Polycystic ovary syndrome (PCOS) is a widespread endocrine and metabolic disorder affecting women of childbearing age (WCBA), with a global prevalence that is estimated to be between 5 and 21% (1–3). This condition is characterized by chronic anovulation, elevated androgen levels, and the presence of multiple ovarian cysts (4, 5). Clinically, PCOS presents with a variety of symptoms such as menstrual irregularities, infertility, excessive hair growth, acne, obesity, and insulin resistance, which contribute to it being a major cause of reproductive and metabolic issues in women (6, 7). Moreover, PCOS is linked to significant long-term health risks. Women with PCOS, especially those with hyperandrogenic traits, are approximately 2.5 times more likely to develop type 2 diabetes and have a higher risk of cardiovascular diseases compared to the general female population (8–10). Additionally, PCOS patients exhibit elevated prevalence of mental health disorders including depression, anxiety, and eating disorders, which amplify disease impact and compromise holistic quality of life (11).

PCOS not only affects immediate reproductive health but also has enduring implications for long-term health. While hyperandrogenic symptoms may lessen with age, leading to a decrease in clinical manifestations post-menopause, the metabolic and cardiovascular complications associated with PCOS continue into later life (12–14). This reduction in overt symptoms complicates diagnosis, particularly in older women who may no longer meet standard diagnostic criteria but continue to experience adverse health outcomes. Therefore, it is essential to address the burden of PCOS during the reproductive years to ensure early detection, prompt intervention, and the prevention of chronic complications. Gaining a deeper understanding of the disease during this critical life stage is vital for reducing its impact on female health and enhancing quality of life.

The Global Burden of Disease Study 2021 (GBD 2021) offers a comprehensive and systematic framework for quantifying the impact of diseases globally, regionally, and nationally (15, 16). By estimating key epidemiological metrics such as incidence, prevalence, and disability-adjusted life years (DALYs), the GBD offers valuable insights into the health effects of various conditions across diverse populations and time frames. Furthermore, the socio-demographic index (SDI), which reflects socio-economic development factors such as income, education, and fertility, is likely to significantly influence the epidemiological profile of PCOS (17–19). Despite the recognized global health significance of PCOS, few studies have systematically analyzed its burden on a global scale, with most existing research being confined to specific regions or countries without considering broader socio-economic and demographic factors.

Leveraging GBD data to assess the global burden of PCOS provides crucial insights into its epidemiology. Firstly, it enables the identification of high-risk regions and populations, facilitating targeted public health strategies and resource allocation to enhance PCOS diagnosis and management. Secondly, analyzing SDI-related trends can elucidate how socio-economic development influences the distribution and clinical outcomes of PCOS, providing a nuanced understanding of disparities in healthcare access, diagnosis, and treatment across different regions. Lastly, longitudinal data on incidence, prevalence, and DALYs provide valuable perspectives on how the burden of PCOS has changed over time, revealing temporal trends that may guide future interventions.

In this study, we utilize GBD 2021 data to conduct a comprehensive assessment of the global burden of PCOS among WCBA from 1990 to 2021. Our analysis examines trends in incidence, prevalence, and DALYs, while also investigating the relationship between these metrics and SDI. The aim of this study is to provide an in-depth understanding of the epidemiological patterns of PCOS, which will aid in the development of evidence-based public health policies and clinical management strategies. Ultimately, our findings will contribute to improving early detection, prevention, and comprehensive management of PCOS, thereby enhancing the health and well-being of women worldwide.

PCOS is a prevalent endocrine disorder affecting WCBA, with global prevalence estimates ranging from 5 to 10% (28). The onset of PCOS is typically during the peripubertal period, and its complex etiology involves genetic, developmental, neuroendocrine, inflammatory, microbiome, and environmental factors (29–31). While the exact pathogenesis remains elusive, it is linked to hypothalamic–pituitary-ovarian axis dysfunction, androgen excess, and insulin resistance (32). In China, PCOS affects approximately 5.6% of reproductive-age women, contributing significantly to anovulatory infertility (33). Common symptoms include menstrual irregularities, hirsutism, infertility, and hyperandrogenism. Additionally, PCOS is associated with increased risks of insulin resistance, type 2 diabetes, dyslipidemia, cardiovascular diseases, metabolic syndrome, sleep apnea, non-alcoholic fatty liver disease, gestational diabetes, and pregnancy-related hypertensive disorders (3, 23). The prevalence of this condition varies with ethnicity, geography, study populations, and diagnostic criteria. A 2017 global study reported 1.55 million incidence cases, 0.43 million DALYs, and an incidence rate of 82.44 per 100,000, marking a 1.45% increase since 2007 (3, 34). A comprehensive analysis of 32 years of GBD data reveals the burden of PCOS in global, regional, and national WCBA populations and explores its correlation with the SDI.

From 1990 to 2021, the WCBA population saw an 89% increase in PCOS prevalence, a 49% rise in incidence, and an 87% surge in DALYs, indicating a substantial disease burden. Diagnosis rates have increased significantly, driven by enhanced medical resource allocation, greater awareness of female health issues, and widespread implementation of the Rotterdam diagnostic criteria. However, the obesity epidemic has also contributed to PCOS incidence, with obese women having two to three times the risk of non-obese women. Genetic factors significantly influence PCOS development, often presenting a familial pattern.

Insulin resistance and obesity are identified as pivotal in PCOS pathogenesis, affecting approximately 60% and 50–75% of patients, respectively (35). Poor diet and sedentary lifestyles exacerbate these risks (36). SDI changes reflect socio-economic and lifestyle impacts on PCOS incidence, with middle SDI countries showing the highest increase in incidence rates and high-middle SDI countries in DALYs rates. Racial differences in incidence and diagnosis should not be overlooked.

In 2021, the disease burden of PCOS among WCBA globally exhibited some key trends. Across different SDI regions, countries with a middle SDI had the highest prevalence, incidence, and DALYs cases for PCOS. However, high SDI countries topped the charts in terms of prevalence, incidence, and DALY rates. From 1990 to 2021, there was an upward trend in prevalence and DALY rates in most SDI regions, with a particularly significant increase in prevalence in middle SDI countries. Despite this, the incidence in high SDI and high-middle SDI countries has declined. In terms of DALY rates, the most notable increase was also seen in middle SDI countries. These data reveal that while the global disease burden of PCOS has generally increased, there are significant differences in the growth trends and magnitude of change across different SDI countries. High SDI countries have the highest prevalence and DALY rates, while middle SDI countries have the fastest growth rate, which may reflect the impact of socio-economic development and lifestyle changes on the incidence of PCOS. Additionally, the decline in incidence rates in some high SDI countries may be related to the allocation of medical resources and disease management strategies in these countries.

Over 32 years, PCOS incidence and prevalence have generally increased, especially in Central Africa, with a 320 and 260% rise, respectively. The high-income Asia-Pacific region alone showed a downward trend, with a 7% decrease in prevalence and a 31% drop in incidence, and a reduction in DALYs. Regional variations in prevalence and incidence changes were observed, with Southeast Asia showing the most significant increase and Tropical Latin America the most decrease. DALY rate changes also varied, with high-income North America showing the most significant decrease and Southeast Asia the most increase.

From 1990 to 2021, at the national level, the prevalence, incidence, and DALY cases of PCOS have increased in most countries. During this period, Equatorial Guinea saw the most significant surge in the number of cases for both prevalence and incidence, with increases of 776 and 571%, respectively. Meanwhile, the US Virgin Islands experienced the most notable decrease in prevalence, while Italy led in the reduction of incidence. In terms of DALY increase, Equatorial Guinea topped the list, and the US Virgin Islands was at the forefront of reduction. Overall, the upward trend in these three key indicators in most countries highlights the significant challenge that PCOS poses to the health of women globally, particularly in Central Africa and the sub-Saharan region as well as Southeast Asia. Concurrently, the downward trend in the high-income Asia-Pacific region indicates the importance of continued efforts to maintain this positive trend. These trends reveal the impact of healthcare services and public health strategies on the management of PCOS in different regions, emphasizing the need for targeted medical resource allocation and public health strategies to address this challenge.

From 1990 to 2021, the prevalence and incidence rates of PCOS among WCBA globally increased significantly with age, especially in the 45 to 49 age group. Globally, the incidence rates of PCOS are on the rise, with the greatest increase seen in the 15 to 19-year-old age group. Changes in different SDI regions have their own characteristics. The increase in incidence rates is particularly pronounced in low-SDI areas, especially in younger age groups. In middle SDI areas, older women have a significant increase in disease burden. The only exception was the high SDI area, where disease burden showed a downward trend in the 45 to 49 age group. Overall, the 45 to 49-year-old age group is the group with the fastest growing PCOS cases. The growth rate is particularly obvious in the high-middle SDI region, and the growth rate is also particularly prominent in the high-income Asia-Pacific region. The peak incidence of PCOS is mainly between the ages of 15 and 19, followed by those between the ages of 20 and 24.

This study, while insightful, is not without its limitations. Firstly, the precision of the GBD data is contingent upon the caliber and accessibility of data from a multitude of nations, which can lead to inconsistencies in data gathering and reporting. The GBD dataset is predicated on health system information that may be incomplete or erroneous in certain regions, notably in low-income areas where healthcare infrastructure is lacking. Secondly, there is a variation in diagnostic criteria for PCOS across different regions, such as those established by the NIH, Rotterdam, and the Androgen Excess and PCOS Society. These diverse criteria can lead to heterogeneity in the rates of prevalence and incidence. It is recommended that future research strive to harmonize diagnostic standards across regions to facilitate more precise comparisons. Thirdly, although this study concentrates on the global trends and impact of PCOS, it does not delve deeply into the multifaceted etiology of the condition. PCOS is shaped by an interplay of genetic, environmental, and lifestyle factors, aspects that were not thoroughly examined in this analysis. Subsequent studies should endeavor to explore the interplay among these factors to gain a more holistic understanding of the development and progression of PCOS.

Over the past 32 years, the global burden of PCOS among WCBA has increased significantly, peaking in the 45–49 age group, particularly in middle SDI regions. The positive correlation between prevalence and SDI highlights the crucial role of socio-economic factors in the epidemiology of PCOS. The physiological characteristics of WCBA make them more susceptible to PCOS, emphasizing the importance of tailored intervention strategies across different age groups and regions. Enhancing early diagnosis, prevention, and comprehensive management of PCOS, with a special focus on the physiological and psychological health of WCBA, is essential for reducing the global burden of PCOS and improving the quality of life for women.