Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age worldwide, characterized by hormonal imbalance, irregular menstrual cycles, polycystic ovaries, and metabolic complications. Affecting an estimated 6% to 20% of women globally, PCOS has significant implications not only for reproductive health but also for long-term metabolic and psychological well-being. Despite its high prevalence, awareness and understanding of PCOS remain alarmingly low, particularly among young women, leading to delayed diagnosis, inadequate management, and worsening of symptoms over time [1-3].

In India, the burden of PCOS is rising sharply, fueled by changing dietary habits, sedentary lifestyles, increased stress levels, and genetic predispositions., Yet, social stigma, misinformation, and lack of open discussions about menstrual and hormonal health continue to hinder early detection and treatment. Young women, particularly in rural and semi-urban regions like Himachal Pradesh are often unaware of the early signs of PCOS—such as acne, excessive hair growth, weight gain, and emotional disturbances—mistaking them as normal variations or cosmetic concerns rather than indicators of a chronic health condition. Consequently, many endure physical and psychological distress without appropriate medical intervention [4-6].

Timely lifestyle interventions, including dietary modifications, regular physical activity, and stress management, have been shown to significantly alleviate PCOS symptoms and improve quality of life. However, without adequate awareness, young women are less likely to adopt preventive strategies or seek early medical help, resulting in complications such as infertility, type 2 diabetes, cardiovascular disease, and mental health disorders later in life. Moreover, gaps in healthcare provider awareness and societal misconceptions further contribute to underdiagnosis and inadequate management of the syndrome [7-9].

This study aims to assess the level of awareness regarding Polycystic Ovary Syndrome among young women in Himachal Pradesh, focusing on their understanding of hormonal imbalances, symptom recognition, and the importance of lifestyle interventions. By identifying knowledge gaps and misconceptions, the research seeks to inform targeted health education initiatives and promote early, proactive management of PCOS to improve long-term health outcomes for young women.

Study Design

A descriptive, cross-sectional, online survey-based study was conducted to assess the level of awareness, knowledge, and perceptions regarding Polycystic Ovary Syndrome (PCOS) among young women in Himachal Pradesh. The design was chosen to capture diverse insights efficiently across rural, semi-urban, and urban areas.

Study Area and Population

The study targeted young women aged 18 to 30 years residing in various districts of Himachal Pradesh. Participants included students, working professionals, and homemakers who were able to understand Hindi or English and had access to internet-enabled devices (smartphones, tablets, laptops).

Study Duration

Data collection was carried out over a three-month period, from January to March 2025.

Sample Size and Sampling Technique

Assuming a 50% awareness rate regarding PCOS (in the absence of extensive prior data for the region), a confidence level of 95%, and a 5% margin of error, the minimum required sample size was calculated as 384 participants. To accommodate potential incomplete responses, the final sample size was expanded to 420.

A convenience sampling technique was employed. The online survey link was distributed through social media platforms (WhatsApp, Instagram, Facebook), university mailing lists, women's health groups, and collaborations with local educational institutions.

Inclusion and Exclusion Criteria

Inclusion Criteria

• Females aged 18–30 years

• Residents of Himachal Pradesh for at least one year

• Able to understand and respond in Hindi or English

• Voluntarily provided informed electronic consent

Exclusion Criteria

• Women formally diagnosed with PCOS (to focus on general public awareness rather than patient experiences)

• Incomplete or duplicate responses

Data Collection Instrument

A structured, pre-validated, bilingual questionnaire (Hindi and English) was designed using Google Forms. The questionnaire was divided into four sections:

• Socio-Demographic Information: Age, education level, occupation, residence type (urban/rural/semi-urban)

• Knowledge and Awareness about PCOS: Understanding of symptoms, risk factors, hormonal imbalance, and lifestyle modifications

• Perceptions and Misconceptions: Beliefs about PCOS causes, treatments, and societal myths

• Sources of Information and Health-Seeking Behavior: Primary sources of PCOS-related information and attitudes toward consulting healthcare professionals

The questionnaire was pilot-tested among 30 participants (excluded from the main study) to assess clarity, reliability, and cultural relevance. Necessary modifications were incorporated based on the pilot results.

Data Collection Procedure

Participants accessed an introductory page that explained the study objectives, voluntary nature of participation, confidentiality assurances, and informed consent requirements. Only after providing consent were participants allowed to proceed to the survey. Each participant could submit only one response, and personal identifiers were not collected to maintain anonymity.

Scoring and Categorization

Each knowledge-based question was awarded:

• 1 point for a correct response

• 0 points for an incorrect or “Don't Know” response

Cumulative knowledge scores were classified into four categories:

• Very Good Awareness: ≥80% correct answers.

• Good Awareness: 60–79% correct answers.

• Fair Awareness: 40–59% correct answers.

• Poor Awareness: <40% correct answers.

Separate domain-specific scores were calculated for symptom recognition, hormonal understanding, and lifestyle intervention knowledge.

Data Analysis

Data from Google Forms were exported into Microsoft Excel and analyzed using IBM SPSS Statistics Version 26.0. Descriptive statistics (frequencies, percentages, means, and standard deviations) summarized demographic details and awareness levels. 

Ethical Considerations

The study was conducted following the ethical principles outlined in the Declaration of Helsinki. Participation was voluntary, and informed electronic consent was obtained from all participants. Confidentiality and anonymity were rigorously maintained, and participants were assured that their responses would be used solely for research purposes without any implications on their access to healthcare or academic standing.

The socio-demographic profile of the 420 young women surveyed in Himachal Pradesh showed a predominant representation of the 18–22 years age group (41.7%), followed by those aged 23–26 years (35.0%) and 27–30 years (23.3%). Educationally, nearly half of the participants (48.8%) were pursuing or had completed undergraduate degrees, while 31.4% had attained postgraduate education, and 19.8% had completed secondary schooling, reflecting a relatively high educational background among respondents. Regarding occupation, students constituted the largest group (50.0%), followed by homemakers (17.9%), self-employed women (16.0%), and those employed in the government or private sectors (16.2%). Residence distribution showed that 43.3% of the participants lived in urban areas, 38.8% in rural areas, and 17.9% in semi-urban localities, ensuring a balanced representation of the varied geographic and socio-economic landscapes of Himachal Pradesh (Table 1)

Table 1: socio-demographic characteristics of participants

The survey findings revealed an encouraging level of awareness regarding PCOS among young women. A high percentage (82.1%) correctly identified PCOS as an endocrine condition, and 85.0% recognized skipped menstrual periods as a key manifestation. Acne (76.9%) and unexplained weight gain (75.2%) were widely acknowledged as clinical features of PCOS, while 72.6% understood its association with insulin resistance. Lifestyle modifications were recognized as effective management strategies by 83.1% of respondents, and 86.2% agreed that specialist consultation is essential for diagnosis. However, knowledge gaps persisted; for example, only 64.8% knew that ovarian cysts are not mandatory for diagnosis, and awareness of the link between PCOS and heart disease was relatively lower (62.1%). Encouragingly, 84.8% identified healthcare professionals as the most reliable source of PCOS information, and 82.4% believed that early intervention could improve long-term outcomes. Nevertheless, misconceptions about PCOS being fully reversible (63.1%) and occasional confusion regarding less common symptoms highlighted areas needing targeted educational efforts (Table 2).

Table 2: awareness and knowledge of polycystic ovary syndrome (pcos) among participants

Knowledge score analysis revealed that almost half of the participants (49.0%) demonstrated a "Good" level of awareness, answering 60%–79% of the knowledge questions correctly. Meanwhile, 25.7% achieved "Very Good" awareness with 80% or more correct responses, indicating a promising level of understanding among a substantial portion of the young women surveyed. However, 18.6% of participants were categorized as having "Fair" knowledge (40%–59% correct answers), and 6.7% fell into the "Poor" category with less than 40% correct responses. These findings suggest that although general PCOS awareness is improving among young women in Himachal Pradesh, considerable knowledge gaps persist among nearly one-quarter of participants, emphasizing the urgent need for more comprehensive, accessible, and youth-focused reproductive health education initiatives (Table 3).

Table 3: knowledge score classification

This study offers important insights into the awareness and understanding of Polycystic Ovary Syndrome (PCOS) among young women in Himachal Pradesh, highlighting both encouraging trends and areas of significant concern. PCOS, being a complex endocrine disorder with wide-ranging reproductive, metabolic, and psychological consequences, necessitates early detection, effective lifestyle management, and informed healthcare engagement. Yet, despite its growing prevalence, public awareness remains inconsistent, and misconceptions persist—findings that this research underscores.

The socio-demographic profile of participants reveals a young, relatively well-educated sample, with almost half of the respondents holding undergraduate degrees and a sizeable proportion actively engaged in higher education. Notably, 50% of participants were students, suggesting that educational institutions present a valuable platform for targeted health interventions. However, even among this educated group, knowledge about PCOS varied considerably, demonstrating that formal education alone does not guarantee reproductive health literacy. The balanced distribution of respondents across urban, rural, and semi-urban settings further strengthens the generalizability of the findings to the broader young female population of Himachal Pradesh.

Encouragingly, a substantial proportion of participants demonstrated awareness of core PCOS features. A majority correctly identified PCOS as an endocrine disorder (82.1%), recognized key clinical signs such as irregular menstruation (85.0%), acne (76.9%), and unexplained weight gain (75.2%), and acknowledged the role of lifestyle interventions (83.1%) in symptom management. The importance of consulting healthcare professionals for diagnosis was affirmed by 86.2% of respondents, while 84.8% recognized healthcare professionals as the primary reliable source of information. These results suggest that foundational awareness of PCOS is emerging among young women, an encouraging sign that public health messaging may be gaining traction, especially in more connected and educated segments of the population.

Nonetheless, critical knowledge gaps remain. For instance, only 64.8% of participants knew that ovarian cysts are not a mandatory diagnostic criterion for PCOS, reflecting a persistent misconception that could delay diagnosis or lead to underdiagnosis. Similarly, only 62.1% were aware of the increased cardiovascular risks associated with PCOS, despite the condition's strong links to long-term metabolic complications. Awareness of the emotional and mental health impacts was also moderate, with 71.7% recognizing PCOS's contribution to mood disorders. Such gaps emphasize the need for comprehensive education that addresses the full spectrum of PCOS manifestations—not merely its reproductive aspects.

Furthermore, misconceptions surrounding the reversibility of PCOS and its causes persist. Approximately 63.1% of participants incorrectly believed that PCOS could be fully reversed, indicating confusion between symptom management and disease eradication. Such misunderstanding may lead to unrealistic expectations and eventual frustration when lifestyle or medical interventions yield symptom control but not "cure." Moreover, the association of PCOS with supernatural causes was largely rejected (82.6%), suggesting progress in dispelling myths, but the persistence of such beliefs among a minority warrants continued attention to culturally sensitive health communication strategies.

Knowledge score classification paints a nuanced picture. While 74.7% of participants exhibited "Good" or "Very Good" awareness, around 25.3% demonstrated only "Fair" or "Poor" understanding—meaning that one in four young women remains at risk of misinformation and delayed healthcare-seeking behavior. This vulnerable group likely includes individuals from lower educational backgrounds, rural areas, or less connected social networks, emphasizing the urgent need for targeted outreach initiatives beyond digital platforms alone.

The findings of this study hold significant implications for public health practice in Himachal Pradesh and similar contexts. Health promotion programs must move beyond mere awareness-raising to focus on deep, nuanced education about PCOS’s varied symptoms, metabolic risks, mental health associations, and the critical importance of sustained lifestyle modifications. School and university-based reproductive health modules, community workshops, and digital awareness campaigns, tailored in local languages and culturally sensitive formats, could bridge current gaps. Additionally, involving healthcare professionals more actively in public education—through workshops, counseling sessions, and routine screening—can enhance early diagnosis and management outcomes.

However, this study also has limitations that warrant consideration. The use of an online survey method may have introduced a digital access bias, potentially underrepresenting young women from remote, economically disadvantaged communities where PCOS awareness might be even lower. Furthermore, self-reported data is inherently susceptible to social desirability bias, potentially leading to slight overestimations of knowledge levels. Future research incorporating a mixed-method approach with both quantitative surveys and qualitative interviews could provide a deeper understanding of attitudes, barriers, and lived experiences surrounding PCOS.

In summary, while this study highlights promising levels of emerging awareness about PCOS among young women in Himachal Pradesh, it also reveals enduring misconceptions and significant educational gaps. Addressing these deficiencies through structured, accessible, and culturally sensitive health education initiatives is essential for empowering young women to recognize early symptoms, seek timely medical intervention, and proactively manage their long-term reproductive and metabolic health. Strengthening PCOS literacy today can lay the foundation for a healthier, more informed generation of women tomorrow.

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