Reproductive & Maternal Health Resource Center

Reproductive & Maternal Health Resource Center

Issue: June 2021
Perspective from Andrea Dunaif, MD
Disclosures: The Flo medical and scientific affairs team provided a critical review and feedback on the manuscript. The authors report no relevant financial disclosures.
May 12, 2021
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Menstrual tracking app reveals clues of ‘broader’ PCOS symptoms

Issue: June 2021
Perspective from Andrea Dunaif, MD
Disclosures: The Flo medical and scientific affairs team provided a critical review and feedback on the manuscript. The authors report no relevant financial disclosures.
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An analysis of polycystic ovary syndrome symptoms using a menstrual tracking app shows common traits of the disorder may be broader than Rotterdam criteria symptoms, according to data published in Reproductive Biology and Endocrinology.

Tarun Jain

“Our findings are based on the largest known PCOS data set and indicate that PCOS phenotypes are complex and vary significantly between countries,” Tarun Jain, MD, associate professor and medical director, division of reproductive endocrinology and infertility, Northwestern University Feinberg School of Medicine, told Healio. “The most frequently reported symptoms — bloating, facial hirsutism, irregular cycles, hyperpigmentation and baldness — are broader than those included in the present criteria to diagnose PCOS. Bloating was the most frequently reported symptom and appeared to be the main predictor of PCOS in our model.”

Bloating, high glucose, and high cholesterol plus high glucose are three of the top predictors for PCOS. Data were derived from Jain T, et al. Reprod Biol Endocrinol. 2021;doi:10.1186/s12958-021-00719-y.

Flo is a widely used female health and well-being app with period tracking functionality that provides a globally representative and medically unbiased perspective on PCOS symptomatology, the researchers wrote. As Healio previously reported, such apps are part of a growing effort to provide women with digital tools to better track menses and reproductive health concerns, and hundreds of apps are now available to track cycle length.

For this study, a chatbot dialogue on PCOS was administered on the Flo app to users from 142 countries with at least 100 respondents who have the app running in English during September and October 2019. The dialogue included 18 questions related to reproductive and general health. Researchers then selected the five countries with the greatest number of respondents: the U.S. (n = 243,238), the United Kingdom (n = 68,325), India (n = 40,092), the Philippines (n = 35,131) and Australia (n = 29,926).

PCOS diagnosis status was determined based on user response to the question, “Have you been checked by a doctor for PCOS recently?” Users who replied “no” were excluded from the analysis. Across the five countries, 14.4% self-reported a PCOS diagnosis (n = 59,871), 8.1% self-reported a negative PCOS status (n = 33,824) and 77.5% had not been recently checked by a physician (n = 323,017). The mean age of women was 27 years.

In four of the top five countries, the most frequently reported symptom among women with a PCOS diagnosis was bloating, observed in 73.8% of U.S. women, 78.6% of U.K. women, 80.4% of women in Australia, and 75.4% of women in the Philippines. Bloating was also a main predictor of PCOS in the researchers’ model, with an OR of 3.76 (95% CI, 3.6-3.94). Additional top predictors of PCOS were high glucose level, with an OR of 2.88 (95% CI, 2.67-3.12); and high blood cholesterol and glucose levels, with an OR of 3.56 (95% CI, 3.26-3.88). Other frequently reported symptoms among all women with a PCOS diagnosis were facial hirsutism (65.47%) and irregular cycles (68.14%), as well as hyperpigmentation among women living in the Philippines (68.46%) and India (66.53%).

Additionally, as BMI increased, the percentage of women who reported a physician-confirmed PCOS diagnosis also increased; however, women in India did not follow this trend.

“The clinical presentation and diagnosis of PCOS may not be straightforward, given the significant variability in its symptoms among women from different parts of the world,” Jain told Healio. “Future work should reevaluate and consider refining the criteria used in diagnosing and caring for the many women with PCOS around the world.”

For more information:

Tarun Jain, MD, can be reached at tarun.jain@nm.org; Twitter: @TarunJainMd.