Background: Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine and reproductive disorders affecting women of reproductive age. Despite its high burden, awareness and understanding of PCOS remain low in many low- and middle-income countries, including Nigeria. This study assessed the knowledge, perception, and risk factors of PCOS among women attending Abia State University Teaching Hospital (ABSUTH), Aba, Nigeria.

Materials and Methods: A hospital-based descriptive cross-sectional study was conducted among 250 women of reproductive age (15–49 years) attending outpatient clinics at ABSUTH. Participants were selected using systematic random sampling. Data were collected through a structured, pretested, interviewer-administered questionnaire covering socio-demographic characteristics, knowledge, perception, risk factors, and health-seeking behaviors related to PCOS. Reliability was established with Cronbach’s alpha of 0.81. Data were analyzed using SPSS version 26. Descriptive statistics summarized the data, chi-square tests assessed associations, and logistic regression identified predictors of knowledge and perception. Statistical significance was set at p < 0.05.

Results: The mean age of respondents was 31.8 ± 7.5 years, with most being married (64.4%) and having a tertiary education (60.4%). Awareness of PCOS was relatively low, with 54.8% identifying irregular menstrual cycles and 50.4% recognizing obesity as symptom. Only 39.2% linked PCOS with infertility. Perception analysis showed 55.2% agreed that PCOS is a serious reproductive health issue, while 60.8% believed it negatively impacts self-esteem and quality of life. Family history of PCOS was reported by 13.6%, while 38.4% reported family history of diabetes, obesity, or infertility. More than half (56.8%) identified weight management and exercise as helpful interventions, though only 22.8% had ever been screened for PCOS. Knowledge score showed significant positive correlations with perception (r = 0.62, p < 0.001), education (r = 0.41, p < 0.001), and willingness to undergo screening (r = 0.38, p < 0.001). Higher educational attainment was significantly associated with awareness (χ² = 28.54, p < 0.001).

Conclusion: The study revealed limited knowledge but relatively positive perceptions of PCOS among women in Aba, Nigeria. Education level emerged as a strong predictor of awareness and willingness to screen. Public health interventions focusing on awareness creation, early screening, and lifestyle modification are needed to improve PCOS prevention and management.

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder affecting reproductive-aged women worldwide and is characterized by a variable combination of menstrual irregularity, hyperandrogenism (clinical or biochemical), and polycystic ovarian morphology on ultrasound. Diagnostic frameworks developed over the past two decades — most notably the Rotterdam consensus and subsequent refinements emphasizing androgen excess — reflect the clinical and phenotypic breadth of PCOS and the ongoing debate about its definition. These diagnostic criteria matter for epidemiology and for comparing prevalence estimates between populations because different criteria capture different phenotypes and severities of the condition [1,2]. 

PCOS is clinically important not only because it is one of the leading identifiable causes of anovulatory infertility, but also because it is associated with long-term metabolic and psychological comorbidities. Insulin resistance and compensatory hyperinsulinaemia are central to many pathophysiologic models and explain the close links between PCOS and obesity, dysglycaemia, adverse lipid profiles, and increased cardiometabolic risk. In parallel, hyperandrogenism accounts for cutaneous and reproductive features (e.g., hirsutism, acne, oligo-/amenorrhoea) that drive health-seeking behaviour and quality-of-life impacts. Contemporary clinical reviews emphasise that the syndrome is lifelong and multidisciplinary in implication, requiring attention to reproduction, cardiometabolic health, and mental well-being [3,4]. 

Estimates of PCOS prevalence vary considerably across settings because of differences in diagnostic criteria, sampling frames, and study methods. Global population and clinic-based estimates reported in recent syntheses place prevalence broadly between about 2% and 26%, with many unselected population studies clustering in the range of ~6–12

Study Design

A hospital-based descriptive cross-sectional study design was employed. This design was considered appropriate because it allowed for the systematic collection of data on the knowledge, perception, and risk factors of polycystic ovary syndrome among women attending the hospital during the study period [12].

Study Area

The study was conducted at the Abia State University Teaching Hospital (ABSUTH), Aba, Abia State, Nigeria. The hospital is a tertiary healthcare institution that serves as a major referral centre for both rural and urban populations in Abia State and its neighbouring states [13]. It provides specialized services in obstetrics and gynaecology, internal medicine, paediatrics, and surgery, making it an ideal setting for a study focusing on reproductive health conditions such as polycystic ovary syndrome (PCOS).

Study Population

The target population comprised women of reproductive age (15–49 years) who attended outpatient clinics at ABSUTH during the study period. These included women visiting the gynaecology, antenatal, family planning, and general outpatient clinics.

Inclusion and Exclusion Criteria

• Inclusion criteria:
  • Women aged 15–49 years.
  • Women who provided informed consent to participate in the study.
  • Women attending outpatient clinics at ABSUTH during the study period.
• Exclusion criteria:
  • Women with a prior diagnosis of severe mental illness or cognitive impairment that could hinder comprehension of the questionnaire.
  • Women who declined participation.
  • Critically ill patients are unable to respond to questions.

Sample Size Determination

The sample size was determined using Cochran's formula for estimating population proportions, as outlined by Akwuruoha et al. [14]:

n = ????????       

The formula components are defined as follows:

• n represents the minimum required sample size.
• Z is set at 1.96, corresponding to a 95% confidence level.
• P denotes the established prevalence of PCOS in Southeast Nigeria.
• e signifies the allowable margin of error, fixed at 5% (0.05).

q = 1 - p

A recent study conducted by Ugwu et al. [15] reported the prevalence of PCOS in Southeast Nigeria as 18.1% 

P = 18.1% = 0.181

q = 1 – 0.181

= 0.819

The minimum sample size was 228, but it was adjusted to 250 to account for a 10% non-response rate.

Sampling Technique

A systematic random sampling technique was used. Using the ANC attendance register, the sampling interval was determined by dividing the estimated number of eligible pregnant women attending ANC during the study period by the required sample size [11]. The first participant was selected randomly, and every 5th eligible woman was subsequently recruited until the sample size was attained.

Data Collection Instrument

Data were collected using a structured, pretested, interviewer-administered questionnaire. The instrument was developed after an extensive review of existing literature on knowledge, perception, and risk factors of PCOS. It was divided into five sections:

1. Socio-demographic characteristics (age, marital status, educational status, occupation, parity, etc.).
2. Knowledge of PCOS (definition, causes, symptoms, complications, and treatment options).
3. Perception of PCOS (attitudes towards the condition, beliefs about severity, and perceived susceptibility).
4. Risk factors for PCOS (family history, obesity, menstrual irregularities, lifestyle habits, etc.).
5. Health-seeking behavior (sources of information, healthcare utilization, and preventive practices).

The questionnaire included both closed- and open-ended questions and was translated into the local Igbo language for participants who could not communicate fluently in English.

Validity and Reliability of the Instrument

The questionnaire was reviewed by experts in reproductive health and epidemiology to ensure content validity. A pilot test was conducted among 20 women attending the General Hospital, Aba, to assess clarity, cultural appropriateness, and reliability. Internal consistency was measured using Cronbach’s alpha, with a coefficient of 0.81 obtained, indicating high reliability.

Data Collection Procedure

Trained research assistants, who were nurses and final-year medical students familiar with the subject matter, administered the questionnaires. Before data collection, participants were informed about the study's objectives and assured of confidentiality. Written informed consent was obtained. Interviews lasted an average of 20–25 minutes.

Data Management and Analysis

Completed questionnaires were checked daily for completeness and consistency. Data were coded and entered into Statistical Package for the Social Sciences (SPSS) version 26.0 for analysis.

• Descriptive statistics such as frequencies, percentages, means, and standard deviations were used to summarize socio-demographic data, knowledge, perception, and risk factors.
• Knowledge scores were computed from participants’ responses, and levels of knowledge were categorized as good, fair, or poor.
• Perception scores were categorized into positive and negative based on Likert scale responses.
• Inferential statistics: The chi-square test was used to assess associations between socio-demographic variables and knowledge, perception, and risk factors. Logistic regression analysis was employed to identify independent predictors of knowledge and perception of PCOS. A p-value < 0>

Ethical Considerations

Permission was also obtained from the hospital management. Informed consent was obtained from each participant before inclusion. Anonymity and confidentiality of the respondents’ information were strictly maintained, and participants were assured that their responses would be used solely for research purposes. Participation was entirely voluntary, and participants could withdraw at any stage without penalty.

The study involved 250 participants, with the majority of respondents aged 25–34 years (36.8%) and 35–44 years (28.4%). The majority were married (64.4%), had tertiary education (60.4%), were formally employed (48.4%), resided in urban areas (62.8%), and were multiparous (42.4%) (Table 1).

Knowledge of PCOS was moderate. The most commonly identified symptoms included irregular menstrual cycle (54.8%), weight gain/obesity (50.4%), and hirsutism (38.4%). Only 19.6% recognized infertility as a symptom. Regarding associated risks, more than half linked PCOS with diabetes (56.8%), while fewer associated it with hypertension (25.6%) and cardiovascular diseases (14.8%). Likert-scale statements revealed strong agreement that PCOS is a hormonal disorder (78.4%), can affect fertility (72.8%), and may be managed with lifestyle and medical treatment (55.2%) (Tables 2a and 2b).

Perceptions showed that respondents acknowledged PCOS as a serious reproductive health issue (55.2%), with 60.8% agreeing that it negatively impacts self-esteem and quality of life. However, only 33.6% strongly perceived that awareness is generally low. Most participants (72%) agreed that early diagnosis prevents complications, and 60.8% supported health education interventions in hospitals and communities (Table 3).

Risk factors highlighted included family history of diabetes, obesity, or infertility (38.4%), sedentary lifestyle, and poor dietary habits, with nearly half reporting no regular physical activity (49.6%). While smoking was uncommon (4.8%), alcohol consumption was reported by 27.2%. Likert-scale responses confirmed that obesity (66%) and poor dietary habits (54.4%) were perceived as major risk factors (Tables 4a and 4b).

Health-seeking behavior revealed that only 22.8% had ever been screened for PCOS, predominantly in public hospitals (13.6%). Nevertheless, willingness to undergo routine screening was high (83.2%). Weight management and exercise (56.8%), dietary modification (47.2%), and medications (38.4%) were the most frequently endorsed preventive interventions, while herbal remedies were less cited (19.6%) (Table 5).

Correlation analyses showed a strong positive association between knowledge and perception (r = 0.62, p < 0 xss=removed xss=removed xss=removed>

Chi-square analyses confirmed that higher education was significantly associated with PCOS awareness (χ² = 28.54, p < 0 xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed>

Table 1: Socio-demographic characteristics

Table 2a: Knowledge of PCOS

Table 2b: Knowledge Statements

1 = Strongly Disagree, 2 = Disagree, 3 = Neutral, 5 = Agree, 5 = Strongly Agree

Table 3: Perception of PCOS

Table 4a: Risk Factors and Behaviours

Table 4b: Risk factor statements

Table 5: Health-seeking Behaviour and Preventive Practices

Table 6a: Correlation coefficients ®

Table 6b: Corresponding p-values

Values are significant at p<0>

Table 7: Chi-square Analyses

This study assessed the knowledge, perception, and risk-factor awareness of polycystic ovary syndrome (PCOS) among 250 women in Abia State, Nigeria, and explored associations with sociodemographic variables and health-seeking behaviours. The findings reveal both encouraging and concerning patterns when compared with the existing literature. In what follows, our discussion situates these results in relation to prior studies, highlights possible explanations, notes implications, and acknowledges limitations.

In the sociodemographic profile, the largest age group was 25–34 years (36.8%), followed by 35–44 years (28.4%), while only 15.2% were aged 45–49 years. This age distribution is broadly consistent with many reproductive health studies in Nigeria, which often sample women in their mid to late reproductive years. The high proportion (60.4%) of participants with tertiary education reflects a relatively educated sample—indeed, previous Nigerian studies such as Omagbemi et al. [16] have observed that women who participate in health surveys tend to be more educated than the general population. In this sample, 62.8% resided in urban areas, which may partly reflect greater recruitment access in urban centres and the likelihood that women in urban areas more readily engage with research activities.

Regarding knowledge of PCOS, while over half of respondents correctly identified “irregular menstrual cycle” (54.8%) and “weight gain/obesity” (50.4%) as common symptoms, lower proportions recognized hirsutism (38.4%), acne (35.2%), infertility (19.6%), and hair thinning (13.6%). Also, 7.2% selected “don’t know.” In terms of associated risks, 56.8% recognized the association with diabetes, 39.2% with infertility, but only 25.6% with hypertension and 14.8% with cardiovascular disease, while 10.4% did not know. On knowledge statements using the Likert scale, the majority agreed that PCOS is a hormonal disorder affecting reproductive-aged women, can be diagnosed by ultrasound and blood tests, affects fertility, is influenced by overweight/obesity, and can be managed by lifestyle modification and medical treatment.

These findings suggest a moderate level of symptom awareness, but substantial gaps in comprehensive knowledge—especially in relation to long-term health risks and less visible symptoms. Comparatively, a study in South-West Nigeria [16] reported that knowledge of PCOS among women was generally inadequate, with many unable to correctly identify hallmark features or complications. Similarly, Jaber et al. [17] in another cross-sectional investigation found that many women lacked correct knowledge about PCOS diagnosis and long-term sequelae. In contrast, in a study of nurses in Lebanon, Srour et al. [5] found relatively higher knowledge among a health-care provider group, reinforcing that professional exposure is likely a strong influencer of knowledge. The discrepancy between clinical populations or health professionals and community women underscores the need for targeted health education programs in the general female population.

In terms of perception, most respondents agreed or strongly agreed that PCOS is a serious reproductive health problem (55.2% when combining “Agree” and “Strongly Agree”), and a substantial proportion recognized negative psychosocial effects: 50.8% agreed that PCOS hurts self-esteem and quality of life, and 43.2

This study reveals that among women in Abia State, knowledge and risk-factor awareness of PCOS are moderate but with notable gaps, perception is generally favourable but still constrained by misinformation and stigma, and actual screening uptake is low despite expressed willingness. Education emerges as a key factor in enhancing awareness and encouraging preventive behaviour. To reduce the burden of undiagnosed PCOS and its complications in Nigeria, health education initiatives, accessible screening services, and stigma-reduction strategies are warranted. Future research should aim to include broader and more representative samples, and ideally incorporate clinical diagnostics to relate knowledge and perception to actual PCOS prevalence and outcomes.