PCOS; The Effects on Women Of Color

In 2019, I started noticing some changes in my body that were causing me to feel insecure. I began to see that hair was growing in areas it was not supposed to be. It felt as though my femininity was dwindling, and I could not understand why the change would occur so early in my life journey.

The efforts to remove the hair were the most challenging I had ever experienced. I wouldn’t shave for fear the hair would grow back thicker. Tweezing or threading was an absolute no, leaving me with dark spots and scars that would take consistent use of Vitamin C serums to just barely reduce the sight of, only to be set back to square one weeks later. Waxing seemed the only compromise, even though it wasn’t necessarily my favorite solution either. After a visit to a dermatologist, the superior solutions made available to me as a “woman of color” were expensive treatments like electrolysis or laser hair removal. (Not guaranteed, though.) 

Rather than waste my money on a quick fix, I opted for the most adult-like thing to do – I went for a visit to my physician and expressed my concerns. I wanted to get to the root of the problem, not just address the cosmetic.

Immediately, she offered me a referral to a nearby Quest Diagnostics for a blood test. She wanted to obtain a blood test for PCOS, Polycystic Ovary Syndrome, and to check my thyroid.

I felt fear drop into my stomach and settle there, quickly taking over and sending worry into my thoughts. I left that office paranoid, concerned that I had somehow done something wrong, and clueless about what my body was even experiencing. The entire experience became even more daunting since my physician didn’t even bother to follow up with me after the blood test.

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Then, I started to wonder – well, what causes an increase in testosterone for women? As women, our ovaries produce both testosterone and estrogen. Small quantities of testosterone are released into the bloodstream by the ovaries and adrenal glands, which is essential for creating new blood cells, maintaining bone health and libido as well as helping to boost other reproductive hormones.

But, what would trigger the body to begin to increase its testosterone levels?

Insulin resistance. As it turns out, “insulin resistance is one of the root physiological imbalances in most, if not all, cases of PCOS (ClevelandClinic, 2020).” Insulin, created by the pancreas, has one purpose: to regulate your blood sugar levels. The foods that cause blood sugar levels to increase are typically high in carbohydrates: rice, bread, fruit, and, you guessed it, sugar. You get insulin resistance when your body fails to regulate its blood sugar levels and can no longer store the sugar broken down during metabolism.

Part of the reason testosterone levels increase in the body is because the body naturally produces it in an effort to overcome insulin resistance. However, Insulin resistance is not only caused by consuming foods high in carbohydrates or foods with significant amounts of sugar, but by what we do with that sugar once it’s in the body. Lack of physical activity and an increase of visceral fat (fat that surrounds the organs) in the abdomen also contribute to insulin resistance in the body.

That day, my physician advised me that I did not have PCOS. My testosterone levels – though high, were still within a safe range. I hung up that phone feeling like I gained no insight whatsoever on what steps I needed to take moving forward or how to proceed with addressing this hairy issue because, hello – still here.

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We must recognize the powerful stigmatizing potential of genetic approaches to disease, especially when they are touted as the only approach.”― Harriet A. Washington

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Side note: On that follow-up call, I did ask my physician if I could just take estrogen and make it all go away. She quickly discouraged this action, stating that an increase in estrogen would bring its own issues: irregular or heavy periods, weight gain, and possibly fibroids.

What I did learn that ultimately shifted the responsibility out of the hands of my physician and into my own was that adjustments to my diet were essential. Luckily for me, I found out in just enough time before I exceeded what was considered safe testosterone levels in a woman’s body. (15 to 70 ng/dL, if you were wondering.)

At the time, my diet favored rice and pasta. It brought me to my knees, knowing how much of my diet would have to change, considering carbohydrates turn into sugar in the body. I’m almost sure I could have put See’s Candies out of business. Reducing my sugar consumption continues to be a primary focus, with an intentional focus on improving hormonal balance within the body.

In the United States, women of color are disproportionately affected by PCOS. The cause? Obesity, poor access to health, and social determinants of health that include access to nutritious foods, education, job opportunities, discrimination, and the neighborhoods we live in.. imagine that. PCOS is not a hormonal disorder that explicitly impacts people of color, but because of the disparities in health care observed and experienced by women of color and the cultural paradigms that influence our choices, there is a higher prevalence of PCOS in the black population. [/blockquote][/pullquote]

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According to a research study by Wendy Wolf and Rachel Wattick of West Virginia University, when evaluating women of different racial backgrounds and adjusting for age and body mass index, there was no difference racially in the women who manage the hormonal imbalance, PCOS. What was consistent was that the prevalence of PCOS is common in women who exceeded a BMI of 30kg and had high insulin and glucose levels.

This leads me to conclude that perhaps, culturally, what we commend as a standard of beauty, could be contributing to health outcomes that we may not even be considering. Did you know that if left untreated, PCOS can lead to diabetes? Affect our ability to have children? Lead to various severe diseases like heart disease?

While I was not found to have PCOS, the experience alone taught me more about my experience with healthcare physicians, the essence of “quality of care,” and how important it is to advocate for yourself and your health. If you plan to visit your physician because you feel you may be experiencing symptoms associated with PCOS, please consider asking these questions:

• Can you tell me if I have an excess of testosterone in the body? (Hyperandrogenism)
• What are my testosterone levels, and what should they be?
• Am I possibly displaying symptoms of oligoovulation or irregular and infrequent periods?

It may be helpful to note that oligoovulation is typically associated with having eight or fewer periods each year. Irregularity doesn’t necessarily have to mean that your period started on the 8th of the previous month, but now is starting on the 22nd. Ask anyway.

We receive messages constantly about health, staying active, and maintaining a healthy diet. However, as we lean into inclusivity and embrace the understanding that bodies change, can we find the balance between vitality and the reality of our unique circumstances? Is it probable that culturally what we idolize as a standard of beauty could be contributing to health outcomes that are causing harm within our community?

Leave a comment and inspire some dialogue below!

Sources

Geographical Prevalence of Polycystic Ovary Syndrome as Determined by Region and Race/Ethnicity

Controlling Your Blood Sugar Can Improve Your PCOS and Hormone Imbalance

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