Why PCOS Gets Missed in Women of Color - And What You Need to Know
Polycystic Ovary Syndrome (PCOS) affects 7 to 10 percent of women of childbearing age, making it the most common endocrine disorder among women. But here's the problem: it's often underdiagnosed in women of color, who also tend to experience more severe symptoms.
If you're a woman of color dealing with irregular periods, unexplained weight gain, excessive hair growth, or struggling to get pregnant, PCOS might be the missing piece of your health puzzle.
What Actually Is PCOS?
PCOS involves three main features, and you only need two for a diagnosis:
Irregular menstrual cycles - Your ovaries aren't releasing eggs regularly, leading to unpredictable periods or no ovulation at all.
Elevated androgen levels - Higher levels of male hormones can cause excessive hair growth on your face, back, or arms, acne, and hair loss on your head.
Polycystic ovaries - Multiple small sacs (follicles) on your ovaries prevent proper egg development.
How PCOS Shows Up Differently in Women of Color
Research shows clear connections between ethnicity and PCOS. Different groups face varying risks and symptoms due to genetic factors, how bodies process glucose and insulin, vitamin D levels, and environmental influences.
Ovarian dysfunction affects all women with PCOS, but research shows it's more common among East Asian women, while Hispanic women are more likely to develop polycystic ovaries. Black and Asian women are more likely to have PCOS without visible cysts, which can lead to missed diagnoses.
Excessive hair growth (hirsutism) presents differently by ethnicity. It's more common in Hispanic, South Asian, and Middle Eastern women with PCOS, while East Asian women usually experience less hair growth in these areas.
Hormone levels vary significantly. South Asian and Indigenous Australian women often have higher testosterone levels. Middle Eastern women tend to have elevated DHEA levels, while Hispanic and Black women with PCOS generally have lower DHEA levels.
Weight and metabolism patterns differ too. East and South Asian women usually have lower BMIs but more abdominal fat, increasing diabetes and heart disease risk. Black women with PCOS are more likely to be obese, though they tend to have better cholesterol profiles. Overall, Black, Hispanic, South Asian, Middle Eastern, and Indigenous Australian women with PCOS are more likely to have insulin resistance.
Why PCOS Gets Missed in Communities of Color
Getting a diagnosis gives you power to take action. Without one, women face higher risks of infertility, diabetes, heart disease, high blood pressure, and endometrial cancer.
The problem? Most research and diagnostic criteria have focused on white women. This means factors affecting communities of color often get ignored, leading to misdiagnosis, delayed care, and worse health outcomes.
Since 2018, the International PCOS Network has recommended considering ethnicity during diagnosis, but many providers still aren't doing this.
The Real Impact on Women of Color
Women of color with PCOS face:
Delayed diagnoses and limited access to fertility care
Medical bias that dismisses their symptoms
Higher rates of insulin resistance and metabolic syndrome
Increased risk of heart disease
Many women with PCOS don't actually have visible cysts on their ovaries. The key signs are irregular periods, elevated androgen levels, or polycystic ovaries - if you have two of these three, you should talk to a doctor about PCOS.
How PCOS Affects Your Fertility
PCOS can seriously impact your ability to get pregnant because it disrupts ovulation. When your ovaries don't release eggs regularly, conception becomes much harder.
The insulin resistance that's common in women of color with PCOS makes things worse. High insulin levels can:
Increase androgen production
Disrupt normal hormone cycles
Make it harder for eggs to mature and release
Contribute to weight gain that further affects fertility
Getting the Care You Deserve
There's no cure for PCOS, but it can be managed effectively. Treatment focuses on your specific symptoms and health goals.
Lifestyle changes are essential - improving your diet and increasing physical activity help manage symptoms and reduce metabolic risks.
Medical treatment might include medications for irregular cycles, fertility issues, or related conditions like diabetes.
For managing PCOS:
Add vitamin D and omega-3s to support hormone balance
Exercise regularly to reduce metabolic risks and improve overall health
Work with a provider who understands how ethnicity affects PCOS diagnosis and treatment
Seek culturally competent care and join support groups
Advocate for access to quality fertility and hormonal healthcare
Finding Providers Who Get It
Look for healthcare providers who:
Understand that PCOS presents differently across ethnic groups
Don't dismiss your symptoms or attribute everything to weight
Take time to explain treatment options
Respect your cultural background and concerns
Are willing to work with you on a comprehensive treatment plan
The Bottom Line on PCOS and Fertility
PCOS is treatable, and many women with the condition go on to have healthy pregnancies. The key is getting diagnosed early and working with providers who understand how it affects women of color specifically.
Your symptoms matter. Your concerns are valid. If you're experiencing irregular periods, unexplained symptoms, or fertility challenges, push for proper testing and evaluation. PCOS might be the answer you've been looking for.
Don't let outdated diagnostic criteria or provider bias keep you from getting the care you need. You deserve healthcare that sees and treats all of you.
For more resources on PCOS, fertility, and finding culturally competent care, visit Oshun Griot.