Women's health: The conditions Black women are told to live with

As Black women, we face unique reproductive health challenges, and they create real disparities. Fibroids, PMOS (formerly PCOS), endometriosis and infertility all affect us disproportionately, and too often we are expected to simply get on with it. This piece, based on research brought together by Dr Sharon Akinola, walks through each condition, how it affects Black women differently, and how you can advocate for yourself. Reproductive health equity is essential, and it is possible.

Endometriosis: pain that is not normal

Endometriosis affects around 10% of women, and probably many more, because it is underdiagnosed and misdiagnosed. In the UK it now takes an average of 9 years and 4 months to be diagnosed.

The inner lining of the womb is called the endometrium. It thickens and sheds through the menstrual cycle. In endometriosis, tissue very similar to that lining grows outside the womb: on the fallopian tubes, the ovaries, the bladder, the bowel, and occasionally as far away as the lungs. It is a chronic condition, and it can cause:

• Severe pelvic pain
• Irregular or very painful periods
• Painful sex
• Bladder symptoms, such as pain or needing to pass urine often, and sometimes blood in the urine
• Bowel symptoms, such as constipation or pain when opening your bowels

Like the womb lining, this tissue responds to hormones, thickening and shedding. But unlike the lining, it has nowhere to go, so it causes scarring (adhesions) and cysts. If it blocks the fallopian tubes, the egg cannot meet the sperm, which is one of the ways endometriosis affects fertility.

It is not supposed to be this way. You are not supposed to have excruciating periods and just get on with it. That needs to be checked, and it could be endometriosis.

For women from ethnically diverse communities in the UK, the average wait is around 11 years, and research suggests Black women are about half as likely as white women to be diagnosed at all. There is also a misconception that endometriosis is rare in women of African heritage, when it may simply be that Black women are not listened to. That belief delays diagnosis, limits treatment and discourages research.

Treatment can include pain relief, from anti-inflammatories through to stronger painkillers when pain is severe, and hormonal treatments such as the combined pill, the progesterone-only pill or a hormonal coil. Scans such as ultrasound or MRI are often used first, and laparoscopy (keyhole surgery) can confirm the diagnosis and remove tissue at the same time. But if nothing is seen, it does not mean you do not have endometriosis, and you should still be managed appropriately. Lifestyle changes help, and assisted reproduction such as IVF may be an option.

PMOS (formerly PCOS): more than a weight problem

Polyendocrine metabolic ovarian syndrome (PMOS), until recently called polycystic ovary syndrome (PCOS), is a hormonal and metabolic condition that disrupts how the ovaries work, so eggs are not released regularly. The old name was misleading, because you do not need multiple cysts to be diagnosed, which is one reason it was changed in 2026. You need two of these three:

1. Irregular periods
2. Raised male hormones, or signs of them such as acne and hirsutism (thick hair on the chin, face, chest or back)
3. Multiple cysts on the ovaries

PMOS tends to be more severe in Black women, with worse hirsutism, more insulin resistance, more difficulty losing weight, and higher cardiovascular risk. It is linked to metabolic syndrome, a cluster of high blood sugar, high cholesterol and obesity that can lead to serious complications and early death. That is why prevention and proper management matter so much for us.

Yet Black women with PMOS often face dismissal and weight stigma. Their symptoms are put down to being overweight, and they are given weight-focused advice instead of the treatment that exists. There is no cure, but there are treatments. And because our symptoms are often worse, PMOS takes a heavy toll on body image and mental health, which becomes a vicious circle.

Perimenopause and menopause: we are not too young

Menopause is when your periods have stopped for 12 consecutive months. Perimenopause is the time leading up to it, and it can last several years, with very similar symptoms.

Black women tend to reach menopause earlier, and our perimenopausal symptoms are often more intense, last longer and can get worse over time. Too often we do not receive adequate hormone treatment, partly because our symptoms are not recognised as perimenopause. We are told we are too young. We are not.

Providers' lack of awareness leads to dismissal in appointments. Historical mistrust also affects whether Black women choose hormone replacement therapy, the first-line treatment. Both have to change: we need to raise awareness that perimenopause is real and often harder for us, and we need to build trust.

Fibroids: common, but not something to ignore

Fibroids are benign growths in the muscle layer of the womb. By the age of 50, most women will have developed them, although many are small and cause no symptoms. Black women are affected much more: we are diagnosed younger, we have more and bigger fibroids, and our symptoms are worse. In one large US study, more than 80% of Black women had fibroids by 50, compared with nearly 70% of white women.

About half of women with fibroids have no symptoms. Others experience heavy or painful periods, needing to pass urine often, constipation, bloating, or an abdomen so swollen that they look pregnant.

Why are we more affected? Suggested factors include starting periods earlier, obesity, stress, low vitamin D and genetics, but we do not know for sure. Outside cancer, only around 1% of new medicines in development target women's health conditions. That has to change.

Treatment options include:

• Hormonal therapy, such as the pill or a hormonal coil
• Uterine fibroid embolisation (UFE), which blocks the fibroid's blood supply
• Endometrial ablation, to reduce heavy bleeding
• Myomectomy, which removes the fibroids and keeps the womb
• Hysterectomy, which removes the womb
• MRI-guided high-intensity focused ultrasound, available only in some specialist centres
• Complementary approaches such as acupuncture, herbal supplements and dietary changes, which some women try, although there is little evidence that they shrink fibroids, so talk to your doctor first

Infertility: twice as likely, and too often silent

US research has found that Black women are around twice as likely as white women to experience infertility, and this gap is not fully explained by fibroids or other known risk factors. Many barriers keep us from getting help: cultural stigma that means we come forward late, lack of awareness, cost and access, too few Black sperm and egg donors, healthcare bias, and the discomfort of fertility clinics that are predominantly white settings.

How we change the narrative

If you have read this far, you now know these disparities exist. Here is what will make a difference:

• Share the knowledge. Keep educating and raising awareness.
• Build community support. Safe spaces where we can talk, feel seen and share what has helped.
• Improve access to care so services are easier for Black women to use.
• Culturally competent care. Believe us, listen to us, and stop dismissing us. A woman can have fibroids, endometriosis and adenomyosis at the same time, and each needs diagnosing and treating.
• Research and data that include us. Research has historically abused our trust, but safeguards today are far more robust. We need to come forward so we can find out why we are affected.
• Mental health support, because systemic racism and stress affect our health and can worsen our symptoms.
• Representation of Black healthcare professionals in leadership, campaigns and education.
• Better access to fertility services and patient advocacy groups.

You are the CEO of your body

Nobody knows your body better than you. If something feels wrong, do not let anyone dismiss you. Get a second, third or fourth opinion if you need to. Tell your doctor what you think is going on and what you would like done. If they disagree, ask calmly: why do you not think it is this? Why are you giving me this treatment? That is not being difficult. It is your right as a patient.

These conditions may not always kill, but they can stop people from living. Please share this with your family and friends. It could change someone's life.