Presentation (CTI)

OBJECTIVES: PCOS, a common endocrine disorder, impacts roughly 5-6 million women in the US. Historically thought of as a single condition, recent evidence suggests multiple PCOS phenotypes with distinct etiologies. This study describes women with a PCOS diagnosis in a large US real-world database in terms of related diagnoses and clinical markers to understand potentially different phenotypes.
METHODS: Females (≥12 years old) with ≥1 of the following criteria between 01/01/2020-04/30/2025 were selected from the Veradigm Network EHR linked to claims: ≥1 claim/EHR record with ICD-10-DX for PCOS (E282) or ≥1 claim/EHR record for PCOS composite criteria of oligomenorrhea (N91.5), hirsutism (L68.0), and/or hyperandrogenism (E28.1) (earliest diagnosis=index). Continuous claims enrollment for 12 months pre- and post-index was required. Demographics and BMI were described as of the index while related diagnoses, laboratory tests, and select medications were evaluated anytime in the patient’s history and during the baseline and follow-up periods.
RESULTS: Of the 261,366 females included, mean (SD) age was 32.7(12.5), 47.2% were White, and mean (SD) BMI was 30.7(7.0). The index diagnosis was primarily based on PCOS (64.2%) and hyperandrogenism (29.8%), while fewer patients had hirsutism (16.7%) or oligomenorrhea (4.7%) (not mutually exclusive). Among diagnoses captured in full history, ‘other irregular menstruation’ was most common (47.1%), followed by type 2 diabetes (13.8%). Infertility was observed in ~6% of patients, primarily due to ‘female infertility, unspecified.’ Approximately 21% were treated with spironolactone and 14% with metformin. With the exception of TSH, <10% of females had evidence of laboratory testing for testosterone, SHBG, LH, prolactin, T3, T4, and FSH.
CONCLUSIONS: Most patients were identified as having PCOS via E282 vs composite criteria. The low prevalence of relevant testing to identify excess androgen production, monitor ovulation, or rule out similar conditions suggests most with PCOS are assessed via a ‘one size fits all’ approach not considering distinct phenotypes.