The tip of the iceberg: Morbidity in polycystic ovary syndrome in reproductive-age women.

Abstract

Context: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-age women, but its true burden remains underestimated due to diagnostic variability and underreporting.

Objective: To estimate the morbidities in reproductive-age women identified with a diagnosis of PCOS in the French national health data system.

Methods: We conducted a retrospective cohort study using the French national health data system (SNDS) to identify reproductive-age women (18-43 years) diagnosed with PCOS (ICD-10 code E28.2) between 2014 and 2022. Morbidity data were assessed in 2022 and compared with an age-matched control group of women without PCOS in the same year. Specific comorbidities were identified using a set of algorithms applied to the system's data and based on both ICD-10 codes and medical acts and drug use. Logistic regression models were used to compare comorbidity rates, with odds ratios adjusted for age and social deprivation.

Results: We identified 21,144 women with PCOS in the health data system. Median age was 35 years [IQR: 29-39]. Compared with the general female population, women with PCOS had significantly higher rates of infertility (adjusted odds ratio (aOR)=24.35), gestational diabetes (aOR=1.64), type 2 diabetes (aOR 14.71), pulmonary embolism (aOR=2.04), arterial hypertension (aOR 5.86), acute stroke (aOR= 2.39), cardioneurovascular disease (aOR 2.12) and psychiatric disorders (aOR=1.66).

Conclusions: Given the high morbidity among women identified with PCOS on ICD-10 code E28.2, improved diagnostic algorithms are needed to better identify PCOS cases in health databases and assess their public health implications.