High PCOS prevalence reported in India

High PCOS prevalence reported in India | Image Credit: © Kiattisak - © Kiattisak - stock.adobe.com.

There is a high prevalence of polycystic ovary syndrome (PCOS) among reproductive-aged women in India, especially with phenotype C, according to a recent study published in JAMA Network Open.¹

PCOS, presenting as hyperandrogenism, irregular menstruation, and polycystic ovarian morphology (PCOM), may lead to multiple adverse metabolic health outcomes. These include obesity, insulin resistance, nonalcoholic fatty liver disease, dysglycemia, and metabolic syndrome. A global prevalence of 4% to 21% has been reported.

In India, rates of PCOS range from 2% to 35%. The prevalence of PCOS is influenced by factors such as geographic location, population ethnicity, differences in androgen and ultrasonography-based assessments, and diagnostic criteria.² Currently, data about PCOS prevalence from well-designed, population-based studies is lacking.¹

To evaluate the prevalence of PCOS in India, alongside its phenotypes and associated comorbidities, investigators conducted a multicenter, epidemiologic, cross-sectional study. Women aged 18 to 40 years were recruited through a stratified sampling procedure from November 1, 2018, to July 31, 2022.

Participants were categorized as screen positive if they had oligomenorrhea, secondary amenorrhea, or clinical hyperandrogenism, while those without any of these features were screen negative. Prior PCOS diagnoses were identified from medical health records.

Eligibility criteria included living in the area for at least 1 year, not being pregnant or lactating, and willingness to participate. Information was obtained through validated questionnaires conducted during face-to-face interviews by trained research staff.

Relevant data included age, menstrual cyclicity, marital status, hirsutism, acne, alopecia, parity, and relevant history. Exclusion criteria included certain chronic disorders or medication use. Transabdominal ultrasonography and hormonal analysis were performed after exclusion, with National Institutes of Health 1990 criteria used to diagnose PCOS.

A single trained observer performed evaluations of hirsutism, androgenic alopecia, and acne vulgaris. The Leeds technique was used to grade acneiform lesions, while PCOM evidence was assessed through transabdominal ultrasonography.

After fasting overnight on days 2 to 7 of a spontaneous or medroxyprogesterone-induced menstrual cycle, blood samples were collected from eligible women. Participants also underwent a glucose test and had kidney function test results, liver function test results, hemogram, and lipid profile collected.

Investigators defined oligomenorrhea as under 8 menstrual cycles per year and secondary amenorrhea as cycle length over 90 days. A modified Ferriman-Gallwey score over 8 indicated clinical hyperandrogenism, while PCOM was indicated by over 12 peripheral follicles. PCOS was defined by any of the 3 diagnostic criteria.

The questionnaire was completed by 8993 women aged a mean 29.5 years, with 196 having diagnosed PCOS, 2251 having positive screen results, and 6546 having negative screen results. Of women with probable PCOS based on positive screen results, 1759 had complete hormonal evaluation, 133 of whom were excluded.

PCOS prevalence ranged from 7.2% to 19.6% depending on the criteria used. All criteria indicated a higher prevalence in urban areas vs rural areas, with the greatest rates in Central and North India and the lowest in Northeastern India.

PCOS phenotype C was observed in 40.8% of cases, making it the most common phenotype. This was followed by phenotype C in 24.6%, phenotype A in 20.2%, and phenotype B in 14.3%. Partial phenotypes were reported in 492 individuals in the non-PCOS cohort, with hyperandrogenism in 257, oligomenorrhea in 75, and PCOM in 160.

Overweight was reported in 32% of women with PCOS and obesity in 10.9% When applying Asian cut-offs, these rates were 20% and 43.2%, respectively. Among pre-PCOS women, overweight and obesity rates were 19.3% and 36.2%, respectively.

Metabolic syndrome was reported in 24.9% of women with PCOS, nonalcoholic fatty liver disease in 32.9%, and any dyslipidemia 91.9%. These rates were 15.9%, 33.1%, and 79.3%, respectively, among women with pre-PCOS.

These results highlighted high rates of PCOS among reproductive-aged women in India, with a prominence of phenotype C. Investigators concluded this data is vital for developing preventive and therapeutic strategies.

Reference

1. Ganie MA, Chowdhury S, Malhotra N, et al. Prevalence, phenotypes, and comorbidities of polycystic ovary syndrome among Indian women. JAMA Netw Open. 2024;7(10):e2440583. doi:10.1001/jamanetworkopen.2024.40583
2. Rosner W, Auchus RJ, Azziz R, Sluss PM, Raff H. Position statement: utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement.J Clin Endocrinol Metab. 2007;92(2):405-413. doi:10.1210/jc.2006-1864