Global, regional, and national burden of polycystic ovary syndrome in women of reproductive age: an analysis of the global burden of disease study 2021 and forecast to 2050

Polycystic ovary syndrome (PCOS) affects 5–20% of women worldwide. This study assessed global, regional, and national PCOS-related burdens. Global Burden of Disease Study 2021 1990–2021 data on women aged 15–49 years across 204 countries/territories were analysed. We estimated PCOS cases, disability-adjusted life years (DALYs), and rates per 100,000, using age- and socio-demographic index (SDI)-stratified analyses. Health inequality was assessed using slope index of inequality and concentration index. Frontier and decomposition analyses evaluated efficiency and drivers of change; Bayesian age–period–cohort (BAPC) modelling projected future trends. In 2021, global PCOS incidence, prevalence, and DALY rates were 60.30, 3,374.68, and 29.56 per 100,000, respectively. From 1990 to 2021, new cases, total cases, and DALYs increased by 49.32, 88.95, and 87.06%, respectively. Middle-SDI regions had the highest burden in 2021; burden correlated with SDI. The 20–39-year age group contributed most DALYs. Despite slight declines in incidence-related inequality, disparities in prevalence, DALYs, and efficiency gaps widened, particularly in high-SDI groups. Population growth and epidemiological shifts in middle- and high-middle-SDI regions were key drivers. BAPC projections suggested continued increases. With increasing global PCOS burden, we emphasise the urgent need for equitable prevention, early screening, and region-specific management strategies, alongside proactive policy planning to address future challenges.