Quality of Life, Psychosocial Well-Being, and Sexual Satisfaction in Women with Polycystic Ovary Syndrome

0021-972X/03/$15.00/0 Printed in U.S.A. The Journal of Clinical Endocrinology & Metabolism 88(12):5801–5807 Copyright © 2003 by The Endocrine Society doi: 10.1210/jc.2003-030562 Quality of Life, Psychosocial Well-Being, and Sexual Satisfaction in Women with Polycystic Ovary Syndrome SIGRID ELSENBRUCH, SUSANNE HAHN, DANIELA KOWALSKY, ALEXANDRA H. ÖFFNER, MANFRED SCHEDLOWSKI, KLAUS MANN, AND ONNO E. JANSSEN Department of Medical Psychology (S.E., M.S.) and Division of Endocrinology, Department of Medicine (S.H., D.K., K.M., O.E.J.), University of Essen, 45122 Essen, Germany; and Division of Angiology, Department of Medicine (A.H.Ö.), Hospital Schwabing, 80804 Munich, Germany Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by chronic anovulation and hyperandrogenism. PCOS is one of the leading causes of infertility and manifests with hirsutism, acne, and obesity. To investigate its impact on health-related quality of life and sexuality, 50 women with PCOS and 50 controls were evaluated with standardized questionnaires (36-item short-form health survey, symptom checklist revised, and life satisfaction questionnaire). The impact of hirsutism, obesity, and infertility was assessed using five-point rating scales, and sexual satisfaction was analyzed with visual analog scales. Patients showed greater psychological disturbances on the symptom checklist revised dimensions, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, aggression, and psychoticism, P OLYCYSTIC OVARY SYNDROME (PCOS) is a common endocrine disorder characterized by chronic anovulation and hyperandrogenism. The prevalence among women of reproductive age is at least 5% (1, 2). Its pathophysiology, most likely a combination of genetic disposition and environmental factors, is not completely understood (3, 4). PCOS is one of the leading causes of infertility and also characterized by hirsutism, cystic acne, seborrhea, hair loss, and obesity (5, 6). A significant proportion of patients with PCOS have been found to suffer from defective insulin secretion and insulin resistance, as documented in U.S. cohorts (5) and German cohorts (our unpublished data). Accordingly, patients with PCOS may be expected to have a higher morbidity and mortality from the sequelae of the metabolic syndrome (type 2 diabetes mellitus, obesity, hypertension, lipid disorders, atherosclerosis). However, although the existing data support an acceleration of the development of an adverse cardiovascular risk profile (7, 8) and even subclinical signs of atherosclerosis (9), it is unclear whether PCOS lowers the age of clinical presentation because a large retrospective study has shown no difference in mortality from cardiovascular events (10), and prospective studies with a sufficient sample size and follow-up have not been done (11). Many aspects of the disorder can very conceivably cause a significant amount of emotional stress (12). Changes in Abbreviations: BMI, Body mass index; FLZ, Fragebogen zur Lebenszufriedenheit (questionnaire on life satisfaction); GSI, Global Severity Index; HRQL, health-related quality of life; PCOS, polycystic ovary syndrome; PSDI, Positive Symptom Distress Index; PST, Positive Symptom Total; SCL-90-R, symptom checklist revised; SF-36, 36-item shortform health survey; VAS, visual analog scale. along with a lower degree of life satisfaction in the life satisfaction questionnaire scales health, self, and sex. Healthrelated quality of life measured with the 36-item short-form health survey revealed significantly decreased scores for physical role function, bodily pain, vitality, social function, emotional role function, and mental health in patients with PCOS. Although patients had the same partner status and frequency of sexual intercourse, they were significantly less satisfied with their sex life and found themselves less attractive. Most of the differences were not affected by correction for body weight. In conclusion, PCOS causes a major reduction in the quality of life and severely limits sexual satisfaction. (J Clin Endocrinol Metab 88: 5801–5807, 2003) appearance, irregular or absent menstrual periods, difficulties conceiving, and possibly disturbances in sexual attitudes and behavior can result in psychological distress and may also influence the feminine identity of patients with PCOS (13). Accumulating evidence on the long-term health risks associated with PCOS (e.g. diabetes mellitus) may also have a negative impact on psychosocial well-being. Indeed, the diagnosis of PCOS has been found to be associated with feelings of frustration and anxiety (14). In adolescents with PCOS, a negative impact on various aspects of health-related quality of life (HRQL), including limitations in physical functioning, general behavior, and family activities, has been found (15). In 1998 a self-administrated quality-of-life-questionnaire (PCOSQ) for women with PCOS was published by Cronin et al. (16), but results of its use have not been published. We now present an investigation of the impact of PCOS on psychosocial and emotional functioning, HRQL, and sexual satisfaction in a German patient sample compared with an age-matched healthy control sample. Subjects and Methods Subject recruitment Patients were recruited from the outpatient clinics of the Division of Endocrinology, Department of Medicine at the University of Essen, based on referrals from gynecologists in the surrounding area or patients attracted by the clinic’s home page. Based on the criteria derived from the 1990 National Institutes of Health conference (3), diagnosis of PCOS was established when either oligomenorrhea (cycles lasting longer than 35 d) or amenorrhea (absence of menstrual cycles in the past 6 months) and either clinical signs of hyperandrogenism [hirsutism with a Ferriman/Gallwey score of more than 7 (17) or obvious acne] or an elevated total testosterone (normal range ⬍ 2.0 nmol/liter) were found, and other 5801 5802 J Clin Endocrinol Metab, December 2003, 88(12):5801–5807 pituitary, adrenal, or ovarian diseases could be excluded. All recruited women were required to be otherwise healthy. Age-matched healthy controls were recruited from a health screening program for employees instituted at the University of Essen. Exclusion criteria for controls included any known medical condition or psychological disorder, irregular periods, or hormonal disturbances. This was verified by personal interview, physical examination, and measurement of hormone parameters including LH, FSH, estradiol, total testosterone, TSH, free T4, and cortisol. All hormone parameters were determined on an automated chemiluminescence assay system (Centaur, Bayer Vital, Fernwald, Germany) with an intraassay variation of less than 5% and an interassay variation of less than 8%. The study protocol was approved by the Ethics Committee of the University of Essen. All participants gave written informed consent before enterin (...truncated)