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Polycystic Ovary Syndrome (PCOS): A Growing Public Health Concern for Young Women

Introduction 

Polycystic Ovary Syndrome (PCOS) is a complex, multifactorial endocrine disorder that affects reproductive-aged women, particularly adolescents and young adults. It is characterized by hyperandrogenism, chronic anovulation or oligo-ovulation, and polycystic ovarian morphology, although the phenotype can vary widely between individuals.

More than a gynecological issue, PCOS is now recognized as a lifelong metabolic, reproductive, and psychological disorder with implications that extend far beyond irregular periods and acne. Its increasing prevalence, often tied to lifestyle changes, urbanization, obesity, and insulin resistance, has made PCOS one of the most common endocrine disorders in young females globally.

PCOS is associated with infertility, type 2 diabetes, cardiovascular risk, mental health issues, and reduced quality of life. Yet, despite its burden, PCOS remains underdiagnosed, misunderstood, and frequently mistreated, especially in adolescents where physiological irregularities can mask its clinical signs.

  • PCOS affects 6%–13% of women of reproductive age, depending on the diagnostic criteria used (Rotterdam, NIH, or AE-PCOS).
  • A 2022 meta-analysis (Lancet Endocrinology) estimated global prevalence at 11.2%, with higher rates in:
    • South Asia and the Middle East (15–18%)
    • Obese adolescents and young adults
    • Urban and sedentary populations
  • Alarmingly, the incidence of adolescent PCOS has tripled over the past 20 years due to:
    • Rising childhood obesity
    • Increased exposure to endocrine-disrupting chemicals
    • Poor dietary and exercise habits

PCOS symptoms often emerge during late puberty and vary depending on the phenotype.

Reproductive Signs

  • Oligomenorrhea: Infrequent or irregular periods (>35 days apart)
  • Amenorrhea: No menstrual cycle for ≥3 months
  • Anovulation: Failure to ovulate regularly
  • Infertility: Resulting from chronic anovulation

Hyperandrogenic Symptoms

  • Acne, especially on face, jawline, and back
  • Hirsutism: Excess hair on face, chest, abdomen
  • Scalp hair thinning (female-pattern hair loss)
  • Oily skin and seborrhea

Metabolic Features

  • Obesity (especially central/visceral)
  • Insulin resistance
  • Acanthosis nigricans (dark neck or underarm folds)
  • Fatigue, sugar cravings, and reactive hypoglycemia

Psychological and Emotional

  • Depression and anxiety
  • Low self-esteem and body image issues
  • Social withdrawal, especially related to hirsutism or weight gain

PCOS is not just a cosmetic or fertility disorder—it has lifelong systemic consequences:

Infertility

  • PCOS is the leading cause of anovulatory infertility.
  • However, with proper ovulation induction and weight management, most women can conceive.

Metabolic Syndrome and Diabetes

  • Insulin resistance is present in ~70% of PCOS women.
  • 4–7 times increased risk of developing type 2 diabetes mellitus (T2DM), often before age 40.

Cardiovascular Disease (CVD)

  • Increased LDL, triglycerides, and low HDL
  • Hypertension and endothelial dysfunction
  • Elevated C-reactive protein (CRP) and carotid intima-media thickness

Endometrial Hyperplasia and Cancer

  • Chronic unopposed estrogen (due to anovulation) can lead to:
    • Endometrial thickening
    • Atypical hyperplasia
    • Increased risk of endometrial carcinoma

Psychiatric Disorders

  • PCOS patients have 2–3x higher prevalence of:
    • Depression
    • Anxiety
    • Eating disorders

Sexual dysfunction

There is no cure for PCOS, but it can be effectively managed through a combination of lifestyle, pharmacologic, and supportive interventions tailored to symptom clusters.

Lifestyle Intervention (First-line Therapy)

  • Weight loss of 5–10% significantly improves ovulatory function and insulin sensitivity.
  • Low-glycemic, high-fiber diet with limited processed carbs
  • Regular aerobic + resistance training (≥150 minutes/week)
  • Behavioral therapy to address disordered eating or body image

Pharmacologic Treatment

Symptom Cluster

Medication Options

Menstrual regulation

Combined Oral Contraceptives (COCs): Estrogen + progestin

Hyperandrogenism

Spironolactone, Flutamide, Finasteride (anti-androgens)

Insulin resistance

Metformin: improves insulin sensitivity, ovulation

Ovulation induction

Letrozole (first-line), Clomiphene citrate

Acne/Hirsutism

Topical retinoids, laser hair removal, oral anti-androgens

Mental Health and Counseling

  • CBT, support groups, and psychiatric evaluation for mood disorders
  • Holistic approach addressing self-image, sexuality, and relationships

Monitoring and Follow-up

  • Annual screen for:
    • T2DM (OGTT preferred over HbA1c)
    • Lipid profile and blood pressure
    • Ultrasound of endometrium in high-risk cases
  1. Teede HJ, Misso ML, Costello MF, et al. International evidence-based guideline for the assessment and management of PCOS 2023. Hum Reprod.
    https://doi.org/10.1093/humrep/deac234
  2. Azziz R, et al. Epidemiology and pathophysiology of the polycystic ovary syndrome in adolescents. Endocr Rev. 2016;37(2):129–144.
    https://doi.org/10.1210/er.2015-1045
  3. Lim SS, et al. Overweight, obesity and central obesity in women with PCOS: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(6):618–637.
    https://doi.org/10.1093/humupd/dms030
  4. March WA, et al. The prevalence of PCOS in a community sample. Hum Reprod. 2010;25(2):544–551.
    https://doi.org/10.1093/humrep/dep402
  5. Moran LJ, et al. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev.2011;(7):CD007506.
    https://doi.org/10.1002/14651858.CD007506.pub3
  6. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to PCOS. Fertil Steril. 2004;81(1):19–25.
    https://doi.org/10.1016/j.fertnstert.2003.10.004

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