|Year : 2020 | Volume
| Issue : 1 | Page : 28-32
Assessment of the prevalence of polycystic ovary syndrome among the college students: A case–control study from Kolkata
Madhumati Chatterjee1, Soma Aditya Bandyopadhyay2
1 Department of Anthropology, Dr. A.P.J. Abdul Kalam Government College, New Town, Kolkata, West Bengal, India
2 Department of Zoology, Sarojini Naidu College for Women, Kolkata, West Bengal, India
|Date of Submission||04-Sep-2019|
|Date of Acceptance||10-Jan-2020|
|Date of Web Publication||14-Apr-2020|
Dr. Soma Aditya Bandyopadhyay
Department of Zoology, Sarojini Naidu College for Women, 30, Jessore Road, Dum Dum, Kolkata - 700 028, West Bengal
Source of Support: None, Conflict of Interest: None
Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. Of late, the disease is on its rise due to environmental changes as well as lifestyle disorders, affecting 4%–26% of adolescent and young women all over the globe. Initially, this condition is asymptomatic in young girls, progressing toward menstrual irregularities, obesity, hyperandrogenism in late puberty and eventually developing insulin resistance, hypertension, type 2 diabetes, cardiovascular diseases, and infertility around middle age. Aims: Early diagnosis is necessary for early intervention, including lifestyle modifications to prevent the immediate and chronic consequences of PCOS. Materials and Methods: Our study design was of a cross-sectional questionnaire-based survey, conducted from September 2017 to March 2018 to investigate the prevalence of PCOS and its association with body composition variables. The study population comprised randomly chosen students (age group 18–20 years) of all discipline. The data were collected from the students using structured questionnaire with Rotterdam's criteria, and anthropometric measurements were taken using standard techniques. Results: Approximately 28% of the college students were found to be at high risk of developing PCOS. More than 85% of the PCOS cases had oligomenorrhea, 19% were hirsute, 41% had acne, 63% had emotional disturbance, and 22% with a positive family history. Furthermore, the body mass index of the PCOS students demonstrated a trend of Grade 1 obesity than the normal females of the same age group. Conclusion: The present study is an attempt to create increased awareness among the students for early and accurate diagnosis, which is the primary step in managing PCOS.
Keywords: Body mass index, hirsutism, obesity, oligomenorrhea, polycystic ovary syndrome, Rotterdam's criteria
|How to cite this article:|
Chatterjee M, Bandyopadhyay SA. Assessment of the prevalence of polycystic ovary syndrome among the college students: A case–control study from Kolkata. J Mahatma Gandhi Inst Med Sci 2020;25:28-32
|How to cite this URL:|
Chatterjee M, Bandyopadhyay SA. Assessment of the prevalence of polycystic ovary syndrome among the college students: A case–control study from Kolkata. J Mahatma Gandhi Inst Med Sci [serial online] 2020 [cited 2021 Jan 16];25:28-32. Available from: https://www.jmgims.co.in/text.asp?2020/25/1/28/282362
| Introduction|| |
Polycystic ovary syndrome (PCOS) is a heterogeneous, multifactorial, complex disorder with a broad spectrum of clinical manifestations such as hyperandrogenism, polycystic ovaries, and ovulatory dysfunction. Reports suggest that women with PCOS are more likely to develop metabolic syndrome with obesity, dyslipidemia, and insulin resistance culminating in serious long-term consequences such as type 2 diabetes mellitus, cardiovascular disease, and infertility., PCOS accounts for significant health-care costs and distress and has a major impact on the quality of life and fertility. Approximately 4%–10% of the world population experiences PCOS although the incidence rate is higher for India, rounding off to 20%–26%. Although it has an alarming incidence globally, the syndrome is enigmatic with unclear etiology and its diagnosis is difficult as it manifests as a spectrum of symptoms than a specific one. The symptoms of PCOS appear insidiously and are coincident with changes that accompany normal pubertal development, so it is difficult to identify the disorder in young girls. Thus, PCOS often goes unnoticed and undiagnosed during the adolescent period, except its manifestation as irregular cycles around menarche. The diverse manifestations of PCOS start at an early age with anovulation, oligomenorrhea, weight gain, hirsutism, and acne, leading to obesity, insulin resistance, and hyperandrogenism in late puberty. It is likely to increase a woman's chance of developing cardiovascular disease, hypertension, type 2 diabetes, and infertility. Of late, the disease is on its rise due to environmental changes as well as lifestyle disorders as a result of modernization. Considering the magnitude and consequences of PCOS, it is important to assess its prevalence in young women.
College students represent a homogeneous group of population whose outreach is feasible and they are the future mothers of the society. Ironically, such students may appear healthy and may not realize that they have PCOS until problems in conceiving are encountered after marriage. Thus, risk assessment in the form of a survey appears to be the most useful method in identifying this condition at the earliest to create awareness among young women to seek timely treatment and prevent its long-term complications. Therefore, the objective of the present study was to assess the prevalence of PCOS and to study the anthropometric variables associated with PCOS among the students of Sarojini Naidu College for Women, Kolkata, WB.
| Materials and Methods|| |
This prospective study was carried out from September 2017 to March 2018 among the students of Sarojini Naidu College for Women, Kolkata, WB. The study design was of a cross-sectional survey comprising randomly chosen undergraduate students, aged between 18 and 20 years, from all disciplines. The participation of the students was voluntary. The objectives of the study were explained to the participants to ensure cooperation, and thereafter, written consent was obtained from them assuring confidentiality. Approval was also taken from the institutional research and ethics committee before the survey.
The data were collected using structured knowledge questionnaire prepared as per the Rotterdam consortium criteria on PCOS. It contained questions relating to the sociodemographic information of the participant, family history of PCOS, age at menarche, pattern of menstrual cycle, skin problems, body hair distribution, and emotional status. The questionnaire was filled in pen-and-paper method. Around 10–15 min was spent to extract the data for each student. The data gathering process was continued till the sample size was 125. Three students having thyroid disorder, hyperprolactinemia, and Cushing's syndrome were excluded from the study. Out of 122 students, 27 were reported to have PCOS and the rest 95 students were without PCOS. After the data collection, anthropometric measurements such as height; weight; hip–waist circumference; abdominal and mid-upper arm circumference (AC and MUAC); and biceps, triceps, suprailiac, subscapular, and medial calf skinfold (BSF, TSF, SISF, SSSF, and MCSF) were taken using standard procedure. The information collected from the study participants was scored and tabulated and the mean, percentage, and standard deviation were calculated. Student's t-test was used to compare the demographic variables with risk levels. P < 0.05 was considered statistically significant.
| Results|| |
Menstrual cycle irregularity
Among the PCOS students, 23 (85.18%) out of 27 students have irregular menstrual cycle, whereas only 8 (8.42%) have menstrual irregularity among the non-PCOS group.
Body mass index
The weight of the participants ranged from 38 to 90 kg. Students with PCOS (72.62 kg) were found to be significantly heavier than those without it (54.77 kg). Distribution of height did not show any difference between PCOS and non-PCOS students. Body mass index (BMI) revealed significant difference between PCOS and non-PCOS females [Figure 1], indicating significantly higher obesity (95% confidence interval [CI]: 5.88–8.55, t = 10.69, P < 0.0001) in PCOS (30.47 ± 2.72) compared to non-PCOS (23.25 ± 3.19) females.
|Figure 1: Histogram showing significant difference in body mass index of polycystic ovary syndrome and nonpolycystic ovary syndrome females,P< 0.0001|
Click here to view
Waist and hip circumference and waist–hip ratio
Both these parameters demonstrated significant differences, indicating higher waist (85.20 vs. 73.27: 95% CI: 8.66–15.19, t = 7.24, P < 0.0001) and hip circumference (108.93 ± 6.35 vs. 91.85 ± 6.41:95% CI: 14.32–19.84, t = 12.24, P < 0.0001) among the PCOS females than their non-PCOS counterparts. Apart from general adiposity measures, regional adiposity measure obtained by waist–hip ratio (WHR) revealed significant difference between PCOS and non-PCOS females. The WHR (0.78 ± 0.05 vs. 0.65 ± 0.16) [Figure 2] appeared to be significantly higher among the PCOS group.
|Figure 2: Histogram showing significant difference in waist–hip ratio of polycystic ovary syndrome and nonpolycystic ovary syndrome group,P< 0.0001|
Click here to view
Body composition variables
The means and standard deviations of body composition variables of the participants are presented in [Table 1]. In addition, significance of difference between the PCOS and non-PCOS group is given for each variable. As evident from [Table 1], the mean values of AC and MUAC and BSF, TSF, SISF, SSSF, and MCSF were found to be higher in students with PCOS in comparison with those without PCOS. However, statistically significant difference could not be established at P < 0.05 for all the variables except AC.
|Table 1: Mean and standard deviations of body composition variables in students with and without polycystic ovary syndrome|
Click here to view
In this study, 18.51% of participants diagnosed with PCOS had hirsutism, whereas the occurrence of the same was much lower, i.e. 7.36%, in the non-PCOS group.
Acne was found in 40.74% of participants with PCOS and in 22.10% of cases without non-PCOS.
Emotional problems in the form of feeling moody, irritable, and depressed were present in 63% of cases with PCOS and 7% of cases without PCOS.
Family history of polycystic ovary syndrome
About 22% of cases showed to have a positive family history, 74% had no family history, and 4% were unaware of their family history regarding the occurrence of PCOS.
| Discussion|| |
PCOS is one of the leading health problems among women and is regarded as one of the primal causes of female subfertility. Globally, the disease is on its rise due to environmental changes as well as lifestyle disorders as a result of modernization. Although a common problem, a number of cases in the community remain undiagnosed due to unclear etiology. Thus, risk assessment in the form of a survey appears to be the ideal strategy for early intervention and prompt treatment to prevent early and late sequel of the syndrome. A simple questionnaire-based survey was found to be an appropriate tool for initial screening of PCOS in college students.
For several years, there has been debate regarding the diagnostic criteria for PCOS. According to the criteria made by the National Institutes of Health in 1990, the diagnosis can be made when chronic anovulation is present in combination with clinical and/or biochemical signs of hyperandrogenism and when related disorders have been excluded. In 2003, a PCOS consensus workgroup, held in Rotterdam and sponsored by the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM), agreed on a revision of the criteria (the Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2004), where polycystic ovary (PCO) was added as one of the diagnostic features of PCOS. Therefore, PCOS was defined by the presence of a PCO with 12 or more follicles measuring 2–9 mm and (i) oligo-/amenorrhea and/or (ii) clinical hyperandrogenism (acne and hirsutism) and/or hyperandrogenemia. Oligo-/amenorrhea was diagnosed by menstrual cycle length of <21 days or more than 35 days. Clinical hyperandrogenism was assessed on the basis of the self-reported degree of acne or hirsutism using self-assessment method. Acne was defined as present if the participant claimed that it was a constant problem or if she was on prescription medication for acne. Hirsutism was defined as present when the student claimed to have dark, thick hair on the upper lip, chest, abdomen, back, or thighs. A questionnaire was prepared by taking into account all the criteria mentioned above along with the sociodemographic profile and family history for risk assessment in adolescents.
The reported prevalence of PCOS all over the globe is highly variable, ranging from 2.2% to 33%.,,,,, The prevalence of PCOS in our study was determined to be 28%, which is consistent with those of the other studies conducted in young women of similar reproductive age group in India.,,,, Our results indicated that roughly 85% of the PCOS cases had oligomenorrhea, 19% of them were hirsute, and 41% had acne. Reports indicate that menstrual irregularity in the early postmenarchal years may be an early sign of PCOS and about 50% of the oligomenorrheic adolescents develop PCOS as adults. BMI as a measure of general obesity/adiposity was significantly higher in students confirmed with PCOS as reported earlier., Moreover, 55.6% of students belonged to the obese category, confirming the fact that obesity and PCOS are closely interrelated. Apart from general adiposity measures, regional adiposity measure obtained by WHR revealed significant difference between PCOS and non-PCOS females. The WHR appeared to be significantly higher in the PCOS group. In general, the body composition of PCOS females differs from the normal females although no significant differences were found in terms of BSF, TSF, SISF, SSSF, and MCSF between cases with and without PCOS. This may be explained by the fact that global obesity rather than the abnormal regional fat distribution characterizes the PCOS women. The common symptoms in PCOS contributed to poor body image and self-esteem and correlated with low quality of scores leading to emotional problems such as feeling moody, irritable, or fatigued as evident in 63% of our PCOS cases., A positive family history has also been indicated in 22% of PCOS cases, which is in accordance with previous studies.
Limitations of the study
The present survey is an attempt to increase awareness for early diagnosis of PCOS among the students, but it has some limitations. Pattern of menstrual cycle, biochemical hyperandrogenemia, and midluteal progesterone level were not evaluated in our cases., Because the study was performed in students, the majority of the cases were unmarried, it excluded an invasive approach for ultrasonography, and as a result, this sensitive and most reliable tool was not used for identifying polycystic ovaries.
| Conclusion|| |
Based on our observations in this study, it can be concluded that the prevalence of PCOS is increasing at a rapid pace in India and it might be an emerging public health challenge in future. A multidisciplinary approach involving periodic screening is required particularly for those with positive family history of PCOS. This will enable early diagnosis and prompt clinical intervention of this condition to prevent long-term health complications associated with PCOS. Lifestyle modifications including regular exercise, weight reduction, and healthy dietary habits along with counseling services for addressing emotional problems should be encouraged which may eventually lead toward a prospective better reproductive health of the young generation.
The authors are grateful to the Principal, Sarojini Naidu College for Women, Kolkata, for the permission and support to carry out this work. They also like to thank the students participating in the study for their positive attitude and cooperation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rodin DA, Bano G, Bland JM, Taylor K, Nussey SS. Polycystic ovaries and associated metabolic abnormalities in Indian subcontinent Asian women. Clin Endocrinol (Oxf) 1998;49:91-9.
Wild RA. Long-term health consequences of PCOS. Hum Reprod Update 2002;8:231-41.
Elsenbruch S, Hahn S, Kowalsky D, Offner AH, Schedlowski M, Mann K, et al
. Quality of life, psychosocial well-being, and sexual satisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003;88:5801-7.
Radha P, Devi RS, Madhavi J. Comparative study of prevalence of polycystic ovarian syndrome in rural and urban population. J Adv Med Dent Sci Res 2016;4:90-5.
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;89:2745-9.
Vijayan CP, Sonia A. Prevalence of polycystic ovary syndrome among students of a teaching collegiate hospital. Health Sci 2013;2:1-11.
Franks S. Polycystic ovary syndrome in adolescents. Int J Obes (Lond) 2008;32:1035-41.
Attlee A, Nusralla A, Eqbal R, Said H, Hashim M, Obaid RS. Polycystic ovary syndrome in university students: Occurrence and associated factors. Int J Fertil Steril 2014;8:261-6.
Kousta E, White DM, Cela E, McCarthy MI, Franks S. The prevalence of polycystic ovaries in women with infertility. Hum Reprod 1999;14:2720-3.
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25.
Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: Towards a rational approach. In: Dunaif A, Givens JR, Haseltine FP, editors. Polycystic Ovary Syndrome. Boston: Blackwell Scientific Publications; 1992. p. 377-84.
Cronin L, Guyatt G, Griffith L, Wong E, Azziz R, Futterweit W, et al
. Development of a health-related quality-of-life questionnaire (PCOSQ) for women with polycystic ovary syndrome (PCOS). J Clin Endocrinol Metab 1998;83:1976-87.
Joshi B, Mukherjee S, Patil A, Purandare A, Chauhan S, Vaidya R. A cross-sectional study of polycystic ovarian syndrome among adolescent and young girls in Mumbai, India. Indian J Endocrinol Metab 2014;18:317-24.
Michelmore KF, Balen AH, Dunger DB, Vessey MP. Polycystic ovaries and associated clinical and biochemical features in young women. Clin Endocrinol (Oxf) 1999;51:779-86.
Polson DW, Adams J, Wadsworth J, Franks S. Polycystic ovaries – A common finding in normal women. Lancet 1988;1:870-2.
Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: A prospective study. J Clin Endocrinol Metab 1998;83:3078-82.
Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Prevalence of polycystic ovarian syndrome in Indian adolescents. J Pediatr Adolesc Gynecol 2011;24:223-7.
Shobha, Devi ES, Prabhu A. An exploratory survey to identify the adolescents with high risk for Polycystic Ovarian Syndrome (PCOS) and to find the effectiveness of an awareness programme among students of selected pre university colleges of Udupi district. IOSR J Nurs Health Sci 2014;3:66-9.
Joseph N, Reddy AG, Joy D, Patel V, Santhosh P, Das S, et al
. Study on the proportion and determinants of polycystic ovarian syndrome among health sciences students in South India. J Nat Sci Biol Med 2016;7:166-72.
Nivetha M, Susan GS. Survey of Polycystic ovarian disease (PCOD) among the girl students of Bishop Heber College, Trichirapalli, Tamil Nadu, India. IOSR J Nurs Health Sci 2016;5:44-52.
Avvad CK, Holeuwerger R, Silva VC, Bordallo MA, Breitenbach MM. Menstrual irregularity in the first postmenarchal years: An early clinical sign of polycystic ovary syndrome in adolescence. Gynecol Endocrinol 2001;15:170-7.
Balen AH, Conway GS, Kaltsas G, Techatrasak K, Manning PJ, West C, et al
. Polycystic ovary syndrome: The spectrum of the disorder in 1741 patients. Hum Reprod 1995;10:2107-11.
Trent M, Austin SB, Rich M, Gordon CM. Overweight status of adolescent girls with polycystic ovary syndrome: Body mass index as mediator of quality of life. Ambul Pediatr 2005;5:107-11.
Barber TM, Golding SJ, Alvey C, Wass JA, Karpe F, Franks S, et al
. Global adiposity rather than abnormal regional fat distribution characterizes women with polycystic ovary syndrome. J Clin Endocrinol Metab 2008;93:999-1004.
Himelein MJ, Thatcher SS. Depression and body image among women with polycystic ovary syndrome. J Health Psychol 2006;11:613-25.
Trent ME, Rich M, Austin SB, Gordon CM. Quality of life in adolescent girls with polycystic ovary syndrome. Arch Pediatr Adolesc Med 2002;156:556-60.
Moini A, Eslami B. Familial associations between polycystic ovarian syndrome and common diseases. J Assist Reprod Genet 2009;26:123-7.
[Figure 1], [Figure 2]