Menstrual tracking app reveals clues of ‘broader’ PCOS symptoms
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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.
“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.”
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.
Perspective
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We are beginning to get a wealth of information about reproductive health from the widespread adoption of menstrual cycle tracking apps, including a recent analysis published in NPJ Digital Medicine (Bull JR, et al. NPJ Digit Med. 2020; doi:10.1038/s41746-019-0152-7). The article is interesting because the massive sample size likely makes the findings of self-reported PCOS fairly robust. The presence of hirsutism and irregular cycles among those women reporting PCOS supports the accuracy of the diagnosis. Therefore, the finding of bloating as the most prevalent symptom of PCOS is intriguing.
It is unfortunate that there is not more information on what is meant by this symptom. Does it signify the presence of fluid retention? Menstrual cycle bloating usually implies progesterone-mediated fluid retention and is considered as a moliminal symptom related to ovulation.
The next step in better understanding bloating as a symptom of PCOS would be to contact a sample of women for interviews or at least to add questions further probing what is meant by bloating. Otherwise, the findings are consistent with what is known about PCOS symptomatology and racial/ethnic variations in these symptoms. Therefore, the findings support the use of this app for identifying women with PCOS, which could be a boon for recruitment and monitoring of women for PCOS-related research studies.
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