Relationship between body mass index and the clinical predictors of polycystic ovary syndrome in adolescent girls


1 PhD student of Reproductive Health, Department of Midwifery and Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Professor, Department of Obstetrics and Gynecology, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences and Metabolism, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Associate Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

4 Assistant Professor, Department of Nutrition, Nutrition Research Department, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

5 PhD in Health Psychology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

6 Professor, Department of Biostatics, School of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.


Introduction: Polycystic ovary syndrome is one of the most common endocrine diseases of adolescents in the world, which has negative effects on fertility issues in adulthood. Since adolescent weight gain increases the risk of symptoms, this study was performed with aim to investigate the relationship between adolescent body mass index and clinical predicting factors of polycystic ovary syndrome.
Methods: This descriptive- analytical study was conducted in 2019 on 751 adolescents aged 16 to 18 years at risk of polycystic ovary syndrome in Tehran girls' high school. Body mass index, menstrual cycle, hair loss, acne and hirsutism were examined. Data were analyzed by SPSS software (version 25) and chi-square and logistic regression tests. P<0.05 was considered statistically significant.
Results: The results of the showed that there was no significant relationship between body mass index with menstrual cycle order (p = 0.142) and also acne (p = 0.64). But significant positive relationship was found between body mass index with hirsutism (p = 0.02) and also hair loss (p = 0.03).
Conclusion: The increase in body mass index is associated with increase in the severity of clinical symptoms of hyperandrogenism such as hair loss and hirsutism in female adolescents at risk for polycystic ovary syndrome.


  1. Naz MS, Tehrani FR, Majd HA, Ahmadi F, Ozgoli G, Fakari FR, et al. The prevalence of polycystic ovary syndrome in adolescents: A systematic review and meta-analysis. International Journal of Reproductive BioMedicine 2019; 17(8):533-42.
  2. Witchel SF, Oberfield SE, Peña AS. Polycystic ovary syndrome: pathophysiology, presentation, and treatment with emphasis on adolescent girls. Journal of the Endocrine Society 2019; 3(8):1545-73.
  3. Sayehmiri F, Faezeh Kiani F, Sayehmiri K, Maleki F, Ahmadi M, Shohani M. Prevalence Of Polycystic Ovary Syndrome In Iranian Women: A Systematic Review and Meta-analysis. Iran J Obstet Gynecol Infertil 2014; 17(115):11-21.
  4. Peña AS, Witchel SF, Hoeger KM, Oberfield SE, Vogiatzi MG, Misso M, et al. Adolescent polycystic ovary syndrome according to the international evidence-based guideline. BMC medicine 2020; 18:1-6.
  5. Uysal G, Sahin Y, Unluhizarci K, Ferahbas A, Uludag SZ, Aygen E, et al. Is acne a sign of androgen excess disorder or not?. European Journal of Obstetrics & Gynecology and Reproductive Biology 2017; 211:21-5.
  6. Akbarzadeh M, Naderi T, Dabaghmanesh MH, Tabatabaie H, Zare Z. The Prevalence of Hirsutism in Girls 14 to 18 Years Old and its Relationship with Polycystic Ovary Syndrome in Shiraz, Iran. Iran J Obstet Gynecol Infertil 2014; 16(81):8-15.
  7. Carmina E, Azziz R, Bergfeld W, Escobar-Morreale HF, Futterweit W, Huddleston H, et al. Female pattern hair loss and androgen excess: a report from the multidisciplinary androgen excess and PCOS committee. The Journal of Clinical Endocrinology & Metabolism 2019; 104(7):2875-91.
  8. Sam S. Obesity and polycystic ovary syndrome. Obes Manag 2007; 3(2):69-73.
  9. Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews 2011(7):Cd007506.
  10. Li L, Feng Q, Ye M, He Y, Yao A, Shi K. Metabolic effect of obesity on polycystic ovary syndrome in adolescents: a meta-analysis. Journal of Obstetrics and Gynaecology 2017; 37(8):1036-47.
  11. Simmonds M, Llewellyn A, Owen CG, Woolacott N. Predicting adult obesity from childhood obesity: a systematic review and meta‐ Obesity reviews 2016; 17(2):95-107.
  12. Lee B, Jeong S, Roh M. Association between body mass index and health outcomes among adolescents: the mediating role of traditional and cyber bullying victimization. BMC public health 2018; 18(1):1-2.
  13. Cha E, Akazawa MK, Kim KH, Dawkins CR, Lerner HM, Umpierrez G, et al. Lifestyle habits and obesity progression in overweight and obese American young adults: Lessons for promoting cardiometabolic health. Nursing & health sciences 2015; 17(4):467-75.
  14. Wojcicki JM. The double burden household in sub-Saharan Africa: maternal overweight and obesity and childhood undernutrition from the year 2000: results from World Health Organization Data (WHO) and Demographic Health Surveys (DHS). BMC public health 2014; 14(1):1-2.
  15. Mohaddesi H, Gheibi Sh, Saei Ghare naz M, Najarzadeh M, Khalkhali HR, Yeganehpoor M. Association between Anthropometric Index and serum level of Vitamin D, Calcium, Mg, Alp and PTH in Women at Reproductive Age. Iran J Obstet Gynecol Infertil 2018; 21(9):18-25.
  16. Reljić V, Maksiković N, Janković J, Mijović B, Perić J, Janković S. Evaluation of the quality of life in adolescents with acne. Vojnosanitetski pregled 2014; 71(7):634-8.
  17. Herskovitz I, Tosti A. Female pattern hair loss. International Journal of Endocrinology and Metabolism 2013; 11(4).
  18. Lumezi BG, Berisha VL, Pupovci HL, Goçi A, Hajrushi AB. Grading of hirsutism based on the Ferriman-Gallwey scoring system in Kosovar women. Advances in Dermatology and Allergology/Postȩpy Dermatologii i Alergologii 2018; 35(6):631-5.
  19. Ko KM, Han K, Chung YJ, Yoon KH, Park YG, Lee SH. Association between body weight changes and menstrual irregularity: The Korea National Health and Nutrition Examination Survey 2010 to 2012. Endocrinology and Metabolism 2017; 32(2):248-56.
  20. Wei S, Schmidt MD, Dwyer T, Norman RJ, Venn AJ. Obesity and menstrual irregularity: associations with SHBG, testosterone, and insulin. Obesity 2009; 17(5):1070-6.
  21. Zhang E, Li X, Zhang B, Cai L, Tao X, Xing W. Relationship between obesity and menstrual disturbances among women of reproductive age. Heart 2012; 98(Suppl 2):E156-.
  22. Marzouk TM, Ahmed WA. Effect of dietary weight loss on menstrual regularity in obese young adult women with polycystic ovary syndrome. Journal of pediatric and adolescent gynecology 2015; 28(6):457-61.
  23. Lacroix AE, Gondal H, Langaker MD. Physiology, menarche. StatPearls [Internet] 2020.
  24. Mustaqeem M, Sadullah S, Waqar W, Farooq MZ, Khan A, Fraz TR. Obesity with irregular menstrual cycle in young girls. Mymensingh medical journal: MMJ 2015; 24(1):161-7.
  25. Mehta A, Hasija Y. Meta-analyses of associations of obesity with risk of melanoma and acne based on case-control studies. Biomedical Dermatology 2019; 3(1):1-6.
  26. Snast I, Dalal A, Twig G, Astman N, Kedem R, Levin D, et al. Acne and obesity: a nationwide study of 600,404 adolescents. Journal of the American Academy of Dermatology 2019; 81(3):723-9.
  27. Lajevardi V, Ghodsi SZ, Daneshpazhooh M, Kazemi H, Aryanian Z, Goodarzi A. The relationship between body mass index and the severity of acne. Iranian Journal of Dermatology 2014; 17(1):13-7.
  28. Halvorsen JA, Vleugels RA, Bjertness E, Lien L. A population-based study of acne and body mass index in adolescents. Archives of dermatology 2012; 148(1):131-2.
  29. Ahmed AA, Nayaf MS, Maulood KJ. The relationship of body mass index and hirsutism in adult females. Our Dermatology online 2015; 6(3):276.
  30. Naeini FF, Najafian J, Jazebi N. Hirsutism and body mass index in a representative sample of Iranian people. ARYA atherosclerosis 2012; 8(1):43-54.
  31. Ghaderi R, Sharifzadeh GR, Javan BP. The relationship of hirsutism with body mass index (BMI) and other factors. Journal of Birjand University of Medical Sciences 2004; 11(1):18-22.
  32. Ruutiainen K, Erkkola R, Grönroos MA, Irjala K. Influence of body mass index and age on the grade of hair growth in hirsute women of reproductive ages. Fertility and sterility 1988; 50(2):260-5.
  33. Tu YA, Lin SJ, Chen PL, Chou CH, Huang CC, Ho HN, et al. HSD3B1 gene polymorphism and female pattern hair loss in women with polycystic ovary syndrome. Journal of the Formosan Medical Association 2019; 118(8):1225-31.
  34. Danesh-Shakiba M, Poorolajal J, Alirezaei P. Androgenetic alopecia: Relationship to anthropometric indices, blood pressure and life-style habits. Clinical, cosmetic and investigational dermatology 2020; 13:137.
  35. Mirmirani P, Carpenter DM. The impact of obesity on the folliculosebaceous unit. Journal of the American Academy of Dermatology 2014; 71(3):584-5.
  36. Randall VA. Androgens and hair growth. Dermatologic therapy 2008; 21(5):314-28.
  37. Sawant N, Chikhalkar S, Mehta V, Ravi M, Madke B, Khopkar U. Androgenetic alopecia: quality-of-life and associated lifestyle patterns. International journal of trichology 2010; 2(2):81.
  38. El Sayed MH, Abdallah MA, Aly DG, Khater NH. Association of metabolic syndrome with female pattern hair loss in women: a case–control study. International journal of dermatology 2016; 55(10):1131-7.
  39. Karrer-Voegeli S, Rey F, Reymond MJ, Meuwly JY, Gaillard RC, Gomez F. Androgen dependence of hirsutism, acne, and alopecia in women: retrospective analysis of 228 patients investigated for hyperandrogenism. Medicine 2009; 88(1):32-45.
  40. Legro RS. Obesity and PCOS: implications for diagnosis and treatment. InSeminars in reproductive medicine 2012; 30(6):496.
  41. Mohamadpour Koldeh M, Fouladvand MA, Avakh Keysami M. Prevalence of overweight and obesity among Bushehrian high-school girls at aged 14-17 years old. ISMJ 2012; 15(3):221-32.
  42. Shakeri M, Mojtahedi Y, Naserian J, Moradkhani M. Obesity Among Female Adolescents of Tehran Schools. Payavard Salamat 2013; 6(5):74-82.
  43. Torabi Z, Amiraslani T, Falakaflaki B. Prevalence of obesity in 12–14 year old children in Zanjan, Iran and some related factors. J Mazandaran University of Medical Sciences 2017; 26(145):122-32.
  44. Hemati MP, Nouri SS, Kousehlou Z, Orujlou S. Prevalence of general and abdominal obesity, overweight among high school girls in Urmia. Nursing and Midwifery Journal 2016; 14(9):802-10.
  45. Zabeen B, Tayyeb S, Naz F, Ahmed F, Rahman M, Nahar J, et al. Prevalence of obesity and central obesity among adolescent girls in a district school in Bangladesh. Indian journal of endocrinology and metabolism 2015; 19(5):649-52.
  46. Abu Baker NN, Daradkeh SM. Prevalence of overweight and obesity among adolescents in Irbid governorate, Jordan. EMHJ-Eastern Mediterranean Health Journal 2010; 16(6):657-62.
  47. Silva AP, Feilbelmann TC, Silva DC, Palhares HM, Scatena LM, Resende EA, et al. Prevalence of overweight and obesity and associated factors in school children and adolescents in a medium-sized Brazilian city. Clinics 2018; 73.
  48. Sanyaolu A, Okorie C, Qi X, Locke J, Rehman S. Childhood and adolescent obesity in the United States: A public health concern. Global pediatric health 2019; 6:2333794X19891305.
  49. Khoshmaram N. Development of School-based Self Care Packages for Adolescences (Doctoral dissertation, Tabriz University of Medical Sciences, School of Management and Medical Informatics).
  50. Zarei F, Ghahremani L, Khazaee-Pool M, Keshavarz Mohammadi N. Exploring The Strengths, Challenges and Improvement Strategy For Health-Promoting Schools From School Health Experts. Iranian Journal of Health Education and Health Promotion 2017; 5(3):240-50.
  51. Mohammad K, Hosseini M, Nourbala A. Secular trends in growth (weight and height) of children in Iran over a decade (1990-1 to 1999). Hakim Research Journal 2006; 9(1):1-18.
  52. Abdolahian S, Tehrani FR, Amiri M, Ghodsi D, Yarandi RB, Jafari M, et al. Effect of lifestyle modifications on anthropometric, clinical, and biochemical parameters in adolescent girls with polycystic ovary syndrome: a systematic review and meta-analysis. BMC endocrine disorders 2020; 20:1-7.
  53. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human reproduction 2018; 33(9):1602-18.
  54. Naghibi F, Golmakani N, Esmaily H, Moharari F. The relationship between life style and the health related quality of life among the girl students of high schools in Mashhad, 2012-2013. Iran J Obstet Gynecol Infertil 2013; 16(61):9-19.