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Journal of Women & Aging
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/wjwa20
PCOS health-related quality-of-life and depressive
symptoms across the lifespan: Comparative study
Pamela J. Wright, Abbas S. Tavakoli & Cynthia F. Corbett
To cite this article: Pamela J. Wright, Abbas S. Tavakoli & Cynthia F. Corbett (2023): PCOS
health-related quality-of-life and depressive symptoms across the lifespan: Comparative study,
Journal of Women & Aging, DOI: 10.1080/08952841.2023.2230112
To link to this article: https://doi.org/10.1080/08952841.2023.2230112
© 2023 The Author(s). Published with
license by Taylor & Francis Group, LLC
Published online: 05 Jul 2023.
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PCOS health-related quality-of-life and depressive symptoms
across the lifespan: Comparative study
Pamela J. Wright , Abbas S. Tavakoli, and Cynthia F. Corbett
Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina,
Columbia, South Carolina, USA
ABSTRACT
The purpose of this cross-sectional study was to compare health-related
quality of life (HRQoL) and depressive symptoms among peri-postmeno-
pausal women with polycystic ovary syndrome (PCOS) aged 43 years rela-
tive to premenopausal women with PCOS aged 18–42 years. An online
survey link comprising questionnaires about demographics, HRQoL, and
depressive symptoms was posted onto two PCOS-specific Facebook
groups. Respondents (n¼1,042) were separated into two age cohorts:
women with PCOS aged 18–42 years (n¼935) and women with PCOS
aged 43 years (n¼107). Data from the online survey were analyzed using
descriptive statistics, Pearson correlations, and multiple regression via SAS.
Results were interpreted through the lens of life course theory. All demo-
graphic variables, except for the number of comorbidities, significantly dif-
fered between groups. HRQoL among older women with PCOS was
significantly better as compared to those aged 18–42 years. Results indi-
cated significant positive linear associations between the HRQoL psychoso-
cial/emotional subscale and other HRQoL subscales and a significant
negative association with age. The fertility and sexual function HRQoL sub-
scales were not significantly associated with the psychosocial/emotional
subscale among women aged 43 years. Women in both groups had mod-
erate depressive symptoms. Study findings demonstrate the need to tailor
PCOS management to women’s life stage. This knowledge can inform
future research about peri-postmenopausal women with PCOS and age-
appropriate and patient-centered healthcare, including requisite clinical
screenings (e.g., depressive symptoms) and lifestyle counseling across the
lifespan.
KEYWORDS
Chronic disease; depression;
life course perspective;
menopause; polycystic
ovary syndrome; quality-of-
life
Introduction
Polycystic ovary syndrome (PCOS) is a complex, heterogeneous collection of symptoms attributed
to hormonal dysregulation (Azziz, 2020). It is the most common cause of subfertility among
women, affecting 20% of women globally across all races and ethnicities (Engmann et al., 2017).
Annual costs for diagnosis and treatment of PCOS exceeded $8 billion in the US in 2020
(Riestenberg et al., 2022). Of women diagnosed with PCOS, approximately 50% have obesity, 70%
have dyslipidemia, and 80% have insulin resistance (Legro et al., 2013). These clinical features
CONTACT Pamela J. Wright wrightpamelaj@sc.edu Department of Biobehavioral Health and Nursing Science, College of
Nursing, University of South Carolina,1601 Greene Street, Columbia South Carolina 29208, USA.
ß2023 The Author(s). Published with license by Taylor & Francis Group, LLC
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://
creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the
original work is properly cited, and is not altered, transformed, or built upon in any way. The terms on which this article has been published
allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
JOURNAL OF WOMEN & AGING
https://doi.org/10.1080/08952841.2023.2230112
increase the risk for cardiometabolic diseases (Osibogun et al., 2020; Zhu et al., 2021) and repro-
ductive cancers (Azziz, 2020)by50% while negatively impacting health-related quality-of-life
(HRQoL) (Moghadam et al., 2018). In addition to these complications, PCOS is associated with
psychological morbidity, as women with PCOS are 3-8 times more likely than women without
PCOS to have depressive symptoms (Cooney et al., 2017) and seven times more likely to attempt
suicide (Månsson et al., 2008).
Historically, PCOS has been considered a controversial diagnosis given its varied symptom
profiles, the debate about diagnostic criteria, and gaps in clinical providers’knowledge (Soucie
et al., 2021; Teede et al., 2018). As such, healthcare professionals and researchers have increased
interest in PCOS within the last ten years. To date, most PCOS studies have only examined cardi-
ometabolic disturbances and health-related quality-of-life (HRQoL) among women of reproduct-
ive age (Sharma & Mahajan, 2021). However, PCOS is a chronic condition that transcends the
reproductive years and requires management across a woman’s lifespan. Older women with
PCOS continue to cope with multiple risk factors due to persistent hormonal dysregulation
and/or have developed one or more cardiometabolic comorbidities, even though fertility may no
longer be relevant.
PCOS-specific health-related quality of life (HRQoL)
HRQoL has been defined as the physical, psychological, and social domains of health, and is seen
as distinct areas that are influenced by a person’s experiences, beliefs, expectations, and percep-
tions (Testa & Simonson, 1996). Several generic instruments, such as the 36-Item Short-Form
(SF-36V
R) Survey (RAND, 2016), have been developed to measure HRQoL using patients’com-
monly reported health outcomes. Whereas generic HRQoL instruments can be used with most
any health condition, they lack specificity for certain health conditions such as PCOS.
In 1988, Cronin et al. (2007) created the first PCOS-specific HRQoL instrument by interview-
ing a clinical population of women with PCOS aged 18–45 years (n¼100) to identify issues asso-
ciated with PCOS. The final selection of questions was based on the authors’“clinical sensibility”
and factor analysis. The original polycystic ovary syndrome questionnaire (PCOSQ) has 26 items
placed in five domains: emotions (8 items), body hair (5 items), weight (5 items), infertility
(4 items), and menstrual problems (4 items). As knowledge advanced about PCOS and its effect
on HRQoL, researchers from the United Kingdom sought to validate the PCOSQ by determining
its factor structure. The PCOSQ was modified (MPCOSQ) by adding four additional questions
about acne and separating the domain of menstrual problems into two domains: menstrual symp-
toms and menstrual predictability (Barnard et al., 2007). However, the psychometrics of both the
PCOSQ and the MPCOSQ revealed poor face and content validity indices, with low alpha coeffi-
cients for the domains of menstrual problems (0.56) and emotions (0.60) (Malik-Aslam et al.,
2010). Thus, Nasiri-Amiri et al. (2016) conducted a mixed-method, sequential, exploratory design
to further define the components of PCOS-specific HRQoL, develop a more comprehensive
instrument to assess PCOS-specific HRQoL among Iranian women aged 18–40 years and assess
its psychometric properties. The new instrument, the PCOSQ-50, included 50 items in six
domains: psychosocial/emotional, fertility, sexual function, obesity/menstrual disorders, hirsutism,
and coping. A psychometric assessment of the PCOSQ-50 revealed a mean content validity index
and ratio of 0.92 and 0.91, respectively, a Cronbach’s alpha of 0.88, Spearman’s correlation coeffi-
cients of test–retest of 0.75, and an intra-class correlation coefficient for the subscales ranging
from 0.57 to 0.88 (Nasiri-Amiri et al., 2016). Stevanovic et al. (2019) found similar psychometric
properties for the PCOSQ-50 when using and assessing the instrument among a small sample of
Serbian women.
In 2018, Nasiri-Amiri and associates performed exploratory factor and confirmatory analyses
to further examine the factor structure of the PCOSQ-50. Based on results, 6 items were omitted,
2 P. J. WRIGHT ET AL.
and the coping domain was replaced with a body image domain. The revised version, the
PCOSQ-43, had a Cronbach’s alpha of 0.92 and an intra-class correlation coefficient that ranged
from 0.91 to 0.94. However, the acceptance and usability of this version is unknown. The
PCOSQ-26 and the PCOSQ-50 remain the more commonly applied PCOS-specific HRQoL
instruments. To date, further recommendations for all versions include additional application and
measurement among different cultural populations of women with PCOS and psychometric test-
ing based on use among larger samples of women with PCOS (Jones et al., 2008; Nasiri-Amiri
et al., 2016,2018; Stevanovic et al., 2019).
Life course theory
Life course theory served as a theoretical lens for this study. Life course theory is a multidimen-
sional framework of the interaction of biological, social, and environmental factors throughout a
woman’s life (Clayton, 2021) (see Figure 1).
The theory describes a sequence of age-differentiated events and roles embedded in a sociocul-
tural context that people enact over time (Mortimer & Shanahan, 2016). These sociocultural con-
texts include stages of life (e.g., parenthood, menopause), social conditions (e.g., age-related
norms), and relationships with other people (e.g., family, friends) during periods of human devel-
opment (childhood, adolescence, adulthood, etc).
Life course theory is guided by five general principles:
1. Lifespan development: human development and aging are lifelong processes, and health in
one stage of life can affect health later in life;
2. Agency: individuals have choice within the opportunities and constraints of social contexts,
i.e., the agency can be constrained by the context in which women with PCOS live;
3. Time and place: life course is shaped by historical time and place, which help determine pre-
dominant cultural beliefs;
4. Timing of life events and experiences: developmental antecedents and consequences across a
life trajectory vary according to timing (e.g., delayed pregnancy may cause fear, shame,
embarrassment, and feelings of failing as a woman) (Kitzinger & Willmott, 2002); and
5. Interdependence: lives are lived interdependently, which impacts interpersonal contexts
(Sanchez, 2014) i.e., social roles and relationships affect PCOS-specific HRQoL and well-
being across the lifespan.
Figure 1. Life course theory (Clayton, 2021).
JOURNAL OF WOMEN & AGING 3
Chronic health conditions impact human development and often alter the sociocultural context
for women as they navigate the life course. For example, for women with PCOS, social stigma
and lower self-esteem due to symptoms such as acne, excessive male-patterned hair growth, sub-
fertility, and miscarriages often negatively impact establishing or maintaining relationships
(Wright et al., 2020). Delayed parenthood, PCOS symptoms (e.g., pain), and the advent of other
chronic conditions may exacerbate psychosocial challenges and countervail women’s working life
or financial status.
As such, we hypothesize that HRQoL among peri-postmenopausal women with PCOS remains
compromised, and depressive symptoms remain common. The purpose of our cross-sectional
study was to compare HRQoL and depressive symptoms among peri-postmenopausal women
with PCOS aged 43 years relative to premenopausal women with PCOS aged 18–42 years.
Materials and methods
Study design and participants
Cross-sectional designs to implement survey research are used to explore and describe the preva-
lence of conditions, risk factors, and outcomes in a population (Setia, 2016; Wang & Cheng,
2020). In this study, we implemented a cross-sectional study to describe and compare the HRQoL
and depressive symptoms between two age cohorts of women with PCOS. After social media
recruitment, the total sample size was 935 women with PCOS aged 18–42 years and 107 women
with PCOS aged 43 years. The study participants were recruited from two PCOS-specific
Facebook groups. The inclusion criteria were women who self-reported a PCOS diagnosis. If eli-
gible, women were invited to complete an internet-based survey using Research Electronic Data
Capture (REDCap) to assess PCOS-specific HRQoL and depressive symptoms. The electronic link
led potential participants to a website that provided additional details about the study. The intro-
ductory description of the study allowed the women to make an informed decision about study
participation. Participants were informed that completing the survey would constitute implied
consent. The Completely Automated Public Turing test to tell Computers and Humans Apart
(CAPTCHA) was used to prevent and minimize false responses. Participants had the option to
enter a drawing to win one of twelve US $50 gift cards. In accordance with 45 CFR 46.104(d)(2)
and 45 CFR 46.111(a)(7), the University of South Carolina (UofSC) Institutional Review Board
provided an “exempt”status for the study (Pro00118636).
Facebook groups
The two PCOS-specific Facebook pages used to post the survey link were titled PCOS Support
Group (21,200 members) and PCOS Diet Support (18,000 members). Members of each Facebook
page were required to apply for membership, which helped to protect against robotic responses.
To gain the privilege of posting a research link, the principal investigator contacted the adminis-
trators of each group to explain the study and address any concerns. The administrators then
posted the survey link on the message board, thus allowing members to access the survey.
Measures
Demographics
The demographic questionnaire included age, race, geographic location, educational attainment,
number of children and comorbid conditions, and marital, employment, and insurance status.
4 P. J. WRIGHT ET AL.
PCOS-specific HRQoL
The PCOSQ-50 was used to measure HRQoL. Responses to all items are rated on a 5-point
Likert-type scale ranging from 0 ¼never (best condition) to 4 ¼always (worst condition). Each
domain results in a subscale score that is calculated as the sum of all answered items divided by
the number of answered items in that domain. The total PCOSQ-50 score is calculated as the
sum of all answered items divided by the number of answered items. Per the PCOSQ-50 scoring
guidelines, missing items are not included when calculating the domain subscale scores or the
total PCOSQ-50 score. Lower scores indicate a better HRQoL. Construct validity was reported at
0.92 and test–retest reliability was reported at 0.91 (Nasiri-Amiri et al., 2018).
Depressive symptoms
The Personal Health Questionnaire-8 (PHQ-8) was used to assess the presence and severity of
depressive symptoms women had experienced within the past 2 weeks. The PHQ-8 consists of
eight items with a 4-point rating ranging from 0 (not at all) to 3 (nearly every day). As a screen-
ing instrument, PHQ-8 scores suggest potential levels depression based on the number of depres-
sive symptoms: 5–9 mild, 10–19 moderate, and 20 major (Kroenke et al., 2009). Construct
validity was reported at 0.75 and internal reliability was reported at 0.81 (Kroenke et al., 2009).
Data collection and management
Study data were collected and managed using REDCap hosted at the University of South
Carolina. REDCap is a secure, web-based software platform designed to support data capture for
research studies, providing (1) an intuitive interface for validated data capture; (2) audit trails for
tracking data manipulation and export procedures; (3) automated export procedures for seamless
data downloads to common statistical packages; and (4) procedures for data integration and
interoperability with external sources (Harris et al., 2009,2019).
The data that support the findings of this study are available from the corresponding author
(PJW) upon reasonable request.
Data analyses
Based on a moderate to small effect size and alpha 0.05, a sample size of 100 was the goal for
each group. REDCap survey data were exported to SAS for Windows 9.4. (Cary, NC) (SASI,
2013), and then cleaned and analyzed. Descriptive statistics were computed on the variables. For
categorical variables, the univariate construction included frequency distribution. For continuous
variables, statistics included a measure of central tendency (mean and median) and a measure of
dispersion (standard deviation and range). The primary outcomes for this study were the psycho-
social/emotional domain subscale of the PCOSQ-50 and the depressive symptoms scale. Our
main independent variable was group age. T-test and Pearson correlations were calculated to
examine bivariate tests of outcomes by selected variables. Multiple regression was used to exam-
ine the relationships between a set of independent variables on the psychosocial/emotional sub-
scale score and the depressive symptoms score.
Results
Group 1: Respondents aged 43 (n¼107) were 47.6 ± 4.1 years of age, mostly White (82.6%),
well-educated (56% had a college degree), married (72.2%), and employed full-time (59.6%). Most
respondents (82%) had one or more chronic conditions, such as high blood pressure or diabetes,
in addition to PCOS.
JOURNAL OF WOMEN & AGING 5
Group 2:Respondents aged 18–42 years (n¼935) were 31.0 ± 5.8 years of age, mostly White
(72%), well-educated (56% had a college degree), married (69%), and employed full-time (65%).
Nearly three-quarters (74%) of the sample had one or more chronic conditions in addition to
PCOS.
All demographic variables except for the number of comorbid conditions significantly differed
between women with PCOS aged 43 years and women with PCOS aged 18–42 years.
See Table 1.
Using social media allowed participation from within and outside the United States (US): 80%
of the respondents in both samples were from the US. The 20% from outside the US were from
areas such as Australia, Europe, Africa, Southeast Asia, and the United Kingdom (see Appendix
for full list by age group).
The means of the total HRQoL and each subscale and the depressive symptoms were calcu-
lated and then compared between age groups (Table 2). Women with PCOS aged 43 years
Table 1. Group-based demographic and health-related characteristics of the women with PCOS in both age cohorts.
Variable
Aged 43
#%
Aged 18–42
#%
Race
African American/Black 3 2.8 220 23.5
Am Indian/Native Am 6 5.5 10 1.1
Asian 0.0 58 6.2
Latino 2 1.9 79 8.4
Middle Eastern/N African 0 0.0 4 0.4
White 91 85.1 515 55.1
Mix of Two 5 4.6 36 3.9
Prefer not to answer 0 0.0 13 1.4
Educational attainment
Some high school 4 3.7 14 1.5
High school or GED 11 10.3 72 7.7
Some college 34 31.8 323 34.6
Bachelors 31 29.4 328 35.1
Masters 24 22.4 165 17.6
Doctorate 2 1.9 26 2.9
Prefer not to answer 1 0.9 7 0.8
Employment status
Not working 17 15.9 171 18.3
Part-time 26 24.3 131 14.0
Full-time 63 58.9 614 65.7
Prefer not to answer 1 0.9 7 2.0
Medical insurance
Yes 94 87.8 808 86.4
No 10 9.4 111 11.9
Prefer not to answer 3 2.8 16 1.7
Marital status
Single 10 9.4 258 27.6
Married/Partnership 78 72.9 643 68.8
Divorced 16 14.9 32 3.4
Widowed 1 0.9 0.0
Prefer not to answer 2 1.9 2 0.2
# Children
0 18 17.1 512 55.0
1–2 60 57.2 303 32.0
3–4 23 21.9 75 8.0
5 4 3.8 4 0.4
Prefer not to answer 41 4.6
#Comorbid conditions
0 34 31.8 240 31.0
1–2 54 50.5 381 49.2
3–4 14 13.1 127 16.4
5 5 4.6 26 3.4
p<.05
6 P. J. WRIGHT ET AL.
scored lower (thus, better) on total HRQoL and all subscales, except for the sexual function sub-
scale. The difference in the sexual function subscale score was not significant. Among women
with PCOS aged 43 years, fifty-nine percent (59%) had depressive symptoms indicating moder-
ate to severe depression. While depressive symptom scores appeared better among the older
women with PCOS, the difference was not statistically significant (Table 2). Notably, the mean
score for depressive symptoms among women with PCOS aged 43 years, like their younger
cohort, indicated moderate depression.
Next, Pearson correlations were calculated between the psychosocial/emotional subscale score
and each of the other HRQoL subscales scores among women aged 18–42, women aged
43 years, and the total sample. Table 3 reports Pearson correlations between the psychosocial/e-
motional subscale scores and each age group and the total sample.
For women with PCOS aged 18–42 years, Pearson correlations between age and all HRQoL
subscales scores ranged from 0.29 (fertility) and 0.04 (sexual function). Pearson correlations
between the psychosocial/emotional HRQoL subscale score and other HRQoL subscale scores
ranged from 0.28 (sexual function) to 0.70 (coping). The results indicated a significant negative
association between both age and the HRQoL subscales psychosocial/emotional, fertility, obesity/-
menstrual, and coping. Thus, when age increased within this age group, the listed HRQoL sub-
scales decreased (i.e., improved). When any subscale score increased (i.e., worsened), the
psychosocial/emotional HRQoL subscale score also increased (i.e., worsened).
For women with PCOS aged 43 years, Pearson correlations between age and all HRQoL sub-
scales scores ranged from 0.04 (fertility and sexual function) to 0.20 (psychosocial/emotional).
Pearson correlations between the psychosocial/emotional HRQoL subscale scores and other
HRQoL subscales scores ranged from 0.38 (fertility and sexual function) to 0.81 (coping). The
results indicated positive associations with significance between this age group and the psychoso-
cial/emotional and coping subscales. Thus, when age increased within this age group, the psycho-
social/emotional and coping subscales also increased (i.e., worsened). When any HRQoL subscale
score increased (i.e., worsened), the psychosocial/emotional HRQoL subscale score increased (i.e.,
worsened) as well.
Table 2. Differences in HRQoL and depressive symptoms between younger and older women with PCOS.
18–42 years
(n¼935)
>43 years
(n¼107)
Variable Mean SD Mean SD p-value
Age 31.0 5.80 47.6 4.10 <.0001
HRQoL Total
a
2.52 0.96 1.89 0.91 <.0001
Psychosocial/ Emotional 2.59 0.67 1.83 0.73 <.0001
Fertility 3.15 1.10 2.18 0.89 <.0001
Sexual Function 1.82 1.04 1.93 0.99 .4110
Obesity/Menstrual 2.59 0.75 1.81 0.77 <.0001
Hirsutism 2.60 1.36 1.70 1.27 <.0001
Coping 2.37 0.85 1.89 0.81 <.0001
Depressive Symptoms 12.43 5.57 11.93 5.42 .3965
a
A lower score on the HRQoL scale and each subscale (range 0.00–4.00) indicates a better HRQoL.
Table 3. Relationship between the psychosocial/emotional subscale and HRQoL domains (Aged 43 years, aged 18–42 years,
and total sample).
18–42 years (n¼935) 43 years (n¼107) Total sample (n¼1,042)
Fertility 0.44 0.38 0.30
Sexual function 0.28 0.38 0.26
Obesity/Menstrual 0.59 0.73 0.64
Hirsutism 0.36 0.54 0.41
Coping 0.70 0.81 0.71
All p-values less than .001
JOURNAL OF WOMEN & AGING 7
For the total sample, Pearson correlations between age and the HRQoL subscale scores ranged
from 0.35 (psychosocial/emotional) to 0.04 (sexual function). Pearson correlations between the
psychosocial/emotional HRQoL subscale score and all other HRQoL subscale scores ranged from
0.26 (sexual function) to 0.71 (coping). Significant negative associations were found between age
and all HRQoL subscales except sexual function, such that when age increased, most all HRQoL
subscale scores decreased (improved). Significant positive associations were found between the
psychosocial/emotional HRQoL subscale score and all other HRQoL subscale scores, such that
when any HRQoL subscale score increased (i.e., worsened), the psychosocial/emotional HRQoL
subscale score increased (i.e., worsened) as well.
Pearson correlations were calculated between the depressive symptoms scale score and each of
the other HRQoL subscales among women aged 18–42, women aged 43 years, and the total
sample (Table 4).
Regression analysis was conducted using the psychosocial/emotional subscale score (Table 5).
For women with PCOS aged 18–42 years, Pearson correlations between the depressive symp-
toms scale score and the HRQoL subscale scores ranged from 0.20 (sexual function and hirsut-
ism) and 0.63 (psychosocial/emotional). The results indicated a significant positive linear
association between depressive symptomology and all HRQoL domains. Thus, when depressive
symptoms scores increased (i.e., worsened) within this age group, all HRQoL subscale scores
decreased (i.e., improved).
For women with PCOS aged 43 years, Pearson correlations between the depressive symptoms
scale score and the HRQoL subscale scores ranged from 0.62 (psychosocial/emotional) and
0.28 (hirsutism). Contrary to the younger cohort, the results indicated a significant negative
association between depressive symptomology and all HRQoL subscales. Thus, when depressive
Table 4. Relationship between depressive symptoms scale and HRQoL domains (Aged 43 years, aged 18–42 years, and total
sample).
18–42 years (n¼935) 43 years (n¼107) Total sample (n¼1,042)
Psychosocial/Emotional 0.63 0.62 0.52
Fertility 0.29 0.37 0.22
Sexual function 0.20 0.30 0.15
Obesity/Menstrual 0.42 0.48 0.32
Hirsutism 0.20 0.28 0.16
Coping 0.52 0.52 0.42
All p-values statistically significant with the p-value set at .005
Table 5. Regression model with psychosocial/emotional subscale (aged 43 years, aged 18–42 years, and total sample)
18-42 Years
(n¼935)
43 Years
(n¼107)
Total Sample
(n¼1,042)
Variables Beta SE P Beta SE P Beta SE P
Intercept 1.631 0.161 0.321 0.483 1.433 0.091
Group 0.344 0.079 <0.001
Age 0.011 0.003 0.001 0.008 0.011 0.464 0.008 0.003 <0.001
Education 0.062 0.018 0.001 0.036 0.045 0.429 0.052 0.017 0.002
Employment 0.018 0.022 0.399 0.125 0.065 0.057 0.017 0.021 0.426
Insurance 0.009 0.054 0.860 0.000 0.166 0.997 0.006 0.052 0.911
Marital Status 0.086 0.039 0.027 0.073 0.112 0.514 0.066 0.037 0.072
# Children 0.028 0.020 0.165 0.036 0.041 0.382 0.009 0.017 0.595
# Comorbid 0.036 0.012 0.003 0.086 0.345 0.014 0.016 0.011 0.160
Fertility 0.063 0.032 0.002 0.020 0.059 0.733 0.046 0.019 0.016
Sexual Function 0.05 0.017 0.003 0.005 0.055 0.928 0.053 0.016 0.003
Obesity/Menstrual 0.18 0.029 <0.001 0.214 0.103 0.041 0.187 0.016 <0.001
Hirsutism 0.050 0.013 <0.001 0.094 0.043 0.033 0.056 0.013 <0.001
Coping 0.321 0.028 <0.001 0.434 0.102 <0.001 0.346 0.027 <0.001
a
R
2
for 18–42 ¼0.55, for 43 ¼0.72, and for total ¼0.61
8 P. J. WRIGHT ET AL.
symptoms scores increased (i.e., worsened) within this age group, the HRQoL subscale scores
decreased (i.e., improved).
For the total sample, Pearson correlations between the depressive symptoms scale score and
HRQoL subscale scores ranged from 0.15 (sexual function) to 0.52 (psychosocial/emotional).
Significant positive linear associations were found between the depressive symptoms scale and all
HRQoL subscale scores, such that when depressive symptoms scores increased (i.e., worsened), all
HRQoL subscale scores increased (i.e., worsened).
Regression analysis was conducted using the psychosocial/emotional HRQoL subscale
(Table 5).
For women aged 18–42 years, the results indicated that all variables in the model were statistic-
ally significant with psychosocial/emotional subscale scores. The beta coefficient for all variables
is positive except for age (b¼1.63, R
2
¼0.55).
For women aged 43 years, results revealed that only obesity/menstrual, hirsutism, and coping
were statistically significant with psychosocial/emotional HRQoL subscale scores (b¼0.14, R
2
¼0.72).
For the total sample, the results indicate that all variables in the model were statistically
significant with the psychosocial/emotional HRQoL subscale. The beta coefficient for all
variables is positive except age (b¼0.76, R
2
¼0.61). For every one-year increase in age,
the psychosocial/emotional HRQoL subscale is predicted to increase (i.e., improve) by 0.8
point.
cGroup-based analyses show that women 43 years had significantly better HRQoL as com-
pared to younger women with PCOS. Thus, as women with PCOS age, their overall HRQoL
improves due to significant changes in the obesity/menstrual, hirsutism, and coping HRQoL sub-
scales. The fertility and sexual function HRQoL subscale scores no longer influenced the psycho-
social/emotional HRQoL subscale score or total HRQoL score of older women with PCOS.
Lastly, regression analysis was conducted using the depressive symptoms score (Table 6).
For women aged 18–42 years, the results indicated that age (b¼0.07), the psychosocial/e-
motional HRQoL subscale score (b¼3.98), and the coping HRQoL subscale score (b¼1.02) were
statistically significant with the depressive symptoms scale (R
2
¼0.44).
For women aged 43 years, results revealed that the psychosocial/emotional (b¼4.54) and
fertility (b¼1.38) HRQoL subscales were statistically significant with the depressive symptoms
scale (R
2
¼0.51).
Table 6. Regression model with depressive symptoms (aged 43 years, aged 18–42 years, and total sample)
18-42 Years
(n¼935)
43 Years
(n¼107)
Total Sample
(n¼1,042)
Variables Beta SE P Beta SE P Beta SE P
Intercept 3.767 1.752 18.221 6.240 15.083 2.658
Group 2.965 0.885 0.008
Age 0.066 0.034 0.053 0.030 0.101 0.779 0.118 0.034 <0.001
Education 0.035 0.187 0.060 0.169 0.449 0.707 0.468 0.190 0.014
Employment 0.393 0.226 0.082 0.109 0.654 0.868 0.278 0.234 0.237
Insurance 0.351 0.555 0.528 3.241 1.642 0.052 0.849 0.584 0.146
Marital Status 0.886 0.397 0.026 0.696 1.104 0.530 1.034 0.411 0.012
# children 0.107 0.208 0.606 0.265 0.406 0.516 0.377 0.193 0.066
# Comorbid 0.629 0.123 <0.001 0.645 0.353 0.071 0.877 0.126 <0.001
PSE3.979 0.390 <0.001 4.535 1.077 <0.001 2.634 0.402 <0.001
Fertility 0.037 0.215 0.863 1.371 0.586 0.022 0.122 0.214 0.569
Sexual Function 0.326 0.178 0.067 0.115 0.544 0.838 0.212 0.185 0.252
Obesity/Menstrual 0.102 0.309 0.974 0.419 1.042 0.688 0.255 0.328 0.438
Hirsutism 0.093 0.134 0.488 0.427 0.441 0.335 0.134 0.142 0.348
Coping 1.016 0.319 <0.001 0.060 1.117 0.957 0.953 0.339 0.005
PSE: psychosocial/emotional
R
2
for 18–42 ¼0.44, for 43 ¼0.51, and for total ¼0.30
JOURNAL OF WOMEN & AGING 9
With an R
2
of 0.30, the results for the total sample indicated that the psychosocial/emotional
(b¼2.63) and coping (b¼0.95) HRQoL subscales were statistically significant with the depressive
symptoms scale. For every one-unit increase in the depressive symptoms scale, the psychosocial/e-
motional subscale is predicted to increase (i.e., worsen) by 2.6 points and the coping subscale is
predicted to increase (i.e., worsen) by 1.0 point.
Discussion
Overall, the findings revealed that women aged 43 years had better HRQoL relative to women
aged 18–42 years. In a cross-sectional study by Forslund et al. (2022), HRQoL and depression
were compared between older women with PCOS (52 ± 5 years) and age-matched controls without
PCOS. The findings of that study indicated that HRQoL among older women with PCOS was no
different than that of older women without PCOS. The authors hypothesized that overall HRQoL
must have improved as the women with PCOS aged, and most likely because subfertility is no
longer a concern (as evident by similar parity with age-matched controls without PCOS). The
authors further posited that older women with PCOS probably develop better coping skills with
PCOS and its biopsychosocial consequences (Forslund et al., 2022). Findings from our study sup-
port these hypotheses, as women with PCOS aged 43 years had a higher prevalence of 1 chil-
dren and a significantly improved HRQoL subscale score for coping. As suggested by a principle
guiding the life course theory, women’s social roles and responsibilities can dictate the perception
of the PCOS biopsychosocial challenges. It can be inferred that subfertility was less of a psycho-
social stressor as the majority (83%) of the older women had children, and 94% of the respond-
ents considered themselves peri- or postmenopausal with the remaining 6% (n¼6) unsure. In
addition, studies about coping among older adults have consistently found higher levels of cop-
ing, resiliency, and adaptability as compared to young adults due to accumulated personal (e.g.,
self-efficacy, optimism), social (e.g., family), and financial resources (Boehlen et al., 2017; Fuller &
Huseth-Zosel, 2021). Consistent with the life course theory, older women with PCOS may
develop increased capabilities to surpass the constraints imposed by PCOS.
Although HRQoL seemed to improve as women with PCOS aged, the findings indicated that
obesity/menstrual and hirsutism continue to significantly affect HRQoL among those aged
43 years. First, menstrual factors were less likely an issue as over half of the participants identi-
fied themselves as menopausal with issues of fertility resolved. However, as suggested by the life-
span development principle of the life course theory, health in earlier life stages affect later life
stages. The likelihood of obesity increases as women with PCOS age due to existing obesity,
hyperandrogenism, and insulin resistance (Barber et al., 2006). Androgen levels remain stable
(i.e., high) or decrease but remain relatively high (i.e., above normal range) as women enter
menopause and estrogen decreases. Consequently, insulin resistance, abdominal adiposity, and
dyslipidemia worsen, and excessive hair growth and balding continue past the menopausal years
(Sharma & Mahajan, 2021). Notably, women with PCOS reach menopause, on average, 2–4 years
later than that of age-matched controls (Forslund et al., 2019; Minooee et al., 2018.) Thus, PCOS
complicates the natural life stage of menopause, and may negatively affect women’s HRQoL,
health status, and needs. However, our findings suggest that the more bothersome PCOS sequelae
and unique healthcare concerns of the menopausal transition are not included on the PCOSQ-50.
Depressive symptoms are common among women with PCOS of all ages due to the interplay
between PCOS psychosocial dynamics and the hormonal disruptions associated with PCOS
(Gnawali et al., 2021). Thus, unsurprisingly, the level of depression was comparable between the
two age cohorts. However, contrary to the younger women with PCOS, the older women with
PCOS reported better psychosocial/emotional and coping even when depressive symptomology
increased. The prolonged transitional life stages experienced by women with PCOS may explain
our finding that indicated women with PCOS aged 43 years experienced moderate depressive
10 P. J. WRIGHT ET AL.
symptoms based on the depressive symptoms screening. Additionally, older women with PCOS
may experience different life (e.g., aging) and health concerns (e.g., menopause, established
comorbidity) than the younger women with PCOS, indicating that the PCOS-specific HRQoL
scale is not designed for peri-post menopausal women with PCOS. Thus, as depicted in the life
course theory, the concerns and priorities of older women with PCOS shift as the women move
across their life course.
Additionally, a distinction exists between the presence of depressive symptoms versus a clinical
diagnosis of depression (McIntyre, 2016). According to Deeks et al. (2010) cross-sectional study,
self-report data for depression corresponded with medically diagnosed and clinically assessed
depression. However, unknown is the prevalence of women with PCOS reporting or seeking care
for depressive symptoms. Depression among women with PCOS has been recognized, and inter-
national guidelines now recommend screening for depression among all women with PCOS at
the time of diagnosis (Teede et al., 2018). We propose that screenings for depression occur
throughout a woman’s life course.
The following demographic variables were significantly different between the younger and
older cohorts of women with PCOS: age, educational level, employment status, medical insurance,
marital status, and number of children. Consistent with the life course theory, each year of life
offers opportunities to seek and complete higher education; attain employment relevant to educa-
tion, and thus medical insurance; marry; and have children. As such, time also revealed women
who had experienced divorce or the death of a spouse or partner. Each life phase from adoles-
cence to menopause is extended, such that women with PCOS reach behavioral (e.g., dating) and
biological (e.g., pregnancy) milestones later in life than women without PCOS. For example, cor-
responding to the life course theory general principle, timing of life events and experiences, time
to parenthood is often extended for women with PCOS as they have an increased risk of adverse
pregnancies prior to, during, and after ovulation induction and assistive reproductive technology
compared to age-matched women without PCOS (Liu et al., 2020; Qin et al., 2013).
Biopsychosocial issues associated with each life phase (e.g., adolescence, menopause) influence
women’s perceptions of and ability to enact gender social roles (Liu et al., 2020), perform respon-
sibilities of partner/caregiver/worker, and engage in self-care behaviors (Sanchez, 2014).
A dearth of research examined the HRQoL and depressive symptoms among women with
PCOS aged 43 years, that is, mostly those women in the peri-postmenopausal years. We advo-
cate for the inclusion of more frequent medical screenings, in addition to mental health screen-
ings throughout the life course of women with PCOS. We also call for further research, especially
longitudinal studies, to advance the limited knowledge about the unique biopsychosocial health
and healthcare needs of older women with PCOS. Older women with PCOS are an understudied,
vulnerable population at risk for premature death due to multiple chronic conditions.
Strengths
This study is one of the first to assess HRQoL and depressive symptoms among women aged
43 years. Thus, its findings add to the scarce information currently available about women with
PCOS in the peri-post-menopausal years. The sample size of the comparison group (women with
PCOS aged 18–42 years) comprised the largest cross-sectional study of women with PCOS to date
and was well-described across several races and ethnicities. The online format for this study
allowed for participant anonymity and was an efficient and effective method to reach a wider
range of eligible and diverse respondents.
JOURNAL OF WOMEN & AGING 11
Limitations
As a cross-sectional research design, the results do not indicate causality between age and
HRQoL or depressive symptoms. The sample size of the older cohort of women (n¼107) was
significantly smaller than the younger cohort (n¼935). However, the sample size of 107 sur-
passed the target goal and provided adequate power. Additionally, per Statista (2023), 43.7% of
Facebook users are female, with 58% aged 18–42 years and 39.5% aged 43 years. Thus, there is a
smaller pool of older women who use Facebook, which may have reduced the ability to recruit a
larger sample size. More importantly, as indicated in our results, peri-postmenopausal women
with PCOS may be coping better with PCOS and be less likely to participate in online forums.
Further, many older women with PCOS have never been diagnosed (Soucie et al., 2021) and
would not self-identify as a member of this population. The survey was administered online, thus
confirmation of PCOS diagnosis was not required and all answers required self-reported data. As
such, responses were subject to recall and social desirability biases. To help prevent robotic
responses, internet safeguards such as CAPTCHA were added. Facebook was used for its PCOS-
specific pages, as users must pass an initial level of screening to participate on the page (Boyle
et al., 2018). In addition, the PCOSQ-50 was developed by Nasiri-Amiri and colleagues after con-
ducting a mixed-method, sequential, exploratory study in 2011–2012 with 23 women diagnosed
with PCOS aged 18–40 years (Nasiri-Amiri et al., 2016). Thus, the current PCOSQ-50 lacks con-
tent specific to women in their peri-postmenopausal years and presents a strong emphasis on
menstruation and fertility, issues that may no longer be relevant to older women with PCOS.
Conclusion
The purpose of our cross-sectional study was to compare HRQoL and depressive symptoms
among peri-postmenopausal women with PCOS aged 43 years relative to premenopausal women
with PCOS aged 18–42 years. The main finding of this study was that HRQoL among women
with PCOS seems to improve with age, yet depressive symptoms remained high, indicating mod-
erate depressive symptomatology. The results were interpreted using the theoretical lens of life
course theory. PCOS affects a woman’s life course by altering biopsychosocial needs, emotional
status, and identity. Thus, the life course theory promotes perspective about and opportunity to
better manage PCOS and prevent associated comorbidities during key and transitional life stages
(Jacob et al., 2017).
Acknowledgements
The authors thank the women who responded to the survey. The authors acknowledge support from the National
Institutes of Health (NIH) F31 Ruth L. Kirschstein National Research Service Award (NRSA) Individual
Predoctoral Fellowship (1F31 NR019206-01A1). The authors also appreciate the Center for Advancing Chronic
Care Outcomes through Research and iNnovation (ACORN) in the College of Nursing at the University of South
Carolina for support.
Disclosure statement
The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of
this article.
Funding
The authors have no funding details to report.
12 P. J. WRIGHT ET AL.
ORCID
Pamela J. Wright http://orcid.org/0000-0003-3889-3636
Data availability statement
Datasets can be made available upon reasonable request by emailing the corresponding author.
Institutional Review Board Approval Statement: Institutional Review Board (IRB) approval to conduct an online
survey was received on 2/15/2022 (Pro00118636).
References
Azziz, R. (2020). Epidemiology and pathogenesis of the polycystic ovary syndrome in adults. http://www.uptodate.
com/contents/epidemiology-and-pathogenesis-of-the-polycysticovary-syndrome/
Barber, T. M., McCarthy, M. I., Wass, J. A., & Franks, S. (2006). Obesity and polycystic ovary syndrome. Clinical
Endocrinology,65(2), 137–145. https://doi.org/10.1111/j.1365-2265.2006.02587.x
Barnard, L., Ferriday, D., Guenther, N., Strauss, B., Balen, A. H., & Dye, L. (2007). Quality of life and psychological
well-being in polycystic ovary syndrome. Human Reproduction,22(8), 2279–2286. https://doi.org/10.1093/hum-
rep/dem108
Boehlen, F. H., Herzog, W., Schellberg, D., Maatouk, I., Saum, K. U., Brenner, H., & Wild, B. (2017). Self-perceived
coping resources of middle-aged and older adults: Results of a large population-based study. Aging & Mental
Health,21(12), 1303–1309. https://doi.org/10.1080/13607863.2016.1220918
Boyle, J. A., Xu, R., Gilbert, E., Kuczynska-Burggraf, M., Tan, B., Teede, H., Vincent, A., & Gibson-Helm, M.
(2018). AskPCOS: Identifying need to inform evidence-based app development for polycystic ovary syndrome.
Seminars in Reproductive Medicine,36(1), 59–65. https://doi.org/10.1055/s-0038-1667187
Clayton, J. A. (2021). NIH takes a life course approach to researching and promoting healthy aging in women.
https://orwh.od.nih.gov/about/director/messages/nih-takes-life-course-approach-researching-and-promoting-
healthy-aging
Cooney, L. G., Lee, I., Sammel, M. D., & Dokras, A. (2017). High prevalence of moderate and severe depressive
and anxiety symptoms in polycystic ovary syndrome: A systematic review and meta-analysis. Human
Reproduction,32(5), 1075–1091. https://doi.org/10.1093/humrep/dex044
Cronin, L., Guyatt, G., Griffith, L., Wong, E., Azziz, R., Futterweit, W., Cook, D., & Dunaif, A. (2007).
Development of a health-related quality-of-life (PCOSQ) for women with polycystic ovary syndrome (PCOS).
Journal of Clinical Endocrinology and Metabolism,83(6), 1976–1983. https://doi.org/10.1210/jcem.83.6.4990
Deeks, A. A., Gibson-Helm, M., & Teede, H. J. (2010). Anxiety and depression in polycystic ovary syndrome:
A comprehensive investigation. Fertility and Sterility,93(7), 2421–2423. https://doi.org/10.1016/j.fertnstert.2009.
09.018
Engmann, L., Jin, S., Sun, F., Legro, R. S., Polotsky, A. J., Hansen, K. R., Coutifaris, C., Diamond, M. P., Eisenberg,
E., Zhang, H., & Santoro, N. (2017). Racial and ethnic differences in the polycystic ovary syndrome (PCOS)
metabolic phenotype. American Journal of Obstetrics and Gynecology,216(5), 493.e1–493.e13. https://doi.org/10.
1016/j.ajog.2017.01.003
Forslund, M., Landin-Wilhelmsen, K., Schmidt, J., Brannstrom, M., Trimpou, P., & Dahlgren, E. (2019). Higher
menopausal age but no differences in parity in women with polycystic ovary syndrome compared with controls.
Acta Obstetricia et Gynecologica Scandinavica,98(3), 320–326. https://doi.org/10.1111/aogs.13489
Forslund, M., Landin-Wilhelmsen, K., Krantz, E., Trimpou, P., Schmidt, J., Brannstrom, M., & Dahlgren, E. (2022).
Health-related quality of life in perimenopausal women with PCOS. Clinical and Experimental Obstetrics &
Gynecology,49(2), 052. https://doi.org/10.31083/j.ceog4902052
Fuller, H. R., & Huseth-Zosel, A. (2021). Lessons in resilience: Initial coping among older adults during the covid-
19 pandemic. The Gerontologist,61(1), 114–125. https://doi.org/10.1093/geront/gnaa170
Gnawali, A., Patel, V., Cuello-Ram
ırez, A., Al Kaabi, A. S., Noor, A., Rashid, M. Y., Henin, S., & Mostafa, J. A.
(2021). Why are women with polycystic ovary syndrome at increased risk of depression? Exploring the etio-
logical maze. Cureus,13(2), e13489. https://doi.org/10.7759/cureus.13489
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data cap-
ture (REDCap) –A metadata-driven methodology and workflow process for providing translational research
informatics support. Journal of Biomedical Informatics,42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010
Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M., O’Neal, L., McLeod, L., Delacqua, G., Delacqua,
F., Kirby, J., & Duda, S. N. (2019). The REDCap consortium: Building an international community of software
partners. Journal of Biomedical Informatics,95, 103208., https://doi.org/10.1016/j.jbi.2019.103208
JOURNAL OF WOMEN & AGING 13
Jacob, C. M., Baird, J., Barker, M., Cooper, C., Hanson, M. (2017). The importance of a life course approach to
health: Chronic disease risk from preconception through adolescence and adulthood. World Health
Organization: White Paper. 1–41. https://www.who.int/life-cours …health/en/
Jones, G. I., Hall, J. M., Balen, A. H., & Ledger, W. L. (2008). Health-related quality of life measurement in women
with polycystic ovary syndrome: A systematic review. Human Reproduction Update,14(1), 15–25. https://doi.
org/10.1093/humupd/dmm030
Kitzinger, C., & Willmott, J. (2002). The thief of womanhood’: Women’s experience of polycystic ovarian syn-
drome. Social Science & Medicine,54(3), 349–361. https://doi.org/10.1016/S0277-9536(01)00034-X
Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B. W., Berry, J. T., & Mokdad, A. H. (2009). The PHQ-8 as
a measure of current depression in the general population. Journal of Affective Disorders,114(1–3), 163–173.
https://doi.org/10.1016/j.jad.2008.06.026
Legro, R. S., Arslanian, S. A., Ehrmann, D. A., Hoeger, K M., Hassan Murad, M., Pasquali, R., & Welt, C. K.
(2013). Diagnosis and treatment of polycystic ovary syndrome: an endocrine society clinical practice guideline.
The Journal of Clinical Endocrinology and Metabolism,98(12), 4565–4592. https://doi.org/10.1210/jc.2013-2350
Liu, M., Murthi, S., & Poretsky, L. (2020). Polycystic ovary syndrome and gender identity. The Yale Journal of
Biology and Medicine,93(4), 529–537.
Liu, S., Mo, M., Xiao, S., Li, L., Hu, X., Hong, L., Wang, L., Lian, R., Huang, C., Zeng, Y., & Diao, L. (2020).
Pregnancy outcomes of women with polycystic ovary syndrome for the first in vitro fertilization treatment: A
retrospective cohort study with 7678 patients. Frontiers in Endocrinology,11(575337), 575337. https://doi.org/10.
3389/fendo.2020.57337
Malik-Aslam, A., Reaney, M. D., & Speight, J. (2010). The suitability of polycystic ovary syndrome-specific ques-
tionnaires for measuring the impact of PCOS on quality of life in clinical trials. Value in Health,13(4), 440–
446. https://doi.org/10.1111/j.1524-4733.2010.00696.x
Månsson, M., Holte, J., Landin-Wilhelmsen, K., Dahlgren, E., Johansson, A., & Land
en, M. (2008). Women with
polycystic ovary syndrome are often depressed and anxious: A case-control study. Psychoneuroendocrinology,
33(8), 1132–1138. https://doi.org/10.1016/j.psyneuen.2008.06.003
McIntyre, R. S. (2016). Implementing treatment strategies for different types of depression. The Journal of Clinical
Psychiatry,77(Suppl 1), 9–15. https://doi.org/10.4088/JCP.14077su1c.02
Minooee, S., Ramezani Tehrani, F., Rahmati, M., Mansournia, M. A., & Azizi, F. (2018). Prediction of age at meno-
pause in women with polycystic ovary syndrome. Climacteric,21(1), 29–34. https://doi.org/10.1080/13697137.
2017.1392501
Moghadam, Z. B., Fereidooni, B., Saffari, M., & Montazeri, A. (2018). Measures of health-related quality of life in
PCOS women: A systematic review. International Journal of Women’s Health,10, 397–408. https://doi.org/10.
2147/IJWH.S165794
Mortimer, J. T., & Shanahan, M. J. (2016). Handbook of the life course. Springer International.
Nasiri-Amiri, F., Ramezani Tehrani, F., Simbar, M., Montazeri, A., & Mohammadpour, R. A. (2016). Health-related
quality of life questionnaire for polycystic ovary syndrome (PCOSQ-50): Development and psychometric prop-
erties. Quality of Life Research,25(7), 1791–1801. https://doi.org/10.1007/s11136-016-1232-7
Nasiri-Amiri, F., Tehrani, F. R., Simbar, M., Montazeri, A., & Mohammadpour, R. A. (2018). The polycystic ovary
syndrome health-related quality of life questionnaire: Confirmatory factor analysis. International Journal of
Endocrinology,16(2), e12400. https://doi.org/10.5812/ijem.12400
Osibogun, O., Ogunmoroti, O., & Michos, E. D. (2020). Polycystic ovary syndrome and cardiometabolic risk:
Opportunities for cardiovascular disease prevention. Trends in Cardiovascular Medicine,30(7), 399–404. https://
doi.org/10.1016/j.tcm.2019.08.010
Qin, J. Z., Pang, L. H., Li, M. J., Fan, X. J., Huang, R. D., & Chen, H. Y. (2013). Obstetric complications in women
with polycystic ovary syndrome: A systematic review and meta-analysis. Reproductive Biology and Endocrinology,
11(2013), 56. https://doi.org/10.1186/1477-7827-11-56
RAND. (2016, October 16). 36-item short form survey from the rand medical outcomes study. RAND
Corporation. http://www.rand.org/health/surveys_tools/mos/mos_core_36item.html
Riestenberg, C., Jagasia, A., Markovic, D., Buyalos, R. P., & Azziz, R. (2022). Health care related economic burden
of polycystic ovary syndrome in the United States: Pregnancy-related and long-term health consequences. The
Journal of Clinical Endocrinology and Metabolism,107(2), 575–585. https://doi.org/10.1210/clinem/dgab613.3
Sanchez, N. (2014). A life course perspective on polycystic ovary syndrome. International Journal of Women’s
Health,6(6), 115–122. https://doi.org/10.2147/IJWH.S55748
SAS Institute Incorporated. (2013). SAS for Windows 9.4. SAS Institute Inc.
Setia, M. S. (2016). Methodology series module 3: Cross-sectional studies. Indian Journal of Dermatology,61(3),
261–264. https://doi.org/10.4103/0019-5154.182410
Sharma, S., & Mahajan, N. (2021). Polycystic ovarian syndrome and menopause in forty plus women. Journal of
Mid-Life Health,12(1), 3–7. https://doi.org/10.4103/jmh.jmh_8_21
14 P. J. WRIGHT ET AL.
Soucie, K., Samardzic, T., Schramer, K., Ly, C., & Katzman, R. (2021). The diagnostic experience of women with
polycystic ovary syndrome (PCOS) in Ontario, Canada. Qualitative Health Research,31(3), 523–534. https://doi.
org/10.1177/1049732320971235
Statista. (2023, May 11). Facebook-Statistics and facts. Statista. https://www.statista.com/topics/751/facebook
Stevanovic, D., Bozic-Antic, I., Stanojlovic, D., Milutinovic, D. V., Bjekic-Macut, J., Jancic, J., & Macut, D. (2019).
Health-related quality of life questionnaire for polycystic ovary syndrome (PCOSQ-50): A psychometric study
with the Serbian version. Women & Health,59(9), 1015–1025. https://doi.org/10.1080/03630242.2019.
1587664015-1025
Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R. J., Andersen,
M., Azziz, R., Balen, A., Baye, E., Boyle, J., Brennan, L., Broekmans, F., Dabadghao, P., Devoto, L., Dewailly, D.,
Downes, L., …Yildiz, B. O. (2018). Recommendations from the International evidence-based guideline for the
assessment and management of polycystic ovary syndrome. Fertility and Sterility,110(3), 364–379. https://doi.
org/10.1016/j.fertnstert.2018.05.004
Testa, M. A., & Simonson, D. C. (1996). Assessment of quality-of-life outcomes. The New England Journal of
Medicine,334(13), 835–840. https://doi.org/10.1056/NEJM199603283341306
Wright, P. J., Corbett, C. F., & Dawson, R. M. (2020). Social construction of the biopsychosocial and medical expe-
riences of women with PCOS. Journal of Advanced Nursing,76(7), 1728–1736. https://doi.org/10.1111/jan.14371
Wang, X., & Cheng, Z. (2020). Cross-sectional studies: Strengths, weaknesses, and recommendations. CHEST
Journal,158(1S), S65–S71. https://doi.org/10.1016/j.chest.2020.03.012
Zhu, T., Cui, J., & Goodarzi, M. O. (2021). Polycystic ovary syndrome and risk of type 2 diabetes, coronary heart
disease, and stroke. Diabetes,70(2), 627–637. https://doi.org/10.2337/db20-0800
Appendix
LOCATION
18-42 YEARS
(n ¼935)
43 YEARS
(n ¼107)
Africa 1 1
Zimbabwe 1
Africa, East
Kenya 2
Uganda 1
Africa, South 2
Cape Town 2
Gauteng 2
Johannesburg 1
Africa, West
Nigeria 4 1
Asia 2
Asia, East
South Korea 1 1
Seoul 1
Asia, South
Pakistan 4 1
Asia, Southeast 1
Malaysia 2
Myanmar 1 1
Philippines 7
Singapore 4
Asia, Southwest
Saudi Arabia 3
Australia 18 2
Ballarat 1
Brisbane 1
New South Wales 2 1
Perth 1
Queensland 3
Sydney 3
Bahamas 2
Canada 13 5
(continued)
JOURNAL OF WOMEN & AGING 15
Continued.
LOCATION
18-42 YEARS
(n ¼935)
43 YEARS
(n ¼107)
Alberta 7
British Columbia 1
Nova Scotia 4 2
Ontario 3
Kitchener 1
Ottawa 1
Saskatchewan 1
Caribbean 2
Puerto Rico 1
Trinidad and Tobago 2
Egypt 1
Cairo 1
Europe 7 1
Iceland 1
Europe, Central
France 2
Germany 2
Poland 1
Europe, North
Finland 1
Norway 3
Europe, Southeast
Bosnia and Herzegovina 1
Croatia 2
Slovenia 1
Europe, West
Belgium 1
Isle of Man 1
Kingdom of Denmark
The Faroe Islands 1
Middle East 2 1
Qatar 1
United Arab Emirates 2
Dubai 1
United Kingdom 18 2
England 11 1
Cheshire 1
Coventry 1
Leeds 1
Peterborough 1
Plymouth 1
West Yorkshire 1 1
Ireland 5
Scotland 2
Buckie Morayshire 1
Glasgow 1
Wales 3
TOTALS 188 21
Percentage 20% 20%
16 P. J. WRIGHT ET AL.
