Abstract
Background and objectives:
Polycystic Ovarian Syndrome (PCOS) is one of the most common endocrine disorders in fertile women. Limited data exists regarding Palestinian’s women awareness and understanding about PCOS. Therefore, we conducted this study to assess the knowledge, awareness and health-related practices of PCOS amongst the Palestinian women.
Material and methods:
Our cross-sectional study was conducted among the female population of Palestine, over the age of 18 years. The convenience sampling method was used to select the participants. A self-constructed questionnaire was used to interview regarding PCOS knowledge, awareness, causes, symptoms, prevention, complication and treatment. The date entry and statistical analysis was performed on STATA (V1).
Results:
A total of 1374 participants were randomly selected and invited to participate, most of them agreed, resulting in a response rate of 99.7%. The largest age group was 25–34 years (36.2%), followed by 18–24 years (33.5%). Awareness of the term PCOS had a mean score of 1.33 (SD = 0.74), indicating that most participants had heard of PCOS. Age was significantly associated with PCOS awareness (F = 3.67, P = 0.007), with participants aged 35–44 years having the highest mean awareness score (M = 1.87, SD = 0.64). Marital status also showed a significant association with awareness (F = 9.30, P = 0.001), as did residency (t = 3.30, P = 0.001). Educational level demonstrated a significant impact on awareness (F = 51.34, P = 0.001), and current work status was another significant factor affecting awareness (F = 52.22, P = 0.001).
Conclusion:
The level of PCOS awareness in the study sample was generally less substantial and inadequate in accuracy. As a result, increasing awareness of PCOS among females in the Palestine is crucial for promoting early diagnosis and improving patient outcomes.
Keywords: hormonal imbalance, hyperandrogenism, infertility, ovarian disorder, polycystic ovarian syndrome
Background
Polycystic Ovarian Syndrome (PCOS) is the most common gynecological endocrinopathy that affects women of reproductive age worldwide with an estimated prevalence of 4%–20%[1]. The variation, in prevalence rates across studies can be attributed to the lack of diagnostic criteria[1]. Additionally, PCOS is often associated with obesity and metabolic syndrome[2]. Despite the established presence of obesity and metabolic syndrome in Palestine[3-5] there is data on the prevalence of PCOS specifically, in this geographic region.
HIGHLIGHTS
Polycystic Ovarian Syndrome (PCOS) is a common endocrinopathy in reproductive-aged women, with awareness and knowledge about it notably deficient in Palestine.
Factors like age, marital status, education, and residency significantly influenced PCOS awareness, emphasizing the need for targeted educational interventions.
Early diagnosis and management of PCOS are crucial to preventing severe complications, yet public misconceptions hinder timely medical attention.
Raising PCOS awareness through community programs and reliable information sources is essential for improving health outcomes.
The guidelines established by the Endocrine Society advocate for the utilization of the Rotterdam criteria as the standard for diagnosing PCOS in females. According to these criteria, a diagnosis of PCOS is confirmed when a minimum of two out of the following three criteria are met: hyperandrogenism, ovulatory dysfunction (characterized by either oligo- or anovulation), and the presence of morphologically polycystic ovaries. Both hyperandrogenism and ovulatory dysfunction manifest as clinical symptoms, while the existence of polycystic ovaries can be discerned through ultrasound examination[6,7]. Consequently, the clinical presentation plays a pivotal role in the diagnosis of PCOS, underscoring the significance of awareness and understanding of the condition’s symptoms and signs.
The clinical presentation of PCOS often does not raise immediate concern for many women. In the case of young adolescents, symptoms such as weight gain, acne, menstrual irregularities, and atypical hair distribution can easily be misconstrued as typical issues associated with puberty[8]. As a result, the condition may go unnoticed until more severe complications arise, with infertility being the primary reason why most patients eventually seek medical attention[9]. Additionally, PCOS has been linked to a heightened risk of developing endometrial cancer, type 2 diabetes mellitus, and cardiovascular diseases[10]. In other age groups, such as perimenopausal women, the presence of menstrual irregularities and expected weight gain may obscure the symptoms of PCOS[11]. This often leads to a recurring pattern where PCOS patients are inadequately assessed and frequently misdiagnosed[12,13].
It is evident that early diagnosis of PCOS allows for more straightforward management compared to the more intricate management required in the later stages of the condition[14]. However, it is worth noting that awareness of PCOS is deficient among both healthcare professionals and the general female population[9].
Several studies encompassing multiple ethnic groups have revealed a notably higher prevalence of PCOS among females of Mediterranean descent[15]. Nonetheless, a comprehensive literature review has uncovered a significant deficiency in the investigation of PCOS prevalence in the Middle East and North Africa (MENA) region. There is a clear gap in the existing body of literature, with limited and outdated articles available on this subject. Moreover, the studies conducted in this region often suffered from constraints such as small sample sizes, non-probability sampling methods, and vague diagnostic criteria. Among the studies identified, only one ventured to assess the regional prevalence of PCOS in the MENA region, reporting a point prevalence of 2079.7 cases per 100 000 in 2019[16]. Additionally, a handful of papers examined local prevalence rates in countries such as Qatar[17], Oman[18], Egypt[19,20], Iran[20], and Syria[21]. For the Gulf region, there are a total of seven articles in the Gulf Council Countries (GCC) addressing PCOS prevalence in the literature as of 2022, with one study conducted in the UAE[22]. To date, only one study conducted in 2020 has specifically examined the prevalence of PCOS in Palestine[23].
A limited number of studies have explored PCOS awareness in the MENA region, either as their primary focus or as a secondary objective[24-28]. In general, these studies consistently reported alarmingly low levels of awareness regarding PCOS[25-27,29]. Notably, most of these investigations revealed that females exhibited the least awareness of PCOS-related complications. This is a cause for concern, as the fear of enduring irreversible complications may serve as a significant motivator for individuals to seek early medical assistance.
Despite the increasing global recognition of polycystic ovarian syndrome (PCOS) as a significant health concern affecting women, there remains a conspicuous gap in the literature concerning the awareness of PCOS among females in Palestine. The dearth of research addressing this issue in the Palestinian context is particularly striking. While the prevalence of PCOS has been examined to a limited extent in this region, a comprehensive exploration of PCOS awareness, which is vital for early diagnosis and prevention of complications, has been notably lacking. As evident from the existing literature, there is a paucity of studies that have delved into the knowledge and understanding of PCOS among Palestinian women. This knowledge gap underscores the need for the present study to bridge the information void and enhance our comprehension of the awareness levels of this syndrome among Palestinian females. Therefore, this study was undertaken to assess the level of PCOS awareness among females in Palestine. It also seeks to shed light on factors that could influence their knowledge and comprehension of this syndrome.
Methods and material
Study design and questionnaire
Our study included females residing in Palestine, aged 18 and above, who spoke English or Arabic. Any visiting female who is not a resident of Palestine was excluded. A questionnaire, based on information retrieved from Medscape and other similar articles was designed to assess the participants knowledge, awareness and understanding regarding PCOS.
The questionnaire had a total of 21 close-ended questions which were divided into four distinct categories: (a) participant demographics, (b) previous experience, (c) knowledge and awareness regarding PCOS, and (d) source of information. Under demographics, participants were acquired about their age, marital status, education, current work status, field of study, residency and governorate followed by a question if the participant is familiar with the term “polycystic ovarian syndrome and/or PCOS.” In previous experience, they were asked if they have ever been diagnosed with PCOS and/or know someone diagnosed with the condition. Under knowledge and awareness regarding PCOS category, participants were acquired about various aspects of the disorder including its characteristic signs or symptoms, causes, prevention, complications and management. Participants reflecting substantial awareness were further evaluated for the accuracy of their knowledge. Multiple mixed options were provided to choose from for each question including “yes”/“no”/ “I am not sure.” Toward the end of the questionnaire, the participants were eventually asked about their source of information by ticking various options which included: family, friends, social media, medical professionals, and/or awareness campaigns. The questionnaire was designed in both Arabic and English so participants can fill it according to their own preference. It was also pilot tested which depicted that the estimated time to complete the form was about 5–6 minutes.
Sample size was calculated using 4p(1-p)/ME2 equation, in which n = sample size, p = prevalence, and ME = marginal error. A total of 1370 participants were recruited in the final study. A non-probability convenience sampling was employed to select the female participants. They were interviewed by the female members of the research team ensuring cultural norms and comfort of the participants in answering questions. Informed consent was taken, keeping the participation of the volunteers completely anonymous and giving them the right to withdraw from the study at any stage.
Statistical analysis
The statistical analysis was performed using STATA (V17). Descriptive statistics were generated, including means and standard deviations for continuous variables, and percentages for categorical variables. Bivariate associations between categorical variables were assessed using the chi-squared test, while differences in continuous variables were examined through the independent t-test and Analysis of Variance (ANOVA). The statistical significance of the connection has been established to be P < 0.05.
Results
Descriptive information
A total of 1370 individuals participated, with the largest age group being 25–34 (36.2%), followed by 18–24 (33.5%). A smaller percentage of participants were aged 35–44 (17.1%), 45–54 (12.3%), and only 0.9% were 55 years or older. In terms of marital status, most participants were married (65.9%), while 30.1% were single, with smaller groups being divorced (1.3%) or widowed (2.6%). Educational attainment varied, with over half of the participants (52.6%) holding a diploma or bachelor’s degree, 23.3% having completed high school, and 13.6% having a middle school education. A small proportion (3.7%) pursued higher studies, and only 1.3% did not attend school.
Regarding employment, 52.7% of participants were unemployed, 31.2% were employed or retired, and 16.1% were students. As for the field of work or study, 19.4% were in the medical field, 38.2% were in non-medical fields, and 42.4% did not respond. In terms of residency, the participants were almost evenly divided between urban (51.8%) and rural (48.2%) areas. Most respondents came from Bethlehem (25.18%) and Hebron (19.93%), with smaller proportions from Jerusalem (6.13%), Ramallah (12.04%), Jericho (13.36%), and other governorates (Table 1).
Table 1.
Participants characteristics (N = 1370)
| Age N(%) | |
| 18–24 | 459 (33.5%) |
| 25–34 | 497 (36.2%) |
| 35–44 | 234 (17.1%) |
| 45–54 | 168 (12.3%) |
| 55 and above | 12 (0.9%) |
| Marital status N (%) | |
| Single | 414 (30.1%) |
| Married | 903 (65.9%) |
| Divorced | 18 (1.3%) |
| Widowed | 35 (2.6%) |
| Educational level N (%) | |
| Did not enter school | 18 (1.3%) |
| Primary school | 73 (5.3%) |
| Middle school | 187 (13.6%) |
| High school degree/high school diploma | 319 (23.3%) |
| Diploma/bachelor’s degree (University) | 722 (52.6%) |
| Higher studies | 51 (3.7%) |
| Current work status N (%) | |
| Student | 222 (16.1%) |
| Employed/Retired | 427 (31.2%) |
| Unemployed | 721 (52.7%) |
| Field of work/study N (%) | |
| Medical | 266 (19.4%) |
| Non-medical | 523 (38.2%) |
| No answer | 581 (42.4%) |
| Residency N (%) | |
| Rural | 661 (48.2%) |
| Urban | 709 (51.8%) |
| Governorate N (%) | |
| Jerusalem | 84 (6.13%) |
| Bethlehem | 345 (25.18%) |
| Hebron | 273 (19.93%) |
| Jericho | 183 (13.36%) |
| Nablus | 138 (10.07%) |
| Qalqilya | 6 (0.44%) |
| Ramallah | 165 (12.04%) |
| Jenin | 128 (9.34%) |
| Tubas | 8 (0.58%) |
| Tulkarem | 16 (1.16%) |
| Others | 24 (1.75%) |
Participant awareness toward PCOS questionnaire scores
According to an analysis of the questionnaire score, the awareness of the PCOS term has a mean of 1.33 (SD = 0.74), indicating that most participants had heard of PCOS. However, fewer participants personally knew someone diagnosed with PCOS, with a mean of 1.68 (SD = 0.74), and the diagnosis of PCOS among the participants themselves had a mean of 2.01 (SD = 0.57), suggesting that the majority had not been diagnosed. Participants generally had a moderate understanding of the signs of PCOS. Awareness of menstrual irregularities as a symptom had a low mean of 1.04 (SD = 0.27), indicating high knowledge, while knowledge of fever as a symptom was lower (mean = 2.03, SD = 0.76), reflecting misconceptions. The mean scores for other symptoms, such as excessive facial hair (mean = 1.25, SD = 0.59), acne/oily skin (mean = 1.34, SD = 0.66), and weight gain (mean = 1.24, SD = 0.57), demonstrated varying degrees of awareness.
Participants showed relatively higher knowledge of the causes of PCOS, with a mean of 1.41 (SD = 0.49). Specific causes such as genetics (mean = 1.57, SD = 0.78) and hormone overproduction (mean = 1.16, SD = 0.51) were more commonly recognized, while aging and lack of sleep were less frequently identified. For the prevention, there was uncertainty, with a mean of 1.93 (SD = 0.78) suggesting that many participants were unsure if PCOS could be prevented. However, they largely agreed that healthy exercise (mean = 1.26, SD = 0.43) and a good diet (mean = 1.09, SD = 0.38) were effective prevention methods. The knowledge of complications of PCOS was moderate (mean = 1.69, SD = 0.85), with infertility (mean = 1.28, SD = 0.45) being the most recognized complication, while back pain (mean = 2.17, SD = 0.64) and asthma (mean = 2.10, SD = 0.74) were less frequently associated with PCOS. Participants were uncertain about PCOS treatment (mean = 2.20, SD = 0.59), although a healthy diet (mean = 1.10, SD = 0.31) and physical exercise (mean = 1.16, SD = 0.50) were viewed as viable treatments. Surgery (mean = 1.19, SD = 0.54) and tablets (mean = 1.69, SD = 0.79) were also recognized, while chemotherapy (mean = 1.19, SD = 0.54) and traditional herbs (mean = 1.62, SD = 0.80) were less commonly perceived as treatments (Table 2).
Table 2.
Distribution of participant awareness toward PCOS (N = 1370)
| Statement | Mean | SD | Min | Max |
|---|---|---|---|---|
| Have you ever heard about PCOS term? | 1.33 | 0.74 | 1 | 3 |
| Do you know anyone who is diagnosed with PCOS? | 1.68 | 0.74 | 1 | 3 |
| Have you ever been diagnosed with PCOS? | 2.01 | 0.57 | 1 | 3 |
| Do you know what are the signs/features of PCOS? | 1.34 | 0.75 | 1 | 3 |
| Do you know that the PCOS symptoms: | ||||
| A. Menstrual irregularities | 1.04 | 0.27 | 1 | 3 |
| B. Hight temperature (Fever) | 2.03 | 0.76 | 1 | 3 |
| C. Excessive facial hair | 1.25 | 0.59 | 1 | 3 |
| D. Ance/ oily skin | 1.34 | 0.66 | 1 | 3 |
| E. Diarrhea | 2.23 | 0.59 | 1 | 3 |
| F. Weight gain | 1.24 | 0.57 | 1 | 3 |
| Do you know what are the causes of PCOS? | 1.41 | 0.49 | 1 | 3 |
| What you think causes PCOS: | ||||
| A. Genetics (run in the family) | 1.57 | 0.78 | 1 | 3 |
| B. Overproduction of hormones | 1.16 | 0.51 | 1 | 3 |
| C. Aging | 1.95 | 0.66 | 1 | 3 |
| D. Food type | 1.51 | 0.75 | 1 | 3 |
| E. Lack of sleep | 1.71 | 0.78 | 1 | 3 |
| Can PCOS be prevented? | 1.93 | 0.78 | 1 | 3 |
| What you think applies to prevention: | ||||
| A. Healthy exercise | 1.26 | 0.43 | 1 | 3 |
| B. Good diet | 1.09 | 0.38 | 1 | 3 |
| C. Vaccine | 1.11 | 0.66 | 1 | 3 |
| D. Weight control | 2.07 | 0.69 | 1 | 3 |
| E. Good hygiene | 1.15 | 0.48 | 1 | 3 |
| F. Stop smoking | 1.15 | 0.76 | 1 | 3 |
| Do you know what are the complications of PCOS? | 1.69 | 0.85 | 1 | 3 |
| What do you think applies to complications? | ||||
| A. Infertility | 1.28 | 0.45 | 1 | 3 |
| B. Vision problems | 1.10 | 0.40 | 1 | 3 |
| C. Back pain | 2.17 | 0.64 | 1 | 3 |
| D. Uterine cancer | 1.40 | 0.70 | 1 | 3 |
| E. Heart diseases | 1.70 | 0.85 | 1 | 3 |
| F. Asthma | 2.10 | 0.74 | 1 | 3 |
| Can PCOS be treated? | 2.20 | 0.59 | 1 | 3 |
| What you think applies to treatment: | ||||
| A. Healthy diet | 1.10 | 0.31 | 1 | 3 |
| B. Physical exercise | 1.16 | 0.50 | 1 | 3 |
| C. Surgery | 1.19 | 0.54 | 1 | 3 |
| D. Tablets | 1.69 | 0.79 | 1 | 3 |
| E. Chemotherapy | 1.19 | 0.54 | 1 | 3 |
| F. Traditional herbs | 1.62 | 0.80 | 1 | 3 |
Participant response
Figure 1 is showing compares the percentages of individuals who are “Assumed Aware” versus “Actually Aware” across five categories: Symptoms, Causes, Prevention, Complication, and Treatment. In each category, the orange bars represent the “Actually Aware” percentages, while the yellow bars show the “Assumed Aware” figures. Notably, in categories such as “Symptoms,” “Prevention,” and “Complication,” the assumption of awareness (yellow) is higher than the actual awareness (orange). For example, 75.69% of individuals assume they are aware of “Complications,” but only 24.31% are actually aware. This highlights a significant gap between perceived and actual knowledge, with a similar trend observed across all categories.
Figure 1.
Participants knowledge on each PCOS aspect.
Figure 2 illustrates the perceived relationship between various preventive methods and their effectiveness, categorized as either “Related” (in yellow) or “Unrelated” (in red). Preventive methods like “Healthy exercise” (96.4%) and “Good diet” (99.2%) were overwhelmingly seen as related to health, while “Vaccines” showed a contrasting result, with 87.3% perceived as unrelated. Other methods such as “Weight control” (83.2% related), “Good hygiene” (66.2% related), and “Stop smoking” (58.2% related) also show significant support as related preventive measures, although their unrelated percentages suggest some variation in public perception. This chart highlights which methods are more widely accepted as effective for prevention.
Figure 2.
Frequently was each preventive method chosen.
Participant perception of the relationship between various health complications and their relevance to health concerns, categorized as “Related” (in yellow) and “Unrelated” (in red). Conditions like “Infertility” (96.9%) and “Back pain” (88.6%) were mostly viewed as related, while “Vision problem” (65.2%) and “Asthma” (84.8%) were predominantly considered unrelated. The complications “Uterine cancer” (77.0% related) and “Cardiovascular problems” (59.3% unrelated) demonstrate mixed views. The chart highlights significant variation in how the public perceives the relevance of different health complications, with some conditions, like infertility, being overwhelmingly seen as related, while others, such as asthma, are viewed as largely unrelated (Fig. 3).
Figure 3.
Frequently was each complication chosen.
Figure 4 illustrates participant perception of the relationship between various preventive methods and their health relevance. “Healthy diet” (97.0%) and “Physical exercise” (97.7%) are overwhelmingly seen as related to health, while “Chemotherapy” (83.5%) is viewed as unrelated by most respondents. “Surgery” is somewhat split, with 68.8% viewing it as related and 31.2% seeing it as unrelated. Other methods, such as “Tablets” (90.8% related) and “Traditional herbs” (72.9% related), show stronger support as health-related preventive measures. This chart highlights that while some traditional and medical interventions are largely accepted, others like chemotherapy face skepticism regarding their relevance in prevention.
Figure 4.
Frequently was each preventive method chosen.
Figure 5 displays the frequency with which various sources of information were chosen. “Medical professionals” (30.7%) were the most frequently chosen source, followed by “Family or friends” (27.9%), indicating that personal relationships and professional advice are the primary sources of health-related information. “Media (TV/Internet/Social media/etc.)” was also a significant source, chosen by 17.9% of respondents. Other combinations of sources, such as “Media and Medical professionals” (5.0%) and “Campaigns” (3.6%), were less frequently chosen, suggesting that while mass communication channels play a role, personal and professional connections dominate.
Figure 5.
Frequently was each source of information chosen.
Comparing PCOS average scores based on participants’ information
Table 3 presents the association between participant characteristics and their awareness average of polycystic ovary syndrome (PCOS).
Table 3.
Association between participant characteristics and their average awareness
| M±SD | Statistical evaluation | ||
|---|---|---|---|
| t/f | P-value | ||
| Age | |||
| 18–24 years | 1.73 ± 0.55 | ||
| 25–34 years | 1.72 ± 0.55 | ||
| 35–44 years | 1.87 ± 0.64 | 3.67 | 0.007* |
| 45–54 years | 1.85 ± 64 | ||
| ≥55 years | 1.74 ± 0.56 | ||
| Marids status | |||
| Single | 1.65 ± 0.46 | ||
| Married | 1.80 ± 0.61 | 9.30 | 0.001* |
| Divorced | 1.78 ± 0.70 | ||
| Widowed | 2.05 ± 0.73 | ||
| Residency | |||
| Rural | 1.81 ± 0.61 | 3.30 | 0.001* |
| Urban | 1.71 ± 0.54 | ||
| Education level | |||
| Did not enter school | 3.0 ± 0.01 | ||
| Primary school | 2.06 ± 0.75 | ||
| Middle school | 2.07 ± 0.70 | 51.34 | 0.001* |
| High school degree/High school diploma | 1.83 ± 0.62 | ||
| Diploma/bachelor’s degree (University) | 1.60 ± 0.41 | ||
| Higher studies | 1.57 ± 0.47 | ||
| Current work status | |||
| Student | 1.64 ± 0.45 | ||
| Employed/Retired | 1.58 ± 0.41 | 52.22 | 0.001* |
| Unemployed | 1.91 ± 0.66 | ||
| Field of work/ study N (%) | |||
| Medical | 1.49 ± 0.28 | ||
| Non-medical | 1.70 ± 0.52 | 64.43 | 0.001* |
| No answer | 1.94 ± 0.67 | ||
t: t-test, F: one-way ANOVA.
Age was significantly associated with the awareness of PCOS (F = 3.67, P = 0.007). Participants aged 35–44 years had the highest mean awareness score (M = 1.87, SD = 0.64), while those aged 25–34 years had the lowest (M = 1.72, SD = 0.55). This indicates a notable variation in awareness across age groups. On the other hand, marital status also showed a significant association with awareness (F = 9.30, P = 0.001). Widowed participants had the highest mean awareness score (M = 2.05, SD = 0.73), while single participants had the lowest (M = 1.65, SD = 0.46), suggesting that marital status may influence awareness or understanding of PCOS. Additionally, residency significantly impacted awareness (t = 3.30, P = 0.001). Participants from rural areas had a slightly higher mean awareness score (M = 1.81, SD = 0.61) compared to those from urban areas (M = 1.71, SD = 0.54).
For educational level, the result demonstrated a significant association with awareness (F = 51.34, P = 0.001). Participants who did not attend school had the highest awareness score (M = 3.0, SD = 0.01), while those with a diploma or bachelor’s degree had lower scores (M = 1.60, SD = 0.41). This result suggests that educational background influences the awareness of PCOS.
Regarding current work status, the result shown was another significant factor (F = 52.22, P = 0.001). Unemployed participants had a higher awareness score (M = 1.91, SD = 0.66) compared to students (M = 1.64, SD = 0.45) and employed/retired participants (M = 1.58, SD = 0.41), indicating that employment status might affect awareness. Finally, the field of work or study showed a significant association (F = 64.43, P = 0.001). Participants in the medical field had the lowest mean awareness score (M = 1.49, SD = 0.28), while those in non-medical fields and those who did not respond had higher scores, suggesting that individuals in the medical field may have a more informed awareness of PCOS.
Discussion
Our study aimed at assessing the knowledge and awareness of female participants of Palestine regarding Polycystic Ovarian Syndrome (PCOS). Most of the participants had adequate awareness of PCOS as a term and moderate understanding of its signs and symptoms. They also depicted substantial knowledge of the causes and complications of the condition however, remarkably insufficient understanding of its treatment. The PCOS awareness was also observed to vary across age groups, marital status, educational level and residence. Most of the participants acquired their information from medical professionals while the awareness through campaigns came last. Our study, therefore, mainly indicates the imperative need of promoting knowledge and awareness about PCOS among the female population of Palestine.
Overall, the PCOS awareness mean was 1.33 (SD = 0.64), reflecting relatively high knowledge in majority of the participants about the disorder. However, a low proportion of the participants were diagnosed with PCOS or knew someone who had received the diagnosis of the condition. PCOS is a complex, multifaceted disorder which is often difficult to diagnose[30]. The diagnosis of PCOS is largely based on clinical observation and certain biomarkers of ovarian and metabolic dysfunction.[30,31] Therefore, a potential reason for our findings can be inadequate identification of clinical symptoms in diagnosing PCOS due to its complex nature and overlapping features with other ovarian and metabolic conditions.[31] Hence, it is pertinent to develop concrete interpretation of PCOS and its symptoms for full diagnostic picture, in order provide early and relevant interventions, especially among this population.
Our study showed a varying degree of awareness regarding each aspect of PCOS amongst the participant population. For each aspect, there was a significant gap observed between “Assumed Aware” with “Actually Aware.” The largest difference was seen for the complications of PCOS which was about 51.4% and smallest difference was seen for signs and symptoms. This indicates an evident gap in the understanding of PCOS among the participants, therefore, reiterating the need of promoting PCOS awareness and management.
A vast majority of the participants believed that healthy exercise and good diet can be important measures for prevention of PCOS, and vaccines are largely an ineffective method to prevent PCOS. However, there were mixed perceptions regarding weight control and stop smoking as useful ways of prevention of PCOS. Lifestyle changes including cessation of smoking and weight loss in obese women are utmost important recommendations for the prevention of PCOS.[32]. Several studies have shown that an estimated 5–10% weight reduction in overweight females can regulate menstrual cycles and ovulation[33,34]. Overall, it plays a vital role in improving pregnancy and other metabolic effects in PCOS patients[32]. This signifies that although participants identified effective prevention methods of PCOS, there remains ambiguity and misconceptions for various other preventive methods of smoking and weight loss. Such misconceptions can lead to longer untreated disease course with complications and increasing dissatisfaction of the patients[12].
Around 97% of the participants agreed that infertility is a major complication of PCOS, as it can cause psychological concerns and stress, further aggravating a patient’s quality of life[35]. Nevertheless, a large proportion of participants falsely believed back pain as a potential complication of PCOS. Moreover, cardiovascular risk is greatly increased with PCOS including coronary artery disease and stroke, but a vast majority was unaware regarding it (59.3%). CVD risk screening remains crucial in PCOS patients, as alleviation in CVD risk and improvement in metabolic profile is attainable via a combination of lifestyle modifications and pharmacotherapy[36]. Many people only seek medical attention when complications occur and thus, such lack of awareness can lead to prolonged time to reach a definite diagnosis, leading to risk of further complications and psychological distress. Therefore, awareness and knowledge regarding it holds utmost importance in the management of PCOS patients.
Most of the participants collectively agreed healthy diet and physical exercise as primary options for the management of PCOS. About three-quarters of the participants believed that traditional herbs can potentially cure PCOS. This can be explained by the cultural beliefs and norms amongst Palestinians in the management of various gynecological illnesses by herbal remedies, including infertility and hormonal imbalances[37]. Unfortunately, most of these herbal remedies lack scientific evidence of effectiveness in PCOS patients. There were mixed views regarding surgery as the viable treatment option for PCOS. It is important to note that PCOS is largely managed through lifestyle modifications and certain pharmacotherapies. Surgery, through laparoscopic ovarian drilling is only considered in patients resistant to drug treatment or fertility problems unresponsive to medical therapy. The mixed response gathered through this option exhibited lack of knowledge of participants about when to use lifestyle modifications or drug therapy and/or surgery for PCOS treatment. A few participants (16.5%) also chose chemotherapy as a treatment of choice for PCOS. Since PCOS occurs due to endocrine dysfunction and is non-malignant and non-cancerous, these participants depicted inadequate awareness regarding the nature of PCOS and its pathophysiology. These options were added to better understand the accuracy of knowledge of the participants in this study.
As for the sources of knowledge, most of the participants chose medical personnel as their primary source of information followed by family and friends. A combination of media and medical professionals and campaigns were reported as less likely source of information, signifying that personal or professional communication played a major role compared to mass media in providing information. To improve reliable information access to the general population, it is crucial not only to educate them about the syndrome but to ensure provision of accurate knowledge and education by the medical professionals, which are more likely used by the people for their source of information. Other than this, intervention measures other than campaigns should be employed to increase the awareness regarding PCOS amongst the community.
Our study also observed that the knowledge regarding PCOS varied across age groups, marital status, work, residence and education level. For instance, the awareness amongst rural areas was less compared to urban areas. Similarly, medical students had better awareness and knowledge about the disease compared to non-medical students. Hence, it is pivotal to target the population deprived of the knowledge of PCOS and take measures to increase availability of information to them. As for those who showed good awareness, it is important to take fruitful steps in improving the accuracy of education they have regarding the syndrome.
Raising awareness about PCOS in the community can encourage potential patients to seek medical care and obtain early diagnoses. This can lead to timely interventions that are both cost-effective and more beneficial for improving patients’ quality of life. Implementing community-wide educational programs and campaigns on PCOS, along with support groups, can provide the population with accurate and reliable information. These initiatives may seem simple, but they can significantly help reduce the burden of PCOS on both patients and the healthcare system.
Limitations
The choice of sampling method was limited by the fact that the data collectors were medical students at the time. A non-probability convenience sampling approach was used to interview females over 18. As a result, the generalizability of the study findings may be affected. Therefore, it is essential to conduct a similar study on a national level for more widely applicable results. Additionally, due to this limitation, most participants in our sample were within the 18–34 age range, which may not accurately reflect the views of other age groups. Furthermore, a small number of individuals declined to participate in the interviews, resulting in a lack of recorded responses from them and potentially introducing biases into the findings. Future research should focus on employing a more diverse sampling method and increasing participation rates to better capture a wider range of perspectives and experiences. Efforts should also be made to ensure representation from various age groups and demographic backgrounds to improve the validity and relevance of the results on a broader scale.
Conclusion
In conclusion, there is a lack of substantial awareness about PCOS among the study participants. The knowledge demonstrated by the sample likely mirrors a broader deficiency in the general population, which may discourage potential patients from seeking necessary medical care and failing to prevent disease progression. Fortunately, the serious complications associated with PCOS can be effectively prevented through early diagnosis and management, which further reiterates the importance of the awareness of the syndrome among potential patients.
Footnotes
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Published online 27 March 2025
Contributor Information
Oadi N. Shrateh, Email: oadi.shrateh@students.alquds.edu.
Eisha Waqar, Email: eishawaqar15@gmail.com.
Ahmad R Al-Qudimat, Email: AAlQudimat@hamad.qa.
Saba Alrojoub, Email: ibanader99@gmail.com.
Rahmeh Deek, Email: Rahmadeek0@gmail.com.
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Ethical approval
None.
Consent
None.
Sources of funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors..
Author’s contribution
O.N.S. conceived the idea; S.R., R.D., Y.A., M.H., A.A.R., A.A., M.A.Z., M.R., B.M.H., L.A.A., and A.S. collected the data; A.R.A. performed the statistical analysis; O.N.S., E.W., and A.R.A. did write up of the manuscript; and finally, O.N.S. and M.N. reviewed and revised the manuscript for intellectual content critically. All authors approved the final version of the manuscript.
Conflicts of interest disclosure
The authors declare that they have no competing interests.
Research registration unique identifying number (UIN)
None.
Guarantor
None.
Provenance and peer review
None.
Data availability statement
The data used to support the findings of this study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data used to support the findings of this study are available from the corresponding author upon reasonable request.