PCOS Awareness, Symptoms, Lifestyle Patterns And Psychological Impact: A Cross-Sectional Survey Among Women Aged Above 30 Years

Polycystic Ovary Syndrome (PCOS) is a multifactorial endocrine disorder in women of reproductive age in the global population, which has been estimated to have a prevalence rate of 621% of the global population based on the diagnostic criteria and population used in the study.1 PCOS has a long-term health impact on women, which makes it one of the most important challenges in the health of The clinical concept of PCOS has been developed over the decades since it was first conceptualized by Stein and Leventhal in 1935. The most commonly used criteria of PCOS are the Rotterdam (2003) diagnostic criteria that describe the disease in terms of three cardinal features: oligo-anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound.2 The broad definition has led to a better inclusivity in the diagnosis of the disease, but has also led to heterogeneity of In addition to its reproductive effects, such as menstrual abnormalities and infertility, PCOS is now being recognised as a multisystem disorder with grave metabolic, cardiovascular and psychological outcomes.

The PCOS women are more insulin resistant, central obese, impaired glucose tolerance and type 2 diabetic mellitus. Dyslipidaemia, and hypertension also contribute to long-term cardiovascular morbidity, thus making PCOS a chronic systemic disorder requiring long-term management. It is a phenomenon itself and not common knowledge that clinical burden of PCOS in women above 30 years is burdened. Years-long hormonal imbalance and metabolic imbalance manifest themselves more at this life stage, and the effects are manifested through increased insulin resistance, increased adiposity, and increased cardiometabolic risk. additional Clinical problems that overlay on this high-risk profile include occupational demands, family issues, and reproductive problems, making PCOS a grossly underdiagnosed disease in this age group due to knowledge of the disease, societal stigmatization, and easy access to specialists. PCOS pathogenesis and progression are focused on the lifestyle factors. High consumption of refined carbohydrates, saturated fats and processed food combined with physical activities are primarily causes of obesity and insulin resistance. Disturbed sleep and persistent psychological stress also interfere with endocrine homeostasis, which exacerbates menstrual abnormalities and hyperandrogenism.5 These are modifiable risk factors, which highlight the importance of lifestyle intervention in the treatment of PCOS. Psychological burden of PCOS is also very important but is regularly ignored in clinical practice.

Women with PCOS have high levels of anxiety, depression and negative body image-especially those who present with weight gain, acne and hirsutism. These psychological outcomes not only reduce the quality of life but also have a negative impact on the adherence to treatment and self-care, creating a vicious cycle of symptom intensification and emotional pain.6 The two-way factor of physical and psychological wellbeing in PCOS requires an actual multidimensional treatment strategy. One of the untapped but strategically located resources in the management of PCOS is community pharmacists. Pharmacists, being the most accessible healthcare providers especially in resource-constrained facilities, can contribute significantly to early symptom detection, evidence-based patient education, medication counselling as well as specialist referral, yet pharmacist interventions in PCOS management are not yet developed.

The large PCOS burden and gaps in knowledge and management highlight the urgent need to have population-specific data to be used in effective population health and clinical interventions. This research thus had an objective of holistically evaluating the PCOS awareness and symptom patterns, lifestyle behaviours, psychological impact and healthcare seeking behaviour among women aged over 30 years in Pune, Maharashtra, India.

MATERIALS AND METHODS

Study Design and Setting:

The study included a cross-sectional, descriptive and survey based study conducted between January to April 2026. The study was conducted at the Dr. D. Y. Patil college of pharmacy, Akurdi and the associated clinical and community centers of Pune in Maharashtra, India. The cross-sectional design was appropriate as it was possible to assess the level of awareness, symptoms prevalence, lifestyle traits and the psychological effect at a given time. Google Forms was used to disseminate physically and online questionnaires to guarantee high encompassment and inclusiveness of the sample as different participants have varying access to healthcare and computer-mediated resources.

Participants:

The study population was composed of women (above the age of 30 years), who were willing to take part and provided informed consent. There were 400 participants who had been recruited using a convenience method of sampling a technique which was considered suitable in exploratory and descriptive research. The inclusion criteria were the participants having to be older than 30 years and able to understand and fill in the questionnaire. Pregnant women, severe psychiatric disorders that might have influenced the quality of responses as well as questionnaires with some incomplete and inconsistent data were excluded.

Instrument:

A questionnaire based on five sections, in a structured, self-administered form was employed. Section A pertained to demography information (age, education, occupancy and marital status). Section B assessed the level of PCOS awareness and knowledge including knowledge of the symptoms, causes and available management. Section C measured the incidence and commonness of self-reported symptoms of PCOS. Section D included lifestyle behaviours in terms of dietary results, pair of exercises, sleep quality and stress. Section E dealt with psychological impact -including anxiety and depressed symptoms- and healthcare-seeking behaviour. Expert review was used to achieve content validity whereby two experts in pharmacology and clinical practice were involved. The alpha coefficient of Cronbachs was 0.81 denoting good reliability which was internal consistency reliability.

Sample Size Determination:

This sample size was calculated using the following formula: n= Z 2 P (1-P)/d 2 where Z=1.96 (95% confidence level), p= 0.15 (prevalence of PCOS) and d= 0.05 (margin of error). That resulted in a minimum sample of 196. To enhance the statistical power, attention to the potential non-response, and to examine the sub-groups the sample was increased to 400.

Statistical Analysis:

The Statistical Package of the Social Sciences, version 26.0 (IBM Corp.) was used to code, enter and analyse the data. All the variables of the study were summarised using descriptive statistics, including counts of frequencies, percentages, mean, and standard deviation. Chi-square test was used to test the relationship among categorical variables especially PCOS awareness and symptom management practices. A p-value of <0.05 was considered statistically significant. Results are provided in tables to make them easily understood..

Ethical Approval:

This study was carried out with ethical approval of the Institutional Ethics Committee (IEC) of Dr. D. Y. Patil College of Pharmacy, Akurdi, Pune, Maharashtra, India, before the data collection began. All subjects gave informed written consent prior to enrolment. The research was carried out as per the Declaration of Helsinki and all other institutional ethical requirements.

RESULTS AND DISCUSSION:

Demographic Characteristics:

Four hundred women aged over 30 years were recruited giving a good representative sample of the urban women in this age group. As shown in Table 1, the majority of respondents (44.5%) belonged to the 31–35 years age group, followed by 36–40 years (31.0%), 41–45 years (14.5%), and above 45 years (10.0%). Education at graduate level was the most prevalent (42.0%), which is in line with the urban characteristics of the study area. In terms of occupation, 32.5 and 32.0 percent of respondents were students or in academics, working professionals and homemakers respectively. Most of the respondents were married (71.5%). A substantial number of the participants were overweight (35.5%) or obese (20.5)- collectively 56% - which is consistent with well-established relationship between PCOS and adiposity.

TABLE 1: DEMOGRAPHIC PROFILE OF RESPONDENTS (n=400)

PCOS Awareness and Knowledge:

Table 2 is a summary of the awareness and knowledge of the respondents about PCOS. Only half of the participants were previously aware of PCOS, which means that about half of the population of the study did not have the basic knowledge of the disorder. Hormonal aetiology of PCOS was only known among 46.3 percent of the respondents, and its possible ability to result in infertility was even less at 43.0. The uptake of screening was also low with only 34.5 percent of the respondents having been screened. These data are similar to Dasgupta et al. (2020), who found that there was 59.5% PCOS awareness among urban Indian women (9) and Nair et al. (2019), who found that only 38.7% of college students in Kerala possessed adequate knowledge related to PCOS (10). Just 30.3% of the respondents stated that their physician had ever talked with them about PCOS, which is a huge missed clinical education opportunity at the point of care.

TABLE 2: AWARENESS AND KNOWLEDGE OF PCOS AMONG RESPONDENTS (n=400)

Symptom Profile:

Self-reported symptom assessment (Table 3) showed that the most common complaint was irregular or absent menstrual cycles, which was reported by 74.0% of the respondents. Unaccounted weight gain (68.0%), mood changes or irritability (59.0%), chronic fatigue (55.0%) and acne or skin issues, sleep disturbances, and bloating or abdominal discomfort followed (47.0% and 49.0%, respectively). These results were very similar to the ones reported by Mehta et al. (2021) in North Indian women11 and consistent with the international evidence based guidelines of Teede et al. (2018).12 A significant observation was the prevalence of the mood changes and chronic fatigue especially in women over 40 years of age indicating that symptoms related to psychology and energy increases with age in PCOS. It is common to ignore these symptoms as typical ageing or everyday stress but not as PCOS-related symptoms, which is why age-specific diagnostic tools in clinical practice are essential. The relatively less prevalent rate of infertility issues (28.0%) may be due to the more advanced age of the sample and mostly completed family planning.

TABLE 3: REPORTED SYMPTOMS OF PCOS AMONG RESPONDENTS (n=400)

Lifestyle Patterns:

Modifiable risk factors were found to be alarmingly common as shown in lifestyle evaluation (Table 4). Most of the respondents 69.0% expressed that they were living a sedentary lifestyle with no physical activity. The dietary habits, which were unhealthy with high carbohydrate or junk foods were reported by 59.0% and only 12.0% were reported to be on a balanced and healthy diet. Forty-nine percent of the participants reported poor sleep quality (less than 6 hours/night) and 85.0% were combined moderate to high perceived levels of stress. Such results are in line with those of Barber et al. (2019) and Moran et al. (2011), who found similar lifestyle patterns in a PCOS cohort,13 and Moran et al. (2011), who found that even minor lifestyle changes, such as a 510% change in body weight via diet and exercise even have a clinically significant effect on menstrual frequency, The huge disparity between evidence-based advice and real practice (only 12% report healthy diet) underscores the importance of organised lifestyle counselling programmes especially via pharmacy-based.

TABLE 4: LIFESTYLE HABITS OF RESPONDENTS (n=400)

Psychological Impact:

The assessment of mental health (Table 5) showed that the morbidity of mental health was significant among the study population. Respondents were found to have moderate-to-severe anxiety (47.0% moderate, 18.0% severe) and moderate-to-severe depressive symptoms (38.0% moderate, 13.0% severe). The moderate-to-severe levels of body image concern were also articulated by 42.0% of the participants. A total of 71.0% of respondents reported social withdrawal either sometimes or often. These rates are more than those reported in Western literature: Dokras et al. (2011) observed the prevalence of depression in 28% and anxiety in 34% of PCOS patients versus controls due to the cultural factors in the Indian population such as societal expectations, reproductive stigma, and low mental health literacy. Sharma et al. (2022) also found a high level of psychological burden in working women with PCOS in Pune.14 The psychological burden was high, but only 9.0% of the participants had consulted a psychological counsellor—a glaring gap that highlights the importance of incorporating mental health screening and support into usual PCOS management pathways.

TABLE 5: PSYCHOLOGICAL IMPACT ASSESSMENT (n=400)

Relationship between PCOS Awareness and Health Management Behaviour:

All the health management behaviours measured had a high and statistically significant correlation with PCOS awareness (Table 6). Aware women were more likely to seek medical help (77.1% vs. 33.7%; χ²=78.24, p<0.001), follow lifestyle modifications (60.0% vs. 25.3%; χ²=51.32, p<0.001), use prescribed medications (56.2% vs. 16.8%; χ²=64.87, p<0.001), and undergo regular screening (49.5% vs. 14.7%; χ²=57.93, p<0.001). These findings are good pointers to the idea that health literacy is central in the disease management behaviour. Awareness also positively correlates with improved healthcare-seeking, better diagnosis and clinical outcomes. This would certainly recommend the priority of certain PCOS awareness campaigns notably, pharmacy based, academic institutions and community health centres as a cost effective and expandable program of community health.

TABLE 6: RELATIONSHIP BETWEEN PCOS AWARENESS AND SYMPTOM MANAGEMENT                                                                                                                   (n=400)

*Statistically significant at p<0.05

Healthcare-Seeking Behaviour and Community Pharmacist Role:

The study population had poor healthcare-seeking behaviour (Table 7). A mere 42.0% of the respondents had talked to a doctor concerning symptoms of PCOS and 31.0% of the respondents had actually been diagnosed. Lifestyle or dietary counselling was only administered to 19.0% and psychological counselling to 9.0%-a number which is a drastic underrepresentation of the psychological weight exposed in this study. The percentage of pharmacist consultation about PCOS is only 12.0% and that is a large missed opportunity. Community pharmacists can be the most appropriate people to bridge the existing knowledge gap in PCOS awareness, patient education, and help managing the disease. They might be engaged in the initial detection and referral of the symptoms, evidence-based patient counselling, supporting adherence to medication, lifestyle change guidance, and signposting mental health. Pharmacist-led model of care can be improved in urban and semi-urban communities to help enhance the level of patient engagement and cover the gaps that exist in comprehensive model of PCOS care.      

TABLE 7: HEALTHCARE-SEEKING BEHAVIOUR AMONG RESPONDENTS (n=400)