Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders affecting women of reproductive age. It is characterized by a combination of menstrual irregularities, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasonography.¹ The condition is associated with reproductive, metabolic, and psychological complications, making it an important public health concern.² Its clinical presentation varies considerably among individuals, ranging from menstrual disturbances and infertility to obesity, insulin resistance, and androgen-related manifestations.

The underlying pathophysiology of PCOS is complex and involves interactions between hypothalamic–pituitary–ovarian dysfunction, insulin resistance, hyperandrogenism, and genetic and environmental factors.³ Increased luteinizing hormone (LH) secretion relative to follicle-stimulating hormone (FSH) may contribute to excessive ovarian androgen production and impaired follicular development.⁴ Furthermore, insulin resistance and compensatory hyperinsulinaemia can stimulate ovarian androgen synthesis and reduce sex hormone-binding globulin (SHBG) production, resulting in increased circulating free androgens.⁵ These hormonal disturbances may contribute to menstrual irregularities, acne, hirsutism, and difficulties with ovulation and conception.

Obesity and excessive weight gain are frequently associated with PCOS and may aggravate its metabolic and reproductive manifestations.⁶ Increased adiposity, particularly abdominal fat accumulation, can contribute to insulin resistance, impaired glucose regulation, dyslipidaemia, and chronic low-grade inflammation.⁷ Acanthosis nigricans is another clinically relevant finding that may indicate underlying insulin resistance.⁸ Women with PCOS may also have an increased risk of developing impaired glucose tolerance, type 2 diabetes mellitus, hypertension, and other metabolic complications.⁹ Therefore, assessment of anthropometric measurements, body mass index (BMI), blood pressure, and glycaemic status is important in the clinical evaluation of affected women.

Hyperandrogenism is among the characteristic clinical features of PCOS and commonly presents as hirsutism, acne, and androgen-related hair loss.¹⁰ Hirsutism, particularly involving the upper lip, chin, abdomen, chest, and back, can significantly affect women's self-esteem and quality of life.¹¹ Menstrual abnormalities, including delayed menstruation, oligomenorrhoea, and amenorrhoea, are also frequently observed and may reflect underlying ovulatory dysfunction.¹² In addition, PCOS is an important contributor to female infertility, although reproductive manifestations vary according to age, hormonal status, metabolic characteristics, and treatment history.¹³

Hormonal investigations and pelvic ultrasonography provide additional information for the assessment of PCOS.¹⁴ Measurements of LH, FSH, testosterone, thyroid-stimulating hormone (TSH), and prolactin help evaluate the hormonal profile and identify possible alternative or coexisting endocrine abnormalities. Pelvic ultrasonography can demonstrate polycystic ovarian morphology, although its findings should be interpreted alongside clinical and biochemical characteristics rather than used as the sole diagnostic criterion. According to internationally accepted diagnostic recommendations, PCOS in adults is generally diagnosed when at least two of the three Rotterdam criteria are present after excluding other conditions that may produce similar clinical manifestations.

Despite increasing awareness of PCOS, its clinical and biochemical presentation varies across populations, and differences in lifestyle, nutritional habits, socioeconomic circumstances, and healthcare-seeking behaviour may influence the observed characteristics. In Pakistan, hospital-based outpatient studies are particularly important for understanding the local pattern of menstrual disturbances, hyperandrogenic manifestations, obesity, metabolic abnormalities, and reproductive problems among women presenting for medical evaluation.

Therefore, the present study was conducted among 155 women attending the outpatient department (OPD) with PCOS to describe their sociodemographic characteristics, menstrual and reproductive history, clinical manifestations of hyperandrogenism, anthropometric measurements, metabolic indicators, hormonal and biochemical profiles, and pelvic ultrasonographic findings. The study aims to provide a comprehensive description of the clinical and physiological characteristics of PCOS in the local population and may help identify important areas for improved screening, early diagnosis, and individualized clinical management.

Study Design: An observational, hospital-based descriptive study was conducted to evaluate the clinical, sociodemographic, anthropometric, metabolic, hormonal, and ultrasonographic characteristics of women with polycystic ovary syndrome (PCOS) presenting to a tertiary care hospital in Abbottabad, Pakistan.

Study Setting: The study was conducted at Ayub Teaching Hospital, Abbottabad, affiliated with Ayub Medical College, Abbottabad, Pakistan. Patients presenting to the outpatient department (OPD) with a clinical diagnosis of PCOS were included in the study.

Study Duration: The study was conducted during the period specified in the approved research protocol. Data were collected from eligible patients presenting to the hospital during the study period.

Study Population and Sample Size: The study population comprised women diagnosed with PCOS and presenting to the OPD of Ayub Teaching Hospital. A total of 155 patients were included in the final analysis. Initially, 160 records were available in the SPSS dataset. Four blank records and one confirmed duplicate record were excluded, leaving 155 unique analytical records.

Inclusion Criteria

1. Female patients of reproductive age (18–40 years).
2. Women diagnosed with PCOS according to the Rotterdam diagnostic criteria.
3. Apparently healthy women without clinical or biochemical evidence of PCOS were included as controls.

Exclusion criteria:

Pregnancy, hyperprolactinaemia, CAH,Cushing's, androgen-secreting tumours, untreated thyroid disease.

Sampling Technique: A non-probability consecutive sampling approach was used to include eligible patients presenting to the OPD during the study period, according to the approved study protocol.

Data Collection Procedure: Data were collected using a structured data collection proforma. Information regarding sociodemographic characteristics, clinical history, physical examination, laboratory investigations, and pelvic ultrasonography was recorded. Sociodemographic variables included age, marital status, residential area, occupation, and educational level.

Clinical history included menstrual cycle characteristics, menstrual flow patterns, weight changes, fertility history, and associated medical conditions such as hypothyroidism, hypertension, diabetes mellitus, and dyslipidaemia. Medication history, particularly oral contraceptive use, was also documented.

Clinical manifestations of hyperandrogenism were assessed through the recorded presence of hirsutism, acne, and alopecia. Hirsutism was documented according to its recorded severity and distribution across different anatomical sites, including the upper lip, chin, chest, abdomen, arms, thighs, and back. Acne was recorded according to its anatomical distribution, while alopecia was classified according to the documented grading.

Anthropometric and Metabolic Assessment: Anthropometric measurements included body weight and height. Body mass index (BMI) was calculated. BMI categories were classified according to both World Health Organization (WHO) and Asian-specific cut-off values. Metabolic assessment included HbA1c levels, recorded blood pressure categories, acanthosis nigricans, and the presence of striae. HbA1c values were categorized as normal (less than 5.7%), prediabetes range (5.7–6.4%), and diabetes range (6.5% or above).

Hormonal and Biochemical Assessment: The hormonal profile included serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone, thyroid-stimulating hormone (TSH), and prolactin. The LH/FSH ratio was calculated to describe the hormonal profile of the study participants. The proportions of women with LH/FSH ratios of ≥2 and ≥3 were also determined. TSH levels were categorized according to the recorded laboratory reference values to identify elevated and reduced TSH concentrations.

Pelvic Ultrasonographic Assessment: Pelvic ultrasonography findings were reviewed to assess ovarian morphology. Participants were classified according to the reported findings into three categories: polycystic ovarian morphology, multifollicular ovaries, and normal ovarian morphology.

Data Management and Statistical Analysis: Data were entered and analyzed using the Statistical Package for Social Sciences (SPSS). The dataset was reviewed for completeness, duplicate entries, missing values, and inconsistencies before analysis. Initially, 160 records were available. Four blank records and one confirmed duplicate record were excluded, resulting in a final sample of 155 women.

Eleven additional pairs of records contained identical medical record numbers but differed in age and multiple clinical and demographic variables. These records were retained as separate observations because they could not be confirmed as duplicate patients. Unlabelled categorical codes were treated as missing values.

Descriptive statistical methods were used to summarize the study findings. Categorical variables were presented as frequencies and percentages, whereas continuous variables were expressed as mean ± standard deviation (SD) or median with interquartile range (IQR), depending on their distribution. The number of available observations was reported separately for variables with missing data, and percentages were calculated using the available observations for each variable. Results were presented in tables to describe the sociodemographic, clinical, anthropometric, metabolic, hormonal, and ultrasonographic characteristics of the study population.

Ethical Considerations: Ethical approval was obtained from the Institutional Medical and Ethics Review Committee, Ayub Medical Teaching Institution, Abbottabad, Pakistan

The analysis covers 155 women with PCOS. The SPSS file held 160 rows: 4 blank rows were dropped, and 1 true duplicate was dropped (MR K0400003986524, identical except age 26 vs 27).

Eleven other MR numbers appear twice, but each pair differs in age and 16–30 other variables, so they are kept as separate patients with mistyped MR numbers. Unlabelled codes (e.g. 3, 4, 22, 95) are treated as missing; percentages use women with data for that variable, and n is shown where it is below 155.

Table 1. Sociodemographic characteristics

Mean age was 25.2 ± 6.8 years (range 15–60); half the women were unmarried and 69.7% lived in urban areas.

Residence excludes 3 records with unlabelled codes.

Table 2. Comorbidities and medication

Hypothyroidism was the most common comorbidity (14.2%); diabetes and dyslipidaemia were uncommon.

Table 3. Menstrual, weight and fertility history

Cycles were delayed or absent in 100 women (64.5%), and 97 (62.6%) reported weight gain. All 21 women with infertility were married (27.6% of married women).

Fertility status is shown as recorded; 22 married women are coded “Not relevant” and 4 unmarried women have a pregnancy or conception code, so this variable needs checking. Excludes 1 fertility code (95) and 2 flow codes (4).

Table 4. Hyperandrogenic features

Hirsutism was recorded in 144 women (92.9%), most often on the upper lip and chin; 105 (67.7%) had acne and 66 (42.6%) had alopecia.

The file’s “F-G score” column (0–9) equals the number of the nine sites marked hirsute, not a Ferriman–Gallwey score, so it is reported as sites involved. Severity does not always match the sites: 3 women graded “None” have 3–6 sites marked

Table 5. Anthropometric and metabolic findings

Mean BMI was 29.8 kg/m²; 66 women (42.6%) were obese by WHO criteria and 122 (78.7%) by Asian cut-offs. Acanthosis nigricans was present in 57 (36.8%) and HbA1c was in the prediabetes or diabetes range in 51 (33.3%).

Blood pressure was recorded only as a category. Only 8 women carry a diabetes diagnosis, but 15 have HbA1c ≥6.5%. Striae exclude 1 record coded 22.

Table 6. Hormonal and biochemical profile

Median LH/FSH ratio was 2.29, with 86 of 150 women (57.3%) at 2 or above. Hormone values are skewed, so median (IQR) is the figure to report.

Units for testosterone and prolactin are not stated in the file. The maxima for LH/FSH ratio (138.3), testosterone (90.28) and TSH (487) look like entry or unit errors and inflate the means. Prolactin values cluster at two scales, which suggests ng/mL and mIU/L were mixed.

Table 7. Pelvic ultrasound findings

Polycystic ovarian morphology was seen in 105 women (67.7%); 47 (30.3%) had normal ovaries on ultrasound.

The present study evaluated the sociodemographic, clinical, anthropometric, metabolic, hormonal, and ultrasonographic characteristics of 155 women with polycystic ovary syndrome (PCOS) attending the outpatient department of Ayub Teaching Hospital, Abbottabad. The findings demonstrate that PCOS is associated with a diverse clinical presentation involving menstrual disturbances, hyperandrogenic manifestations, increased body weight, and hormonal and metabolic abnormalities. The mean age of participants was 25.2 ± 6.8 years, indicating that most women presented during their reproductive years. More than half (51.0%) were unmarried, while 69.7% belonged to urban areas. These findings suggest that PCOS affects women across different sociodemographic groups and that awareness and early clinical evaluation are important for timely identification and management.

Menstrual disturbances were among the most frequently observed clinical manifestations. Delayed menstruation was reported by 48.4% of participants, while 16.1% experienced amenorrhoea. Overall, 64.5% had delayed or absent menstrual cycles, indicating a considerable frequency of menstrual dysfunction in this population. These findings are consistent with the established pathophysiology of PCOS, in which ovulatory dysfunction results from disturbances in ovarian steroidogenesis and hypothalamic–pituitary–ovarian regulation. Regarding reproductive history, infertility was recorded in 21 women, representing 27.6% of married participants. This highlights the reproductive implications of PCOS, although fertility-related findings should be interpreted cautiously because some records contained inconsistent fertility classifications.

Hyperandrogenic manifestations were particularly prominent in the present study. Hirsutism was recorded in 92.9% of participants, with the upper lip (79.9%) and chin (79.2%) being the most frequently affected sites. Acne was present in 67.7%, while 42.6% had some degree of alopecia. These findings demonstrate the considerable clinical burden of androgen-related symptoms among women attending the OPD. However, the recorded hirsutism severity classification did not consistently correspond with the number of affected body sites, which should be considered when interpreting these findings.

The anthropometric findings demonstrated a substantial burden of excess body weight. The mean BMI was 29.8 ± 6.6 kg/m², and 42.6% of participants were classified as obese according to WHO criteria. When Asian-specific BMI cut-offs were applied, the proportion classified as obese increased to 78.7%. This difference highlights the importance of considering population-specific BMI thresholds when evaluating metabolic risk in South Asian women. Furthermore, acanthosis nigricans was observed in 36.8% of participants, suggesting that insulin resistance may be an important associated clinical feature. HbA1c was within the prediabetes range in 23.5% and the diabetes range in 9.8% of women, indicating the need for appropriate metabolic screening and follow-up.

These findings are comparable to a previous Pakistani study conducted by Rafiq et al. at Ayub Teaching Hospital, Abbottabad, in which obesity was reported in 59.1% of participants and 70% reported weight gain. Acanthosis nigricans was present in 31.8% of their patients, compared with 36.8% in the present study. Similarly, a study involving 440 women from different hospitals in Pakistan reported obesity in 80%, acne in 67.3%, hirsutism in 68%, and menstrual irregularities in 71.8%. The similarity in several clinical manifestations supports the importance of comprehensive metabolic and clinical assessment in women with PCOS.¹⁵

The hormonal profile showed a median LH/FSH ratio of 2.29, with 57.3% of participants having a ratio of ≥2. Elevated TSH levels (greater than 4.0 µIU/mL) were observed in 25.2% of women, suggesting the importance of evaluating associated thyroid abnormalities during PCOS assessment. Polycystic ovarian morphology was identified in 67.7% of participants, whereas 30.3% had normal ovarian morphology. These findings emphasize that ultrasound appearances may vary among women with clinically diagnosed PCOS. The 2023 international evidence-based guideline also emphasizes that PCOS diagnosis should be based on appropriate combinations of clinical, biochemical, and ovarian criteria rather than ultrasonography or the LH/FSH ratio alone¹⁶.

Overall, the present study demonstrates that women with PCOS attending Ayub Teaching Hospital commonly experience menstrual dysfunction, hyperandrogenic manifestations, excess body weight, and metabolic abnormalities. The findings highlight the importance of early recognition, appropriate hormonal investigations, metabolic screening, lifestyle modification, and individualized clinical management. However, the study has certain limitations, including its hospital-based design, descriptive nature, missing observations in some variables, and inconsistencies in selected medical record entries. Additionally, extreme hormonal values and unspecified laboratory units may have influenced the reported mean values. The absence of a control group and inferential analysis also limits comparisons and conclusions regarding associated risk factors. Despite these limitations, this study provides useful local clinical information regarding the diverse presentation of PCOS and emphasizes the need for integrated reproductive and metabolic healthcare.

LIMITATION: This study was limited by its hospital-based observational design and relatively small sample size of 155 participants, which may restrict the generalizability of findings. Missing data, inconsistencies in some medical records, and unspecified units for certain hormonal measurements may have affected the accuracy of selected results. Furthermore, the absence of a control group and longitudinal follow-up limited the assessment of associations and long-term outcomes.

The present study provides an overview of the clinical, sociodemographic, anthropometric, metabolic, hormonal, and ultrasonographic characteristics of 155 women with polycystic ovary syndrome attending Ayub Teaching Hospital, Abbottabad. The findings indicate that PCOS commonly presents with menstrual irregularities, hyperandrogenic manifestations, and excess body weight. Hirsutism, acne, and alopecia were frequently observed, while a considerable proportion of participants had obesity, acanthosis nigricans, and abnormal HbA1c levels. Hormonal variations and polycystic ovarian morphology further demonstrated the heterogeneous clinical presentation of this syndrome. These findings highlight the importance of comprehensive clinical assessment, early diagnosis, and routine metabolic and hormonal screening in women with PCOS. Individualized management involving lifestyle modification, weight management, appropriate medical treatment, and reproductive health counselling may help improve long-term outcomes. Overall, an integrated multidisciplinary approach is essential to address the reproductive, metabolic, and endocrine consequences of PCOS and improve the quality of life of affected women.

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