PCOS prevalence swings with the diagnostic tool

Polycystic ovary syndrome — described here as polyendocrine metabolic ovarian syndrome — is the most common hormonal disorder in women of reproductive age, and it is linked to infertility as well as long-term metabolic and psychological problems. In the Gulf Cooperation Council region, the authors note that rising obesity, dietary change and sedentary lifestyles may be pushing that burden higher. Yet published prevalence figures for the region vary wildly, and the researchers suspected the variation reflected differences in diagnostic criteria and measurement rather than genuine differences in how many women are affected. The question they set out to answer was therefore twofold: what is the best pooled estimate, and what actually drives the disagreement between studies.

The team ran a systematic review and meta-analysis following PRISMA 2020, searching PubMed, Scopus, Web of Science, the Cochrane Library and Embase plus Google Scholar for observational studies published up to 1 June 2026. Eligible studies reported prevalence and related clinical features among women of reproductive age living in GCC countries. After duplicate removal, 570 records were screened, 25 studies met the inclusion criteria and 24 entered the quantitative analysis once one high-risk study was excluded. Risk of bias used the Joanna Briggs Institute checklist for prevalence studies, and pooling used a random-effects DerSimonian-Laird model with a Freeman-Tukey double arcsine transformation. Subgroup analyses and meta-regression examined country, diagnostic method, setting and publication period.

Across 24 studies covering 77,890 women, pooled prevalence was 17.59% with a 95% confidence interval of 12.98-23.40%. Country estimates ranged from 6.56% in Oman to 23.0% in Saudi Arabia, and heterogeneity was extreme throughout at I2 = 99.6%. Meta-regression singled out the diagnostic tool as the most important source of variation, explaining 42.7% of between-study variance: studies using structured Rotterdam or NIH criteria clustered around 13-14%, whereas those relying on self-report or physician diagnosis without standardised criteria reported 20-37%. Reported clinical features included menstrual irregularity in up to 100% of cases in clinical cohorts, hirsutism in 5-100%, acne and oily skin in 17-74% and obesity in 17-73%. Awareness of the condition among women ranged from under 3% to nearly 100%.

The headline pooled figure confirms that PCOS is common in this region, but the more useful result complicates every prevalence number that has been quoted before it: how the condition was ascertained accounts for a large share of the apparent differences between studies. That is a measurement problem, not a biology problem, and it means cross-country comparisons based on mixed methods are hard to trust. The design also cannot say whether prevalence is rising alongside obesity and sedentary living, only that both are high in the same populations. Open questions include how much of the residual heterogeneity comes from sampling and setting, and what standardised screening would show if applied consistently across GCC countries.

If you have seen very different prevalence figures for PCOS quoted in headlines, this analysis is a reason to think much of that spread comes from the definition being used rather than from real differences between groups of women. It also underlines how variable the clinical picture is: menstrual irregularity, excess hair growth, acne and obesity were reported across enormously wide ranges in the included studies. The very wide gap in awareness, from under 3% to nearly 100%, suggests recognition of the condition is patchy rather than uniform. None of this speaks to individual diagnosis or management, which remains a clinical matter, and the figures here describe women in Gulf countries specifically.