(C-064) Trends in Polycystic Ovary Syndrome and Its Associated Pharmacological Treatments in the United Kingdom from 1998 to 2023

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among females of reproductive age worldwide; however, there are significant knowledge gaps regarding its incidence and pharmacological treatment. No drugs are currently approved specifically for the management of PCOS, but several are used off-label.

Objectives: To describe the incidence of PCOS and to identify the prevalence and treatment sequences of drugs used to manage the disorder.

Methods: We used primary care data from the United Kingdom Clinical Practice Research Datalink (CPRD) to assemble a cohort of patients aged 15 years and older who received a first diagnosis of PCOS between January 1998 and December 2023. We calculated the incidence rate of PCOS in each year of the study period and by age group with 95% confidence intervals (CIs) based on the Poisson distribution. We identified prescriptions for hormonal contraceptives, metformin, ovulation inducers (clomiphene, tamoxifen, and aromatase inhibitors), and anti-androgens (spironolactone and other anti-androgens) and calculated the proportion of patients using each drug over the study period and categorized treatment sequences for each of these drugs.

Results: We identified 182,835 females aged 15 years and older who were diagnosed with PCOS between 1998 and 2023. The incidence rate of PCOS diagnoses was 1.08 (95% CI 1.08–1.09) per 1,000 person-years over the entire study period, with a steady increase from 0.34 (95% CI 0.32–0.36) per 1,000 person-years in 1998 to 1.74 (95% CI 1.71–1.77) per 1,000 person-years in 2023, and with a pronounced dip in 2020. The rate of PCOS diagnosis was highest in females aged 20–34 (IR 3.52 [95% CI 3.50–3.54] per 1,000 person-years), followed by females aged 15–19 years (IR 2.77 [95% CI 2.74–2.80] per 1,000 person-years). The median age at diagnosis was 26 years (Q1–Q3: 22–31 years). Use of hormonal contraceptives and metformin was most common, with 49.9% and 22.8% of patients receiving at least one prescription for these drugs over the study period, respectively. Use of other medications was less common, with 3.8% of patients ever receiving a prescription for an ovulation inducer and 2.8% ever receiving a prescription for an anti-androgen. The most common treatment patterns were use of hormonal contraceptives only (36.0%), metformin only (9.4%), metformin followed by contraceptives (5.1%), and contraceptives followed by use of metformin (3.9%), with all other treatment patterns having a prevalence of less than 1%.

Conclusions: The incidence of PCOS diagnoses greatly increased from 1998 to 2023, with the highest rates of diagnoses in females aged 20–34. Pharmacological treatment remains limited to primarily metformin and hormonal contraceptives.