Anxiety and depression in polycystic ovary syndrome: A comprehensive investigation

Polycystic ovary syndrome (PCOS) is associated with high levels of depression, which impact quality of life and limit self-efficacy, yet less is known about prevalence of anxiety. This cross-sectional, observational study of community-based women with PCOS comprehensively examined mood and found that anxiety existed at higher levels than depression, anxiety was underdiagnosed, and more women with PCOS who reported infertility were depressed. © 2010 by American Society for Reproductive Medicine

Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome

Context: Polycystic ovary syndrome (PCOS) is a complex, chronic, and under-recognized disorder. Diagnosis experience may have lasting effects on well-being and self-management. Objective: To investigate PCOS diagnosis experiences, information provided, and concerns about PCOS. Design: Cross-sectional study using an online questionnaire. Setting: Recruitment via support group web sites in 2015 to 2016. Participants: There were 1385 women with a reported diagnosis of PCOS who were living in North America (53.0%), Europe (42.2%), or other world regions (4.9%); of these, 64.8% were 18 to 35 years of age. Main Outcome Measures: Satisfaction with PCOS diagnosis experience, satisfaction with PCOS information received at the time of diagnosis, and current concerns about PCOS. Results: One-third or more of women reported >2 years (33.6%) and ≥3 health professionals (47.1%) before a diagnosis was established. Few were satisfied with their diagnosis experience (35.2%) or with the information they received (15.6%). Satisfaction with information received was positively associated with diagnosis satisfaction [odds ratio (OR), 7.0; 95% confidence interval (CI), 4.9 to 9.9]; seeing ≥5 health professionals (OR, 0.5; 95% CI, 0.3 to 0.8) and longer time to diagnosis (.>2 years; OR, 0.4; 95% CI, 0.3 to 0.6) were negatively associated with diagnosis satisfaction (independent of time since diagnosis, age, and world region). Women's most common concerns were difficulty losing weight (53.6%), irregular menstrual cycles (50.8%), and infertility (44.5%). Conclusions: In the largest study of PCOS diagnosis experiences, many women reported delayed diagnosis and inadequate information. These gaps in early diagnosis, education, and support are clear opportunities for improving patient experience

Polycystic ovary syndrome: A biopsychosocial understanding in young women to improve knowledge and treatment options

Aim.To assess psychological features in young women with and without PCOS. Methods.Observational, cross-sectional pilot study in young women aged 1825 with (n=24) or without (n=22) PCOS (age: 22.41±0.39 vs. 21.95±0.47 years, p=0.46; BMI: 29.17±1.54 vs. 22.05±0.83kg/m2, p=0.0003). The main outcome measures were quality of life, anxiety, depression, risk perception and fears on future health. Results.Women with PCOS demonstrated worsened quality of life (p=0.033) and greater anxiety (p=0.01) and depression (p=0.023) than women without PCOS related to BMI status. Women with PCOS were more likely to perceive themselves as at risk of obesity (p=0.012) and infertility (p<0.0001), and perceived greater importance in reducing future risk of prediabetes (p=0.027), gestational diabetes (p=0.039), type 2 diabetes (p=0.01), heart disease (p0.005), obesity (p0.0007) and infertility (p=0.023) than women without PCOS. Women with PCOS were more likely to have fears about future health related to weight gain (p=0.045), loss of femininity (p=0.035), loss of sexuality (p=0.003) and infertility (p=0.019) than women without PCOS. Conclusions.Worsened quality of life, anxiety and depression in young women with PCOS is related to BMI. Risk perception is appropriately high in PCOS, yet perceived risks of future metabolic complications are less common than those related to weight gain and infertility

Premature menopause: A comprehensive understanding of psychosocial aspects

Objective To compare experience of premature menopause (PM), information sources, treatments, depression, anxiety, body image, sexual function and self-efficacy, between women with premature ovarian failure (POF), surgically induced menopause (SIPM), chemically induced menopause (CIPM), and controls. Design Cross-sectional observational pilot study using validated and devised questionnaires in 77 Australian women (POF, n = 25; SIPM, n = 17; CIPM, n = 12; controls, n = 23). Results The average age of all women was 34.8 years (standard deviation (SD) ± 5.7 years), and time since PM diagnosis was 3.8 years (SD ± 4.4 years, p = 0.19). The gynecologist (69%) and internet (67%) were the best expected sources of information. Women with PM feared osteoporosis more than controls (p < 0.0001). Women with SIPM (p = 0.006) and POF (p = 0.01) had higher rates of depression compared to controls. SIPM women were more anxious than women with POF (p = 0.04) and both SIPM (p = 0.002) and CIPM (p = 0.02) women were more anxious than controls. Women with POF had higher health evaluation (p = 0.03), fitness evaluation (p = 0.01) and fitness orientation (p = 0.01) than women with SIPM. Controls had higher health evaluation than women with SIPM (p = 0.001) and CIPM (p = 0.04), higher fitness evaluation than women with SIPM (p = 0.02) and CIPM (p = 0.04), and higher fitness orientation than SIPM women (p < 0.0001). Sexual dysfunction (p < 0.0001) and dyspareunia (p = 0.001) were higher in CIPM women than controls. Controls were more sexually responsive than POF women (p = 0.008). SIPM (p = 0.008) and POF (p = 0.04) women reported decreased confidence to manage disease. Conclusion Depression, anxiety, body image, sexual dysfunction and self-confidence are compromised for women across different groups of premature menopause. Understanding these differences is important to the development of individual management plans based on the needs of women. © 2011 International Menopause Society

Is having polycystic ovary syndrome a predictor of poor psychological function including anxiety and depression?

BACKGROUND: The impact of metabolic and reproductive features of polycystic ovary syndrome (PCOS) compromises psychological functioning. We investigated factors associated with negative psychological functioning to determine whether they were predictive of anxiety and depression in PCOS. Methods A cross-sectional study was performed by questionnaire in 177 women with PCOS (mean ± SD age 32.8 ± 7.8 years) and 109 healthy controls (mean age 41.9 ± 15.4 years). Main outcome measures were anxiety and depression, measured using the Hospital Anxiety Depression Scale (HADS) and Multidimensional Body-Self Relations Questionnaire (MBSRQ), respectively. Results Women with PCOS, compared with control women, had a higher mean anxiety HADS score (9.5 ± 3.9 versus 6.5 ± 3.6; P < 0.001), a higher mean depression score (5.7 ± 3.7 versus 3.3 ± 3.1; P < 0.001) and more negative body image in 7 out of 10 subscales of the MBSRQ. Multivariate regression analysis in PCOS showed that anxiety was predicted by self-worth (P < 0.0001), health evaluation (P = 0.005), time taken to diagnose PCOS (P = 0.003) and age (P = 0.02), while in control women, anxiety was predicted by self-worth (P = 0.009), health evaluation (P = 0.001) and rural living (P = 0.03). Depression in PCOS was predicted by self-worth (P = 0.0004), quality of life (QOL) (P = 0.004), fitness orientation (P = 0.002), appearance evaluation (P = 0.001) and time to diagnosis (P = 0.03) and in women without PCOS, by self-worth (P < 0.0001), QOL (P < 0.0001), illness orientation (P = 0.001) and appearance orientation (P = 0.02). CONCLUSIONS Women with PCOS have increased anxiety, depression and negative body image compared with women without PCOS. In women with or without PCOS, body image and self-worth are predictors of both anxiety and depression, while QOL also predicts only depression. Time taken to diagnose PCOS is associated with poor psychological functioning. © The Author 2011. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved

Women’s perspectives of early menopause: development of a word cloud

Objective: Early menopause (EM), menopause aged <45 years, occurs spontaneously or secondary to medical treatments and is associated with multiple health impacts. A word cloud is an image where the word size reflects the frequency of use. We aimed to assess the perspectives of women with EM using a word cloud. Methods: Women diagnosed with EM, recruited from clinics/community, completed a survey including the open-ended question ‘What words do you associate with EM?’. Demographics and medical history were collected. Data analysis included descriptive statistics, identification of word themes/stems/synonyms, word frequency, and chi-square test. A word cloud was constructed from words used by two or more women using ‘Wordle’ (www.wordle.net). Results: Responses were obtained from 190/263 participants. The mean age was 54 ± 11 years, with EM diagnosed at age 38 ± 5 years. The cause of EM was unknown (30% of women), bilateral oophorectomy (27%), cancer therapy (25%), or autoimmune/genetic/metabolic (17%). The commonest words reported were hot flushes (36.8% of women), mood swings (20.5%), and infertility (16.8%), which varied with age and cause of EM. Few women reported neutral/positive words. Conclusion: Most words that women associate with EM have negative connotations and refer to symptoms. A word cloud is a novel way to illustrate women’s perspectives

Polycystic ovary syndrome support groups and their role in awareness, advocacy and peer support: A systematic search and narrative review

Polycystic ovary syndrome (PCOS) is a common and distressing condition in which women often lack adequate support and information to achieve the best health and well-being outcomes. PCOS support groups provide evidence-based information, provide peer support, raise awareness and advocate for woman-centred care. We summarise recent evidence and provide reflections from PCOS support group leaders. Women seek and receive information, as well as emotional and social support, from support groups. They report benefits such as confidence to manage the condition, having greater agency in their healthcare. Some support groups have long-standing partnerships with healthcare providers and researchers, making substantial contributions to advocacy and raising awareness. Major opportunities exist for healthcare providers, professional societies and support groups to collaborate, improving the availability of evidence-based information through support groups

Knowledge of PCOS in physicians-in-training: identifying gaps and educational opportunities

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women. A recent study found that many obstetrics and gynecology (ObGyn) practicing physicians are unaware of the Rotterdam criteria recommended for diagnosis. Our objective was to identify gaps in trainee knowledge of PCOS diagnostic criteria and management. An online survey was sent out to US ObGyn physicians-in-training in 2018. The primary outcomes were identification of at least one component of each Rotterdam criteria (Rot-3): (1) oligomenorrhea/amenorrhea, (2) clinical or biochemical hyperandrogenism, and (3) ovarian volume or antral follicle count, and identification of all five components (Rot-5). Secondary outcomes were identification of comorbidities and management of PCOS. Multivariable logistic regression was used controlling for gender, seniority (PGY) status, program type, completion of an REI rotation, and number of PCOS patients seen. 85.4% of 347 trainees completing the survey reported using Rotterdam criteria to diagnose PCOS. However, only 55% identified Rot-3 and less than 10% identified Rot-5. Seniority (PGY4 OR 2.2; 95% CI: 1.2–4.1; p =.01) and completion of REI rotation (OR 1.8 95% CI: 1.2, 1.8; p =.006) were associated with identifying Rot-3. Similar findings were noted with identifying Rot-5. Our study identified significant gaps in knowledge regarding PCOS, suggesting an urgent need for improving strategies for trainee education to increase patient satisfaction and provide comprehensive care

Improving the provision of pregnancy care for Aboriginal and Torres Strait Islander women: A continuous quality improvement initiative

Background: Australian Aboriginal and Torres Strait Islander (Indigenous) women are at greater risk of adverse pregnancy outcomes than non-Indigenous women. Pregnancy care has a key role in identifying and addressing modifiable risk factors that contribute to adverse outcomes. We investigated whether participation in a continuous quality improvement (CQI) initiative was associated with increases in provision of recommended pregnancy care by primary health care centers (PHCs) in predominantly Indigenous communities, and whether provision of care was associated with organizational systems or characteristics. Methods: Longitudinal analysis of 2220 pregnancy care records from 50 PHCs involved in up to four cycles of CQI in Australia between 2007 and 2012. Linear and logistic regression analyses investigated associations between documented provision of pregnancy care and each CQI cycle, and self-ratings of organizational systems. Main outcome measures included screening and counselling for lifestyle-related risk factors. Results: Women attending PHCs after ≥1 CQI cycles were more likely to receive each pregnancy care measure than women attending before PHCs had completed one cycle e.g. screening for cigarette use: baseline = 73 % (reference), cycle one = 90 % [odds ratio (OR):3.0, 95 % confidence interval (CI):2.2-4.1], two = 91 % (OR:5.1, 95 % CI:3.3-7.8), three = 93 % (OR:6.3, 95 % CI:3.1-13), four = 95 % (OR:11, 95 % CI:4.3-29). Greater self-ratings of overall organizational systems were significantly associated with greater screening for alcohol use (β = 6.8, 95 % CI:0.25-13), nutrition counselling (β = 8.3, 95 % CI:3.1-13), and folate prescription (β = 7.9, 95 % CI:2.6-13). Conclusion: Participation in a CQI initiative by PHCs in Indigenous communities is associated with greater provision of pregnancy care regarding lifestyle-related risk factors. More broadly, these findings support incorporation of CQI activities addressing systems level issues into primary care settings to improve the quality of pregnancy care

Health habits and health related behaviours of women with lifestyle related diseases

No description supplie