Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic condition in women of reproductive age that is defined by two main features: ovulatory dysfunction and hyperandrogenism as well as polycystic ovarian morphology [1]. Is a multi-faceted disorder with reproductive, metabolic and psychological effects that markedly influences the quality of life and long-term health outcomes [2]. The prevalence rates differ widely across the world, depending on the criteria used for diagnosis and characteristics of the population studied, but PCOS is a significant public health problem affecting women of reproductive age [3]. In addition to its reproductive effects, PCOS is currently understood to be a metabolic condition, which is closely related with insulin resistance, impaired glucose metabolism, obesity, dyslipidaemia, and higher cardiovascular risk [4]. Insulin resistance is an underlying cause of many women with PCOS, and is a factor that leads to hyperinsulinemia, ovarian androgen excess, anovulation and metabolic dysfunction [5]. This interrelationship is clinically important with 40–60% women suffering from PCOS also having diabetes mellitus and 40–60% women with diabetes mellitus also having PCOS. Chronic insulin resistance and glucose intolerance are the key factors in the pathogenesis of PCOS, and women with PCOS are more likely to develop diabetes mellitus, especially type 2 diabetes (T2DM), than women in the general population [6]. Women with PCOS have an increased prevalence of IFG, IGT, metabolic syndrome and manifest diabetes at an earlier age [7]. This association is important to identify early as untreated metabolic dysfunction can lead to increased long term morbidity.

Obesity also exacerbates the metabolic effects of PCOS and can contribute to greater hormonal imbalance, irregular menstruation, infertility, hyperandrogenism and cardiometabolic risk [8]. Adiposity has a vicious cycle effect by causing an increasing of insulin resistance and chronic low-grade inflammation [9]. There are lean forms of PCOS, but obesity is very common among many affected individuals [10]. The typical clinical features of PCOS include menstrual irregularities, oligomenorrhea, amenorrhea, infertility, hirsutism, acne, weight gain and metabolic abnormalities [11]. The diagnosis is delayed however, especially in resource-poor areas where metabolic screening may not be routinely performed [12]. There are implications of diabetes mellitus and obesity for screening and integrated management for women with PCOS. The burden of metabolic diseases, like among women of reproductive age, has emerged in Pakistan as a growing problem with rising rates of obesity, diabetes and endocrine disorders [13]. Other factors such as transitions of lifestyle, urbanisation, dietary changes and physical inactivity could further contribute to metabolic reproductive disorders [14].

Objective: To determine the frequency of polycystic ovary syndrome with diabetes mellitus and obesity among reproductive-age women presenting to tertiary care hospitals in Pakistan

This was a cross-sectional analytical study conducted at Tertiary Care Hospital in Islamabad from March 2024 to September 2025, including 375 reproductive-age women. Women aged 18-45 years with menstrual irregularities, infertility, hirsutism, acne, obesity, possible endocrine disturbances, or possible polycystic ovary syndrome were included. Patients who met the following two criteria were included: they had PCOS according to the standard Rotterdam criteria (two of three criteria present: oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology) and they agreed to participate with informed consent. Women pregnant, with known adrenal disorders, thyroid dysfunction, hyperprolactinemia, Cushing syndrome, ovarian tumors, congenital adrenal hyperplasia, type 1 diabetes mellitus, prior ovarian surgery, and those with incomplete clinical/laboratory records were excluded. Data Collection Data were collected after the ethical approval with a structured proforma. Demographic and clinical parameters assessed were age, marital status, menstrual history, infertility status, hirsutism, acne, family history of diabetes, physical activity patterns, anthropometric parameters such as height, weight, BMI and WC. Where appropriate, clinical examination and appropriate hormonal evaluation were conducted. Ovarian morphology evaluation was performed using ultrasound. Diabetes mellitus was diagnosed using the standard diagnostic criteria for fasting blood glucose and/or HbA1c test. BMI classification criteria were used to define obesity. The participants were divided according to the presence or absence of PCOS, diabetes mellitus (DM), and obesity and associations between metabolic and reproductive variables were assessed. Statistical Analysis The data were analysed by SPSS version 26.0. All the continuous variables were reported as mean ± SD and categorical variables as frequencies and percentages. Clinical characteristics and predictors of PCOS and metabolic comorbidity were compared between groups using independent t-tests, Chi-square tests and multivariable logistic regression. A P-value of < 0.05 was deemed as statistically significant.

The study included 375 reproductive-age women with a mean age of 28.9 ± 6.4 years. Most were aged 26–35 years (171; 45.6%) and married (248; 66.1%). The mean BMI was 29.7 ± 5.8 kg/m², and mean waist circumference was 92.4 ± 11.6 cm. Menstrual irregularity was reported in 219 (58.4%), infertility in 146 (38.9%), hirsutism in 127 (33.9%), and acne in 102 (27.2%) women.

Table 1: Baseline Demographic, Clinical, and Metabolic Characteristics of

Reproductive-Age Women (n = 375)

Confirmed PCOS was present in 156 (41.6%) women, while diabetes mellitus and obesity were found in 88 (23.5%) and 171 (45.6%) participants, respectively. PCOS with diabetes was observed in 61 (16.3%), PCOS with obesity in 103 (27.5%), and PCOS with both diabetes and obesity in 47 (12.5%) women, showing a strong metabolic burden.

Table 2: Frequency of PCOS, Diabetes Mellitus, and Obesity among Study Participants

Women with PCOS were younger than non-PCOS women (27.4 ± 5.8 vs. 30.0 ± 6.7 years; p=0.001) and had significantly higher BMI (32.1 ± 5.4 vs. 28.0 ± 4.9 kg/m²; p<0.001) and waist circumference (98.3 ± 10.4 vs. 88.2 ± 9.7 cm; p<0.001).

Table 3: Comparative Clinical and Metabolic Characteristics between Women with and Without PCOS

Logistic regression showed menstrual irregularity was the strongest predictor of PCOS (aOR 5.84; 95% CI: 3.29–10.36; p<0.001), followed by obesity (aOR 4.68), hirsutism (aOR 4.11), diabetes mellitus (aOR 3.92), and family history of diabetes (aOR 2.36). These findings indicate that reproductive symptoms and metabolic abnormalities strongly predict PCOS.

Table 4: Multivariable Logistic Regression Analysis for Predictors of PCOS

This study aimed to assess the prevalence of PCOS and its relation with DM and obesity among reproductive age females attending tertiary care centres in Pakistan and revealed significant burden of PCOS along with DM and Obesity. The results validate the increasing awareness of PCOS as an endocrine and metabolic disease that needs a holistic clinical assessment. The mean age of the study population was relatively young (28.9 ± 6.4 years) with majority between 26–35 years (45.6%). Menstrual irregularity was the most common complaint (58.4%) followed by infertility (38.9%), hirsutism (33.9%) and acne (27.2%). All these clinical characteristics are typical of the reproductive manifestation of PCOS. The previous study also found that menstrual abnormalities, infertility and hyperandrogenic features were also common in women who were assessed for PCOS [15]. An important discovery was the prevalence of confirmed PCOS in 156 (41.6%) women. This higher incidence may be due to a higher proportion of tertiary care symptomatic cases and not due to community prevalence because patients presenting to specialist centers are often endocrine or reproductive complaints. Also, another research found that the prevalence of PCOS was found to be higher in the hospital-based, symptomatic groups than in the population-based screening groups [16]. The metabolic burden that was observed was quite high. Eighty-eight (23.5%) of the participants had diabetes mellitus, 171 (45.6%) had obesity, and 74 (19.7%) had impaired fasting glucose. Importantly, 61 (16.3%) women were found to have both PCOS and diabetes, 103 (27.5%) women were found to have PCOS and obesity and 47 (12.5%) were found to have both PCOS and diabetes and obesity. Here are the findings that indicate there is a high metabolic similarity that's linked to PCOS. In another study, obesity, insulin resistance and glucose intolerance were also found to be more common in women with PCOS [17]. A comparative analysis revealed that women with PCOS had much worse metabolic profile. Mean BMI was markedly higher in the PCOS group (32.1 ± 5.4 vs. 28.0 ± 4.9 kg/m²; p<0.001), while waist circumference was substantially greater (98.3 ± 10.4 vs. 88.2 ± 9.7 cm; p<0.001), indicating increased central adiposity. Sixty-six.0% of women with PCOS were obese compared with 31.1% of women without PCOS and 39.1% of women with PCOS had diabetes mellitus compared to 12.3% of non-PCOS women. The results found here strongly confirm the known metabolic dysfunction that is seen in patients with PCOS. Another study reported similar obesity indexes and glucose metabolism dysfunction in women suffering from PCOS [18]. Women with PCOS were slightly younger than the non-PCOS participants (27.4 ± 5.8 years vs. 30.0 ± 6.7 years; p=0.001) indicating that PCOS may be a disorder that could start at an early age in reproductive life and have significant metabolic consequences. The reproductive, however, were significantly more severe in patients with PCOS, compared with non-PCOS participants, with menstrual irregularity being the most common (82.1% vs 41.6%, p<0.001), followed by infertility (52.6% vs 29.2%, p<0.001) and hirsutism (57.1% vs 17.4%, p<0.001). Another study also found that there were significant correlations between PCOS and menstrual dysfunction, infertility and clinical hyperandrogenism [19]. The regression analysis also elucidated the factors that predicted PCOS. Menstrual irregularity (aOR 5.84; p<0.001), obesity (aOR 4.68), hirsutism (aOR 4.11), diabetes mellitus (aOR 3.92) and family history of diabetes (aOR 2.36) were the strongest predictors. The results are consistent with the hypothesis that both reproductive and metabolic parameters be taken into account when screening for PCOS. Obesity, metabolic dysfunction and hyperandrogenic symptoms were also found as important factors for the diagnosis of PCOS in a previous study [20]. Limitations This study has several limitations. Being a cross-sectional hospital-based study, causal relationships between PCOS and associated metabolic abnormalities cannot be definitively established. The tertiary care setting may overrepresent symptomatic or higher-risk women, limiting generalizability to the broader community population. Diagnostic classification may be influenced by variability in hormonal and ultrasound assessment. Insulin resistance markers beyond standard diabetes screening were not comprehensively evaluated. Lifestyle factors such as dietary habits, socioeconomic determinants, and long-term follow-up outcomes were also not fully assessed

It is concluded that polycystic ovary syndrome represents a substantial clinical burden among reproductive-age women presenting to tertiary care hospitals in Pakistan, with a high coexistence of diabetes mellitus and obesity. Women with PCOS demonstrated significantly greater metabolic dysfunction, central obesity, menstrual irregularities, infertility, and hyperandrogenic features compared with non-PCOS women. Menstrual irregularity, obesity, hirsutism, diabetes mellitus, and family history of diabetes were significant independent predictors of PCOS. Early identification and integrated reproductive-metabolic screening are essential for timely intervention and long-term risk reduction.

1. Meng Y, Zhao T, Zhang R, Zhu X, Ma C, Shi Q. Global burden of polycystic ovary syndrome among women of childbearing age, 1990–2021. Front Public Health. 2025;13:1514250.
2. Yang S, Zhang H, Shi L, et al. Menstrual disorder is associated with blood type in PCOS patients. BMC Endocr Disord. 2025;25(1):77.
3. Khatun H, Rahman R, Halim T, Khan A, Hasan MM. Prevalence and risk factors of polycystic ovary syndrome among reproductive-aged women. Int J Reprod Contracept Obstet Gynecol. 2025;14:1081–1085.
4. Nisa KU, Tarfeen N, Mir SA, et al. Effect of junk food on hormonal and metabolic manifestations in polycystic ovarian syndrome phenotypes. Indian J Clin Biochem. 2025;40(2):218–232.
5. Thomas O, Kudesia R. Healthy moms, healthy babies: culinary and lifestyle medicine for PCOS and preconception health. Am J Lifestyle Med. 2025.
6. Bondok M, Abouzeid S, Khedr NA, Gaafar S, Gaber H. Cutaneous manifestations in patients with polycystic ovary syndrome. Endocr Pract. 2024;30(12 Suppl):S34.
7. Alqasem MH, Alfaifi HM, Alqarni AM, Alnefaie W, Alshahrani RR. Prevalence and knowledge of polycystic ovary syndrome among female medical students. Bahrain Med Bull. 2024;46:2290–2295.
8. Alkhezi F, AlNemash N, AlMutairi J, et al. Prevalence of and risk factors associated with polycystic ovary syndrome among female university students. Womens Health Rep. 2024;5:579–587.
9. Ghazzawi RA, Taher FH, Sayed RA, et al. Prevalence of polycystic ovarian syndrome and its relation to urinary tract symptoms among female medical students. J Obstet Gynecol Reprod Sci. 2024;8:1–8.
10. Alenzi EO, Alqntash NH, Almajed EH, AlZabin AK. Risk of polycystic ovary syndrome: a population-based analysis. BMC Womens Health. 2024;24:623.
11. Singh S, Pal N, Shubham S. Polycystic ovary syndrome: etiology, current management, and future therapeutics. J Clin Med. 2023;12:1454.
12. Christ JP, Cedars MI. Current guidelines for diagnosing PCOS. Diagnostics. 2023;13:1113.
13. Fahs D, Salloum D, Nasrallah M, Ghazeeri G. Polycystic ovary syndrome: pathophysiology and controversies in diagnosis. Diagnostics. 2023;13:1559.
14. Afrine S, Haque JA, Morshed MS, et al. Ovarian volume is more closely related to manifestations of PCOS than follicle number per ovary. Clin Exp Reprod Med. 2023;50:200–205.
15. Vanden Brink H, Jarrett BY, Pereira N, et al. Diagnostic performance of ovarian morphology on ultrasonography across anovulatory conditions. Diagnostics. 2023;13:374.
16. Muhaidat N, Mansour S, Dardas M, et al. Current awareness status of and recommendations for polycystic ovarian syndrome. Int J Environ Res Public Health. 2023;20:4018.
17. Mohmed FES, Aljuhaysh RM, Alonze SK, Alhagbani MA. Prevalence and risk factors of polycystic ovarian syndrome. J Pharm Res Int. 2023;35:13–19.
18. Sruthi VL, Bindu PM, Lakshmi YS. A study on prevalence of polycystic ovarian syndrome in medical students. Int J Acad Med Pharm. 2023;5:117–122.
19. Aljuaid A, Sindi HA, Alhadi WIA, Althobaiti L, Imran I. Knowledge, attitude, and practice of lifestyle modifications among Saudi women diagnosed with PCOS. Cureus. 2023;15:e49398.
20. Rababa’h AM, Matani BR, Yehya A. An update of polycystic ovary syndrome: causes and therapeutic options. Heliyon. 2022;8:e11010