PCOS is an extremely common endocrine disease in women of reproductive age around the world. It is defined by the presence of both hyperandrogenism, oligoovulation, and polycystic ovarian morphology. The syndrome carries strong reproductive, metabolic, and psychological implications and is thus a public health issue. The estimated prevalence of PCOS is highly variable, from 6-20% based on different diagnostic criteria and different populations studied. Established in 2003, the Rotterdam criteria are the most widely accepted diagnostic criteria and include at least two of the following three: oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology as seen on ultrasonography [1,2].PCOS is linked with many negative health effects, such as irregular periods, inability to get pregnant, increased insulin resistance and type 2 diabetes mellitus, obesity, dyslipidaemia, hypertension, and cardiovascular disease. PCOS patients also have a higher risk of anxiety, depression, and lower quality of life. Such complications account for significant health service utilization and cost. It is therefore very important that women at risk are identified early so that timely interventions can be taken and long-term morbidity averted [3]. Several factors are involved in the cause of PCOS, and there are interactions between these. Family history has long been recognised as an important predictor and a strong genetic predisposition. Obesity (especially central obesity) worsens insulin resistance and hyperandrogenism, which further worsens the clinical manifestations. Sedentary lifestyle, unhealthy diet, and metabolic abnormalities further play their role in the onset and progression of the disease. However, the contribution of these risk factors is different in various populations and ethnic groups, even after the study [4,5]. The burden of PCOS is now becoming increasingly evident in developing countries, including Pakistan, with changing lifestyles, urbanization, and an increase in obesity. But, in many cases, women are not diagnosed due to limited awareness, social stigma on reproductive health issues, and a lack of screening practices. Data on the prevalence of diseases and associated risk factors collected as part of the hospital-based studies offer important information about diseases in women who seek health care services. This type of information helps to design targeted prevention with the aim of improving reproductive health outcomes [6,7]. Multiple studies around the world have reported different prevalence rates for PCOS, and have found obesity, family history, menstrual irregularities, and physical inactivity to be key determinants. However, there is limited local information, especially in tertiary care settings where women with a variety of demographic and clinical characteristics come for evaluation. A knowledge of the prevalence and risk factors for PCOS can enable clinicians to target high-risk groups and take preventive and therapeutic measures accordingly [8].Hence, the present study was carried out to find out the prevalence of PCOS among reproductive age women visiting the tertiary care hospital and to assess the relation of reproductive (age, TSH, AMH), lifestyle (BMI, whiteratio, weight, height, blood pressure) and demographic (age at marriage, parity, consanguineous marriage, age at menarche, age at menopause, smoking, and alcohol) risk factors with PCOS [9].

Study Objective

To assess the prevalence of polycystic ovary syndrome and the demographic, reproductive, and lifestyle-related risk factors in women of reproductive age in a tertiary care hospital.

Study Design and Settings This cross-sectional study was carried out in Department of Obstetrics and Gynecology Saidu Group of Teaching Hospitals, Swat, Pakistan between January and June 2026. Participants The women who attended the gynecology outpatient department were sampled consecutively, with a total of 100 women aged 18-45 years being recruited. They were checked for symptoms suggestive of PCOS and assessed clinically, biochemically, and ultrasonographically. All participants gave written informed consent before they entered the study. Sample Size Calculation Sample size was determined using the WHO sample size formula using a prevalence of PCOS of 30%, a 95% confidence interval, and a 9% margin of error. A minimum of 90 participants was pre-determined. Finally, 100 women were recruited to complete the surveys because they were not returned. Inclusion Criteria • Women aged 18–45 years. • Women who visit the gynecology outpatient department. • Ability to give informed consent. • Completely available clinical and demographic data. Exclusion Criteria • Pregnant women. • Women who have prior thyroid problems. • Women with hyperprolactinemia. • Women within the last three months who are on hormonal therapy. • Women who have congenital adrenal hyperplasia or tumours of the adrenal glands that produce androgens. • Incomplete clinical records. Diagnostic and Management Strategy When the Rotterdam criteria were used to diagnose PCOS. Participants were clinically evaluated, anthropometrically assessed, hormone analyzed, and evaluated ultrasonographically of the pelvis. The women who were diagnosed with PCOS were counseled on lifestyle change, weight management, and proper gynecological follow-up. Statistical Analysis Data was entered and analyzed in SPSS 26.0. program. Data for continuous variables were reported as mean ± standard deviation, and for categorical variables as numbers and percentages. Chi-square test and independent t-test were used to examine the relationship between the variables. The p-value was defined as <0.05 as statistically significant

A total of 100 reproductive-age women were included in the study. The mean age of participants was 27.8 ± 5.6 years. Based on the Rotterdam criteria, PCOS was diagnosed in 32 women, resulting in a prevalence of 32.0%. The highest prevalence was observed among women aged 21–30 years (40.6%), although the association between age group and PCOS was not statistically significant (p=0.081). Obesity (BMI ≥30 kg/m²) was identified in 43 participants and demonstrated a significant association with PCOS (50.0% vs. 23.5%; p=0.004). A positive family history of PCOS was reported in 28 participants and was significantly associated with disease occurrence (57.1% vs. 22.2%; p=0.001). Menstrual irregularities were present in 68.8% of women diagnosed with PCOS compared with 20.6% among women without PCOS (p<0.001). Physical inactivity was significantly more common in the PCOS group than in the non-PCOS group (62.5% vs. 35.3%; p=0.012). Infertility was reported by 34.4% of women with PCOS compared with 11.8% of women without PCOS (p=0.009). Educational status did not show a statistically significant association with PCOS prevalence (p=0.427). Overall, obesity, family history, menstrual irregularities, physical inactivity, and infertility emerged as significant risk factors for PCOS.

Intervention Outcome

Lifestyle counselling emphasizing diet modification, nutrition, and weight reduction, along with increased physical activity, was offered to women diagnosed with PCOS. At follow-up, there was an increase in awareness and adoption of lifestyle recommendations in the majority of participants, suggesting the possibility of early counseling and preventive interventionst.

Table 1. Baseline Demographic and Clinical Characteristics of the Study Participants (N=100)

Values are presented as frequencies and percentages. BMI = Body Mass Index; PCOS = Polycystic Ovary Syndrome.

Table 2. Prevalence of Polycystic Ovary Syndrome Among Study Participants (N=100)

PCOS prevalence was calculated according to the Rotterdam diagnostic criteria. Data are presented as frequency, percentage, and mean ± standard deviation.

Table 3. Association Between Risk Factors and Presence of PCOS

Chi-square test was used to compare categorical variables. A p-value <0.05 was considered statistically significant.

Table 4. Distribution of PCOS According to Age Groups

The highest prevalence of PCOS was observed among women aged 21–30 years. However, the association between age group and PCOS prevalence did not reach statistical significance (p>0.05).

This study compared the prevalence of polycystic ovary syndrome (PCOS) and risk factors among women in the reproductive age group at a tertiary care hospital. The prevalence of PCOS was 32%, which highlights the impact of PCOS on reproductive and metabolic health in the study population. In addition, obesity, family history of PCOS, irregular periods, physical inactivity, and infertility were found to be important risk factors for PCOS [11]. The prevalence in the current study does not differ from the prevalence found in recent regional and international studies based on the Rotterdam criteria. Prevalence rates from 20% to 35% have been reported from studies published between 2021 and 2025, depending on the population characteristics and approaches to diagnosis [12]. Our relatively high prevalence rate may be related to the fact that we had a hospital-based sample, and women are more likely to come to a hospital with a gynecological or endocrine complaint than to a general practice. In the current study, obesity was found to be one of the major predictors of PCOS. Women who were obese also had significantly higher rates of PCOS as compared to non-obese women. The same effect was observed in other studies from South Asia, the Middle East, and Europe in which obesity was found to worsen insulin resistance and hyperandrogenism, which are linked to the pathogenesis and clinical symptoms of PCOS [13]. A recent study has pointed to a bi-directional association between obesity and PCOS, and that excess adiposity is likely to exacerbate PCOS symptoms and be a factor in the progression of the disease [14]. There was also a strong correlation of family history with PCOS. This discovery comes on the heels of other Study indicating that genes are a key factor in disease development. Familial clustering of PCOS has been shown in several recent studies, and several genes involved in hormonal regulation, insulin signaling, and ovarian function have been identified [15]. The findings presented here support the need for a thorough family history in clinical assessment and screening of women with an increased risk. Women with PCOS had significantly more menstrual irregularities. This is not surprising, since ovulatory dysfunction is a very important feature of the Rotterdam diagnostic criteria [16]. These observations have been consistently described in the current literature, and irregular cycle is one of the most common clinical symptoms of PCOS [17]. The high number of menstrual disturbances seen in the present study makes it important to consider menstrual symptoms as an early indicator for possible underlying endocrine dysfunction. Being physically inactive was also an important factor for PCOS. Those who were sedentary women had a higher prevalence of diseases than physically active women. Similar conclusions have been made in recent Study that examined lifestyle factors associated with PCOS. Physical inactivity is known to be a risk factor for PCOS pathophysiology, as it leads to weight gain, insulin resistance, and metabolic dysregulation. Regular exercise is a key component of PCOS treatment advice as it has positive effects on weight loss, insulin sensitivity, and reproductive health [18].

Limitations

There were some limitations in this study. Because of its cross-sectional design, it was impossible to infer causality between identified risk factors and PCOS. The results are not generalizable due to the small sample size and the single tertiary care hospital studied. Further to this, self-reported lifestyle details might have resulted in recall and reporting bias,

Reproductive-age women visiting the tertiary care hospital had a high prevalence of PCOS. Factors that were significantly associated were obesity, family history, menstrual irregularity, physical inactivity, and infertility. Identification of women at risk at a young age and provision of lifestyle-based intervention could enhance reproductive health and lower the long-term burden of PCOS.

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