Alterations in cognitive function among reproductive-age women with polyendocrine metabolic ovarian syndrome: A systematic review and meta-analysis

Abstract

Polyendocrine metabolic ovarian syndrome (PMOS) is a common endocrine disorder affecting 1.55 million women of reproductive age worldwide. While its physical and reproductive impacts are well-documented, the cognitive effects of PMOS remain under-researched and poorly understood. This systematic review aims to investigate existing literature on cognitive function in women with PMOS. The objective of this review is to identify specific cognitive differences between women with PMOS and those without, highlight gaps in current research and clinical care, and inform the development of more comprehensive care frameworks for individuals with PMOS. A systematic search was conducted using Ovid MEDLINE, Ovid EMBASE, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) for studies published up to June 23, 2025. Eligible studies underwent data extraction and risk of bias assessment in accordance with standard systematic review protocols. Out of 2887 articles screened, 22 studies met the inclusion criteria. Twenty-two studies involving 136,008 women with PMOS and 333,895 without PMOS were included. Across cognitive domains, pooled correlations generally indicated small, non-significant negative associations, including executive function (r = −0.12, 95% confidence interval [CI] –0.26 to 0.02), attention (r = −0.13, 95% CI –0.38 to 0.14), and working memory (r = −0.14, 95% CI –0.31 to 0.05). Substantial heterogeneity was observed in several domains, often driven by individual outlying studies. Risk of bias was generally low, and funnel plots with Egger's regression provided no evidence of publication bias. This review underscores the need for further research into the cognitive aspects of PMOS. Addressing this gap is essential for developing a more comprehensive approach to PMOS treatment and support beyond its traditional focus on physical and reproductive health.