PMOS (formerly PCOS) in Indian women: the specific picture

A nationwide study of 38,709 Indian women found a PMOS prevalence of 19.6% using Rotterdam diagnostic criteria, significantly higher than the global estimate of 8–13%. This is not a rounding difference. It reflects a real biological pattern: South Asian women, and Indian women specifically, have higher rates of insulin resistance, different adiposity distribution, and hormone profiles that predispose to PMOS at a higher population rate.

The most common phenotypes in Indian women with PMOS are Types C and D under the Rotterdam classification, the anovulatory/hyperandrogenic patterns and the anovulatory/polycystic ovary pattern. These may present differently from the pattern most commonly described in Western clinical literature, which has historically focused more on the hyperandrogenic presentation.

Lean PMOS, PMOS in women with a normal or low BMI, is disproportionately common in South Asian populations. Women with lean PMOS have insulin resistance at lower body weights. Standard BMI-based screening misses this group.

Indian women with PMOS have exceptionally high rates of associated metabolic complications. Research published in Lancet Regional Health South East Asia (2023) found that 91.9% of Indian women with PMOS had dyslipidemia (abnormal blood fats), 43.2% had obesity, and 24.9% had metabolic syndrome. These are not incidental findings, they reflect the same insulin resistance pathway that drives the hormonal picture.

Insulin resistance in Indian women with PMOS can be present at BMI as low as 21–23 kg/m². The ICMR has recognised that the standard BMI threshold of 25 for overweight is not appropriate for South Asian populations, and uses 23 as the investigation threshold for insulin resistance-related conditions.

The combination of PMOS-related anovulation and metabolic dysregulation means that Indian women with PMOS face both fertility challenges and a substantially elevated risk of gestational diabetes, type 2 diabetes, and cardiovascular disease over the lifecourse. These risks are modifiable through early detection and appropriate management.

Lifestyle intervention, South Asian-adapted dietary modification, post-meal walking, and resistance training, remains the first-line approach for PMOS with insulin resistance. The dietary modifications most relevant for Indian women include reducing refined carbohydrate load (switching from white rice and maida to millets, brown rice, and whole-grain roti), increasing dietary protein, and managing portion sizes particularly for high-glycaemic-index foods including many traditional sweets and fried foods.

Myo-inositol 2–4g daily has a growing evidence base for insulin-resistant PMOS, including lean phenotype. It is available over-the-counter in India. Metformin is prescribed for insulin-resistant PMOS in Indian clinical practice and is widely available at low cost.

For women trying to conceive with PMOS-related anovulation, ovulation induction with letrozole or clomiphene citrate is the first-line fertility treatment in Indian clinical practice, consistent with NICE and international guidelines.