PCOS Awareness Month: Expert Explains Why Your Cycle Can Signal Diabetes Risk

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Polycystic ovary syndrome (PCOS), now also called polyendocrine metabolic ovarian syndrome (PMOS), is one of the clearest early signals a woman's body gives of future diabetes, heart disease and liver disease. Reading that signal early, and linking reproductive care with metabolic screening, is one of the most effective prevention opportunities in women's health today. The opportunity is large because the condition is common and growing.

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On PCOS Awareness Month, we spoke to Dr Sabine Kapasi, CEO of Enira Consulting Pvt Ltd, founder of ROPAN Healthcare Pvt Ltd and a UN Advisor, who explained the link between PCOS and metabolic health.

The World Health Organization (WHO) estimates that 10-13% of women worldwide have PCOS, and up to 70% of them do not know it. The numbers are also climbing. The Global Burden of Disease Study 2019, published in PLOS One, found that new cases rose 54.3% between 1990 and 2019, from 1.4 million to 2.1 million a year. A later analysis for 2021 ranked PCOS second only to type 2 diabetes for its age-adjusted rate of new cases among the conditions studied. A condition this common, and growing this fast among women of childbearing age, belongs in every national NCD strategy.

Why PCOS Is More Than A Reproductive Condition

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PCOS is often described through its visible symptoms: irregular cycles, acne and weight gain around the midsection. These are not separate problems. They are downstream effects of a single hormonal pathway. "Raised insulin levels push the ovaries to overproduce androgens (male hormones) and suppress the liver's output of sex hormone-binding globulin. The same insulin resistance later sets the stage for diabetes and heart disease. Treating the reproductive symptoms apart from their metabolic cause misreads the condition from the start," said Dr Kapasi.

The connection shows up clearly in outcomes data. A 2025 cross-sectional study on PCOS and metabolic syndrome found that women with the condition and normal blood sugar at baseline face a 54% risk of progressing to type 2 diabetes within six years of developing impaired glucose tolerance. That trajectory unfolds during a woman's twenties and thirties, the years when most health systems are not screening her for either diabetes or heart disease.

Where Health Policy Falls Short

Global NCD frameworks were built around four categories: cardiovascular disease, cancer, chronic respiratory disease and diabetes. Reproductive endocrine conditions were never folded into that structure. As a result, PCOS is managed in isolation, usually within fertility care, and cut off from the metabolic screening it needs.

"A woman diagnosed with PCOS at a gynaecology visit rarely leaves with a referral for glucose or lipid testing. A woman flagged as prediabetic in primary care is rarely asked about her cycle history. It is one continuous disease process, split across two appointments," added Dr Kapasi.

Global Burden of Disease data from 2021 shows the weight of that gap. Metabolic risk factors account for 100% of type 2 diabetes deaths worldwide, and PCOS incidence is rising fastest in the same regions carrying the heaviest diabetes burden. The overlap is too large to keep treating as coincidence.

Steps Toward Integrated Screening

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None of this needs new infrastructure. It needs existing systems to work together.

• At diagnosis: Fasting glucose and lipid tests can become standard when PCOS is diagnosed, rather than something a patient must request.
• In diabetes and heart screening: Protocols can include a basic question about menstrual regularity, especially for women under 40, who fall outside most standard cardiometabolic screening windows on age alone.
• In insurance: Frameworks can classify PCOS-related metabolic testing as NCD prevention, giving it the funding priority diabetes screening already receives, rather than routing it only through fertility budgets, which are often the first to be cut.

Adolescent health services offer the biggest opportunity. PCOS symptoms typically first appear between ages 15 and 19, just as insulin resistance is taking hold. Catching the condition then, before years of metabolic strain build up, is the cheapest and most effective point of intervention across the whole disease timeline. School clinics and adolescent health programmes already reach this age group. What is missing is a clear mandate to screen for PCOS when it first appears," explained Dr Kapasi.

Bottomline

Dr Kapasi concluded, "Women's health policy keeps organising itself around separate budgets, specialists and reporting lines for reproductive and chronic disease care. PCOS is the clearest argument against that structure. The ovary and the pancreas respond to the same hormone, and health systems that keep them in separate departments will keep stepping in years later than they should, after prediabetes has become diabetes and the early warning has passed."

Disclaimer: The information provided in this article is for general informational and educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or a qualified healthcare provider with any questions you may have regarding a medical condition.