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Harrison C, Tay CT, Busby MA, Mousa A, Teede H, Boivin J. Challenges experienced by those with polycystic ovary syndrome in healthcare interactions: a qualitative evidence synthesis. Reprod Biomed Online 2024; 49:104293. [PMID: 39067213 DOI: 10.1016/j.rbmo.2024.104293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 07/30/2024]
Abstract
Studies report interaction difficulties between patients with polycystic ovary syndrome (PCOS) and healthcare professionals (HCP). This systematic review and qualitative evidence synthesis aimed to collate and synthesize the existing peer-reviewed literature investigating challenges for people with PCOS when interacting with HCP. Medline, PsycInfo, EMBASE, All EBM and CINAHL were searched from 1990 to September 2022. Study risk of bias (RoB) was performed and all textual data relevant to challenging interactions between patients with PCOS and HCP were extracted and analysed using thematic synthesis. Of the 6353 studies identified, 28 were included. Two were appraised as high, four as moderate and 22 as low RoB. Four analytic themes were derived illustrating that interactions were challenging when: (i) medical information (PCOS, its management) was not shared in the best way; (ii) information provision and deliberation opportunities were insufficient to achieve outcomes that mattered to patients; (iii) interactions prompted but did not support patient activation; and (iv) health system-level barriers (e.g. policies and guidelines) were present or made worse by HCP behaviour. Future research should examine methods for the implementation and evaluation of established frameworks for sharing medical information and supporting patient agency in the context of PCOS care.
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Affiliation(s)
- China Harrison
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), Bristol, UK; National Institute for Health Research, Health Protection Research Unit (HBU) in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chau Thien Tay
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Clayton, Australia
| | | | - Aya Mousa
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Clayton, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Clayton, Australia
| | - Jacky Boivin
- Cardiff Fertility and Reproductive Research, School of Psychology, Cardiff University, Cardiff, Wales, UK..
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Gomula J, Warner M, Blandford A. Women's use of online health and social media resources to make sense of their polycystic ovary syndrome (PCOS) diagnosis: a qualitative study. BMC Womens Health 2024; 24:157. [PMID: 38443902 PMCID: PMC10913566 DOI: 10.1186/s12905-024-02993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND With the growing availability of online health resources and the widespread use of social media to better understand health conditions, people are increasingly making sense of and managing their health conditions using resources beyond their health professionals and personal networks. However, where the condition is complex and poorly understood, this can involve extensive "patient work" to locate, interpret and test the information available. The overall purpose of this study was to investigate how women with polycystic ovary syndrome (PCOS) across two healthcare systems engage with online health resources and social media to better understand this complex and poorly understood lifelong endocrine disorder. METHODS A semi-structured interview study was conducted with women from the US ( N = 8 ) and UK ( N = 7 ) who had been diagnosed with PCOS within the previous five years. Transcribed data was analysed using a reflexive thematic analysis method. RESULTS We highlight the information needs and information-seeking strategies women use to make sense of how PCOS affects them, to gain emotional support, and to help them find an effective treatment. We also show how women with PCOS use online health and social media resources to compare themselves to women they view as "normal" and other women with PCOS, to find their sense of "normal for me" along a spectrum of this disorder. CONCLUSION We draw on previous models of sense-making and finding normal for other complex and sensitive health conditions to capture the nuances of making sense of PCOS. We also discuss implications for the design and use of social media to support people managing PCOS.
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Affiliation(s)
- Julia Gomula
- Computer Science Department, UCL, Gower Street, London, UK
| | - Mark Warner
- Computer Science Department, UCL, Gower Street, London, UK.
| | - Ann Blandford
- Computer Science Department, UCL, Gower Street, London, UK
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Guan M, Li R, Shen Q, Wang GP, Li Z, Xiao M, Lei J. Women's experience of polycystic ovary syndrome management: A systematic review and meta-synthesis. Int J Gynaecol Obstet 2024; 164:857-868. [PMID: 37605982 DOI: 10.1002/ijgo.15031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/09/2023] [Accepted: 07/23/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common chronic condition in women of child-bearing age. There is currently no effective treatment, so early and long-term management is essential. However, there are many problems in the practice of disease management in women with PCOS that make it difficult to achieve good outcomes. OBJECTIVE To explore women's experience of PCOS management and identify the relevant facilitators and barriers to management. SEARCH STRATEGY A structured search was undertaken in five bibliographic databases (MEDLINE, Web of Science, CINAHL, Embase, PubMed, and Cochrane) from the date of establishment of the database up to December 2022. SELECTION CRITERIA All qualitative and mixed-methods studies available in English describing the experience of PCOS management from the patients' perspective were included. DATA COLLECTION AND ANALYSIS The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to appraise study quality. The evidence was synthesized using a pragmatic meta-aggregative approach guided by the capability, opportunity, and motivation model of behavior (COM-B). MAIN RESULTS A total of 13 studies were included with 85 equivocal findings and 12 credible findings. The findings were meta-aggregated into three themes: (1) capability of women with PCOS, including patients' attitudes toward disease and management, knowledge, and skills of the disease; (2) opportunities in PCOS management, including information about PCOS, diagnostic delay, disease characteristics, disease management plan, and logistical and environmental problems; and (3) motivation in PCOS management, including impact of symptoms, perceived needs, support and feedback, and unpleasant medical experience. CONCLUSIONS This study identifies facilitators and barriers to PCOS management from the patient perspective, which can guide the design and implementation of PCOS management programs for patients. This study also provides information for future research into how the COM-B theory can be incorporated into specific management plans to promote patient action.
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Affiliation(s)
- Minhui Guan
- Xiang Ya Nursing School of Central South University, Changsha, China
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Rong Li
- Xiang Ya Nursing School of Central South University, Changsha, China
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Quan Shen
- Xiang Ya Nursing School of Central South University, Changsha, China
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Guang Peng Wang
- Xiang Ya Nursing School of Central South University, Changsha, China
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ziyan Li
- Xiang Ya Nursing School of Central South University, Changsha, China
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Meili Xiao
- Xiang Ya Nursing School of Central South University, Changsha, China
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jun Lei
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China
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Kaur I, Singh A, Suri V, Kishore K, Rana SV, Sahni N, Bhattacharya S. Assessment of quality of life in patients having Poly-Cystic Ovarian Syndrome: A cross-sectional facility-based study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:190. [PMID: 37545991 PMCID: PMC10402774 DOI: 10.4103/jehp.jehp_21_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/12/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is a complex and heterogeneous disorder affecting various body organs. Menstrual irregularity, anovulation, and many cosmetic issues faced by PCOS patients endanger the essence of being a woman and may have a deleterious impact on their health-related quality of life (HRQOL). This study aimed to assess HRQOL in patients with PCOS and to identify the clinical and socio-demographic factors that might predict poor HRQOL. MATERIALS AND METHODS This cross-sectional study was carried out in the tertiary care hospital in India. A total of 275 women visiting the same setting and diagnosed with PCOS were included. The participants' quality of life was studied using a disease-specific HRQOL questionnaire. Information regarding clinical and socio-demographics was collected using the interviewer schedule. For evaluating the predictors of HRQOL in PCOS subjects, analysis of variance and independent t-test was applied. For subgroup analysis, the post hoc (Gabriel) test was applied. RESULTS The average total score of HRQOL of the study participants was 125.41 ± 29.1. The lowest weighted mean score was for menstrual problems. Among the socio-demographic variables, age and educational level influenced the HRQOL scores. Highly educated women reported the poorest HRQOL. The analysis of variance also indicated a significant variation in HRQOL scores among body mass index categories [F (4,270) = 5.09, P = <.001] and hirsutism status [F (2,272) = 14.222, P =<.001]. CONCLUSIONS Menstrual irregularity, hirsutism, increased body mass index, educational status, and age are critical in altering HRQOL in PCOS cases. Clinicians should inquire about the HRQOL of patients with severe clinical manifestations and appropriate support must be provided during patient care.
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Affiliation(s)
- Ishwarpreet Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amarjeet Singh
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kamal Kishore
- Department of Biostatistics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Satya Vati Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nancy Sahni
- Department of Dietetics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sudip Bhattacharya
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Deoghar, Jharkhand, India
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Fossey B, McCaffery KJ, Cvejic E, Jansen J, Copp T. Understanding the Relationship between Illness Perceptions and Health Behaviour among Women with Polycystic Ovary Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5998. [PMID: 37297602 PMCID: PMC10252798 DOI: 10.3390/ijerph20115998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
This paper aims to delineate the cognitive, emotional, and behavioural responses of women with polycystic ovary syndrome (PCOS) to their illness by applying the Common-Sense Model of Self-Regulation (CSM) to their health behaviour. An online cross-sectional design was used to examine the relationship between participants' illness perceptions (illness identity, consequence, timeline, control, and cause) and emotional representations of their PCOS, and their health behaviours (diet, physical activity, and risky contraceptive behaviour). The participants were 252 women between the ages of 18 and 45 years, living in Australia, and self-reporting a diagnosis of PCOS, recruited through social media. Participants completed an online questionnaire regarding illness perceptions as well as their diet, physical activity, and risky contraceptive behaviour. Illness identity was positively associated with the number of maladaptive dietary practices (B = 0.71, 95% CI: 0.003, 0.138; p = 0.04), and perception of longer illness duration was associated with reduced physical activity (OR = 0.898, 95% CI: 0.807, 0.999; p = 0.49) and risky contraceptive behaviour (OR = 0.856, 95% CI: 0.736, 0.997; p = 0.045). The limitations of the study include all data being self-reported (including PCOS diagnosis), and the potential for analyses of physical activity and risky contraceptive use being underpowered due to reduced sample sizes. The sample was also highly educated and restricted to those who use social media. These findings suggest that illness perceptions may play a role in influencing health behaviour in women with PCOS. A better understanding of the illness perceptions of women with PCOS is needed to increase health-promoting behaviour and improve health outcomes for women with PCOS.
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Affiliation(s)
- Brittany Fossey
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW 2006, Australia
| | - Kirsten J. McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Jesse Jansen
- Department of Family Medicine, School Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Tessa Copp
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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Presswala B, De Souza LR. The diagnostic experience of polycystic ovary syndrome: A scoping review of patient perspectives. PATIENT EDUCATION AND COUNSELING 2023; 113:107771. [PMID: 37141692 DOI: 10.1016/j.pec.2023.107771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/02/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Polycystic Ovary Syndrome (PCOS) is a common endocrine condition with a complex diagnostic process. The present study aims to understand patient perceptions of the process of PCOS diagnosis, and how challenges during diagnosis can influence patient understanding of PCOS and trust in healthcare providers (HCPs). METHODS A scoping review framework was followed. Six databases were searched for patient experiences of PCOS diagnosis, between January 2006 - July 2021. Data extraction and thematic analyses were conducted. RESULTS Of the 338 studies screened, 21 studies fulfilled the inclusion criteria. Patient experiences of the diagnostic process were stratified into three themes: emotional, negotiating, and incomplete. As a result of these experiences, patients begin to perceive their HCPs as lacking knowledge and empathy. CONCLUSION There are prevailing gaps in how PCOS diagnostic criteria are understood and applied in the clinical setting, leading to a lengthy diagnostic process. Additionally, poor HCP communication negatively affects patient trust in HCPs. PRACTICE IMPLICATIONS Practicing patient-centered care and empowering patients by addressing their specific information needs are essential to improving the diagnostic experience and care of individuals living with PCOS. These recommendations may also apply to the diagnosis of other complex chronic conditions.
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Affiliation(s)
- Batul Presswala
- Faculty of Health Sciences, McMaster University, 1280 Main St. West, MDCL 3500, Hamilton, ON L8S 4K1, Canada; Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1A 0K9, Canada.
| | - Leanne R De Souza
- Human Biology Program, Health Studies Program, University College, University of Toronto, Room 281, 15 King's College Circle, Toronto, ON M5S 3H7, Canada
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Tay CT, Williams F, Mousa A, Teede H, Burgert TS. Bridging the Information Gap in Polycystic Ovary Syndrome: A Narrative Review with Systematic Approach. Semin Reprod Med 2023; 41:12-19. [PMID: 38052244 DOI: 10.1055/s-0043-1777086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a complex endocrinopathy with wide-ranging implications for affected individuals. Literature has shown that patients with PCOS are dissatisfied with the health information provided to them and that healthcare professionals lack adequate knowledge. In this narrative review with systematic approach, we explored the unmet information needs in PCOS care for both patients and healthcare professionals. A comprehensive search of databases yielded 41 relevant studies, predominantly of observational and qualitative design. Adults and adolescents with PCOS desire wide ranging health information and express a keen desire for weight management guidance. Importantly, discussions surrounding weight should be addressed knowledgeably and without weight bias. Therefore, healthcare professionals should facilitate access to comprehensive evidence-based resources. Lack of information drives PCOS-related online searches. Referral to support groups that promote individual agency in the self-management aspects of PCOS can furthermore guide patient resource acquisition. Patients prefer guidance from professionals that understand the psychosocial complexity of PCOS and can empathize with experiences of stigmatization or even marginalization depending on the cultural context of the individual. The findings informed the 2023 International Evidence-Based PCOS Guideline, recommending patient-centered communication, evidence-based information resources, and culturally sensitive approaches to optimize PCOS care.
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Affiliation(s)
- Chau Thien Tay
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Fleur Williams
- Monash School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Tania S Burgert
- Division of Pediatric Endocrinology, Children's Mercy Kansas City, Kansas City, Missouri
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Effect of using 5A's model for lifestyle counseling on psychological symptoms in women with polycystic ovary syndrome: a randomized field trial. Sci Rep 2022; 12:21847. [PMID: 36528714 PMCID: PMC9759549 DOI: 10.1038/s41598-022-26274-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Lifestyle modification in women with polycystic ovary syndrome (PCOS) could be associated with increased psychological symptoms. This study aimed to evaluate the effect of lifestyle modification counseling using 5A's model on the psychological symptoms of women with PCOS. This double-blind, randomized field trial was performed on 70 women with PCOS in two groups of lifestyle modification counseling based on 5A's model and counseling without using the model. The intervention was performed based on five stages of the 5A's model (Assess, Advise, Agree, Assist, Arrange) during a week, and psychological symptoms were assessed using Symptom Checklist-90-R before the intervention and one and three months after the intervention. The results showed that one and three months after the intervention, the level of psychological symptoms, except obsessive-compulsive level, were significantly lower in the intervention group than in the control group (p < 0.05). Moreover, the level of these symptoms decreased over time in the intervention group (p < 0.0001). Using the 5A's model in lifestyle modification counseling is associated with the promotion of psychological health in women with PCOS, and this model is recommended for lifestyle counseling in women with polycystic ovary syndrome.
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Muacevic A, Adler JR, Imran HJ. Development of the First Health-Related Quality of Life Questionnaires in Arabic for Women With Polycystic Ovary Syndrome (Part III): Scoring System Interpretation. Cureus 2022; 14:e32166. [PMID: 36601178 PMCID: PMC9806282 DOI: 10.7759/cureus.32166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Our team developed the first highly reliable, validated, easily comprehensible, and self-administered polycystic ovary syndrome quality of life (PCOSQOL)-42 and PCOSQOL-47 questionnaires for unmarried and married women with polycystic ovary syndrome (PCOS), respectively. Using such scales needs a scoring system that covers the responses to each item per domain and overcomes the missing responses. we developed a scoring system for PCOSQOL-42 and PCOSQOL-47 to interpret the items' responses at any similar population. METHODS The scoring was inspired by the 5-point Likert scale that was used during the creation of PCOSQOL-42 and PCOSQOL-47, where each item represents the woman's experience in the last two weeks before seeking consultation, i.e., Never=5 or no effect, on the health-related quality of life (HRQOL), (Seldom=4), (Quite often=3), (Very often=2), and (Always=1 or the maximal effect on the QOL). The sum of the total points in each item per domain was evaluated. Then we divided the results by the number of the items that had been scored only to get the final domain score as a (mean ± SD). The ultimate or final score per the questionnaire was gained from the sum of individual domain scores divided by the number of domains that had been evaluated. Ultimately, the first interval values (from 1 to < 3 points) represent marked effects on HRQOL; second interval values (from 3 to < 4 points) represent the marginal effect on HRQOL; third interval values (from 4 to < 5 points) represent the minimal effect on HRQOL; fourth interval (5 points) represents no effect on HRQOL. RESULTS The lower the score, the greater the negative impact on HRQOL. Although all domains in both questionnaires showed a marked reduction in HRQOL, women in either cohort were more concerned with their body image dissatisfaction and psychological distress induced by PCOS than their reproductive concerns. The mean score calculated for the questionnaire had a greater negative impact than the emotions subscale and was similar to the subscale for infertility. All mean points per item and domain values indicate a marked effect (< 3 points) on QOL using PCOSQOL-42 and PCOSQOL-47. All values referred to a marked reduction in PCOSQOL-47 points, whether item or domain-wise. CONCLUSIONS The current scoring system provides an easy way to interpret the responses in both questionnaires and overcome the missing responses in any item per domain. There was a marked impact on all domains of HRQOL using both questionnaires, with a special impact on body image and psychological concerns. The responses of women in either cohort to the sexual and reproductive items were extremely high, reflecting the scope of this problem in the life of women with PCOS.
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Ismayilova M, Yaya S. 'I'm usually being my own doctor': women's experiences of managing polycystic ovary syndrome in Canada. Int Health 2022; 15:56-66. [PMID: 35567790 PMCID: PMC9808519 DOI: 10.1093/inthealth/ihac028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/07/2022] [Accepted: 04/16/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a complex, chronic condition characterized by anovulation, polycystic ovarian morphology and hyperandrogenism that requires lifelong management. To reduce the risk of comorbidity and to manage symptoms, lifestyle management and pharmaceuticals such as oral contraceptives are the most common forms of treatment and should be tailored to the individual patient. The literature to date has shown PCOS patients to experience widespread dissatisfaction with the amount and quality of information they receive from providers, along with lower levels of trust in physicians. Little is known about the lived experiences of women managing PCOS in Canada, across age groups. METHODS In-depth remote interviews explored women's lived experiences managing PCOS and the barriers and facilitators they encountered in their management journeys. Data were analyzed using thematic analysis and interpretive description methodology. RESULTS Twenty-five in-depth, telephone interviews conducted with participants (aged 18-63 y) across Canada revealed participants lacking sufficient information and guidance from physicians, especially in primary care. Areas in need of more guidance included lifestyle management and mental health. Lack of empathy and weight bias among physicians were also perceived by participants. Older participants received little guidance on treatment options postmenopause. Loss of trust and withdrawal from seeking medical care were prominent themes, along with greater self-reliance on self-management, including self-educating and self-experimenting with treatments. CONCLUSIONS Most women in this study were frustrated with the level of involvement and information provision from their doctors. Key recommendations are identified for the provision of care to younger and older patients with PCOS. Improved education for physicians may be needed to improve the quality of healthcare provision for PCOS.
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Affiliation(s)
- Miya Ismayilova
- Interdisciplinary School of Health sciences, University of Ottawa, 25 University Private, Ottawa, ON K1N 7K4, Canada
| | - Sanni Yaya
- Corresponding author: Tel: +1-613-562-5800; E-mail:
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Ismayilova M, Yaya S. What can be done to improve polycystic ovary syndrome (PCOS) healthcare? Insights from semi-structured interviews with women in Canada. BMC Womens Health 2022; 22:157. [PMID: 35538531 PMCID: PMC9092874 DOI: 10.1186/s12905-022-01734-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 04/25/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common and perplexing condition affecting metabolic, reproductive, cardiovascular, and psychological health in women. Previous studies point to widespread dissatisfaction and frustration in women with the information and care they receive. Studies have found delays with the diagnosis of PCOS and gaps in knowledge in physicians regarding the diagnosis and management of PCOS. Little has been heard from women on what they think can be improved with PCOS care, especially in Canada. This qualitative study explores women's experiences navigating the healthcare system and their insights on what could be improved based on their lived experiences. METHODS Twenty-five participants were interviewed remotely over the phone by the first author between October and December 2018.Interviews were semi-structured and in-depth. Data were analyzed using thematic analysis and interpretive description methodology. RESULTS Twenty-five in-depth interviews conducted with participants across Canada (ages 18-63) revealed three overall areas in need of improvement. First, women emphasized a need for greater knowledge and awareness of PCOS in primary care physicians (PCPs) as well as the need for the medical community to prioritize women's health. Second, participants advocated for greater PCOS awareness and de-stigmatization in the general community and in women and girls, and any individuals with female reproductive systems. Third, participants brought up several needed resources, such as the need for more PCOS research to be funded and undertaken, more PCOS specialists and experts to be available, credible doctor-provided information (e.g., pamphlets, websites), and age-specific support groups and mental health supports to be available. Participants were generally unaware of existing PCOS organizations and brought up the need for established PCOS organizations to aid in the training and retraining of doctors and local awareness-building in communities. CONCLUSIONS Participants believed that PCPs in Canada needed to be well-versed on how to diagnose and manage PCOS to prevent delays in diagnosis and provide easier access to care. Further, greater awareness and de-stigmatization in the general community are needed so women can identify symptoms early and have access to support from those around them. Overall, PCOS may be an overlooked and under-prioritized condition, both in the Canadian healthcare system and general community.
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Affiliation(s)
- Miya Ismayilova
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON K1N 6N5 Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Tay CT, Pirotta S, Teede HJ, Moran LJ, Robinson T, Skouteris H, Joham AE, Lim SS. Polycystic Ovary Syndrome Models of Care: A Review and Qualitative Evaluation of a Guideline-Recommended Integrated Care. Semin Reprod Med 2021; 39:133-142. [PMID: 34187051 DOI: 10.1055/s-0041-1727191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous disorder and many women are dissatisfied with their healthcare under the current fragmented health services. Here, we review existing literature on PCOS healthcare services and qualitatively evaluate an integrated PCOS service based on experiences of women with PCOS. Limited prior PCOS-dedicated services have been studied and their quantitative and efficacy-focused evaluations are summarized. Here, we also provide a broader PCOS service evaluation via semistructured interviews and surveys, with thematic analysis based on a predetermined evaluation framework. Fifteen women completed interviews and surveys. Overall the integrated, evidence-based PCOS service was well-received and women were generally satisfied with appropriateness, effectiveness, and reported positive health impact resulting from the service. Integrated care, tailored treatments, education, lifestyle support, and laser therapy were highly valued. Patients reported improvements on symptoms, understanding and confidence in managing PCOS, and emotional well-being. Elements of efficiency in the initial stages, awareness and communication, and the need for service expansion and tensions between evidence-based treatments and patient preferences were also captured to guide improvement. Further research into models of care is recommended to meet the needs of women with PCOS.
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Affiliation(s)
- Chau Thien Tay
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Clayton, Victoria, Australia
| | - Stephanie Pirotta
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Clayton, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Tracy Robinson
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Anju E Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Clayton, Victoria, Australia
| | - Siew S Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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13
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Doudenkova V. Médicalisation et autonomie des femmes affectées par le syndrome des ovaires polykystiques. CANADIAN JOURNAL OF BIOETHICS 2021. [DOI: 10.7202/1077630ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Le syndrome des ovaires polykystiques (SOPK) est un trouble endocrinien répandu qui affecte environ 10% des femmes en âge de procréer. Bien qu’il soit principalement connu pour ses effets sur la fertilité, le SOPK est considéré comme un facteur de risque pouvant mener au diabète de type 2. Il est également associé à des conditions comme les cancers hormono-dépendants, les troubles psychiatriques ou encore les maladies cardio-vasculaires. La volonté de prévenir les conditions associées pourrait pousser à une plus grande médicalisation des femmes atteintes par le SOPK, notamment par d’éventuels dépistages. Cet article examine les facteurs potentiels pouvant contribuer à la médicalisation de ces femmes et la manière dont leur autonomie pourrait être affectée par ce phénomène. Entre autres, l’article met en évidence comment la médicalisation façonne des représentations collectives et individuelles par rapport aux notions de santé, de maladie et de traitement. Dans une perspective relationnelle de l’autonomie, il attire l’attention sur l’importance de reconnaitre comment la médicalisation influence ces représentations et l’impact potentiel que cela pourrait avoir sur les femmes. Encourager la démédicalisation du SOPK par une approche visant à soutenir la santé pousse à interroger ces représentations et fait partie des pistes de solution permettant de favoriser l’autonomie des femmes affectées par le SOPK. Il devient alors possible non seulement de contrôler la maladie, mais aussi de soutenir la santé, voire de faire les deux selon la situation individuelle.
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Affiliation(s)
- Victoria Doudenkova
- Programmes de sciences biomédicales, Faculté de médecine, Université de Montréal, Montréal, Canada
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14
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Al Wattar BH, Bueno A, Martin MG, Ibáñez NC, Harasani K, Garad R, Franks S, Balen A, Bhide P, Piltonen T, Romualdi D, Laven J, Moss N, Andrews C, Hawkes R, Mol BW, Teede H, Thangaratinam S, Khan KS. Harmonizing research outcomes for polycystic ovary syndrome (HARP), a marathon not a sprint: current challenges and future research need. Hum Reprod 2021; 36:523-528. [PMID: 33332572 DOI: 10.1093/humrep/deaa331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/14/2020] [Indexed: 10/04/2023] Open
Abstract
Investing in clinical research and evidence-based medicine has helped to improve the care for women with polycystic ovary syndrome (PCOS). However, several important questions remain unanswered on the optimal prevention and management strategies for PCOS. Addressing this uncertainty is often hindered by suboptimal research conduct leading to inefficient evidence synthesis and research wastage. PCOS research is often practised by varied specialized teams in silo leading to disharmonious and fragmented efforts neglecting the lifelong impact of PCOS on women's wellbeing. Poor engagement among key stakeholders and lay consumers continues to limit the impact and benefits of research to society. Selective reporting on surrogate outcomes with a 'significant' P-value is a common malpractice in PCOS outputs. Effective adoption of the harmonizing research outcomes for PCOS (HARP) core outcome set is needed to minimize heterogeneity in reporting and promote research excellence. Small single-centre studies offer limited value to assess the varied PCOS phenotypes. Efficient large scale data-sharing is needed to address complex research questions and glean the benefits of big data research. We propose a roadmap to address these challenges and remedy future research need by promoting patient and public involvement in PCOS research to guide research efforts and address real patients' needs; engaging all key stakeholder groups to promote a multi-disciplinary lifelong approach to new research; continuously refining research needs and priorities to revise the knowledge gap and allocate resources judiciously; standardizing outcomes definitions and measurement tools to harmonize reporting and promote excellence in research; and by investing in large data-sharing infrastructure to facilitate big data research and govern ethical data sharing.
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Affiliation(s)
- Bassel H Al Wattar
- Warwick Medical School, University of Warwick, Coventry, UK
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| | - Aurora Bueno
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
- Inst Invest Biosanitaria Ibs GRANADA, Granada, Spain
| | - Miguel Garcia Martin
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
- Inst Invest Biosanitaria Ibs GRANADA, Granada, Spain
| | - Naomi Cano Ibáñez
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
- Inst Invest Biosanitaria Ibs GRANADA, Granada, Spain
| | - Klejda Harasani
- Department of Pharmacy, University of Medicine of Tirana, Tirana, Albania
| | - Rhonda Garad
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash Centre for Health Research and Implementation, Monash University Melbourne, Melbourne, VIC, Australia
- Monash Centre for Health Research and Implementation, School Public Health, Monash University, Clayton, VIC, Australia
| | - Steve Franks
- Imperial College School of Medicine, Institute of Reproductive and Developmental Biology, Hammersmith Hospital, London, UK
| | - Adam Balen
- Leeds Fertility, Seacroft Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Priya Bhide
- Homerton University Hospital NHS Foundation Trust, London, UK
- Barts Research Centre for Women's Health (BARC), Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Terhi Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Daniela Romualdi
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Woman and Child Health, Azienda Ospedaliera Card.Panico, Tricase, Italy
| | - Joop Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ngawai Moss
- Barts Research Centre for Women's Health (BARC), Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | - Ben W Mol
- Department of Obstetrics and Gynaecology, University of Monash, Melbourne, Australia
- Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK
| | - Helena Teede
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash Centre for Health Research and Implementation, Monash University Melbourne, Melbourne, VIC, Australia
- Monash Centre for Health Research and Implementation, School Public Health, Monash University, Clayton, VIC, Australia
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
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15
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The mental health of women with polycystic ovary syndrome: a systematic review and meta-analysis. Arch Womens Ment Health 2021; 24:11-27. [PMID: 32514730 DOI: 10.1007/s00737-020-01043-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Abstract
Polycystic ovary syndrome (PCOS) has been proposed to be associated with several mental health problems, including anxiety, depression, diminished sexual satisfaction, and lowered health-related quality of life, etc. A systematic review and meta-analysis of published literature was conducted comparing the mental health of women with and without PCOS. Ten English and Chinese databases were searched up to 12/31/2018. Random-effects models were introduced, and subgroup analysis, sensitivity test, and meta-regression were carried out to determine the source for heterogeneity among studies. Forty-six studies, including 30,989 participants (9265 women with PCOS and 25,638 controls), were qualified for review according to the inclusion criteria. Twenty-eight studies reported depression symptoms, 22 studies were on anxiety, 16 studies showed quality of life (QoL) status, 12 studies were about sexual dysfunction, five on emotional distress, four on binge eating, and four on somatization. Women with PCOS reported significantly higher depression (SMD = 0.64; 95% CI 0.50-0.78), anxiety (SMD = 0.63; 95% CI 0.50-0.77), lower QoL (SMD = - 0.55; 95% CI -0.69 to -0.40), and not significant sexual dysfunction (SMD = - 0.24; 95% CI - 0.49 to 0.01). Studies from different countries, adopting various diagnosis criteria, using diverse instruments, as well as in different years, have reported heterogenetic results. Women with PCOS in China reported a larger effect size of depression and anxiety than patients from other countries. The results of this study have indicated that women with PCOS suffer from depression, anxiety, and experience a lower quality of life, whereas their sexual function is not distinct from that of healthy women. Psychological health care interventions for women with PCOS were addressed.
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16
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Zhang D, Gao J, Qin H, Chang H, Wu X. Phenotypic features and fertility outcomes of women with polycystic ovary syndrome: The effect of quality of life. J Obstet Gynaecol Res 2020; 47:233-242. [PMID: 33090690 DOI: 10.1111/jog.14478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/27/2020] [Accepted: 08/30/2020] [Indexed: 11/28/2022]
Abstract
AIM This work sought to evaluate the correlation between the five domains of the Polycystic Ovary Syndrome Questionnaire (PCOSQ) and anxiety and depression scales and the clinical phenotype and fertility outcomes in infertile polycystic ovary syndrome (PCOS) patients and to determine the effect of quality of life (QOL) on the clinical, biochemical and fertility disorders in these patients. METHODS The data in this study came from a large-scale hospital-based cohort survey of infertile PCOS patients across mainland China. A total of 1000 infertile PCOS subjects diagnosed according to the modified Rotterdam criteria ranging in age from 20 to 40 years in 21 sub-centers (27 hospitals) were enrolled. Baseline anthropometric parameters, endocrine indexes, metabolic panel, QOL questionnaires and the fertility outcomes of ovulation, conception, pregnancy, pregnancy loss and live birth were collected. RESULTS PCOSQ scores were significantly correlated with most of the baseline parameters. PCOSQ-weight domain scores of National Institute of Health-PCOS group were significantly lower compared with non-National Institute of Health-PCOS group. The five domains scores of PCOSQ were significantly negatively correlated with the body mass index levels of PCOS patients. The serum testosterone levels (total testosterone, free testosterone and free androgen index) were significantly negatively correlated to the scores for the weight, body hair, infertility and emotion domains of PCOSQ. Scores on the anxiety and depression scales were significantly and positively correlated with luteinizing hormone, luteinizing hormone/follicle-stimulating hormone levels. In the low-score group of infertility domain, the rates of conception, pregnancy and live birth decreased significantly. CONCLUSIONS QOL appears to have an impact on the physical symptoms of PCOS, and the emotional stress of infertility affects fertility outcomes.
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Affiliation(s)
- Duojia Zhang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Jingshu Gao
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Huichao Qin
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Hui Chang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiaoke Wu
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
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17
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Ee C, Smith C, Moran L, MacMillan F, Costello M, Baylock B, Teede H. "The whole package deal": experiences of overweight/obese women living with polycystic ovary syndrome. BMC WOMENS HEALTH 2020; 20:221. [PMID: 33008386 PMCID: PMC7532653 DOI: 10.1186/s12905-020-01090-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 09/27/2020] [Indexed: 12/20/2022]
Abstract
Background Polycystic Ovary Syndrome (PCOS) is a common female reproductive disorder with multiple manifestations. There are relatively few qualitative studies exploring the nature of living with PCOS despite its high prevalence. Qualitative research can enhance clinical practice via the provision of patient insights into the experience of living with their condition. Methods We conducted two focus groups and three semi-structured interviews of Australian overweight/obese women with PCOS aged 18–46 years between March and April 2017 who were recruited through social media advertising. Interviews and focus groups were audio recorded and transcribed verbatim. Thematic analysis was applied to the data, using the method of constant comparison. Results Ten women contributed data from two focus groups and two semi-structured interviews. Five themes emerged from the data: complexity of the condition with its multiple manifestations, difficulties with delayed diagnosis and lack of information provided after diagnosis, negative experiences on social media and online forums and the need for support, frustration over lack of a “cure”; and the impact of symptoms and concern about long-term sequelae. Conclusions Living with PCOS appears to generate a significant degree of anxiety about the future, dissatisfaction with current treatment models, and loss of feminine identity. Gaps in timely diagnosis, information and support provision need to be addressed. This includes supporting weight management as a fundamental concern for women with PCOS.
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Affiliation(s)
- Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Caroline Smith
- Graduate Research School, and NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation - MCHRI, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Vic, 3168, Australia
| | - Freya MacMillan
- School of Health Sciences, and the Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Michael Costello
- School of Women's and Children's Health, UNSW, Royal Hospital for Women, Barker St, Randwick, NSW, 2031, Australia
| | - Brandi Baylock
- Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation - MCHRI, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Vic, 3168, Australia
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18
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Ekramzadeh M, Hajivandi L, Noroozi M, Mostafavi F. Psychological Experiences of Adolescent Girls with Polycystic Ovary Syndrome: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:341-347. [PMID: 33014747 PMCID: PMC7494171 DOI: 10.4103/ijnmr.ijnmr_276_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/29/2020] [Accepted: 04/28/2020] [Indexed: 11/04/2022]
Abstract
Background Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in the women of reproductive age. In addition to multiple physical problems, this syndrome has many psychological manifestations. Thus, the present research was conducted aimed at investigating the psychological experiences of the adolescent girls with PCOS. Materials and Methods This research was conducted using the qualitative content analysis method. A total of 18 adolescent girls with PCOS and 15 healthcare providers were selected by the purposive sampling method. The data were collected through in-depth interviews, focus group discussions, and field notes, which were analyzed using the conventional content analysis method. Results After analyzing, three main categories and seven subcategories were extracted. First, the psychological experiences related to the disease symptoms had three subcategories: "psychological experiences related to hirsutism, alopecia, and acne," "psychological experiences related to obesity," and "psychological experiences related to menstrual disorders." Second, the psychological experiences related to disease complications had two subcategories: "psychological experiences related to infertility" and "psychological experiences related to disease progression." Third, the psychological experiences related to treatment of the disease had two subcategories: "psychological experiences related to prolongation of the treatment and uncertain fate of the disease" and "psychological experiences related to the complications of the medical treatment." Conclusions Results of the study showed that adolescent girls with PCOS were exposed to multiple concerns endangering their psychological health. Therefore, it is recommended to provide adequate and appropriate information about the disease and its consequences, as well as psychosocial supports and regular assessment of psychological state by the team of healthcare providers in the adolescent girls with PCOS.
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Affiliation(s)
- Maryam Ekramzadeh
- Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Hajivandi
- Department of Nursing and Midwifery, Kazerun Medical Sciences Branch, Islamic Azad University, Kazerun, Iran
| | - Mahnaz Noroozi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firoozeh Mostafavi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Copp T, Cvejic E, McCaffery K, Hersch J, Doust J, Mol BW, Dokras A, Mishra G, Jansen J. Impact of a diagnosis of polycystic ovary syndrome on diet, physical activity and contraceptive use in young women: findings from the Australian Longitudinal Study of Women’s Health. Hum Reprod 2020; 35:394-403. [DOI: 10.1093/humrep/dez274] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
STUDY QUESTION
Do diet, physical activity and contraceptive use change after receiving a diagnosis of polycystic ovary syndrome (PCOS)?
SUMMARY ANSWER
Using longitudinal data 12 months apart, young women newly diagnosed with PCOS were more likely to stop using contraception but did not change their physical activity or vegetable intake.
WHAT IS KNOWN ALREADY
Diagnostic criteria for PCOS have widened to capture more women, despite limited evidence of the benefits and harms. Possible benefits of a PCOS diagnosis are that it may help women with family planning and motivate them to implement healthy lifestyle changes to reduce the reproductive, metabolic and cardiovascular risks associated with PCOS. However, there are no empirical studies investigating how women respond to a diagnosis of PCOS with respect to their health behaviour, and longitudinal population-based studies are lacking.
STUDY DESIGN, SIZE, DURATION
This is a longitudinal analysis of two waves of data collected 12 months apart from the cohort born 1989–1995 in the Australian Longitudinal Survey on Women’s Health, a population-based cohort study. Women in this cohort were first surveyed in 2012-2013, aged 18-23 years.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Women who responded to the 2014 survey (aged 19–24, n = 11 344) and 2015 survey (aged 20–25, n = 8961) were included. Using logistic regression, multinomial logistic regression and linear regression, change in vegetable intake, physical activity and contraceptive use were compared for women newly diagnosed with PCOS to women not reporting a diagnosis of PCOS. Changes in psychological distress and BMI were also examined.
MAIN RESULTS AND THE ROLE OF CHANCE
Young women reporting a new diagnosis of PCOS were no more likely to increase their vegetable intake or physical activity than women not reporting a PCOS diagnosis. Women newly diagnosed with PCOS were 3.4 times more likely to stop using contraception during the 12-month study period than women without PCOS (14% versus 4%, 95% CI = 2.3 to 5.1, P < 0.001). This difference remained significant after controlling for demographics, chronic conditions associated with PCOS, endometriosis, BMI and psychological distress (P < 0.001).
LIMITATIONS, REASONS FOR CAUTION
All data was self-reported including PCOS diagnosis, assessment of diet quality was limited to vegetable intake only. The exact timing of diagnosis within the 12-month period and whether the women intended to conceive are unknown. The number of women reporting a new diagnosis of PCOS was also relatively small.
WIDER IMPLICATIONS OF THE FINDINGS
These findings suggest that a diagnosis of PCOS may not produce short-term benefits by way of improving health behaviour. The observed reduction in contraception use suggests some women may be at increased risk of unplanned pregnancies, highlighting the importance of counselling about contraceptive needs. Both potential benefits and harms must be considered when determining the appropriateness of a PCOS diagnosis.
STUDY FUNDING/COMPETING interest(s)
The Australian Longitudinal Study on Women’s Health is funded by the Australian Government Department of Health. BWM reports consultancy for ObsEva, Merck, Merck KGaA and Guerbet. No further competing interests exist.
TRIAL REGISTRATION NUMBER
N/A
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Affiliation(s)
- Tessa Copp
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Erin Cvejic
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Jolyn Hersch
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Jenny Doust
- Wiser Healthcare, Centre for Research in Evidence-Based Practice, Bond University, Robina, 4226, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3800, Australia
| | - Anuja Dokras
- Penn PCOS Centre, Department of Obstetrics and Gynaecology, University of Pennsylvania, Philadelphia, 19104, USA
| | - Gita Mishra
- School of Public health, Faculty of Medicine, The University of Queensland, QLD, 4006, Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
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20
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Copp T, Hersch J, Muscat DM, McCaffery KJ, Doust J, Dokras A, Mol BW, Jansen J. The benefits and harms of receiving a polycystic ovary syndrome diagnosis: a qualitative study of women's experiences. Hum Reprod Open 2019; 2019:hoz026. [PMID: 31687475 PMCID: PMC6822814 DOI: 10.1093/hropen/hoz026] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/08/2019] [Accepted: 08/22/2019] [Indexed: 12/22/2022] Open
Abstract
STUDY QUESTION What are the benefits and harms of receiving a polycystic ovary syndrome (PCOS) diagnosis in a community sample of women, including impact on psychosocial wellbeing, lifestyle choices and behaviour? SUMMARY ANSWER Although some women benefit considerably from the diagnosis, such as through increased awareness and reassurance, women with minimal symptoms may experience more harm than benefit, including long-lasting anxiety and altered life plans. WHAT IS KNOWN ALREADY Disease labels can validate symptoms and play a vital role in understanding and coping with illness; however, they can also cause harm by evoking illness schemas about severity and permanence. Regarding PCOS, the diagnostic criteria have expanded over time to include women with milder phenotypes (such as those without signs of androgen excess). This has occurred despite limited investigation of the benefits and harms of the diagnosis and has increased the number of women diagnosed. STUDY DESIGN SIZE DURATION Semi-structured interviews were conducted face-to-face or by telephone with 26 participants from April-July 2018 to explore women's experiences with the diagnosis, including the benefits and harms of receiving the diagnosis and the impact on their life. PARTICIPANTS/MATERIALS SETTING METHODS In total, 26 women in the community self-reporting a diagnosis of PCOS (reporting mild to severe symptoms) made by a medical doctor, aged 18-45 years and living in Australia were recruited through social media. Data were analysed thematically using Framework analysis. MAIN RESULTS AND THE ROLE OF CHANCE The study identified a range of both positive and negative effects of a PCOS diagnosis in the immediate, short and long-term, which were influenced by symptom severity, expectations and experience. For women with previously unexplained and bothersome symptoms, it was a relief to receive a diagnosis, and this resulted in an increased understanding about the importance of a healthy lifestyle. By contrast, women with milder symptoms often reported feeling shocked and overwhelmed by the diagnosis, consequently experiencing anxiety about the associated long-term risks. The majority of women, regardless of symptom severity, experienced prolonged worry and anxiety about infertility, resulting for some in risk taking with contraception, unintended pregnancies, pressure to conceive early or altered life plans. With time, many women developed positive coping strategies and perceived the diagnosis to be valuable, including those who felt they had experienced minimal benefit or even harm. LIMITATIONS REASONS FOR CAUTION PCOS diagnosis was self-reported and the sample was highly educated. WIDER IMPLICATIONS OF THE FINDINGS Fear of infertility was salient for many women, underscoring the need for accurate information, counselling and reassurance of fertility potential. Given the risk of significant consequences, health professionals should use a tailored approach to PCOS diagnosis to increase the benefits of appropriate and timely diagnosis for women affected by significant symptoms, while reducing the harms of unnecessarily labelling healthy women for whom the benefits of a diagnosis are small. STUDY FUNDING/COMPETING INTERESTS The study was funded by the University of Sydney Lifespan Research Network and an NHMRC Program Grant (APP1113532). B.W.M. reports consultancy for ObsEva, Merck, Merck KGaA and Guerbet. No further competing interests exist. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- T Copp
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, 2006, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, 2006, Australia
| | - J Hersch
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, 2006, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, 2006, Australia
| | - D M Muscat
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, 2006, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, 2006, Australia
| | - K J McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, 2006, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, 2006, Australia
| | - J Doust
- Wiser Healthcare, Centre for Research in Evidence-Based Practice, Bond University, Robina 4226, Australia
| | - A Dokras
- Penn PCOS Centre, Department of Obstetrics and Gynaecology, University of Pennsylvania, Philadelphia 19104, USA
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, 3800, Australia
| | - J Jansen
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, 2006, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, 2006, Australia
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Thorpe C, Arbeau KJ, Budlong B. 'I drew the parts of my body in proportion to how much PCOS ruined them': Experiences of polycystic ovary syndrome through drawings. Health Psychol Open 2019; 6:2055102919896238. [PMID: 31903221 PMCID: PMC6928539 DOI: 10.1177/2055102919896238] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Polycystic ovary syndrome is a chronic endocrine disorder associated with persistent physical symptoms and psychological and lifestyle repercussions. Eighty-nine participants (83 females, 6 non-binary) aged 19-43 years described their experiences of polycystic ovary syndrome through drawings and personal accounts. Four descriptive themes were identified: awareness of visible and invisible symptoms, misshapen self and body, limitations and barriers and resignation. Taken together, participants described a condition with all-encompassing effects: much more than symptom management alone. Findings support the use of drawings as an appropriate method with this population and suggest continuing need for supports for individuals with polycystic ovary syndrome.
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22
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Gomez AM, Arteaga S, Ingraham N, Arcara J. Medical conditions, pregnancy perspectives and contraceptive decision-making among young people: an exploratory, qualitative analysis. Contraception 2019; 100:72-78. [PMID: 30980830 PMCID: PMC6589374 DOI: 10.1016/j.contraception.2019.03.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 03/23/2019] [Accepted: 03/27/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore perspectives on family planning among young people who perceive they are infertile or will have difficulty carrying a pregnancy to term owing to medical conditions or procedures. METHODS This exploratory analysis examined pregnancy plans and contraceptive behavior among 12 young adults with a diagnosed medical condition or who had undergone a medical procedure associated with impaired fertility, and who had discussed fertility with a healthcare provider. We utilized data from a larger study investigating prospective pregnancy intentions and plans among 50 young (ages 18-24) women and their male partners (n=100). RESULTS Medical conditions included endometriosis, polycystic ovary syndrome, and lupus. For some, medical conditions/procedures led to use of no or less effective contraception; perceived risk for pregnancy was low, though seven participants had previously experienced pregnancies. Participants also described how medical conditions altered their timelines for pregnancy and overall desire for children; for example, one participant described continuing an unplanned pregnancy because she feared it would be her only chance to parent. CONCLUSION This exploratory analysis suggests that among young people, medical issues perceived to affect fertility and pregnancy may influence pregnancy planning and contraceptive behavior. Young people may lack knowledge about fertility and the impact of a medical condition; thus it is critical that providers clarify the difference between anticipated difficulty conceiving and complete infertility. Tailored contraceptive care is needed for young adults with medical conditions that may affect fertility to ensure they have the necessary information to make informed family planning decisions. IMPLICATIONS Medical conditions known to affect fertility may influence young people's family planning desires and behaviors. Understanding how young adults process information about medical conditions' impact on their fertility and change or make plans in response is important in order to best meet their family planning needs.
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Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA.
| | - Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Natalie Ingraham
- Department of Sociology and Social Services, California State University, East Bay, 25800 Carlos Bee Boulevard, Hayward, CA 94542, USA
| | - Jennet Arcara
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
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A mixed-methods study of coping and depression in adolescent girls with polycystic ovary syndrome. J Am Assoc Nurse Pract 2019; 31:189-197. [PMID: 30681649 DOI: 10.1097/jxx.0000000000000125] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Polycystic ovary syndrome (PCOS) is a complex metabolic disorder associated with clinical manifestations that could be psychologically distressing to adolescent girls considering the concern of body image during the developmental stage of adolescence. Poor psychological functioning is related to increased mortality, higher health care costs, and negative health outcomes. Coping has been identified as impacting health and adaptation to illness; therefore, the purpose was to examine coping and depression in adolescent girls with PCOS. METHODS Adolescent girls, aged 13-18 years and diagnosed with PCOS completed questionnaires regarding coping and depression and participated in interviews. A convergent, parallel, mixed-method design was used. CONCLUSIONS Girls perceived very little control over the aspects of PCOS, with menstrual irregularities and the threat of infertility reported as the most stressful and least controllable aspects of PCOS. Lower control was a predictor of greater depression among the participants. IMPLICATIONS FOR PRACTICE Providers should strive to establish rapport with adolescent girls and ask specifically about their concerns surrounding PCOS to provide meaningful health education. Providers should also be aware of the risk for depression among this population and should routinely screen patients and keep channels of communication open regarding the symptoms of depression.
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Zhang X, Zheng Y, Guo Y, Lai Z. The Effect of Low Carbohydrate Diet on Polycystic Ovary Syndrome: A Meta-Analysis of Randomized Controlled Trials. Int J Endocrinol 2019; 2019:4386401. [PMID: 31885557 PMCID: PMC6899277 DOI: 10.1155/2019/4386401] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/14/2019] [Accepted: 07/31/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To assess the effect of a low carbohydrate diet (LCD) on women with polycystic ovary syndrome (PCOS). METHODS Data from randomized controlled trials (RCTs) were obtained to perform a meta-analysis of the effects of LCD in PCOS patients. The primary outcomes included the changes in BMI, homeostatic model assessment for insulin resistance (HOMA-IR), and blood lipids, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), follicle-stimulating hormone (FSH), luteotropic hormone (LH), total testosterone (T), and sex hormone-binding globulin (SHBG). RESULTS Eight RCTs involving 327 patients were included. In comparison with the control group, the LCD decreased BMI (SMD = -1.04, 95% CI (-1.38, -0.70), P < 0.00001), HOMA-IR (SMD = -0.66, 95% CI (-1.01, -0.30), P < 0.05), TC (SMD = -0.68, 95% CI (-1.35, -0.02), P < 0.05), and LDL-C (SMD = -0.66, 95% CI (-1.30, -0.02), P < 0.05). Stratified analyses indicated that LCD lasting longer than 4 weeks had a stronger effect on increasing FSH levels (MD = 0.39, 95% CI (0.08, 0.71), P < 0.05), increasing SHBG levels (MD = 5.98, 95% CI (3.51, 8.46), P < 0.05), and decreasing T levels (SMD = -1.79, 95% CI (-3.22, -0.36), P < 0.05), and the low-fat and low-CHO LCD (fat <35% and CHO <45%) had a more significant effect on the levels of FSH (MD = 0.40, 95% CI (0.09, 0.71), P < 0.05) and SHBG (MD = 6.20, 95% CI (3.68, 8.72), P < 0.05) than the high-fat and low-CHO LCD (fat >35% and CHO <45%). CONCLUSION Based on the current evidence, LCD, particularly long-term LCD and low-fat/low-CHO LCD, may be recommended for the reduction of BMI, treatment of PCOS with insulin resistance, prevention of high LDL-C, increasing the levels of FSH and SHBG, and decreasing the level of T level. Together, the analyzed data indicate that proper control of carbohydrate intake provides beneficial effects on some aspects of PCOS and may represent one of the important interventions improving the clinical symptoms of affected patients.
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Affiliation(s)
- Xiaoshuai Zhang
- Chongqing Medical University, No. 1, Medical College Road, Yuzhong District, Chongqing 400010, China
| | - Yang Zheng
- Chongqing Medical University, No. 1, Medical College Road, Yuzhong District, Chongqing 400010, China
| | - Yanan Guo
- Chongqing Medical University, No. 1, Medical College Road, Yuzhong District, Chongqing 400010, China
| | - Zhiwen Lai
- Department of Gynecology, Chengdu Xinan Gynecological Hospital, Chengdu, China
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25
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Lin AW, Bergomi EJ, Dollahite JS, Sobal J, Hoeger KM, Lujan ME. Trust in Physicians and Medical Experience Beliefs Differ Between Women With and Without Polycystic Ovary Syndrome. J Endocr Soc 2018; 2:1001-1009. [PMID: 30140785 PMCID: PMC6101505 DOI: 10.1210/js.2018-00181] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/17/2018] [Indexed: 11/19/2022] Open
Abstract
CONTEXT Women with polycystic ovary syndrome (PCOS) report dissatisfaction with their early medical care. Little is understood about factors that can encourage stronger patient-provider relationships and promote treatment adherence. OBJECTIVE To compare trust in physicians and beliefs about social support from health care providers between women with and without PCOS. DESIGN Cross-sectional study with online questionnaire. SETTING Medical clinic referral or broader community recruitment via advertising and websites. PARTICIPANTS Three hundred thirty-two US-based women with PCOS or with regular menses (n = 134 and n = 198, respectively). MAIN OUTCOME MEASURES Trust and social support toward health care providers [primary care physicians (PCPs), specialists, and/or nurse practitioners and physician assistants]. RESULTS PCOS was associated with greater distrust in the PCP's opinion (P < 0.01) and greater confidence about the PCP's prioritization of general health concerns (P = 0.04) than the comparison group. Patients with PCOS felt that the PCP spent less effort and were less qualified to treat PCOS health concerns than general health concerns (both P < 0.001). No significant associations were observed between PCOS diagnosis and trust in specialists. When examining social support, women with PCOS felt they had more arguments with their health care providers than the comparison group (P = 0.02). CONCLUSION Women with PCOS reported greater overall distrust in the PCP's opinions and more arguments with their health care providers than women without PCOS. These findings support a need to identify additional areas of improvement in the patient-provider relationship to ensure continuity of care for patients with PCOS who require life-long surveillance.
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Affiliation(s)
- Annie W Lin
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Elena J Bergomi
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Jamie S Dollahite
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Jeffery Sobal
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Kathleen M Hoeger
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Marla E Lujan
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
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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; 10:397-408. [PMID: 30123008 PMCID: PMC6078086 DOI: 10.2147/ijwh.s165794] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Polycystic ovary syndrome (PCOS) is associated with biochemical and hormonal disturbance and adverse cosmetic, reproductive, metabolic, and psychological consequences, resulting in reduced health-related quality of life (HRQoL). Various generic and specific questionnaires have been used for assessing different dimensions of HRQoL in PCOS women. The purpose of this systematic review was to identify those general and specific instruments and to determine the factors that affect HRQoL in PCOS women. Materials and methods The research strategy involved general and specific terms in relation to PCOS women and their QoL. A review was performed on studies that were published between 1945 to 2017 and that were indexed in MEDLINE, ISI Web of Science, and Scopus. A narrative synthesis of the data was provided. Results In total, 52 studies (9 qualitative and 43 quantitative) were included in the review. The analysis indicated that 3 specific and 5 general instruments were used to measure the QoL in PCOS women. Of these, the 36-Item Short Form Health Survey (SF-36) and the Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (PCOSQ) were used most frequently. All studies assessed different aspects of QoL in PCOS women and found that PCOS had negative effects on QoL in this population. Conclusion The PCOSQ and the SF-36 were used most frequently for the assessment of QoL in PCOS women. Perhaps using either a specific questionnaire solely or a specific questionnaire in conjunction with a generic measure would be more appropriate when measuring QoL in PCOS women. However, both questionnaires showed that they are able to capture different aspects of QoL in PCOS women and to identify areas that can help to improve QoL in these women.
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Affiliation(s)
- Zahra Behboodi Moghadam
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Fereidooni
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran,
| | - Mohsen Saffari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Montazeri
- Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran,
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Doudenkova V. La bioéthique, l’art et le syndrome des ovaires polykystiques : propos impressionniste visant à réhabiliter les corps tabous et les ovaires blâmés. BIOÉTHIQUEONLINE 2018. [DOI: 10.7202/1044280ar] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
La bioéthique pousse à une prise de responsabilité de l’être humain face aux problèmes qu’il se crée tandis que l’art inspire un réenchantement dans le but de donner un sens différent au monde mécanique et technoscientifique d’aujourd’hui. La santé n’échappe pas à cette vision rigide et les croyances qui y sont reliées sont présentées dans un conte paradigmatique et absurde où la santé devient l’objet de la rationalité instrumentale et scientifique de la biomédecine. Suite à cette contextualisation, il devient plus aisé de comprendre le parcours frustrant décrit par les femmes atteintes du syndrome des ovaires polykystiques (SOPK) dans le contexte de leurs soins. La biomédecine conçoit le SOPK de façon biologique et individuelle oubliant l’apport d’une vision plus globale. À l’opposé de la biomédecine, des approches préventives cherchant l’amélioration de l’état de santé et non le traitement de la maladie, offrent une perspective plus holistique du soin. Dans ce contexte, l’art est conçu comme une façon originale de se souvenir des valeurs oubliées: une plus grande sensibilité et humanité, un rapport à la santé qui est respectueux de la vie, une créativité dans le contexte du soin. La démarche devient un geste moral et beau appelant non plus à lutter contre un mal, mais à prendre soin de la santé dans l’amour et la paix, ouvrant alors de nouvelles possibilités pour améliorer la qualité de vie des femmes concernées et donc produire un plus grand bien.
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Affiliation(s)
- Victoria Doudenkova
- Programmes de bioéthique, Département de médecine sociale et préventive, École de santé publique (ÉSPUM), Université de Montréal, Montréal, Canada
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Nasiri Amiri F, Ramezani Tehrani F, Esmailzadeh S, Tohidi M, Azizi F, Basirat Z. Sexual function in women with polycystic ovary syndrome and their hormonal and clinical correlations. Int J Impot Res 2017; 30:54-61. [DOI: 10.1038/s41443-017-0006-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 06/10/2017] [Accepted: 07/14/2017] [Indexed: 02/03/2023]
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29
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Lin AW, Dollahite JS, Sobal J, Lujan ME. Health-related knowledge, beliefs and self-efficacy in women with polycystic ovary syndrome. Hum Reprod 2017; 33:91-100. [DOI: 10.1093/humrep/dex351] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Indexed: 01/01/2023] Open
Affiliation(s)
- Annie W Lin
- Division of Nutritional Sciences, Cornell University, 244 Garden Ave, Ithaca, NY 14853, USA
| | - Jamie S Dollahite
- Division of Nutritional Sciences, Cornell University, 244 Garden Ave, Ithaca, NY 14853, USA
| | - Jeffery Sobal
- Division of Nutritional Sciences, Cornell University, 244 Garden Ave, Ithaca, NY 14853, USA
| | - Marla E Lujan
- Division of Nutritional Sciences, Cornell University, 244 Garden Ave, Ithaca, NY 14853, USA
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30
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Martin ML, Halling K, Eek D, Krohe M, Paty J. Understanding polycystic ovary syndrome from the patient perspective: a concept elicitation patient interview study. Health Qual Life Outcomes 2017; 15:162. [PMID: 28821294 PMCID: PMC5562990 DOI: 10.1186/s12955-017-0736-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to explore the need for a new disease-specific patient reported outcome (PRO) measure for use in clinical trials of drugs designed to target the underlying causes of polycystic ovary syndrome (PCOS), and in the process contribute to our understanding of the symptoms and impacts that define the patient experience with PCOS. METHODS Semi-structured interviews were conducted in 20 women diagnosed with PCOS according to the Rotterdam criteria who had not menstruated in the previous month. The relative importance of PCOS symptoms and impact concepts to patients was determined by analyzing the frequency of their expression in the interview transcripts. These insights were compared to clinicians' perceptions of PCOS. RESULTS Pain- and discomfort-related symptoms accounted for the highest proportion (27.6%) of the 735 patient expressions, although clinicians did not consider pain to be important to patients with PCOS. The most frequently expressed individual symptoms were cramping (70% of patients; 14.7% of concepts), irregular menstruation (95% of patients; 12.2% of concepts), facial hair growth (75% of patients; 10.6% of concepts), heavy bleeding (70% of patients; 8.8% of concepts), infertility (70% of patients; 5.4% of concepts), and bloating (60% of patients; 5.2% of concepts). Cramping, heavy bleeding, and bloating were not identified by clinicians as being important to patients with PCOS. The impacts most frequently reported by patients with PCOS related to emotional well-being (e.g. anxiety/stress) and coping behaviors (e.g. acne medication, hair removal). CONCLUSIONS The only validated PCOS-specific PRO, the PCOSQ, does not capture some key PCOS symptoms and impacts expressed by patients with PCOS, most notably those related to pain and discomfort, bleeding intensity and coping behaviours. Furthermore, some key PCOS symptoms may be under-recognized in the clinic.
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Affiliation(s)
- Mona L. Martin
- Health Research Associates, 6505 216th St SW, Mountlake Terrace, Seattle, WA 98043 USA
| | - Katarina Halling
- AstraZeneca Gothenburg, Pepparedsleden 1, 431 83 Mölndal, SE Sweden
| | - Daniel Eek
- AstraZeneca Gothenburg, Pepparedsleden 1, 431 83 Mölndal, SE Sweden
| | - Meaghan Krohe
- Adelphi Values, 7th Floor, 290 Congress St, Boston, MA 02210 USA
| | - Jean Paty
- Quintiles, 8 Skyline Dr, Hawthorne, New York, NY 10532 USA
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31
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Tomlinson J, Pinkney J, Adams L, Stenhouse E, Bendall A, Corrigan O, Letherby G. The diagnosis and lived experience of polycystic ovary syndrome: A qualitative study. J Adv Nurs 2017; 73:2318-2326. [PMID: 28329428 DOI: 10.1111/jan.13300] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2017] [Indexed: 11/30/2022]
Abstract
AIMS To explore the impact of the diagnosis of polycystic ovary syndrome on health/ill health identity, how women experience this diagnosis and their health beliefs. BACKGROUND Polycystic ovary syndrome is a common and heterogeneous condition, giving rise to a wide range of different health concerns. Previous research on polycystic ovary syndrome has been dominated by the medical perspective and less is known about the experiences and needs of women. DESIGN A qualitative study of 32 premenopausal adult women with polycystic ovary syndrome (diagnosis confirmed by Rotterdam criteria), aged between 18 and 45 years, recruited from a primary and secondary care setting. METHODS Thematic analysis of transcripts from 11 focus groups conducted between 2013-2015. RESULTS/FINDINGS Women identified a range of concerns affecting personal and reproductive identity, health knowledge and beliefs: (1) delays and barriers to diagnosis; (2) general lack of empathy by the medical profession; (3) difficulty in accessing specialist referral; (4) lack of information from professionals; (5) inconsistent and sometimes unsatisfactory experiences with medications; (6) insufficient help and advice regarding in/fertility; (7) relative lack of awareness or concern about longer term risks such as diabetes; and (8) significant discrepancies between the beliefs of women with polycystic ovary syndrome and how they experienced the attitudes of healthcare professionals. CONCLUSIONS There appears to be a divergence between women's experience and attitudes of healthcare professionals. The diagnosis, support and lived experience of women with polycystic ovary syndrome could be enhanced by better professional recognition of these concerns, improved knowledge and communication about polycystic ovary syndrome and better access to support and specialist advice.
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Affiliation(s)
- Julie Tomlinson
- Pool Health Centre, Cornwall, UK.,St. Austell Healthcare, Cornwall, UK.,Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Jonathan Pinkney
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.,Department of Endocrinology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Linda Adams
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | | | - Alison Bendall
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Oonagh Corrigan
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Gayle Letherby
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
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32
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Kaczmarek C, Haller DM, Yaron M. Health-Related Quality of Life in Adolescents and Young Adults with Polycystic Ovary Syndrome: A Systematic Review. J Pediatr Adolesc Gynecol 2016; 29:551-557. [PMID: 27262833 DOI: 10.1016/j.jpag.2016.05.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/22/2016] [Accepted: 05/16/2016] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To review recent data exploring the relationship between polycystic ovary syndrome (PCOS) and health-related quality of life (HRQoL) in adolescents and its implication for management of adolescents with this syndrome. DESIGN AND SETTING We performed a systematic literature search in MedLine, Embase and PsychInfo from 1980 to September 2015 and manual search in reference lists of selected articles. Inclusion criteria were articles in English or French with a focus on HRQoL in patients with PCOS aged between 13 and 24 years. Qualitative, cross-sectional, or interventional studies were considered as eligible. Two reviewers each independently selected and reviewed the relevant articles. RESULTS Of a total of 93 publications, 7 were selected through a systematic search, and 2 were added after a manual search. Seven studies used quantitative methods and 2 studies used a qualitative one. A meta-analysis was not possible because of the methodological diversity among the selected articles. All articles showed that PCOS has a negative influence on HRQoL in adolescents. Body weight issues and body mass index (BMI) appeared to have the strongest effect on HRQoL; some studies reported a normalization of HRQoL scores after adjustment for BMI. Patient information and patient-provider relationship were also reported to affect HRQoL. Elements in favor of the effectiveness of multidisciplinary management, associated lifestyle modifications, and psychological support, in improving HRQoL were identified. CONCLUSION PCOS significantly reduces HRQoL in adolescent girls. The extent to which body weight issues and BMI mediate this effect deserves further evaluation. A detailed understanding of the psychosocial challenges that patients with PCOS face is limited, mainly because of the small number of studies available, restricted sample size, and the methodological diversity of the questionnaires used. The effect of early lifestyle modification, and medical and psychological treatment should continue to be explored.
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Affiliation(s)
- Chloe Kaczmarek
- Medical School, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Dagmar M Haller
- Adolescent and Young Adult Program, Department of Community Medicine and Primary Care and Department of Pediatrics, Geneva University Hospitals, and Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Michal Yaron
- Medical School, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.
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Brunner F, Fliegner M, Krupp K, Rall K, Brucker S, Richter-Appelt H. Gender Role, Gender Identity and Sexual Orientation in CAIS ("XY-Women") Compared With Subfertile and Infertile 46,XX Women. JOURNAL OF SEX RESEARCH 2015; 53:109-124. [PMID: 26133743 DOI: 10.1080/00224499.2014.1002124] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The perception of gender development of individuals with complete androgen insensitivity syndrome (CAIS) as unambiguously female has recently been challenged in both qualitative data and case reports of male gender identity. The aim of the mixed-method study presented was to examine the self-perception of CAIS individuals regarding different aspects of gender and to identify commonalities and differences in comparison with subfertile and infertile XX-chromosomal women with diagnoses of Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) and polycystic ovary syndrome (PCOS). The study sample comprised 11 participants with CAIS, 49 with MRKHS, and 55 with PCOS. Gender identity was assessed by means of a multidimensional instrument, which showed significant differences between the CAIS group and the XX-chromosomal women. Other-than-female gender roles and neither-female-nor-male sexes/genders were reported only by individuals with CAIS. The percentage with a not exclusively androphile sexual orientation was unexceptionally high in the CAIS group compared to the prevalence in "normative" women and the clinical groups. The findings support the assumption made by Meyer-Bahlburg ( 2010 ) that gender outcome in people with CAIS is more variable than generally stated. Parents and professionals should thus be open to courses of gender development other than typically female in individuals with CAIS.
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Affiliation(s)
- Franziska Brunner
- a Institute for Sex Research and Forensic Psychiatry , University Medical Center Hamburg-Eppendorf
| | - Maike Fliegner
- a Institute for Sex Research and Forensic Psychiatry , University Medical Center Hamburg-Eppendorf
| | - Kerstin Krupp
- a Institute for Sex Research and Forensic Psychiatry , University Medical Center Hamburg-Eppendorf
| | - Katharina Rall
- b Department of Obstetrics and Gynaecology , Tübingen University Hospital
| | - Sara Brucker
- b Department of Obstetrics and Gynaecology , Tübingen University Hospital
| | - Hertha Richter-Appelt
- a Institute for Sex Research and Forensic Psychiatry , University Medical Center Hamburg-Eppendorf
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BALIKCI A, ERDEM M, KESKIN U, BOZKURT ZINCIR S, GÜLSÜN M, ÖZÇELIK F, AKGÜL EÖ, AKARSU S, ÖZTOSUN M, ERGÜN A. Depression, Anxiety, and Anger in Patients with Polycystic Ovary Syndrome. Noro Psikiyatr Ars 2014; 51:328-333. [PMID: 28360650 PMCID: PMC5353166 DOI: 10.5152/npa.2014.6898] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 03/06/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Polycystic Ovary Syndrome (PCOS) is a syndrome of heterogeneous nature, affecting multiple systems, particularly the endocrine system. We propose to investigate the possible relationships among hormonal changes, levels of anxiety, depression, and anger in patients with PCOS. METHOD Forty-four female patients with PCOS and 44 body mass index (BMI )-matched healthy women participated in this study. We measured the sociodemographic features, some serum hormonal levels (insulin, gonadotropins, prolactin, dehydroepiandrosterone sulfate (DHEAS), thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), 17 OH-progesterone, and total and free testosterone), and some other biochemical parameters of the participants. Also, all participants completed the Trait Anger-Anger Expression Scale (STAS), Beck Depression, and Beck Anxiety Inventories. We evaluated the psychiatric scale scores obtained from PCOS patients and control subjects. We used the independent-samples t-test for parametric data to evaluate normal distribution, and Mann-Whitney U-test was used for both abnormally distributed and nonparametric data. We used Pearson correlation analysis to evaluate the potential connection between the two groups' data. RESULTS The mean ages of the patients with PCOS and control subjects who participated in this study were 27.3±5.6 and 27.4±6.1 years, respectively. The measures of BMI, insulin, luteinizing hormone (LH), DHEAS, and total testosterone serum levels in the patient group were significantly higher than in the control group (p<.05). There was a statistically significant positive correlation between Beck anxiety scores and serum DHEAS levels (Pearson r=.4366, P=.0001). We found significant differences between the two groups in terms of trait anger, anger control, outward and inward anger, anxiety level, and depression scores (P<.05). CONCLUSION Anxiety symptoms indicate a stronger relationship compared to depression with DHEAS serum levels via the autonomic nervous system, considering the gamma-aminobutyric acid (GABA)-antagonistic effect of DHEAS. Obesity, hirsutism, and infertility may reduce self-confidence and create depressive symptoms in patients with PCOS. In addition, changes in hormonal levels may lead to anxiety directly. Possibly, depressive symptoms are a secondary reflection of these changes.
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Affiliation(s)
- Adem BALIKCI
- Gülhane Military Medical Academy, Department of Psychiatry, Ankara, Turkey
| | - Murat ERDEM
- Gülhane Military Medical Academy, Department of Psychiatry, Ankara, Turkey
| | - Uğur KESKIN
- Gülhane Military Medical Academy, Department of Obstetrics and Gynaecology, Ankara, Turkey
| | - Selma BOZKURT ZINCIR
- Erenköy Mental Health and Neurological Diseases Education and Research Hospital, Department of Psychiatry, İstanbul, Turkey
| | - Murat GÜLSÜN
- Gülhane Military Medical Academy, Department of Psychiatry, Ankara, Turkey
| | - Fatih ÖZÇELIK
- Gümüşsuyu Military Hospital, Department of Biochemistry, İstanbul, Turkey
| | - Emin Özgür AKGÜL
- Gülhane Military Faculty of Medicine, Department of Biochemistry, Ankara, Turkey
| | - Süleyman AKARSU
- Gülhane Military Medical Academy, Department of Psychiatry, Ankara, Turkey
| | - Muzaffer ÖZTOSUN
- Turkish Armed Forces Medical Command, Department of Biochemistry, Ankara, Turkey
| | - Ali ERGÜN
- Gülhane Military Medical Academy, Department of Obstetrics and Gynaecology, Ankara, Turkey
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Hongxia M, Huiling L, Jingshu G, Hongli M, Jianping L, Ernest NH, Annika B, Elisabet SV, Xin M, Xiaoke W. Value of qualitative research in polycystic ovary syndrome. Chin Med J (Engl) 2014. [DOI: 10.1097/00029330-201409200-00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Nasiri Amiri F, Ramezani Tehrani F, Simbar M, Montazeri A, Mohammadpour Thamtan RA. The experience of women affected by polycystic ovary syndrome: a qualitative study from iran. Int J Endocrinol Metab 2014; 12:e13612. [PMID: 24829583 PMCID: PMC4013493 DOI: 10.5812/ijem.13612] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 09/29/2013] [Accepted: 01/29/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common chronic endocrine disorder. It has significant and diverse clinical consequences including reproductive, metabolic, and psychological morbidities as well as predisposition to malignancies. It is unclear how women with PCOS experience symptoms of this syndrome. OBJECTIVES The aim of this study was to clarify the dimensions and components of quality of life in iranian women with PCOS. PATIENTS AND METHODS This study was a qualitative study to explore and document perceptions of women with PCOS about their disorder and quality of life. Semi-structured interviews with open ended questions were conducted with 23 women with PCOS. The interviews were continued to reach data saturation. The study was conducted in the Reproductive Endocrinology Research Center of Shahid Beheshti University of Medical Sciences. All the interviews were recorded and transcribed. Constant comparative analysis of the data was conducted manually according to the Strauss and Corbin analysis method. RESULTS The study revealed that the most important factors affecting quality of life in women with PCOS were the role functioning items as well as physical, mental, emotional, cognitive, and social dimensions. CONCLUSIONS Comprehensive cares concerning various mental, emotional, cognitive, and social dimensions of quality of life should be planned for women with PCOS.
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Affiliation(s)
- Fatemeh Nasiri Amiri
- Department of Midwifery and Reproductive Health, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, IR Iran
- Corresponding author: Fahimeh Ramezani Tehrani, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122432500, Fax: +98-2122416264, E-mail:
| | - Masoumeh Simbar
- Department of Midwifery and Reproductive Health, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Ali Montazeri
- Mental Health Research Center, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, Tehran, IR Iran
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Nasiri Amiri F, Ramezani Tehrani F, Simbar M, Mohammadpour Thamtan RA, Shiva N. Female Gender Scheme is Disturbed by Polycystic Ovary Syndrome: A Qualitative Study From Iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e12423. [PMID: 24719724 PMCID: PMC3965857 DOI: 10.5812/ircmj.12423] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/03/2013] [Accepted: 07/15/2013] [Indexed: 11/16/2022]
Abstract
Background: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting up to one in every five women of reproductive age. The majority of researches on PCOS focus on its biomedical aspects, often overlooking and neglecting women’s own perceptions and experiences. Objectives: This study aimed to explore women’s perception and experiences that influence their personal gender role. Patients and Methods: This research is a qualitative study by conventional content analysis. Semi-structured interviews were conducted with 23 reproductive aged women with PCOS, recruited from the reproductive endocrinology research center. , in-depth interviews were continued to reach data saturation. The study was carried out at the reproductive endocrinology research center of Shahid Beheshti University in Tehran All the interviews were recorded and transcribed, and qualitative content analysis of the data was conducted manually. Results: Four themes were identified. Content analysis of the interviews revealed these women mainly perceived themselves with lack of physical attractiveness, loss of womanhood, interruption of sexual role and disruption of fertility potential, feelings were related to symptoms e.g. ‘excess’ hair; absent or disrupted menstrual cycle, obesity and infertility commonly experienced by women with PCOS. Conclusions: Women with PCOS are challenged in their perceptions of themselves as “feminine” because of their hairy appearance, irregular menses and lack of fertility and this influences their gender roles. Medical practitioners must understand how PCOS precisely affects women’s roles and initiate management aimed at reconstructing their “womanhood”, along with their medical treatment.
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Affiliation(s)
- Fatemeh Nasiri Amiri
- Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Fatemeh Nasiri Amiri, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122432500, Fax: +98-2122416264, E-mail:
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Masoumeh Simbar
- Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | | | - Niloofar Shiva
- Reproductive Endocrinology Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, IR Iran
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Abstract
Polycystic ovary syndrome (PCOS) is a major public health problem in the US. Worldwide, the public is largely unaware of the condition and health care providers do not seem to fully understand it. Research on PCOS has primarily focused on its etiology and clinical characteristics and less on the psychosocial aspects of human development associated with PCOS. This paper posits that a life course perspective provides a framework for further understanding the psychosocial experiences of women with PCOS and the contexts in which they live. The paper discusses how life course principles of human development, constraints on agency, interdependence of lives, time and place, and timing of events and experiences are relevant to the management of PCOS and prevention of its complications.
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Affiliation(s)
- Ninive Sanchez
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
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Billhult A, Stener-Victorin E. Acupuncture with manual and low frequency electrical stimulation as experienced by women with polycystic ovary syndrome: a qualitative study. Altern Ther Health Med 2012; 12:32. [PMID: 22471422 PMCID: PMC3365875 DOI: 10.1186/1472-6882-12-32] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 04/03/2012] [Indexed: 11/26/2022]
Abstract
Background Polycystic ovary syndrome (PCOS) affects 5-10 percent of all fertile women and is associated with anovulation/oligoovulation, hyperandrogenism, and polycystic ovaries. Pharmacological treatment is often effective but associated with unwanted side effects. Acupuncture treatments have been shown to improve menstrual bleeding patterns and ovulation as well as hyperandrogenism, without side effects. The purpose of the present study was to describe the experience of acupuncture for women diagnosed with PCOS. Methods Eight women with PCOS living in western Sweden, were interviewed following repeated acupuncture treatments. Data was analyzed using systematic text condensation as described by Malterud. Results The experience of acupuncture for women diagnosed with PCOS can be described in five categories; the experience of hope, getting results, feelings of responsibility, skepticism and proof of effect, and feeling normal. Conclusion Since acupuncture is a promising treatment for the symptoms of the common syndrome PCOS, the present study adds to the knowledge base by providing the important experiences of patients receiving the treatment. Acupuncture provides a possibility for patients to gain hope as the treatment shows results. The results show that acupuncture empowers the patients to take responsibility for their future well-being, although they may have been initially skeptical to the treatment. Because the syndrome had affected them for some time, even small changes offered a chance for them to feel that their bodies were capable of normal function. Trial Registration The trial is registered at Clinical Trials.gov with Identifier number NCT00484705.
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