BACK GROUND OF THE STUDY:

Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder in women of reproductive age, characterized by oligo/anovulation, hyperandrogenism, and polycystic ovarian morphology. Its global prevalence ranges from 2.2% to 26%, and it is associated with long-term risks including type 2 diabetes, cardiovascular disease, dyslipidemia, endometrial cancer, and non-alcoholic fatty liver disease. Diagnosis is based on criteria like the Androgen Excess Society (2006), Rotterdam, and NIH standards, which require ruling out other conditions.^3,4,5 Management includes pharmacological treatments such as insulin sensitizers and anti-androgens, as well as lifestyle interventions like diet, exercise, and weight reduction. Advanced options like IVF, in vitro maturation, and embryo cryopreservation may be considered to address fertility while avoiding complications like ovarian hyper stimulation syndrome OHSS⁵.

Structured teaching programs have been shown to significantly improve awareness and attitudes toward PCOS and infertility. In a study by Priya Chouhan¹, knowledge scores increased from 13.69 to 32.05 among 100 female students’ post-intervention. Similarly, Ravina Patel² observed improved knowledge and more positive attitudes among 60 college students, with statistically significant changes. These educational interventions proved effective across different demographics. Additionally, a cross-sectional study by McCook⁶using the PCOSQ found that obesity had the greatest impact on the health-related quality of life of 128 women with PCOS, followed by concerns about menstruation, infertility, emotions, and body hair. This underscores the psychological burden of PCOS and the vital role of nursing in holistic care.

A qualitative study focusing on the impact of hyperandrogenism in young women is crucial as it provides a deeper understanding of the emotional, psychological, and social challenges faced by individuals affected by the condition. Qualitative research methods, such as interviews or focus groups, offer participants a platform to share their personal experiences, revealing emotional and psychological struggles that may be overlooked in quantitative studies. This approach not only helps healthcare providers deliver more holistic care that addresses both physical and emotional needs but also empowers young women by giving them a voice in the healthcare process. Additionally, qualitative studies can raise awareness, reduce stigma, and improve support systems, thereby enhancing the overall well-being of those affected by hyperandrogenism and PCOS.⁷

AIM:

Exploring the impact of clinical signs of hyperandrogenism among young female adults qualitatively at selected colleges in Madurai.

PHENOMENOLOGY:

Phenomenology, rooted in a philosophical tradition developed by Husserl and Heidegger, is an approach to discovering the meaning of people's life experiences. Phenomenological researchers ask: What is the essence of this phenomenon as experienced by these people? What does it mean? Phenomenologists investigate subjective phenomena in the belief that critical truths about reality are grounded in people's lived experiences .⁸

RESEARCH QUESTION:

What is the impact of hyperandrogenism on young female adults?

OBJECTIVE:

To explore the impact of clinical signs of hyperandrogenism among young female adults.

RESEARCH METHODOLOGY:

Research Approach and Research Design:

A qualitative research approach was adopted for this study, and a descriptive phenomenological research tradition was chosen to understand the impact of clinical signs of hyperandrogenism among young female adults.

Sampling Strategies:

This study comprised young female adults aged between 17 and 23 years who were studying B. Sc Nursing at selected nursing colleges in Madurai.

Sample:

The sample of the study included young female adults who fulfilled the inclusion criteria.

Sample Size:

The sample size was determined based on the guiding principles of data saturation, which means sampling continued until no new information emerged, and redundancy was achieved. Data saturation is reached when themes become repetitive, patterns become consistent, and no new insights are obtained. This ensures that the sample captures a sufficient range of perspectives. In this study, six information-rich participants were included, which was deemed adequate to reach saturation, as no new themes or insights were expected from additional participants.

Sampling Technique:

Participant selection was based on intensity sampling.

Sampling Criteria:

· Aged between 17 and 23 years, unmarried, and available during the period of data collection.

· Willing to participate, able to express themselves in either Tamil or English, and willing to have the information audio-taped.

Tools and Techniques:

The tools for the current study consisted of:

· Part A: Semi-Structured Interview Schedule on Socio-Demographic Variables. It included age in years, religion, family monthly income, type of family, and place of residence.

· Part B: Semi-Structured Interview Schedule to Explore the Impact of Hyperandrogenism

Part: Qualitative Core Question:

How does hyperandrogenism influence your daily functioning and overall well-being?

Apart from the core questions, ice-breaking, grand tour, and probing questions were used to gather the necessary information, ensuring the adequacy of data collection

Rigor of Qualitative Data:

Credibility ensures findings accurately reflect participants' perspectives through methods like member checking and peer debriefing. Dependability is maintained through systematic documentation, ensuring consistency and replication. Confirmability is achieved via audit trails and data triangulation, minimizing researcher bias. Transferability is ensured through detailed descriptions of the research context, participants, and methodology for broader applicability¹⁴.

Data Collection Procedure:

Informed consent was obtained. Using a semi-structured interview schedule, the data was collected and audiotaped simultaneously. It took 30 to 45 minutes to collect the data.

The data was transcribed in Tamil (the regional language) and then translated into English. The accuracy of the translation was confirmed through the review process, where the field notes and recorded data from the voice recordings were provided to a peer reviewer for validation. The researcher promptly described the data and verified the information with the participants’ files. The data was organized, coded, and stored systematically for analysis. For data analysis, the researcher employed Colaizzi’s method. Qualitative data analysis was done simultaneously.

Ethical Consideratons:

Ethical clearance was obtained from Sacred Heart Nursing College. Formal written permission was secured from the Principal of the College of Nursing. All ethical considerations were strictly followed.

THEMES EMERGED AND THEIR EXHAUSTIVE DESCRIPTION

Theme 1 - Persistent Appearance-Related Challenges and Treatment Frustration:

The presence of prominent upper lip hair has been a significant source of appearance-related distress, leading to repeated attempts to manage it. Despite trying various home remedies, the issue persists, contributing to frustration and dissatisfaction. The concern is further intensified by the feeling that others focus primarily on the mustache, making social interactions more stressful. However, a promising new tool, a shaver, has provided some relief, proving to be effective and painless, offering a temporary sense of control over the situation.

The realization of the seriousness of hair growth has deepened over time, especially after multiple failed treatments, including home remedies and laser treatments, none of which have yielded satisfactory results. The persistent hair growth remains troubling, reinforcing the dislike for appearance and fuelling the continuous search for effective solutions. This has led to exploring various treatments based on online suggestions and recommendations from others, highlighting the ongoing struggle to find a lasting remedy.

Theme 2 - Emotional Distress and Self-Image Struggles

The presence of prominent upper lip hair has led to deep emotional pain, especially when alone at home, where the weight of past bullying experiences becomes overwhelming. Seeing the reflection in the mirror serves as a painful reminder, intensifying self-image issues. The distress is particularly heightened during social events, where a well-dressed appearance feels overshadowed by this concern, diminishing confidence.

Self-consciousness and distress are further triggered by comments from relatives, leading to emotional disappointment and a strong urge to withdraw. The uncertainty about how to handle the issue, coupled with fear of judgment, makes seeking help an added struggle. The emotional burden manifests as shame, stress, and avoidance, particularly when others notice and comment. The constant worry and frustration sometimes result in tears, as no attempted solution has brought satisfaction.

Even minor imperfections, such as a single pimple, intensify emotional distress, adding to the feeling of inadequacy. The persistent stress leads to loss of self-confidence, making social interactions more challenging. Despite efforts to accept these changes, it remains a struggle, with body image concerns extending beyond hair growth—such as how darkened areas affect the appearance of jewelry, diminishing the sense of beauty and self-worth.

Theme 3 - Social Influence and Support Challenges:

Social interactions and support systems play a critical role in shaping emotional well-being, yet they often become sources of distress and insecurity. Experiences of bullying from friends, though sometimes brushed off as playful, leave a lasting emotional impact, creating feelings of hurt and self-doubt. The lack of family support further exacerbates these struggles, as family members dismiss concerns or refuse medical intervention, making it difficult to seek proper guidance or solutions.

Family interactions add to the distress, as relatives frequently comment on appearance, sometimes subtly and other times openly, reinforcing self-consciousness and embarrassment. Suggestions such as visiting a beauty parlor reflect the societal emphasis on external fixes rather than deeper understanding or support. Social pressure intensifies through casual remarks and direct bullying, with comments like "You look like a boy," making the individual feel scrutinized and judged. This constant external focus on appearance leads to heightened self-awareness and anxiety in social settings.

Despite these challenges, there is an ongoing effort to seek advice from others in hopes of finding a solution. Friends mention the availability of various treatments, and online suggestions provide numerous recommendations, leading to exploration of different remedies, even if they do not always yield satisfying results. However, these influences can be conflicting, with family perspectives often dismissing the concern as genetic and implying that no effective treatment exists. This dismissal further deepens frustration and helplessness, making it difficult to reconcile personal distress with external invalidation. Ultimately, the loss of self-confidence in social interactions becomes a major consequence, affecting emotional well-being and the ability to engage comfortably with others.

Theme 4 - Insufficient Knowledge and Need for Clarity:

The sudden and unexplained changes have led to a deep sense of uncertainty and confusion, making it difficult to process the situation. There is a persistent need for information and understanding, as the lack of clarity creates emotional distress and a feeling of being lost. The shock of experiencing these changes without prior knowledge has heightened frustration, leaving a sense of helplessness. This overwhelming lack of clarity reinforces the urge to gain insight and seek further information, as understanding the nature and cause of these changes feels essential before taking any action. The desire for knowledge grows stronger, as knowing more about these changes may provide relief, reassurance, and a sense of control over the situation.

DISCUSSION:

Polycystic ovary syndrome (PCOS) presents several challenges, primarily in diagnosis, symptom management, psychological impact, and access to reliable resources. Lau et al¹¹. and Dewani et al¹². highlight widespread dissatisfaction with delayed diagnoses and inconsistent healthcare knowledge, emphasizing the need for better-trained professionals and standardized guidelines. Symptom management remains inadequate, as Lau et al.¹¹ found treatment strategies too generalized, while Dewani et al.¹²linked insulin resistance to worsening symptoms. Kite et al.¹³further revealed that BMI significantly affects health-related quality of life (HRQoL), yet physical activity alone does not improve outcomes, suggesting a need for more individualized treatment approaches. The psychological burden is another major concern, with Lau et al¹¹. reporting body image issues and frustration, Kite et al.¹³ identifying low self-esteem as a key factor affecting both physical and mental health, and Dewani et al¹². linking hormonal imbalances to emotional distress. These findings emphasize the importance of integrating psychological support into PCOS management. Additionally, despite the widespread use of online resources, Lau et al.¹¹found them unreliable, and Dewani et al. stressed the need for better education on PCOS mechanisms. This underscores the necessity of developing culturally sensitive, evidence-based resources co-created with healthcare professionals and individuals with PCOS. Addressing these interconnected issues will improve patient experiences and treatment outcomes.

CONCLUSION:

This qualitative exploration highlights the multifaceted impact of hyperandrogenism on young female adults. The condition extends beyond physical symptoms—such as hirsutism, acne, and menstrual irregularities—to deeply affect psychological well-being and social functioning. Participants reported diminished self-esteem, emotional distress, and challenges in social interactions, often exacerbated by societal beauty standards and limited support systems. These findings emphasize the need for comprehensive, multidisciplinary care that addresses both the clinical and psychosocial aspects of hyperandrogenism. Based on these insights, a Nurse-Led Comprehensive PCOS Awareness Package (NLCPAP) can be devised to improve awareness, facilitate early intervention, and provide holistic support for affected individuals.

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Received on 24.02.2025 Revised on 25.03.2025

Accepted on 17.04.2025 Published on 17.05.2025

Available online from May 20, 2025

Int. J. Nursing Education and Research. 2025;13(2):91-96.

DOI: 10.52711/2454-2660.2025.00019

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