“Clinical used for data collection. Psychological Distress levels were

 “Clinical
Manifestation of Polycystic Ovarian syndrome & it’s relationship with
Psychological Distress Levels among the concerned subjects  in Allahabad City”.

 

Abstract

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Polycystic
Ovarian Syndrome is a complex endocrinopathy affecting women of reproductive
age affecting  5 to 10 % population
worldwide. In India, it has been reported that 9.13 to 22.5 % population are
suffering from this syndrome, but prevalence rate varies with different regions
of the country. Likewise, vast difference has also been reported in clinical
manifestation of PCOS. It is increasingly recognised that ethnic differences
are likely contributors to the differing manifestations of PCOS. It is now
accepted that this problem is arising from persistent anovulation with a
spectrum of etiologies and clinical manifestations. However, there has been
very limited research data available in India regarding pattern of clinical
manifestation of PCOS and most of the research studies done in South India. It
has also been reported in previous studies that PCOS affects quality of life
and can worsen existing anxiety and depression either due to the features of
PCOS  or associated comorbidities. Hence, it seems necessary to find out
the pattern of clinical manifestation of PCOS and it’s relationship with
Psychological Distress levels among PCOS subjects. Objective: 1) To
find out pattern of clinical manifestation of PCOS in Allahabad city.2) To find
out the association between Clinical Manifestation and Psychological Distress
levels among PCOS sufferers. Materials
& Methods: In this cross-sectional, descriptive study, 200 patients
with PCOS were recruited from various Hospitals & Nursing Homes of
Allahabad city. A self made questionnaire with items related to pieces of information
about clinical symptoms was used for data collection. Psychological Distress
levels were assessed using the P.G.I Health Questionaire N1. Statistical
analyses were performed using SPSS Ver. 20.0. Chi Square test was used to test
the association between variables. A p-value less than 0.05 was considered as
statistically significant. Results: The
findings of the study revealed that PCOS subjects having more clinical
manifestation were moderate to severe neurotic. The most common phenotypic expression
found to be was Androgenic Alopecia followed by Hirsuitism however, mild to
moderate level hirsuitism was found in patients, severe hirsuitism cases were
rare which is believed to be a most common clinical symptom found in Asian
countries as compared to Western countries.After that Duration Between Menses,
Acanthosis Nigricans, Insomnia, Acne Vulgaris, Sleep Apnea and infertility in a
sequence was reported. Infertility present in most of the married subjects but
most of the subjects having children with PCOS were also found moderate to
severe neurotic. Conclusion: The research
study revealed that most of the PCOS subjects having different clinical
manifestation comes under moderate to severe neuroticism .

Keywords: Endocrinopathy, Anovulation, Hirsuitism, Acanthosis
Nigricans, Acne Vulgaris, Androgenic alopecia

 

 

 

 

INTRODUCTION

 

Polycystic Ovarian Syndrome is characterized by multiple
phenotypes i.e clinical symptoms which varies with ethnic origin. Globally,
prevalence estimates of PCOS are highly variable, ranging from 2.2% to as high
as 26%. The differences in phenotype and clinical symptoms of PCOS related to
the clinical, hormonal, and metabolic characteristics among various ethnic
backgrounds, including Hispanics, African Americans, Asians, and Indians, need
to be considered when assessing and treating these individuals. According
to Times of India survey (15 May,2017)
it was found that eastern part of India showed a higher percentage of women
(25.88 per cent) affected by PCOS. The figure was 18.62 per cent in north India
and 18 per cent in south India. India is a country of cultural variation and
the figures of survey itself explains the ethnic variation behind clinical
manifestation of the PCOS.

AIMS/OBJECTIVE:

Ø 
To
find out the pattern of clinical manifestation among population having
Polycystic Ovarian Syndrome in Allahabad City.

Ø 
To
find out the relationship between clinical manifestation of Polycystic Ovarian
Syndrome and Psychological Distress levels among concerned population.

METHODOLOGY:

The research study was non comparative, cross-sectional, descriptive
& hospital based survey. In this Study, purposive sampling was done on the
basis of Rotterdam criteria to get Polycystic Ovarian Syndrome patients, after
that age based stratification was done to get 200 patients of 18-48 years of
age group from various Hospitals, Nursing Homes of Allahabad city. Patients
suffering from serious metabolic disease had been excluded from the study. A
self made questionnaire with items related to pieces of information about
clinical symptoms was used for data collection. Psychological Distress levels
were assessed using the P.G.I Health Questionaire N1. Statistical analyses were
performed using SPSS Ver. 20.0. Chi Square test was used to test the
association between variables. A p-value less than 0.05 was considered as
statistically significant.

 

 

 

 

 

 

 

 

 

RESULT & DISCUSSION/FINDINGS

The present
study was carried out at Nursing Homes, Hospitals and community in Allahabad
City. The findings of the study are
following:

Ø  Table:1 Most Common Clinical
Manifestation of PCOS

 

 
CLINICAL SYMPTOMS

 
PARAMETERS

 
FREQUENCY
      (N)

 
PERCENTAGE
            (%)

Androgenic Alopecia        Present            
                                       Absent
Hirsuitism                        Present
 
 
                                    Absent
 
Duration
between           
Menses                         
 
 
 
 
Acanthosis
Nigricans      Present
                                       Absent
Insomnia                       Present
                                      Absent
 
Acne
Vulgaris               Present
                                    Absent
 
 
Sleep
Apnea                  Present
                                    Absent
Infertility                      Present
                                    Absent
                          *Not Applicable
(*NA=Unmarried girls)
 
 



Mild
Moderate
Severe
 
199 Days
 
 
 
 
7 hours sleep
 
 
 

152
48
90
52
4
54
52
83
 
32
33
 
97
103
76
124
 
67
133
 
           59
141
50
57
93

76
24
45
26
2
27
26
41
 
16
16
 
48.5
51.5
38
62
           
            33.5
66.5
 
29.5
70.5
25
28.5
46.5

 

v  Androgenic alopecia was reported in 155 patients out of
200,(about 77.5 % population) and it was reported to be the most common
clinical symptom of PCOS which is then followed by hirsuitism among 71 %
population, duration between menses among 60 % population, acanthosis nigricans
among 51 % population, insomnia among 36% population, acne vulgaris among 33.5
% population, sleep apnea among 27.5 % population, infertility among 25 %
population were reported. However, the findings is in contrast with previous
research finding done in North India by Abid
et al., 2017 who ranked
androgenic alopecia in third place about 31 % after hirsuitism and acne vulgaris.
According to Quinn et al.,2014 Androgenic alopecia is prevalent in 22% of subjects
meeting diagnostic criteria for PCOS.

v  Mild to Moderate
level Hirsuitism was reported among PCOS Sufferers while severe cases of
hirsuitism were rare. This finding is in contrast with the previous research
finding of Philip etal.,2014 who revealed that Hirsuitism being a more prevalent symptom of
hyperandrogenism in women from the Indian subcontinent
and from Mediterranean countries than
it is in those of northern European or
east Asian origin. In our study, hirsuitism ranked in second place after
androgenic alopecia while according
to previous study by Abid et al., 2017  the prevalence of hirsutism was reported to
be 78 % and he ranked it in first place to be the most common clinical symptom.

v  In most of the cases about 41 %, duration between menses was
reported to be in normal range, after that in 26 % cases, menses duration was
reported to be less than 21 days while 16 % population suffered from menstrual
delay of more than 199 days and about rest of 16 % population suffered from
menstrual delay of 35-60 days. Oligomenorrheoa was present in 32 % patients.
However, hypomennorhea was reported in major population. In the present study
all patients complained of irregular menses while mennorhagia was reported in
26% cases which is also reported by Maslyanskaya
et al.,2017 who revealed that
PCOS was the most common etiology seen in adolescent patients hospitalized for
abnormal uterine bleeding. However in our study, it has been observed that menstrual
delay among major population comes within normal range. Hence it has been
revealed that although menstrual duration remains regular, hypomennorhea comes
out to be a better predictor of PCOS. However, most of the population believed
regular menstrual cycle to be a better predictor of menstrual health, while in
most of the cases, menstrual bleeding shifted from 5 days to 3 days and even
less in some cases.

v  AN is a velvety,
mossy, hyper pigmented skin disorder. Presence of AN appears to be more a sign
of insulin resistance than distinct disease itself. Acanthosis Nigricans
was reported in 48.5% subjects and got fourth place in a sequence while
according to Abid et al.,2017 it has been observed in 30 % population but he
ranked it too at the fourth place. The
finding of study is concordant with the previous study by Sunita et al.,2013, who
revealed that 44.16% patients showed presence of AN, a surrogate marker of
insulin resistance.

v  Insomnia was
reported in 38 % population.According to Franik
et al.,2016, clinically
significant insomnia according to both AIS and ISI, occurred significantly more
often in women with PCOS than in women without PCOS.

v  In our study, Acne
vulgaris was reported in 33.5 % population while about 48 % population were
having this symptom according to Abid et
al., 2017  who ranked it second most common symptom
after hirsuitism.

v  Sleep Apnea was reported in 29.5 %
population. According to Vgontzas et
al.,2001, the risk for Obstructive Sleep Apnea is at least
5-fold higher, and perhaps as much as thirty-fold higher in PCOS, than in
similarly obese women.

v  In present
study, it has been revealed that 25 % population were suffering from
infertility at the time of survey. Although PCOS is believed to be one of the
biggest cause behind Infertility but in our study, some of the population were
either having children with PCOS or they were unmarried at the time of survey
while about 2-17 years of infertility had been reported among married subjects.
However, Sunita et al.,2013 revealed that about 44.68% married PCOS women
complained of infertility.

                   

 

 

 

 

 

Ø  Table:2 Relationship between
Psychological Distress Level & Clincal Symptoms of PCOS in Concerned
Subjects

 

 
 
CLINICAL SYMPTOMS
 
 

 
 
PARAMETER

 
 
MILD
NEUROTIC
 

 
 
MODERATE
NEUROTIC

 
 
SEVERE
NEUROTIC

 
 
P
VALUE

 
 Androgenic Alopecia
 
Hirsuitism
 
 
 
Duration
between Menses
 
 
Acanthosis
Nigricans
 
Insomnia
 
Acne Vulgaris
Sleep Apnea
 
 
 
Infertility
 
 
 
 
 
 
 

 
   Present
     
Absent
Mild
Moderate
Severe
Absent
199 Days
Present

Absent
Present
Absent
Present

Absent
Present
Absent 
 
Present
Absent
*Not
Applicable
(Unmarried
Girls )

 
3
0
3
0
0
0
3
0
0
0
3
0
0
3
0
3
0
3
 
0
0
3

 
45
13
15
14
0
29
16
32
3
7
32
26
7
51
24
34
14
44
 
19
20
19

 
104
29
72
35
4
22
30
51
26
26
62
71
66
67
43
90
45
88
 
28
31
71

 
         P
>.05
Not
Significant
 
P
.05
Not
Significant
P
.05
Not
Significant
P
> .05
Not
Significant
 
P

x

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