CHAPTER -II

REVIEW OF LITERATURE

 INTRODUCTION OF REVIEW OF LITURATURE

Review of literature is one of the most important steps in the research process. It is an
account of what is already known about particular phenomenon. The main purpose of literature
review is to convey to the readers about the work already done and the knowledge and ideas
that have been already established on a particular topic of research. A literature review is an
account of the previous efforts and achievement of scholars and researcher on a phenomenon.
Actually, it is of discursive prose, and not a least describing or summarizing one piece of
literature after another.

Before starting any research, a literature review of previous studies and experiences
related to proposed investigation has to be done. One of the most satisfied aspects of literature
review is the contribution it makes to the new knowledge, insight, and general scholarship of
the researchers.

 MEANING OF LITERATURE REVIEW

A review of literature is a description and analysis of literature relevant to particular field or

topic. It provides overview of what work already had been carried out, who are the key researcher
who did that work, which of the questions are already answered regarding a particular areas of
research interest, what methods and methodologies were used to answer the particular questions
and what are the prevailing theories and hypothesis. Literature review is defined as, “A broad,
comprehensive, in depth, systematic and critical review of scholarly publication, unpublished
printed or audio-visual materials and personal communications.”

 REVIEW OF LITERATURE HAS BEEN CATEGORIZED UNDER FOLLOWING

HEADINGS:
A. LITERATURE RELATED TO PCOD (POLYCYSTIC OVARIAN DISEASE)
B. LITERATURE RELATED TO KNOWLEDGE REGARDING PCOD (POLYCYSTIC
OVARIAN DISEASE)
 SECTION - A

LITERATURE RELATED TO PCOD

(POLYCYSTIC OVARIAN DISEASE)

Linda Kujanpää,Riikka K. Arffman,Paula Pesonen,Elisa Korhonen,Salla Karjula,Marjo-

Riitta Järvelin,Stephen Franks,Juha S. Tapanainen,Laure Morin-Papunen,Terhi T. Piltonen
(2022), conducted on Women with polycystic ovary syndrome are burdened with multimorbidity
and medication use independent of body mass index at late fertile age: A population-based cohort
study. women with polycystic ovary syndrome (PCOS) at age 46 years. The study revealed that,
Overall morbidity risk was increased by 35% (risk ratio [RR] 1.35, 95% confidence interval [CI]
1.16–1.57) and medication use by 27% [RR 1.27, 95% CI 1.08–1.50) compared with non-PCOS
women, and the risk remained after adjusting for body mass index. Diagnoses with increased
prevalence in women with PCOS were migraine, hypertension, tendinitis, osteoarthritis, fractures,
and endometriosis. PCOS was also associated with autoimmune diseases and recurrent upper
respiratory tract infections and symptoms. Interestingly, healthcare service use did not differ
between the study groups after adjusting for body mass index.the study concluded that, Women
with PCOS are burdened with multimorbidity and higher medication use, independent of body
mass index.

Megha Sharma, Meenakshi Khapre,  Vartika Saxena, and Pawna Kaushal (2021),

conducted on Polycystic ovary syndrome among Indian adolescent girls – A systematic review and
met analysis. Indian adolescent girls (14-19 years).the study revealed that, twelve studies were
included in the meta-analysis. The total number of participants in the study was 4473. All studies
scored average and above as per the NIH quality assessment tool. The prevalence of PCOS
among adolescents based on the Rotterdam criteria was 17.74 per 100 (CI = 11.77-23.71) with
I2 =97 %. Hospital-based studies had a comparatively higher prevalence of PCOS as compared to
community-based. The study concluded that, Pooled prevalence of PCOS among Indian
adolescents’ girls was high, approximately one in five.

Rao, Manisha Ms; Broughton, K. Shane PhD; Lemieux, Monique J.(2020),conducted on

Cross-sectional Study on the Knowledge and Prevalence of PCOS at a Multi-ethnic University,
even hundred sixty-nine respondents including 722 females and 47 males completed the
survey. ,the study revealed that, approximately, 28.5% of female respondents indicated a formal
diagnosis of PCOS, and 40.5% of those without a formal diagnosis had 2 or more symptoms that
align with PCOS. A majority of participants ranked their PCOS knowledge as “Know some” or less
(66.3% women and 83% of men). Healthcare professionals were the most common information
source in women with a PCOS diagnosis (83.7%). Hispanics were least likely to use healthcare
resources (36%) and to seek information from family and friends (17.6%). Differences were also
observed by education level.the study concluded that, Although women in this study recorded a
PCOS prevalence above the national average (6%–12%) and were more likely to seek information
from healthcare professionals, these numbers may have been skewed attributable to an increased
likelihood of polycystic women to respond to the questionnaire. Ethnicity and education need to be
accounted for in designing informative material for polycystic women and their family and friends.

Marzieh Saei Ghare Naz,1 Fahimeh Ramezani Tehrani,2 Giti Ozgoli (2019) the study
conducted on, Polycystic Ovary Syndrome in adolescents: a qualitative study, Fifteen adolescents
aged 13–19 years with PCOS participated the study revealed that, The analysis of the data helped
extract the main theme of the research as “dealing with PCOS”. The main theme consisted of
three themes and 12 sub-theme: (1) Escaping the problem (sub-themes: Adopting a forgetting
mindset, and concealment and minimization of the disorder); (2) Depressive mood (sub-themes:
Poor self-perception and low self-esteem, isolation, sleep disturbances, passive aggressive
behavior, emotional turmoil, feelings of humiliation, and adolescents’ perceptions); and (3) Coping
with the disease (sub-themes: Recovery of health, positive thinking, hope for recovery).the study
concluded that, In this study, the adolescents with PCOS showed a coping response to their
disorder in the form of problem-solving, developing a depressive mood or adjusting to the disorder.
Recognizing the mental health needs of these adolescents and improving their quality of life
require the identification of ways through which they deal with PCOS.

Zahra Behboodi Moghadam,  Bita Fereidooni, Mohsen Saffari & Ali Montazeri (2018).the

study conducted on, Polycystic ovary syndrome and its impact on Iranian women’s quality of life: a
population-based study.the study revealed that, The mean score for quality of life domains (from
the greatest to the least serious concern) were: infertility (3.43 ± 1.63), emotions (3.55 ± 1.17),
menstrual problems (3.77 ± 1.36), body hair (3.80 ± 2.05) and weight (4.32 ± 1.80), respectively.
The higher score represents better function. However, multivariate analysis revealed that hirsutism
had the strongest impact on the patients’ quality of life (p < 0.001) followed by infertility (p = 0.038)
and menstrual irregularity (p = 0.003).the study concluded that, impairment of quality of life was
associated with PCOS related conditions such as hirsutism, infertility and menstrual problems.

Amal Alessa, Dalal Alied, Sara Almutairi, etc.all (2017), conducted a cross- sectional study
to assess the level of knowledge of PCOS among 2000 women of age group (18-50) in Saudi
Arabia. The study revealed that the level of knowledge of PCOS was significantly related
higher educational level and woman with health college qualification. The study concluded that
there is a high level of awareness of PCOS among Saudi Arabia.
 Nitin Joseph, Aditya G.R.Reddy, Divya Joy, Vishakha patel, (2016), conducted a
cross sectional study to assess the proportion of university students with PCOS among 480
participants in Mangalore city in Karnataka state. The study revealed that 39 were already
diagnosed with PCOS, 40 were at high risk and 401 were at low risk for PCOS. The study
concluded that PCOS is a common disorder among young women in this setting and this
warrants provide screening activities.
.

BIBLIOGRAPHY

1) Linda Kujanpää,Riikka K. Arffman,Paula Pesonen,Elisa Korhonen,Salla Karjula,Marjo-Riitta

Järvelin,Stephen Franks,Juha S. Tapanainen,Laure Morin-Papunen,Terhi T. Piltonen.
Women with polycystic ovary syndrome are burdened with multimorbidity and medication
use independent of body mass index at late fertile age: A population-based cohort study.
Volume101, Issue7July 2022, First published: 08 June 2022Pages 728-736.
https://doi.org/10.1111/aogs.14382
2) Megha Sharma,  Meenakshi Khapre,  Vartika Saxena, and Pawna Kaushal (2021), Polycystic
ovary syndrome among Indian adolescent girls – A systematic review and metanalysis.
International library of medicine,Received 2021 Jul 17; Revised 2021 Sep 23; Accepted
2021 Sep 26. PMCID: PMC8560138,PMID: 34733568, Published online 2021 Sep
30. doi: 10.3126/nje.v11i3.38460

https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.14382

3) Rao, Manisha MSa; Broughton, K. Shane PhD b; LeMieux, Monique J.(2020), Cross-
sectional Study on the Knowledge and Prevalence of PCOS at a Multiethnic University.
Address reprint requests to Monique J. LeMieux, PhD, Department of Nutrition and Food
Sciences, Texas Woman’sUniversity, Denton, TX. E-mail: mlemieux@twu.edu Progress in
Preventive Medicine: June 2020 - Volume - Issue - p e0028,doi:
10.1097/pp9.0000000000000028
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8560138/
4) Marzieh Saei Ghare Naz,1 Fahimeh Ramezani Tehrani,2 Giti Ozgoli (2019) Polycystic
Ovary Syndrome in adolescents: a qualitative study Psychology Research and Behavior
Management 2019:12 715–723
https://www.dovepress.com/polycystic-ovary-syndrome-in-adolescents-a-qualitative-study-
peer-reviewed-fulltext-article-PRBM#
5) Zahra Behboodi Moghadam,  Bita Fereidooni, Mohsen Saffari & Ali Montazeri (2018).,
Polycystic ovary syndrome and its impact on Iranian women’s quality of life: a population-
basedstudy.BMCWomen'sHealth 18, 164(2018).Received20,Published11October2018.http
 s://doi.org/10.1186/s12905-018-0658-1
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0658-1#Sec6

6) Amal Alessa, Dalal Aleid, Sara Almutairi, Razan AlGhamdi, Noura Huaidi, Ebrahim
Almansour, Sheren Youns Awareness of polycystic ovarian syndrome among Saudi
females.Faculty of Medicine, Princess Nora Bint Abdul Rahman University, Riyadh,
Saudi Arabia.International Journal of Medical Science and Public Health 2017 | Vol 6 |
Issue 6 Received: January 16, 2017; Accepted: February 07, 2017
http://www.ijmsph.com/fulltext/67-1486420204.pdf

7) Nitin Joseph, Aditya G.R.Reddy, Divya Joy, Vishakha patel, (2016), cross sectional study to
assess the proportion of university students with PCOS among 480 participants in
Mangalore city in Karnataka state. Journal of Natural Science Biology and Medicine July
20167(2):166. july 2016 | Vol 7 | Issue 2.DOI:10.4103/0976-9668.184704
(PDF) Study on the proportion and determinants of polycystic ovarian syndrome among
health sciences students in South India (researchgate.net)
SECTION - B

LITERATURE RELATED TO KNOWLEDGE REGARDING PCOD

(POLYCYSTIC OVARIAN DISEASE)

Vitoria Melo,Thomas Silva,Thaissa Silva,Juliana Freitas,Joselita Sacramento,Mirian

Vazquez andEdilene Araujo (2022).conducted on, Omega-3 supplementation in the treatment of
polycystic ovary syndrome (PCOS) – a review of clinical trials and cohort.the study revealed that,
Altogether, 96 articles were obtained without duplicates. After reading the titles and abstracts, 21
studies were selected. The main reason for excluding the articles was the non-adequacy to the
proposed theme or studies done on animals or in vitro conditions. After the reading completing, 21
articles remained in the study, which met the criteria established (Figure 1). The average time for
clinical trials in this review endured from 6 to 12 weeks (only two articles lasted 6 months) and an
average of 63.7 women participated in the study. The age of these women ranged between 18 and
45 years. Out of the 21 clinical trials, 12 used fish oil as a source of omega-3 supplementation; 2
used omega-3 fat associated with vitamin E; 2 used linseed oil; 3 used linseed oil associated with
vitamin E; and 2 used fish oil and linseed oil in the same study. Parameters associated with PCOS
were analyzed, such as lipid, glycemic, hormonal profiles, and inflammation and oxidative stress
biomarkers, and anthropometric parameters.the study concluded that, ow any direct benefits of the
omega-3 supple-mentation in PCOS, this fatty acid clearly promotes indirect benefits by improving
the metabolic profile associated with the disease. However, due to the great heterogeneity of the
studies, it became difficult to standardize the dosages and the time of use. However, more efficient
results could be noticed in the lipid and glycemic profiles with dosages between 1200 to 1500 mg
of the fish-oil EPA+DHA/day, 800 mg of ALA/day or 400 mg of ALA+400 IU of vitamin E from oil
linseed during the same time between 8 and 12 weeks. As for the androgenic profile, the dosage
of 1200 to 1500 mg of EPA+DHA seems to be necessary for a longer period, i.e. 6 months of use.
As for the anthropometric profile, the studies analyzed in women with PCOS are scarce and
incongruous regarding the benefits from weight loss and/or body fat. For the antioxidant profile and
biomarkers of the inflammatory process, positive results were observed for the reduction of CRP
and regulation of PPAR-γ gene expression with different doses above 12 weeks of use. Since the
results are promising, further studies should be performed with better-defined standards regarding
the dosage and the supplementation time.

Anuradhaa Subramanian, Astha Anand, Nicola J Adderley, Kelvin Okoth, Konstantinos A Toulis,
Krishna Gokhale, Christopher Sainsbury, Michael W O’Reilly, Wiebke Arlt, and Krishnarajah
Nirantharakumar(2021)conducted on, Increased COVID-19 infections in women with polycystic
ovary syndrome: a population-based studyThe study revealed that, We identified 21 292 women
with a coded diagnosis of PCO/PCOS and randomly selected 78 310 aged and general practice
matched control women. The crude COVID-19 incidence was 18.1 and 11.9 per 1000 person-
years among women with and without PCOS, respectively. Age-adjusted Cox regression analysis
suggested a 51% higher risk of COVID-19 among women with PCOS compared to women without
PCOS (HR: 1.51 (95% CI: 1.27–1.80), P < 0.001). After adjusting for age and BMI, HR reduced to
1.36 (1.14–1.63)], P = 0.001. In the fully adjusted model, women with PCOS had a 28% increased
risk of COVID-19 (aHR: 1.28 (1.05–1.56), P = 0.015).the study concluded that, Women with PCOS
are at an increased risk of COVID-19 infection and should be specifically encouraged to adhere to
infection control measures during the COVID-19 pandemic.

S. Budharam, S. Veeramreddy, D. S. Goluguri and A. Rajani(2020) conducted on a study on

identification of risk factors of polycystic ovarian syndrome by conducting survey and minimizing
them through patient counselling and its impact on quality of life, o make awareness about PCOS
among young subjects, the study revealed that, Results indicated that there is 26.9% in the age
group of 16-20 years and 36.4% in the age group of 21-25 years and 31.2% in the age group 26-
30 years of surveyed girls were having PCOS symptoms. In our study in the age group of 16-20
years, 12% of the females were found to be with oligo ovulation, 6.08% with anovulation, and 8.8%
with hirsutism. In the age group of 21-25 years, 20% were found with oligoovulation, 7% with
anovulation, and 11.6% with hirsutism. In the age group of 26-30 years, 12.5% with oligoovulation,
6.25% with anovulation, and 12.5% with hirsutism. Conclusion: Thorough knowledge of the
disorder and counselling for adolescents should be included in the curriculum, which will provide
awareness towards the disorder and lifestyle modifications. Accurate diagnosis at a younger age.

Ritu Deswal,Smiti Nanda,Veena S. Ghalaut,Prasanta S. Roy,Amita S. Dang (2019).the study

conducted on, Cross-sectional study of the prevalence of polycystic ovary syndrome in rural and
urban populations. To assess the prevalence and risk factor profile of polycystic ovary syndrome
(PCOS) in Haryana, India. study was conducted among women of reproductive age in Haryana
between December 2015 and May 2017.the study concluded that, Among total 2400 women
screened, 94 (4.21%) had PCOS. The PCOS phenotypes were 30% clinical HA (hirsutism, H),
64% biochemical HA, 35% PCO, 16% H+MI, 10% MI+PCO, 52% MI+HA, 14% PCO+H, and 19%
PCO+H+HA. Overall, 67 (71%) of the women with PCOS resided in urban regions and 27 (29%) in
rural regions. The study revealed that, the women with PCOS, a considerably higher proportion
resided in urban regions of Haryana. The difference may be attributed to lifestyle and dietary
factors. Ignoring PCOS may put women at risk of serious long-term health consequences that are
difficult to manage. Lifestyle changes and continuous surveys should be promoted for better
management.

A.Aarthi,(2019).the study conducted on, a study to assess the effectiveness of video assisted
teaching programme on awareness and attitude regarding early identification and management of
polycystic ovarian syndrome among adolescent girls in selected colleges at Madurai. The study
result showed that, in control group, pretest mean score of awareness was 11.43 ±3.07 the
posttest mean score was 12.27±sd 2.65, the mean difference was 0.84. the obtained “t” value was
1.85, which was not statistically significant. • in experimental group, pretest mean score of
awareness was 11.70 ±2.48 the posttest mean score was 21.03±sd 1.42, the mean difference was
9.33. the obtained “t” value was 29.90, which was statistically highly significant. in control group
posttest mean score of attitude was 53.27±5.48. in experimental group posttest mean score was
73.77±4.94, the mean difference was 20.50. the obtained “t” value was 15.20, which was
statistically highly significant.the study concluded that, video teaching is effective by improving the
awareness and attitude among adolescent girls.

Claire Brutocao , Feras Zaiem , Mouaz Alsawas , Allison S Morrow , M Hassan Murad , Asma

Javed (2018) . Psychiatric disorders in women with polycystic ovary syndrome: a systematic review
and meta-analysis.The study revealed that, 57 studies reporting on 172,040 patients. The majority
of studies addressed depression and anxiety. Studies had fair methodological quality although
most estimates were unadjusted. Women with PCOS were more likely to have a clinical diagnosis
of depression (odds ratio (OR), 2.79; 95% CI, 2.23-3.50), anxiety (OR, 2.75; 95% CI, 2.10-3.60),
bipolar disorder (OR, 1.78; 95% CI, 1.43-2.23) and obsessive compulsive disorder (OCD) (OR,
1.37; 95% CI 1.22-1.55), but not social phobia or panic disorder. Using various scales, the severity
of symptoms of depression, anxiety, obsessive compulsive disorder, and somatization disorders
were higher compared to women without PCOS.the study concluded that, PCOS is associated
with an increased risk of diagnosis of depression, anxiety, bipolar disorder, and obsessive
compulsive disorder. It is associated with worse symptoms of depression, anxiety, OCD, and
somatization. Screening for these disorders to allow early intervention may be warranted.

Anitharajendra babu, Mini Abraham (2017).the study conducted on, Effectiveness of Planned

Teaching Programme regarding Polycystic Ovarian Disease among Adolescent Girls. The results
showed that, 52 (86.67%) of the adolescent girls had inadequate knowledge, 08 (13.33%) had
moderate knowledge, and none of them had adequate knowledge on polycystic ovarian disease
in  pre-test, whereas in post-test 07 (11.67%) had moderate knowledge, 53(83.33%) had adequate
and none of them had inadequate knowledge regarding Polycystic Ovarian Disease. The
concluded that Planned teaching Programme was effective to create awareness and to increase
knowledge among the adolescent girls..

Khushbu Patel(2017).the study conducted on, A Study to Assess the Effectiveness of Planned
Teaching Program on Polycystic Ovarian Syndrome in Terms of Knowledge and Attitude among
Adolescent Girls in Selected Higher Secondary Schools of Ahmedabad City. the study result
showed that, Adolescent girls had inadequate knowledge (76.67 %) and (23.33%) had moderately
adequate knowledge in pre-test after planned teaching program 48.33 % had moderately
adequate knowledge, 50.00% had adequate knowledge and 1.66% had inadequate knowledge.
Regarding the attitude level 80% of Adolescent girls had unfavourable attitude and 20 % had
favourable attitude in pre-test. In post-test 55% had favourable attitude and 45 % had
unfavourable attitude. Paired‘t’ test was applied to compare pre-test and post-test mean and
standard deviation. Knowledge and attitude level of Adolescent girls on Polycystic ovarian
syndrome was statistically significant. There was significant association between pre-test
knowledge and attitude with demographic variables such as Age, Age of menarche, Stream of
study and family income per month. which was statistically confirmed with chi-square test.
 section b
1) Vitoria Melo,Thomas Silva,Thaissa Silva,Juliana Freitas,Joselita Sacramento,Mirian
Vazquez andEdilene Araujo (2022).conducted on, Omega-3 supplementation in the
treatment of polycystic ovary syndrome (PCOS) – a review of clinical trials and cohort.
Published Online: 18 Feb 2022,Volume & Issue: Volume 56 (2022) - Issue 1 (January
2022),Page range: 66 - 79
DOI: https://doi.org/10.2478/enr-2022-0008
https://sciendo.com/article/10.2478/enr-2022-0008

2) Anuradhaa Subramanian, Astha Anand, Nicola J Adderley, Kelvin Okoth, Konstantinos A Toulis,
Krishna Gokhale, Christopher Sainsbury, Michael W O’Reilly, Wiebke Arlt, and Krishnarajah
Nirantharakumar(2021), Increased COVID-19 infections in women with polycystic ovary
syndrome: a population-based study. 2021 May;184(5):637-645.
PMID: 33635829,PMCID: PMC8052516,DOI: 10.1530/EJE-20-1163
Increased COVID-19 infections in women with polycystic ovary syndrome: a population-based study
- PubMed (nih.gov)

3) S. Budharam, S. Veeramreddy, D. S. Goluguri and A. Rajani(2020) conducted on a

study on identification of risk factors of polycystic ovarian syndrome by conducting
survey and minimizing them through patient counselling and its impact on quality of life,
o make awareness about PCOS among young subjects. Department of Pharmacy
Practice, MNR College of Pharmacy, Sangareddy, Telangana, India. Published: 01
November 2020
DOI: 10.13040/IJPSR.0975-8232.11(11).5747-52
https://ijpsr.com/bft-article/a-study-on-identification-of-risk-factors-of-polycystic-ovarian-
syndrome-by-conducting-survey-and-minimizing-them-through-patient-counseling-and-
its-impact-on-quality-of-life/
4) Ritu Deswal,Smiti Nanda,Veena S. Ghalaut,Prasanta S. Roy,Amita S. Dang (2019). Cross-
sectional study of the prevalence of polycystic ovary syndrome in rural and urban
populations. First published: 20 June 2019
https://doi.org/10.1002/ijgo.12893

5) A.Aarthi,(2019). a study to assess the effectiveness of video assisted teaching Programme

on awareness and attitude regarding early identification and management of polycystic
ovarian syndrome among adolescent girls in selected colleges at Madurai.
http://repository-tnmgrmu.ac.in/18721/1/300306919aarthi.pdf
6) Claire Brutocao , Feras Zaiem , Mouaz Alsawas , Allison S Morrow , M Hassan
Murad , Asma Javed (2018) . Psychiatric disorders in women with polycystic ovary
syndrome: a systematic review and meta-analysis. 2018 Nov;62(2):318-
325,PMID: 30066285,DOI: 10.1007/s12020-018-1692-3
Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-
analysis - PubMed (nih.gov)

7) Anitharajendra babu, Mini Abraham (2017).the study conducted on, Effectiveness of

Planned Teaching Programme regarding Polycystic Ovarian Disease among Adolescent
Girls. Assistant Professor, Department of Obstetrical and Gynaecological Nursing,
Rajalakshmi College of Nursing, Accepted on 28.03.2017,DOI: 10.5958/2454-
2652.2017.00030.0.
https://ijanm.com/HTMLPaper.aspx?Journal=International%20Journal%20of%20Advances
%20in%20Nursing%20Management;PID=2017-5-2-9
8) Khushbu Patel(2017).the study conducted on, A Study to Assess the Effectiveness of
Planned Teaching Program on Polycystic Ovarian Syndrome in Terms of Knowledge and
Attitude among Adolescent Girls in Selected Higher Secondary Schools of Ahmedabad City.
J Nur Today 2016Vol. 3 Issue 2 Published:15.03.2017.
http://www.jolnt.com/volume3-second-issue/v3-i2-(v2-i1-7)-p-50-61.pdf