycystic ovary syndrome: a case-control study. Original Article. https://doi.org/10.1590/1806-9282.20220367
• Angin P, Yoldemir T and Atasayan K. Quality of life among infertile PCOS patients. Arch Gynecol Obstet 300, 461—467 (2019). https://doi.org/10.1007/s00404-019-05202-z
• Azizi Kutenaee M, Amirjani S, Asemi Z et al. The impact of depression, self-esteem, and body image on sleep quality in patients with PCOS: a cross-sectional study. Sleep Breath 24, 1027—1034 (2020). https://doi.org/10.1007/s11325-019-01946-9
• Balaji S, Amadi C, Prasad S, Bala Kasav J, Upadhyay V, Singh AK, Surapaneni KM, Joshi A. Urban rural comparisons of polycystic ovary syndrome burden among adolescent girls in a hospital setting in India. Biomed Res Int. 2015;2015:158951. doi: 10.1155/2015/158951. Epub 2015 Jan 5. PMID: 25629036; PMCID: PMC4299689.
• Bates G W and Whitworth N S (1982). Effect of body weight reduction on plasma androgens in obese, infertile women. Fertility and Sterility,38(4), 406-409.
• Bazarganipour F, Ziaei S, Montazeri A, Foroozanfard F, Kazemnejad A, Faghihzadeh S. Body image satisfaction and self-esteem status among the patients with polycystic ovary syndrome. Iran J Reprod Med. 2013 Oct;11(10):829-36. PMID: 24639704; PMCID: PMC3941334.
• Behboodi Moghadam Z, Fereidooni B, Saffari M, Montazeri A. Measures of health-related quality of life in PCOS women: a systematic review. Int J Womens’ Health. 2018 Aug 1;10:397-408. doi: 10.2147/IJWH.S165794. PMID: 30123008; PMCID: PMC6078086.
• Bullinger M (1994). Ensuring international equivalence of quality of life measures: problems and approaches to solution. In J Orley and W Kuyken (Eds), Quality of Life Assessment: International Perspectives. Heidelberg: Springer-Verlag.
• Deswal R, Narwal V, Dang A and Pundir C S (2020, October-December). The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. Journal of Human Reproductive Sciences,13(4), 261-271. 10.4103/jhrs.JHRS_95_18
• Dokras A, Clifton S, Futterweit W and Wild R (2012, January). Increased prevalence of anxiety symptoms in women with polycystic ovary syndrome: systematic review and meta-analysis. Fertility and Sterility,97(1), 225-230. https://doi.org/10.1016/j.fertnstert.2011.10.022
• Himelein M J, Thatcher S S. Depression and Body Image among Women with Polycystic Ovary Syndrome. Journal of Health Psychology. 2006;11(4):613-625. doi:10.1177/1359105306065021
• Joshi A (2022). PCOD (Polycystic Ovarian Disease): A Review Article. The Electrochemical Society,107(1). DOI 10.1149/10701.15973ecst
• Kaczmarek C, Haller D M and Yaron M (2016, December). Health-Related Quality of Life in Adolescents and Young Adults with Polycystic Ovary Syndrome: A Systematic Review. Journal of Pediatric and Adolescent Gynecology,29(6), 551-557. https://doi.org/10.1016/j.jpag.2016.05.006
• L Barnard, D Ferriday, N Guenther, B Strauss, A H Balen, L Dye, Quality of life and psychological well-being in polycystic ovary syndrome, Human Reproduction, Volume 22, Issue 8, August 2007, Pages 2279—2286, https://doi.org/10.1093/humrep/dem108
• L Cronin, G Guyatt, L Griffith, E Wong, R Azziz, W Futterweit, D Cook, A Dunaif, Development of a Health-Related Quality-of-Life Questionnaire (PCOSQ) for Women with Polycystic Ovary Syndrome (PCOS), The Journal of Clinical Endocrinology & Metabolism, Volume 83, Issue 6, 1 June 1998, Pages 1976—1987, https://doi.org/10.1210/jcem.83.6.4990
• Lih M Liao, Jelena Nesic, Paul M Chadwick, Katherine Brooke-Wavell & Gordana M Prelevic (2008). Exercise and body image distress in overweight and obese women with polycystic ovary syndrome: A pilot investigation, Gynecological Endocrinology, 24:10, 555-561, DOI: 10.1080/09513590802288226
• Montazeri A, Ziaei S and Bazarganipour F (2013, October). Body image satisfaction and self-esteem status among the patients with polycystic ovary syndrome. International Journal of Reproductive BioMedicine,11(10), 829-36.
• S Coffey and H Mason (2003). The effect of polycystic ovary syndrome on health-related quality of life, Gynecological Endocrinology, 17:5, 379-386, DOI: 10.1080/09513590312331290268
• Shrestha A, Dixit A and Zaidi A (2019). Assessment of Lifestyle and Diet Modification of Patients Suffering from Polycystic Ovarian Disease (PCOD) in North India. Journal of Food and Nutrition Sciences,7(4), 60-65.
• Shrivastava V, Batham L, Mishra S and Mishra A (2019). Management of Symptoms Associated with Obsessive-Compulsive Disorder (OCD) and Poly-cystic Ovarian Disease (PCOD) through an Integrated Approach including Yagya Therapy. Interdisciplinary Journal of Yagya Research,2(1), 39 - 51. https://doi.org/10.36018/ijyr.v2i1.28
• Striegel-Moore, R H and Cachelin, F M (1999). Body image concerns and disordered eating in adolescent girls: Risk and protective factors. In N G Johnson and M C Roberts (Eds.). Beyond appearance: A new look at adolescent girls (pp. 85— 108). Washington, DC: American Psychological Association.
• S, D, Menezes L and Shaikh S (2015, February). The Impact Of Media On The Body Image Perception, Body Image Satisfaction & Self Esteem Among Women. Social Media for GenNext. https://www.researchgate.net/publication/318820424_The_Impact_Of_Media_On_The_Body_Image_Perception_Body_Image_Satisfaction_Self_Esteem_Among_Women
• Tabassum F, Jyoti C, Sinha HH, Dhar K, Akhtar MS. Impact of polycystic ovary syndrome on quality of life of women in correlation to age, basal metabolic index, education and marriage. PLoS One. 2021 Mar 10;16(3):e0247486. doi: 10.1371/journal.pone.0247486. PMID: 33690645; PMCID: PMC7946178.
• T (1998). Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment. Psychological Medicine, 28(3), 551-558. doi:10.1017/S0033291798006667
• Urman B, Sarac E, Dogan L, Gurgan T. Pregnancy in infertile PCOD patients. Complications and outcome. The Journal of Reproductive Medicine. 1997 Aug;42(8):501-505. PMID: 9284012.
• Varghese R, Joy A, Saji S M and Radhakrishnan R (2018). Health related complications associated with polycystic ovarian disease (PCOD). The Pharma Innovation,7(11), 86-90. https://www.researchgate.net/profile/Rahul-Radhakrishnan-5/publication/328760520_Health_related_complications_associated_with_polycystic_ovarian_disease_PCOD/links/5be1604f299bf1124fbe4351/Health-related-complications-associated-with-polycystic-ovarian-dis
• Wang Y, Zhao X, Zhao H, Ding H, Tan J, Chen J, Zhang R, Azziz R, Yang D. Risks for gestational diabetes mellitus and pregnancy-induced hypertension are increased in polycystic ovary syndrome. Biomed Res Int. 2013;2013:182582. doi: 10.1155/2013/182582. Epub 2013 Nov 25. PMID: 24371816; PMCID: PMC3859212.
• Zarate D, Marmara J, Hosking W and Potoczny C (2021, July). Body Appreciation Scale (BAS-2): measurement invariance across genders and item response theory examination. BMC Psychology,9(1). DOI:10.1186/s40359-021-00609-30