AIIMS Screening Finds 3-5% Adolescent Girls May Have Polycystic Ovary Syndrome

A school-based screening programme by doctors at Delhi's All India Institute of Medical Sciences (AIIMS) has found that an estimated 3-5 per cent of adolescent girls screened may have polycystic ovary syndrome (PCOS), according to preliminary findings of the ongoing study.

The screening, which began around 2023, has covered more than 4,000 children in seven government and private schools in Delhi. The findings are yet to be published.

The doctors say the exercise has also brought into focus a bigger challenge, identifying PCOS in teenagers when symptoms such as irregular periods and acne can be part of normal puberty.

"PCOS affects not only the ovaries but also the endocrine and metabolic systems, so we need to look at the child as a whole and not just at menstrual irregularities," said Dr Rajni Sharma, professor in the Division of Pediatric Endocrinology at AIIMS.

PCOS is associated with excess androgen, a group of hormones that includes male sex hormones, and problems with ovulation. The condition can cause irregular periods, acne and excess facial or body hair, and is associated with insulin resistance, obesity and Type 2 diabetes.

Why doctors are cautious about diagnosing PCOS in teenagers

A teenager having irregular periods does not automatically mean she has PCOS, doctors said.

The menstrual cycle can take time to become regular after the first period. Acne is also common during puberty, while the ovaries of healthy adolescents can normally show several developing follicles.

This makes it difficult to separate a disorder from normal adolescent development.

International guidelines have therefore set a higher threshold for diagnosing PCOS in adolescents. Under the 2023 recommendations, doctors look for both persistent menstrual irregularity and evidence of excess androgen, while excluding other conditions that may produce similar symptoms.

Ultrasound is not recommended as a diagnostic tool for adolescent PCOS because a multi-follicular appearance of the ovaries is common during normal development.

Girls who have only one of the required features may instead be considered at higher risk and followed up over time.

Dr Sharma said prevalence figures for teenagers also need to be viewed cautiously because diagnostic criteria have become more stringent. AIIMS doctors cited estimates of around 3-8 per cent among adolescents aged 10-19, compared with older estimates that had placed prevalence at around 10 per cent in some settings.

Being thin does not rule out PCOS

Doctors at AIIMS also cautioned against viewing PCOS only through the lens of obesity.

Dr Vandana Jain, professor in the Division of Pediatric Endocrinology, said a girl's growth pattern should be considered rather than relying only on whether she falls above a conventional overweight or obesity cut-off.

PCOS can occur in adolescents who are normal-weight or thin, sometimes described as "lean PCOS".

Doctors said the condition is thought to arise from an interaction of genetic, hormonal and metabolic factors. Insulin resistance can lead to increased insulin production, which may stimulate the ovaries to produce more androgens and interfere with normal ovulation.

They also pointed to lifestyle factors, including diets dominated by refined carbohydrates and highly processed foods, inadequate physical activity and increasing screen time, as factors that may contribute to metabolic risk.

Dr Jain recommended regular physical activity and balanced meals containing fruits, vegetables, whole grains and adequate protein.

The doctors also highlighted another possible risk pattern: low birth weight followed by rapid or excessive weight gain, which may be associated with metabolic problems later in life.

Why early identification matters

AIIMS doctors said PCOS should not be treated simply as a menstrual or fertility-related condition.

A family history of PCOS, obesity or Type 2 diabetes can increase a girl's risk. The condition is also associated with insulin resistance and a higher likelihood of developing Type 2 diabetes and other metabolic problems.

Dr Rima Dada, professor in the Department of Anatomy at AIIMS, discussed yoga as part of lifestyle management, saying it can have effects on insulin levels, hormonal regulation, inflammation, sleep and stress.

The condition can also take a psychological toll during adolescence.

Dr Renu Sharma, a child psychologist in the Department of Psychiatry at AIIMS, said symptoms such as weight gain, acne and excess facial hair can affect body image and self-esteem and expose adolescents to bullying and difficulties in relationships with peers and family.

She also flagged anxiety, depression, eating disorders and concerns about future fertility among issues that may arise in adolescents with PCOS. These psychological and social difficulties can, in turn, affect academic performance.

The terminology used for the condition is also being reconsidered. An international guideline group has proposed "polyendocrine metabolic ovarian syndrome" (PMOS), a term intended to reflect the broader hormonal and metabolic nature of the disorder and the fact that ovarian cysts are not necessary for a diagnosis.

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