New Delhi: With obesity, metabolic abnormalities and menstrual irregularities emerging as common findings among adolescent girls, AIIMS Delhi is conducting a large study of nearly 4,000 schoolgirls to assess the prevalence of polyendocrine metabolic ovarian syndrome (PMOS) under newer and more stringent diagnostic criteria.

PMOS was earlier referred to as polycystic ovary syndrome (PCOS).

Under the revised criteria based on clinical signs or laboratory findings, both menstrual irregularity and hyperandrogenism are required for a diagnosis in adolescents. Experts said prevalence estimates based on older definitions may therefore not reflect the number of adolescents who meet the newer criteria.

The study, being conducted in collaboration with the Society of Endocrine Health in Elderly, Adolescents and Children, was started in October 2023 following the revision of the criteria for diagnosing the condition, said Dr Rajni Sharma, professor of Paediatrics, division of Paediatric Endocrinology at the Department of Paediatrics at AIIMS, Delhi.

Children from six schools, including government and private, are being covered under the study, with nearly 4,000 girls screened so far.

"The preliminary findings showed a high prevalence of obesity, metabolic problems and irregular menstrual cycles among the girls. The same group of girls is being followed up to monitor changes in their health and metabolic parameters over time," Dr Sharma said.

Experts said early identification is important as hormonal and metabolic problems during adolescence can have long-term health implications.

Adolescent girls diagnosed with PMOS are called to AIIMS for further evaluation and are counselled about adopting a healthy lifestyle, maintaining physical activity and following appropriate treatment, including hormonal and non-hormonal approaches where required, Dr Sharma informed.

"The adolescents are also screened for anxiety, depression, sleep problems and eating disorders, and those requiring support are provided psychological counselling," Dr Sharma said.

Menstrual irregularity in the initial years after the first period can be part of normal development, while signs of increased androgen levels, such as excessive hair growth or moderate-to-severe acne, along with laboratory findings, need to be considered for an appropriate diagnosis, said Dr Vandana Jain, Professor in the division of Paediatric Endocrinology, Department of Paediatrics, AIIMS, Delhi.

Dr Jain said ultrasound findings alone should not be used to diagnose PCOS in adolescents in the absence of other clinical or biochemical evidence.

Doctors further said excessive screen time, including prolonged use of smartphones and social-media platforms such as Instagram, is emerging as an important lifestyle concern among adolescents and can indirectly contribute to the metabolic risk factors associated with PMOS.

"Long hours spent on phones often mean less time for outdoor play and physical activity. Screen use, particularly late at night, can also interfere with sleep.

"Social-media use may further expose adolescents to food-related content and encourage sedentary routines, while eating or snacking during prolonged screen use can contribute to excess calorie intake," Dr Renu Sharma, Child and Adolescent Psychologist in the Department of Psychiatry at AIIMS Delhi, said.

Studies have found an association between higher screen time and overweight or obesity among adolescents.

Dr Renu Sharma, however, said screen time by itself does not cause PMOS. Rather, prolonged sedentary behaviour, inadequate physical activity, disturbed sleep, obesity and associated metabolic abnormalities can add to the risk profile. They advised adolescents to take regular breaks from screens and include daily physical activity in their routine.

Experts said yoga could form part of a lifestyle-based approach to managing PMOS among adolescents, particularly by improving physical activity, reducing stress and supporting metabolic health.

"Yoga practices involving asanas, breathing exercises and meditation can help adolescents become more physically active while also addressing stress and sleep-related problems. This may be particularly relevant because adolescents with PMOS can experience psychological concerns, including anxiety, low self-esteem, emotional eating and body-image issues," Dr Rima Dada, Professor in the Department of Anatomy at AIIMS, Delhi, said.

Dr Dada explained that yoga improves and enriches the gut microbiome and increases those bacteria which reduce inflammation and also discussed the positive impact of yoga on the metabolome.

A more recent systematic review of yoga interventions in PCOS also reported potential benefits for metabolic, hormonal, menstrual and psychological outcomes, although researchers cautioned that the available studies are heterogeneous and generally limited in size, she said.

Dr Dada said yoga should therefore be viewed as a complementary lifestyle intervention and not a replacement for medical treatment when treatment is required.

PMOS in adolescents can present with irregular menstrual cycles, excessive hair growth on the face or body, persistent or moderate-to-severe acne, weight gain and obesity, particularly around the abdomen. Some girls may also develop darkening and thickening of the skin, a sign often associated with insulin resistance.

However, symptoms can vary considerably and not every adolescent with irregular periods has PMOS. The condition is linked to a combination of hormonal and metabolic factors, including increased androgen activity and insulin resistance. Genetics, excess weight, physical inactivity and other lifestyle factors may contribute to the development or worsening of these abnormalities.

Dr Sharma said PCOS should not be diagnosed solely on the basis of an ultrasound showing polycystic-appearing ovaries. Clinical or biochemical evidence of increased androgen levels, together with age-appropriate menstrual irregularity, needs to be assessed, while other conditions that can mimic PCOS should be excluded, she added.

This report was published from a syndicated wire feed. Apart from the headline, the EdexLive Desk has not edited the copy.