Srinagar: Across the Kashmir Valley, Polycystic Ovary Syndrome (PCOS), also commonly referred to as PCOD, has become a growing concern for young women and their families. The World Health Organisation (WHO) estimates that PCOS affects about 10–13% of women of reproductive age worldwide. A 2020 study of women aged 15–40 in the Kashmir Valley also pointed to a significant prevalence of the condition. Of 171 participants identified as probable PCOS cases who underwent detailed clinical, biochemical, hormonal and sonographic assessment, 35.3% met the Rotterdam criteria for PCOS. The study’s authors described the prevalence as high and called for wider studies to confirm the findings.
Yet in the conservative rural belts and district townships of the Valley, the medical condition is colliding with deep-seated social anxieties surrounding female fertility. A PCOS diagnosis can be treated by some families as a biological deadline. Fearing that their daughters may face fertility problems or social stigma associated with visible symptoms, some parents push young women towards marriage at the age of twenty or twenty-one.
Lifestyle and Metabolic Risk
PCOS is a complex hormonal and metabolic condition whose exact cause is not fully understood. WHO notes that women with PCOS are at increased risk of insulin resistance, type 2 diabetes and obesity, while healthy eating and physical activity form an important part of managing the condition. Physical inactivity is another concern. Changing domestic patterns and urbanisation, coupled with limited access to outdoor spaces and sports infrastructure for adolescent girls, can make regular physical activity more difficult.
Mental health is an equally important part of the picture. A Kashmir-based study involving 110 women diagnosed with PCOS found a high prevalence of psychiatric disorders, particularly major depression, panic disorder and generalised anxiety disorder.
The Clinical Perspective: On-Ground Realities
Inside the busy Out-Patient Departments (OPDs) of tertiary care centres, clinicians frequently witness how a medical diagnosis can turn into domestic panic. “This is a distinct and deeply entrenched trend that we observe frequently in clinical practice,” says Dr Adnan, a consultant gynaecologist at GMC Anantnag. “In our society, a PCOS or PCOD diagnosis is often widely misunderstood as an immediate sentence of permanent infertility rather than a manageable hormonal imbalance. Because a woman’s societal worth is so heavily tied to her ability to bear children, this diagnosis triggers an immediate cultural panic among parents.” Dr Adnan says the pressure is particularly strong in rural areas, where limited health literacy and traditional attitudes can amplify fears about fertility and marriage.
“Young women themselves are almost never truly ‘okay’ with being rushed into marriage. Some accept it out of guilt and a desire to ease their parents’ anxiety; others feel deep frustration and fear over losing agency because of a treatable medical condition.” He says much of his work involves correcting these misconceptions. “Parents immediately jump to the conclusion that their daughter is permanently infertile. We have to repeatedly explain that it is a manageable hormonal and metabolic condition, not a reproductive dead-end.” PCOS can affect ovulation and fertility, but a diagnosis does not mean inevitable infertility. WHO identifies PCOS as a leading cause of infertility while also noting that treatment can improve fertility and that women with PCOS can be supported to become pregnant.
Caught in the Middle: Victims of the Marriage Rush
For many young women in rural villages, the gap between clinical advice and family expectations creates severe emotional strain. In a village near Bijbehara, twenty-two-year-old Mehak (name changed upon request) sits in her marital home, where she moved fourteen months ago after her family arranged her marriage midway through her final college semester. She had been diagnosed with PCOS at seventeen after experiencing irregular menstrual cycles and noticeable facial hair growth. “My father is a farmer, and neither of my parents understood what hormones were,” Mehak says. “The only thing our neighbors told them was that if a girl has cysts, she will stop being able to conceive after twenty-three. Every evening at home turned into a discussion about my marriage. My mother kept crying, telling me that once people in the village found out about my ovaries, no respectable family would send a proposal. I gave in because I felt guilty seeing my parents so anxious. But as soon as the wedding was over, the pressure to get pregnant started immediately. When I didn’t conceive in the first six months, they started taking me to fertility clinics. The exact anxiety they tried to escape by marrying me off early became my daily reality.”
In Shopian, twenty-year-old Insha (name changed) shares a similar experience regarding the physical stigma surrounding the condition. Insha began dealing with rapid weight gain and severe facial acne when she was sixteen. “In our village, physical appearance is closely tied to marriage proposals,” Insha explains. “When the doctor wrote PCOD on my report, my relatives told my parents that we should finalise a match immediately while the symptoms were still manageable with various treatments. They argued that if I waited until finishing my degree at twenty-four, my weight and facial hair would get worse, and no one would agree to marry me. It felt like I was being treated as someone whose value was about to expire.”
Pushing Back: Fighting for Agency
Despite strong traditional pressure, some young women are using medical information to defend their education and career goals. In Baramulla, twenty-three-year-old Zainab, a final-year computer applications student, was diagnosed with PCOS and insulin resistance at the age of twenty. When the ultrasound report arrived, her family immediately began looking for a match. “My grandmother told us we had to marry me off within the year before things got complicated,” Zainab recalls. “I refused to accept that a hormonal problem meant I had to drop out of university. I read medical articles online, found out how insulin resistance works, and took my mother with me to an endocrinologist in Srinagar. I asked the doctor to explain directly to her that my ovaries were not permanently damaged.”
The consultation helped change her family’s perspective. “The doctor told my mother clearly that marriage does not cure hormones, and that with exercise and proper diet, fertility is manageable,” Zainab says. “I cut down on bakery foods, started walking an hour every day, and took my prescribed medicine. My cycles improved, and my weight stabilised. I told my family that I will complete my degree and find a job first. My medical health is something I need to manage for myself, not an excuse to rush into a marriage I am not ready for.”
The Need for Public Health Intervention
Medical practitioners emphasise that addressing PCOS in Kashmir requires expanding health education beyond hospital walls. Frontline healthcare workers, including Accredited Social Health Activists (ASHAs) and Primary Health Centre (PHC) staff, need specific training to educate rural families on adolescent endocrine health. Providing accurate information in schools and community centres can help families view PCOS as a common, manageable hormonal and metabolic condition rather than a reproductive emergency.
For Mehak, Insha and Zainab, the issue extends far beyond a medical report. Their experiences show how quickly uncertainty about fertility can enter decisions about education, careers and marriage. For young women already learning how to manage a chronic health condition, the diagnosis should not become a deadline for deciding the rest of their lives.
