Analysis pipeline.

Analysis pipeline to calculate relative risk ratios (RR) for future health outcomes in PCOS (green) and PCOS and Pain (blue) cohorts for the 103,675,738 women queried. STEP 1 shows the number of women in the case and controls for both the PCOS (green) and PCOS and Pain (blue) cohorts. STEP 2 shows the number of cases and controls after 1:1 propensity score matching. STEP 3 shows the different future health conditions that were considered for future health outcomes. STEP 4 shows that the final step is calculating the relative risk for the future health outcomes.

Prevalence of conditions and medications associated with PCOS and Pain.

Barplots show the prevalence (%) (left y-axis) of different diseases associated with PCOS (green) and PCOS and Pain (blue) (x-axis). Purple line indicates the prevalence fold-change between the PCOS and PCOS and Pain cohorts (right y-axis).

Relative risk ratios for future health outcomes associated with PCOS and Pain.

Relative risk ratios (RR) (x-axis) for future health outcomes (y-axis) for both PCOS (green) and PCOS and Pain (blue) cohorts. Darker hued circles indicate RR, while lighter hued boxes indicate the 95% confidence intervals. The black dashed line is set 1 and is the threshold for RR, where > 1 is increased RR and < 1 is decreased RR.

Self-reported race-stratified relative risk ratios for future health outcomes (A–K).

Relative risk ratios (RR) for future health outcomes (y-axis) stratified by self-reported race. Colors represent different self-reported race groups (x-axis): Asian (orange), Black or African American (yellow), Other (red), White (purple). Error bars represent the 95% confidence intervals. Significant differences between RR are represented by asterisks (*), where p-value ≤ 0.05 = *, p-value ≤ 0.005 = **, p-value ≤ 0.0005 = ***, and p-value ≤ 0.00005 = ****. Red dashed lines is set 1 and is the threshold for RR, where > 1 is increased RR and < 1 is decreased RR.

Prevalence of Pain for women with PCOS before and after medications.

Prevalence (%) changes (y-axis) of pain for women with PCOS cohort before and after prescription of COCPs (yellow), metformin (purple), and spironolactone (orange) (x-axis). Analysis was done separately for abdominal and pelvic pain (solid lines) and dysmenorrhea (dashed lines).

Inclusion and exclusion criteria for PCOS (top) and PCOS and Pain (bottom) cases and control cohorts.

Index Events for Women in TriNetX.

Schematic representing how events were indexed in TriNetX for both the PCOS (green) and PCOS and Pain (blue) cohorts.

Analysis pipeline for self-reported race groups.

Self-reported race-stratified TriNetX relative risk ratio analysis pipeline for future health outcomes in PCOS and Pain cohorts. Colors represent different self-reported race groups: Asian (orange), Black or African American (yellow), Other (red), White (purple).

Index events for PCOS and medications.

Schematic representing how the PCOS and medication events were indexed in TriNetX for both abdominal and pelvic pain and dysmenorrhea.

Demographic results for PCOS case and control cohorts before and after 1:1 propensity score matching.

For each cohort analysis, cases were matched on the following criteria: age at the index event, self-reported race, overweight, obesity, and other hyperalimentation (ICD-10-CM E65-E69) status, type 2 diabetes mellitus (T2D) (ICD-10-CM E11) status, essential (primary) hypertension (ICD-10-CM I10) status, and hyperlipidemia, unspecified (ICD-10-CM E78.5) status. Baseline conditions were assessed up to one day before the index event.

Demographic and baseline characteristics for PCOS and Pain case and control cohorts before and after 1:1 propensity score matching.

For each cohort analysis, cases were matched on the following criteria: age at the index event, self-reported race, overweight, obesity, and other hyperalimentation (ICD-10-CM E65-E69) status, type 2 diabetes mellitus (T2D) (ICD-10-CM E11) status, essential (primary) hypertension (ICD-10-CM I10) status, and hyperlipidemia, unspecified (ICD-10-CM E78.5) status. Baseline conditions were assessed up to one day before the index event.

Age-stratified Prevalence of PCOS and PCOS and Pain.

Bar plots show the prevalence (%) of overall PCOS (green) and PCOS and Pain (blue) stratified by 10-year age groups. The total number of women with PCOS is 576,876 and the total number of women with PCOS and Pain is 171,326.

Counts and prevalence (%) of PCOS cases and controls for self-reported race groups.

Relative risk ratios (RR) for PCOS and PCOS and Pain cases and control cohorts.

Significant differences in RR between PCOS and PCOS and Pain cohorts are bolded.

Relative risk ratios (RR) for race-stratified PCOS and Pain cohorts.

Significance for relative risk ratios for each self-reported race combination.

Both P-value (P) and adjusted p-values using Benjamini-Hochberg (P(BH)) are reported. Significant differences in RR between self-reported race groups are bolded.