Effect of Structured Awareness Programme on Polycystic Ovarian Syndrome (PCOS) among Adolescent Girls

 

Veena Kirthika. S¹*, Himabindu Daggumati¹, Padmanabhan. K¹, Jibi Paul¹,

Selvaraj Sudhakar¹, Senthil Selvam. P²

¹Faculty of Physiotherapy, Dr. M. G. R. Educational and Research Institute, Maduravoyal, Chennai – 600095

²School of Physiotherapy, Vels Institute of Science, Technology and Advanced Studies, Chennai, Tamil Nadu

 

ABSTRACT:

OBJECTIVE: The aim of the study is to evaluate the effect of structured awareness program on polycystic ovarian syndrome (PCOS), to create awareness on PCOS, to find out high risk adolescents for PCOS and to co-relate clinical symptoms of PCOS with biochemical tests. BACKGROUND: Polycystic ovarian syndrome is a gynaecological endocrine disorder affecting females in reproductive age and is most commonly seen in adolescent girls. Females with PCOS might have problems like irregular menstruation, obesity, acne, hirsutism, hyperinsulinemia etc., due to hyperandrogenemia which results in oligovulation/anovulation. PCOS is one of lifestyle disorder which can be preventable. Though the incidence of PCOS is rapidly increasing, the adolescent girls are unaware and have inadequate knowledge about PCOS and its complications.  Hence this study focuses in evaluating the knowledge of PCOS and provides an awareness program which helps to recognize high risk individuals. METHODOLOGY: The present study is an observational study  conducted among 300 adolescent girls aged between 14-18years. Adolescent girls were given structured awareness program. High risk adolescents were  screened by using Polycystic Ovarian Syndrome Questionnaire (PCOSQ) after giving awareness program. All the adolescents with the age 14-18years are included in this study and adolescent girls who are seriously ill and those who are not willing to participate are excluded from the study. RESULT: The present study findings showed that among 300 adolescent girls, 96.3% were not aware of PCOS. PCOSQ findings revealed that 32% had irregular menstrual cycle, 26.3% had hirsutism and 13.2% had weight gain. On whole, statistical results of present study revealed the prevalence rate of PCOS is about 12.3% and we also identified 10.3% high risk girls and 23.3% low risk girls for developing PCOS.    

 

 

INTRODUCTION:

Polycystic ovarian syndrome (PCOS) is a most common endocrine ovarian disorder affecting 2-8% women of reproductive age worldwide^[1]. The term Polycystic ovarian disease (PCOD) was first described by Irving stein and Michael Lenvethal as a triad of amenorrhoea, Obesity and Hirsutism in 1935^[2]. Now a days it is also referred as syndrome O i.e., Overnourishment, Ovarian confusion, Over production of androgen hormones, Ovulatory disruption, so PCOD is called as PCOS^[3].

 

In India 2, 66, 26,765 population is affected with PCOS^[4]. Highest reported prevalence of PCOS is 52% among south Asian people^[4]. Currently PCOS is affecting 2.2-26% of young girls in India^[3] with 9.13% to 36% prevalence in adolescents only^[5,6]. PCOS became a lifestyle disorder as obesity, unhealthy dietary habits and physical inactivity are some of the risk factors for developing PCOS. The Rotterdam 2003 criteria defines PCOS as incidence of any two of the three key criteria, namely, oligovulation and/or anovulation, excess androgen activity and polycystic ovaries (PCO)^[7,8]. All the risk factors associated with PCOS will not be a causative factor for developing PCOS. General risk factors for PCOS include obesity, physical inactivity; unhealthy dietary habits whereas Biochemical risk factors include Low Density Lipoprotein-Cholesterol (LDL-C), Insulin Resistance (IR), increased levels of serum free testosterone and Clinical risk factors include disturbances in periodicity/timing of menstrual cycle, hirsutism, acne, central alopecia^[9]. If the women with PCOS left untreated, she is at risk for developing PCOS associated complications like infertility, metabolic dysfunctions like 2 diabetes mellitus, hypertension and other cardiovascular and cerebrovascular disorders^[10,11]. These complications add burden to the women which will be affecting the social and emotional wellbeing which in turn affects the Quality of life of women. The long-term follow-up of 786 PCOS women found an increased risk of endometrial cancer^[12]. Lifestyle modification is the primary cause for increased incidence of PCOS. In view of the high risk of PCOS in Indian women, the relative lack of medical infrastructure to deal with the chronic outcomes of PCOS, effective, evidence based treatment guidelines for India are an immeadiate necessity^[13]. In India 40% of women are affected by PCOS but among them 60% come to hospitals for treatment when they recognize that they have got infertility^[14]. Though the prevalence rate of PCOS is rapidly increasing, the adolescent girls and women have inadequate knowledge regarding PCOS. Hence, the knowledge level of female have key role in early detection of PCOS. Early diagnosis and appropriate treatment is very important to prevent the long term complications associated with PCOS. One disease specific questionnaire has been developed by Cronin et al (1998) called Polycystic Ovary Syndrome Questionnaire (PCOSQ)^[15]. It contains 26 items, measuring the following five areas of HRQoL: emotions (8 items, e.g. moody as a result of having PCOS?), body hair (5 items, e.g. growth of visible hair on chin?), weight (5 items e.g. had trouble dealing with your weight?), infertility problems (4 items, e.g. concerned with infertility problems?) and menstrual problems (4 items, e.g. irregular menstrual periods?)^[16].

 

Health education is one of the generality widely adopted health promotion strategy to improve knowledge on condition which helps in early detection to prevent its long-term complications ^[17]. Hence, the present study focuses on providing structured awareness programme on PCOS which helps to identify the high risk adolescents for PCOS by using PCOSQ. The high risk adolescents were identified and sent for higher referrals at medical centers to correlate the clinical symptoms of PCOS with biochemical tests. This helps in early diagnosis of adolescents with PCOS.

METHODOLOGY:

This study is an observational study was conducted among 300 adolescent girls aged between 14-18years at A.C.S. Medical College and Hospital. All the samples were selected by simple convenient method and gathered to provide structured awareness program (SAP). Study duration was 5 weeks. High risk adolescents were screened by using Polycystic Ovarian Syndrome Questionnaire (PCOSQ) and modified ferriman-gallwey scale after giving awareness program. Adolescent girls who are seriously ill and those who were not willing to participate are excluded from the study.

 

PROCEDURE:

Structured awareness program (SAP) on PCOS was provided in the form of power point presentation to improve the knowledge regarding PCOS, its risk factors and it’s prevention. The SAP was provided for about 30min, twice a week for a period of 5 weeks. Each session consists of 40 subjects. Immediate after the awareness program, the self-administered PCOSQ which was developed by cronin et al (1998) and Ferriman-Gallwey Scale (FGS) for scoring of hirsutism developed by Ferriman and Gallwey (1961) was given to the subjects to fill up which helps to identify the high risk girls. PCOSQ consists of 26 items grouped into 5 domains: emotions (8 items), body hair (5 items), weight (5 items), infertility (4 items), and menstrual problems (4 items). For each question, there are seven rating options. Option 1 represents the greatest possible impairment, while Option 7 represents the least impairment. Choose only one option for each question. This modified FGS incorporates nine body regions for assessment of hair growth, rated from 0 (no growth of terminal hair) to 4 (extensive hair growth) in each of the nine locations. The total score ranges from 0 to 36 and a score of 8 or more than 8 is considered androgen excess. A score of 8-15 indicates mild hirsutism and >15 indicates moderate or severe hirsutism. The high risk girls was identified by using PCOSQ and FGS and sent them for gynaecological referral. Adolescent girls were diagnosed with PCOS based on the Rotterdam criteria.

 

DATA ANALYSIS:

The collected data was tabulated and analyzed by descriptive data and correlation analysis by using spss software version 16.

 

 

Table – 1   PCOSQ Score

Variable	Mean	Median	SD	Range	Min	Max
Body hair	31.87	35	6.75	30	5	35
Emotions	51.08	54	7.47	51	5	56
Infertility	37.35	28	1.46	9	19	28
Menstrl problem	23.85	26	5.1	23	5	28
Weight gain	30.73	35	7.21	30	5	35

 

 

 

Ferriman-Gallwey scores of hirsutism

Description	Frequency (n)	Percentage %
No hirsutism	221	73.6
Mild hirsutism	54	18.1
Moderate-severe hirsutism	25	8.3

 

Table-2  Ferriman – Gallwey Scores of hirsutism

 

Table-3   Knowledge scores

 

Table-4  Rotterdam Criteria

 

TABLE-5   Diagnosis of PCOS

 

 

RESULTS:

The present study findings showed that among 300 adolescent girls, 96.3% were not aware of PCOS. PCOSQ finding revealed that 32% had irregular menstrual cycle, 26.3% had hirsutism and 13.2% had weight gain. MFGS of hirsutism showed that 18.1% girls presented with mild hirsutism where as 8.3% girls presented with moderate-severe hirsutism. Overall results revealed the prevalence rate of PCOS is about 12.3% with 10.3% high risk girls and 23.3% low risk girls for developing PCOS.

DISCUSSION:

PCOS is one of the common conditions present in 12-21% of women of reproductive age, up to 70% of women with PCOS remain undiagnosed^[18]. PCOS is most common problem among adolescent girls than that of other age group. The present study revealed that only 11 subjects i.e. 3.6% had adequate knowledge on PCOS where as 289 adolescent girls i.e. 96.3% were not aware of the condition PCOS, its signs and symptoms and management. This is supported by the studies done by Nimo Biam (September- December 2011) showed that adolescent girls had an inadequate knowledge regarding PCOS, and by Hanan Elsayed Mohamed (8- August 2015) reported the same. After the session of structured awareness program (SAP) all the subjects have improved their knowledge level about causes, risk factors, clinical features, management and prevention of PCOS. Subjects were also able to identify the risk factors what they had at that moment. This was supported by the study on effectiveness of educating program which showed that highest improvement of knowledge regarding all the program content and mean post test score was higher than the mean pretest knowledge score (Amasha and Heeba 2014).

 

PCOSQ was used to identify the high risk adolescents in which greater the score indicates less impairment and lesser score indicates severe impact of the disease. This study identified 79 (26.3%) subjects with hirsutism    and 96 (32%) subjects with irregular menstrual cycle and 41 (13.6%) subjects had difficulties in maintaining their ideal weight. We also revealed the prevalence rate of PCOS is about 12.3% (n=37) based on the Rotterdam criteria for diagnosis of PCOS. Clinical hyperandrogenism was assessed by means of Ferriman and Gallwey scoring system (FGS 1961). FGS showed total of 79 subjects presented with hirsutism out of which 54 subjects were categorized under mild hirsutism whereas 25 subjects had moderate- severe hirsutism. Out of 37 adolescents with PCOS, 15 subjects had a family history of PCOS.

 

This study also recognized 101 adolescents at risk for developing PCOS. They were again classified into high risk group and low risk group based on the number, severity and duration of risk factors. 31 subjects under high risk category had combination of risk factors like family history and irregular menstruation with/without obesity. Remaining 70 were under low risk category had only any one of the risk factors such as irregular menstruation/obesity/family history/hirsutism. The subjects were given additional information regarding the effect of exercise in management and prevention of PCOS. Lifestyle changes, including diet, exercise, and behavioral modification, appear to improve the metabolic and reproductive abnormalities of overweight and obese patients with PCOS ^[19]. Barnard L, Ferriday D (2007) showed that lack of exercise and low physical activity play a role in the prevalence of PCOS. A rapid increase in prevalence of PCOS associated with morbid conditions such as IR, excess body fat, adverse body fat patterning, hypertriglyceridemia and obesity related diseases (DM, CVD) in Asian Indians has been noted in recent review of literature on PCOS ^[20].

 

This study also identified that though the subjects had suffer from signs and symptoms of PCOS they were hesitate to consult gynaecologist because of lack of knowledge regarding PCOS. This was only because of lack of knowledge about PCOS and its complications. These findings are consistent with the findings of the study conducted by Avery (2013). With rise in the number of cases of PCOS, it becomes imperative to explore the disease, its varied clinical presentation, and the existing knowledge and practices to manage PCOS among women diagnosed with PCOS ^[21].

 

CONCLUSION:

This study concluded that there is significant effect of giving Structured Awareness Program (SAP) on PCOS among adolescent girls which also aids in early diagnosis of PCOS.

 

REFERENCES:

1.            Knochenhauer ES.et al. Prevalence of Polycystic Ovarian Syndrome. Journal of clinical endocrinology and metabolism 1998;

2.            SteinIF, leventhal MN. Amenorrhoea associated with bilateral polycystic ovaries. American journal of obstetrics and gynaecology 1935; 29: 181.

3.            Nivetha. M and Susan. G. Suganya. Survey of polycystic ovarian disease among the girl students of Bishop Heber College, Trichirapalli, Tamilnadu, India. IOSR Journal of Nursing and Health Science (IOSR-JNHS) e-ISSN: 2320-1959.p- ISSN: 2320-1940 volume 5, Issue 4 ver. I (Jul-Aug. 2016), PP 44-52.

4.            Pramila D’Souza. A Study to assess the effectiveness of planned teaching programme (PTP) on polycystic ovarian syndrome (PCOS) among adolescents girls in selected high schools at mangalore. Nitte University Journal of Health Science. NUJHS Vol. 3, September 2013, ISSN 2249-7110.

5.            Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Prevalence of polycystic ovarian syndrome in Indian adolescents. J. Pediatr. Adolesc. Gynecol. 2011; 24:223-227.

6.            Nair MK, Pappachan P, Balakrishnan S, Leena ML, George B, Russell PS. Menstrual irregularity and poly cystic ovarian syndrome among adolescent girls—a 2 year follow-up study. Indian. J. Pediatr. 2012; 79 (Suppl 1): S69-S73.

7.            Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J. Clin. Endocrinol. Metab. 2004; 89(6):2745-2749.

8.            Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group: Revised 2003 consensus on diagnostic criteria and longterm health risks related to polycystic ovary syndrome. Fertil. Steril. 2004; 81:19-25.

9.            Evidence-based guideline for the assessment and management of polycystic ovary syndrome. Jean Hailes Foundation for Women’s Health on behalf of the PCOS Australian Alliance; Melbourne, 2011. pp:1-127.

10.       Christian RC, Dumesic DA, Behrenbeck T, Oberg AL, Sheedy PF, 2^nd, Fitzpatrick LA. Prevalence and predictors of  coronay artery calcification in women with polycystic ovarian syndrome. J Clin Endrcrinol Metab.,88, 2003,2562-8.

11.       de Groot PC, Dekkers OM, Romijn JA, Dieben SW, Helmerhorst FM. PCOS, Coronary heart disease, stroke and the influence of obesity: a systematic review and meta-analysis. Hum Reprod Update,17, 2011, 495-500.

12.       Wild S et al. Card iovas culard isease inwom en with polycy sticovarian syndrom eatlong-term followup: aretros pectiveco hortstudy. Human Fertility.2000;52:595-600.

13.       Sonia Malik, Kuldeep Jain. Management of polycystic ovary syndrome in India; PCOS Guidelines. April 16, 2015, IP: 182.69.98.25.

14.       Bharathi SP, Ravichandran BS, Abeetha M. Benefits of kayakalpa yoga over polycystic ovary syndrome patients. Available from http://www.venthathirianscience/benefits of kayakalpa yoga.

15.       Noman UI Haq. Prevalence and Knowledge of polycystic ovarian syndrome (PCOS) among female science students of different public Universities of Quetta, Pakistan. Imperial Journal of Interdisciplinary Research (IJIR), Vol-3, Issue-6, 2017.

16.       L. CRONIN, G. GUYATT, L. Development of a Health-Related Quality-of-life Questionnaire (PCOSQ) for Women with polycystic ovary syndrome (PCOS); Journal of Clinical Endocrinology and Metabolism; vol. 83, No.6.

17.       Price N., and Knibbs S., (2009): How effective is peer education in addressing young people’s sexual and reproductive health needs in developing countries? Children and Society; 23: 291-302

18.       Boyle, J and Teede, H.J.(2012): polycystic ovary syndrome, An update, Australian Family Physician,(AFP), Volume 41, No.10, 752-756, http://www.racgp.org.au/afp/2012/october/polycystic-ovary syndrome/

19.       Nicandri KF, Hoeger K. (2012): Diagnosis and treatment of polycystic ovarian syndrome in adolescents. Curr Opin Endocrinology, Diabetes Obes jour 19(6):497-504

20.       Allahbadia GN, Merchant R. Polycystic ovary syndrome in the Indian subcontinent. Semin. Reprod. Med. 2008; 26(1):22-34.

21.       Manita Dalal et al., An exploratory Survey To Assess The Knowledge, Practice And Prevalence of Polycystic Ovarian Syndrome Among Women Attending Gyne OPD Of Selected Hospital Of Delhi With A View To Develop A Health Care Package On Polycystic Ovarian Syndrome And Its Management:(IOSR-JNHS): e-ISSN: 2320-1959.p- ISSN: 2320-1940 Volume 3, Issue 6 VER. IV (Nov.- Dec. 2014), pp 39-42.

 

 

 

 

Received on 01.06.2019           Modified on 31.07.2019

Accepted on 21.08.2019         © RJPT All right reserved