Health & Medical Endocrine disease

Quality of Life and Psychological Morbidity in Women with PCOS

Quality of Life and Psychological Morbidity in Women with PCOS

Summary and Introduction

Summary


Objective: Polycystic ovary syndrome (PCOS) has clinical features and implications for long-term health that may lead to decreased quality of life (QoL) and psychological morbidity. We studied QoL in women with PCOS, compared the findings with population norms and assessed whether they correlated with reported quality of patient information received.
Design: Cross-sectional study.
Patients Women with PCOS by National Institutes of Health (NIH) criteria, diagnosis confirmed by one endocrinologist.
Measurements: Four questionnaires were mailed: the Short Form-36 (SF-36), the Quality-of-Life Questionnaire for Women with Polycystic Ovary Syndrome (PCOSQ), the General Health Questionnaire-28 (GHQ-28) and an assessment of information quality and sources, the Patient Information Questionnaire (PIQ).
Results: Questionnaires were sent to 443 women with PCOS from one endocrinologist's database; 203 women aged 15–65 years agreed to participate. To compare with Australian population norms, data from those women aged 18–44 years (n = 173) were used. Of these, 64% were obese, 18% overweight and 18% of normal weight. The demographics, socioeconomic status and untreated biochemistry of the responders and the total patient group were not significantly different. SF-36 scores were significantly lower than the age- and sex-matched Australian population (P < 0·01), including the overweight subset (P < 0·01). Health-related QoL by PCOSQ was similar to other published studies. GHQ-28 identified psychological morbidity in 62·4%, compared with 26·4% in a matched Australian population (P < 0·0001). Body mass index (BMI) was negatively correlated with QoL (P < 0·01). There was a positive association between the psychological domain of QoL and the subjective assessment of the quality of health-related information in general (P < 0·001), for hirsutism (P < 0·01) and for menstrual irregularity (P < 0·05).
Conclusions: We have shown impaired QoL and increased prevalence of psychological morbidity in PCOS compared with population norms. The perception of inadequate information about the condition correlated with poorer QoL scores. Improved information delivery may lead to an improvement in QoL and needs to be tested with an intervention study.

Introduction


Polycystic ovary syndrome (PCOS) is the most common form of endocrine disorder in premenopausal women. The reported prevalence of PCOS among women of reproductive age varies according to the mode of diagnosis and is estimated to be between 5% and 10%. The syndrome usually manifests itself in adolescence, soon after menarche, with the clinical hallmarks of ovulatory dysfunction and hyperandrogenism. The clinical spectrum of PCOS encompasses hirsutism, acne and male pattern alopecia, the sequelae of hyperandrogenism, and infertility as a result of ovulatory disturbance. However, insulin resistance and subsequent hyperinsulinaemia are thought to be central to the pathophysiology of PCOS and there is a high prevalence of obesity, dyslipidaemia, glucose intolerance and diabetes in women with PCOS.

There are many features of PCOS that might predispose to impaired quality of life (QoL), including infertility, cosmetic effects of hyperandrogenism, weight gain and obesity and long-term health implications. We postulated that the clinical features and health implications of PCOS are likely to lead to loss of self-esteem and poor body image, developing into decreased QoL and psychological morbidity. If so, this should be addressed in the treatment of women with PCOS.

In this study we conducted a cross-sectional survey of women with PCOS to measure QoL with standardized instruments both specific to PCOS and general to the population. We compared these measures with normative data from an Australian population and with published data from other studies on PCOS. We aimed to identify how women with PCOS perceive the information that is available to them about their condition, and to assess whether their qualitative assessment of this information was correlated with QoL.

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