Individuals with PCOS with indigenous ethnicity may be disproportionately impacted by PCOS but there is very limited research on this to date.[1]  In this article we explore the link between PCOS and having Indigenous ethnicity.

The United Nations acknowledges indigenous peoples as those who “are the descendants … of those who inhabited a country or a geographical region at the time when people of different cultures or ethnic origins arrived”.[2]  Individuals with indigenous ethnicity span a diverse mix of genetic and cultural backgrounds across more than 70 countries worldwide including the Lakota, Mayas and Aymaras of the Americas, the Inuit and Aleutians of the circumpolar region, the Saami of northern Europe, the Aborigines and Torres Strait Islanders of Australia and the Maori of New Zealand.[3]

There is limited research on the prevalence and impact of PCOS in individuals with indigenous ethnicity;[4] for example:

• In Australia, a small study suggested that PCOS may have higher prevalence in indigenous women and that these were the group also at high risk for cardiometabolic disease;[5]

• In Canada, PCOS is likely to be a contributing factor to the elevated rates of diabetes, gestational diabetes and metabolic syndrome (MeTS) in indigenous women but this link is yet to be explored;[6],[7]

• In New Zealand, a small study found that Maori and Pacific Island women with PCOS were more obese, had higher rates of insulin resistance and lipid abnormalities than women with European ethnicity;[8]

• In the US, a study of Pima Indian women founder relatively higher levels of androgens that also did not decline as much with age compared with Caucasian women; and

• In the US, PCOS is likely to be a contributing factor to the elevated rates of obesity in Alaskan and Native American women but this link is yet to be fully explored.[9]

The underlying cause of PCOS is a result of a complex interaction of genetic, epigenetic and environmental factors.[10]  Genetic factors relate to how individual or groups of genes are implicated in health and disease.[11]  Epigenetic factors relate to how genes are expressed or function, in response to the environmental factors within the womb or later in life.[12]  Environmental factors include lifestyle, diet, stress / trauma and exposure to endocrine-disruptors,[13] natural or man-made chemicals that may mimic, block or interfere with the body’s hormones.[14]

Whilst PCOS is associated with a number of specific genetic variations, genetic factors are believed to be largely common across different ethnic groups.  Only <10% of PCOS hereditability was found to be due to genetic factors.[15]

Disparities in the expression of the disease are therefore believed to be largely driven by social determinants of health (SDOH), “the conditions in the environment of where people are born, live, learn, work, play, worship and age”.[16] 

There is a vast array of variables included within SDOH and limited research to date.  Underlying factors are likely to include dietary makeup, accessibility and affordability of fresh fruit and vegetables which can vary by socioeconomic status, cultural norms and geographic location.[17]

The factors are also likely to include a rich mix of cultural and social factors, including multi-generational effects.  For example, one study found that individuals with the highest risk of PCOS (in general) were those with a higher personal education level but whose parents had a low parental education level.[18]

Reviewed by Keila Turino Miranda, an expert on PCOS and cardiovascular outcomes in transgender men

Sources

[1] chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0041-1730021.pdf

[2] chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.un.org/esa/socdev/unpfii/documents/5session_factsheet1.pdf

[3] chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.un.org/esa/socdev/unpfii/documents/5session_factsheet1.pdf

[4] chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0041-1730021.pdf

[5] https://pubmed.ncbi.nlm.nih.gov/26387977/

[6] https://www.ajmc.com/view/first-nations-women-of-canada-have-higher-diabetes-rates-study-finds

[7] chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://nwac.ca/assets-knowledge-centre/EIPCCP-Newsletter-September-2023-ENG-1.pdf

[8] https://pubmed.ncbi.nlm.nih.gov/11453273/

[9] https://pmc.ncbi.nlm.nih.gov/articles/PMC9991752/

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883751/

[11] https://www.cdc.gov/genomics/about/basics.htm

[12] https://www.cdc.gov/genomics/disease/epigenetics.htm

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9864804/

[14] https://www.niehs.nih.gov/health/topics/agents/endocrine

[15] https://www.fertstert.org/article/S0015-0282(23)00069-9/fulltext

[16] https://health.gov/healthypeople/priority-areas/social-determinants-health

[17] https://www.fertstert.org/article/S0015-0282(23)00069-9/fulltext

[18] https://www.fertstert.org/article/S0015-0282(23)00069-9/fulltext