Hormonal imbalance, fertility issues now affecting women in 20s: 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.