Obesity and dysglycemia independently predict symptom burden but not satisfaction with care in polycystic ovary syndrome: a cross-sectional study.

Purpose Polycystic ovary syndrome (PCOS) is associated with a broad range of reproductive, metabolic, and psychosocial symptoms. This study aimed to evaluate whether body mass index (BMI) and dysglycemia independently predict symptom burden and to explore how these factors relate to patient-perceived care gaps, as reflected by satisfaction with counselling. Methods We conducted a cross-sectional analysis of 1,926 self-identified women with PCOS. Participants reported symptom prevalence and rated satisfaction with counselling across six clinical domains using a 0-100 scale. Logistic regression models assessed associations between BMI, dysglycemia (prediabetes, gestational diabetes, type 2 diabetes), and PCOS symptoms. Multivariate linear regression was used to identify predictors of satisfaction with counselling. Results The most frequently reported symptoms were body image dissatisfaction (78.2%), hirsutism (75.0%), and menstrual irregularity (65.0%). Both higher BMI and dysglycemia were independently associated with increased odds of infertility (BMI: OR 1.48, 95% CI 1.38-1.58, p < 0.001; dysglycemia: OR 1.85, 95% CI 1.50-2.28, p < 0.001), as well as with depression, anxiety, alopecia, and hirsutism (all p < 0.001)Dysglycemia was not significantly associated with acne or menstrual irregularity. Mean satisfaction with PCOS counselling was low (35.1 ± 26.9), with the lowest scores reported for aesthetic concerns (31.4 ± 27.8). In adjusted models, depression, alopecia, body image dissatisfaction, and hirsutism were independently associated with lower satisfaction. BMI and dysglycemia were not independently associated with satisfaction after accounting for symptoms. Conclusion While obesity and dysglycemia contribute to increased PCOS symptom burden, they do not explain low satisfaction with care. Perceived care gaps are most pronounced in emotional and aesthetic domains, indicating the need for more holistic, patient-centered PCOS care models.