Predictive factors of health-related quality of life in patients with polycystic ovary syndrome: a structural equation modeling approach

Objective: To determine association between health-related quality of life (HRQOL) and psychosexual variables in patients with polycystic ovary syndrome (PCOS). Design: Cross-sectional study. Setting: Two private gynecology clinics. Patient(s): A sample of 300 women with PCOS were entered into the study and were subdivided into three groups: hyperandrogenism (HA) and PCO morphology; menstrual dysfunction and PCO morphology; menstrual dysfunction and HA and/ or PCO morphology. Then each patient completed the following questionnaires: the Hospital Anxiety and Depression Scale, the Body Image Concern Inventory, the Rosenberg Self-Esteem Scale, the Short-Form Health Survey, and the Female Sexual Function Index. Intervention(s): None. Main Outcome Measure(s): Both direct and indirect relationships among clinical symptoms, psychologic status, self-esteem, body image, and sexual function as independent predictors of HRQOL were examined with the use of structural equation modeling analysis. Result(s): The clinical variables and psychologic distress had the strongest indirect relationships with HRQOL in the HA phenotype. The highest effect of PCOS symptoms on HRQOL impairment in patients with menstrual irregularities along with HA and patients with menstrual irregularities along with polycystic ovaries was exerted by clinical variables, poor perception of self-worth, negative body image, and sexual dysfunction. Conclusion(s): In patients with various phenotypes of PCOS, the effects of mediating variables on HRQOL are different. In patients with PCOS, the findings suggest that mediating factors, especially psychologic distress, self-esteem, body image, and sexual function, play an important role and should be taken into consideration and adequately treated if present. (C) 2013 by American Society for Reproductive Medicine.