|Year : 2019 | Volume
| Issue : 2 | Page : 112-117
Knowledge, attitude, and practice toward weight reduction among polycystic ovary syndrome women at Taif city
Nisreen Khalid Aref Albezrah, Farzana Rizwan Arein
Department of Obstetrics and Gynecology, College of Medicine, Taif University, Taif, Saudi Arabia
|Date of Web Publication||13-Sep-2019|
Dr. Nisreen Khalid Aref Albezrah
Department of Obstetrics and Gynecology, College of Medicine, Taif University, P. O. Box: 888, Taif 21974
Source of Support: None, Conflict of Interest: None
Objective: The aim of this study is to identify the knowledge, attitude, and practices related to weight reduction among women with polycystic ovary syndrome (PCOS) of reproductive age group. Materials and Methods: The descriptive cross-sectional study was conducted from August 2017 to July 2018 in the Department of Obstetrics and Gynecology, King Abdul Aziz Specialists Hospital, Taif, Saudi Arabia. One hundred participants were recruited from the outpatient clinic having satisfied the eligibility criteria through nonprobability consecutive sampling. Through closed-ended questions, participants were inquired about sociodemographic conditions, marriage, presenting complaints, knowledge, awareness of symptoms, and attitude and practices of weight reduction related to PCOS. The study is approved by the Ethical Review Committee of Taif University. Written informed consent was obtained from all the participants prior to enrollment in this research. The data were analyzed using Computer program SPSS Version 22 for Microsoft Window (Statistical Package for Social Science; SPSS Inc., Chicago, IL, USA). Results: A total of 100 study participants completed the pro forma with the mean age as 31.29 years. Majority (89%) had heard about the ovarian cyst before, with around 34% had received knowledge through health education. Moreover, 81% were aware about the problems of the disease, with around 69% reported delay of pregnancy and 31% informed menstrual problems as problems of PCOS. Importantly, 63% were aware about the methods of treatment, with treatment options as weight reduction (44.44%). Two-third (66%) of the study participants believed that weight reduction is an effective treatment. Among those, 21 (31.8%) believed improving ovulation, 2 (3.04%) improving psychological condition and both (60.61%) were improved by weight reduction. Conclusion: The current level of awareness among Saudi women with PCOS about the beneficial effects of weight reduction as the first line of therapy was poor.
Keywords: Awareness, health education, healthy lifestyle, knowledge, polycystic ovary syndrome, weight reduction
|How to cite this article:|
Albezrah NK, Arein FR. Knowledge, attitude, and practice toward weight reduction among polycystic ovary syndrome women at Taif city. Saudi J Health Sci 2019;8:112-7
| Introduction|| |
Polycystic ovary syndrome (PCOS) being a heterogeneous disorder that included a spectrum of metabolic and reproductive features (i.e., infrequent or absent menstrual cycles, androgen excess, polycystic ovarian morphology, and/or infertility. PCOS is considered one of the most common endocrine disorders among women of reproductive age group ranging from 6% to 26% globally., No clear cause of PCOS has been documented; however, evidence suggesting the genetic basis for the syndrome as familial clustering of cases and heritability of endocrine and metabolic features have been reported.,
PCOS is a broad-spectrum disorder, as its consequence is beyond the reproductive system and leads to serious metabolic (i.e., type 2 diabetes, metabolic syndrome, and cardiovascular diseases) as well as psychological impact (i.e., anxiety, depression, poor self-esteem, and decrease quality of life). The PCOS significantly impacts the health and well-being of the individual, if not timely diagnosed or intervention is delayed, thereby leading to increased cholesterol levels, insulin resistance, glucose intolerance, type 2 diabetes, and increased risk of myocardial infarction.,, More importantly, the diagnosis of PCOS is arguable as many women remain undiagnosed or delayed recognition across the globe. Different sets of diagnosis criteria are available for the diagnosis of PCOS, i.e., the Rotterdam criteria (presence of any two of the following: excess of androgen, ovulatory dysfunction, and polycystic ovaries) recommended in Europe; however, in the United States, the National Institute of Health adopts different criteria.
The major and most important risk factor for PCOS is obesity that exacerbates the reproductive and metabolic effect. It has been reported that more than 80% of the PCOS are overweight or obese. The lifestyle intervention, i.e., weight loss, healthy diet, and physical activity (exercise), has been recommended as the first line of treatment for women with PCOS. These interventions counteract the cardiovascular and metabolic risks effectively. The weight reduction among reproductive-age women with PCOS has been highlighted by the fact that as little as 5% weight loss could improve the menstrual irregularities and restore ovulation more significantly among younger aged women. More importantly, the first international evidence-based guideline for the diagnosis and management of PCOS has also proposed the prevention of weight gain.
Thus, the previous studies have highlighted the reduction of weight and physical activity as the first line of therapy among reproductive-age women with PCOS. However, these studies are mostly clinical trial with follow-ups. There is a paucity of information about the knowledge, attitude, and awareness among the PCOS women related to weight loss. Therefore, the study was conducted with an aim to identify the knowledge, attitude, and practices related to weight reduction among women with PCOS of reproductive age group. Moreover, the participants were inquired in depth about weight reduction as the first line of treatment. The findings of the study will be of utility in improving the health education and support for women with PCOS, thereby increasing the overall health outcomes.
| Materials and Methods|| |
The descriptive cross-sectional study was conducted from August 2017 to July 2018 in the Department of Obstetrics and Gynecology, King Abdulaziz Specialists Hospital, Taif, Saudi Arabia. The participants were recruited from the outpatient clinic having satisfied the eligibility criteria for being enrolled in this research. The inclusion criteria were as follows: confirmed diagnosis of PCOS, women of reproductive age (25–35 years), body mass index (BMI) greater or equal to 26 kg/m2, could read and apprehend the Arabic questionnaire without difficulty, and willingness to participate in the study. Women with psychiatric illness, illiterate women, and diagnosis of major chronic diseases (i.e., diabetes, hypertension, kidney disease, and thyroid disease) were excluded from the study.
One hundred women with PCOS through nonprobability consecutive sampling were recruited in this cross-sectional study. The self-administered questionnaire was used to assess the knowledge, attitude, and practices related to weight reduction among PCO women of reproductive age group from the selected study site. The first part of the questionnaire consisted of sociodemographic questions (i.e., age in years, education, residence, and monthly income), questions related to marriage (i.e., marital status and duration of marriage), and presenting complaints. Moreover, the study participants were also inquired about the knowledge, awareness of symptoms, attitude, and practices of weight reduction related to PCOS. Majority of questions had binary response as yes/no, whereas few questions had multiple response options as desirable.
The study was conducted according to the ethical guidelines of Helsinki Declaration. The study is approved by the Ethical Review Committee of Taif University. Written informed consent was obtained from all the participants prior to enrollment in this research. The participants had the right to withdraw at any point of the research. Importantly, it was ensured that anonymity and confidentiality of the study participants' data were maintained throughout the research.
The data were analyzed using Computer program SPSS Version 22 for Microsoft Window (Statistical Package for Social Science; SPSS Inc., Chicago, IL, USA). The data recorded on the predesigned pro forma were entered in the SPSS software and validated twice for incorrect entries. Descriptive statistics were performed where categorical variables were presented as frequency/percentage and quantitative variables as mean ± standard deviation.
| Results|| |
[Table 1] shows details of sociodemographic characteristics and presenting complaints of the study participants. The mean age of women with PCOS enrolled was 31.29 years. Majority (45%) of the study participants were graduate, followed by education 11–12 years (34%) and 5 years of education or less (11%). Moreover, around 79% of women reside in the urban areas and around 77% were married. The mean duration of marriage (years) was 9.24 years. Furthermore, the monthly income (riyals) for around two-fifth of the study participants were 5000–10,000 riyals, followed by 32% having income >10,000 riyals. Importantly, the most reported presenting complaint among women with PCOS was menstrual problem (42%), followed by delay of pregnancy (40%).
|Table 1: Sociodemographic characteristics and presenting complaints of the study participants (n=100)|
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[Table 2] entails details about knowledge of the study participants about PCOS. Majority (89%) had heard about the ovarian cyst before with 39% had source of knowledge as friends, 34% received knowledge through health education, whereas remaining 27% reported mass media as the source of knowledge. Moreover, 81% were aware about the problems of the disease, with around 69% reported delay of pregnancy and 31% informed menstrual problems as problems of PCOS. Importantly, 63% were aware about the methods of treatment, with treatment options as weight reduction (44.44%), ovarian cystectomy (33.33%), injectables (4.77%), and others as 17.46%.
|Table 2: Knowledge of the study participants about the polycystic ovary syndrome|
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[Table 3] shows details related to the awareness of the study participants related to symptoms of the PCOS. The most reported symptoms were irregular menstrual cycle (52%), facial acne (32%), hirsutism (37%), psychological disturbance (37%), reduction in fertility (39%), weight gain (37%), pelvic pain (35%), frontal hair loss (23%), abortion (24%), diabetes (15%), early puberty (13%), and hypertension.
|Table 3: Awareness of the study participants about the symptoms of polycystic ovarian syndrome|
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[Table 4] shows details related to attitude and practices of the study participants about weight reduction among the study participants. Two-third (66%) of the study participants believed weight reduction is an effective treatment. Among those, 21 (31.8%) believed improving ovulation, 2 (3.04%) improving psychological condition, and both (60.61%) were improved by weight reduction. However, among 34 participants with opinion as weight reduction as not effective in treatment, around 71% found it not useful, 3 (8.82%) believed it having side effects, whereas both options were selected by 5 (14.71%) participants. Thirty-eight participants had used methods of weight reduction prior, with diet as 18.42%, sports or physical activity as 10.53%, and both as around 66%. Among 38 participants, 34 (89.47%) found these methods useful. The effectiveness of these methods was believed to be in getting pregnant (14.71%), menstrual regulation (58.82%), and psychological (17.65%). Finally, when the study participants were inquired who planned diet, majority (73.53%) reported physicians, followed by mass media (14.71%) and friends (11.76%).
|Table 4: Attitude and practices of the study participants about weight reduction among polycystic ovarian syndrome patients|
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| Discussion|| |
The present study was conducted to assess the current level of knowledge, attitude, and practices related to weight reduction among women with PCOS of reproductive age group following their diagnosis. Although weight reduction has been recommended as the first line of therapy, no previous regional study specifically evaluated the awareness among PCOS women in Saudi Arabia.
The present study highlighted that health education after friends was the most frequent source of information received by PCOS women. Moreover, the results also highlighted that delay in pregnancy and menstrual problems were conceived as problems and long-term outcomes of PCOS. As it has been reported by a study that infertility rates among women with PCOS are very high and these women are much concerned about increasing their chances to get pregnant. Moreover, about four-fifth of the study participants were aware about the problems of the disease with 89% having heard of ovarian cyst prior. It has been repeatedly reported in the literature that obesity is a risk factor for PCOS, as obesity induces mild chronic inflammation in adipose tissues, thereby increasing insulin resistance leading to increased risk of diabetes, dyslipidemia, and cardiovascular disorder.,, The narrative review conducted has clearly reported that PCOS is clearly associated with the poor pregnancy outcome and emphasized a healthy lifestyle for women with PCOS. Another study that recruited the study participants with the age group of 18–30 years has reported that the sign and symptoms among PCOS women were infertility, irregular ovulation or menstrual period, and enlarged ovaries, with prolonged symptoms leading to diabetes, heart disease, and endometrial cancer. Moreover, a study conducted in India that recruited the study participants with the age group of 30–50 years reported the signs and symptoms as irregular menstruation, obesity, excessive hair growth, etc., with prolonged disease leads to diabetes, heart disease, and endometrial cancer.
Importantly, weight reduction was the most opted option by the study participants. A recent study has reported that among patients with PCOS, the fundamental parts of the therapy are lifestyle modifications and weight loss with losing as little as 5% of body mass increases frequency of ovulations and chances of pregnancy and improves hormonal profile. Another study clearly stated that women with PCOS were associated with greater perceived susceptibility for disease and weight gain and poorer perceived control over these health outcomes. Moreover, women with PCOS also perceived fewer benefits of healthy behaviors on weight gain with less than half of the PCOS group attempting to follow government diet recommendations (47%). Another study highlighted that women with PCOS demonstrated worsened quality of life, increased anxiety, depression, risk of obesity, infertility, perceived greater importance in reducing future risk of prediabetes, gestational diabetes, type 2 diabetes, heart disease, obesity, and infertility than women without PCOS. Moreover, women with PCOS were more likely to have fears about future health related to weight gain, loss of femininity, loss of sexuality, and infertility as compared to women without PCOS related to BMI status.
The present study also highlighted that weight reduction improves condition as improving ovulation and psychological conditions. Moreover, the methods followed to decrease weight were diet and sports or both, with around 90% found it useful and effective. It was argumented by the participants that weight reduction was effective in terms of getting pregnant, menstrual regulation, and improving psychological conditions. In the current study, the women that changed their lifestyle by following physician-guided diet regimen and practicing sports expressed positive experiences. Clinical trials provided evidence that lifestyle intervention effectively regulated menstrual period, reduced insulin resistance, and the circulating cholesterol levels. Moreover, the dietary measures achieve the best results in adolescents and young adults and so health education should be directed to these age groups.
The present study conducted had certain limitations. First, the study was conducted at only study site, Gynecology Department of Taif University with limited participants enrolled. This had reduced the generalizability and external validity of the study findings. Second, in the current study on account of the nature of the questionnaire, the participants might have overreported or underreported their knowledge, attitude, and practices, thus influencing the findings of the study due to self-reporting bias. Therefore, in future, a study should be conducted at multiple sites with more number of participants being recruited randomly, with a validated tool inquiring more robustly about the knowledge, attitude, and practices related to weight reduction among women with PCOS.
| Conclusion|| |
It can be concluded that the current level of awareness among Saudi women with PCOS about the beneficial effects of weight reduction as the first line of therapy was poor. The study emphasized the need to improve the health education among these population using different sources with more targeted approach to provide clear, concise, appropriate, and timely information. Importantly, for improved outcomes and increased compliance to weight loss and involvement in physical activity, it will be beneficial to engage PCOS women in shared decision-making during the course of management and should be motivated that lifestyle change will impact in terms of improved health outcomes.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol 2013;6:1-3.
March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ, et al.
The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010;25:544-51.
Lauritsen MP, Bentzen JG, Pinborg A, Loft A, Forman JL, Thuesen LL, et al.
The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria versus revised criteria including anti-mullerian hormone. Hum Reprod 2014;29:791-801.
Mykhalchenko K, Lizneva D, Trofimova T, Walker W, Suturina L, Diamond MP, et al.
Genetics of polycystic ovary syndrome. Expert Rev Mol Diagn 2017;17:723-33.
Li L, Baek KH. Molecular genetics of polycystic ovary syndrome: An update. Current Molecular Med 2015;15:331-42.
Amsterdam ESHRE/ASRM-Sponsored 3rd
PCOS Consensus Workshop Group. Consensus on women's health aspects of polycystic ovary syndrome (PCOS). Hum Reprod 2012;27:14-24.
Gibson-Helm M, Teede H, Dunaif A, Dokras A. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2017;102:604-12.
Wild RA, Rizzo M, Clifton S, Carmina E. Lipid levels in polycystic ovary syndrome: Systematic review and meta-analysis. Fertil Steril 2011;95:1073-90.
Mani H, Levy MJ, Davies MJ, Morris DH, Gray LJ, Bankart J, et al.
Diabetes and cardiovascular events in women with polycystic ovary syndrome: A 20-year retrospective cohort study. Clin Endocrinol (Oxf) 2013;78:926-34.
Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al.
Diagnosis and treatment of polycystic ovary syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2013;98:4565-92.
Sheik R. Awareness of obesity as a risk factor for polycystic ovary syndrome. J Pharm Sci Res 2015;7:471-3.
Lass N, Kleber M, Winkel K, Wunsch R, Reinehr T. Effect of lifestyle intervention on features of polycystic ovarian syndrome, metabolic syndrome, and intima-media thickness in obese adolescent girls. J Clin Endocrinol Metab 2011;96:3533-40.
Moran LJ, Pasquali R, Teede HJ, Hoeger KM, Norman RJ. Treatment of obesity in polycystic ovary syndrome: A position statement of the androgen excess and polycystic ovary syndrome society. Fertil Steril 2009;92:1966-82.
Teede HJ, Misso ML, Boyle JA, Garad RM, McAllister V, Downes L, et al.
Translation and implementation of the Australian-led PCOS guideline: Clinical summary and translation resources from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Med J Aust 2018;209:S3-S8.
Panidis D, Tziomalos K, Papadakis E, Katsikis I. Infertility treatment in polycystic ovary syndrome: Lifestyle interventions, medications and surgery. Front Horm Res 2013;40:128-41.
Deligeoroglou E, Vrachnis N, Athanasopoulos N, Iliodromiti Z, Sifakis S, Iliodromiti S, et al.
Mediators of chronic inflammation in polycystic ovarian syndrome. Gynecol Endocrinol 2012;28:974-8.
Koh-Banerjee P, Wang Y, Hu FB, Spiegelman D, Willett WC, Rimm EB, et al.
Changes in body weight and body fat distribution as risk factors for clinical diabetes in US men. Am J Epidemiol 2004;159:1150-9.
Fan J, Song Y, Wang Y, Hui R, Zhang W. Dietary glycemic index, glycemic load, and risk of coronary heart disease, stroke, and stroke mortality: A systematic review with meta-analysis. PLoS One 2012;7:e52182.
Bahri Khomami M, Boyle JA, Tay CT, Vanky E, Teede HJ, Joham AE, et al.
Polycystic ovary syndrome and adverse pregnancy outcomes: Current state of knowledge, challenges and potential implications for practice. Clin Endocrinol (Oxf) 2018;88:761-9.
Priyanka Shenoy B, Brundha MP. Awareness of polycystic ovarian disease among females of age group 18-30 years. J Pharm Sci Res 2016;8:813-6.
Chandrasekhar H, Brundha MP. Awareness of polycystic ovarian disease among females of age group 30 – 50 years. J Pharm Sci Res 2016;8:817-21.
Marciniak A, Lejman-Larysz K, Nawrocka-Rutkowska J, Brodowska A, Songin D. Polycystic ovary syndrome – Current state of knowledge. Pol Merkur Lekarski 2018;44:296-301.
Lin AW, Dollahite JS, Sobal J, Lujan ME. Health-related knowledge, beliefs and self-efficacy in women with polycystic ovary syndrome. Hum Reprod 2018;33:91-100.
Moran L, Gibson-Helm M, Teede H, Deeks A. Polycystic ovary syndrome: A biopsychosocial understanding in young women to improve knowledge and treatment options. J Psychosom Obstet Gynaecol 2010;31:24-31.
[Table 1], [Table 2], [Table 3], [Table 4]