The Impact of the COVID-19 Pandemic on Health and Health Care Experience in Those With Polycystic Ovary Syndrome

Abstract

Purpose

Polycystic Ovary Syndrome (PCOS) is a complex endocrine-metabolic disorder and is associated with a variety of health disorders. The management of PCOS requires a multidisciplinary health care approach. The COVID-19 pandemic affected access and delivery of health care. The aim of this study was to assess the impact of the pandemic on the health and health care experience of those affected by PCOS.

Patients and Methods

An online survey was conducted January 2021 to July 2022 in Canada, open to anyone who identified as having PCOS. Data collected in REDCap included questions on demographics, symptoms, and experience of PCOS management during the pandemic.

Results

The majority (59%) of respondents (n=194, mean age 34±8 years) experienced pandemic-related employment changes and self-reported a high stress level (73±21/100). Of those who reported changes in body weight, 58% gained weight, which they attributed to unhealthy eating habits and a lack of exercise during the pandemic, and 16% lost weight, which they credited to increased physical activity and a shift towards healthier eating habits. The respondents ascribed the impact of COVID-related changes to clinic cancellations, delayed appointments, long wait times for referrals and lab work, lack of access to exercise facilities and insufficient social support. Some respondents voluntarily reduced access to health care services to limit COVID exposure. COVID-19-related health status was perceived as more important than their own PCOS-related symptoms. Virtual appointments via telehealth were regarded as beneficial for 20% of users.

Conclusion

Individuals with PCOS reported an overall reduction in COVID-related access to health care and supports. Some adapted to the use of telemedicine, while others experienced increased stress due to a lack of access to health care and an inability to manage their PCOS symptoms. The pandemic further highlighted that those with PCOS often experience a lack of accessibility to multidisciplinary health care and supports needed to manage their condition.

Plain Language Summary

Polycystic ovary syndrome (PCOS) is a complex disorder affecting up to 18% of women and can impact overall health and quality of life across the lifespan. It is characterized by irregular menstrual cycles, heavy menstrual bleeding, male-pattern hair growth, and acne due to excess production of male hormones. PCOS is associated with an increased risk of infertility, pregnancy complications, obesity, type 2 diabetes, cardiovascular diseases, and mental health disorders such as anxiety, depression, and negative self-image. Because of its complexity, PCOS requires a multidisciplinary health care approach including endocrinologists, gynecologists, dietician, exercise specialists, and psychologists/psychiatrists. In this paper, we describe the findings of a self-administered survey in those who self-reported having PCOS. The survey explores the patients’ view of the challenges in health care management during the COVID-19 pandemic. The COVID-19 pandemic caused disruptions in the delivery of health care and many patients struggled to find the support they needed. COVID-19 caused unprecedented challenges to the health care system but also presented opportunities for alternative health care delivery models. Our findings highlight the need to incorporate viable individualized and alternative care options for people with chronic conditions such as PCOS, to support self-management and prevent deterioration in health and well-being during times of unforeseen health crises. While the survey is restricted to respondents in Canada, the findings and proposed improvements provide distinct insights that are of international relevance as there is ample evidence of similar experiences regarding health care access and support during the COVID-19 pandemic around the world.

Introduction

Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder affecting 6–18% of women across their lifespan.^1–3 The diagnosis of PCOS includes menstrual-anovulatory dysfunction, clinical or biochemical hyperandrogenism and polyfollicular ovary morphology and is associated with a range of co-morbidities that impact health and well-being.^4–6 Those affected by PCOS have an increased prevalence of obesity, diabetes, cardiovascular disease, sleep apnea, and mental illness including anxiety and depression.^7–11 The management of PCOS requires multiple health care providers to address the symptoms and co-morbidities, including family physicians, endocrinologists, gynecologists, dieticians, psychologists, and other allied health care professionals; however, often the complex health care needs are not addressed in the health care system.^12–15 In Canada, we have reported that individuals with PCOS report significant delays in diagnosis, insufficient information and limited preventive care of comorbidities, lack of treatment support and referrals to health care specialists.¹² Similar findings on the lack of health care for those with PCOS have been reported worldwide.^{13,14,16–19}

The COVID-19 pandemic greatly affected the access and delivery of health care for all peoples. In individuals with complex health conditions such as PCOS, access to health care faced additional challenges due to COVID-related limitations and restructuring of health care delivery. Since the first Corona virus wave in March 2020, the health care system adapted to new regulations and needed to balance the increased demand of COVID-19 related care with that of all other illnesses.²⁰ In Canada and other countries, general practitioners and other outpatient providers were redeployed to in-patient services or compelled to provide in-person care for urgent cases only and turned to telemedicine or virtual care as an alternative in health care delivery.²¹ The risk of coronavirus infection prevented many with new or existing chronic health conditions from seeking medical attention, partly due to public health restrictions and individuals self-isolating to prevent the spread of infection. Mental illness including depression, anxiety, and sleep disorders rose during the COVID-19 pandemic and lockdown periods.^22,23 Fear of becoming infected, changes in employment status, and altered living conditions caused unprecedented stress levels for many people, particularly for those self-managing chronic health conditions like PCOS.^24,25

It is important to understand the effects of pandemic-related changes to health care services, delivery and supports for individuals with PCOS who already were experiencing inadequate access to health care. The aim of this study was to assess the impact of the COVID-19 pandemic on the health and health care experience of those living with PCOS.

Methods

Study Design and Survey

A cross-sectional study was conducted using an online survey open to individuals in Alberta, Canada, with a diagnosis of PCOS. The survey adhered to the Checklist of Reporting Results for Internet E-Surveys (CHERRIES) guidelines to ensure adequacy and transparency.²⁶ The survey was housed in the secure electronic data capture application REDCap.²⁷ Development of the survey has been described previously.¹² It included questions adapted from validated PCOS questionnaires on patient experience related to diagnosis, follow-up care and symptom management,¹³ and was pilot tested by PCOS patients and health care professionals who care for those with PCOS. An additional short component of the survey asked participants about PCOS-related health and health care experiences during the COVID-19 pandemic. The survey was introduced in January 2021, before the rollout of vaccines, and approximately nine months after COVID-19 was declared a pandemic and a national emergency in Canada, leading to substantial restrictions in human interaction including social distancing, masking, and employment layoffs, added responsibilities at home and work-from-home regulations.²⁸ The health care system adapted to the COVID-19 pandemic by deploying health care personnel to in-patient and urgent care including COVID wards, resulting in reduced health care access for non-COVID, chronic diseases and other non-life-threatening conditions.²⁹ Survey responses were collected until June 2022, by which time Canada had experienced five significant COVID-19 waves with peaks in May 2020, January, April and September 2021, and January 2022.²⁹ Responses to the COVID-19 pandemic-related changes in health and health care perceptions and experience were specified as prior to and post March 2020, when COVID restrictions were imposed.

Study Population

Survey participants were those who self-identified as living with PCOS following a diagnosis established by a family physician or other specialist clinician. Recruitment and participant inclusion criteria have been described previously.¹² The survey was anonymous but included clear consent information; completing the survey implied informed consent and included publication of anonymized responses and direct quotes. The study complies with the Declaration of Helsinki and was approved by the University of Alberta Health Research Ethics Board (Pro0095542).

Data Analysis

Descriptive analysis was applied to nominal questions, and open-ended questions were analyzed using qualitative content analysis.³⁰ Self-reported stress level during the COVID-19 pandemic was measured on a slider scale from 0 to 100, with 0 = no stress and 100 = maximal stress. Correlation analysis was used to assess the degree of the relationship between perceived stress level and employment status, and linear regression analysis was performed to identify the effect of age on the perceived stress level. For statistical analysis, we used IBM SPSS statistics version 27 with a value of p <0.05 considered statistically significant.

Results

Participant Demographics

From a total of 222 respondents, 194 were included in the analysis based on survey completion and residency in Canada. Of those, 193 identified as female, two as non-binary/gender fluid (one in addition to identifying as female), and 9 as LGBTQ+ (in addition to identifying as female). Respondents were an average of 34 [SD ± 8] years of age and were in a variety of employment settings, with over half of the respondents (58%) working full-time and 16% part-time; 14% of respondents were involved in full- or part-time study.¹² Employment status did not change for 38% of survey respondents after March 2020, when COVID-19 was declared a pandemic and COVID restrictions were imposed. The majority (59%) experienced some type of change to their employment status which included working from home (23%), layoff from their job (16%) or change to employment (8%). A few reported going on maternity leave (3%) or filing for disability (1.5%) (Table 1).

Table 1.

Participant Demographics and Employment Status Before and During the COVID-19 Pandemic

Participants n=194	Range	Mean ± SD
Age (years)	21–79	33.98 ± 8.36
Height (cm)	152–185	165.83 ± 6.95
Body weight (kg)	34.0–168.0	96.93 ± 26.90
Body mass index calculated (kg/m2)	14.6–61.6	34.90 ± 9.38
		N [%]
Employment status before the COVID-19 pandemic	Not employed Self employed Unpaid work Part-time/contract Full time work Part-time study Full-time study	25 [12.9] 17 [8.8] 3 [1.5] 31 [16.0] 112 [57.7] 7 [3.6] 20 [10.3]
Change in employment status during COVID-19 pandemic restrictions	Employment did not change Changed to working from home Laid off or lost my job Found other employment Othera	73 [37.6] 44 [22.7] 31 [16.0] 15 [7.7] 25 [12.9]

Notes: ^aOther included those on maternity (n=6) or disability (n=3) leave, stay at home moms (n=5), students studying online (n=4), those unemployed before and during the COVID-19 lock-down (n=3), and one retiree.

COVID 19-Related Changes in Body Weight, Eating Habits, and Exercise Regimes

The average body mass index (BMI) of respondents was 35 kg/m² (Table 1). Most of the respondents had body weight in the range of overweight (8%, BMI 25–29) or obesity (77%, BMI > 30). More than half of respondents (57%) reported changes in their body weight during the COVID-19 pandemic, with 31.4% experiencing weight gain. Fluctuation in body weight was reported in about 10% of respondents and 26% reported no changes to their body weight (Table 2). Respondents who gained weight attributed their weight increase mainly to pandemic-related shifts to unhealthy eating habits and reduced exercise and activity levels. Some respondents (9%, all except for two with a BMI >25) were able to lose weight during the pandemic, with most attributing this to healthier eating habits (72%, Figure 1A) and increased activity levels (61%, Figure 1B), including daily walks, regularly exercise, and yoga. Those with fluctuation in body weight reported initial weight gain followed by a reduction in weight or an initial loss of weight followed by weight gain; some respondents reported several cycles of body weight fluctuations. Most of those who stated no changes in body weight during the pandemic also did not perceive any changes in their eating habits (50%, Figure 1A) or exercise levels (80%, Figure 1B).

Table 2.

Impact of the COVID-19 Pandemic on Body Weight

Weight change during COVID-19 [N=194]	N [%]
My weight changed	110 [56.7]
● Gained weight	64 [33.0]
● Lost weight	18 [9.3]
● Fluctuating weight	20 [10.3]
● Pregnancy-related	8 [4.1]
My weight stayed about the same	50 [25.8]
Do not know, not monitored	13 [6.7]
Not responded	21 [10.8]

Figure 1.

(A) Change in eating habits during the COVID-19 pandemic. Data is derived from survey answers of respondents who provided information on changes in both, body weight and eating habits, since the start of the COVID-19 pandemic (March 2020). The percent of improved, worse, or unchanged eating habits is recorded for those reporting on gained, lost, fluctuate, or no change in body weight. (B) Change in exercise/activity levels during the COVID-19 pandemic. Data is derived from survey answers of respondents who provided information on changes in both, body weight and exercise/activity levels, since the start of the COVID-19 pandemic (March 2020). The percent of improved, worse, or no change in exercise or activity levels is recorded for those reporting on gained, lost, fluctuate, or no change in body weight.

Impact of COVID 19 Pandemic on Access to Health Care

Half of the respondents reported having visited a physician or other health care professional, mostly for follow-up visits related to their PCOS during the COVID-19 pandemic. One-third (34%) of respondents did not see a physician or health care professional related to their PCOS condition, and these respondents were more likely to report a worsening of eating habits and reduced exercise levels. Although 41% of respondents felt they needed to see a health care provider to manage their PCOS symptoms, these respondents were not able to do so due to COVID-19 restrictions and inability to access a physician. One respondent stated, “… the doctor I was seeing called and said he couldn’t see me due to restrictions” and “I tried to see my endocrinologist but they wouldn’t do in person appointments … and also wouldn’t refer me somewhere else”. Virtual medical appointments were only used by 14% of respondents, and 3.6% switched to other health care providers or services. About 40% of respondents indicated that COVID-19 pandemic and restrictions affected access to health care related to the management of their PCOS condition, whilst nearly 50% reported that the pandemic did not affect their PCOS-related health care.

Of the 48% who commented on their health care experience in open questions, most stated that the COVID-19 pandemic had a negative effect on the management of their PCOS condition (Table 3). Reduced access to clinics, cancelled appointments and extended wait times emerged as major reasons for their negative experiences. Respondent statements included “I’ve had multiple appointments to see my doctor cancelled due to COVID” and “I can’t get into anything. Urgent Referrals are being seeing months out from the submission date”. Lifestyle management was perceived to be more challenging for 12% of respondents during the COVID-19 pandemic. Responses included “not going to school, thus not walking daily, which seems like not a lot but had an impact on my wellbeing such as weight gain” and “staying on track for exercise is harder. And that’s screwing up my eating habits”.

Table 3.

Impact of the COVID-19 Pandemic on PCOS-Related Health Care Experience

Participants commenting in open questions, N=92	N [%]
Themes from open question: In what ways has the COVID-19 pandemic or restrictions affected your health care related to the management of your PCOS condition? a
Negative effect
● Reduced access to clinic care, limited clinic hours	25 [27.2]
● Cancellation, delays and longer wait times	22 [23.9]
● Challenges with lifestyle management (reduced exercise, challenges to maintain a healthy diet)	12 [13.0]
● Risk of Corona virus exposure	10 [10.9]
● Challenges of virtual telemedicine	8 [8.7]
● PCOS no longer considered important or urgent	7 [7.6]
● Reduced mental health/Covid-related stress	6 [6.5]
● Reduced information	1 [1.1]
No negative effect
● Adequate care/no change in care	19 [20.7]
● Appreciation of virtual telemedicine	2 [2.2]
● Enjoy extra time for self management	1 [1.1]

Notes: ^a Respondent answers could be grouped under more than one theme. Two respondents had no prior PCOS-related care and therefore could not compare their current care to pre-pandemic care.

Another reason for not seeking health care was to avoid potential coronavirus infection, exemplified in a respondent’s quote “weighing the risk of exposure”. While telehealth was offered to several respondents, most were not satisfied with the service. One survey participant felt that “phone appointments are extremely rushed and you feel pressured to let the doctor go as soon as possible”; another stated that “Specialist […diet and exercise…] appointments over phone are difficult at times”. Respondents said that they felt their PCOS condition was no longer considered important, as the COVID-19 pandemic was given priority in the health care system. Participant statements included, “I just feel as though PCOS is not an important thing at the moment as COVID is the only thing anyone cares about at this time” and “falling into the ‘not sick enough’ category for COVID precautions has directly impacted my ability to go to appointments and do bloodwork”.

Respondents expressed their stress related to the pandemic and feelings of reduced mental health, including comments such as “depression from being isolated, social anxiety getting worse from not exposing myself”. Some respondents stated that their PCOS condition was not managed and may have led to changes in mental health and body weight gain. This is exemplified in the following quote: “PCOS condition basically isn’t medically managed at all….it leads to depression, anxiety and weight gain”. The average stress level rating by respondents was 73.1 ± 20.7 [mean ± SD]; with 32% of respondents rating their stress level during the pandemic as >80 and 8% indicated the maximum stress level of 100. We did not find a difference in perceived stress levels with regard to COVID-related changes in employment status; however, stress levels were significantly dependent on age, with younger respondents reporting higher levels of stress during the pandemic compared to older respondents (R square: 0.02978, p = 0.034).

For the respondents who felt they did receive adequate care during the pandemic (Table 3), it was mostly due to pregnancy- related health care. Respondents stated “…. I have been pregnant (high risk) and was adequately monitored” and “I was pregnant for most of the pandemic. I feel my care was reduced in some ways due to limiting exposure to public, but in other ways my care increased to care for my baby and my health”.

Some respondents (15%) did not experience a change in care during the pandemic, and for over one-third of respondents (38%), this was primarily attributed to not being satisfied with their health care already prior to the pandemic. Respondents stated: “no [change because of pandemic], I haven’t been getting proper care before or after”, “they [health care] haven’t [changed]. They were poor then and they’re poor now” and “I don’t think COVID has affected PCOS supports at all, they were lacking before and they are just lacking now”.

In spite of the challenges in telemedicine, a few respondents appreciated receiving care via telehealth. Respondents stated… “given the fact that I have two small children at home, and living in a rural area, the ease of access to virtual appointments has increased, and I very much appreciate that. I have found that to be extremely helpful” and “I actually think it’s improved via virtual contact methods with family doctors such as Email and video calls or telephone calls”. One respondent found the extra time due to the COVID-19 pandemic restrictions were useful to help focus on self-management of PCOS symptoms: “it just gave me time to get reacquainted with myself and learn to eat better… hopefully, I can get to the next stage and add indoor exercise to the list”.

Discussion

There is evidence that the COVID-19 pandemic and isolation restrictions had a negative impact on health, health behaviors and health care, particularly in the early pandemic before vaccinations became available.^31–35 Employment changes such as lay-offs from work or changes to home-office work arrangements often resulted in behaviors with a detrimental effect on health in the general population, including decreased levels of physical activity and a more sedentary lifestyle.^36–38 In Canada, employment rates declined by nearly 20% compared to rates before the pandemic in January 2020 to May 2020.³⁹ Mandated public health restrictions limited in-person activities to reduce the spread of COVID-19. This included in-person outpatient and continuous care visits to clinicians. The high number of coronavirus infections, specifically in the first wave, demanded an initial shift in the health care system to focus on critically ill COVID-19 patients.

In many ways, the perceptions of those with PCOS in our survey echo the sentiment of the health care experience of the general population during the COVID-19 pandemic. Similarly to individuals in the general population, the majority of our survey respondents reported changes to their employment status to working from home or losing their job. The COVID-19 pandemic was associated with a worsening of eating habits, reduced physical activity and exercise, and weight gain in 30–40% of respondents, similar to findings in other populations.^38,40–43

Promotion of physical activity and regular exercise as part of a healthy lifestyle is a primary recommendation for individuals with PCOS.^44,45 While reduced physical activity levels were reported by a third of respondents, an equal number of respondents stated their exercise level was about the same as their level before the pandemic and 20% of respondents claimed an improvement in exercise and/or activity levels. We were not able to further explore the reasons for this range in findings; however, changes in physical activity appear to be dependent on individual circumstances. No change in physical activity levels could indicate respondents had low activity levels before the pandemic, or they had established exercise regimes that were not affected by the COVID-19 pandemic. These could have included home exercise routines and use of home work-out equipment and usual activities such as walking or running, which were able to be maintained during the pandemic.

COVID-19 restrictions and social isolation, together with the fear of coronavirus infection, had a tremendous impact on the mental health of populations, including psychological distress, anxiety and depression.^46,47 In Canada, almost half of the population reported experiencing increased stress associated with the pandemic in early 2021 compared to pre-pandemic levels.⁴⁸ Specific risk factors for decreased mental health during the pandemic in Canada and in other countries included the female sex, young adult age, preexisting conditions associated with higher odds of developing depression and anxiety, and higher COVID-19 infection risk.^48–50 These risk factors correlate with our findings that stress levels were higher among younger respondents.

PCOS is associated with an increased risk of depression and anxiety, related to self-worth, body image, body weight, and symptoms such as hirsutism and acne.^51–54 Increased depression and anxiety and high stress levels were reported by respondents in our survey. In addition, PCOS is associated with an increased risk of eating disorders and disordered eating patterns.⁵⁵ Stress may add to this risk and has been observed to lead to changes in appetite and food cravings that can impact food intake and body weight.^40,55–58 For women with PCOS, stress leading to food cravings can be especially worrisome as they commonly struggle with overweight and obesity.^55,59 Based on open comments, COVID-19 restrictions and social isolation caused a decrease in the ability to exercise and may have contributed to changes in eating habits and higher food intake, resulting in increased emotional stress and body weight concerns. As a consequence, this creates a vicious cycle of loss of control associated with altered eating habits, body image and weight gain concerns, resulting in decreased mental health and wellbeing. This is best described by one respondent: “My ability to self-manage my condition and self-regulate is difficult with the stress I’m experiencing during the pandemic. I feel like in order to manage my PCOS, I need to exercise regularly and try to maintain a lower carb/lower sugar diet. Being more isolated, sedentary at home, increased access to snack foods, and emotional eating in response to stress and anxiety is basically the perfect storm for someone with my condition”.

Many survey respondents noted that their PCOS-related health care needs had lost importance and were neglected during the pandemic. However, many respondents also stated access to health care was already challenging before the pandemic, and we recently reported on the barriers to health care in this PCOS population.¹² The perceptions and experiences of individuals with PCOS regarding changes in the health care system during COVID-19 were likely not that different from those of individuals without PCOS.⁶⁰ However, the consequences of disruptions in access to health care for PCOS patients may have a significant impact given they are at higher risk of adverse health outcomes, including psychological conditions, diabetes and cardiovascular disease.¹¹ In addition, those with PCOS have been reported to have a higher risk of COVID-19 infection and may display more severe symptoms and complications due to their endocrine-metabolic co-morbidities.^61–66 In respondents the additional barriers of COVID-related isolation restrictions, lack of continuous care, and the fear of exposure to coronavirus infection during the pandemic contributed to not being able to adequately manage their PCOS condition.

The COVID-19 pandemic caused unprecedented challenges to the health care system but also presented opportunities for alternative modes of health care delivery.^67,68 In Alberta, measures were initiated in response to the challenges including increased mobilization and training of health care staff, the introduction of new models of care, and the establishment of telemedicine to facilitate virtual outpatient visits via telephone or video. Evidence has shown that continuity of care and outpatient follow-up in Alberta was not affected by the COVID-19 pandemic due to the increased delivery of virtual care.⁶⁹

The pandemic situation highlights the importance of the provision of adequate health care so that health and wellbeing of vulnerable populations are less negatively affected in times of unforeseen health crises. Maintaining a high standard of care for those with complex chronic conditions, such as PCOS, is imperative during extended times of epidemic/pandemic outbreaks to prevent a deterioration of these conditions. For individuals with PCOS, continuous and multidisciplinary care is important in the management of symptoms and co-morbidity risks, and this can be easily compromised during pandemics. Alternative health care delivery such as telehealth and expert websites was reported by some respondents to be informative and supportive during the pandemic given social-distancing and restrictions on in-person clinic visits. As COVID-19 restrictions included temporary school closure and online schooling, many parents with school-aged children appreciated not having to leave home for work or clinic visits. Regular remote check-ups and customized health care information via the internet/health system for those with PCOS could be helpful in more effectively managing their health care and addressing concerns related to their negative perception that their condition is less important or their physician having less time for appointments. Provision of tools to support for self-efficacy and management of PCOS could aid in reducing stress levels and improve general health and well-being in order to counter any future public health crises. What we have learned from the pandemic is that those with PCOS are a vulnerable at-risk population and post-COVID-19, more attention needs to be paid to a multidisciplinary care for these patients, including resources dedicated to patient education and integrative models of care that support their health care needs.

During the pandemic, virtual care/telemedicine was adopted; however, health care providers and patients initially were not prepared for this new mode of health care delivery. The post-COVID-19 era has proven that the use of digital technologies has greatly improved access for people living in remote locations, especially in a vast country like Canada. In addition to ensuring equitable health care solutions, in the post-COVID-19 era there is a realization that telehealth is convenient for patients and has become an integral part of chronic disease management. Understanding the perspectives of individuals who are affected by PCOS will be helpful in developing further online education and effective telehealth delivery.

Limitations

The findings and interpretations of the survey are limited by self-reported PCOS status, recall bias, unverified statements of health conditions, self-perceptions of eating habits and exercise, and potential under-representation of the diverse PCOS population, which was dependent on survey access.¹² Our survey did not assess how the lack of access to health care through COVID-19 may have impacted health care related to specific areas such as menstrual difficulties, fertility treatment, hirsutism, and other PCOS-related symptoms. We also did not report on incidence or frequency of coronavirus infection in the respondents, and this may have impacted survey results. Our findings regarding the perceived shortcomings of access to health care during the pandemic may not be generalized to other PCOS populations in different global regions; however, other investigators have reported on the negative impact of pandemic-related lockdown measures and restrictions on sleep, mental health and physical wellbeing for individuals with PCOS.^70–73

Conclusion

Findings from our survey are similar to challenges encountered in the health care systems globally during the COVID-19 pandemic. There are continuous and complex health care challenges and needs for those with PCOS, and the impact on health and wellbeing appeared to be amplified during the pandemic. While some individuals seemed to be able to cope with changes and adjust, or even welcomed new procedures; others indicated experiencing additional stress and difficulties in self-managing their PCOS symptoms. As women and young adults have been identified as a population at higher risk for COVID-19-related stress, a patient-centered approach to health care for those with PCOS is required to overcome challenges related to PCOS management. Listening to their concerns and providing supports are imperative, so patients do not feel neglected by the health care system and are provided with the tools and resources to manage their disease, even during pandemic conditions. It is important for the health care system to incorporate viable individualized and alternative options for people with chronic conditions that need continuous management, such as PCOS, particularly during times of health care challenges to support self-management and prevent deterioration in health and well-being.

Funding Statement

This research has been funded by the Women and Children’s Health Research Institute (WCHRI) of the University of Alberta.

Data Sharing Statement

Complete survey data pertaining to the current study are available from the corresponding author in accordance with appropriate data use agreements.

Authors’ Information (Optional)

Dr. Donna Vine leads the PCOSTogether (https://pcos.together.ualberta.ca/) research and community outreach program at the University of Alberta. Dr. Vine contributes to knowledge translation and continuing medical education activities for the Canadian Society of Endocrinology and Metabolism.

Dr. Mahua Ghosh is an Associate Professor at the University of Alberta and a Royal College of Physician and Surgeons of Canada certified endocrinologist, who provides clinical care to people with PCOS at the Alberta Health Services/Kaye Edmonton Clinic. Dr. Ghosh is the Chair for Guidelines Committee of Canadian Society of Endocrinology and Metabolism.

Ethics Approval and Informed Consent

The study was approved by the University of Alberta Health Research Ethics Board; ID: Pro00095542. Informed consent was obtained from survey respondents.

Consent for Publication

Not applicable.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.