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

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.