Polycystic ovary syndrome is the most common gynaecological endocrinopathy, affecting 5-10% of women in the reproductive age world-wide. PCOS is associated with problems like menstrual irregularities, hirsutism, obesity, insulin resistance, acne and in later life it is associated with problems like infertility, diabetes mellitus, late menopause, dyslipidemia, cardiovascular diseases and uterine cancer. Awareness is necessary for early intervention and to minimize the immediate and chronic consequences of PCOS [1-3].

PCOS is on its rise due to lifestyle and environmental changes which occurs with modernization. Recent research has found that one in five Indian adolescents' girls have PCOS. Lack of knowledge considered to be the major factor leading to this phenomenon Awareness is necessary for early intervention, including behaviour modification, to minimize the immediate and chronic consequences of PCOS [4-6].

PCOS is being under evaluated and possibly under diagnosed in the adolescent population. The diverse manifestations of PCOS start at an early age when a girl is maturing into a young woman. The symptoms of PCOS can vary from woman to woman; therefore, a woman often does not realize she has the syndrome. Public information and awareness about the symptoms and the serious nature of the disorder are crucial to identifying women in need of treatment. In addition, for women to make informed decisions about their health management, the information upon which they base their decisions should be accurate, current, based on well-performed research studies and obtained from well-informed and well-trained physicians and other caregivers. In different parts of India, there have been many studies on PCOS but only a small number of them have been done in the state of Himachal Pradesh.

Objectives of the Study

To evaluate the awareness and knowledge regarding polycystic ovary syndrome among school going adolescent girls of Himachal Pradesh.

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study area: Whole state of Himachal Pradesh

• Study duration: Between October 2022 to December 2022

• Study population: All school going adolescent girls between 10-19 years of age who were studying in the Himachal Pradesh for 12 months or more

• Sample size: 400 school going adolescent girls assuming 50% have adequate knowledge regarding PCOS, 5% absolute error, 95% confidence level and 5% non response rate

• Study tool: A google form questionnaire consisting of questions regarding socio-demography, knowledge about PCOS was created. The questionnaire was initially pre-tested on a small number of school children to identify any difficulty in understanding by the respondents

• Description of Tool

• Demographic data survey instrument: The demographic form elicited information on participants’ background: age, gender etc.

• Questionnaire: The questionnaire contains 20 structured questions regarding knowledge about PCOShaving three options i.e., Yes, No and Don’t Know. The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero in each category. Scoring was done on the basis of marks as >80% (16-20) = very good, 60-79% (12-15) = Good, 41-59% (8-11) = Fair, <40% (< 8) = poor

• Validity of tool: By the experts in this field

• Data collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin in schools going girls of both rural and urban area of Himachal Pradesh till the 400 responses were collected

• Data analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage

• Ethical Considerations: Participants confidentiality and anonymity was maintained

Through a non-experimental descriptive survey, the current study sought to evaluate the knowledge about PCOS among school-age adolescent girls in Himachal Pradesh. The study included 400 School Going Adolescents Girls. The participants' average age was 15.2±5.4 years (Table 1).

Table 1: Knowledge Regarding PCOS among Study Participants

In the present study 24.5% (98) participants had very good knowledge (16-20 marks) towards Polycystic ovarian syndrome, 30.25% (121) had good knowledge (12-15 marks), 34.0 % (136) had fair knowledge (8-11 marks) and 11.25% (45) having poor knowledge (<8 marks) (Table 2).

Table 2: Knowledge Score Towards PCOS among Study Participants

PCOS is one of the major endocrine diseases of concern among women. According to the International Classification of Diseases (ICD), PCOS is a complex disease that manifests as infertility, hirsutism, obesity and menstrual disturbances such as oligomenorrhea, amenorrhea and anovulation. PCOS is associated with bilateral enlarged ovaries studded with atretic follicles and evidence of fluid-filled cysts as identified by ultrasound scanning [1].

A timely diagnosis of PCOS in symptomatic adolescent girls is important for the initiation of appropriate treatment and management initiatives. However, this can be achieved by spreading awareness through educational interventions and other measures such as educating the susceptible population regarding the symptoms, etiology, age of onset and PCOS-related health care services [2,3].

The World Health Organization (WHO) defines an adolescent as any person between 10 and 19 years. Due to the modern lifestyle, PCOS is commonly seen in the adolescent age group. The clinical manifestation of PCOS may be complete in adolescence but the diagnosis is challenging as some features of PCOS overlap with the transitional characteristics from puberty to adulthood.

The present study included the school going adolescent girls of Himachal Pradesh and the awareness among them was critically poor. This probably might be due to less exposure to society. This, in a long run, could have created stigma regarding the expression of their enthusiasm toward the physical and mental transformations occurring after menarche [4].

Diagnosis of PCOS in adolescence is a challenge because of overlapping symptoms of PCOS with normal pubertal changes in adolescents. Incidence of PCOS among adolescence has been increasing due to modern lifestyle. Early diagnosis is important to instill early lifestyle modifications which will prevent metabolic and reproductive complications. Health education and screening for PCOS need to be incorporated in School or community based adolescent health programs. An assessment of target groups by simple menstrual history could detect possible PCOS during early adolescence to facilitate appropriate early intervention. We also recommend open discussion on menstruation problems in adolescent groups should be encouraged in schools and aaganwadi centres. Health talk should be established between mother and daughter and break the hesitance to seek timely medical advice [5].

Educational programs to increase awareness of the disease should be made mandatory in curriculum. Screening of PCOS in schools/colleges/universities and all types of educational institutes and primary health care centers is extremely important. PCOS awareness workshops and support groups should be established on regional levels. Health professionals should be encouraged for educating patients and their family members for long-term consequences and also motivating them for regular follow-ups. National level public advertisements on television, radio, Internet, newspaper and magazines that are easily accessed and understood by individuals are required urgently. Young females should also be encouraged for regular physical exercises, participation in sports activities, avoiding sugar containing drinks and frequent fast food consumption, stress management through meditation and discussion with health care professionals about their reproductive health [6].

The present study observed that the current level of awareness on PCOS among the adolescents girls of Himachal Pradesh is still in low key and in the grey zone which could be overcome by extensive awareness programme. The present study emphasized the need to health education and awareness programmes to be incorporated in educational system improve to combat the low knowledge especially utilizing different sources, targeted approach to provide clear, appropriate and tangible information and preventive measures. Counseling for adolescents should be included in the curriculum which will provide awareness towards the disorder and lifestyle modification. There is a need for intensified efforts in early detection. Accurate diagnosis at a younger age may be a key to preventing many of the long-term health consequences associated with this syndrome.

Limitations of the Study

Due to the limited sample size and cross-sectional character of the current investigation, it was challenging to generalise the results. In addition, because the questionnaire was delivered online, it was impossible to verify that the participants did not look up the answers to the questions in online or printed dictionaries. If the participants did this, the data may be negatively skewed, giving erroneous information about the participants' degree of awareness regarding PCOS. Future studies should concentrate on qualitative investigations with a larger sample size, such as focus groups, to uncover obstacles to promoting appropriate knowledge around PCOS.

1. Upadhye, J.J. and C.A. Shembekar. “Awareness of PCOS (Polycystic Ovarian Syndrome) in Adolescent and Young Girls.” International Journal of Reproduction, Contraception, Obstetrics and Gynecology, vol. 6, no. 6, 2017, pp. 2297-2301.

2. Vaithy. K.A. et al. “Knowledge, Attitude and Awareness towards Polycystic Ovarian Syndrome among Women of South East Coastal Population of India.” IP Journal of Diagnostic Pathology and Oncology, vol. 5, no. 2, 2020, pp. 215-219.

3. Jena, S.K. et al. “Awareness and Opinion about Polycystic Ovarian Syndrome (PCOS) among Young Women: A Developing Country Perspective.” International Journal of Adolescent Medicine and Health, vol. 33, no. 3, 2021, pp. 123-126.

4. Jabeen, A. et al. “Polycystic Ovarian Syndrome: Prevalence, Predisposing Factors, and Awareness Among Adolescent and Young Girls of South India.” Cureus, vol. 14, no. 8, 2022.

5. Sasikala, R. et al. “A Study of Knowledge and Awareness on Polycystic Ovarian Syndrome among Nursing Students in a Tertiary Centre in South India.” The New Indian Journal of OBGYN, vol. 8, no. 1, 2021, pp. 121-125.

6. Sharma, M. et al. “Polycystic Ovary Syndrome among Indian Adolescent Girls - A Systematic Review and Metanalysis.” Nepal Journal of Epidemiology, vol. 11, no. 3, 2021, p. 1063.