Global, regional, and national prevalence and trends of gynecological diseases among women of childbearing age from 1990 to 2021: An analysis of the global burden of disease study 2021

Gynecological diseases (GDs)—including endometriosis, uterine fibroids, and female infertility—pose a significant but often overlooked threat to women’s health worldwide [ 1 – 5 ]. Women of childbearing age (WCBA), defined as those aged 15–49, are especially vulnerable to these conditions [ 5 ]. For instance, endometriosis affects around 10% of WCBA globally, yet access to standardized and effective care remains limited [ 6 ]. These diseases not only impact reproductive health but also lead to substantial psychological and socioeconomic burdens [ 7 – 9 ]. Despite their serious health implications, most existing studies focus on individual conditions, specific populations [ 10 – 12 ], or all age groups combined [ 5 ], rather than addressing GDs specifically in WCBA. The changing landscape of risk factors—such as delayed childbearing [ 13 ], increasing rates of metabolic syndrome [ 14 , 15 ], and greater exposure to environmental endocrine disruptors [ 16 ]—further highlights the need for a systematic assessment of trends over time [ 17 ]. In addition, the burden of GDs differs significantly across regions and socio-demographic groups, making it crucial to understand geographical disparities and temporal changes in prevalence [ 5 ]. As global attention to women’s health grows [ 18 ], accurate and comprehensive data on GD prevalence are urgently needed. Methodological inconsistencies and the often mild or asymptomatic nature of early-stage GDs contribute to their underestimation in routine health statistics [ 19 , 20 ]. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides a valuable opportunity to address these gaps by applying standardized case definitions, using the American College of Obstetricians and Gynecologists (ACOG) criteria where applicable [ 1 ]. This study aims to improve the epidemiological understanding of GDs by estimating their prevalence at global, regional, and national levels and analyzing trends over recent decades.

Globally, an estimated 1.21 billion prevalent cases of GDs among WCBA were reported in 2021, corresponding to an ASPR of 62,091.73 cases per 100,000 population (95% UI: 62,088.24 to 62,095.23) ( Table 1 ). Among the 21 GBD regions, North Africa and the Middle East had the highest ASPR (70,779.89; 95% UI: 70,766.79 to 70,792.99), while South Asia recorded the highest number of prevalent cases, reaching 321.52 million ( Fig 1A and 1C ). At the national level, Iran had the highest ASPR (72,483.08; 95% UI: 72,448.66 to 72,517.51), followed by Turkey (71,747.88; 95% UI: 71,712.42 to 71,783.35) ( Fig 2A ). (A) Age-standardized prevalence rate of GDs in 2021. (B) Estimated annual percentage changes in the age-standardized prevalence rate of GDs from 1990 to 2021. (C) Number of prevalent cases of GDs in 2021. (D) Proportions of prevalent cases attributed to each GD in 2021. GBD = Global Burden of Diseases, Injuries, and Risk Factors Study. (A) Overall gynecological diseases. (B) Uterine fibroids. (C) Polycystic ovarian syndrome. (D) Female infertility. (E) Endometriosis. (F) Genital prolapses. (G) Premenstrual syndrome. (H) Other gynecological diseases. Between 1990 and 2021, the global number of prevalent cases increased by 51.96%, while the ASPR remained stable (EAPC = 0; 95% CI: –0.03 to 0.02) ( Table 1 ). At the regional level, the most significant ASPR increase was observed in High-income North America, with an average annual rise of 0.2% (95% CI: 0.13 to 0.27) ( Fig 1B ). Among the 204 countries and territories analyzed, 106 exhibited an increasing ASPR trend ( Fig 3A , S4 Table in S1 File ), with Taiwan experiencing the most pronounced rise (EAPC = 0.3; 95% CI: 0.23 to 0.37), followed by the Philippines (EAPC = 0.28 [95%CI: 0.22 to 0.34]). (A) Overall gynecological diseases. (B) Uterine fibroids. (C) Polycystic ovarian syndrome. (D) Female infertility. (E) Endometriosis. (F) Genital prolapses. (G) Premenstrual syndrome. (H) Other gynecological diseases. In 2021, the global number of prevalent cases among WCBA was estimated at 85.18 million for uterine fibroids, 65.77 million for PCOS, 110.09 million for female infertility, 21.05 million for endometriosis, 32.02 million for genital prolapse, 889.97 million for PMS, and 400.68 million for other GDs ( Table 1 ). Correspondingly, their ASPR per 100,000 population were as follows: uterine fibroids, 4,352.34 (95% UI: 4,351.41 to 4,353.26); PCOS, 3,372.56 (95% UI: 3,371.75 to 3,373.38); female infertility, 5,636.81 (95% UI: 5,635.76 to 5,637.86); endometriosis, 1,077.83 (95% UI: 1,077.37 to 1,078.29); genital prolapse, 1,634.39 (95% UI: 1,633.82 to 1,634.96); PMS, 45,637.68 (95% UI: 45,634.68 to 45,640.68); and other GDs, 20,492.62 (95% UI: 20,490.61–20,494.62). Additionally, PMS accounted for the highest proportion of all prevalent cases of GDs across the 21 GBD regions, except for North Africa and the Middle East ( Fig 1D ). From 1990 to 2021, the global ASPR for uterine fibroids, PCOS, and female infertility showed an increasing trend. In contrast, the global ASPR for endometriosis, genital prolapse, and other GDs declined, while the global ASPR for PMS remained stable ( Table 1 ). In 2021, regionally, the highest ASPR per 100,000 population for each GDs was reported as follows: uterine fibroids in Eastern Europe (10268.73 [95% UI: 10260.39 to 10277.07]) (S5 Table in S1 File ), PCOS in High-income Asia Pacific (10140.46 [95% UI: 10130.07 to 10150.87]) (S6 Table in S1 File ), female infertility in East Asia (8420.38 [95% UI: 8417.34 to 8423.42]) (S7 Table in S1 File ), endometriosis in Oceania (1921.6 [95% UI: 1906.74 to 1936.56]) (S8 Table in S1 File ), genital prolapse in Tropical Latin America (3614.03 [95% UI: 3609.37 to 3618.71]) (S9 Table in S1 File ), PMS in South Asia (50420.87 [95% UI: 50414.57 to 50427.18]) (S10 Table in S1 File ), and other GDs in North Africa and the Middle East (48113.93 [95% UI: 48103.11 to 48124.76]) (S11 Table in S1 File ). From 1990 to 2021, among the 21 regions, the highest ASPR were observed in Tropical Latin America for uterine fibroids (EAPC = 1.21 [95% CI: 1.12 to 1.31]), Southeast Asia for PCOS (EAPC = 2.3 [95% CI: 2.19 to 2.4]), Andean Latin America for female infertility (EAPC = 8.21 [95% CI: 6.69 to 9.76]), Eastern Europe for endometriosis (EAPC = 0.33 [95% CI: 0.15 to 0.5]), Eastern Europe for genital prolapse (EAPC = 0.68 [95% CI: 0.28 to 1.09]), High-income North America for PMS (EAPC = 0.53 [95% CI: 0.45 to 0.62]), and Eastern Sub-Saharan Africa for other gynecological diseases (EAPC = 0.03 [95% CI: 0.01 to 0.04]). Among the 204 countries and territories, the highest ASPR per 100,000 population for each GDs in 2021 were as follows: Latvia for uterine fibroids (11729.95 [95% UI: 11630.98 to 11829.72]) ( Fig 2B , S12 Table in S1 File ), Italy for PCOS (15308.01 [95% UI: 15285.15 to 15330.9]) ( Fig 2C , S13 Table in S1 File ), Central African Republic for female infertility (11739.3 [95% UI: 11678.7 to 11800.17]) ( Fig 2D , S14 Table in S1 File ), Niger for endometriosis (2520.75 [95% UI: 2505.72 to 2535.86]) ( Fig 2E , S15 Table in S1 File ), Paraguay for genital prolapse (4480.37 [95% UI: 4448.92 to 4512]) ( Fig 2F , S16 Table in S1 File ), Pakistan for PMS (51547.67 [95% UI: 51529.23 to 51566.12]) ( Fig 2G , S17 Table in S1 File ), and Yemen for other gynecological diseases (49967.45 [95% UI: 49915.67 to 50019.28]) ( Fig 2H , S18 Table in S1 File ). Between 1990 and 2021, the fastest increases in ASPR were observed in Brazil for uterine fibroids (EAPC = 1.23 [95% CI: 1.14 to 1.33]) ( Fig 3B ), Maldives for PCOS (EAPC = 3.39 [95% CI: 3.11 to 3.66]) ( Fig 3C ), Ecuador for female infertility (EAPC = 9.35 [95% CI: 7.3 to 11.44]) ( Fig 3D ), Iceland for endometriosis (EAPC = 1.19 [95% CI: 0.92 to 1.46]) ( Fig 3E ), Russia for genital prolapse (EAPC = 0.88 [95% CI: 0.45 to 1.31]) ( Fig 3F ), United States for PMS (EAPC = 0.61 [95% CI: 0.52 to 0.71]) ( Fig 3G ), and Taiwan for other gynecological diseases (EAPC = 1.18 [95% CI: 0.87 to 1.5]) ( Fig 3H ). At the regional level, the ASPR of overall GDs remained stable with increasing SDI initially, but began to decline when the SDI reached 0.55 ( Fig 4A ). Between 1990 and 2021, regions such as North Africa and the Middle East, Eastern Europe, and Western Europe showed higher-than-expected ASPRs for GDs based on their SDI. (A) Overall gynecological diseases. (B) Uterine fibroids. (C) Polycystic ovarian syndrome. (D) Female infertility. (E) Endometriosis. (F) Genital prolapses. (G) Premenstrual syndrome. (H) Other gynecological diseases. The solid line represents the expected values based on SDI and prevalence rates across all locations. Each region is represented by 32 points, showing the observed age-standardized prevalence rate for each year from 1990 to 2021. The shaded area indicates the 95% confidence interval (CI) of the expected values. Points above the solid line indicate a higher-than-expected prevalence, while those below the line represent a lower-than-expected prevalence. GBD = Global Burden of Diseases, Injuries, and Risk Factors Study. SDI = Socio-demographic Index. For specific GDs, the ASPR of uterine fibroids and PMS both initially increased with rising SDI but began to decline once the SDI reached 0.60 ( Fig 4B and 4G ). In contrast, the ASPR for PCOS increased exponentially with higher SDI ( Fig 4C ). However, the ASPRs for female infertility, endometriosis, genital prolapse, and other GDs all showed a decreasing trend as SDI increased ( Fig 4D , 4E , 4F , and 4H ). Among WCBA, the prevalence rate of overall GDs generally increased with age, peaking in the 40–44 years age group ( Fig 5A ). Interestingly, for women aged 15–19 and 20–24 years, regions with a middle SDI had the highest prevalence rate of overall GDs. In contrast, for women aged 25–29 and 30–34 years, the highest prevalence rate was observed in low-middle-SDI regions. For women aged 35–39, 40–44, and 45–49 years, the highest prevalence rates were found in low-SDI regions. Globally, as well as across the five SDI quintiles, the contribution of PMS and PCOS to overall GDs decreased with age, whereas the contribution of uterine fibroids increased with age ( Fig 5B ). (A) Prevalence rates of GDs globally and across the 5 SDI regions from 1990 to 2021, stratified by age group. (B) Proportions of prevalent cases attributed to each GD within each age group across the globe and the 5 SDI regions in 2021. (C) Estimated annual percentage changes in the prevalence rate of GDs from 1990 to 2021, categorized by age group and SDI. SDI = Socio-demographic index. From 1990 to 2021, the most significant increase in prevalence rates for overall GDs occurred in the 20–24 years age group, while the largest decrease was observed in the 45–49 years age group ( Fig 5C ). These trends indicate that the burden of GDs is increasingly affecting younger WCBA. Specifically, the fastest increase in prevalence rates was seen for uterine fibroids in women aged 40–44 years, PCOS in women aged 15–19 years, female infertility in women aged 25–29 years, PMS in women aged 20–24 years, and other GDs in women aged 15–19 years ( Fig 6 ). In contrast, the prevalence rates of endometriosis and genital prolapse either decreased or remained stable across all age groups among women of childbearing age ( Fig 6D and 6E ). (A) Uterine fibroids. (B) Polycystic ovarian syndrome. (C) Female infertility. (D) Endometriosis. (E) Genital prolapses. (F) Premenstrual syndrome. (G) Other gynecological diseases. SDI = Socio-demographic index.

In conclusion, GDs continue to impose a substantial and increasing health burden on WCBA worldwide, with significant disparities observed across regions and socio-demographic levels. Policymakers and healthcare systems must prioritize the development of accessible, equitable, and culturally sensitive services, especially in low- and middle-income regions where access remains limited. Enhancing public awareness, expanding routine screening programs, and investing in women’s health research are critical steps toward mitigating this burden. Strengthening primary care and referral systems for timely intervention can play a pivotal role in improving outcomes and quality of life.

The estimates presented in this study were obtained from the GBD 2021 [ 1 ]. With each new release of the GBD, data are updated, and methodological improvements are implemented; therefore, estimates for the entire time series replace those from previous GBD cycles [ 21 ]. This section outlines the key methodological steps used in generating the estimates reported in this study. More detailed descriptions of the methods can be found in the Supporting information and the GBD 2021 methods appendices ( https://www.healthdata.org/gbd/methods-appendices-2021/gynaecological-diseases ). The GBD 2021 study was approved by the Institutional Review Board committee at the University of Washington. Informed consent was waived due to the use of deidentified data ( https://www.healthdata.org/research-analysis/gbd ). All estimates in this study pertain to women of childbearing age (WCBA), defined as those aged 15–49 years according to World Health Organization (WHO) criteria [ 22 , 23 ]. The estimates are presented globally, by region, and across 5–year age groups (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, and 45–49) for the years 1990–2021. Regional estimates are based on geographic classifications, including 21 GBD world regions (S1 Table in S1 File ) and 204 countries or territories. Additionally, countries and territories were categorized into five quintiles based on the Socio-demographic Index (SDI): low, low-middle, middle, high-middle, and high (S2 Table in S1 File ). The SDI is a composite measure of social development, calculated as the geometric mean of three standardized indicators: the total fertility rate among women under 25 years, the average years of schooling for individuals aged 15 and older, and lag-distributed income per capita [ 1 ]. All rates are reported per 100,000 people per year, with 95% uncertainty intervals (UIs) derived from the 25th and 975th values of 1,000 draws, which were propagated through each estimation step [ 1 ]. In the GBD 2021 study, GDs were defined using standardized diagnostic criteria, with the ACOG guidelines serving as the reference standard where applicable. The analysis focused on the prevalence of key GDs, including uterine fibroids, polycystic ovarian syndrome (PCOS), female infertility, endometriosis, genital prolapse, premenstrual syndrome (PMS), and a category of other GDs. The “other GDs” category encompasses conditions such as inflammatory disease of the cervix uteri, diseases of Bartholin’s gland, other inflammatory disorders of the vagina and vulva, vulvovaginal ulceration and inflammation, and non-inflammatory disorders of the ovary, fallopian tube, and broad ligament [ 1 ]. All diseases were classified according to the corresponding codes of International Classification of Diseases, 10th Revision (ICD-10), as adopted in the GBD study. A detailed mapping of these classifications is provided in S3 Table in S1 File . The GBD methodology integrates data from diverse sources—including vital registration, surveys, hospital records, and disease registries—using advanced statistical models such as DisMod-MR 2.1, a Bayesian meta-regression tool [ 1 ]. This tool enables the synthesis of heterogeneous data while adjusting for known biases and inconsistencies (e.g., differences in case definitions or reporting practices across countries and time periods). As part of the GBD estimation process, internal validation techniques are applied, including out-of-sample predictive validity checks and data quality scoring, to assess the robustness of model estimates. The GBD, led by the Institute for Health Metrics and Evaluation (IHME), is a collaborative research initiative that estimates global trends in population, fertility, morbidity, and mortality [ 21 ]. GBD 2021 integrates a wide range of data sources, including surveys, censuses, vital statistics, and other health-related records, covering 204 countries and territories from 1990 to 2021. In GBD 2021, prevalence estimates for GDs were generated using the Bayesian meta-regression tool DisMod-MR 2.1. This modeling framework synthesizes data from population surveys, cohort studies, health system administrative records, and registry microdata, ensuring internal consistency across different regions, age groups, and time periods [ 1 ]. To minimize the impact of data heterogeneity, standardization and calibration steps were applied during the estimation process. This study utilized annual estimates of region-, country-, and age-specific prevalence numbers and rates for GDs among women aged 15–49 years from 1990 to 2021. These estimates were obtained from GBD 2021 through the Global Health Data Exchange (GHDx) query tool ( http://ghdx.healthdata.org/gbd-results-tool ). This study calculated the age-standardized prevalence rate (ASPR) of GDs per 100,000 population employing the following formula: In this formula, a i represents the age-specific rate for the i t h age subgroup, while w i denotes the corresponding population count for that age subgroup i , sourced from the GBD Study Population Estimates (1950–2021) [ 24 ]. A represents the total number of age groups. The global age-standardized population used for these calculations was obtained from the World Standards database, developed by the WHO ( https://seer.cancer.gov/stdpopulations/world.who.html ). ASPR is the prevalence rate of a condition standardized to a global age structure to allow for comparisons across populations with different age distributions [ 25 ]. To assess temporal trends in the prevalence of infertility, we calculated the estimated annual percentage change (EAPC) in the ASPR [ 26 ]. EAPC is a summary measure used to quantify the average annual change in age-standardized rates over a specified period, derived from a log-linear regression model [ 27 ]. This was done by fitting a regression model to the natural logarithm of the ASPR, expressed as y = α + β x + ε , where y = l n ( A S P R ) and x represents the calendar year. The EAPC was then computed using the formula 100 × ( exp ( β ) − 1 ) , with the corresponding 95% confidence interval (CI) derived from the linear regression model. An ASPR was considered to show an increasing or decreasing trend over time if the EAPC and its corresponding 95% CI were entirely above or below zero, respectively. If the 95% CI included zero, the change in ASPR was regarded as statistically insignificant. Additionally, a Locally Weighted Scatterplot Smoothing (LOWESS) model was used to examine the correlation between the ASPR and the SDI across 21 regions [ 28 ]. LOWESS is a non-parametric regression technique that fits a smooth curve through the data points, allowing for visualization of potential nonlinear trends without assuming a specific model structure [ 29 ]. Spearman correlation analyses were conducted to calculate the correlation coefficient ( r ) and corresponding p -values, assessing the strength and significance of the relationship between ASPR and SDI. All statistical analyses and mapping were performed using R software, version 4.2.3 (R Foundation for Statistical Computing), with significance set at P  < 0.05. The GBD 2021 study was approved by the Institutional Review Board committee at the University of Washington. Informed consent was waived due to the use of deidentified data ( https://www.healthdata.org/research-analysis/gbd ).

S2 Table. Socio-demographic Index (SDI) quintiles for 204 countries and territories estimated in GBD 2021. S3 Table. Case definitions and mapping of International Classification of Diseases (ICD) codes to gynecological diseases in GBD 2021. S4 Table. The global prevalence of gynecological diseases among women aged 15–49 years in 1990 and 2021, along with the trends and changes observed between these years, by country and territories. S5 Table. The global prevalence of uterine fibroids among women aged 15–49 years in 1990 and 2021, along with the trends and changes observed between these years. S6 Table. The global prevalence of polycystic ovarian syndrome among women aged 15–49 years in 1990 and 2021, along with the trends and changes observed between these years. S7 Table. The global prevalence of female infertility among women aged 15–49 years in 1990 and 2021, along with the trends and changes observed between these years. S8 Table. The global prevalence of endometriosis among women aged 15–49 years in 1990 and 2021, along with the trends and changes observed between these years. S9 Table. The global prevalence of genital prolapses among women aged 15–49 years in 1990 and 2021, along with the trends and changes observed between these years. S10 Table. The global prevalence of premenstrual syndrome among women aged 15–49 years in 1990 and 2021, along with the trends and changes observed between these years. S11 Table. The global prevalence of other gynecological diseases among women aged 15–49 years in 1990 and 2021, along with the trends and changes observed between these years. S12 Table. The global prevalence of uterine fibroids among women aged 15–49 years in 1990 and 2021, along with the trends and changes observed between these years, by country and territories. S13 Table. The global prevalence of polycystic ovarian syndrome among women aged 15–49 years in 1990 and 2021, along with the trends and changes observed between these years, by country and territories. S14 Table. The global prevalence of female infertility among women aged 15–49 years in 1990 and 2021, along with the trends and changes observed between these years, by country and territories. S15 Table. The global prevalence of endometriosis among women aged 15–49 years in 1990 and 2021, along with the trends and changes observed between these years, by country and territories. S16 Table. The global prevalence of genital prolapses among women aged 15–49 years in 1990 and 2021, along with the trends and changes observed between these years, by country and territories. S17 Table. The global prevalence of premenstrual syndrome among women aged 15–49 years in 1990 and 2021, along with the trends and changes observed between these years, by country and territories. S18 Table. The global prevalence of other gynecological diseases among women aged 15–49 years in 1990 and 2021, along with the trends and changes observed between these years, by country and territories. (PDF)