Concerns of Women Diagnosed With Polycystic Ovary Syndrome Regarding the Process and Having Children: A Qualitative Study
Abstract
Aim: This study aims to examine the concerns of women diagnosed with PCOS regarding the process and childbearing using interpretative phenomenological analysis.
Methods: This qualitative research was conducted between February and June 2024 with 17 women, aged 18–35 years, who had been diagnosed with PCOS within the past 1–12 months and had visited a Women’s Health Clinic at a Training and Research Hospital. The study data were collected through a personal information form and a semistructured interview form, using individual face-to-face structured interviews.
Results: The emotions expressed in the interviews were categorized under three main themes: “Emotions Experienced Upon Diagnosis,” “Anxiety Regarding Childbearing,” and “Sources of Information.” During the interviews, participants narrated their emotions and experiences related to PCOS within a narrative flow. The study findings revealed that the most commonly experienced emotions were anxiety, sadness, and concerns about infertility. The majority of participants expressed significant anxiety about the possibility of not being able to conceive. The primary source of information about the disease was the Internet, followed by doctors, although it was noted that the participants felt that they did not receive sufficient information from their doctors about their condition.
Conclusion: The study highlights that women with PCOS experience anxiety related to the disease and concerns about infertility after diagnosis, and it identifies the factors influencing these anxieties. The findings from this study may contribute to the development of supportive healthcare and emotion regulation strategies for women with PCOS.
1. Introduction
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, affecting an estimated 5%–10% of women worldwide [1]. Although the exact mechanism of its development is not fully understood, it is considered a significant public health issue that arises from the interplay of genetic and environmental factors, leading to metabolic, reproductive, and psychological adverse effects in women [2].
Clinically, PCOS is characterized by hyperandrogenism, anovulation, and insulin resistance, manifesting as menstrual irregularities (oligomenorrhea and amenorrhea), hirsutism, alopecia, infertility, and pregnancy losses [3–5]. Long-term effects include psychosocial issues, type II diabetes, cardiovascular diseases, and endometrial cancer [5]. The symptoms and manifestations of PCOS can vary over time and differ among individuals [6, 7].
The short- and long-term effects of PCOS can lead to significant anxiety among women and in society [8]. Psychological research on PCOS has generally focused on the psychosocial impacts of the disorder. Considering the scope of health issues and the distressing physical symptoms, it has been noted that PCOS and its associated symptoms are linked to lower quality of life and increased psychological distress in patients [9, 10].
Healthcare professionals must be aware of how patients perceive their symptoms and focus on addressing their needs to improve individual care and quality of life [11]. A review of the literature reveals that there is a limited number of qualitative studies examining women’s experiences with PCOS in depth [12–15]. In the Turkish context, only two studies have been identified [16, 17]. Therefore, this study was designed to directly explore the emotions women experience after being diagnosed with PCOS, understand their current situation, and determine their anxiety regarding the disease process and childbearing.
2. Methods
2.1. Objective
The objective of this study is to identify the concerns of women diagnosed with PCOS regarding the process and their anxieties about childbearing.
2.2. Type, Location, and Time of the Study
This study was designed as a qualitative research project conducted with women who visited X Training and Research Hospital. Data collection took place between February and June 2024.
2.3. Sample Selection
The criterion sampling method, one of the purposive sampling techniques, was used to determine the study group. Criterion sampling involves selecting individuals, events, objects, or situations that possess the qualities relevant to the problem under investigation [18]. Therefore, the sample consisted of women diagnosed with PCOS.
During the data collection process, 17 women who met the inclusion criteria for the study and had been diagnosed with PCOS were interviewed. All participants voluntarily agreed to participate in the study. The sample size was determined based on data saturation [19], and the study was completed with a total of 17 participants. The sample included both married and single women, with nine single and eight married women interviewed.
Women who had been diagnosed with PCOS within the past 1–12 months, aged between 18–35 years, fluent in Turkish, and willing to participate voluntarily and provide informed consent were included in the study. Women with any speech or comprehension impairments or those diagnosed with psychiatric disorders were excluded from the study.
2.4. Data Collection and Tools
Descriptive Information Form: This form, prepared by the researchers, consists of 18 items.
Semistructured Interview Form: Interview questions were developed based on a review of PCOS studies and reviewed by six field experts. The semistructured interview form consists of six questions.
2.4.1. Data Collection
Content analysis was used to analyze the data. In content analysis, similar data are grouped into specific codes, categories, and themes and organized in a way that is understandable to the reader [19]. During data analysis, the recorded interviews were transcribed verbatim, with notes added regarding participants’ gestures and changes in tone.
Participants’ names were not used in the writing of the data, and each interviewee was coded with a number for ease of the analysis (e.g., Participant 1 as P1 and Participant 2 as P2). The data were carefully reread before the analysis, significant data were coded, and appropriate codes were grouped into categories. These categories were then combined to form the themes of the study. Finally, the themes were organized and interpreted in a manner that was understandable to the reader. To enhance the reliability of the study, an international checklist was used during the data collection and report preparation stages (COREQ: Consolidated criteria for reporting qualitative studies) [20].
2.5. Ethical Considerations
All procedures performed in the study were carried out by the rules specified in the Declaration of Helsinki and its annexes. Approval for this study was received from the Hamidiye Health Sciences University, Hamidiye Scientific Research Ethics Committee, on 08.12.2024 with reference number 23534. Informed consent was obtained from all participants included in the study.
3. Results
The average age of the women participating in the study was 25.17 ± 4.54 years (min: 19, max: 35). Nine of the women (52.9%) were single, 64.7% were university graduates, 58.8% were employed, 88.2% had an income equal to their expenses, and 88.2% did not smoke. Four women (23.5%) reported that their lives were affected by PCOS. Regarding the symptoms experienced due to PCOS, all women reported menstrual irregularities. Hirsutism was observed in 52.9% of the women, weight gain in 35.2%, and acne problems in 29.4% (Table 1).
Participant number | Age | Marital status | Education level | Job | Income status | Smoking | Impact of life | Symptoms seen |
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K1 | 27 | Single | License | Employee | Middle income | Yes | No | Weight gain, acne, hirsutism, and menstrual irregularity |
K2 | 20 | Single | License | Student | Middle income | No | Yes | Menstrual irregularity, excessive bleeding, and pain |
K3 | 32 | Married | Master’s degree | Banker | Middle income | No | Yes | Menstrual irregularity |
K4 | 24 | Married | Secondary education | Not working | Middle income | No | No | Menstrual irregularity and hair growth |
K5 | 25 | Married | License | Healthcare worker | Excess income | No | No | Menstrual irregularity, hair growth, and weight gain |
K6 | 21 | Single | License | Not working | Middle income | No | No | Menstrual irregularity, hair growth, and weight gain |
K7 | 24 | Married | High school | Not working | Middle income | Yes | No | Menstrual irregularity, hair growth, weight gain, and acne |
K8 | 29 | Married | High school | Not working | Middle income | No | No | Menstrual irregularity and hair growth |
K9 | 31 | Married | Secondary education | Not working | Middle income | No | No | Menstrual irregularity, hirsutism, and mood disorder |
K10 | 21 | Single | License | Student | Middle income | No | No | Menstrual irregularity, hirsutism, and acne |
K11 | 23 | Single | License | Healthcare worker | Excess income | No | No | Acne and pain |
K12 | 20 | Single | License | Student | Middle income | No | Yes | Menstrual irregularity, hirsutism, and irritability |
K13 | 35 | Married | Primary education | Textile | Middle income | No | Yes | Menstrual irregularity |
K14 | 26 | Single | License | Not working | Middle income | No | No | Menstrual irregularity, acne, weight gain, and hair loss |
K15 | 25 | Single | License | Trainer | Middle income | No | No | Menstrual irregularity, acne, and hair loss |
K16 | 19 | Single | License | Student | Middle income | No | No | Menstrual irregularity |
K17 | 26 | Married | License | Not working | Middle income | No | No | Menstrual irregularity, acne, and weight gain |
The findings of this qualitative study are categorized under three main themes: emotions experienced after the diagnosis, thoughts regarding the possibility of having children, and sources of information.
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Fear: (K2) “I had a feeling that I might have PCOS because my mother and sister also have it, and they struggled to have children… I was afraid that I might not be able to have children in the future. After the diagnosis, the doctor prescribed me birth control pills and said that if I took them, I would have regular periods, but if I didn’t, I would continue to experience the same symptoms, which made me a bit anxious. As I mentioned, I felt anxious about the difficulties I might face in having children in the future (became emotional).”
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(K17) “I remember feeling scared when I was first diagnosed with PCOS because I had no knowledge about the condition. I started researching the disease to see if I would face any problems now or in the future. During my research, I learned that it could lead to difficulties in conceiving, which made me sad and worried. At that time, I was in a relationship, and we were considering marriage (said in a sad tone).”
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Anxiety About Conceiving: (K8) “I found out that I had polycystic ovary syndrome during a check-up. It was a condition I had heard about often, but no one in my family had it, so I never thought I would have it. I was upset when I found out because it’s a condition that can lead to infertility (became emotional). I wanted to have children. I have always loved spending time with babies and children. I could say my nieces and nephews grew up with me (became a bit emotional). The doctor suggested we start treatment and progress as needed, so I agreed, and we began the treatment process.”
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(K14) “When I was diagnosed with PCOS, I was mainly concerned about the possibility of not being able to become a mother due to my irregular periods. I constantly felt the need to stay thin, thinking that maybe my body needed to be below a certain weight because of this condition (felt unhappy here). Weight issues have always been challenging for me. The effects I mentioned caused quite a bit of stress and fear, leading to a sense of demoralization.”
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Stress: (K3) “I was diagnosed when I was around 18 years old, just starting university, and away from my family. Because of this, I was really stressed at the time. I started treatment after the diagnosis, and later, my cysts ruptured as well.”
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(K7) “At first, I didn’t know what PCOS was, so I didn’t really feel anything. Later, after doing some research and getting explanations from the doctors, I didn’t panic, but I did feel stressed. I experienced some anxiety issues, you could say. The treatment process after the diagnosis was also exhausting for me (felt unhappy here).”
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Sadness: (K4) “When they first told me, I was obviously sad. I thought I might never be able to have children. It was tough at first. They tried to regulate my periods initially, and then I started taking medication. But, as I said, this kind of pressure is really hard to deal with.”
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(K10) “Honestly, I was a bit sad when I first heard about it. I realized that this condition won’t go away and will continue indefinitely. When I learned that it could potentially lead to infertility in the future, I was very upset. I really hope this doesn’t happen but knowing that it’s a possibility makes me very sad. Out of everything, this is what upset me the most.”
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Anxiety: (K5) “When I first learned that I had PCOS, I was very anxious and upset because I didn’t know much about it and thought it might be a tumor or cancer (felt sad here). I was stressed during that time. Later, when I found out that the symptoms could be reduced with medication, I felt a sense of relief…”
Theme | Code | Participants | f |
---|---|---|---|
Feelings | Fear | K1, K2, K6, K14, and K17 | 5 |
Pregnancy anxiety | K2, K3, K4, K6, K7, K8, K11, K14, and K17 | 9 | |
Stress | K3, K5, K7, K14, and K15 | 5 | |
Sadness | K2, K4, K5, K6, K8, K10, K12, K14, and K17 | 9 | |
Anxiety | K5, K6, K7, K9, K11, K12, K13, K14, K15, and K17 | 10 |
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Absence of Anxiety: (K9) “No, I didn’t feel any anxiety. As I mentioned, my condition developed after my fourth child, so I didn’t have any concerns in this regard (said happily).”
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(K13) “I was a bit worried, but they never told me that I couldn’t have children. I didn’t experience anything like that. I have a son, thank God. I didn’t undergo any treatment… My child was conceived naturally.”
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Doctor’s Statements: (K8) “When I learned that I had polycystic ovary syndrome, the doctor told me that I couldn’t conceive because of this condition. At that moment, I felt as if I would never be able to become a mother again (became emotional). I felt terrible. The doctor then told me that I could get pregnant with treatment. He never spoke negatively to me. I chose to trust the doctor. If the doctor had told me that I would never be able to have children, I might not have been able to see these days. I met many women online who had undergone treatment and successfully conceived. Seeing that many women had gone through what I was going through, I focused entirely on the treatment. It was difficult, but thankfully, I have a child now.”
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Fear of Not Being Able to Conceive: (K6) “Yes, I feel anxious and worried about not being able to become a mother because of my PCOS. On a scale of one to ten, I would rate my anxiety at seven. I want to become a mother in the future. The possibility that my PCOS could prevent me from becoming a mother makes me very sad and anxious.”
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Internet Information: (K1) “Yes, I felt a lot of anxiety because every woman wants to have children when she gets married in the future. Women with this condition might face difficulties in becoming a mother, which makes me very anxious. The reasons for my anxiety might be the information I found online during my research.”
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Doctor’s Statements: (K3) “…Because a few doctors told me that I wouldn’t be able to have children because of this condition. One doctor even said that I would definitely never be able to have children. This situation was very distressing for me. However, when I went to another doctor, they said there was no issue and that I could try. I decided to give it a try. About 5-6 months after stopping my medication, I conceived my son naturally (was happy)…”
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Social Pressure: (K12) “Yes, I experienced anxiety. Since I didn’t know how the disease progressed, I felt anxious. Later, when I learned that having children wasn’t impossible, I felt relieved. If I were to rate my anxiety level on a scale of 1 to 10, I would say it was at level 7. The main reason for my anxiety was the common belief that not having regular periods means you can’t have children.”
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(K14) “The information I gathered from my research online and from people around me about the difficulties in becoming a mother is one of the reasons for my anxiety.”
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Irregular Menstruation: (K7) “Because my periods are irregular, I’m unable to conceive. This has caused significant stress for me.”
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(K15) “I think all women feel anxiety and concern about not being able to become a mother. Irregular periods are known to be one of the factors that can prevent pregnancy. When my periods are irregular, I feel anxious about the future.”
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(K1) “…The fact that my periods never become regular and the long gaps between them increase my anxiety and fear levels. I could also add that I struggle with losing weight, and being overweight is an important factor in not being able to have children.”
Theme | Code | Participants | f |
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State of not being anxious | I have no anxiety | K9 and K13 | 2 |
Doctor’s statements | K3 and K8 | 2 | |
Anxiety state | Anxiety about not getting pregnant | K1, K2, K3, K4, K5, K6, K7, K8, K10, K11, K12, K14, K15, and K17 | 14 |
Internet information | K1, K2, and K6 | 3 | |
Doctor’s statements | K3 | 1 | |
Environmental pressure | K4, K12, nd K15 | 3 | |
Menstrual irregularity | K1, K7, and K15 | 3 |
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Internet: (K1) “As I mentioned, after the diagnosis, I researched online and gained some information. This negatively impacted my anxiety levels. There are many potential effects of PCOS, and when I thought a lot about the possibility of these affecting me in the future, I became scared and anxious.”
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(K4) “I learned most things by researching online; I didn’t get much information from my doctor. When I went to the doctor, they would just proceed with the treatment without much explanation…”
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(K6) “My doctor didn’t provide me with any information, not even about my diagnosis, which I only found out by checking the e-Nabız app. Because of this, I had to research online to understand my condition.”
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Doctors: (K2) “As I mentioned, I was already aware of PCOS because it was present in my family. After finding out I had PCOS, I did more detailed research, starting with the internet. When I went to see the doctor, I asked him about it. The doctor who diagnosed me also had PCOS and explained it to me, saying that there was no need to worry… Initially, I was anxious and worried, but after realizing that many others also had PCOS, my anxiety and worries decreased to a normal level.”
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(K3) “Every time I visit, the doctors explain PCOS to me. So, I know as much as they’ve explained. It used to affect my anxiety levels, but now I know that many women around me have this condition… Therefore, as my knowledge increased and I took care of myself, my anxieties and worries decreased.”
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(K5) “After being diagnosed, I naturally asked my doctor for information about PCOS. That’s how I initially learned about it.”
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Lack of Information: (K10) “I didn’t get much information from the doctor. They just mentioned that PCOS can cause issues like hirsutism and acne, but they didn’t explain much else. I had to look things up online myself. Honestly, I don’t know much; I only have some basic knowledge.”
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(K13) “I wasn’t given much information. They just told me I had this condition, and I’m now going for regular check-ups…”
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Close Contacts: (K16) “I did some research online, but I mainly talk to my cousin, who also has PCOS…”
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(K14) “Initially, I had some knowledge because my sister also has PCOS. Later, I did some research online to increase my awareness about the condition.”
Theme | Code | Participants | f |
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Source of information | Internet | K1, K2, K4, K6, K7, K8, K9, K10, K12, K14, K15, K16, and K17 | 13 |
Doctors | K2, K3, K5, K7, K8, K9, K11, K12, K14, K15, and K17 | 11 | |
Lack of information | K10 and K13 | 2 | |
Relatives | K14 and K16 | 2 |
4. Discussion
PCOS is a condition that affects not only women’s physical health but also their psychosocial health. Studies indicate that PCOS affects women’s health in multiple ways, both in the short and long term [11, 21]. Women diagnosed with PCOS carry significant psychological burdens along with hormonal changes and physical symptoms. The main reasons for these burdens include infertility concerns, body image concerns, and pressures from social expectations [22]. In this study, participants were asked, “What emotions did you experience when you were diagnosed with PCOS?” The responses predominantly described feelings of anxiety, sadness, concern about infertility, fear, and stress. The literature indicates that PCOS can lead to psychological disorders such as depression and anxiety in women [23]. It has been reported that anxiety symptoms are prevalent among women with PCOS [24], with high anxiety scores [25], and that women with PCOS experience anxiety due to fears of not being able to conceive [26, 27]. The results of this study are consistent with the literature, indicating that women with PCOS experience high levels of anxiety, as well as sadness, concern about infertility, fear, and distress.
Infertility is among the most common reasons for seeking medical help among women with PCOS. The underlying factors are often related to anovulation or irregular ovulation processes [28]. Fertility issues among women with PCOS can lead to anticipatory anxiety about whether they will be able to have children [29, 30]. It has been reported that women experience societal and familial pressure related to childbearing [16, 22]. In this study, when asked, “Did you experience anxiety regarding the ability to have children after being diagnosed with PCOS?” most women reported experiencing anxiety. The main reasons for this anxiety included concerns about infertility, information obtained from the Internet, societal pressure, irregular menstruation, and statements made by doctors. The literature review shows that in Pekince’s qualitative study, women expressed fear of not being able to have children and reported experiencing family pressure to conceive [16]. Similarly, Hadjiconstantinou et al.’s qualitative study also noted that women with PCOS experience anxiety about childbearing, findings that are consistent with the results of this study [30]. Women with PCOS generally experience anxiety about conceiving.
Another issue raised by the participants was the lack of adequate healthcare support. In this study, when participants were asked, “What are your sources of information about PCOS?” the majority mentioned the Internet, followed by doctors, close contacts, and a lack of information. The common experience among participants was that they became knowledgeable about PCOS after conducting online research. It was also noted that participants did not receive sufficiently detailed information about PCOS during their medical appointments. One participant mentioned that she found out about her PCOS diagnosis not from her doctor but by checking her personal information on the e-Nabız system after her appointment. Studies in the literature also indicate that individuals with PCOS often do not receive adequate information from healthcare professionals [31, 32], do not receive the expected support from healthcare services [33], and frequently experience disagreements with their healthcare providers [34]. In this context, the present study supports the literature, suggesting that healthcare professionals should take measures to strengthen the patient–doctor relationship to better support PCOS patients and address various dimensions of patients’ social support needs, such as informational and emotional support [33]. These research findings indicate that women with PCOS often obtain information about the condition from the Internet, which contributes to increased stress.
Studies show that women diagnosed with PCOS are dissatisfied with long-term counseling and treatment services related to both medical and psychological issues [35, 36]. In this context, it is crucial to incorporate mental health interventions into the treatment and care processes for PCOS, considering the psychosocial aspects of women’s health. Additionally, the role of society in this process is essential; awareness-raising campaigns and educational programs can encourage greater participation from women in treatment by providing information about the psychological effects of PCOS, thereby contributing to a more empathetic society [37]. To alleviate psychological burdens and successfully manage the treatment process, healthcare professionals must understand individuals’ challenges and adopt a sensitive, holistic approach. This can be achieved through a patient-centered approach, compassionate community support, and personalized counseling interventions [38–40].
5. Conclusion
This study highlights the emotions experienced by women with PCOS following their diagnosis, their concerns about childbearing, factors that exacerbate their anxiety, and their experiences with healthcare services. The findings can serve as a resource for developing preventive treatment protocols and contribute to improving women’s health. In this regard, the study could significantly contribute to the literature by helping to understand the emotions elicited by the disease in the target patient population and by informing the development of strategies for emotion regulation.
Consent
Written informed consent was obtained from the participants of the study to publish this paper.
Conflicts of Interest
The authors declare no conflicts of interest.
Author Contributions
H.Ö. drafted the research protocol. H.Ö., S.A., E.Ş., S.K., and E.G. contributed to the conceptualization and design of the study. S.A., E.Ş., and E.G. contributed to data collection. H.Ö. contributed to data analysis. H.Ö. and S.K. drafted the original manuscript. All authors contributed to the critical revision and approval of the final manuscript.
Funding
This study was supported by TÜBİTAK under program 2209 A (grant number B.14.2.TBT.0.06.01.00-221-408405).
Acknowledgments
We would like to express our gratitude to all the women who voluntarily participated in the study.
Open Research
Data Availability Statement
The authors do not have permission to share the data.