Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age, with a global prevalence ranging from 6-10%, although this rate can vary depending on diagnostic criteria and geographical factors. In India, the prevalence is reported to be between 9-22% of women in reproductive age, with urban regions exhibiting a higher incidence due to lifestyle factors such as obesity and sedentary habits [1]. PCOS is characterized by a combination of endocrine disturbances, including hyperandrogenism, insulin resistance, and ovarian dysfunction. The syndrome is associated with a variety of reproductive symptoms, such as irregular menstrual cycles, anovulation, and infertility, as well as metabolic complications like obesity, dyslipidemia, and insulin resistance [2]. While extensive research has been conducted in Western populations, region-specific data, particularly for India, remains limited, and there is a particular scarcity of studies focusing on the Central Indian population.

Insulin resistance (IR) plays a pivotal role in the pathophysiology of PCOS and is present in 65-70% of affected women. This metabolic disorder contributes significantly to the development of Type 2 diabetes (T2D) and cardiovascular diseases (CVD) in this population [3]. Obesity, which is prevalent in a significant proportion of women with PCOS, exacerbates insulin resistance, further increasing the risk for metabolic syndrome [4]. Studies from urban Indian populations have revealed high rates of both obesity and IR, with these conditions contributing to the growing health burden in the country. However, there remains a significant research gap when it comes to understanding how these metabolic disturbances manifest in women from Central India, a region that has not been adequately studied [5].

The understanding of the metabolic and endocrine characteristics of PCOS in the Central Indian context is crucial for developing region-specific diagnostic criteria and treatment strategies. Madhya Pradesh, a state in Central India, has seen increasing urbanization and changing dietary habits, both of which have contributed to rising obesity rates and metabolic diseases, including PCOS. Despite this, data from this region on the prevalence of endocrine abnormalities and metabolic dysfunction in women with PCOS is still scarce [6]. By investigating these characteristics in a case-control study design, this research aims to fill the existing gap in knowledge, providing insights into the endocrine and metabolic profiles of women with PCOS in Madhya Pradesh.

This study will contribute to the growing body of knowledge about PCOS in India, particularly in regions underrepresented in the literature. It will focus on key variables such as testosterone, dehydroepiandrosterone sulfate (DHEAS), insulin resistance, and obesity, comparing women with PCOS to age-matched healthy controls. The findings will be crucial for the development of targeted interventions and public health strategies aimed at addressing the metabolic and reproductive health challenges posed by PCOS in Central India.

Study Design

This study was a case-control research design conducted at Index Medical College, Hospital, and Research Center, Indore, Madhya Pradesh. The aim was to evaluate the endocrine and metabolic characteristics of women diagnosed with Polycystic Ovary Syndrome (PCOS) and compare them to a healthy control group. The study specifically focused on measuring hormonal levels (testosterone, DHEAS), insulin resistance, and metabolic dysfunction (BMI, waist circumference, blood pressure) in both groups.

Study Population and Recruitment

The study included a total of 130 women, divided into two groups:

1. PCOS Group: 65 women diagnosed with PCOS, attending the gynecology and endocrinology outpatient departments at Index Medical College, Hospital, and Research Center, based on the Rotterdam Criteria for diagnosis. The participants in this group were diagnosed by certified clinicians and had clinical symptoms of hyperandrogenism (hirsutism, acne), irregular menstrual cycles, and polycystic ovaries confirmed via ultrasound.
2. Control Group: 65 healthy women, age-matched (between 18-35 years), without any history of endocrine disorders or metabolic dysfunction, recruited from the same hospital setting. These participants were selected to match the PCOS group for age, sex, and region, to ensure a comparable baseline for analysis.

Inclusion Criteria

• Women aged 18-35 years.
• For the PCOS group, women who met the Rotterdam Criteria for PCOS diagnosis.
• For the control group, healthy women with no history of PCOS, diabetes, thyroid disorders, or any other metabolic disorders.
• Women who consented to participate in the study.

Exclusion Criteria

• Women with other known endocrine disorders (e.g., hyperthyroidism, hypothyroidism, Cushing’s syndrome).
• Women who were pregnant or breastfeeding.
• Women with incomplete data or who failed to complete the follow-up tests.

Data Collection

The data collection was carried out over a period of six months, from January 2023 to June 2023, at Index Medical College, Hospital, and Research Center. The following procedures were followed:

1. Clinical Assessment:
• A structured interview was conducted to collect demographic details, medical history, and lifestyle factors (e.g., physical activity, diet).
• Physical examination was done to assess symptoms of hyperandrogenism (hirsutism, acne, alopecia) and obesity (BMI and waist circumference).
2. Hormonal Assays:
• Blood samples were collected after an overnight fast to measure serum levels of testosterone and DHEAS (Dehydroepiandrosterone Sulfate), which are markers of hyperandrogenism in PCOS.
• Serum insulin levels were measured to calculate the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), an established method for assessing insulin resistance.
3. Metabolic Measurements:
• Body Mass Index (BMI): Calculated using weight (kg) and height (m²).
• Waist Circumference: Measured at the midpoint between the lower rib and the iliac crest, to assess abdominal obesity.
• Blood Pressure: Measured using a calibrated mercury sphygmomanometer to assess cardiovascular risk.
4. Ultrasound Imaging:
• Pelvic ultrasound was conducted to confirm the presence of polycystic ovaries in the PCOS group. This was done as part of the routine diagnostic procedure for women diagnosed with PCOS.

Statistical Analysis

• Descriptive Statistics: Frequencies, percentages, and means were used to summarize the demographic characteristics of the study population.
• Comparative Analysis: The endocrine and metabolic features between the PCOS group and the control group were compared using the Student's t-test for continuous variables (e.g., testosterone levels, BMI) and chi-square test for categorical variables (e.g., presence of hirsutism, obesity).
• Regression Analysis: To assess the relationship between metabolic and endocrine characteristics, regression models were used to evaluate factors contributing to insulin resistance and obesity in the PCOS group.

Ethical Considerations

The study was approved by the Institutional Ethics Committee of Index Medical College, Hospital, and Research Center (Ethics approval reference: IMCH/2022/03). Written informed consent was obtained from all participants before enrollment in the study. Confidentiality of participant data was maintained throughout the study.

The following results were obtained from the study comparing the endocrine and metabolic features of women diagnosed with PCOS and healthy controls. The data show significant differences between the two groups across several key parameters.

Testosterone and DHEAS Levels

As shown in Figure 1, women in the PCOS group had significantly higher testosterone levels (mean = 62.5 ng/dL) compared to the control group (mean = 22.1 ng/dL). Similarly, DHEAS levels were higher in the PCOS group (mean = 285.1 µg/dL) compared to the control group (mean = 135.6 µg/dL) (Figure 2).

Insulin Resistance (HOMA-IR)

The HOMA-IR index, used to assess insulin resistance, was significantly higher in the PCOS group (mean = 2.3) compared to the control group (mean = 0.9), indicating a marked difference in insulin sensitivity between the two groups (Figure 3).

Body Mass Index (BMI) and Waist Circumference

The BMI was notably higher in the PCOS group (mean = 28.1 kg/m²) compared to the control group (mean = 23.5 kg/m²) as depicted in Figure 4. Similarly, women in the PCOS group had a significantly larger waist circumference (mean = 84.5 cm) compared to the control group (mean = 72.2 cm), which is consistent with findings of higher abdominal obesity in women with PCOS.

Elevated Blood Pressure

Approximately 35% of women in the PCOS group had elevated blood pressure (systolic BP > 130 mmHg or diastolic BP > 85 mmHg), as compared to only 10% in the control group. This suggests an increased cardiovascular risk in women with PCOS.

Table 1: Endocrine and Metabolic Features of PCOS vs Control Group

Table 2: Prevalence of Elevated Blood Pressure in PCOS vs Control Group

The study demonstrates significant endocrine and metabolic abnormalities in women with PCOS in Madhya Pradesh. Elevated testosterone and DHEAS levels indicate the presence of hyperandrogenism in women with PCOS, consistent with the clinical presentation of the disorder. The increased insulin resistance, as reflected in the higher HOMA-IR values, suggests that these women are at a higher risk for developing Type 2 diabetes and other metabolic disorders. The higher BMI and waist circumference further underline the link between obesity and PCOS, which may exacerbate metabolic dysfunction and increase the risk of cardiovascular diseases.

Figure 1 Comparison of Endocrine and Metabolic Parameters between Women with PCOS and Healthy Controls

 Testosterone Levels (ng/dL):

• PCOS (Blue): Significantly higher testosterone levels in women with PCOS (mean = 62.5 ng/dL) compared to healthy controls (mean = 22.1 ng/dL).
• Control (Green): Lower testosterone levels observed in the control group.

  DHEAS Levels (µg/dL):

• PCOS (Blue): Higher levels of DHEAS in the PCOS group (mean = 285.1 µg/dL) compared to the control group (mean = 135.6 µg/dL).
• Control (Green): Lower DHEAS levels observed in the control group.

  HOMA-IR Index:

• PCOS (Blue): Higher HOMA-IR index (mean = 2.3) indicating increased insulin resistance in women with PCOS compared to healthy controls (mean = 0.9).
• Control (Green): Lower HOMA-IR index in the control group, indicating better insulin sensitivity.

  BMI (kg/m²):

• PCOS (Blue): Higher BMI in women with PCOS (mean = 28.1 kg/m²) compared to the control group (mean = 23.5 kg/m²).
• Control (Green): Lower BMI in healthy controls.

These findings highlight the urgent need for public health interventions focusing on early diagnosis, management of metabolic risks, and lifestyle modifications in women with PCOS in Central India.

The findings of this study indicate significant differences in both endocrine and metabolic characteristics between women diagnosed with Polycystic Ovary Syndrome (PCOS) and healthy controls in Central India. Specifically, the women with PCOS exhibited elevated levels of testosterone and DHEAS, which are consistent with the hallmark endocrine dysfunctions seen in this syndrome. These findings corroborate previous studies, which have consistently linked PCOS to hyperandrogenism, contributing to symptoms such as hirsutism, acne, and alopecia in affected women [7]. The elevated testosterone levels observed in our study (mean = 62.5 ng/dL) align with those reported in other populations, reinforcing the global relevance of these endocrine abnormalities [8].

In addition to the hormonal imbalances, our study found a high prevalence of insulin resistance in women with PCOS, as evidenced by the significantly higher HOMA-IR index in the PCOS group (mean = 2.3) compared to the control group (mean = 0.9). This result is consistent with the extensive body of literature showing that insulin resistance is a central feature of PCOS and a major contributing factor to the development of Type 2 diabetes and cardiovascular diseases in these women [9][10]. Insulin resistance in PCOS is thought to be driven by an interplay of genetic predisposition and environmental factors, including obesity, which may exacerbate the metabolic dysfunction observed in these women [11].

Obesity, particularly abdominal obesity, was another major finding in our study. Women with PCOS exhibited significantly higher BMI and waist circumference compared to the control group. These results are in line with previous research, which has shown that obesity is a common comorbidity in women with PCOS, affecting up to 80% of affected individuals [12]. The link between obesity and insulin resistance in PCOS is well-established, and our findings support the hypothesis that excess adiposity, particularly visceral fat, contributes to the increased metabolic risks observed in these women [13].

In terms of cardiovascular health, our study found that 35% of women with PCOS had elevated blood pressure, compared to just 10% in the control group. This indicates a higher risk of developing cardiovascular disease in women with PCOS, which has been documented in several studies [14]. Elevated blood pressure in PCOS is thought to be related to the underlying insulin resistance and the metabolic syndrome frequently observed in these women. Furthermore, studies have shown that the risk of cardiovascular disease in women with PCOS increases significantly with the presence of other risk factors, such as obesity and dyslipidemia, both of which were prevalent in our study population [15].

The findings from this study highlight the need for early diagnosis and intervention to address both the endocrine and metabolic aspects of PCOS in Central India. While the clinical focus has traditionally been on managing the reproductive symptoms of PCOS, such as infertility and irregular menstrual cycles, there is increasing recognition of the need to address the metabolic and cardiovascular risks associated with this condition. Lifestyle interventions, including weight management through diet and exercise, have been shown to improve both the reproductive and metabolic outcomes in women with PCOS [16][17]. Given the high prevalence of obesity and insulin resistance in our study population, these interventions should be a key component of the management strategy for women with PCOS in this region.

Furthermore, the high prevalence of metabolic dysfunction observed in women with PCOS in Madhya Pradesh underscores the need for region-specific research and healthcare strategies. While the global understanding of PCOS has improved significantly, there remains a gap in knowledge regarding its regional manifestation, especially in areas like Central India, where socio-economic factors, dietary habits, and healthcare access may differ from those in urban or Western populations [18]. This study provides important insights into the specific endocrine and metabolic challenges faced by women with PCOS in Madhya Pradesh and calls for tailored public health interventions to address these challenges.

In conclusion, this study confirms that women with PCOS in Madhya Pradesh exhibit significant endocrine and metabolic abnormalities, including hyperandrogenism, insulin resistance, obesity, and elevated blood pressure. These findings emphasize the need for a holistic approach to the management of PCOS that goes beyond reproductive health and addresses the long-term metabolic and cardiovascular risks associated with the disorder. Public health initiatives aimed at early diagnosis, lifestyle modifications, and improved healthcare access are crucial to mitigating the long-term health risks faced by women with PCOS in Central India.

This study highlights significant endocrine and metabolic abnormalities in women with PCOS in Madhya Pradesh, including elevated testosterone, DHEAS, insulin resistance, obesity, and increased blood pressure. These findings emphasize the need for a comprehensive approach to PCOS management, focusing not only on reproductive health but also on addressing the long-term metabolic and cardiovascular risks. Early diagnosis, lifestyle modifications, and region-specific public health strategies are crucial for improving the health outcomes of women with PCOS in Central India.

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