Prevalence and Clinical Factors Associated With Polycystic Ovary Syndrome Among Women Presenting With Menstrual Irregularities: A Cross-Sectional Study

Abstract

Objective: To determine the prevalence of polycystic ovary syndrome (PCOS) and identify clinical factors independently associated with PCOS among women presenting with menstrual irregularities.

Study design: Analytical cross-sectional study.

Setting and duration: Department of Obstetrics and Gynecology, Qazi Hussain Ahmad Medical Complex, Nowshera, Pakistan, from March 2023 to August 2023.

Material and Methods: Four hundred women aged 15–45 years presenting with menstrual irregularities were recruited by non-probability consecutive sampling. PCOS was diagnosed according to the 2023 International Evidence-based Guideline. In adults, diagnosis required at least two of three features after exclusion of relevant alternative disorders: ovulatory dysfunction, clinical and/or biochemical hyperandrogenism, and polycystic ovarian morphology (PCOM). PCOM was assessed by transvaginal ultrasonography performed by a radiologist, with follicle number per ovary (FNPO) ≥20 in at least one ovary used as the adult threshold. In adolescents, diagnosis required both ovulatory dysfunction and hyperandrogenism; ultrasound morphology and AMH were not used diagnostically. Biochemical hyperandrogenism was assessed using total and free testosterone measured in the hospital laboratory. AMH was an additional supportive investigation only. Associations with PCOS were evaluated using univariable and multivariable logistic regression; there were no missing data for variables included in the analyses.

Results: Of 400 women, 96 (24.0%) met the diagnostic criteria for PCOS. Mean BMI was higher in women with PCOS than in those without PCOS (27.9 ± 4.0 vs 25.4 ± 4.0 kg/m²; p<0.001). On multivariable analysis, hirsutism (aOR 7.35, 95% CI 4.04–13.39), family history of PCOS (aOR 4.36, 95% CI 2.31–8.23), acne (aOR 4.20, 95% CI 2.21–7.99), infertility history (aOR 3.54, 95% CI 1.74–7.20), BMI ≥25 kg/m² (aOR 3.23, 95% CI 1.75–5.95), and menarche before 12 years (aOR 2.31, 95% CI 1.17–4.56) were independently associated with PCOS. Age was not independently associated with PCOS (aOR 1.03, 95% CI 0.97–1.08; p=0.338).

Conclusion: Approximately one in four women presenting with menstrual irregularities met the 2023 guideline-based diagnostic criteria for PCOS. Hirsutism, family history of PCOS, acne, infertility history, BMI ≥25 kg/m² and early menarche were associated with PCOS after multivariable adjustment. These findings characterize a symptomatic hospital-based population and should not be interpreted as a validated diagnostic or prediction model.

Keywords: polycystic ovary syndrome; menstrual irregularities; oligomenorrhea; hyperandrogenism; hirsutism; cross-sectional study.