The main aim of this study is to explore health-related quality of life (HRQoL) among women with polycystic ovary syndrome (PCOS) before and after DCI treatment. Among study sample of thirty-eight women with confirmed PCOS we evaluated basic characteristics of study population, metabolic profile and score form self-reported HRQoL before and after three-months DCI supplementation.
PCOS is characterized by oligo-anovulation, clinical and biochemical hyperandrogenism and polycystic ovary (22–26). The huge psychological problems in women with PCOS are infertility and aesthetic problems, which affect most of these patients. Also, these chronic symptoms are the main reasons why women seek for treatment. In the basis of these clinical disorders and objective dysfunction, the crucial problem for functioning women with PCOS is psychological disorders and lower life style (13, 27, 28). In that sense, this study evaluated the changes in self-evaluation of current life style and symptoms related to ovarian dysfunction, even that we know the laboratory and clinical evaluation results. Definitely, chronic disorders such as PCOS may have major effects on the quality of life that need to be precisely assessed (14–19).
We used HRQoL as a valuable instrument and appropriate test in evaluating health related quality of life in women with PCOS. In comparison with other instruments, our instrument is a multidimensional concept used to describe physical, emotional and social aspects of particular diseases and their treatments. Also, this HRQoL can be used as specific and general tool. Cronin et al used HRQoL in cross-sectional study for measuring the quality of life in women with PCOS aged between 18–45 years (29). Other authors, such as Wong et al, used instrument for examining the relative impact of PCOS on quality of life (32), while the Trent et al used a specific questionnaire for evaluating the life style in adolescents with PCOS (33). There are also other used questionnaires, such as instrument which examine the sexual satisfaction in women with PCOS (34, 35), instrument that evaluate the infertile PCOS women with different ethnic and cultural backgrounds or using the laser on the severity of hirsutism etc (36).
In our study, item’s score related to menstrual problems and emotions differed the most, so we can observe that the use of DCI had the greatest impact on the intensity of menstrual problems, and thus the existence of primary emotions in this regard. Also, the feelings related to changes in body weight of the participants also differed after a three-month period, which does not have to be a consequence of the applied supplementation, because we know that there was no change in body weight.
Namely, a statistically significant difference was observed in the occurrence of menstrual problems before and after three months of treatment with DCI, while there were no changes in other domains of HRQoL. Interestingly, supplementation led to the alleviation of menstrual problems in most subjects which could not be a placebo effect of DCI.
Overall, PCOS has a negative impact on the HRQoL of women in reproductive period. Weight, hirsutism, infertility and menstrual problems appeared to be most affected rather than areas of physical functioning. Definitely, all HRQoL measurements taken before DCI treatment were worse in comparison with the status after treatment in the same group of women with PCOS. This difference was not reflected in the baseline characteristics of the participants because we used the same group, and that is the best way to observe and conclude some effects of any treatment.
Other study conducted by Yanan Li et al, systematically reviewed the literature to identify the impact of PCOS on specific health-related quality of life domains. They used standard SF-36 questionnairre and include physical functioning, body pain, general health, vitality, social function, emotional role function and mental health. Conclusion of this meta-analysis showed that women with PCOS score lower in each dimension of the SF-36, mostly in the emotional role function (37).
Furthermore, other meta-analysis evaluated the differences between two therapy strategies in women with PCOS on quality of life over the time and after treatment. Misso et al (38) determined and compared the effectiveness of metformin and clomiphene citrate for improving fertility outcomes in women with PCOS and a BMI < 32 kg/m2. They concluded that still there is insufficient evidence to establish a difference between metformin and clomiphene citrate in terms of ovulation, pregnancy, live birth, miscarriage and multiple pregnancy rates, as well as quality of life.
Also, Lim et al (39) concluded that lifestyle intervention may improve the free androgen index (FAI), weight and BMI in women with PCOS, but on the other side they were uncertain of the effect of lifestyle intervention on glucose tolerance. Large meta-analysis conducted on Forty-six studies, including 30,989 participants compared the mental health of women with and without PCOS. The results of this study have indicated that women with PCOS suffer from depression, anxiety, and experience a lower quality of life, whereas their sexual function is not distinct from that of healthy women. Psychological health care interventions for women with PCOS were addressed (39, 40).
Evidence supports that the PCOS is a common, reproductive endocrinopathy associated with serious short- and long-term health risks. In that case, there is many ingestible complementary medicines for potential treatment of PCOS. Literature data suggested that there is some positive primary endpoint of inositol administration on menstrual regulation. On the other hand, vitamin D and calcium supplementation have no significant beneficial effects on hormonal status and hyperandrogenism (41).
Sarris et al investigated the effects of adjuvant therapy on mental disorders. They concluded that treatment with inositol, zinc, folic acid, vitamin C, and tryptophan, was nonsignificant in reducing the symptoms of depressive disorders and improving quality of life in general (42).
Evidence from study which included 1291 participants with PCOS supported the thesis that inositol supplementation has some certain advantages in improving of ovarian function and glycolipid metabolism in comparison with other available nutraceuticals. Based on that data, inositol but not specified which type, could be effective in improving of quality of life in the same time (43).
Definitely, we are strongly support that DCI treatment could improve some aspects of life style of women with PCOS, especially regarding menstrual irregularity. Future research is needed to identify ways to improve communication between women with PCOS and their doctors, particularly around the diagnosis and potential for infertility. Finally, doctors need to be more aware of the emotional and psychological impact of PCOS upon women’ HRQoL and of the potential for poor general health through risk-taking behaviors that may occur due to the potential loss of fertility.
Limitation of this study lie in the small number of participants, but taken into the account that the following and selecting of the similar group of women with the same type of PCOS is very difficult, it is justified then. Although the number of missing questionnaires was small, some form of selection bias cannot be ruled out. This difference was not reflected in the baseline characteristics of the participants because we used the same group, and that is the best way to observe and conclude these beneficial effects of DCI treatment.