Consultation experiences and treatment adherence among women with polycystic ovary syndrome in the Philippines: a qualitative study

Introduction

Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine disorders, with significant health consequences for women of reproductive age (1). The World Health Organization (WHO) estimates that 6–13% of women in this age group are affected (2). Prevalence is higher among certain ethnic groups; women of Asian descent—particularly those of South Asian ethnicity—have a greater prevalence compared with non-Hispanic White, Black, and Hispanic women (3). A study using the Flo app, a widely used female health and well-being platform, found that among the five countries with the largest number of Flo app users, the highest proportion of PCOS-positive users was in the Philippines, followed by India, the United Kingdom, the United States, and Australia (4). In the Philippines, women aged 20–29 years have the highest likelihood of being diagnosed with PCOS (5).

The hallmark features of PCOS include anovulation, polycystic ovaries, and hyperandrogenism, which may manifest as hirsutism, acne, and alopecia (6,7). The syndrome also has significant metabolic and psychological implications. Metabolic features include insulin resistance, obesity, lipid abnormalities, and an increased risk of impaired glucose tolerance and type 2 diabetes mellitus (8). Psychologically, women with PCOS have higher rates of anxiety, depression, and body dissatisfaction compared with women without the condition (9-11). They are also at increased risk for long-term complications such as cardiovascular disease, certain cancers, and infertility. Regular monitoring of body mass index (BMI), blood pressure, metabolic parameters, and mental health is essential to manage symptoms effectively, reduce long-term risks, and improve quality of life (12). In the Philippines, the most reported symptoms include bloating, hyperpigmentation, irregular menstrual cycles, baldness, and facial hirsutism. In contrast, metabolic features such as hypercholesterolemia and hyperglycemia—considered strong predictors of PCOS in other high-prevalence countries—are less frequently reported (4).

Diagnosis of PCOS is most often based on the Rotterdam 2003 criteria, which require at least two of the following three features: (I) irregular or absent menstrual periods; (II) clinical or biochemical evidence of hyperandrogenism; and (III) polycystic ovarian morphology on ultrasound. In 2006, the Androgen Excess Society revised these criteria, requiring clinical or biochemical hyperandrogenism in combination with either oligo-anovulation or polycystic ovaries (13). In low-resource settings such as the Philippines, hyperandrogenism is often diagnosed clinically because biochemical testing (e.g., testosterone, estrogen, insulin) is not routinely accessible (5).

However, uncertainty in symptom profiles, variation in diagnostic criteria among practitioners, a historical lack of diagnostic clarity, and gaps in provider knowledge have compounded the challenges faced by women with PCOS (14-16). An international survey found that nearly two in three women with PCOS were dissatisfied with the time taken to receive a diagnosis and the number of healthcare professionals they had to consult (17). In another study involving more than 1,300 women with PCOS, one-third reported waiting 2 years or longer for a diagnosis, and over half had seen more than two healthcare providers. Many also reported dissatisfaction with the diagnostic process, citing substantial unmet needs such as emotional support, adequate counseling, and clear information about the syndrome and its long-term implications (18).

PCOS management is individualized according to a patient’s health goals, as symptoms vary widely. Lifestyle modification is the first-line intervention for all patients, regardless of symptom presentation. Recommended first-line pharmacological treatments include combined oral contraceptives for hyperandrogenism and menstrual irregularity, metformin for metabolic features, and letrozole for infertility (19-21). Given the multifaceted nature of PCOS management, understanding treatment adherence and its influence on outcomes is essential. Unlike “compliance”, which can imply passivity, “adherence” emphasizes a collaborative patient-provider relationship, recognizing the patient’s active role in managing their health. However, adherence among women with PCOS remains low (22). Improving outcomes requires identifying and addressing the barriers that hinder adherence (23).

Despite the high prevalence of PCOS in the Philippines, little is known about the consultation process, diagnostic journey, and multifactorial treatment approaches from the patient perspective. To date, no studies have explicitly examined treatment adherence, including reasons for discontinuation, in this context (22,24). Understanding these barriers and facilitators can highlight gaps in current practice and inform culturally appropriate treatment strategies for Filipino women with PCOS.

This study aimed to explore the consultation experiences of women with PCOS in the Philippines and to identify the barriers and facilitators influencing their treatment adherence. We present this article in accordance with the COREQ reporting checklist (available at https://jhmhp.amegroups.com/article/view/10.21037/jhmhp-24-151/rc).

Methods

Study design

This qualitative study utilized semi-structured virtual interviews to explore the consultation experiences and the barriers and facilitators to treatment adherence among women with PCOS in the Philippines. The present study was predicated on interpretivism, which focuses on the participants’ subjective experiences. This approach allows the enhancement of clinical practice via the provision of women’s insights (25).

Ethical considerations

The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. Ethical approval was obtained from the University Ethics Review Committee of Adamson University (approval No. 2022-02-PHA-01). Participation in the study was voluntary. Women were informed that the individual in-depth interview would be recorded. Written informed consent was obtained through a Google form, and verbal consent was secured from the women before proceeding with the interview process. To ensure confidentiality and to protect the women’s identities, participant ID numbers were used to anonymize the gathered interview data.

Study area

Participants with a confirmed diagnosis of PCOS were recruited from partner obstetrician-gynecologists’ (Ob-Gyns’) clinics across three regions in Luzon, Philippines—Region IV-A (CALABARZON: Cavite, Laguna, Batangas, Rizal, and Quezon), the National Capital Region (NCR), and Region III (Central Luzon). These regions were selected because they have the highest number of women of childbearing age in the country (26). No data are currently available on the prevalence of PCOS by region in the Philippines.

Study participants

Participants were Filipino women diagnosed with PCOS according to the Rotterdam criteria who could communicate in either Filipino or English. PCOS diagnoses were self-reported based on prior clinical evaluations and documented medical records. Exclusion criteria included women who were pregnant, peri- or postmenopausal, those with self-reported diagnoses of major psychiatric disorders (e.g., clinical depression, schizophrenia, anxiety), and those with other chronic illnesses requiring specialist care beyond their Ob-Gyn or medications unrelated to PCOS management. These exclusions were applied to ensure a well-defined, consistent sample and to minimize potential confounding factors that could influence experiences, symptom patterns, and treatment adherence specific to PCOS.

Data collection

Data were collected from 20 women diagnosed with PCOS between February 18 and March 4, 2023. Purposive sampling was used to select participants based on disease duration and socio-demographic characteristics, including age, marital status, occupation, and education level. To capture a broad range of experiences, the sample included women with recent diagnoses (within the past year) as well as those living with PCOS for 5 years or longer, reflecting perspectives from early coping and adjustment to long-term management and adherence. Age and marital status were also considered, as PCOS symptoms and their perceived impact often change over time; for example, fertility concerns or body image issues may be more prominent in certain life stages. The age range was limited to 18–45 years: those aged 15–17 years were excluded to avoid the need for parental consent, while women aged 46–49 years were excluded to avoid confounding symptoms related to the menopausal transition. Occupation and education level were included to ensure diversity in socioeconomic backgrounds.

Individual in-depth interviews were conducted virtually via Zoom, each lasting 30–90 minutes. A semi-structured interview guide, pretested with three participants, was used to explore women’s consultation experiences and treatment adherence. The pretest results led to rewording of some questions—particularly those with medical or technical terms that participants found unclear—and to adjustments in question order to create a more natural conversational flow and encourage deeper reflection. It also helped identify questions requiring additional follow-up prompts.

Questions on consultation experiences were developed based on the WHO’s definition of quality care, covering four dimensions: (I) effectiveness; (II) safety; (III) people-centeredness; and (IV) timeliness. Questions on treatment adherence were adapted from the conceptual model by Peh et al. [2021] (27), which identifies five contributing factors: (I) condition-related; (II) medication-related; (III) healthcare system or healthcare professional-related; (IV) patient-related; and (V) socioeconomic.

Thematic saturation was assessed by tracking the point at which no new themes emerged from subsequent interviews. After approximately 17 interviews, core themes began to repeat. Three additional interviews were conducted to confirm that thematic saturation had been reached. Following each interview, the research team summarized key points and engaged in reflective discussions to monitor emerging ideas.

Data analysis

Data from video-recorded interviews were transcribed verbatim in the languages used by the women. The MAXQDA software program (VERBI Software GmbH, Berlin, Germany) was used to support data analysis, following Braun and Clarke’s Reflective Thematic Analysis framework as an analytical guide to systematically identify, organize, and capture patterns of meaning across narratives (28).

In the first analytic phase, two researchers (D.M.G. and M.C.V.) familiarized themselves with each transcript by reading it repeatedly and comprehensively. They selected portions of the data and assigned corresponding codes. Codes were then integrated based on conceptual similarity to better understand their relationships and underlying meanings. All researchers (D.M.G., M.C.V., S.M.M., and K.C.L.) reviewed the potential themes.

To ensure coherence, the researchers went back and forth in reviewing the themes to remove redundancies and avoid overlap. Initial themes were guided by the WHO’s definition of quality care and health services and by the Peh et al. [2021] framework for therapy adherence (27). Using both inductive and deductive approaches, additional themes—hindrances and health literacy—emerged for consultation experiences, while healthcare system- or healthcare professional-related factors, although part of the original framework, did not surface as themes for treatment adherence in the collected data.

A constant comparison method was used to test the validity of the study’s theoretical assumptions. The analysis results were also shared with women diagnosed with PCOS to gather their feedback and verify the accurate interpretation of their narratives.

Rigor

Rigor was maintained using Lincoln and Guba’s [1985] evaluative criteria for trustworthiness (29). Credibility was achieved through 30–90-minute in-depth interviews conducted by two researchers (S.M.M. and K.C.L.) using a semi-structured guide, ensuring consistency across sessions while allowing participants to share open-ended insights. Clarifications were made during interviews to ensure accuracy, and peer debriefing followed each session to reflect on participants’ responses. Researchers not involved in data collection (D.M.G. and M.C.V.) reviewed transcripts for clarity and validity, evaluated the appropriateness of data for each theme, and refined the coding framework to ensure alignment between participants’ narratives and the analytic interpretations.

Transferability was ensured through purposive sampling that captured variations relevant to the study context. Dependability was supported by maintaining a detailed audit trail and engaging in ongoing peer debriefing throughout the analysis. Confirmability was strengthened through systematic documentation of coding and theme development in MAXQDA, complemented by reflexive discussions to ground interpretations in participants’ accounts. Finally, member checking was conducted by emailing all participants a thematic summary with selected quotes and inviting feedback on the accuracy and relevance of the findings to their lived experiences.

Results

General characteristics of the women

Table 1 presents the general characteristics of the participants. Of the 20 women, eight were from Central Luzon, six from the NCR, and six from CALABARZON. Twelve participants were aged 18–24 years, seven were aged 25–30 years, and one was aged 31–36 years. The majority were single (90.0%), held a bachelor’s degree (90.0%), and were employed (85.0%). Most participants (80.0%) had been living with PCOS for 1–5 years.

Consultation experiences

Table 2 presents six key themes that describe women’s consultation experiences: (I) hindrances; (II) health literacy; (III) effectiveness; (IV) safety; (V) people-centeredness; and (VI) timeliness.

Hindrances

The first theme, ‘hindrances’, comprises two sub-themes: (I) scheduling conflicts; and (II) financial constraints.

Conflict of schedule

Work and daily schedules often prevented women from attending consultations, making it difficult for them to comply with the advised follow-up visits.

“As per her (Ob-Gyn) advice, follow-up check-ups should be every 3 or 6 months, but I failed to comply since I cannot find time for it. If I go for a consultation on a weekend, the doctor will probably be unavailable since they are in the hospital or clinic only during the weekdays.” (Participant 19, 27 years).

Financial capacity

Several women reported that having health insurance eased the financial burden of frequent consultations and ongoing PCOS management. However, for others, the need to budget for both follow-up appointments and recommended therapies posed a financial challenge, making it difficult to attend regular follow-ups and adhere to treatment.

“Just recently, it is really the finances because consultation plus the monthly medication is too expensive...” (Participant 15, 25 years).

Health literacy

The second theme, ‘health literacy’, includes two sub-themes: (I) knowledge and awareness gained from consultations; and (II) sources of additional information for unresolved concerns.

Health awareness

Most women reported that consultations increased their awareness of PCOS and made them more health-conscious. They gained a better understanding of the condition and its management, with many noting the importance of diet (e.g., reducing sugar and processed food intake), physical activity (e.g., home workouts or walking), and stress management (e.g., mindfulness, setting work-life boundaries) in treatment.

“It was an eye-opener for me when the doctor told me what might happen if I do not take care of myself... like if I do not comply with healthy living and exercising, my PCOS will have a greater impact on my health.” (Participant 19, 27 years).

Self-education

Some women turned to the internet for information on PCOS, feeling that their condition had not been sufficiently explained during consultations.

“Most of what I know about PCOS is from the research I did after my diagnosis. When I got diagnosed, I was prescribed with a medicine then I was only informed of its triggers. But since I already know that I have PCOS, I had the desire to know what other possibilities may occur with having it.” (Participant 17, 25 years).

Despite some seeking information online, most women still preferred physicians as their primary source of information. One participant noted that consulting experts is best, given the prevalence of misinformation online.

“Social media has a wide audience reach, and there can be a lot of hearsay from people. So, it is still best to consult experts regarding PCOS...” (Participant 9, 24 years).

Effectiveness

The third theme, ‘effectiveness’, highlights the perceived impact of medical care on women’s condition. It comprises two sub-themes: (I) health outcomes, referring to symptom improvements; and (II) routine monitoring by Ob-Gyns, including follow-up appointments, symptom tracking, and treatment plan adjustments.

Health outcomes

Most women reported that visits to their Ob-Gyn helped them manage health concerns, leading to positive outcomes. They often linked the effectiveness of PCOS management to the quality of consultations and the suitability of prescribed medications.

“The consultations really helped me a lot, since my menstruation went back to its normal cycle and the acne around my face cleared up...” (Participant 8, 24 years).

Routine monitoring

Follow-up consultations increased the likelihood of positive outcomes by allowing timely and appropriate treatment adjustments.

“It [follow-up check-ups] helps because you will have a chance to tell the doctor that you don’t like the effects of the prescribed medications on you..., then necessary prescription changes may be done.” (Participant 14, 28 years).

Routine monitoring also gave women a greater sense of control over their PCOS, enabling them to track their progress and assess their overall health.

“She (Ob-Gyn) monitors my weight gain. She once said I am too heavy, which pushed me to take my medications regularly. After that, she noticed my weight loss. This is because she always weighs me every time I attend consultations.” (Participant 13, 23 years).

Safety

The fourth theme, ’safety’, comprised two sub-themes: (I) the sense of relief women experienced during consultations, often from feeling heard, validated, and guided; and (II) uncertainty about the future, shaped by concerns over long-term complications, risks associated with PCOS, and the absence of definitive treatment pathways.

Sense of relief

Some women described how affirming and supportive communication from their Ob-Gyns provided them with a sense of security and emotional relief during consultations, reinforcing trust in their care.

“I had a better understanding of the possible consequences if I ignored it (PCOS). Through that consultation, it dawned on me that there is still a chance for it to be okay, there is still a chance to regulate my PCOS. In a way, it lessened my stress. Before when I read about PCOS, it seemed so scary, but since I had my consultation, there was enlightenment.” (Participant 4, 24 years).

Uncertainty of the future

Despite receiving consultations, some women remain uncertain about the future, largely due to the potential long-term comorbidities associated with PCOS and the lack of definitive treatment pathways for PCOS, which leaves women unsure about the direction of their care and long-term health outcomes.

“Actually, I still get bothered by the possibility that my PCOS may lead to high blood pressure and diabetes even though I am taking proper medication.” (Participant 17, 25 years).

The fluctuating nature of PCOS symptoms also contributed to women’s uncertainty, leading to feelings of anxiety and apprehension during consultations.

“Every 6 months, prior to a check-up, I get in line for an ultrasound, then I get so nervous because of its (cyst) fluctuating size. Sometimes it exceeds the normal size, then after 6 months, the volume gets smaller, and after that it will again return to its large volume. That experience for me is very difficult to deal with.” (Participant 12, 24 years).

People-centeredness

The fifth theme, ‘people-centeredness’, focuses on the patient-provider rapport during consultations.

Patient-provider rapport

Satisfaction with healthcare services encouraged women to remain with their Ob-Gyns, whereas unresolved concerns led to dissatisfaction and, in some cases, switching to a different provider.

“My new Ob-Gyn is good, and this pushes me to go on a scheduled appointment for my PCOS as compared with my previous Ob-Gyn. She is more detailed and has a more friendly approach. She is not rushing, and she explains the right way of taking the medicines with me.” (Participant 4, 24 years).

Timeliness

The final theme, ‘timeliness’, includes two sub-themes: (I) waiting time during scheduled appointments; and (II) the promptness of diagnosis.

Waiting time

Most women reported long waiting times even during scheduled appointments, with several expressing frustration over extended waits for brief consultations with their Ob-Gyns.

“We have this one appointment where she (Ob-Gyn) came 1 hour late, then she only talked to me for 5 minutes. After that, I lost interest in attending the next consultations.” (Participant 10, 23 years).

“They (Ob-Gyn) are always late for about an hour, then we only have quick consultations, it does not even reach 15 minutes.” (Participant 14, 28 years).

Some women, however, reported minimal waiting times, with a few noting that they were seen immediately for their consultations.

“Around 30 minutes, it is just quick.” (Participant 2, 32 years).

Timely diagnosis

Women generally described their diagnosis as timely. Several received a PCOS diagnosis during their initial consultation, while others waited about a week for laboratory results before confirmation—a timeframe they still considered reasonable.

“I had my consultation, then I was informed right away that it was PCOS, then the result of the ultrasound was given to me right after my first consultation.” (Participant 18, 23 years).

“During my first consultation, she (Ob-Gyn) already had an idea that I have PCOS, but of course, she still waited for the ultrasound, which took a week...” (Participant 10, 23 years).

Treatment adherence

Table 3 presents four key themes that emerged as barriers and facilitators to women’s treatment adherence: (I) patient-related; (II) condition-related; (III) medication-related; and (IV) socioeconomic factors.

Patient-related factors

The first theme under treatment adherence is patient-related factors that include: the women’s (I) perceptions, (II) goals and motivations, as well as the (III) challenges that they deal with in the management of their PCOS.

Perceptions

Women’s perceptions of their condition influenced their treatment adherence. When asked about the importance of taking prescribed medications as directed, responses varied, though most believed it was necessary for improvement.

“If I don’t help myself, I won’t get better. It is a must to take medications regularly for my health.” (Participant 19, 27 years).

Others felt that since there is no cure, taking prescribed medications was unnecessary.

“It’s not curable, so I stopped taking the medications.” (Participant 15, 25 years).

Motivations and goals

Women’s motivations and goals encouraged them to adhere to treatment despite unwanted side effects and challenges in maintaining a healthy lifestyle. Most reported taking their medications consistently to manage PCOS and improve their chances of bearing a child in the future.

“My goal by 2028 is to conceive.” (Participant 13, 23 years).

Others were motivated by the desire to improve their quality of life, which had been negatively affected by the condition.

“My motivation is to return to the times when I don’t feel anything (symptoms of PCOS). Sometimes I felt envious of other women. To them, menstruation only lasts for 3 days, and if they work out, they get the fit that they want. That’s why I’m trying to be okay because I want to be like that again.” (Participant 1, 25 years).

Challenges

Personal challenges hindered women’s ability to comply with medication regimens and lifestyle changes. A common difficulty was losing weight despite efforts such as strict dieting and regular exercise.

“There are times that I don’t exercise, and when stressed, I feel the need to eat a lot. I don’t entirely comply with what the doctor says.” (Participant 11, 23 years).

Some women reported forgetting to take their pills on time due to personal commitments or work demands.

“Every month you take pills, packet by packet, sometimes you will forget and then you will remember after 2 hours...” (Participant 9, 24 years).

Another challenge affecting treatment adherence was the failure to follow up with their Ob-Gyn. Prescriptions for contraceptive pills were valid for only 3 to 6 months, requiring a return visit for renewal. Many women missed these follow-ups, leaving them uncertain whether to continue their current pills or switch to a different prescription.

“I stopped taking my pills because the last time I attended my consultation was in the month of May. I am still not able to go back for a check-up, so I decided to just discontinue it since I already had my regular menstruation.” (Participant 6, 24 years).

Condition-related factors

The second theme, ‘condition-related factors’, focuses on disease outcomes, including the risk of complications associated with PCOS.

Disease complications

The potential complications of PCOS motivated women to adhere to medications and maintain a healthy lifestyle. They emphasized that consistent treatment is essential to prevent future health problems.

“I think if I don’t regulate my menstruation or I won’t adhere to medication treatment, it can lead to high blood pressure and diabetes. I worry that someday it (PCOS) will lead to that.” (Participant 4, 24 years).

Medication-related factors

The third theme, ‘medication-related factors’, includes two sub-themes: (I) the role and efficacy of medications in treating and managing PCOS; and (II) their short- and long-term effects on women with the condition.

Efficacy

The positive effects of prescribed medications facilitated treatment adherence, as symptom improvements reinforced women’s motivation to continue therapy.

“I take my medication because of its effectiveness. When I started taking the pills, although there were side effects, it instantly regulated my menstruation and minimized the acne around my chin area. It cleared up right away.” (Participant 8, 24 years).

Short-term and long-term effects of medication

Short-term side effects—such as fatigue, nausea, vomiting, and headache—hindered medication adherence. While some women continued treatment despite these effects, others were unable to tolerate them and chose to discontinue medication.

“I was given metformin, but I completely discontinued it since I am vomiting every time I take it.” (Participant 10, 23 years).

One woman reported switching to complementary medicine after discontinuing her prescribed medication due to weight gain.

“I feel like I’m gaining weight with pills, so I decided to stop it. Then I had Barley as an alternative. Despite not taking pills for around 4 or 5 months, I still have my menstruation regularly.” (Participant 1, 25 years).

Perceived risks of long-term medication use also led a small minority of women to discontinue treatment.

“You become at risk of breast cancer if you take pills for a long time, which is why I stopped taking it.” (Participant 17, 25 years).

Socioeconomic factors

The fourth theme, ’socioeconomic factors’, includes two sub-themes: (I) the impact of financial status; and (II) the role of social encouragement on women’s adherence to their prescribed regimen.

Financial impact

For most women, financial constraints were not a barrier to treatment adherence, as they set aside a portion of their income or received family support to cover medication costs.

“There was no problem with my adherence since I can afford to buy the pills. I still continuously take it.” (Participant 8, 24 years).

However, a few women reported that their financial situation affected their adherence, with one participant sharing that she had stopped taking medication at one point due to financial constraints.

“I stopped taking my pills because they were pricey. It was hard for me to maintain it.” (Participant 10, 23 years).

Support system

Supportive family and friends encouraged women to engage in physical activity, adhere to medications, and follow dietary restrictions. Some women also received financial assistance from their families to cover medication costs. A few noted that their families knew little about their condition, but this did not affect their adherence.

“My parents are the ones who give me money to buy my medicines. They also remind me to always take my medicines. They also send videos of PCOS women from other countries that share what they did and their success stories.” (Participant 13, 23 years).

Some women shared that having friends to confide in and exchange experiences with greatly helped them manage their PCOS.

“My friends ask me how I feel with my medicines, and since some of them also have PCOS, they share their experiences with me, so I do not feel alone. I feel like I am not alone on this journey.” (Participant 10, 23 years).

Discussion

Despite recognizing the importance of Ob-Gyn consultations for managing PCOS, women in this study faced challenges such as scheduling conflicts, financial constraints, and limited health literacy. Barriers to adherence included treatment side effects, concerns about the long-term use of oral contraceptives, and personal circumstances. Conversely, facilitators such as family support and awareness of PCOS-related complications encouraged adherence.

Hindrances to follow-up appointments were a major factor affecting women’s consultation experiences in this study. Despite recognizing the importance of these visits for managing PCOS, many participants were unable to attend due to work schedules—often overlapping with standard clinic hours—and financial constraints. Similar findings were reported in a qualitative study from Australia, where clinicians identified poor patient attendance at follow-up appointments as a significant barrier to effective treatment (30). These barriers highlight how structural and financial constraints can limit continuity of care and influence treatment outcomes for women with PCOS.

Women’s varied consultation experiences also influenced their health literacy regarding PCOS. Interactions with healthcare providers were pivotal in enhancing their understanding of the condition and supporting informed decision-making. However, some participants felt the information provided was insufficient, prompting them to seek additional knowledge online. A qualitative study in Canada similarly found that women often turned to social media for PCOS-related information and peer connection (24). A cross-sectional study of PCOS-diagnosed women recruited via social media further showed that the way a diagnosis is communicated—including word choice and emotional impact—can shape women’s perceptions of their condition and its long-term implications (31). These findings illustrate how both the content and delivery of information during consultations can influence women’s understanding, perceptions, and overall satisfaction with care.

Women also reported that effective consultations and consistent monitoring during follow-up visits improved their symptoms and gave them a greater sense of control over their health. This is consistent with earlier research showing that tracking and discussing disease progress can enhance outcomes by enabling timely treatment adjustments (32). Ongoing communication with healthcare providers is essential for supporting disease management and ensuring continuity of care (33). Collectively, these findings underscore sustained patient–provider engagement as a cornerstone of effective PCOS management.

For some women, consultations provided a sense of relief, particularly when reassured that PCOS could be managed even if not cured. However, this was not universal, as others remained anxious about potential comorbidities despite adhering to prescribed medications. Given the role of consultations in patient safety (34,35), effectively addressing patients’ uncertainty is essential for alleviating anxiety.

In the Philippines, prompt access to laboratory results and ultrasounds often allows healthcare providers to diagnose PCOS during the first consultation, facilitating timely management. This contrasts with findings from a cross-sectional study of 1,385 women with PCOS from North America, Europe, and other regions, where prolonged diagnostic timelines frequently left women’s needs unmet (16). Timely diagnosis is critical for reducing uncertainty, enabling early lifestyle changes, lowering the risk of diabetes and cardiovascular disease, and mitigating the psychosocial impacts of PCOS (36). Overall, these findings underscore the importance of timely diagnosis in optimizing both clinical and psychosocial outcomes for women with PCOS.

This study also identified facilitators and barriers to adherence. Perceptions of PCOS strongly influenced adherence: positive perceptions supported better self-management, while negative perceptions reduced adherence. This is consistent with a qualitative study in Iran, which found that women’s beliefs and knowledge about PCOS significantly affected adherence (23). Personal factors such as motivation, treatment goals, and challenges during therapy were also influential. Having a clear endpoint kept many motivated to take medications and maintain lifestyle changes, echoing findings from a Canadian qualitative study (37).

For many, the potential risk of complications such as diabetes and infertility was a strong motivator to adhere to treatment and lifestyle changes. A similar finding was reported in Australia, where immediate health concerns, particularly infertility, prompted lifestyle modifications (38). Nonetheless, adherence was hindered by challenges such as forgetting doses, delays in prescription renewal, and difficulty sustaining healthy habits. Because prescriptions are typically valid for 3 to 6 months, some participants were uncertain whether to continue medication without follow-up consultations. This mirrors findings from Iran, where women reused expired prescriptions due to missed follow-ups, increasing anxiety, and reducing adherence (23). Busy schedules, fatigue, and difficulty maintaining diet plans—particularly due to medication-induced hunger—were also barriers, consistent with findings from India (22).

Medication effectiveness also influenced adherence. Women were more compliant when symptoms such as irregular menstruation improved, while dissatisfaction with ineffective medications reduced adherence. Side effects, including fatigue, nausea, vomiting, and headaches, were additional barriers, echoing previous studies (22,23). Concerns about long-term risks, such as breast cancer from extended contraceptive use, were also raised. While studies suggest the overall risk is low (39), similar concerns were reported in China (40), where fear of adverse drug reactions negatively affected adherence.

Family support emerged as a major facilitator of adherence, potentially amplified by the collectivist culture in the Philippines. Filipino families often provide emotional, psychological, and financial support, with interdependence playing a central role in daily life (41). Sharing experiences with friends and colleagues also improved women’s perceptions of PCOS, positively influencing adherence. This aligns with studies from Iran and the United Kingdom (23,42), which highlight the importance of social support in mitigating the psychosocial impact of PCOS and promoting adherence.

The financial burden of PCOS treatment varied among participants. While most reported no financial difficulties, some faced significant challenges in consistently affording monthly medications. In the Philippines, outpatient PCOS medications are not covered by the Philippine Health Insurance Corporation (PhilHealth) (43). A systematic review of lived experiences with PCOS identified treatment costs and limited healthcare access as major barriers, particularly in countries without free healthcare at the point of delivery (23). These findings underscore how gaps in financial coverage can lead to inequities in access to consistent PCOS treatment.

This study has several limitations. The use of virtual interviews conducted via Zoom may have introduced selection bias by excluding women without stable internet access or technology, potentially resulting in a sample skewed toward those with higher income or education levels. Most participants were employed and held a bachelor’s degree, suggesting better self-management capabilities and healthcare accessibility compared with more financially constrained women. The sample also had a narrow age range and marital status profile, focusing on women for whom fertility concerns were not yet a significant issue. Women diagnosed with anxiety, depression, and other chronic illnesses were excluded, despite these being common comorbidities among women with PCOS, limiting the applicability of findings to such groups. The study focused solely on Ob-Gyn-centered care, which may have restricted the scope of consultation experiences explored. Furthermore, most participants were from highly urbanized regions in the Philippines, where access to healthcare services and transportation is less challenging, potentially affecting the generalizability of findings to women in more remote or underserved areas.

Despite these limitations, this is the first study to explore consultation experiences and treatment adherence among women with PCOS in the Philippines. A key strength was the use of probing questions during interviews, which encouraged participants to openly share their thoughts and experiences, yielding rich and nuanced data. Member checking was conducted by sharing the findings with participants to verify the accuracy and resonance of the interpretations. The study also ensured the inclusion of women with diverse PCOS-related symptoms and health concerns, contributing to the depth and breadth of perspectives captured.

Conclusions

Women’s consultation experiences, personal values, perspectives, and the attitudes of healthcare professionals vary considerably and play a critical role in shaping health outcomes. Alongside these interactions, treatment adherence is essential for improving quality of life among women with PCOS. Sustained adherence depends on women’s ability to address barriers to medication use and maintain healthy lifestyle practices. Effective PCOS management, therefore, requires addressing both the factors that hinder treatment adherence and the challenges encountered during consultations.

Recommendations

Further research in the Philippines is needed to develop culturally appropriate strategies for PCOS care, supported by evidence-based local guidelines, policies, and reference materials for accurate diagnosis and effective treatment. Ob-Gyns should address women’s concerns, involve them in decision-making, and provide clear next steps before the end of each consultation, with written summaries of key points, medications, and follow-up instructions to improve recall and adherence. Continuity of care can be enhanced through pre- and post-consultation surveys, reminder systems, flexible scheduling, and telemedicine to overcome accessibility barriers, while mobile health tools such as apps for tracking symptoms, medications, or physical activity can help women monitor their progress. To improve treatment adherence, healthcare providers should develop simpler, cost-effective therapies and prioritize counseling to ensure women understand their regimens, while strengthening coping resources—such as local support groups—to provide peer support and shared strategies for managing PCOS.

Acknowledgments

The researchers express their heartfelt gratitude and appreciation towards the PCOS women and the partner Ob-Gyns for being generous with their time and for their fruitful cooperation.

Footnote

Reporting Checklist: The authors have completed the COREQ reporting checklist. Available at https://jhmhp.amegroups.com/article/view/10.21037/jhmhp-24-151/rc

Data Sharing Statement: Available at https://jhmhp.amegroups.com/article/view/10.21037/jhmhp-24-151/dss

Peer Review File: Available at https://jhmhp.amegroups.com/article/view/10.21037/jhmhp-24-151/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jhmhp.amegroups.com/article/view/10.21037/jhmhp-24-151/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work, ensuring that any questions regarding accuracy or integrity are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments and received ethical approval from the University Ethics Review Committee of Adamson University (approval No. 2022-02-PHA-01). Written informed consent was obtained via a Google form, and verbal consent was confirmed before each interview. To protect confidentiality and participants’ identities, ID numbers were used to anonymize all interview data.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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