The influence of hyperandrogenism, obesity and infertility on the psychosocial health and well -being of women with polycystic ovary syndrome.

Polycystic Ovary Syndrome (PCOS) is a chronic, lifelong endocrine disorder characterized by hyperandrogenism, hyperinsulinemia, chronic anovulation and infertility impacting over 5 million women in the U.S. alone. Co-morbidity concerns include insulin resistance, diabetes, hypertension, cardiovascular disease and endometrial cancer. Previous research has primarily focused on the physiology and treatment of PCOS. The aim of the current study was to test the nature and degree of the influence of obesity, hyperandrogenism, and infertility on the emotional health, relationship satisfaction, and personal image of women with PCOS as measured by standardized instruments. This study used a convenience sample of 128 women with PCOS from a private reproductive endocrinology practice. Half of the women were currently attempting to conceive in addition to being treated for their PCOS. Most subjects were white (97%) and married (78%). The mean age was 30 +/- .48 years, mean weight 213 +/- 51.7 pounds, and all lived in the southern Appalachian region of the southeast United States. A cross-sectional, correlational design was utilized. A one time self-administered health survey with eight imbedded questionnaires was administered during the first week of the subject's menstrual cycle. Instruments administered included the Derogatis Brief Symptom Inventory (BSI), Derogatis Affects Balance Scale, Health-Related PCOS Quality of Life Questionnaire (PCOSQ), Dyadic Adjustment Scale, Brief Index of Sexual Functioning, Index of Sexual Satisfaction, BEM Sex Role Inventory, and the Body Dissatisfaction Subscale of the Eating Disorder Inventory-2. Clinical measures included total testosterone, sex hormone binding globulin, free androgen index, body mass index, waist-to-hip ratio (WHR), and degree of hirsutism. Unlike two previous investigations, this study found no relationship between hyperandrogenism and negative mood. Surprisingly, fertility intent was a strong predictor of emotional distress. PCOS women currently attempting conception reported lower emotional distress and negative mood than those not undergoing infertility treatment. These findings suggest the following conclusions: First, women with PCOS are at increased risk for emotional distress, which is not mediated by a distorted body image due to obesity or hirsutism. Second, women with an elevated WHR (>.85 i.e. androgenized) have decreased dyadic cohesion, and reported spending less time engaged in activities together as a couple. Third, seeking treatment for infertility may reduce the risk of depression at least temporarily in PCOS women. Lastly, the PCOS Quality of Life instrument (PCOSQ) was a useful screening tool, correlating well with PCOS physical and emotional symptoms. Although the PCOSQ emotions domain correlated well with each of the nine subscales and three global indices of the BSI [range (r = -.40 through -.60), p = .001], it was not sensitive enough to distinguish specific psychological disorders.Ph.D.Health and Environmental SciencesMental healthNursingObstetricsUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/130133/2/3042131.pd