CC BY-NC-ND 4.0 · Ann Natl Acad Med Sci
DOI: 10.1055/s-0042-1750359
Original Article

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

Renuka Jakhar
1   School of Medical and Allied Sciences, G. D. Goenka University, Gurgaon, Haryana, India
,
Elina Dewanji Sen
1   School of Medical and Allied Sciences, G. D. Goenka University, Gurgaon, Haryana, India
,
Rohit Dutt
1   School of Medical and Allied Sciences, G. D. Goenka University, Gurgaon, Haryana, India
› Author Affiliations
Funding None.
 

Abstract

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

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

Statistical Analysis Analysis was done using IBM SPSS Statistics for Windows, Version 23.0. Descriptive statistics was used to calculate frequency and percentage of variables. Pearson's chi-square test of independence was used to identify factors associated with awareness of PCOS. A p-value of < 0.05 was considered to be statistically significant.

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

Conclusion The present study indicates awareness of PCOS among college going females was very poor. There is an urgent need of increasing awareness about PCOS among young adult college going females to reduce the prevalence, for early diagnosis, and treatment of the disease. It is also needed to prevent long-term consequences of PCOS.


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Introduction

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

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


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Materials and Methods

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

Study Design

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


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Sample

Inclusion criteria were females above 18 years available in campus at time of data collection and willing to participate in the study. Convenient sampling was used. Females not meeting inclusion criteria were excluded from the study.


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Questionnaire Development and Validation

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


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Sample Size

Cochran formula for infinite population was used and minimum sample size came out to be 385. A total of 424 participants were needed after calculating for attrition rate of 10%. Total 428 samples were recruited.


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Statistical Analysis

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


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Results

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

Table 1

Sociodemographic characteristics of participants

Variables

Frequency (n = 428)

Percent

Age (in years)

 18 to 20

298

69.63

 21 to 23

108

25.23

 > 24

22

5.14

Area of living

 Rural

224

52.34

 Suburban

125

29.21

 Urban

79

18.46

Type of family

 Joint

228

53.27

 Nuclear

200

46.73

Religion

 Hindu

416

97.20

 Muslim

12

2.80

Mother education

 None

65

15.19

 Up to graduation

337

78.74

 Postgraduation

26

6.07

Father education

 None

16

3.74

 Up to graduation

373

87.15

 Postgraduation

39

9.11

Table 2

Personal details of participants

Variables

Frequency (n = 428)

Percent

Menarche age (in years)

 11 to 13

113

26.40

 14 to 16

303

70.79

 17 to 19

12

2.80

Dysmenorrhea

 Absent

201

46.96

 Present

227

53.04

Pads used in a day

 2 to 4

395

92.29

 5 to 7

33

7.71

Days of menstrual flow

 2 to 4

234

54.67

 5 to 7

183

42.76

 > 8

11

2.57

Menstrual cycle (in days)

 < 21

59

13.79

 21 to 35

319

74.53

 > 35

21

4.91

 Amenorrhea

5

1.17

 Randomly, no fix date

24

5.61

Family history of PCOS

 Absent

423

98.83

 Present

5

1.17

Abbreviation: PCOS, polycystic ovarian syndrome.


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

Table 3

Respondents' knowledge of PCOS

Knowledge

Frequency (n = 428)

Percent

Heard about PCOS

78

18.22

Didn't heard about PCOS

350

81.78

Source of knowledge

 Doctor

10

2.34

 Friend

22

5.14

 Family

5

1.17

 Internet

33

7.71

 Health and hygiene session in college

8

1.87

Knowledge of anatomical part

 It's a disease of ovary

73

17.06

Abbreviation: PCOS, polycystic ovarian syndrome.


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

Table 4

Signs/symptoms of PCOS

Signs/symptoms

Frequency (n = 428)

Percent

Irregular or absent menses

43

10.05

Facial acne

43

10.05

Abnormal hair growth

29

6.78

Reduced fertility

13

3.04

Weight gain

42

9.81

Frontal hair loss

11

2.57

Pelvic pain

25

5.84

Out of control eating

6

1.40

Stress

24

5.61

Anxiety

24

5.61

I don't know

5

1.17

Abbreviation: PCOS, polycystic ovarian syndrome.


Table 5

Causes/risk factors of PCOS

Causes/risk factors

Frequency (n = 428)

Percent

Insulin resistance

15

3.50

Weight gain

19

4.44

Hormone imbalance

39

9.11

Physical inactivity

20

4.67

I don't know

11

2.57

Abbreviation: PCOS, polycystic ovarian syndrome.


Table 6

Diagnosis of PCOS

Diagnostic methods

Frequency (n = 428)

Percent

Menstrual history

25

5.84

Physical checkup

33

7.71

Blood test

15

3.50

Ultrasound scan

32

7.48

I don't know

13

3.04

Abbreviation: PCOS, polycystic ovarian syndrome.


Table 7

Complications related to PCOS

Complications

Frequency (n = 428)

Percent

Diabetes

10

2.34

Endometrial cancer

11

2.57

Ovarian cancer

22

5.14

Increased androgens

8

1.87

Cardiovascular disease

6

1.40

I don't know

27

6.31

Abbreviation: PCOS, polycystic ovarian syndrome.


Table 8

Psychological complications of PCOS

Psychological complications

Frequency (n = 428)

Percent

Anxiety

23

5.37

Depression

30

7.01

Snoring

10

2.34

Binge eating disorder

7

1.64

Walking unrefreshed from sleep

17

3.97

I don't know

24

5.61

Abbreviation: PCOS, polycystic ovarian syndrome.


Table 9

Treatment options for PCOS

Treatment

Frequency (n = 428)

Percent

Lifestyle modifications

15

3.50

Laparoscopic ovarian drilling surgery

11

2.57

Hormone replacement therapy

9

2.10

Cognitive behavioral therapy

2

0.47

I don't know

2

0.47

Abbreviation: PCOS, polycystic ovarian syndrome.


Table 10

Preventive measures of PCOS

Preventive measures

Frequency (n = 428)

Percent

Fiber-rich diet

35

8.18

Exercise

35

8.18

Meditation

27

6.31

Weight loss

15

3.50

I don't know

8

1.87

Abbreviation: PCOS, polycystic ovarian syndrome.


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

Table 11

Association between sociodemographic characteristics of participants and knowledge of PCOS

Variables

Knowledgeable (n = 78)

Not knowledgeable (n = 350)

Test statistic

p-Value

Age (in years)

 18 to 20

55

243

x2 = 1.350

0.509

 21 to 23

21

87

 > 24

2

20

Area of living

 Rural

39

185

x2 = 2.314

0.314

 Suburban

20

105

 Urban

19

60

Type of family

 Joint

41

187

x2 = 0.019

0.89

 Nuclear

37

163

Religion

 Hindu

77

339

Fisher's exact

0.703

 Muslim

1

11

Mother education

 None

4

61

 Up to graduation

64

273

x2 = 13.632

0.001[a]

 Postgraduation

10

16

Father education

 None

1

15

 Up to graduation

66

307

x2 = 4.217

0.121

 Postgraduation

11

28

Abbreviation: PCOS, polycystic ovarian syndrome.


a p < 0.05.


Table 12

Association between personal details of participants and knowledge of PCOS

Variables

Knowledgeable (n = 78)

Not knowledgeable (n = 350)

Test statistic

p-Value

Menarche age (in years)

 11 to 13

17

96

x2 = 1.103

0.576

 14 to 16

59

244

 17 to 19

2

10

Dysmenorrhea

 Absent

42

159

x2 = 1.815

0.178

 Present

36

191

Pads used in a day

 2 to 4

72

323

x2 = 0.000

0.995

 5 to 7

6

27

Days of menstrual flow

 2 to 4

36

198

x2 = 2.887

0.236

 5 to 7

40

143

 > 8

2

9

Menstrual cycle (in days)

 < 21

9

50

Fisher's exact = 10.839

0.022[a]

 21 to 35

55

264

 > 35

10

11

 Amenorrhea

0

5

 Randomly, no fix date

4

20

Family history of PCOS

 Absent

73

350

Fisher's exact

< 0.001[a]

 Present

5

0

Abbreviation: PCOS, polycystic ovarian syndrome.


a p < 0.05.



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Discussion

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

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

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

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

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

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

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


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Conclusion

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


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Conflict of Interest

None declared.

Acknowledgments

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

Prior Presentation

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


Ethical Approval

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


Author Contributions

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



Address for correspondence

Renuka Jakhar, MPT, BPT
School of Medical and Allied Sciences, G. D. Goenka University
Village Alipur, P. O. Ghamroj, Tehsil Sohna, Gurgaon 122103, Haryana
India   

Publication History

Article published online:
27 June 2022

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