Prevalence and Risk Factors of Polycystic Ovary Syndrome (PCOS) Among Reproductive-Age Women

Abstract

Polycystic Ovary Syndrome (PCOS) is the most common endocrine-metabolic disorder affecting women of reproductive age worldwide, with global prevalence estimates ranging from 10–13% depending on diagnostic criteria (Rotterdam, NIH, AES). This review synthesizes current epidemiological data and risk factor profiles, emphasizing the syndrome’s heterogeneous presentation hyperandrogenism, ovulatory dysfunction, polycystic ovarian morphology and its multisystem implications spanning reproductive (infertility, miscarriage), metabolic (insulin resistance, type 2 diabetes, dyslipidemia, NAFLD), cardiovascular (hypertension, endothelial dysfunction), and psychological (depression, anxiety, reduced quality of life) domains. Major risk factors include genetic predisposition (familial clustering, polymorphisms in FSHR, DENND1A, LHCGR, and THADA loci), obesity (BMI >25 kg/m² doubles risk), insulin resistance (present in 50–70% of cases), prenatal androgen exposure, and environmental contributors (endocrine-disrupting chemicals, sedentary lifestyle, Western dietary patterns). Regional variations show higher prevalence in South Asian and Middle Eastern populations (15–20%), often linked to higher rates of central adiposity and insulin resistance despite lower overall BMI. Emerging evidence highlights evolutionary mismatch modern caloric surplus and reduced physical activity amplifying ancestral thrifty genotypes and the bidirectional relationship between PCOS and obesity. Early screening, lifestyle modification, and targeted interventions (metformin, inositols, GLP-1 agonists) offer opportunities for risk mitigation. The review underscores the need for standardized diagnostic criteria, large-scale longitudinal studies in diverse populations, and integrated management addressing both reproductive and cardiometabolic sequelae to reduce long-term morbidity.