A Cross-Sectional Survey of Knowledge and Attitude Towards Polycystic Ovary Syndrome Among Pharmacy Students

Abstract

Polycystic Ovary Syndrome (PCOS) is a complex endocrinal abnormality affecting 5% to 7% of women in their reproductive age. Adequate knowledge and a right attitude play an important role in the management of the disease as well as to prevent the disease and their complications. This study aimed to assess the knowledge and attitude of pharmacy students towards PCOS. A questionnaire based cross sectional was conducted in pharmacy department students aged between 17 to 21 years old of Arunai college of pharmacy, Tiruvannamalai, Tamilnadu. The questionnaire framed on the basis of knowledge and attitude towards PCOS. There was a total of 292 participants was analyzed. Most of the study participants aware about PCOS and had adequate knowledge and positive attitude towards the disease. However most of them lacks knowledge on its complications. The level of education and participation in scientific activities were found to have a positive association with satisfactory knowledge and good attitude towards PCOS.

Keywords

Introduction

The uterus is a muscular organ located in the female pelvis, characterized by its pear-like shape and situated in between bladder and rectum. It comprises of three main parts: Fundus, Body and cervix.

Layer of Uterus are as follows:

• • Endometrium: The inner lining of the uterus, which thickens an shed during the menstrual cycle.
  • Myometrium: The muscular middle layer responsible for contraction during labor.
  • Perimetrium: The outer layer of the uterus.
• The primary function of the uterus is to nurture a fertilized egg and to support the development of a fetus.

• Ovaries are situated on both sides of the uterus, linked by ligaments. These two small almond- shaped organs are crucial for both menstrual cycles and conception. They are responsible for producing eggs for fertilization and secreting the hormones like estrogen, progesterone.
• The ovaries contain follicles that house for developing eggs, its know as oocytes. This organs produce hormones that regulate the menstrual cycle and pregnancy. However , in certain cases the ovaries may develop multiple small fluid-filled cysts containing immature eggs, leading to a condition know as Polycystic Ovary Syndrome (PCOS).
• PCOS is a heterogeneous syndrome that is classically characterized by features of anovulation combined with symptoms of androgen excess.^4,6,9 It’s a common reproductive and hormonal disorder affecting 6-10% of women during their reproductive years, which is span from the first menstrual period (menarche)to menopause, typically manifests in young women with symptoms including irregular periods, excessive hair growth and difficulty conceiving.²
• In Polycystic ovaries it contains either 12 or more follicles, measuring 2-9 mm in diameter or an increased ovarian volume of more 10cm³.⁶
• PCOS is also referred to as the “Syndrome O” due to Overproduction of insulin, Over-nourishment, Ovulatory disruption and Ovarian confusion.¹⁵
• The term polycystic ovarian syndrome was first described by IRVING STEIN and Michael Leventhal as a triad of ‘Amenorrhea’, ‘Obesity’ and ‘Hirsutism’ in 1935 when they observed the relation between obesity and reproductive disorder. It is hence also known as the ‘Stein Leventhal Syndrome’ Or Hyperandrogenic Anovulation and is the most common endocrine disorder in this population.¹³
• Women with PCOS are more likely to develop high blood pressure after menopause.⁶ It is a non-communicable disease, has been largely overlooked despite its significant impact.
• It is a heritable disorder which affects women throughout their life time and can be transferred to the next generation. Women are more likely to develop PCOS if female relatives have PCOS, experience irregular periods or have diabetes. Genetic contribution to PCOS can come from maternal and paternal lineages.¹
• It is commonly linked to hormonal imbalance, particularly sex hormones. Additionally, it is often associated with various metabolic and cardiovascular condition including: obesity, diabetes mellitus, insulin resistance, metabolic syndrome, dyslipidemia, hypertension, cardiovascular disease.^8,16
• Pregnant women with PCOS face heightened risk of pregnancy – related complication like Gestational diabetes mellitus (GDM), Preeclampsia (The condition with high blood pressure and damage to organ such as the liver and kidneys).⁶
• The quality of life (QOL) for women with PCOS is notably compromised due to its symptoms, resulting in heightened distress levels compared to women without PCOS.^7,14,16

Etiology:

5. PCOS has attributed by three key factors: ovarian cyst, elevated levels of androgen and irregular menstrual cycles. It often experiences anovulation due to immature eggs in the ovarian follicles, which fail to reach the necessary threshold for ovulation to occur.
5. The absence of ovulation distupts the balance progesterone, estrogen, LH and FSH, leading to increased production of androgens in individuals with PCOS which in turn       causes irregular menstrual cycles and infertility issues.¹⁶
5. The exact causes of PCOS remains unclear.

Detect adolescent girls at potential risk for PCOS by assessing radius indicative signs and symptoms such as:

• Irregular, missed or unusually light menstrual cycles.
• Ovarian enlargement or presence of multiple cysts.
• Excessive hair growth on areas like the back, chest, abdomen (Hirsutism)Weight gain especially around mid-section.
• Persistent acne or increased skin oiliness.
• Hair thinning or male – pattern hair loss.
• Difficulty to conceiving (Infertility).
• Skin tags, particularly on the neck or armpits.
• Discoloration or thickening of skin in folds such, as the neck, armpits and the breasts (as acanthosis nigricans), which presence as dark, velvety patches. 
• Obstructive sleep apnea.
• Metabolic and cardiovascular issues including high blood pressure abnormal lipid level, abdominal fat accumulation, insulin resistance and elevated insulin level.

• To encourage medical consultation by referring those identified with PCOS symptoms to gynecologists for proper diagnosis, early intervention, and comprehensive care, emphasizing the importance of managing the long?term consequences of the condition.

Prevalence:

• • • According to Abdulaziz University in 2015 it affects the female reproductive age, with prevalence of 3.4% worldwide.¹⁹
    • The prevalence of PCOS continuously increases and reaches 26% by the age of 15.¹¹
    • According to the Herdin (2017) women with PCOS have a higher incidence of hypertension compared to those without PCOS, with a prevalence rate of 19.2%.

Risk Factors:

Cardiovascular Disease:

5. Research conducted in New Zealand in January 1997 indicated that women with polycystic ovaries are more susceptible to heart disease. This study found that a significant proportion (42%) of women suffering heart disease had eight or more ovarian cyst, whereas only 22% of women without heart disease had a similar condition. As a result, it is recommended that dose women be closely monitored and counseled on reducing their consumption of fat and cholesterol. PCOS is also associated with endothelial dysfunction which can lead to an increased risk of myocardial infarction. Studies have shown that women with PCOS are more likely to experience myocardial infarction compared to age matched controls.

    Infertility:

5. PCOS significantly impacts ovulation and fertility, with over 75% women experiencing anovulatory infertility.^5,18 Treatment strategies are tailored to individual patient profile, addressing issues like follicular arrest and the impaired selection of a dominant follicle, while also considering the risk of pregnancies.^12,18

Diagnosis:

• If PCOS is suspected, the following diagnostic tests must be performed ¹⁰

1. Pelvic examination: The doctor checks the reproductive organs to identify any abnormal growths, masses, or other irregularities.
2. Laboratory tests: These helps diagnose the disorder and include:

• Blood tests: This test measure the hormones level, glucose and lipids. They check testosterone (the main circulating androgen), other androgens, sex hormone- binding globulin (SHBG), prolactin, the ratio of luteinizing hormone to follicle stimulating hormone (LH\FSH), and the CA-125blood test, which screens for ovarian cancer. All these are determined through blood sample.
• Biochemical tests: These assess insuli resistance by measuring triglycerides, cholesterol and fasting glucose levels.
• Imaging: Trans –abdominal ultrasound is performed to assess the shape of the polycystic ovary and to count ovarian follicles.
  • • Other assessments: These include evaluating the patient’s diet and sleep patterns.

Management:

The management of PCOS focus on relieving symptoms and include:

1. Lifestyle Modifications (Non-Pharmacological Method):

5. The primary goal is weight loss for those who are overweight.⁵ Losing weight helps reduce androgen levels, luteinizing hormone, and insulin, which in turn regulates ovulation and increases chances of pregnancy.

2. Medication-Based Treatment (Pharmacological Method):

1. Ovulation Induction: The preferred medication for stimulating ovulation in PCOS is clomiphene citrate. Aromatase inhibitors like letrozole may also be used.

2. Anti-Diabetic Agents: Drugs like metformin or thiazolidinediones enhance fertility by lowering insulin resistance and reducing androgen levels in the blood.

3. Gonadotropins: When clomiphene or metformin fail, injections of human menopausal gonadotropin (HMG) and follicle-stimulating hormone (FSH) can induce ovulation.

4. Anti-Androgen Medications: Drugs such as spironolactone, flutamide, and finasteride reduce androgen levels, helping to lessen symptoms like excessive hair growth (hirsutism) and acne.

• Oral Contraceptive Pills: These help regulate menstrual cycles and prevent abnormal bleeding.    

3.Surgical Option:

• Laparoscopic Ovarian Drilling involves making small punctures on the ovary surface to destroy androgen-producing tissue. This leads to decreased androgen levels and can be as effective as medical treatments.

MATERIALS AND METHODS:

Study Design:

A cross – sectional study was conducted focusing on Knowledge awareness and perception on PCOS.

Study Place:

The study was conducted in Arunai College of Pharmacy, Tiruvannamalai, Tamilnadu.

Study Period:

 Four months (From April 2025 to July 2025).

Study Requirement:

• For the survey study, we required a well-designed and validated questionnaire form.
• The questionnaire form includes the demographic data and basic questions based on PCOS.
• Subjects were selected based on inclusion and exclusion criteria.

Sample Size:

A total of 300 questionnaires were distributed among the girls students along with the consent form.

Sample Technique:

Random sampling based on inclusion and exclusion criteria.

Inclusion Criteria:

• • • The girls pharmacy college student from age group of 16 to 26 years were included in the study.
    • Students who are willing to participate in the study.

Exclusion Criteria:

• The girls’ students below age 16 and above 26 years were excluded.
• Male participants
• Questionnaire excludes hyperandrogenism, ovarian cyst size.

Study Method:

• • Selection of students based on the inclusion and exclusion criteria.
  • Before begin this study, A general details were informed to the students about the study and questionnaire.
  • The questionnaire and consent form was provided and the data was collected.
  • Report submission.

Data Collection Procedure:

5. Data was collected through questionnaire developed before hand. The questionnaire was constructed in parts related to demograhpics, information sources, understanding of signs and symptoms and risk factors.

Key Words Used:

5. PCOS, Hirsutism, Menstrual irregularities, Infertility, Anovulation, Cysts in ovary.

RESULTS & DISCUSSION:

The study population comprised about 292 female participants from pharmacy department. The study reveals that among 292 students most of them were with symptoms of PCOS and about 91.4%  having irregular periods; 53 participants were found to be with hirsutism and 28 with thyroid disorder ; 251 participants was not following balanced diet which leads to abnormal BMI in this study 96 girls was found to be obese condition. Most of them lacking to done physical activities and undergoing sedentary lifestyle 56 girls having increased acne.

Table: 1- Frequency and Percentage for the study sample by their knowledge about PCOS

PCOS is the most common endocrine abnormality in women. The prevalence of PCOS increased with the time worldwide.^3,10 Our study results shown that there are 18 surveyed participants having PCOS and some of them having symptoms ; the identified adolescents with the risk od PCOS were insisted to undergo proper diagnostics and treatment. Among the patients with PCOS, 85.9% with higher BMI range , obesity aggravates the abnormality. In 2005, reports showed that lifestyle changes have influenced the prevalence of PCOS. Furtherly, this study shows that lack of exercise ,low physical activity and following sedentary lifestyle play a vital role in the prevalence of PCOS. We recommend that an optimal body mass index should be maintained to prevent not only PCOS for many health complications. Various life style modifications including regular exercise atleast half an hour a day and dietary modifications in the form of small frequent meals will be required to achieve weight maintenance and prevent thyroid abnormalities as well as decrease the aggravation of acne. Another complication called Hirsutism . in the health setting pf PCOS, it is difficult to treat because lack of randomized control trials based on treatment in this patient group.¹² Many women with this complication faces the lack of confidence and insecurity. This reflects a huge impact on psychological wellness of women leads to depression.¹⁷ As we expected, we found that satisfactory level of knowledge and positive attitude towards PCOS. This findings might be due to the fact that educated women tend to get more information through their studies or though attending various scientific activities.¹¹ Yet substantial number of participants acknowledged that having unaware about various aspects of PCOS like the complications such as increased risk of cardiac abnormalities , higher risk of diabetes mellitus, insulin resistance and endometrial cancer.

Limitations: 

The studied students were not asked for if received the PCOS diagnosis, androgen levels, infertility, conception rate; our study conducted as a baseline research work and the portion in limitations will be considered in future more in depth studies.

CONCLUSION:

The findings from this study indicate variations in knowledge levels among undergraduate female Pharmacy students regarding different aspects of PCOS. While a substantial portion exhibited good knowledge, gaps were observed in certain domains, suggesting the need for targeted educational interventions to enhance understanding and awareness of PCOS among budding healthcare professionals and then healthcare providers should play a vital role in providing primary source of information about the PCOS thereby bridge the knowledge gap and improve the awareness and understanding among commoners.

ACKNOWLEDGEMENT:

Our grateful gratitude to the Principal , HOD, other staff members and students of Arunai college of pharmacy, Tiruvannamalai for the permission, many helpful suggestions, support and constructive advices rendered throughout this study. Our heartfelt thanks to all the girls participating in this study with positive attitude, patience and trust.

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