Living with Polycystic Ovary Syndrome (PCOS) can be an uphill battle for any woman, but for Black women, the journey often comes with additional layers of complexity and struggle. Despite being a common endocrine disorder affecting millions worldwide, PCOS remains underdiagnosed and misunderstood, particularly within the Black community. The intricate interplay of genetic predispositions, racial biases in healthcare, and socioeconomic hurdles creates a unique set of challenges that many Black women face in silence.
From navigating delayed diagnoses to battling systemic biases in medical care, Black women with PCOS often find themselves at a disadvantage. Studies have shown that women with PCOS can see multiple healthcare providers over several years before receiving a proper diagnosis, and Black women are disproportionately affected by these delays due to implicit biases and a lack of culturally competent care. Moreover, the mental health toll of PCOS—exacerbated by societal stressors and the physical symptoms of the disorder—adds another layer of difficulty to managing this chronic condition.
But there is hope and strength in understanding and community. By shedding light on these challenges and advocating for better support systems, we can empower each other to take charge of our health and well-being.
What is PCOS?
PCOS stands for Polycystic Ovarian Syndrome and affects up to 10% of all women of reproductive age. It is characterized by irregular menstrual periods, disruption of normal metabolism & excessive hair growth and increases the risk for health conditions including infertility obesity, type 2 diabetes, depression and more.
Most women with this condition grow small cysts on their ovaries, hence the name. However, not all women diagnosed with PCOS have that symptom. PCOS is essentially a metabolic and reproductive health condition where an excessive amount of male sex hormones (androgens) affect ovulation.
Black women often encounter more severe manifestations of these symptoms, exacerbated by higher rates of insulin resistance and obesity, which are closely linked to the syndrome.
What causes PCOS?
While the exact cause of PCOS remains unknown, several factors are believed to contribute to its development like genetics, hormonal imbalances, environmental and lifestyle factors. So how does PCOS actually affect women? Well, let's take a look at the menstrual cycle. There are four phases of the menstrual cycle and each phase is governed by a set of hormones (namely estrogen, progesterone, FSH and LH). Each of these hormones help with egg stimulation and quality and helps build the uterine lining for a successful and healthy pregnancy.
Ovulation is the pinnacle of the menstrual cycle--yes, not the actual bleed--and is a key phase in a woman's reproductive and overall health. After the follicular phase where the dominant follicle (a sac containing a mature egg) has been stimulated by FSH (follicle-stimulating hormone), ovulation occurs. During ovulation, a surge of LH (luteinizing hormone) causes the follicle to release a mature egg for fertilization. In cases of PCOS, a woman does not make enough of the hormones needed to ovulate (FSH and LH) which inhibits the stimulation and maturation of the follicles containing the egg.
When ovulation does not happen, the ovary develops many small cysts or sacs with unreleased eggs that make extra hormones causing a cascade of issues like irregular menstrual cycles and amenorrhea (the absence of a period).
Other hormonal imbalances associated with PCOS included:
- The LH level is typically raised, while FSH is either normal or suppressed (LH:FSH ratio of 3:1)
- The baseline estrogen level is increased.
- Hyperprolactinemia is present in approximately 15% of cases.
- Testosterone is only slightly raised i.e. <5 n.mol/l (normal value is 0.5-2.6 n.mol/l).
PCOS in Black women.
Although there isn't much information available about the racial disparities among PCOS patients, women's health experts say that Black women are at a greater disadvantage. While the causes of PCOS in Black women include the general factors mentioned above, they also face unique challenges due to a combination of genetic, socioeconomic, and healthcare-related factors:
Genetic and ethnic factors:
Research has shown that genetics play a significant role in PCOS and some studies have found that certain genetic markers associated with PCOS are more prevalent in Black women. This genetic predisposition, combined with environmental and lifestyle factors, can exacerbate the severity of PCOS symptoms. For example, insulin resistance is a symptom of PCOS and is more prevalent in Black women. This means that your body might be producing more insulin, which can lead to higher levels of androgens (male hormones). High levels of androgens can cause symptoms like excess hair growth, acne, and irregular periods.
Disparities in diagnosis and treatment:
Black women often face implicit biases within the healthcare system. This can lead to delays in diagnosis and mismanagement of PCOS. Studies show that Black women with PCOS may see multiple healthcare providers and experience longer delays before receiving an accurate diagnosis compared to their white counterparts.
Additionally, Black women are underrepresented among healthcare providers, which can impede culturally competent care and understanding of the specific challenges that we face. Luckily, more and more Black health and wellness professionals are beginning to show up and build communities to support Black women.
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Socioeconomic Barriers:
Socioeconomic factors further compound the difficulties Black women face in managing PCOS. Limited access to healthcare, lower income levels, and food deserts significantly impact health outcomes. Studies found that Black women are disproportionately affected by these socioeconomic barriers, making it difficult to maintain a healthy lifestyle and manage PCOS effectively.
Not to mention most of the information around food and lifestyle changes to treat PCOS symptoms aren't culturally-relevant or require additional time and money that may not be a privilege for most Black women.
Support for Black women with PCOS:
Despite these challenges, there are steps Black women can take to manage PCOS effectively. Lifestyle changes such as a balanced diet, regular exercise, and stress management can significantly improve symptoms. Community support is also vital.
If you are currently looking for support on your journey to treating your PCOS symptoms, join our mailing list for helpful wellness secrets and nourishing recipes that nurture your hormone health.
