{
  "abstract": "Structured abstractO_ST_ABSObjectiveC_ST_ABSTo study the prevalence of co-occurring endometriosis and polyendocrine metabolic ovarian syndrome (PMOS), estimate infertility odds, and characterize menstrual symptom profiles associated with this combined phenotype in a population cohort.\n\nDesignProspective digital cohort in the United States (US).\n\nSubjects90,714 consented participants enrolled between November 2019 and June 2025 who completed relevant surveys; a subset of 25,152 participants with menstrual cycle logs linked to monthly surveys contributed to symptom analyses.\n\nExposureParticipants were classified by self-reported physician diagnosis into four groups: endometriosis alone, PMOS alone, co-occurring endometriosis and PMOS (endometriosis+PMOS), or neither condition (reference group).\n\nMain Outcome Measures(1) Odds of self-reported physician-diagnosed infertility (ever/never, cross-sectional), estimated using multivariable logistic regression adjusted for age, race/ethnicity, and subjective socioeconomic status; (2) number of adverse menstrual symptoms logged per cycle, assessed using negative binomial mixed-effects models adjusted for age, race/ethnicity, and hormonal contraceptive use.\n\nResultsAmong 90,714 participants, the mean age was 35.1 years (standard deviation: 11.6) and the majority identified as non-Hispanic White (72%). Prevalence estimates were 11% for PMOS alone, 6% for endometriosis alone, and 2% for endometriosis+PMOS. Individuals with endometriosis+PMOS more frequently reported unemployment, low socioeconomic status, active smoking, poorer subjective health, early menarche, current irregular cycles, and a broad range of comorbidities. Infertility odds were highest for endometriosis+PMOS (odds ratio: 12.49 [95% confidence interval: 11.13-13.99]), followed by PMOS alone (6.12 [5.69-6.59]) and endometriosis alone (4.31 [3.93-4.72]), with the combined effect exceeding additive expectations (relative excess risk due to interaction: 3.05 [1.65-4.46]). Individuals with endometriosis+PMOS logged 11% more symptoms per cycle than those with neither condition (incidence rate ratio: 1.11 [1.04-1.19]) and had the highest odds of logging pelvic pain, fatigue, and sleep changes, among other symptoms.\n\nConclusionIn this large US digital cohort, co-occurring endometriosis and PMOS affected 1 in 50 participants and was associated with markedly elevated infertility odds exceeding additive expectations, and a heightened menstrual symptom burden. Several risk factors and health impacts characteristic of each condition appeared amplified in individuals with both conditions, suggesting a subgroup with compounded clinical complexity and greater care needs.",
  "abstract_shown": true,
  "affiliations": [
    "Harvard T.H. Chan School of Public Health"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "S. Werdin"
    },
    {
      "name": "Z. Wang"
    },
    {
      "name": "E. Huffman"
    },
    {
      "name": "A. M. Z. Jukic"
    },
    {
      "name": "A. J. Wilcox"
    },
    {
      "name": "S. Suharwardy"
    },
    {
      "name": "J.-P. Onnela"
    },
    {
      "name": "B. A. Coull"
    },
    {
      "name": "M. A. Williams"
    },
    {
      "name": "S. Mahalingaiah"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6f9jv244b6bsq.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.13.26365449",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.13.26365449v1.full",
  "id": "6f9jv244b6bsq",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.13.26365449v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "obstetrics and gynecology"
    ],
    [
      "openalex",
      "2743|Endometriosis Research and Treatment"
    ]
  ],
  "openalex": "W7221827664",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.13.26365449v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-13",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/6f9jv244b6bsq.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:52Z",
      "native_id": "10.64898/2026.10.13.26365449",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.13.26365449v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:obstetrics and gynecology",
      "subfield": "reproductive-child"
    }
  ],
  "title": "Menstrual symptoms and infertility odds among individuals with co-occurring endometriosis and polyendocrine metabolic ovarian syndrome",
  "title_text": "Menstrual symptoms and infertility odds among individuals with co-occurring endometriosis and polyendocrine metabolic ovarian syndrome",
  "type": "preprint",
  "updated_at": "2026-10-30T12:20:52Z",
  "url": "https://research.draconitic.com/paper/6f9jv244b6bsq",
  "venue": "medRxiv",
  "versions": []
}