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PCOS: Econometric Study

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Fahid Fayaz Darangay

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.
Signs and symptoms of PCOS vary from patient to patient. A diagnosis of PCOS is made when you experience at least two of these signs:
• Irregular periods. Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than nine periods a year, more than 35 days between periods and abnormally heavy periods.
• Excess androgen. Elevated levels of male hormones may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.
• Polycystic ovaries. Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.
Complications of PCOS can include Infertility, Gestational diabetes or pregnancy-induced high blood pressure, Miscarriage or premature birth, Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat accumulation in the liver, Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease, Type 2 diabetes or prediabetes, Sleep apnea, Depression, anxiety and eating disorders, Abnormal uterine bleeding, Cancer of the uterine lining (endometrial cancer) etc. Obesity is also associated with PCOS and can worsen complications of the disorder.
Statistics: World Health Organization (WHO) estimates that PCOS has affected 116 million women (3.4%) worldwide in 2012 [1]. Globally, prevalence estimates of PCOS are highly variable, ranging from 2.2% to as high as 26%.
A study conducted by Mohammad Ashraf Ganie, Aafia Rashid, Danendra Sahu, Sobia Nisar, Ishfaq A. Wani and Junaida Khan gives us the following alarming results.
Out of a total of 3300 eligible women, 964 women were evaluated using a structured questionnaire. Among these, 446 (46.4%) were identified as “probable PCOS” cases. Out of 171 probable PCOS women who completed all biochemical, hormonal, and sonographic assessment, 35.3% qualified for a diagnosis of PCOS using Rotterdam criteria. The prevalence of PCOS was 28.9% by NIH criteria and 34.3% by AE‐PCOS criteria. The prevalence of PCOS is high among Kashmiri women and is probably the highest in a published series globally. A countrywide systematic prevalence study is warranted to reconfirm the findings.
Another Study: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. Due to the logistics of diagnosis and lack of consensus on the diagnostic criteria, there are very few prevalence studies in the community. This study was aimed to assess the prevalence of PCOS in women 18-25 years of age, conducted in college girls from Lucknow, North India.
Sample size for the study was calculated as 1052. Girls from 3 different colleges were approached (n = 2150), 1520 (70.7%) agreed to participate. They were asked to fill up a questionnaire asking details of menstrual cycle and features of hyperandrogenism. Hirsutism was self-reported. Responses were verified by a trained research assistant. A probable case was defined as a girl with menstrual irregularity (MI) or hirsutism (H) or both. All the probable cases were invited for detailed examination, hormone estimation, and ovarian ultrasonography.
Of the 1520 girls, 200 (13.1%) were labeled as probable cases; 175 (87.5%) had MI and 25 (12.5%) had both MI and H. Of the 200 cases, 75 (37.5%) had hormonal evaluation while 11 agreed for ultrasonography. 27 girls had confirmed PCOS. Therefore, if all the 200 girls would have had hormonal evaluation, 56 girls were likely to be confirmed as PCOS, giving a calculated prevalence of 3.7% (95% CI, 2.6–4.4) in this population. The mean age of these PCOS cases was 18.96 ± 1.73 yrs, body mass index was 21.72 ± 5.48 Kg/m2, and waist hip ratio was 0.81 ± 0.08. Only 12% girls had a body mass index ≥ 27.5 Kg/m2, but 44% had waist hip ratio > 0.81, again highlighting that despite low BMI, Indians have more abdominal obesity.
Calculated prevalence of PCOS in women between the ages of 18-25 years from Lucknow, north India, is 3.7%. Majority of these girls were lean but have abdominal obesity. The prevalence reported in earlier studies varies between 2.2% to 26%.
These variations are due to difficulties in hormonal evaluation and lack of consensus on diagnostic criteria. For diagnosis of PCOS, ovarian ultrasonography and blood tests have to be done in the follicular phase. This limits large epidemiological studies in the community. Using different criteria, prevalence has been estimated as 4.0%–11.9% in the community from 3 different countries.
There is paucity of data from India. Insulin resistance is central to the pathogenesis of PCOS, and Indians are known to have high prevalence of insulin resistance, so the prevalence of PCOS may be high in our population. Prevalence of PCOS in young women (18-25 years) is 3.7%, and majority of them were lean. Even at this young age, these women were at a high risk of metabolic syndrome because of the increased prevalence of abnormal waist-hip ratio and pre-hypertension. This study was conducted by Harmandeep Gill, Pallavi Tiwari, and Preeti Dabadghao.
(The author is currently pursuing masters in Financial Economics from Madras School of Economics, Chennai)

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