At 16, when Anushka Gaikwad stopped getting her periods, she did what most teenagers wouldn’t—she visited the nearest clinic in her village of Cundaim in Goa. Instead of looking for an underlying hormonal problem, the doctor asked her to take a pregnancy test. Alarmed, Anushka persuaded her mother to seek another opinion in Panaji. A sonography finally revealed the real cause: Polycystic Ovarian Syndrome (PCOS), now referred to as Polyendocrine Metabolic Ovarian Syndrome (PMOS) to better reflect what doctors now understand about the condition.Now 22, she says, “I realised later how little people—even healthcare providers in smaller towns—understood women’s problems. Her experience is far from unique. PMOS is the most common endocrine disorder affecting women of reproductive age worldwide. But despite the name change, many still think of it as a disease of the ovaries. In reality, experts say it is a metabolic disorder that affects nearly every system in the body — from insulin regulation and fertility to cardiovascular health, sleep, mood and mental wellbeing.According to The Lancet, PMOS affects around one in eight women globally. In India, however, the burden is significantly higher, with recent studies suggesting that one in five women may have the condition. “Almost one in five women below the age of 25 have some impact of PMOS, compared to the global average of around 8-13 per cent,” says Dr Anshumala Shukla, head, Minimally Invasive Gynaecology, at Kokilaben Dhirubhai Ambani Hospital, Mumbai, who specialises in endometriosis and PMOS and is part of WHO efforts to draw up guidelines for the former. “Part of this is because India already has very high rates of diabetes and insulin resistance. Added to that are rapid urbanisation, easy access to processed food, sedentary lifestyles and rising stress levels.”Also Read | Kerala doctor lost 31 kg on an experimental obesity drug: What are side effects and challenges?Why India is seeing early PMOSDoctors caution that the increase in diagnoses is partly because more women are seeking help for menstrual problems. “It’s no longer taboo to see a gynaecologist,” says Dr Meenakshi Ahuja, principal director, Obstetrics and Gynaecology, Fortis La Femme, Delhi. But awareness has not spread evenly. Women in rural areas often remain undiagnosed for years, while mothers—who are usually the first point of support for adolescent girls—frequently have little understanding of the condition.India’s underlying metabolic profile also makes women more vulnerable. A family history of diabetes and insulin resistance increases susceptibility to PMOS. While Dr Ahuja estimates India’s overall prevalence at around 10%, she says rates in cities—where sedentary routines and poor sleep are more common—may range between 25% and 40%.Dr Shukla believes the younger age at diagnosis is no coincidence. “Teenagers today spend much longer on screens, eat more unhealthy food and often don’t exercise regularly. Those who already have a genetic tendency start showing symptoms soon after they begin menstruating.” Then there is smoking, common among women in their 20s. This raises levels of free testosterone in the blood that manifests as acne, excess facial hair and hair loss. Smoking increases fasting insulin levels, worsening insulin resistance. This can lead to rapid weight gain and a higher risk of developing type 2 diabetes. Smoking further triggers body inflammation and reduces your ovarian reserve (the number and quality of your eggs) by almost 20%.What are symptoms?Irregular periods remain the symptom that prompts most women to seek medical help, but doctors say they are only one part of the picture. They look for irregular or delayed menstrual cycles caused by a lack of ovulation, signs of excess male hormones such as facial hair or male-pattern hair loss, ultrasound evidence of enlarged ovaries with multiple follicles, and hormonal abnormalities in blood tests, including elevated Anti-Müllerian Hormone (AMH) levels, the last measuring the number of small, early-stage egg follicles in the ovaries. In women with PCOS, this follicle count is often very high.Story continues below this adThe syndrome can also trigger weight gain, infertility, insulin resistance, sleep disturbances, anxiety and depression. For Nakshatra Borgaonkar, the diagnosis came at 14. When her periods finally began, they came only once before disappearing for another five months. A scan confirmed PMOS. A decade later, she says the diagnosis itself was not the hardest part. “Nobody really explained what was happening to my body. I was simply told to stop eating junk food and eat small meals, an advice that pushed me towards years of unhealthy eating habits,” she says. She describes herself as having spent years on the eating disorder spectrum, fuelled by emotional eating linked to hormonal changes she barely understood.Also Read | Wading through floodwater, Mumbai woman develops painful red bumps and fever: What is leptospirosis?The invisible emotional burdenHer experience reflects what nutritionist Kavita Devgan sees routinely. “The emotional burden is often left unaddressed. If I spend 15 to 20 minutes with a regular patient, I spend almost 40 minutes with someone with PMOS,” says Devgan. And part of it has to do with women navigating PMOS almost entirely on their own.For Tahera, 23, it was only after beginning treatment that she realised excessive body hair and persistent acne were symptoms of PMOS. Once prescribed oral contraceptive pills, she noticed her skin clearing and body hair reducing. Dr Shukla says these emotional consequences are common. “High testosterone levels can lead to weight gain, which causes anxiety and depression,” she says. Irregular periods themselves also contribute to anxiety. “Mood disorders and body image issues are very much part of PMOS.”Stress worsens the condition by increasing cortisol, which increases insulin resistance, which in turn worsens PMOS. Poor sleep compounds the problem. “You can’t sleep at 3 or 4 in the morning and wake up at 11. That disrupts the body’s circadian rhythm,” says Dr Shukla.Story continues below this adTreatment isn’t about losing weightFor years, PMOS treatment has been reduced to a familiar refrain: lose weight. “But it has more to do with the hormonal imbalance and insulin resistance,” says Ritika Samaddar, Regional Head, Clinical Nutrition and Dietetics, Max Healthcare. “If you don’t first address the hormonal imbalance, any weight loss that happens is likely to be temporary.” That means focusing less on eating less and more on eating better. “The quality of food becomes more important than simply cutting down the quantity. Protein and fibre are gradually increased over several weeks before patients are advised what to cut back on. Blanket denials backfire and leave young women feeling guilty rather than empowered,” she says.Dr Shukla agrees that lifestyle is the cornerstone of treatment. “You may have a genetic tendency for PMOS because of your family history,” she says. “But if your lifestyle involves processed food, excess carbohydrates, little exercise and poor sleep, those genes begin to express themselves.” Exercise, she adds, should not be viewed as a temporary fix for weight loss but as a long-term part of managing insulin resistance.That is reflected in patient experiences too. Rachita Jain noticed her symptoms several years after the birth of her second child. “I was completely occupied with the children and stopped taking care of myself and routines. Weight gain, bloating and swelling came first. Missed periods followed. I was diagnosed with PMOS at 34,” she says. Exercise and diet changed that. Anushka noticed something similar. During college, her daily four-kilometre walk kept her menstrual cycles relatively regular. During holidays, when that routine disappeared, the irregularity often returned.Medication also has a role, but experts caution against the widespread misconception that everyone with PMOS needs birth control pills. “They are recommended only for certain patients,” says Dr Shukla. Women with highly irregular periods and significantly elevated male hormones may benefit from oral contraceptive pills, while others can be managed with medicines that improve insulin resistance or simply help regulate menstrual cycles.Story continues below this adThe cost of living with PMOSManaging PMOS is not just emotionally demanding — it can also become financially draining. Since being diagnosed at 16, Anushka has undergone six ultrasounds, many of them simply because she consulted different gynaecologists after moving cities.Whether so many scans are medically necessary is itself debatable. PMOS cysts are functional, explains Dr Ahuja. They form and disappear as part of the menstrual cycle and generally do not require repeated imaging once a diagnosis has been established. “The patient’s symptoms and menstrual cycle are much better indicators of how treatment is progressing,” she adds. A follow-up scan may be useful to confirm that ovarian size has normalised, but routine repeat imaging often adds cost without changing management.What is needed are routine screening of adolescent girls, simple hormone tests and early diagnosis long before the condition worsens.