WHEP Scholar Imari Patel
Drexel University College of Medicine, Class of 2021

Polycystic ovarian syndrome (PCOS) is the most common endocrine abnormality in women, leading to a number of life-threatening and emotional stressors, such as increased cardiometabolic diseases, insulin resistance, obesity, hirsutism, infertility, depression and anxiety. Over 100 million women of reproductive age worldwide are affected by this syndrome, with a rise in incidence in rapidly developing urban environments in countries such as India, China and Korea.

Twin studies have revealed that PCOS contains a strong genetic component.  Alterations in mitochondrial DNA from external stress or heritable polymorphisms in VEGF could be specific risk factors for PCOS in the Indian population. However, the increasing prevalence of PCOS in South Asia is seen in young females residing in the urban environment and the upper-middle class. With globalization of the Indian economy in the early 1990s, there was a rapid change of lifestyle, transitioning to unhealthier foods, sedentary habits, increased stress and interrupted sleep patterns – all risk factors that could be contributing to the rise of this disorder. Interestingly, the increased rate of PCOS is not only observed in women in their native countries, but it has also been noted in immigrants. Therefore it is likely that a combination of these risk factors is contributing to the increasing prevalence in South Asian women.

Although challenges exist with predicting the prevalence in South Asian women due to numerous factors such as diversity within the South Asian subcontinent and inconsistent criteria for diagnosis, it is evident that women of this population face a greater risk of developing PCOS compared to other ethnicities or geographical areas. Studies have demonstrated that South Asian women usually present with PCOS earlier compared to Caucasian women. Many South Asian females present with a lean phenotype rather than obesity, which can be misleading for clinicians. Because the South Asian population is generally at an increased risk of developing cardiometabolic diseases, it is important to diagnose these women early in the course of the disorder to avoid the development of metabolic disturbances.