The Impact of Obesity, Smoking, Family History, and Hirsutism on Polycystic Ovarian Syndrome (PCOS) in Women of Reproductive Age: A Meta-Analysis

Abstract

Polycystic ovarian syndrome (PCOS) is one of the most prevalent endocrine disorders among women of reproductive age. According to WHO (2023), PCOS affects approximately 8–13% of women of reproductive age. Several studies have reported that lifestyle, hormonal, and genetic factors are among the risk factors for PCOS. This study aimed to analyze and estimate the impact of obesity, smoking, family history, and hirsutism on the incidence of PCOS among women of reproductive age. This meta-analysis was conducted based on the PICO model. The population was women of reproductive age. The exposures included obesity, smoking, family history, and hirsutism, with comparison groups of normal weight, non-smoking, no family history, and no hirsutism. The outcome was PCOS. The databases used were Google Scholar, PubMed, BMC, ScienceDirect, and Springer Link. The keywords used were ("determinant" OR "risk factor") AND "obesity" AND "smoking" AND "family history" AND "hirsutism" AND ("PCOS" OR "polycystic ovarian syndrome") AND "cross-sectional" AND ("multivariate" OR "odds ratio"). The inclusion criteria were full-text articles with an observational study design, reported adjusted odds ratios (aORs), and were published between 2017 and 2025. Data analysis was performed using Review Manager 5.3. This meta-analysis included 14 cross-sectional studies conducted in China, Australia, Pakistan, Saudi Arabia, India, Indonesia, the United States, Kuwait, Bangladesh, and Jordan, with a total sample size of 17,136 women of reproductive age. Obesity (aOR=2.01; 95% CI: 1.22–3.33; p<0.001), family history (aOR=3.05; 95% CI: 2.09–4.44; p<0.001), and hirsutism (aOR=2.19; 95% CI: 1.54–3.11; p<0.001) were significantly associated with an increased risk of PCOS. The association between smoking and PCOS was not statistically significant (aOR=1.10; 95% CI: 0.91–1.73; p=0.31). In conclusion, obesity, family history, and hirsutism were significantly associated with an increased risk of PCOS among women of reproductive age.