Diagnostic drift in adolescent PCOS in LMICs: implications for prevalence and reproductive health policy

Abstract

The diagnostic criteria for polycystic ovary syndrome (PCOS) have primarily been centered around adult populations, yet they are frequently applied to adolescents in clinical settings, as well as in epidemiological studies. This correspondence discusses how the inconsistent use of adult diagnostic criteria in adolescents, particularly in low- and middle-income countries (LMICs), may contribute to diagnostic heterogeneity and distorted prevalence estimates. Structural limitations in these settings, such as limited access to standardized biochemical assays and reliance on ultrasonography, may exacerbate this variability. Due to these constraints, physiological features of normal development in puberty may be misclassified as pathological, resulting in premature diagnostic labeling and non-comparable epidemiological data. Improved adherence to adolescent-specific recommendations and the development of harmonized, age-appropriate, and resource-sensitive diagnostic standards are necessary to ensure more accurate disease classification and informed reproductive health policy.