Methods:
Cross-sectional analysis of the Australian Longitudinal Study on Women’s Health using survey data from 2003 (women born 1973-78) and 2019 (women born 1989-95). Outcomes included family size aspiration, infertility history, contraceptive practices, and birth outcomes. Differences were compared using T-tests, Pearson chi-square tests, or Fisher’s exact tests. Logistic regression with interaction terms between PCOS and cohort generation explored associations.
Results:
A total of 16,712 women were included. Family size aspirations were similar regardless of PCOS status in both cohorts, but more women in the newer cohort desired no children (15% vs 8%) and were nulligravida (79% vs 55%, p<0.01). More women with PCOS experienced infertility in both cohorts. In the newer cohort, more women with PCOS had conceived compared to those without PCOS (31% vs 20%, p<0.01). Contraceptive use was higher in the newer cohort (82% vs 70%, p<0.01) with consistent reasons for non-use. Live birth rates were higher (99% vs 71%, p<0.01) and termination of pregnancy lower (9% vs 36%, p<0.01) in the newer cohort, but miscarriage rates were higher (42% vs 28%, p<0.01). Miscarriage was more common in women with PCOS in both cohorts. Logistic regression revealed significant reproductive outcome differences over 17 years, with PCOS associated with lower nulligravida (aOR 0.66, 95%CI 0.57-0.83) but higher miscarriage rates (aOR 1.63, 95%CI 1.29-2.05).
Conclusions:
The newer generation of women with PCOS initiated family at a younger age. Contraceptive use increased, but contraceptive choice did not advance. Reproductive outcomes changed significantly, with PCOS linked to lower nulligravida and higher miscarriage rates. These findings highlight the evolving reproductive health landscape for women with PCOS and underscore the need for continued research and targeted interventions to improve outcomes for this high-risk population.