The Influence of Polycystic Ovary Syndrome (PCOS) and Other Related Factors upon Health-Related Quality of Life in Women of Reproductive Age: A Case-Control Study

Figures & data

Figure 1. Flow diagram for the recruitment of women of reproductive age into the study group with polycystic ovary syndrome (PCOS) and the one without (control).

Table 1. Key sociodemographic characteristic of the study participants with polycystic ovary syndrome (PCOS) and without (control).

Variable	Total (n = 130)	PCOS (n = 64)	Control (n = 66)
Age range (years)	19–45	21–45	19–45
Ethnicity
White	108 (83.1%)	57 (89.1%)	51 (77.3%)
Asian or Asian British	13 (10%)	2 (3.1%)	11 (16.6%)
Black or Black British	3 (2.3%)	–	3 (4.5%)
Chinese	1 (0.8%)	1 (1.6%)	–
Gypsy or Traveler	1 (0.8%)	1 (1.6%)	–
Other mixed background	3 (2.3%)	3 (4.7%)	–
Declined to specify	1 (0.8%)	–	1 (1.5%)
Marital Status
Single	52 (40%)	23 (35.9%)	29 (43.9%)
Married	52 (40%)	22 (34.4%)	30 (45.5%)
Divorced	6 (4.6%)	5 (7.8%)	1 (1.5%)
Widowed	1 (0.8%)	1 (1.6%)	–
Civil partnership	3 (2.3%)	1 (1.6%)	2 (3.0%)
Other	16 (12.3%)	12 (18.8%)	4 (6.1%)
Children
Yes	38 (29.2%)	14 (21.9%)	24 (36.4%)
No	92 (70.8%)	50 (78.1%)	42 (63.6%)
Occupation
Full-time employed	63 (48.5%)	34 (53.1%)	29 (43.9%)
Part-time-employed	16 (12.3%)	10 (15.6%)	6 (9.1%)
Student	35 (26.9%)	10 (15.6%)	25 (37.9%)
House person	5 (3.8%)	5 (7.8%)	–
Unemployed	2 (1.5%)	1 (1.6%)	1 (1.5%)
Other	9 (6.9%)	4 (6.3%)	5 (7.6%)
Education
Secondary	6 (4.6%)	6 (9.4%)	–
College	28 (21.5%)	15 (23.4%)	13 (19.7%)
Undergraduate	50 (38.5%)	26 (40.6%)	24 (36.4%)
Postgraduate	32 (24.6%)	14 (21.9%)	18 (27.3%)
Doctorate	14 (10.8%)	3 (4.7%)	11 (16.7%)
Household Income
≤ £39,999	77 (59.2%)	43 (67.3%)	34 (51.5%)
£40,000–£79,999	42 (32.3%)	16 (25%)	26 (39.4%)
≥ £80,000	11 (8.4%)	5 (7.8%)	6 (9.1%)

Note: All percentage data rounded to one decimal place.

Table 2. Comparison of self-reported variables between women with polycystic ovary syndrome (PCOS) and the control group.

	Total (n = 130)	PCOS (n = 64)	Control (n = 66)	Missing PCOS/CON	Median or mean diff	95% CI for MD		Cohen’s d	p value
						Lower	Upper
Age (years)	31 (11.25)	30 (9.75)	32 (13.50)	0/0	−2.00	−4.00	1.00	−0.192	0.297
Height (cm)	165.1 (10.00)	165.1 (8.06)	164.5 (9.25)	0/0	0.60	−1.40	2.80	0.107	0.349
Weight (kg)	65.16 (38.27)	91.30 (45.31)	63.00 (18.30)	0/0	28.30	12.77	33.00	1.121	<0.001
BMI (kg/m^2)	24.51 (13.29)	32.91 (16.60)	23.28 (5.25)	0/0	9.63	4.65	11.59	1.129	<0.001
WC (cm)	81.28 (31.60)	101.60 (40.62)	74.00 (16.66)	11/8	27.60	15.24	32.50	1.315	<0.001
Self-esteem scale^▲	16.86 (5.68)	14.00 (5.21)	19.34 (5.20)	5/1	−5.32	−7.18	−3.47	−1.020	<0.001
Self-efficacy/exercise^▲	42.40 (17.77)	40.44 (21.35)	43.64 (15.95)	2/0	−3.20	−9.83	3.43	−0.170	0.341
SF12v2
Physical functioning	56.5 (8.59)	56.5 (5.59)	56.5 (0.00)	5/2	0.00	−0.00	−0.00	−0.606	.001
Role physical	57.2 (13.80)	48.0 (18.40)	57.2 (9.21)	5/2	−4.61	−9.21	−0.00	−0.710	<.001
Bodily pain	57.4 (10.20)	47.3 (20.40)	57.4 (10.20)	5/2	−10.19	−10.19	−0.00	−0.742	<.001
General health	44.7 (10.80)	44.7 (15.10)	55.5 (10.80)	5/2	−10.78	−10.78	−0.00	−0.768	<.001
Vitality	47.7 (10.10)	37.7 (20.10)	47.7 (12.60)	5/2	−10.06	−10.06	−10.06	−0.955	<.001
Social functioning	46.5 (20.20)	36.4 (10.10)	46.5 (10.10)	5/2	−10.10	−10.10	−10.09	−0.946	<.001
Role emotional	44.9 (19.60)	33.7 (16.80)	50.5 (16.80)	5/2	−11.18	−16.77	−5.59	−0.934	<.001
Mental health	40.2 (12.20)	34.1 (12.20)	46.3 (12.20)	5/2	−12.19	−12.19	−6.10	−1.082	<.001
SF-12 physical	55.6 (11.00)	53.3 (12.40)	57.0 (7.19)	5/2	−3.51	−6.29	−0.83	−1.159	<.001
SF-12 mental^▲	37.8 (11.20)	31.9 (10.70)	43.2 (8.76)	5/	−11.28	−14.79	−7.77	−1.155	<.001
IPAQ-LF
MET-min/wk	3478.5 (3257.9)	3447.0 (3648.0)	3010.5 (3295.5)	5/5	436.50	−385.00	1278.00	0.158	0.280
Sitting-min/wk	2370.0 (1515.0)	2460.0 (1665.0)	2340.0 (1830.0)	1/0	120.00	−300.00	540.00	0.060	0.603
EBBS
Benefits	88.50 (18.00)	84.0 (14.75)	93.5 (17.0)	4/0	−9.50	−12.00	−4.00	−0.595	0.001
Barriers	39.00 (8.25)	38.0 (9.25)	41.5 (8.25)	4/0	−3.50	−6.00	−1.00	−0.482	0.003
Total^▲	128.85 (25.00)	122.78 (18.92)	133.47 (20.50)	4/0	−10.69	−16.59	−4.78	−0.639	0.001

Note: Unless otherwise indicated, data are presented as median (IQR) and Mann-Witney U tests performed; ^▲ Parametric data reported as mean (SD), and Welch’s t-test performed; CON: Control group; CI: confidence interval; MD: median/mean difference; BMI: body mass index; WC: waist circumference; HRQoL: health-related quality of life; IPAQ-LF: International Physical Activity Questionnaire Long Form; MET-min/wk: Metabolic equivalent of task minutes per week as measured by the IPAQ-LF; EBBS: Exercise Benefits/Barriers Scale; p value: significant values indicated by p ≤ 0.05.

Table 3. Domain-specific scores of the health-related quality-of-life questionnaire for women with polycystic ovary syndrome (PCOS-Q) reported from the study participants with PCOS.

PCOS-Q Domain	Median Score	Interquartile Range
Emotions	3.05	1.57
Body hair	2.60	3.30
Weight	1.90	2.75
Infertility	2.50	3.81
Menstrual problems	3.00	2.25

Figure 2. Schematic presentation of the path analysis model based on the findings of the present study. Bidirectional arrows are indicative of correlation between exogenous variables. Single directional arrows indicate significant standardized path coefficients and bias-corrected 95% confidence intervals for direct effects. A dashed arrow indicates nonsignificant direct effects. All values rounded to two decimal places (PCOS: diagnosed with polycystic ovary syndrome; BMI: body mass index (self-reported); HRQoL: health-related quality of life as measured by aggregate SF-12 score; MET-min/wk: metabolic equivalent of task minutes per week as measured by the IPAQ-LF).

Table 4. Direct, indirect, and total effects of variables in the Health-Related Quality of Life (HRQoL) causal model.

	Standardized Coefficient	95% CI for β		p value
		Lower	Upper
Direct Effects
PCOS → HRQoL	0.230	0.099	0.420	0.004
PCOS → Self-esteem^†	0.364	0.163	0.517	0.021
PCOS → SEE^†	−0.039	−0.220	0.116	0.517
PCOS → EBBS^†	0.225	−0.022	0.426	0.068
BMI → HRQoL	−0.234	−0.368	−0.076	0.007
BMI → Self-esteem^†	−0.213	−0.478	0.000	0.050
BMI → SEE^†	0.082	−0.134	0.233	0.460
BMI → EBBS^†	−0.180	−0.415	−0.009	0.038
Self-esteem → HRQoL	0.326	0.185	0.445	0.018
Self-esteem → MET-min/wk^†	−0.069	−0.252	0.162	0.612
SEE → MET-min/wk^†	0.224	−0.078	0.419	0.118
EBBS → MET-min/wk	0.260	−0.055	0.542	0.119
EBBS → HRQoL	0.254	0.124	0.391	0.010
EBBS → SEE^†	0.520	0.368	0.654	0.006
MET-min/wk → HRQoL^†	0.029	−0.113	0.164	0.740
Indirect Effects
PCOS → HRQoL	0.177	0.072	0.283	0.018
PCOS → MET-min/wk^†	0.051	−0.057	0.177	0.305
BMI → HRQoL	−0.116	−0.266	−0.018	0.023
BMI → MET-min/wk^†	−0.035	−0.154	0.059	0.519
Self-esteem → HRQoL	−0.002	−0.035	0.008	0.626
SEE → HRQoL^†	−0.006	−0.026	0.038	0.411
EBBS → MET-min/wk	0.117	−0.006	0.285	0.066
EBBS → HRQoL	0.011	−0.038	0.093	0.684
Total Effects
PCOS → HRQoL	0.407	0.255	0.571	0.011
BMI → HRQoL	−0.351	−0.507	−0.194	0.005
Self-esteem → HRQoL	0.324	0.196	0.446	0.012
EBBS → HRQoL	0.265	0.127	0.407	0.012
EBBS → MET-min/wk	0.376	0.130	0.586	0.015

PCOS: Diagnosed with polycystic ovary syndrome; BMI: Body Mass Index; HRQoL: Health-related Quality of Life as measured by total SF-12 score; SEE: self-efficacy for exercise; EBBS: Exercise Benefits/Barriers Scale; MET-min/wk: Metabolic equivalent of task minutes per week as measured by the International Physical Activity Questionnaire Long Form (IPAQ-LF); 95% CI: Bias corrected 95% confidence interval; → denotes causal direction of path.

^† Data reported are equal to Total Effects for path.

Table A1. Correlation matrix (Kendall’s τ_b) for self-reported variables for all study participants.

		Age	Weight	BMI	WC	SEE	Benefit	Barrier	EBBS	SES	SF12 Phys	SF12 Mental	SF12 Total	MET-min/wk	Sitting
Age	τ P
Weight	τ P	.062 .305
BMI	τ P	.039 .519	.804 < .001
WC	τ P	.040 .543	.685 < .001	.652 < .001
SEE	τ P	.031 .609	−.036 .546	−.078 .196	−.069 .294
Benefit	τ P	.148 .017	−.125 .041	−.169 .006	−.218 <.001	.305 < .001
Barrier	τ P	.053 .400	−.097 .115	−.141 .022	−.176 .008	.319 < .001	.411 < .001
EBBS	τ P	.131 .034	−.140 .022	−.188 .002	−.244 < .001	.340 < .001	.819 < .001	.611 < .001
SES	τ P	.094 .137	−.271 <.001	−.211 <.001	−.326 <.001	.095 .130	.234 < .001	.229 < .001	.270 < .001
SF12 Phys	τ P	.084 .196	−.288 <.001	−.305 <.001	−.342 <.001	.063 .331	.338 < .001	.236 < .001	.347 < .001	.299 < .001
SF12 Mental	τ P	.119 .062	−.288 <.001	−.252 < .001	−.352 < .001	.112 .077	.267 < .001	.308 < .001	.313 < .001	.535 < .001	.543 < .001
SF12 Total	τ P	.103 .102	−.297 < .001	−.280 < .001	−.365 < .001	.083 .184	.303 < .001	.305 < .001	.339 < .001	.463 < .001	.737 < .001	.844 < .001
MET-min/wk	τ P	.060 .338	.163 .008	.139 .025	.137 .041	.212 < .001	.155 .014	.152 .018	.175 .006	.058 .369	.057 .395	.015 .815	.037 .573
Sitting	τ P	−.095 .118	.006 .924	−.019 .749	.028 .668	−.167 .006	.009 .879	−.051 .406	−.015 .800	−.042 .498	.000 .996	−.039 .534	−.020 .748	−.161 .010

BMI: body mass index; WC: waist circumference; MET-min/wk: metabolic equivalent of task minutes per week as measured by the International Physical Activity Questionnaire Long Form; SES: self-esteem scale; EBBS: Exercise Benefits/Barriers Scale; SEE: self-efficacy for exercise; SF12: 12-item short form health survey.

Table A2. Highest and lowest scoring items from the Exercise Benefits/Barriers Scale separated by study group (women with PCOS vs. women without PCOS [control] group).

	PCOS Group (n = 64)	Control Group (n = 66)
Number	Top three benefits
1.	Exercising increases my level of physical fitness	Exercising increases my level of physical fitness
2.	Exercise improves my flexibility	Exercising increases my level of physical fitness
3.	Exercising improves functioning of my cardiovascular system	Exercise gives me a sense of personal accomplishment
	Bottom three benefits
27.	Exercising is a good way for me to meet new people	Exercising lets me have contact with friends and persons I enjoy
28.	Exercise is good entertainment for me	Exercising is a good way for me to meet new people
29.	Exercising lets me have contact with friends and persons I enjoy	Exercising increases my acceptance by others
	Top three barriers
1.	Exercise tires me	Exercise tires me
2.	Exercise is hard work for me	Exercise is hard work for me
3.	I am fatigued by exercise	I am fatigued by exercise / exercising takes too much of my time
	Bottom three barriers
12.	There are too few places for me to exercise	My spouse (or significant other) does not encourage exercising
13.	Places for me to exercise are too far away	I am too embarrassed to exercise
14.	I think people in exercise clothes look funny	I think people in exercise clothes look funny

Data Availability Statement

The data that support the findings of this study are available from the corresponding author [CK] upon reasonable request.