Body image perception and self-esteem in females with polycystic ovary syndrome: a systematic review and meta-analysis

Background Polycystic ovary syndrome (PCOS) is a complex endocrine disorder associated with metabolic, reproductive, and psychosocial complications and affects 10% women of reproductive age worldwide. Evidence regarding its psychological impact, particularly body image perception and self-esteem, remains limited. This meta-analysis aimed to quantitatively evaluate differences in body image perception and self-esteem in women with PCOS and controls. Methods A systematic search of PubMed, Web of Science, Cochrane Library, and Google Scholar was conducted from inception to December 30, 2025. Search terms included combinations of “PCOS” OR “polycystic ovary syndrome” AND “body image” OR “body perception” OR “self-esteem.” Observational studies assessing body image perception or self-esteem in women with PCOS compared with controls were eligible. Study selection and screening were performed according to predefined criteria. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated using meta-analytic models. Results We identified 804 records, 31 full-text articles were screened, and 18 studies were included in the meta-analysis. Women with PCOS showed poorer body image perception compared with controls (MD = −0.94, 95% CI, −1.69 to −0.18, p = 0.02). In contrast, pooled analysis showed no statistically significant difference in self-esteem between women with PCOS and controls (MD = −0.50, 95% CI −1.29 to 0.29, p = 0.22). Conclusion Women with PCOS experience poorer body image perception than healthy controls, with no difference in self-esteem. Integrating psychological assessment into PCOS care, and targeted interventions addressing body image concerns may be beneficial. Further large-scale studies across diverse populations using standardized assessment tools are warranted.