Quality of women’s life and polycystic ovary syndrome (PCOS)

Dec 16, 2020

Polycystic ovary syndrome (PCOS) is characterised by enlarged ovaries, multiple ovarian cysts and endocrinological and metabolic changes (hyperandrogenism, insulin resistance and consequent hyperinsulinemia). Among women of reproductive age, PCOS is very common and characterised by a high risk of developing anxiety and depressive disorders. In recent years there has been increasing evidence that PCOS is significantly associated with a health-related reduction in quality of life (QoL), largely driven by the clinical features of this syndrome, with depressive symptoms, anxiety, poor body image and low self-esteem, and a general impairment of mental health. However, information related to QoL, subjective experiences related to the disorder and psychological disorders in women with PCOS is scarce.  Subfertility and infertility cause severe psychological distress. In infertile PCOS patients, the physical manifestations, typical of hyperandrogenism, may also negatively affect self-esteem, social involvement and psychological comfort. Most of the studies on QoL have been done in women who had been taking oral contraceptives for a long time and had no desire to become pregnant in the short term. The possible impact of combined oral contraceptives (COCs) and other drugs (i.e., those that modulate carbohydrate metabolism) on QoL and psychological state is often overlooked, and, therefore, many of the surveys conducted include women taking drugs and this may induce data bias. As infertility and other PCOS-related symptoms have a huge impact on quality of life and psychological well-being, a recent study published on Reproductive Science by Naumova et al.investigates the quality of life of infertile PCOS women and analyses the association between clinical/biochemical characteristics and physical/psychological well-being of PCOS patients in comparison with two control groups: one with tubal infertility factor (TFI) and one with male infertility factor (MFI). The study examines 46 women with this syndrome, with infertility and diagnosed with PCOS on the basis of the Rotterdam Criteria (which we recall to be the presence of 2 out of 3 factors among: anovulation, hyperandrogenism, presence of ovarian cysts), aged between 18 and 40 years. Control groups: 50 women with TFI and 31 healthy women with MFI. Quality of life related to general health was assessed using the SF-36 questionnaire, adapted for the Spanish-speaking general population, consisting of 36 self-administered questions, reflecting overall health self-esteem over the past year: physical functioning (ten questions), physical role functioning (four questions), body pain (two questions), and general health (five questions). The mental component (MCS) includes four domains: vitality (four questions), emotional role functioning (three questions), social functioning (two questions) and mental health (five questions). Scores range from 0 to 100, with higher scores indicating better health. Disease-specific PCOS-related QoL was assessed with the Polycystic Ovary Syndrome Questionnaire (PCOSQ). This questionnaire consists of 26 items measuring five domains of PCOS-specific symptoms in the 2 weeks preceding the assessment, including emotions (8 items), body hair (5 items), weight (5 items), infertility problems (4 items), and menstrual problems (4 items). Each question requires an answer on a 7-point scale, with lower scores indicating more harm.

Infertile PCOS patients showed significantly worse QoL scores in the domains characterizing mental health, compared to women with other causes of infertility. In addition, body pain, general health and vitality scores were significantly lower in women with PCOS than in women with male infertility. Significant differences in the scores of domains describing physical health were not found between the groups of patients with endogenous infertility. Patients with infertile PCOS reported low scores in all domains of the PCOSQ. The analysis showed that PCOS-related hirsutism and weight gain were the factors most associated with reduced quality of life and self-perception, as they largely interfere with external appearance and social norms. One of the main findings of this study is that patients with PCOS had significantly worse mental health scores compared to women with other causes of infertility. Low scores in the mental domains indicate an impaired emotional state, with a significant limitation of social contacts, a decreased level of communication with others, and the possible presence of depressive and anxiety disorders. 

Clinical manifestations of androgen excess and weight gain may lead women with PCOS to be dissatisfied with their appearance, make them feel unfeminine, and produce emotions and discomfort. In all women with PCOS, low scores were found in all items of the SF-36 questionnaire and in all PCOSQ domains. It is noteworthy that in these women, the mental health component and domains in the SF-36 questionnaire were more affected than the physical dimension. The lowest scores were in the emotional role domain, in agreement with the results of other studies. The authors of the present study found no significant differences in the QoL associated with the physical health component between the groups with PCOS and TFI. However, compared to women with non-endogenous causes of infertility (MFI), women with PCOS showed significantly lower scores in the domains of body pain and general health, as well as in mental health. In the present study, patients with PCOS showed a reduced QoL in all domains of the PCOSQ. After adjusting the data for clinical variables, patients’ concerns about hirsutism and excess weight had the greatest impact on health-related quality of life. The total PCOSQ score was significantly lower in respondents with a BMI> 25 and in those with clinical and biochemical hyperandrogenism. The results suggest that clinical hyperandrogenism has a negative correlation with the scores of the mental health component.

Conclusions

In conclusion, women’s quality of life can be challenged by infertility and other symptoms related to polycystic ovary syndrome, thus negatively affecting self-esteem, the psychological sphere itself and consequently social maladjustment. However, in order to reduce these problems and improve health, assistance from specialists should be an essential part.

Reference

  1. Quality of Life in Infertile Women with Polycystic Ovary Syndrome: a Comparative Study Naumova et al. Reprod Sci. 2020 Nov 19