Cross-sectional study to assess the knowledge, attitude, and behavior of women suffering from PCOS and their effect on the skin

Introduction
Polycystic ovarian syndrome, or PCOS, was known initially as “Stein-Leventhal
syndrome,” but it was later referred to as “polycystic ovary disease” (PCOD) before
being referred to as PCOS. Ovarian cysts, oligo- or anovulation, and hyperandrogenism
are the hallmarks of this heterogeneous endocrine and metabolic disorder, which has a
significant impact on the lives of women of childbearing age [1-2]. Although the exact
cause of PCOS is still unknown, researchers believe that the condition is primarily
linked to insulin resistance, hyperandrogenism, and hyperinsulinemia. These two
elevated hormones both affect how the ovary works and affect how other hormones that
control menstruation work normally. A steady hormonal unevenness in the body
weakens the working of the ovaries, prompting the development of growths inside the
ovarian sac. This is the origin of the term “polycystic ovary syndrome” [3]. Stress,
obesity, genetics, lifestyle, and prenatal factors are additional factors that influence
PCOS to varying degrees. PCOS is frequently characterized by hyperandrogenism and
hyperinsulinemia, both of which contribute to a variety of intricate body dysfunctional
mechanisms. PCOS causes oligomenorrhea/amenorrhea, infertility/early miscarriage,
and their major effect on the skin include hirsutism, acne, androgenetic alopecia, and
acanthosis nigricans, among other unpleasant symptoms. For the finding of PCOS, the
Rotterdam Rules are broadly utilized around the world, and its utilization is suggested
by the Endocrine Society in 2013, the American Foundation of Family Doctors (AAFP)
Rules in 2016, and the Global Proof-based Rule for the appraisal and the executives of
polycystic ovary disorder 2018 [4]. For PCOS to be diagnosed, women must meet at
least two of the three criteria, including oligo-/anovulation, clinical or biochemical
hyperandrogenism, and/or ovarian cysts. Other conceivable hormonal problems ought
to likewise be prohibited [5]. It meets the symptomatic prerequisites set by the Places
for Infectious Prevention and Counteraction (CDC). A comprehensive evaluation of the

patient’s medical history, physical examination, basic laboratory tests, and comorbidity
risk assessment is recommended without ultrasound and other types of imaging tests
for the diagnosis of PCOS in addition to using the Rotterdam criteria [6]. Reproductive
difficulties include infertility, late menopause, and even endometrial cancer can result
from PCOS. Due to the presence of risk factors like central obesity, high blood pressure,
atherosclerotic dyslipidemia, and insulin resistance, women with PCOS are also more
likely to develop metabolic syndrome [7]. Women with PCOS frequently experience
long-term consequences like type 2 diabetes, heart disease, sleep apnea, and
psychological issues like anxiety and depression. As a result, early PCOS diagnosis
and treatment are essential for reducing healthcare costs and preventing long-term
complications.

Treatment
PCOS treatment should be tailored to each patient based on their clinical presentations,
and it should aim to achieve the desire to conceive. Infertility or anovulation can be
treated with first-line medications like clomiphene or letrozole or second-line
medications like metformin if a pregnancy is desired, as stated in the American Family
Physician (AAFP) Guideline 2016 and the Australian Family Physician (AFP) Guideline
2012, respectively. In vitro preparation (IVF) is one of the normal medicines for ladies
with PCOS however presents different difficulties going from a poor to a misrepresented
reaction, unfortunate egg-to-follicle proportion, unfortunate treatment, unfortunate
blastocyst change, and ovarian hyper stimulation condition. Hormonal contraceptives
like oral contraceptives or hormonal intrauterine devices (IUDs) should be the first line
of treatment for ovulatory dysfunction if no pregnancy is desired. Metformin should be
the second line of treatment. Patients can be recommended skin cream, benzoyl
peroxide for skin inflammation, electrolysis and phototherapy for hirsutism, metformin
for insulin obstruction, and way-of-life adjustments for stoutness to defeat the particular
condition they are confronting. Between 2.2 and 48% of women worldwide suffer from
PCOS [8-9]. Since the latter part of the 1900s, studies have demonstrated a trend
toward an increasing prevalence of PCOS. 12.6% of employees in various parts of the
world had PCOS, according to a prevalence study. Numerous nations have conducted
research on health-related practices, knowledge, and prevalence. As a result, the goal
of this study was to find out how women knew, felt, and behaved about PCOS.
Healthcare professionals are the most common source of information that helps patients
become more aware of it [10-12].
Material and Methods
The study was cross-sectional and conducted for a period of 3 months at Shadan
Medical College, Hyderabad. After ethical committee clearance was obtained to
commence the study. Women of reproductive age were included in the study.

Study Design
Questionnaire-based research with a set of validated questions covering knowledge,
attitude, and behavior. A pilot study and prior references on this domain were used to
validate the questions. Questionnaires were reviewed by the panel of gynecologists,
dermatologists, and pharmacists.
Type of study: Observation cross sectional study.
Inclusion criteria:
1) Women with age 18-45 age
2) Patient who can understand the questionnaire
Exclusion criteria:
1) Women age less than 18
2) Women age greater than 45
Sample size: 300
Sampling method
Patients visiting outpatients department of Obstetrics and Gynecology and Dermatology at
Shadan Medical College Hyderabad were allowed to fill the questionnaire.

Data analysis plan
First section: consist of the presenting patient’s socio-demographic profile and characteristics
included age, education profile, marital status, presenting patient medical history such as
diabetes, hypertension, and so on.
Second section
To assess the knowledge, attitude, and behavior of the presenting cases regarding Polycystic
Ovary Syndrome using a questionnaire format.

Third section
Consist of patients experiencing major effects on the skin like acne, hirsutism, and seborrheic
dermatitis.
Questionnaires were framed and reviewed by the panel of pharmacist, gynecologist,
and dermatologist. To avoid bias, the questions were kept straightforward, easy to
understand, and free of leading questions. Before the participants were given the

questionnaires, the aims and objectives were explained to them in the language they
understood. It was made sure that the questionnaire’s language was changed to
accommodate different understandings.

In order to prevent bias based on voluntary participation, participants were assured that
participation in the study was entirely voluntary. The analysis of the results was done
using Microsoft Excel, the data were analyzed using descriptive statistics, frequency
and percentages, and the result was presented using tables.
Results
Out of 300 participants, 47.67% were in the age group of 18-25 .30.3% were in the age
group of 26- 35 and 21.33 were in the age group 36-45. 8.33%were having SSC
education qualification .41.33% were having intermediate qualifications. 19% were
graduate, 14% were post-graduate 17.33 % were illiterate 41.67% were single. 58%
were married. 26.33% were students, 29.67% were housewives, and 23.67 % were
working women .23% were in other categories. 29.67% were having a history of
diabetes. 21.33 were having a history of hypothyroidism, 14% of the participants were
having a history of contraceptive use
19.33% were having a history of hypertension, and 14.67 % were not having any co-
morbidity.
Demographics of the patients
Table 1

S. No Age in years Number (n)

Percentage
(%)
1 18-25 143 47.67
2 26-35 91 30.3
3 36-45 64 21.33
Total 100 100

18-25 26-3536-45Total

Age in years

0
20
40
60
80
100
120
140
160

Fig 1

Table 2

S. No Education Number(n)

Percentage
(%)
1 Ssc 25 8.33
2 Intermediate 124 41.33
3 graduation 57 19
4 Post-Graduation 42 14
5 Illiterate 52 17.33
Total 100 100.00

SscIntermediategraduationPost graduationIlliterateTotal

Education

0
20
40
60
80
100
120
140

Fig 2

Table 3

S. No Marital status Number(n) Percentage (%)
1 Single 125 41.67
2 Married 174 58
Total 100 100

Table 4
S. No Occupation Number(n) Percentage (%)
1 Student 79 26.33
2 Housewives 89 29.67
3 Working 71 23.67
4 Others 69 23

Total 100 100.00

StudentHousewivesWorkingOthersTotal

o

0
20
40
60
80
100
120

Fig 3

Table 5

S. No Patient History Number(n)

Percentage
(%)
1 Diabetes 89 29.67
2 Hypothyroidism 64 21.33
3 Use of contraceptive 42 14
4 Hypertension 58 19.33
5 Nil 44 14.67
Total 100 100

DiabetesHypothyrodismUse of
contraceptive

HypertensionNilTotal
Patients history

0
20
40
60
80
100
120

Fig 4

Knowledge of the participants towards PCOS
19.67% heard about PCOS 80% didn’t heard about PCOS 30.33% reported absences of periods
as PCOS.12.33% as presences of longer periods 57.33% doesn’t know about pcos.11% of the
participants reported genetic as the reason for pcos.13% of the participants reported as weight
gain.23.67% reported as hormonal imbalance.12.33% reported all the above as the reason for
pcos.40% reported as I don’t know. 15.33% reported acne as symptoms of PCOS, 21.33% as hair
loss, 11% as rashes16% all of the above symptoms.36.67% do not know the symptoms of PCOS.
23.67% of the participants answered that PCOS can be diagnosed based on symptoms16.67%
from hormone tests 11.7% diagnosed from ultrasound. 9.67% of the above listed 38%
participants do not know how to diagnose pcos.11.33% reported medication as treatment option
available 21.67% as ovarian cystectomy. 23.3% as weight management.8.67% reported as all
above the above 35% do not know the treatment options.

Table no 6.1 Did u hear about PCOS

S. No

Answer
option Number(n)

Percentage
(%)
1 Yes 59 19.67
2 NO 240 80
Total 100 100

Table no 6.2 what is PCOS
S. No Answer option Number(n) Percentage (%)
1 Absence of periods 91 30.33
2 Presence of longer periods 37 12.333
3 I don’t know 172 57.33
Total 100 100

Table no 6.3 What are the reason for PCOS
S. No Answer option Number (n) Percentage (%)
1 Genetics 33 11
2 Weight gain 39 13
3 Hormonal imbalance 71 23.67
4 All the above 37 12.33

5 I don’t know 120 40
Total 100 100

GeneticsWeight gainHormonal
imbalance

All the aboveI don’t knowTotal
Reason for pcos

0
20
40
60
80
100
120
140

Fig 5

Table no 6.4 what are the symptoms of PCOS

S. No Answer option

Number (n)
Percentage
(%)

1 Acne 46 15.33
2 Hair loss 64 21.33
3 Rashes 33 11
4 All the above 48 16
5 I don’t know 110 36.67
Total 100 100.00

Acne HairlossRashesAll the above I don’t knowTotal

Symptoms of pcos

0
20
40
60
80
100
120

Fig 6

Table 6.5 how do you diagnose pcos

S. No Answer option Number(n)

Percentage
(%)
1 Based on symptoms 71 23.67
2 Hormone test 50 16.67
3 Ultrasonography 35 11.7
4 All the above 29 9.67
5 I don’t know 114 38.00
Total 100 100

Table no 6. 6 what are the treatment options available

S. No Answer option Number(n)

Percentage
(%)
1 Medication 34 11.33

2 Ovarian cystectomy 65 21.67
3 Weight management 70 23.3
4 All the above 26 8.67
5 I don’t know 105 35.00
Total 100 100

MedicationOvarian
cystectpmy

Weight
management

All the above I don’t knowTotal

Treatment option available

0
20
40
60
80
100
120

Fig 7

The attitude of participants towards PCOS

27.67% reported as weight loss reduction help in healthy lifestyle.10.67% to monitor insulin
level, 24.67 helps in weight reduction.8.67% reported all of the above 28.33 % do not know the
weight loss reduction in PCOS helps in .28% of the participants reported weight loss reduction
helps to improve ovulation, 35.33% participants reported weight loss reduction help to improve
physiological condition, 13.33% reported all of the above 23.33 % don’t know weight loss
reduction helps. 17.67% of participants reported that diet helps in maintaining hormone balance,
30% reported as exercise help in maintaining hormone balance.16.33% of the participants
reported that medication helps in maintaining hormone balance.11% of the participants reported
all of the above as maintaining the hormone in balance.25% don’t know.

Table no 6.7 what do you think weight loss reduction help in PCOS

S. No Answer option Number(n) Percentage (%)
1 Healthy lifestyle 83 27.67
2 Monitor insulin level 32 10.67
3 Weight reduction 74 24.67
4 All the above 26 8.67
5 I don’t know 85 28.33
Total 100 100

Table no 6.8 what do you think weight loss reduction help in achieving
S. No Answer option Number(n) Percentage (%)

Improve ovulation 84 28
Improve Physiological condition 106 35.33
All the above 40 13.33
I don’t know 70 23.33
Total 100 100

Table no6.9 what do you to maintain the hormone balance in control

S.No. Answer option Number(n) Percentage (%)
Diet 53 17.67
Exercise 90 30
Medication 49 16.33
All the above 33 11
I don’t know 75 25.00
Total 100 100

Pcos major effect on skin

39.33% reported as acne as major symptoms of pcos.13.67% participants reported hair loss as
symptoms of pcos, 20.67 as acne scar,11%all of the above ,15.33 do not the effect on the skin.40
% of the participants heard about hirsutism, 58.67% did not heard about hirsutism , 48.67%
reported unwanted facial hair as hirsutism,17.67% reported as no hair.33.33%do not know about
hirsutism.22% of the participants reported hirsutism effect mostly on chin, 40% reported chest
and thigh,14% reported chin , chest & thigh, 24% participants do not know part of the body
which hirsutism effect.19.67% reported nose to be effected in seborrheic dermatitis,39.33%
reported eyebrow and ear to be effected in seborrheic dermatitis,15% reported as nose , eyebrow
&ear ,26% do not know the part of the body were seborrheic dermatitis effect.24.33% reported
over the lips as the major hair growth seen in the patient ,25% reported as lower back,26.67% as
lower abdomen,10.67% as all of the above ,3.33% do not know major hair growth,41% of the
participants suffering from skin tags ,59% of the participants not suffering from skin tags.37.33
% were suffering from acanthosis nigrican, 62.33% were not suffering from acanthosis nigricans.
Table no 6.10 what are the major symptoms of PCOS patients suffer

S. No Answer option Number(n) Percentage (%)
Acne 118 39.33
Hair loss 41 13.67
Acne scar 62 20.67
All the above 33 11
I don’t t know 46 15.33
Total 100 100

AcneHair lossAcne scarAll the above I dont knowTotal

Symptoms experience by the patients

0
20
40
60
80
100
120
140

Fig 8
Table no 6.12 have you heard about hirsutism

S. No Answer option Number(n) Percentage (%)
1 Yes 120 40
2 No 176 58.67
Total 100 100

Table no 6.12 what is hirsutism

S. No Answer option Number(n)

Percentage
(%)
1 Unwanted facial hair 146 48.67
2 No hair 53 17.67
3 I don’t know 100 33.33
Total 100 100

Unwanted facial hairNo hairI don’t knowTotal

Patients knowing about hirutism

0
20
40
60
80
100
120
140
160

Fig no 9

Table no 6.14 which part of hirsutism effect

S. No Answer option Number(n) Percentage (%)
1 Chin 66 22
2 Chest and thigh 120 40
3 Both a&b 42 14
4 I don’t ’t know 72 24
Total 100 100

ChinChest and
thigh
Both a&bI dont knowTotal
Parts of the body hirustism effect

0
20
40
60
80
100
120
140

Fig 6.10
Table no 6.15 are you suffering from seborrheic dermatitis

S. No Answer option Number(n)

Percentage
(%)

1 Yes 94 31.33
2 No 204 68
Total 100 100

Table no 6.16 which part of the body seborrheic dermatitis affect

S. No Answer option Number(n)

Percentage
(%)
1 Nose 59 19.67
2 Eyebrow & ear 118 39.33
3 Both a&b 45 15
4 I don’t know 78 26
Total 100 100

NoseEyebrow & earBoth a&bI don’t knowTotal

Parts of the body seborrhic dermatitis effect

0
20
40
60
80
100
120
140

Fig 6 .11

Table no 6.17 what are the major hair growth seen in patients

S. No Answer option Number(n)

Percentage
(%)
1 Over the lips 73 24.33
2 Lower back 75 25

3

Lower
abdomen 80 26.67
4 All the above 32 10.67
5 I don’t know 40 13.33

Total 100 100

Over the lipsLower backLower
abdomen
All the aboveI don’t knowTotal
Major hair growth seen

0
20
40
60
80
100
120

Fig 6.12

Table no 6.18 are you suffering from skin tags.

S. No Answer option Number(n)

Percentage
(%)
1 Yes 123 41
2 No 177 59
Total 100 100

Table no 6.19 are you experiencing dark patch on skin / acanthosis nigrican

S. No Answer option Number(n) Percentage (%)
1 Yes 112 37.33
2 No 187 62.33
Total 100 100

Discussion
19.67% heard about pcos which is contrary to the study conducted by Jia Ean goh et al
where 61.20% heard about pcos which is contrary to the study conducted by [13],
where 89% heard about pcos.57.33% reported that they don’t know about pcos which is
contrary to the study conducted by [14] 39.8% reported absence of periods leading to
an imbalance of female sex hormone.40 % don’t know the reason for pcos which is
contrary to [15] where 32.1% of genetic factors are responsible for pcos. 36.67% don’t
know the symptoms of pcos which is contrary to [16] where 56.9% of hair loss a
symptom of PCOS. 38% don’t know the diagnosis of PCOS which is contrary to [17]
were pcos diagnosed by vaginal ultrasound. Another study conducted which is contrary
to Jia ean goh was 57% pcos can be diagnosed by ultrasound where 35% don’t know

the treatment option for pcos which is contrary to [18] where 44.44% answered as
weight reduction as a treatment option for PCOS which is contrary to [19] where 43%
weight reduction and medical management is the treatment option. About 28.33% don’t
know the weight loss reduction helps in.13.33% both (improve ovulation and improve
physiological conditions) weight loss help in which is contrary to the study conducted by
[20] were 60.61% reported improve ovulation and improve physiological conditions)
weight loss helps in.25% don’t know how to control hormone imbalance.65.79%
reported that both diet and exercise help in maintaining hormone in control study is
contrary to [22]. 39.33% of acne as major symptoms patient experienced in pcos .71,7%
experienced acne which is similar to the study conducted by [24] 46.30% experienced
acne as symptoms of PCOS which is similar [23]. 77% experience hair loss as major
symptom of pcos the study is contrary to [24]. 58.67% didn’t hear about hirsutisms .63%
did not hear about hirsutism the study is similar to [25]. 70.5% heard about hirsutism
where the study is contrary to [24] 48.67% reported unwanted facial hair as hirsutism
the study is similar to [25].76% reported to have hirsutism which is almost similar to
[27]. 40% hirsutism effect chest and thigh the study is similar to [26]. 68% of the
participant not suffering from seborrhoea dermatitis .26.67% major hair growth seen
lower abdomen study is similar to [28]. 59% of participants not suffered from skin tags.
37.33% suffered from acanthosis nigirican.

Conclusion
It can be concluded from the study majority of the participants were in the age group of 18- 25
having intermediate education and were found to be married housewives as their occupation
majority of the participants had a history of diabetes. Only 46.77% of the participants had
knowledge about pcos. 29.55% of the participants had favorable attitude and practice toward

pcos.48.84 % of the participants had knowledge about PCOS and their major effect on skin
.majority of the participants experienced acne and hirsutism. 39.33% suffered from seborrhea
dermatitis which patient experienced on eyebrows and ear. Hence effective pharmacist
counseling need to be implemented.

Acknowledgement: Authors are thankful to Shadan Medical College for carrying out research.

Conflict of interest: there is not conflict of interest.

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