Polycystic ovary syndrome in Mexico: from adolescence to adulthood

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among individuals of reproductive age with ovaries, yet in Mexico there is no epidemiologic information or explicit public health policies addressing the condition. Given its high prevalence and burdensome metabolic, reproductive, and psychosocial symptoms, there is a clear need to generate evidence that implementation and guideline frameworks identify as necessary to close evidence–practice gaps: quantifying disease burden and current care gaps, identifying modifiable determinants that can be targeted early, and understanding how people experience the condition and encounter barriers within families, workplaces, and health systems. This dissertation addresses each of these elements using the Mexican Teachers’ Cohort. First, a nested validation study developed and evaluated a Spanish-language, symptom-based questionnaire against clinical assessments, showing that a model using menstrual and diagnostic items can classify PCOS with high discrimination, providing a feasible tool to estimate PCOS burden in large epidemiologic studies and inform primary care guidelines. Second, applying this tool to the full cohort, life-course analyses showed that persistently higher and increasing body size from childhood through late adolescence was associated with higher odds of PCOS, whereas adolescent diet showed weaker and less consistent associations, highlighting adolescent adiposity as a key modifiable target for prevention. Third, in-depth interviews with women living with PCOS illuminated how symptoms, weight, fertility concerns, and medical dismissal are negotiated within specific social and institutional contexts, as well as strategies of coping, resistance, and narrative reframing that shape care-seeking. Together, these studies align with core principles for designing effective public health responses by integrating evidence on measurement, modifiable risk, and lived experience, and they provide a foundation for future guideline implementation and policy development for PCOS in Mexico.