Prevalence, Phenotypes, and Comorbidities of Polycystic Ovary Syndrome Among Indian Women
Authors: Ganie Mohd Ashraf , Chowdhury Subhankar , Malhotra Neena , Sahay Rakesh , Bhattacharya Prasanta Kumar , Agrawal Sarita , Jabbar P. K. , Suri Vanita , Rozati Roya , Sreenivas Vishnubhatla , Baba Mohammad Salem , Wani Imtiyaz Ahmad , Rashid Haroon , Nair Abhilash , Shukla Amlin , Arora Taruna , Kulkarni Bharati ,   PCOS Study Group, Koul Parvaiz , Shah Zafar Amin , Masoodi Shariq , Parvez Tabasuum , Yatoo Ghulam Nabi , Chow Naseer Ahmad , Gojwari Tariq , Wani Muzaffar , Qayoom Seema , Khan Wahid , Walia Rama , De Deepenkar , Arora Aashima , Singh Tulika , Khanna Neena , Naik Nitish , Prakash Shyam , Gupta Nandita , Sagar Rajesh , Sharma Jai Bhagwan , Kandasamy Devasenathipathy , Bodhey Narender Kuber , Mohapatra Eli , Siddiqui Sabah , Kamilya Gourisankar , Singh Archana , Mukhopadhyay Pradip , Sarkar Nehar Ranjan , Ruram Alice Abraham , Abraham Jessy , Lynser Donboklang , Agrawal Manika , Rao Laksman , Bindu Sudha , Ponnuru Malathi , Ahmad Nadeem , Rani Sujatha , Khan Aleem Ahmad , Ahmad Sultan Rizwan , Rao Prabhakar , C Nirmala , George Anuja Elizabeth , Leelamma Jayasree , Thakur Gaurav , Noor Saba , Paddar Khursheed , Meshram Gaivee Vinam , Choudhary Shouvik , Rashid Aafia , Showkat Wasia , Bashir Rohina , Rashid Rabiya , Manzoor Jabish , Ahmad Nisar , Adhikary Pieu , Pramanik Subhasish , Harish Rahul , Makhdoomi Mudasir , Fayaz Mudasir , Rehman Nafeez , Ravi Neha , Kumar Ajay , Chandrakar Siffali , Kumar Nithlesh , Banerjee Sudipta , Minhaj Humaira , Bhaskar Balaji , Iqbal Shaik , Babu Ram , Suresh Arya , Sharma RS , Singh Shalini , Roy Malabika , Rasilly Reeta , Chandiok Nomita , Rajab Mehnaaz , Reshi Arifa , Farhat Deeba , Rashid Abid , Jahan Nusrat , Choudhary Shavini , Mohiudin Naila , Ranjith Samala , Rather Khalid ul Islam 
Published: October 2024

Importance

The prevalence of polycystic ovary syndrome (PCOS) varies across the globe. Indian studies on PCOS are limited by poor design, small sizes, regional representations, and varying methods.

Objectives

To estimate the nationwide prevalence of PCOS in India, examine the phenotypic spectrum, and assess the magnitude of comorbidities associated with PCOS.

Design, Setting, and Participants

This cross-sectional study recruited 9824 women aged 18 to 40 years from November 1, 2018, to July 31, 2022, across 5 zones of the country. A prevalidated questionnaire dichotomized women into screen-positive and screen-negative groups. Relevant clinical, hormonal, and sonographic assessments categorized women as either women with criteria-based PCOS (ie, National Institutes of Health [NIH] 1990 criteria, Rotterdam 2003 criteria, or Androgen Excess and Polycystic Ovary Syndrome Society [AE-PCOS] criteria), women with partial phenotypes (hyperandrogenism, oligomenorrhea, or polycystic morphology labeled as pre-PCOS), or healthy women, in addition to quantitating various comorbidities.

Main Outcomes and Measures

The prevalence and phenotypes of PCOS among women of reproductive age and the burden of comorbidities associated with PCOS.

Results

A total of 8993 women (mean [SD] age, 29.5 [6.2] years) were enrolled in this study; 196 women were already diagnosed with PCOS, 2251 were categorized as screen positive, and 6546 were categorized as screen negative. The mean (SD) age of screen-positive women (28.1 [6.4] years) was lower than that of screen-negative women (29.7 [6.1] years) (P &amp;lt; .001), and the mean (SD) age at menarche was higher in the former group (13.2 [1.3] vs 13.1 [1.2] years; P &amp;lt; .001). The national prevalence of PCOS was 7.2% (95% CI, 4.8%-10.8%) by NIH 1990 criteria, 19.6% (95% CI, 12.7%-29.2%) by Rotterdam 2003 criteria, and 13.6% (95% CI, 8.4%-21.6%) by AE-PCOS criteria. Overall, PCOS phenotypes C (501 [40.8%]) and D (301 [24.6%]) were the most common, and 492 women (pre-PCOS subgroup) had oligomenorrhea (n = 75), hyperandrogenism (n = 257), or polycystic ovarian morphology (n = 160) only. Among women with PCOS (n = 1224), obesity was present in 529 (43.2%), dyslipidemia in 1126 (91.9%), nonalcoholic fatty liver disease in 403 (32.9%), metabolic syndrome in 305 (24.9%), impaired glucose tolerance in 111 (9.1%), diabetes in 41 (3.3%), and hypertension in 101 (8.3%). The pre-PCOS subgroup (n = 492) displayed similar metabolic aberrations (dyslipidemia: 390 [79.3%]; metabolic syndrome: 78 [15.9%]; nonalcoholic fatty liver disease: 163 [33.1%]; impaired glucose tolerance: 62 [12.6%]; diabetes: 7 [1.4%]; and hypertension: 26 [5.3%]).

Conclusions and Relevance

In this cross-sectional study of reproductive-age women recruited across India, the prevalence of PCOS was high, with phenotype C being predominant. Most of these women had metabolic abnormalities. These findings are crucial for developing preventive and therapeutic strategies, potentially integrating PCOS management into national health programs.