Polycystic ovary syndrome, commonly known as PCOS, is not a rare or obscure condition. It is one of the most frequent hormonal disorders affecting women of childbearing age across the world. It takes a toll not only on physical health but also on emotional well-being and social opportunity. Global studies suggest that PCOS affects between 5 and 12 percent of women, depending on the criteria used. This means tens of millions of women are living with it. What is more worrying is that around 70 percent of women with PCOS remain undiagnosed, which allows a treatable problem to become a lifelong burden.
In Pakistan, the crisis is even more severe. Research shows that the number of women with PCOS here is higher than the world average. While the global rate is around 5 to 12 percent, hospital-based studies in Pakistan report between 21 and 30 percent. In different provinces, the figures vary, sometimes as high as one in three women. In infertility clinics across the country, PCOS is the most common cause of failure to ovulate, which makes it the leading reason for infertility in Pakistani women seeking help. These figures are not just numbers on paper; they are backed by the rising rates of obesity, insulin resistance, irregular periods, and mental distress in young women.
There are many reasons why PCOS is so common and at the same time so overlooked in Pakistan. Women in South Asia are genetically more prone to weight gain around the abdomen and to problems with insulin, the hormone that regulates blood sugar. This makes them more likely to develop diabetes. In fact, South Asian women get type 2 diabetes four to seven years earlier than women in Western countries, and often at lower weights. Studies show that about 50 to 70 percent of women with PCOS have insulin resistance.
On top of these biological risks, cultural attitudes also make things worse. Talking openly about menstruation, excess hair growth, or reproductive concerns is often discouraged. A survey in Pakistan showed that more than 60 percent of women first tried traditional remedies before going to a doctor. Health systems add another barrier because many primary care clinics do not routinely screen for menstrual problems, and many doctors are not trained in using the diagnostic criteria for PCOS. As a result, many women only get help when they face serious complications such as infertility or diabetes.
In many communities, infertility or menstrual irregularities are seen as a woman’s failure rather than as a medical issue
The impact of PCOS goes beyond irregular periods. It can cause insulin resistance, prediabetes, type 2 diabetes, high cholesterol, and a cluster of conditions called metabolic syndrome. For fertility, the effects are devastating. In South Asia, PCOS is responsible for nearly 40 percent of cases of infertility caused by a lack of ovulation. Many women undergo repeated cycles of disappointment, expensive treatments, and emotional stress. Mental health is another major casualty.
International studies show that up to 40 percent of women with PCOS have depression, and between 34 and 57 percent suffer from anxiety. Research from Pakistan confirms this pattern, with one study showing that 45 percent of women with PCOS had depression compared with only 18 percent in women without PCOS. Symptoms such as excess facial hair, acne, and weight gain further affect self-confidence and often expose women to hurtful comments, which only deepens their distress.
The social consequences are equally serious. In many communities, infertility or menstrual irregularities are seen as a woman’s failure rather than as a medical issue. Women are often judged or blamed, while financial limitations and lack of decision-making power further restrict their access to testing and treatment. Many women hide or downplay their symptoms to avoid gossip or judgment, which reduces the number of officially reported cases. This creates a vicious cycle: fewer cases are recorded, health planners underestimate the problem, and resources are not allocated. In reality, a large silent population is suffering without recognition or support.
Diagnosing PCOS sounds simple, but it can be complicated in practice. Doctors look for a combination of irregular periods, signs of excess male hormones such as excess hair growth, and ultrasound images showing many small follicles in the ovaries. But the criteria differ between guidelines, and not all doctors apply them consistently. In Pakistan, access to ultrasounds and hormone tests is uneven, especially outside cities. This means different studies report very different rates, which makes it hard for the government to plan services properly. To make matters worse, many women with mild or few reproductive symptoms may still be at high risk of diabetes or heart disease, which shows why relying only on obvious symptoms is not enough.
Changing the way society views PCOS, from a private shame to a common medical condition, can help remove stigma and encourage more women to seek care
Treatment, fortunately, exists and works when used early. Lifestyle changes, such as weight loss and regular exercise, are the cornerstone and can improve both fertility and metabolic health. Medicines like metformin improve insulin resistance and regulate cycles, while hormonal contraceptives help with periods and reduce symptoms like acne and excess hair growth. For infertility, drugs that trigger ovulation and assisted reproductive techniques can be used. However, these treatments are not available to everyone. Structured lifestyle support is rare, long-term follow-up with endocrinologists is expensive, and fertility treatments are mostly concentrated in costly private clinics in large cities. Many families cannot afford them, creating a gap between what is medically possible and what women can actually access.
Despite being so common, PCOS remains under-researched. Most studies come from high-income countries and focus on reproductive aspects. In Pakistan and other low and middle-income countries, there are very few large studies that track long-term health outcomes like diabetes or heart disease in women with PCOS. This is a major concern because the condition looks different in South Asian women compared with women of European descent. Without local evidence, it is difficult to design effective strategies. According to the Global Burden of Disease study in 2021, PCOS accounts for more than 1.5 million years of healthy life lost worldwide, with the steepest rise seen in South Asia.
The way forward has to be comprehensive. Doctors at the community level need practical training to recognise PCOS with affordable tests. Schools should provide education about menstrual health to normalise early help-seeking. Training for general practitioners and gynaecologists should cover both the physical and mental health aspects of PCOS. Policymakers need to see it not just as a fertility issue but as a contributor to the national epidemic of non-communicable diseases such as diabetes. Public health campaigns to reduce childhood obesity and promote healthy eating will also help. Fertility services must be made affordable and accessible to prevent avoidable suffering.
At the same time, more research is urgently needed in Pakistan. We need standardised national surveys to establish the true prevalence, long-term studies that follow girls from adolescence into adulthood, and health systems research to design affordable treatment models. Equally important is community engagement to break taboos. Schools, women’s groups and local organisations can all play a role in spreading the message that menstrual irregularities and infertility are medical issues, not personal failures.
With early diagnosis and proper treatment, the difference is life-changing. Women can regain regular cycles, improve their fertility, and reduce the risk of diabetes. Just as importantly, having their concerns validated and treated restores dignity and confidence. Changing the way society views PCOS, from a private shame to a common medical condition, can help remove stigma and encourage more women to seek care. Ignoring this problem only allows a silent epidemic to grow, harming families, communities and the health system. The evidence is already strong enough to justify national action that combines prevention, detection, and affordable treatment. Pakistan cannot afford to wait any longer.