Measures of health-related quality of life in PCOS women: a systematic review

Figures & data

Figure 1 The flow diagram of the review.

Table 1 Quantitative studies that measured HRQoL of women with PCOS (n=43)

Study; country	Design	Objective	Diagnosis criteria	Age (years, mean ± SD)	HRQoL instruments used	Sample size	Main outcomes
Cronin et al;^Citation21 USA	Cross-sectional	Designing tools for measuring the QoL in women with PCOS	NIH	18–45	PCOSQ	100 PCOS; 12 interviews	Developing PCOSQ, which includes 26 items
Wong et al;^Citation65 Canada	Cross-sectional	Examining the relative impact of the number and severity of patient problems on HRQoL	Not stated	30.5±6.7	PCOSQ	100	Including all potential items in calculating a domain score provided a more accurate portrait of HRQoL
Trent et al;^Citation52 USA	Cross-sectional	Evaluating the HRQoL in adolescents with PCOS and its correlation with patients’ perception	NIH	13–22	CHQ-CF87	146 control, 97 PCOS	Patients had worsened QoL. Patients with higher self-perceived severity scored were lower on the general health perception
Trent et al;^Citation66 USA	Cross-sectional	Evaluating the fertility concerns and sexual behavior in young PCOS women compared with healthy women	NIH	13–22	CHQ-CF87	146 control, 97 PCOS	PCOS women were 3.4 times more likely to be worried about fertility issues
Elsenbruch et al;^Citation30 Germany	Case–control	Evaluating the quality of life, mental status, and sexual satisfaction in PCOS women	NIH	Controls: 29.9±5.7; PCOS: 28.4±5.0	SF-36, SCL-90-R	50 control, 50 PCOS	PCOS caused a major reduction in the QoL and severely limits sexual satisfaction
Hashimoto et al;^Citation67 Brazil	Case–control	Evaluating the impact of weight status on symptom perception and QoL in PCOS women with different background	NIH	Brazilian: 25.5±3.9; Austrian: 23.8±4.7	PCOSQ	50 control, 50 PCOS	In Brazilian women, hirsutism and in Austria obesity had the greatest impact on QoL
Guyatt et al;^Citation22 Canada	Cross-sectional	Measuring the psychometric properties of the PCOSQ	NIH	29.4±5.7	PCOSQ	393	Factor analysis provided moderate to strong support for the 5-domain structure of the PCOSQ
Schmid et al;^Citation24 Austria	Cross-sectional	Study of infertile PCOS patients QoL with different ethnic and cultural backgrounds	Not stated	18–39	PCOSQ	14 Muslim, 35 Austrian PCOS	HRQoL of women with an Islamic background was affected to a greater degree than that of Austrian women
Jones et al;^Citation23 UK	Cross-sectional	Measuring the psychometric properties of the PCOSQ	NIH	–	PCOSQ, SF-36	92	The PCOSQ is a reliable instrument for measuring the HRQoL
Van Wely et al;^Citation68 the Netherlands	Interventional	Evaluating the impact of laparoscopic electrocautery of the ovaries versus recombinant FSH on the PCOS patients’ HRQoL	Rotterdam	Electrocautery: 28.5±3.7; FSH: 28.7±4.1	SF-36	Electrocautery: 83, FSH: 85	HRQoL was not affected in both groups. FSH treatment was slightly more burdensome for women’s HRQoL than electrocautery
Clayton et al;^Citation69 UK	Interventional	Evaluation the effect of laser on the severity of facial hirsutism and on psychological complications in PCOS women	Not stated	PCOS: 33.0±8.0; control: 32±6.5	WHOQOL-BREF	37 control, 51 intervention	Laser treatment reduced the severity of facial hair as well as alleviating depression and anxiety in patients
McCook et al;^Citation27 USA	Cross-sectional	Evaluating the influence of the major clinical features of PCOS on patients’ QoL	Not stated	20–41	PCOSQ	128	The most common HRQoL concern reported by women with PCOS was weight. BMI and fertility loss had the greater impact on QoL
Trent et al;^Citation53 USA	Cross-sectional	Assessing the BMI impact on the QoL of adolescents with PCOS	NIH	13–22	CHQ-CF87	146 control, 97 PCOS	BMI is a primary mediator in the relationship between PCOS and HRQoL reductions
Hahn et al;^Citation47 Germany	Case–control	Examining the extent of different PCOS manifestations on QoL, psychosocial well- being, and sexual satisfaction	NIH	PCOS: 29.0±5.4; control: 30.0±5.7	SF-36, SCL-90-R	120 control, 50 PCOS	PCOS patients showed significant reductions in QoL, psychosocial well-being, and sexual satisfaction
Elsenbruch et al;^Citation40 Germany	Cross-sectional	Evaluation of psychological stress in untreated PCOS patients and to assess the impact of emotional distress on QoL	NIH	31.3±1.3	SF-36, SCL-90-R	143	Majority of patients exhibited psychological disturbances. Emotional distress together with obesity leads to large decrements in QoL
Lipton et al;^Citation70 UK	Cross-sectional	Assessing the behavioral and psychological burden of facial hair in PCOS women	Not stated	33.0±7.4	WHOQOL-BREF	88	Facial hair carries a high psychological burden for women. 29% of patients reported depression and anxiety
Coffey et al;^Citation25 UK	Case–control	Comparing the QoL in women with PCOS with the general population and patients with other medical conditions	AES	PCOS: 27.5; control: 28.8	SF-36, PCOSQ	22 control, 96 PCOS	PCOS had a negative impact on HRQoL even when compared with other medical conditions (asthma, epilepsy, diabetes, arthritis, and coronary heart disease)
Hahn et al;^Citation39 Germany	Interventional	Evaluation the effects of metformin treatment on HRQoL, emotional well-being, and sexuality in PCOS women	NIH Rotterdam	29.3±6.3	SF-36, SCL-90-R	327	Treatment improved the psychosocial, emotional, and psychosexual situation of PCOS patients
Barnard et al;^Citation33 UK	Cross-sectional	Assessing the quality of life of women with PCOS, studying the factor analysis and adding acne factor	Rotterdam	31.0±6.5	MPCOSQ	935 control, 424 PCOS	The PCOSQ was modified to include acne. The PCOS groups had significantly worse QoL than controls
Drosdzol et al;^Citation60 the Netherlands	Case–control	To evaluate the effect of PCOS on QoL and marital sexual satisfaction	Rotterdam	19–40	SF-36	40 control, 50 PCOS	PCOS decreased QoL and sexual functioning among women. A negative effect of hirsutism severity on general well- being and sexual life was also observed
Ching et al;^Citation26 Australia	Case–control	Evaluation of QoL and psychological complications in PCOS women, compared the findings with general norms	NIH	PCOS: 15–65; control 18–44	SF-36, PCOSQ, GHQ-28	173 control, 203 PCOS	Impaired QoL and increased prevalence of psychological morbidity in PCOS compared with population norms were obtained
Tan et al;^Citation48 Germany	Cross-sectional	Assessing the impact of infertility on various aspects of psychological function in PCOS women	NIH	28.1±4.8	SF-36, SCL-90-R	115	PCOS obtained a major risk factor for psychosocial and emotional problems. Infertility was not a primary determinant of psychological problems
Rofey et al;^Citation41 USA	Interventional	Evaluating cognitive–behavioral therapy on psychological problems of PCOS adolescents	AES	12–18	SF-36	25	Depressive symptoms and weight decreased significantly
Harris-Glocker et al;^Citation71 USA	Interventional	Assessing the effect of treatment (metformin, lifestyle) on the QoL in obese PCOS adolescents	NIH	12–18	PCOSQ	36	QoL was improved in both groups (lifestyle and obsessive–compulsive disorder treatment)
Ladson et al;^Citation72 USA	Interventional	Assessing the effect of treatment (metformin, lifestyle) on the QoL of adolescents with PCOS	NIH	13–18	PCOSQ	28	QoL was significantly improved in both treatment groups
Moran et al;^Citation73 Australia	Case–control	Evaluating the psychological features in young girl with PCOS compared with healthy women	Rotterdam	18–25	PCOSQ	22 control, 24 PCOS	Worsened QoL in PCOS women
Thomson et al;^Citation34 Australia	Interventional	Assessing the effect of exercise and dietary restriction on depressive symptoms and HRQoL in obese women with PCOS	Rotterdam	29.3±0.7	PCOSQ	104	Dietary restriction, with/without exercise, had similar benefits for improving depression and HRQoL in obese women with PCOS
Ladson et al;^Citation74 USA	Interventional	Determining the effect of lifestyle changes (caloric restriction and exercise) on the QoL of PCOS women	NIH	29.0±4.5	PCOSQ	114	QoL was improved in emotion and weight areas within each treatment group
Bazarganipour et al;^Citation75 Iran	Cross-sectional	Assessing the prevalence of mood disorders and examine predictors for psychological well-being among Iranian PCOS women	Rotterdam	15–40	SF-36	300	32% of patients showed elevated anxiety and depression. QoL was very impaired in women with anxiety and depression
Bazarganipour et al;^Citation76 Iran	Cross-sectional	Evaluating the effect of different clinical symptoms of PCOS on patients HRQoL	Rotterdam	15–40	MPCOSQ	200	Worsened HRQoL in PCOS women was related to more menstrual problems and infertility than to obesity
Stener-Victorin et al;^Citation77 Sweden	Interventional	The effect of exercise and acupuncture on the QoL in PCOS women	Rotterdam	29.9±4.4	SF-36, PCOSQ	114	Anxiety and depression improved in women treated with acupuncture. HRQoL was improved in both groups
Bazarganipour et al;^Citation78 Iran	Cross-sectional	Determining the association between HRQoL and psychosexual variables in patients with PCOS	Rotterdam	15–40	MPCOSQ	300	The highest effect of PCOS symptoms on HRQoL was exerted by clinical variables, poor perception, negative body image, and sexual dysfunction
De Frène et al;^Citation79 Belgium	Cross-sectional	Investigating the relationship between PCOS symptoms with sexual and relational satisfaction in obese women and their partners	Rotterdam	18–43	PCOSQ	62	PCOS characteristics and its concerns were associated with the sexual and/or relational satisfaction of couples
McCook et al;^Citation28 USA	Cross-sectional	Investigating the relative contributions of PCOS manifestations to psychological symptoms	Rotterdam	18–48	PCOSQ	126	Patients were at a greater risk for depression, anxiety, and interpersonal sensitivity. Menstrual problems predicted every dimension of psychological distress
Benetti-Pinto et al;^Citation50 Brazil	Case–control	Assessing the sexual function and QoL in PCOS women	Rotterdam	PCOS: 26.9±4.9; control: 35.6±7.3	WHOQOL-BREF	102 control, 56 PCOS	PCOS women had a worse sexual function and worse QoL in the self-assessment of the health area. Obesity was correlated to the worsening in QoL
Guidi et al;^Citation80 Italy	Cross-sectional	Assessing the psychosocial effects of PCOS on adolescents	NIH	16–19	PCOSQ	394	Impaired well-being and QoL were found among young females with PCOS
Stefanaki et al;^Citation81 Greece	Interventional	The effect of mindfulness – stress program on mental status and QoL in PCOS women	Rotterdam	15–40	PCOSQ	73	Stress, anxiety, and depression levels decreased and QoL improved
Nasiri-Amiri et al;^Citation37 Iran	Mixed methods	Designing HRQoL measurement tool in Iranian women with PCOS	Rotterdam	18–40	PCOSQ-50	200 PCOS, 23 interviews	The PCOSQ-50 was a valid and reliable instrument for the assessment of QoL of women with PCOS
Shishehgar et al;^Citation42 Iran	Case–control	Comparing the effects of obesity on the HRQoL between women with PCOS and controls	AES	PCOS: 28.6±4.9; control: 29.0±5.8	SF-36	140 control, 142 PCOS	The physical aspects of HRQoL were adversely affected by obesity in both groups, but these impaired effects were greater in PCOS group
Huang-TzOu et al;^Citation82 Taiwan	Interventional	Effect of metformin on the QoL of women with PCOS	Rotterdam	18–45	WHOQOL-BREF, PCOSQ	109	Metformin improved HRQoL of PCOS women especially in overweight patients
Dokras et al;^Citation83 USA	Interventional	Evaluation of the effect of weight loss on mood disorders and QoL in obese women with PCOS	Rotterdam	18–40	SF-36, PCOSQ	149	Weight loss result in significant improvements in several physical and mental domains related to QoL
Ozcan Dag et al;^Citation84 Turkey	Case–control	Assessment of temperament and QoL in PCOS patients	Rotterdam	PCOS: 22.6±4.5; control: 21.3±2.1	SF-36	38 control, 53 PCOS	PCOS patients had significantly higher rates of depressive and anxious compared with controls. QoL was significantly lower in patients
Panico et al;^Citation44 Italy	Case–control	Comparing the QoL in obese and normal weight women with PCOS	Rotterdam	Controls: 16.4–31; PCOS: 17.2–29	SF-36, PCOSQ, SCL-90-R	80 control, 100 PCOS	Worsening of HRQoL in PCOS patients compared with controls

Abbreviations: AES, Androgen Excess Society; BMI, body mass index; CHQ-CF87, Child Health Questionnaire-Child Form; FSH, follicle-stimulating hormone; GHQ-28, General Health Questionnaire-28; HRQoL, health-related quality of life; MPCOSQ, Modified PCOSQ; NIH, National Institutes of Health; PCOS, polycystic ovary syndrome; PCOSQ, Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire; PCOSQ-50, Polycystic Ovary Syndrome Questionnaire; QoL, quality of life; SCL-90-R, Symptom Checklist-90-Revised; SF-36, 36-Item Short Form Health Survey; WHOQOL-BREF, World Health Organization Quality-of-Life-BREF.

Table 2 Different components of quality of life in PCOS women

Dimensions	Studies
Psychological and emotional	McCook et al,^Citation27 Coffey et al,^Citation25 Elsenbruch et al,^Citation40 Jedel et al,^Citation85 Teede et al,^Citation3 Månsson et al,^Citation86 McCook et al,^Citation28 Podfigurna-Stopa et al,^Citation62 Weiss and Bulmer,^Citation16 Bazarganipour et al,^Citation75 Nasiri Amiri et al,^Citation87 and Taghavi et al^Citation19
Body image	Trent et al,^Citation66 Ekbäck et al,^Citation14 Bazarganipour et al,^Citation75 and Taghavi et al^Citation19
Social	Trent et al,^Citation66 Jones et al,^Citation23 Schmid et al,^Citation24 Ekbäck et al,^Citation14 Moran et al,^Citation73 Bazarganipour et al,^Citation75 Taghavi et al,^Citation19 and Weiss and Bulmer^Citation16
Sexual	Elsenbruch et al,^Citation30 Trent et al,^Citation66 Tan et al,^Citation48 Månsson et al,^Citation86 Benetti-Pinto et al,^Citation50 and Taghavi et al^Citation19
Physical
Weight	Barnard et al,^Citation33 Hahn et al,^Citation43 Elsenbruch et al,^Citation30 Kaczmarek et al,^Citation32 Trent et al,^Citation53 Benetti-Pinto et al,^Citation50 and Shishehgar et al^Citation42
Hirsutism and acne	Elsenbruch et al,^Citation30 Ekbäck et al,^Citation14 and Khomami et al^Citation29
Menstrual problem	Bazarganipour et al,^Citation36 Bazarganipour et al,^Citation75 McCook et al,^Citation27 and McCook et al^Citation28
Infertility	Schmid et al,^Citation24 Elsenbruch et al,^Citation30 Hahn et al,^Citation43 Bazarganipour et al,^Citation75 Nasiri Amiri et al,^Citation61 and Khomami et al^Citation29
Medical	Van Wely et al,^Citation68 Hahn et al,^Citation39 Trent et al,^Citation53 Hahn et al,^Citation39 Thomson et al,^Citation34 Harris-Glocker et al,^Citation71 Dokras et al,^Citation83 Stefanaki et al,^Citation81 and Rofey et al^Citation41

Abbreviation: PCOS, polycystic ovary syndrome.

Table 3 Most general and specific instruments for assessing HRQoL in women with PCOS

Instruments	No of items	Dimensions covered	Studies
General instruments
SF-36	36	Physical functioning, vitality/energy, physical role limitation, bodily pain, mental health, emotional role limitation, general health perception, and social functioning	Elsenbruch et al,^Citation30 Jones et al,^Citation23 Van Wely et al,^Citation68 Hahn et al,^Citation47 Hahn et al,^Citation39 Elsenbruch et al,^Citation40 Coffey et al,^Citation25 Drosdzol et al,^Citation60 Ching et al,^Citation26 Tan et al,^Citation48 Rofey et al,^Citation41 Bazarganipour et al,^Citation75 Stener-Victorin et al,^Citation77 Dokras et al,^Citation83 Shishehgar et al,^Citation42 Ozcan Dag et al,^Citation84 and Panico et al^Citation44
SCL-90-R	90	Somatization, obsessive–compulsive, interpersonal sensitivity, paranoid ideation, psychoticism, anxiety depression, phobia, and aggression	Elsenbruch et al,^Citation30 Hahn et al,^Citation47 Hahn et al,^Citation39 Elsenbruch et al,^Citation40 and Tan et al^Citation48
CHQ-CF87	87	Change in health in the last year, role/social emotional, behavioral, physical, bodily pain, behavior, mental health, self-esteem, general health perceptions, family activities, family cohesion, and physical functioning	Trent et al,^Citation52 Trent et al,^Citation66 and Trent et al^Citation53
WHOQOL-BREF	26	General health, physical health, psychological, health, Social relationship, and environmental	Clayton et al,^Citation69 Lipton et al,^Citation70 Benetti-Pinto et al,^Citation50 and Huang-TzOu et al^Citation82
GHQ-28	28	Somatic symptom, anxiety/insomnia, social dysfunction, and depression	Ching et al^Citation26
Specific instruments
PCOSQ	26	Emotion, hirsutism, infertility, weight, and menstrual problem	Cronin et al,^Citation21 Wong et al,^Citation65 Hashimoto et al,^Citation67 Guyatt et al,^Citation22 Jones et al,^Citation23 Schmid et al,^Citation24 McCook et al,^Citation27 Coffey et al,^Citation25 Ching et al,^Citation26 Rofey et al,^Citation41 Harris-Glocker et al,^Citation71 Moran et al,^Citation73 Thomson et al,^Citation34 Ladson et al,^Citation72 Stener-Victorin et al,^Citation77 De Frène et al,^Citation79 Stefanaki et al,^Citation81 McCook et al,^Citation28 Dokras et al,^Citation83 and Panico et al^Citation44
MPCOSQ	30	Emotion, hirsutism, infertility, weight, menstrual problem, and acne	Barnard et al,^Citation33 Bazarganipour et al,^Citation36 and Bazarganipour et al^Citation78
PCOSQ-50	50	Psychosocial and emotional, fertility, sexual, obesity, and menstrual disorders, hirsutism, and coping	Nasiri-Amiri et al^Citation37

Abbreviations: CHQ-CF87, Child Health Questionnaire-Child Form; GHQ-28, General Health Questionnaire-28; HRQoL, health-related quality of life; MPCOSQ, Modified PCOSQ; PCOS, polycystic ovary syndrome; PCOSQ, Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire; PCOSQ-50, Polycystic Ovary Syndrome Questionnaire; SCL-90-R, Symptom Checklist-90-Revised; SF-36, 36-Item Short Form Health Survey; WHOQOL-BREF, World Health Organization Quality-of-Life-BREF.

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