Hormonal imbalance, fertility issues now affecting women in 20s, say experts

NEW DELHI: A growing number of young women are experiencing hormonal imbalance and fertility-related issues much earlier than previously seen, with experts attributing the trend to a combination of biological shifts and modern lifestyle factors.

Doctors say there is a noticeable change in clinical patterns, with conditions once common in women in their late 30s now increasingly being diagnosed in those in their 20s.

"There is a clear and concerning shift in women's health today, where issues related to hormonal imbalance and fertility are appearing much earlier than we traditionally observed," Priti Arora Dhamija, senior consultant and lead IVF, gynaecology at the Sitaram Bhartia Institute of Science and Research, said.

She noted that one contributing factor is the earlier onset of puberty.

"One of the key reasons is the earlier onset of puberty with many girls now attain menarche as early as 8-9 years, which can lead to a relatively earlier decline in ovarian reserve," she said.

Studies published in journals such as The Lancet Child and Adolescent Health have documented a steady decline in the age of puberty onset over the past few decades, linked to improved nutrition but also rising obesity and environmental exposures.

However, experts emphasised that biology alone does not explain the trend, with lifestyle factors playing a significant role.

"Today, young women are growing up in a high-stress, high-performance environment, often marked by erratic sleep cycles, excessive screen time, poor dietary habits, and limited physical activity. These factors contribute to rising rates of obesity, PCOS, and metabolic disturbances in the early 20s," Dhamija said.

Chronic stress, she added, disrupts the hypothalamic pituitary ovarian axis, leading to hormonal imbalance and irregular ovulation.

"In addition, behavioural factors such as early sexual activity, multiple partners, and lack of medical supervision in contraceptive use are contributing to higher incidences of sexually transmitted infections and uterine health issues, which can further impact fertility. Environmental exposure to hormone-like substances through food and pollution is an emerging concern as well," she said.

Juhi Bharti, Additional Professor in the Department of Obstetrics and Gynaecology at AIIMS, Delhi, said clinicians are increasingly observing diminished ovarian reserve in younger women.

"Clinically, we are now observing diminished ovarian reserve in women in their late 20s, a trend that was previously more common in the late 30s. While not necessarily irreversible, this shift highlights the need for early awareness and timely intervention," she said.

Supporting this trend, data from the Indian Society of Assisted Reproduction (ISAR) and international fertility studies indicate a rise in cases of diminished ovarian reserve and polycystic ovary syndrome (PCOS) among women under 30.

PCOS alone is estimated to affect nearly one in five women of reproductive age in India, according to various epidemiological studies.

Experts stressed that fertility should be viewed as a reflection of overall health rather than just age.

"Poor sleep doesn't just cause fatigue, it disrupts hormonal signalling, may accelerate reproductive ageing, and impacts fertility potential. Aligning sleep with natural circadian rhythms is therefore a key, yet often overlooked, pillar of reproductive health," Dr Bharti said.

Echoing similar concerns, Bhawani Shekhar, Associate Consultant at the Centre of IVF and Human Reproduction at Sir Ganga Ram Hospital, said, "We gynaecologists are increasingly observing a shift in women's health with signs of hormonal imbalance and fertility issues appearing in the 20s," she said.

She added that many patients now report irregular menstrual cycles, PCOS, infertility and early signs of ovarian ageing, largely linked to modern lifestyle patterns.

"Unhealthy diet, sedentary routine and lack of regular exercise play a significant role, with smoking and alcohol further contributing to the problem. In addition, chronic stress increases cortisol levels and poor sleep affects the circadian rhythm, further impacting hormone levels and ovarian health," she said.

These trends are a warning sign but what is reassuring is that all these factors are modifiable, she said.

"So the focus needs to shift towards prevention. Prioritising balanced nutrition, regular physical activity, adequate sleep and stress management can help in maintaining hormonal balance and reproductive health," Shekhar said.