Physical activity and health-related quality of life in women with polycystic ovary syndrome attending fertility clinics in Sri Lanka: a cross-sectional study

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder that substantially impairs health-related quality of life (HRQoL). Regular physical activity is a recommended first-line intervention, but the relationship between activity and HRQoL is understudied in South Asian women, particularly in those attending fertility clinics who carry the additional psychological burden of infertility. This study aimed to examine the association between physical activity levels and PCOS-specific HRQoL in women with PCOS attending fertility clinics in Colombo, Sri Lanka. An analytical cross-sectional study was conducted at the fertility clinics of two tertiary care hospitals in Colombo, Sri Lanka: De Soysa Hospital for Women and Children and Castle Street Hospital for Women between 13 October and 7 November 2025. Eighty-five women aged 18–45 years with a clinician-confirmed diagnosis of PCOS were recruited by convenience sampling. Physical activity was assessed using the International Physical Activity Questionnaire – Short Form (IPAQ-SF), validated to the Sri Lankan setting, and expressed as MET-minutes per week. HRQoL was measured using the Polycystic Ovary Syndrome Questionnaire (PCOSQ), validated in the Sri Lankan setting, which yields a total score and five domain scores (emotions, body hair, weight, infertility, menstrual problems) on a 1–7 scale, with higher scores indicating better HRQoL. PCOS phenotype was classified according to the Rotterdam criteria. Continuous variables were summarized using medians and interquartile ranges, and Spearman’s rank correlation (rs) was used to examine the association between physical activity and HRQoL. The mean (SD) age was 28.0 (4.9) years, and the median (IQR) age was 28 (24–30) years; the median body mass index was 30.2 (28.0–32.4) kg/m². The majority of participants (60.0%, n = 51) were classified as having low physical activity, with a median total activity score of 1017.0 (569.5–2459.3) MET-minutes/week. The median overall PCOSQ score was 3.07 (2.37–3.64), indicating moderate HRQoL impairment; the lowest-scoring domain was body hair and appearance (median 2.20), and the highest was infertility-related worries (median 3.50). Physical activity showed a statistically significant moderate positive correlation with overall HRQoL (rs = 0.465, p < 0.001). Domain-specific analyses revealed significant moderate positive correlations with emotional well-being (rs = 0.493, p < 0.001), weight (rs = 0.470, p < 0.001) and infertility (rs = 0.464, p < 0.001) domains, while body hair (rs = 0.210, p = 0.054) and menstrual symptoms (rs = − 0.027, p = 0.805) were not significantly associated. Phenotype-stratified analyses showed significant associations in Phenotype A (rs = 0.384, p = 0.004) and Phenotype B (rs = 0.490, p = 0.015); Phenotypes C (n = 2) and D (n = 4) were underpowered. In this cross-sectional sample, higher physical activity levels were associated with better overall PCOS-specific quality of life among women attending fertility clinics in Colombo, with the strongest domain-specific associations observed for emotional well-being, weight, and infertility-related concerns. Because the design was cross-sectional, causality cannot be inferred. Nonetheless, given that sixty per cent of participants did not meet recommended activity levels, these findings support routinely assessing physical activity in fertility clinic care and suggest that physical activity may be a useful target for future longitudinal and interventional studies of HRQoL in women with PCOS in Sri Lanka. Polycystic ovary syndrome (PCOS) is a common hormonal condition in women of reproductive age that can cause irregular periods, difficulty becoming pregnant, weight gain, and unwanted hair growth, and it often affects women’s day-to-day well-being. We asked eighty-five women with PCOS who were attending fertility clinics at two hospitals in Colombo, Sri Lanka, how physically active they were and how the condition was affecting their quality of life. 60% of the women were not doing enough physical activity to meet international recommendations, and most reported moderately reduced quality of life, with concerns about body hair and appearance and weight affecting them the most. Women who were more physically active reported better overall quality of life, better emotional well-being, fewer weight-related concerns, and less infertility-related distress. These findings suggest that asking women with PCOS about physical activity and helping them to be more active could be a simple and low-cost way for fertility clinics in Sri Lanka to improve patients’ wellbeing alongside the medical treatment they are already receiving.