Individuals with Middle Eastern ethnicity may experience a higher than average prevalence of PCOS[1],[2] and manifest PCOS symptoms differently from those with other ethnicities.[3]

In this article we explore the link between PCOS and having Middle Eastern ethnicity.

Individuals with Middle Eastern ethnicity span a diverse mix of genetic and cultural backgrounds from Turkey, Cyprus, Syria, Lebanon, Iraq, Iran, Israel, the West Bank, the Gaza Strip, Jordan, Egypt, Sudan, Libya, and the various states and territories of Arabia (Saudi Arabia, Kuwait, Yemen, Oman, Bahrain, Qatar, and the United Arab Emirates).[4]

Individuals with Middle Eastern ethnicity are believed to have a prevalence of PCOS of between 20 and 30%[5],[6] and have been shown to manifest PCOS symptoms differently than other groups, including higher prevalence of:

• Hirsutism, the growth of excessive male-pattern hair in women after puberty;[7],[8]

• Abnormal free androgen index (FAI), a measure of androgens based on a blood test;[9]

• Elevated high-density lipoprotein (HDL) cholesterol, the “good” cholesterol that helps removes other forms of cholesterol from your bloodstream;[10],[11]

• Elevated C-reactive protein (CRP), a protein made by the liver that increases when there is an inflammatory response in the body;[12],[13] and

• Elevated concentrations of dehydroepiandrosterone sulfate (DHEAS), a steroid hormone that your body converts into estrogen and androgens.[14]

The underlying cause of PCOS is a result of a complex interaction of genetic, epigenetic and environmental factors.[15]  Genetic factors relate to how individual or groups of genes are implicated in health and disease.[16]  Epigenetic factors relate to how genes are expressed or function, in response to the environmental factors within the womb or later in life.[17]  Environmental factors include lifestyle, diet, stress / trauma and exposure to endocrine-disruptors,[18] natural or man-made chemicals that may mimic, block or interfere with the body’s hormones.[19]

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.[20]

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”.[21] 

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.[22]

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.[23]

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

Sources

[1] https://www.degruyter.com/document/doi/10.1515/reveh-2021-0036/html?lang=en

[2] https://fakihivf.com/pcos-in-the-middle-east/

[3] https://www.nature.com/articles/s41598-020-75109-2

[4] https://www.britannica.com/place/Middle-East

[5] https://www.degruyter.com/document/doi/10.1515/reveh-2021-0036/html?lang=en

[6] https://fakihivf.com/pcos-in-the-middle-east/

[7] https://www.sciencedirect.com/science/article/pii/S0015028223000699#

[8] https://www.ncbi.nlm.nih.gov/books/NBK470417/

[9] https://www.nature.com/articles/s41598-020-75109-2

[10] https://www.nature.com/articles/s41598-020-75109-2

[11] https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/hdl-cholesterol/art-20046388

[12] https://www.nature.com/articles/s41598-020-75109-2

[13] https://www.mayoclinic.org/tests-procedures/c-reactive-protein-test/about/pac-20385228

[14] https://www.rbmojournal.com/article/S1472-6483(20)30642-8/fulltext

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

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

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

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

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

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

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

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

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