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. 2025 Oct 17;312(6):1967–1976. doi: 10.1007/s00404-025-08121-4

Temporal trends in the prevalence of polycystic ovary syndrome in China from 1990 to 2021, and projections until 2036: a comparison with Japan, Asia, and global level

Chongyi Wang 1, Ayan Mao 2, Yujie Yang 2, Ying Zhang 1, Qiong Wu 2, Na Zhang 1, Wuqi Qiu 2,✉
PMCID: PMC12705847  PMID: 41107503

Abstract

Background

The burden of polycystic ovary syndrome is increasing worldwide, which places a heavy burden on society and healthcare systems. This study investigates the independent effects of age, period, and cohort on the polycystic ovary syndrome prevalence from 1990 to 2021 in China, Japan, Asia and World. And then predicts the future burden of polycystic ovary syndrome over the next decade.

Method

The data were collected from the Global Burden of Disease (GBD) 2021 study, and the average annual percent change (AAPC) and relative risks (RRs) analyzed by joinpoint regression and APC-IE model. And this study employed the BAPC model to predict future disease burdens in China and Japan.

Results

In 2021, there were 533.533*104 (95% CI: 376.054*104, 750.101*104) cases of PCOS in China, accounting for 28.69% of all cases in Asia and 14.56% globally. The ASPR of PCOS in China increased from 1990 to 2021, with an AAPC of 2.01 (95% CI: 1.99, 2.03), which was significantly higher than that of Japan (0.21; 95% CI: 0.20, 0.22), Asia (1.30; 95% CI: 1.28, 1.31) and the global average (0.81; 95% CI: 0.80, 0.82). The age-period-cohort analyses revealed that the relative risk (RR) of polycystic ovary syndrome increased with age, peaking at 20–24 years in Chinese women (RR = 1.591) and Japan women (RR = 1.64). And Japan showed a slight increase in the 35–39 age group (RR = 1.583). The period effect of polycystic ovary syndrome showed a consistent upward trend in China, Japan, Asia, and globally. And China experienced the most substantial increase from 1992–1996 (RR = 0.701) to 2017–2021 (RR = 1.271). The cohort effect of PCOS demonstrated a declining trend across regions, but China and Asia experienced an incline from 2002–2006 to 2007–2011 birth cohort. By 2036, the ASPR of PCOS in China is projected to increase by 27% from 2021, reaching 1961.45/100,000.

Conclusions

The prevalence of the PCOS in China has increased significantly over the past three decades. The age group with a high prevalence of polycystic ovary syndrome among Chinese women is 20–25 years old. And women in the new birth cohort are more likely to develop polycystic ovary syndrome. It is imperative that the government standardize the diagnosis and treatment of polycystic ovary syndrome and provide health education to the women.

Keywords: Polycystic ovary syndrome, Age, Period, Cohort model, Joinpoint regression, Bayesian age, Period, Cohort

What does this study add to the clinical work

In 2021, China had 5.3 million PCOS cases, contributing 15% of the global burden.
PCOS rates in China rose faster (2% yearly) than in Japan, Asia, or globally from 1990 to 2021.
Women aged 20–24 face the highest PCOS risk in China and Japan, with a secondary peak at 35–39 in Japan.
Recent birth cohorts (born after 2007) in China and Asia show increased PCOS risk compared to older birth cohorts (born between 2002 and 2006).
By 2036, China’s PCOS prevalence is projected to rise by 27%, emphasizing the need for urgent healthcare action.
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Introduction

Polycystic ovary syndrome (PCOS) is an endocrine and metabolic disorder characterized by hyperandrogenemia (elevated blood levels of androgens), ovulatory dysfunction, and polycystic ovaries (PCO) [1]. The prevalence of PCOS is estimated to be 6–10% among women of reproductive age, depending on the diagnostic criteria used [2]. The link between polycystic ovaries and infertility has been clearly defined [3]. Additionally, PCOS is associated with various maternal pregnancy and delivery complications, such as miscarriage, pre-eclampsia, and labor induction [4]. Furthermore, it is linked to other health issues, including obesity [5], diabetes [6], cardiovascular diseases [7], depression [8], cancer [9], obstructive sleep apnea [10] and so on. Notably, children born to mothers with PCOS have a higher incidence of obesity and diabetes [11].

The development of PCOS is influenced by a combination of environmental [12], lifestyle [13], and genetic factors [14], which disrupt the normal hormonal balance in women. In 2019, Japan reported the second-highest age-standardized prevalence rate of PCOS globally [15]. Similarly, a recent study indicated that the prevalence of PCOS among Chinese women has increased by nearly 65% over the past decade, with more severe phenotypes [16] significantly impacting women’s quality of life. Given the cultural similarities as well as the differences in socioeconomic status and maternal healthcare policies between China and Japan, it is crucial to explore the burden of PCOS in these two countries. A previous study has highlighted a positive correlation between the burden of PCOS and the Socio-demographic Index (SDI) at the national level [15]; however, no study has specifically focused on PCOS trends specifically in China and Japan.

Therefore, this study conducted an analysis of the prevalence rates and trends of PCOS in China and Japan, utilizing the latest data from the Global Burden of Diseases Study 2021 database. Additionally, we compared these trends with averages from Asia and globally, and projected the prevalence of PCOS in these regions until 2036. These insights aimed to inform policy and resource allocation decisions to improve women’s health.

Methods

Data sources

The Global Burden of Diseases, Injuries, and Risk Factors Study 2021 dataset provides the estimates of epidemiological data regarding the burden of 317 diseases and injuries across 21 GBD regions and 204 countries and territories from 1990 to 2021. The data is publicly accessible through the Global Health Data Exchange (https://ghdx.healthdata.org/gbd-2021) [17]. In the GBD database, PCOS is defined according to NIH criteria, which includes chronic anovulation and hyperandrogenism in women in whom secondary causes have been excluded (https://www.healthdata.org/research-analysis/diseases-injuries-risks/factsheets/2021-polycystic-ovarian-syndrome-level-4) [18]. PCOS related data collection, disease models are displayed in the GBD 2021 methods appendix (https://ghdx.healthdata.org/gbd-2021/code/nonfatal-13) [19]. In this study, we extracted rats on the prevalence of PCOS in China, Japan, Asia and Global within the age range of 10–15 years from the GBD 2021 through the GBD Results Tool (https://vizhub.healthdata.org/gbd-results/) [20].

Statistical analysis

Joinpoint regression analysis

Joinpoint regression analysis was employed to estimate the trends in the prevalence of PCOS in China, Japan, Asia, and globally from 1990 to 2021. The joinpoint regression model was used to describe changes in trend data, segmenting variations through piecewise regression [21]. There are two types of joinpoint regression models: linear (y = xb) and log-linear (lny = xb). The model calculates the annual percentage change (APC) for each period to describe the trends of independent segments and test which trends are statistically significant. Additionally, it computes the average annual percent change (AAPC) and its 95% confidence interval (CI) to summarize the average trend. We conducted the joinpoint regression analysis using Joinpoint software version 5.0.2, provided by the United States National Cancer Institute Surveillance Research Program. Statistical significance was conducted at a two tailed P < 0.05.

Age-period-cohort analysis with the intrinsic estimator method

The age-period-cohort (APC) model was utilized to analyze the contributions of age, period, and cohort effects on the prevalence of PCOS in China, Japan, Asia, and globally. The APC model is based on the Poisson distribution, which can be expressed as follows: Yi = μ + α* agei + β* periodi + γ* cohorti + ε. In this equation, Y represents the response variable, α denotes the coefficient for age, β signifies the coefficient for period, γ indicates the coefficient for period, μ is the intercept of the model, and ε is the residual of the model. The age effect reflects the impact of age on disease prevalence or mortality; the period effect indicates the changes in screening methods, medical technology, and other factors; and the cohort effect refers to the impact of risk factor exposure and lifestyle among individuals born in the same cohort. However, in this model, there exists a linear dependence among age, period, and cohort, which can be expressed as cohort = period − age [22]. To address the issue of collinearity, we employed the APC model using the intrinsic estimator (IE). And this model has been proved to be unbiased, estimable, and effective [23]. We conducted this model by Stata MP 17.

Bayesian age-period-cohort model projection

This study employed the BAPC model to predict future disease burdens. The Bayesian age-period-cohort (BAPC) model has been widely applied in epidemiological research, particularly in investigations that incorporate age-structured population data and intricate cohort effects [24]. In this study, we utilized the “BAPC” R package to forecast the PCOS burden of China, Japan, Asia and Global until 2036. We conducted this model by R 4.4.0.

Results

Trends in the burden of PCOS in China, Japan, Asia and globally, 1990–2021

Table 1 shows that the prevalence and DALYs of PCOS in China, Japan, Asia and globally from 1990 to 2021. The trends in the prevalence of PCOS for these regions are illustrated in Fig. 1. In 2021, the age-standardized prevalence rate (ASPR) of PCOS in China was 832.95/100000 (95% CI: 590.98/100000, 1169.17/100000), which was lower than that of Japan. However, due to China’s large population, in 2021, there were 533.533*104 (95% CI: 376.054*104, 750.101*104) cases of PCOS in China, accounting for 28.69% of all cases in Asia and 14.56% globally. Notably, although Japan’s ASPR was significantly higher than China’s, it exhibited an overall fluctuating upward trend, while China’s prevalence continues to rise at a faster rate.

Table 1.

The ASPR of PCOS in China, Japan, Asia, and globally from 1990 to 2021

Location Prevalence
1990 2021 1990–2021 AAPC (95% CI)
Prevalence cases, number * 104 (95% UI) ASPR per 100,000 (95% UI) Prevalence cases, number * 104 (95% UI) ASPR per 100,000 (95% UI)
China 533.533 (376.054, 750.101) 832.95 (590.98, 1169.17) 1007.752 (712.001, 1424.928) 1544.17 (1081.83, 2169.82) 2.01* (1.99, 2.03)
Japan 384.522 (274.965, 534.189) 5930.96 (4259.12, 8254.48) 323.464 (231.071, 454.064) 6334.11 (4579.73, 8798.66) 0.21* (0.20, 0.22)
Asia 1859.884 (1340.378, 2574.842) 1165.42 (842.34, 1611.93) 4059.162 (2892.441, 5683.343) 1734.06 (1231.69, 2422.25) 1.30* (1.28, 1.31)
Global 3665.116 (2622.794, 5060.393) 1372.77 (984.64, 1891.60) 6947.325 (4953.142, 9572.448) 1757.83 (1253.36, 2421.26) 0.81* (0.80, 0.82)
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ASPR age-standardized prevalence rate, AAPC average annual percentage change, UI uncertain interval, CI confidence interval

*indicates that the AAPC is significantly different from zero at the alpha = 0.05 level

Fig. 1.

Fig. 1

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Trends in ASPR of PCOS in China, Japan, Asia, and globally from 1990 to 2021. ASPR, age‐standardized incidence rate

Joinpoint regression analysis

By joinpoint regression analysis, we calculated the AAPC in the prevalence of PCOS in China, Japan, Asia and globally from 1990 to 2021 (Table 1). The ASPR of PCOS in China increased from 1990 to 2021, with an AAPC of 2.01 (95% CI: 1.99, 2.03), which was significantly higher than that of Japan (0.21; 95% CI: 0.20, 0.22), Asia (1.30; 95% CI: 1.28, 1.31) and the global average (0.81; 95% CI: 0.80, 0.82). Notably, during the period from 1990 to 2021, the ASPR of PCOS in Japan consistently ranked second in the world; however, the ASPR in China was increasing at a faster rate than that of Japan.

Besides, the joinpoint models were applied to segment the temporal trends of PCOS prevalence and DALYs into distinct time periods and to estimate the APCs of each period (Fig. 2). In China, the ASPR of PCOS varied across seven periods, with an APC of 1.04 in the most recent period from 2019 to 2021 (P > 0.05). In contrast, Japan experienced an APC of −0.23 during the same period (P > 0.05). Furthermore, Japan’s ASPR exhibited two distinct inflection points in 2005 and 2019. Overall, China’s ASPR has shown a more significant increase in recent years, while Japan’s has begun to decline.

Fig. 2.

Fig. 2

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Joinpoint regression analysis of the ASPR for PCOS in China, Japan, Asia, and globally

APC-IE analysis

The relative risks (RRs) of age, period, and cohort effects on the prevalence of PCOS in China, Japan, Asia and globally were presented in Fig. 3 and Table 2. After controlling for period and cohort factors, age was found to be significantly associated with PCOS prevalence across all regions. As age increased, the RRs in the four regions exhibited a similar pattern: initially rising rapidly, then gradually declining, and finally dropping sharply. Women aged 20–24 demonstrated a peak risk of PCOS in China (RR = 1.591) and Japan (RR = 1.64), while Japan showed a slight increase in the 35–39 age group (RR = 1.583), in contrast to a continuous decline in China beyond the 25–29 age range.

Fig. 3.

Fig. 3

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Relative risk of PCOS prevalence by age, period and cohort effects

Table 2.

RR of PCOS prevalence in China, Japan, Asia, and globally by age, period, and cohort

Group RR (95% CI)
Duration China Japan Asia Global
Age 10–14 0.259 (0.259, 0.26) 0.244 (0.243, 0.244) 0.248 (0.248, 0.249) 0.27 (0.269, 0.27)
Age 15–19 1.199 (1.197, 1.2) 1.152 (1.150, 1.153) 1.132 (1.132, 1.133) 1.133 (1.133, 1.134)
Age 20–24 1.591 (1.59, 1.592) 1.64 (1.638, 1.642) 1.545 (1.544, 1.546) 1.519 (1.519, 1.519)
Age 25–29 1.591 (1.59, 1.592) 1.614 (1.612, 1.616) 1.567 (1.567, 1.568) 1.546 (1.546, 1.546)
Age 30–34 1.556 (1.555, 1.558) 1.575 (1.573, 1.577) 1.558 (1.558, 1.559) 1.542 (1.541, 1.542)
Age 35–39 1.51 (1.509, 1.512) 1.583 (1.581, 1.584) 1.544 (1.544, 1.545) 1.531 (1.53, 1.531)
Age 40–44 1.458 (1.457, 1.459) 1.519 (1.517, 1.521) 1.514 (1.513, 1.514) 1.498 (1.498, 1.499)
Age 45–49 1.265 (1.264, 1.267) 1.217 (1.215, 1.218) 1.286 (1.285, 1.287) 1.26 (1.259, 1.26)
Age 50–55 0.293 (0.293, 0.293) 0.292 (0.292, 0.293) 0.313 (0.313, 0.314) 0.313 (0.313, 0.313)
Period 1992–1996 0.701 (0.701, 0.702) 0.906 (0.905, 0.907) 0.78 (0.779, 0.78) 0.856 (0.855, 0.856)
Period 1997–2001 0.861 (0.86, 0.861) 0.943 (0.942, 0.944) 0.873 (0.873, 0.874) 0.927 (0.927, 0.927)
Period 2002–2006 1.004 (1.003, 1.004) 1.003 (1.002, 1.004) 0.972 (0.971, 0.972) 0.985 (0.985, 0.985)
Period 2007–2011 1.091 (1.09, 1.092) 1.026 (1.025, 1.027) 1.068 (1.067, 1.068) 1.025 (1.025, 1.026)
Period 2012–2016 1.19 (1.19, 1.191) 1.047 (1.046, 1.048) 1.163 (1.163, 1.164) 1.09 (1.09, 1.09)
Period 2017–2021 1.271 (1.27, 1.272) 1.085 (1.084, 1.086) 1.217 (1.216, 1.217) 1.145 (1.145, 1.145)
Cohort 1942–1946 1.172 (1.166, 1.178) 1.208 (1.202, 1.214) 1.254 (1.25, 1.257) 1.222 (1.219, 1.224)
Cohort 1947–1951 1.131 (1.128, 1.134) 1.162 (1.159, 1.165) 1.2 (1.198, 1.201) 1.196 (1.195, 1.197)
Cohort 1952–1956 1.106 (1.104, 1.108) 1.139 (1.136, 1.141) 1.117 (1.116, 1.118) 1.115 (1.114, 1.116)
Cohort 1957–1961 1.079 (1.077, 1.08) 1.111 (1.109, 1.113) 1.06 (1.059, 1.061) 1.074 (1.074, 1.075)
Cohort 1962–1966 1.039 (1.037, 1.04) 1.074 (1.072, 1.076) 1.015 (1.015, 1.016) 1.045 (1.045, 1.046)
Cohort 1967–1971 0.992 (0.991, 0.993) 1.038 (1.037, 1.04) 0.976 (0.976, 0.977) 1.012 (1.011, 1.012)
Cohort 1972–1976 0.971 (0.97, 0.972) 1.012 (1.011, 1.014) 0.975 (0.975, 0.976) 0.995 (0.995, 0.996)
Cohort 1977–1981 0.962 (0.961, 0.963) 0.992 (0.991, 0.994) 0.968 (0.967, 0.968) 0.973 (0.972, 0.973)
Cohort 1982–1986 0.965 (0.964, 0.966) 0.971 (0.969, 0.973) 0.953 (0.953, 0.953) 0.951 (0.95, 0.951)
Cohort 1987–1991 0.95 (0.949, 0.95) 0.945 (0.944, 0.947) 0.925 (0.925, 0.926) 0.925 (0.925, 0.926)
Cohort 1992–1996 0.928 (0.927, 0.929) 0.914 (0.912, 0.915) 0.91 (0.909, 0.91) 0.916 (0.916, 0.916)
Cohort 1997–2001 0.912 (0.911, 0.913) 0.882 (0.879, 0.884) 0.903 (0.903, 0.904) 0.903 (0.902, 0.903)
Cohort 2002–2006 0.905 (0.904, 0.907) 0.849 (0.846, 0.851) 0.903 (0.902, 0.904) 0.886 (0.885, 0.886)
Cohort 2007–2011 0.935 (0.931, 0.94) 0.801 (0.794, 0.808) 0.918 (0.916, 0.92) 0.867 (0.865, 0.868)
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After controlling for age and cohort effects, the period effect of PCOS showed a consistent upward trend in China, Japan, Asia, and globally. Notably, China experienced the most substantial increase from 1992–1996 (RR = 0.701; 95% CI: 0.701, 0.702) to 2017–2021 (RR = 1.271; 95% CI: 1.27, 1.272). Between 1992 and 2001, the RR values for all regions remained below 1, with China’s being the lowest. However, since 2002, China has exhibited a higher RR than the other three regions.

The cohort effect of PCOS demonstrated a declining trend across regions. However, the cohort effect RR among individuals born in China between 2007 and 2011 (0.935 (95% CI: 0.931, 0.94)) was higher than that of those born between 2002 and 2006 (0.905 (95% CI: 0.904, 0.907)), with a similar trend of Asian. After the cohort between 1987 and 1991, the RR in China was found to be higher than that in Japan.

Predicted trends of PCOS prevalence in 2022–2036 by BAPC

The BAPC model forecasts a continued rapid increase in the ASPR of PCOS in China (Fig. 4), while the ASPR in Japan exhibits a declining trend. By 2036, the ASPR of PCOS in China is projected to increase by 27% from 2021, reaching 1961.45/100,000 (Table 3), thereby maintaining its rapid upward trajectory. In contrast, Japan is expected to experience a 6.4% decline over the next few decades, stabilizing at approximately 5931.58/100000 by 2036.

Fig. 4.

Fig. 4

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Prediction of PCOS prevalence in China, Japan over 15 years (2022–2036). The solid lines represent the true trend of ASPR of PCOS during 1992–2021; the dashed lines represent the predicted trend of ASPR of PCOS; the gray dot vertical line split data into true trend (1992–2021) and predicted trend (2022–2036)

Table 3.

Prediction of PCOS prevalence in China, Japan over 15 years (2022–2036)

Year ASPR, per 100,000
China Japan
2022 1572.34 6318.75
2023 1595.40 6299.90
2024 1618.15 6279.42
2025 1640.94 6257.29
2026 1665.27 6234.04
2027 1692.25 6210.04
2028 1719.22 6184.73
2029 1745.67 6157.54
2030 1772.44 6128.42
2031 1801.11 6098.06
2032 1832.94 6067.01
2033 1864.42 6035.03
2034 1895.53 6001.70
2035 1927.38 5967.02
2036 1961.45 5931.58
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Discussion

This study presented the secular trends in the prevalence of PCOS in China, Japan, Asia, and globally from 1990 to 2021, based on the GBD 2021 database. Using the APC-IE model, we compared the age, period, and cohort differences among these four regions. Additionally, we predicted the ASPR of PCOS for the years 2022–2036 in China and Japan. This study aims to provide a theoretical foundation for policymakers in women’s health and serve as a reference for research related to PCOS.

Faster increase of PCOS prevalence in China compared to Japan

In the past 30 years, China’s ASPR of PCOS has risen at a significantly faster pace than that of Japan, Asia, and the global average. While Japan shows a relatively slow and stable trend, China’s rapid increase signals an escalating public health challenge. This trend may be attributable to multiple factors.

First, the Socio-demographic Index (SDI) serves as a comprehensive measure of the development status of a country or region. It is calculated based on a combination of indicators, including per capita income, average education level, and fertility rates. The Global Burden of Disease Study 2021 indicates a continuous upward trend in China’s SDI values from 1990 to 2021, which parallels the trend in the ASPR of PCOS. A previous study also reached a similar conclusion, finding positive associations between the burden of PCOS and the SDI at the national levels [15]. Furthermore, with urbanization and increasing GDP, lifestyle behaviors associated with PCOS risk, such as reduced physical activity, higher caloric intake, and increased stress, have become more prominent in China. In contrast, Japan’s relatively stable GDP and aging population have mitigated similar effects. Additionally, the widespread adoption of diagnostic criteria [25] and broader screening coverage [26] in recent China have contributed to the increased detection of PCOS cases, while Japan’s long-established healthcare systems, characterized by effective diagnostic and reporting practices, has shown stable trends.

Higher PCOS risk in younger cohorts in China

China’s cohort effects demonstrate a downward trend followed by an upward trend, with the inflection point occurring between 2002 and 2006, indicating that the younger generations have a significantly higher PCOS risk compared to earlier generations, while younger cohorts in Japan show a declining risk. Exposure to stressful events during adolescence can lead to chronic mental disorders and exacerbate stress-related hormonal imbalances, ultimately resulting in the development of PCOS [27]. A meta-analysis study has indicated that since the early 1990s, the mental health of Chinese adolescents has deteriorated across birth cohorts [28]. Additionally, a study found an association between the melatonin receptor (MTNR) gene and susceptibility to PCOS in the Han Chinese population [29]. In general, the increase in mental disorders may contribute to the rising prevalence of PCOS.

The rapid rise in obesity rates of China, driven by the widespread adoption of high-fat and high-sugar diets [30], is closely linked to PCOS [31]. Obesity increases insulin resistance and testosterone production through circulating androstenedione, while suppressing gonadotropin secretion, thereby increasing the risk of developing PCOS [32]. Additionally, the increased consumption of various food components may contribute to a higher prevalence of polycystic ovaries. Whey protein, an estrogenic endocrine disruptor found in many sports nutrition supplements [33], can also play a role in this context. Conversely, a diet rich in phytochemicals can enhance a woman’s hormonal balance and metabolic health, ultimately mitigating the negative consequences of PCOS [34]. In China, between 2000 and 2020, the intake of plant-based foods decreased significantly by 12%, while the intake of animal-based foods increased by 68% [35]. These changes in dietary patterns may be associated with the rising prevalence of polycystic ovaries.

Lastly, the occurrence of ovulatory dysfunction in individuals with PCOS has been associated with exposure to environmental pollutants. A study has indicated that the use of plastic cutlery and certain interior decorations is associated with ovulatory dysfunction in individuals with PCOS [36]. Bisphenol A has been positively correlated with endocrine disruption in PCOS [37] and a meta-analysis has demonstrated an association between the persistent organic pollutants (POPs) and PCOS. With the rapid economic development and urbanization in China, the issue of POP pollution is becoming increasingly severe [38]. These factors may contribute to the rising prevalence of PCOS among the younger generation in China.

Peak age for PCOS is 20–24 years both in China and Japan, while a secondary peak at 35 years in Japan

By conducting an APC analysis using the IE method, we found that age was significantly associated with the prevalence of PCOS. Both China and Japan exhibited the highest prevalence of PCOS in the 20–24 age group. Previous studies supported this conclusion, indicating that women in China aged 20–24 are at the highest risk for PCOS [16]. In contrast, in Europe, women aged 35–39 years showed the highest prevalence rates for PCOS [39]. Additionally, in Japan, a slight increase in RR was observed within the 35–39 age group. This secondary peak in Japan may be linked to delayed childbearing [40], as the average age of first childbirth for Japanese women has risen from 27.16 years in 1990 to 30.6 years in 2022 [41]. The trend of delayed childbearing trends in Japan may increase metabolic stress and exacerbate PCOS symptoms in older reproductive-age women. Furthermore, the variations in the age of sexual maturity among women across different regions and ethnic groups [42], which may result in differences in hormone levels, could be an another contributing factor to the age disparities in the onset of PCOS.

Health promotion advices and policy recommendations

To reduce the incidence of PCOS and to alleviate its associated adverse effects, it is essential to adopt a comprehensive approach that involves individuals, healthcare providers, and governmental entities. At the individual level, “2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome”[43] mentions that fundamental and essential strategies for the prevention and management of PCOS include adopting a healthy lifestyle. This encompasses maintaining a balanced diet, engaging in regular moderate exercise, minimizing mental stress, quitting smoking, and restricting alcohol consumption. Furthermore, it is imperative to undergo regular medical check-ups for the early detection of symptoms associated with PCOS, which facilitates timely intervention.

At the hospital level, a survey estimated that up to 75% of patients with PCOS remain undiagnosed in clinical practice [44]. In regions where the availability of reproductive endocrinologists is inadequate, there is an urgent need to strengthen the continuing education of obstetricians and gynecologists regarding the diagnosis and treatment of PCOS to improve the quality of medical services for these patients. Currently, there is a lack of comprehensive treatment options for PCOS, with the primary approach being symptom-oriented [45]. Therefore, it is essential for healthcare providers to offer individualized treatment plans to alleviate symptoms effectively.

Policy support at the national level is also of significant importance. “Chinese guideline for diagnosis and management of polycystic ovary syndrome” [46] incorporates TCM treatment protocols and integrates them with existing diagnostic and therapeutic guidelines from abroad. Furthermore, in order to reduce the incidence of complications, comorbidities, and adverse pregnancy outcomes in patients with PCOS during pregnancy, and to ensure the safety of both mothers and infants, China has implemented a guidebook: “Chinese expert consensus on the management of patients with polycystic ovary syndrome before and during pregnancy and after delivery” [47].

Research limitations and future directions

This study had several limitations. Firstly, estimates of the disease burden are based on the DisModMR model rather than actual data. In some countries with suboptimal health conditions, the rate of disease diagnosis is low, which consequently underestimated the prevalence of PCOS. Additionally, GBD only used the National Institutes of Health (NIH) criteria to define the PCOS. However, there are two other diagnostic criteria for PCOS: the Rotterdam criteria and the Androgen Excess and PCOS (AE-PCOS) Society criteria. Differences in diagnostic criteria across studies or regions can affect the accuracy of prevalence estimates. Furthermore, these diagnostic criteria for PCOS focus on a woman’s prolonged anovulation and hyperandrogenism, which may not be applicable to all populations. Finally, there is a deficiency of data at the risk factor level within the GBD. However, PCOS is associated with a range of influencing factors. Consequently, this study could not rely on the GBD database to elucidate the factors influencing PCOS.

Conclusion

This study analyzed the temporal trends in the prevalence of PCOS in China, Japan, Asia and globally from 1990 to 2021. The prevalence of the PCOS in China has increased significantly over the past three decades, at a much faster rate than in Japan, Asia and the world. Furthermore, the prevalence among the birth cohort from 2007 to 2011 is higher than that of previous birth cohorts. The BAPC model predicted that the ASPR of PCOS in China will continue to increase rapidly over the next 12 years, while it was expected to decline in Japan. These findings indicated a notable increase in the prevalence of PCOS in China, which has significant implications for women’s health. Therefore, it is essential to raise awareness and concern regarding this condition. A series of measures need to be implemented, such as educational initiatives for women, improving diagnosis and treatment rates for PCOS, standardizing diagnostic and therapeutic practices, and encouraging healthy lifestyle choices.

Author contributions

CW: Proposed research ideas, data processing and analysis, manuscript writing. AM: Guidance on the paper’s ideas, discussion and refinement. YY: Guidance on the paper’s ideas and paper polishing. YZ: Substantial revisions to the paper. QW: Paper polishing and formatting revisions. NZ: Paper polishing and formatting revisions Corresponding Author: Conceptualization, supervision, reviewing, and editing of the paper.

Funding

Not applicable.

Data availability

No datasets were generated or analysed during the current study. Data will be made available on this website: (https://ghdx.healthdata.org/gbd-2021).

Declarations

Conflict of interest

The authors declare no competing interests.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

No datasets were generated or analysed during the current study. Data will be made available on this website: (https://ghdx.healthdata.org/gbd-2021).

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