Phenotypic Spectrum, Menstrual Irregularity, and Reproductive Outcomes Among Women with PCOS Attending Public Hospitals in Gujranwala: A -Participant Cross-Sectional Study

Abstract

Background: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age and is characterized by menstrual irregularities, hyperandrogenism, and polycystic ovarian morphology. It contributes substantially to infertility, metabolic dysfunction, and psychological morbidity, particularly in South Asian populations where lifestyle and genetic factors may amplify disease expression. Objective: This study aimed to evaluate the clinical, hormonal, and reproductive characteristics of women with PCOS in Gujranwala, Pakistan, and to identify phenotypic predictors of infertility. Methods: A cross-sectional analysis was conducted among 500 women aged 18–44 years, diagnosed using Rotterdam criteria. Demographic, menstrual, and clinical data were collected through structured interviews. Hormonal assays measured LH, FSH, and testosterone levels, while ultrasound confirmed ovarian morphology. Multivariable logistic regression identified independent predictors of infertility. Statistical analysis was performed using SPSS v26, with significance set at p < 0.05. Results: The mean age was 28.3 ± 6.5 years. Oligomenorrhea (76%), acne (58.6%), and hirsutism (53.6%) were predominant features. Infertility affected 67.8% of participants. Independent predictors included oligomenorrhea (aOR 3.84, p < 0.001), elevated testosterone (aOR 2.67, p = 0.001), obesity (aOR 1.92, p = 0.017), and ultrasound-confirmed PCOS (aOR 2.43, p = 0.006). Depression was reported in 74.8% of women. Conclusion: PCOS in Pakistani women presents with severe reproductive and psychological manifestations. Early detection, lifestyle interventions, and integrated psychosocial care are essential to mitigate infertility and metabolic complications.