This case study interview was conducted on Thursday 10th July 2025

Interviewee: B.AA / 30-35 yrs old / Black British African / SouthEast London

1.0 The Diagnosis Journey

1.1 B.AA is a Black British African woman from London who began experiencing symptoms of PCOS in her early teens. At the age of 12, she entered puberty and noticed that her menstrual cycles were significantly longer and more irregular than expected. Concerned about these changes, her mother booked an appointment with their GP when B.AA was 13 years old. During that consultation, the GP advised that her irregular cycles were likely due to her weight and recommended she cut out dairy and focus on weight loss. There was no further investigation or explanation offered at that time.

At age 15, following a second GP visit, B.AA was referred for an ultrasound scan. The results confirmed the presence of cysts on her ovaries, and she was formally diagnosed with polycystic ovary syndrome (PCOS). However, the diagnosis was not clearly explained to her. She recalls being unfamiliar with the condition and receiving little information or support. Instead, she was told that PCOS was common among women from her ethnic background and that her symptoms would improve with weight loss.

1.2 B.AA distinctly remembers how heavily the conversation was focused on her weight. The clinical team did not offer comprehensive information about PCOS or discuss any treatment options beyond lifestyle changes. As a result, she was left feeling humiliated, ashamed, and blamed for her condition. She internalised the belief that her weight was the sole cause of her diagnosis, which significantly affected her confidence and emotional well-being during a critical stage of adolescence.

2.0 Impact of Race & Ethnicity

2.1 Throughout her PCOS journey, B.AA felt that her experiences were often dismissed or minimised, particularly in interactions with white British healthcare professionals. She perceived that, because she did not present as visibly distressed (either physically or emotionally) her concerns were not taken seriously. In several consultations, she noted that the focus remained solely on her weight and BMI, with little acknowledgement of how her racial or cultural background might inform her health experience. This lack of cultural sensitivity left her feeling unseen and unsupported.

One experience in her twenties particularly stood out. During a consultation regarding her ongoing struggle with PCOS-related weight gain, B.AA asked her GP for a referral to a dietitian to help with her weight management. When she shared her goal of losing 5–6 stone, the GP responded with a dismissive laugh and said, “Be realistic.” The comment left her feeling ashamed, undermined, and judged. She questioned whether the response would have been the same had she been a white British woman.

This interaction (and others like it) contributed to B.AA’s growing sense that her ethnicity, cultural context, and lived experience were not being taken into account in her care. She felt her attempts to advocate for herself were often met with indifference or condescension, further alienating her from a system that should have been supportive.

2.2 B.AA’s experiences with her family and community mirrored the sense of isolation and misunderstanding she faced in healthcare settings. At the time of her diagnosis, the only person she confided in was her mother, despite having a younger sister at home. Her mother later disclosed the diagnosis to B.AA’s father (from whom she had been separated since B.AA was three years old) when B.AA was 16.

Instead of offering support, her father responded with suspicion and blame, accusing her of being sexually active and implying that this was the cause of her condition. At the time, B.AA had not been sexually active, and the accusation left her feeling confused, ashamed, and deeply hurt.

These experiences contributed to a broader sense of not being believed or supported. B.AA felt that those she should have been able to trust, both in healthcare and within her family, made her feel responsible for her condition. The absence of compassion and the culturally insensitive responses, even within her religious community, left a lasting impact on her emotional well-being and spiritual identity.

B.AA shared that she consulted her maternal relatives including her grandmother, mother, and two aunts to explore any family history of PCOS. While none of them had been diagnosed with the condition, all four experienced fibroids either during pregnancy or following childbirth, which required medical intervention and removal. Due to this family history, B.AA raised concerns with her GP on multiple occasions to check for fibroids. Clinical investigations confirmed that she did not have fibroids.

Although B.AA does not share this specific diagnosis, she recognises a pattern of reproductive health issues on her maternal side. She perceives a generational link to womb-related conditions within her family, which has contributed to her broader understanding of her own health and sense of inherited vulnerability.

2.3 In her early 20s, B.AA returned to her GP to seek support for managing her irregular menstrual cycles. She was prescribed the oral contraceptive pill, which was recommended as a way to regulate her cycle and alleviate some of the symptoms of PCOS. While she initially followed this treatment, she later reflected on the long-term implications of having to take medication daily. Over time, she alternated between the oral contraceptive and the contraceptive injection to manage her symptoms.

During a follow-up appointment, B.AA raised concerns about finding a more sustainable, long-term solution that didn’t rely on hormonal contraception. In response, healthcare professionals advised her to return when she was ready to have children, at which point they would explore fertility options. However, she was also told that many women with PCOS are unable to conceive, and was cautioned not to set her expectations too high. This experience left B.AA feeling discouraged and unsupported. Rather than being offered comprehensive care or a personalised plan, she felt that the conversation around her reproductive

future was prematurely closed off, reinforcing a sense of hopelessness and lack of agency over her condition.

2.4 B.AA reflected that during her diagnostic journey, her cultural background and family medical history were not meaningfully considered. She noted that healthcare professionals did not ask about generational patterns or related conditions within her family, which could have provided a more informed and tailored approach to her care. Instead, the guidance she received felt generalised — a “one-size-fits-all” approach that did not acknowledge the nuances of her lived experience.

While B.AA did not experience overt stereotyping or direct medical racism, she did feel that her early concerns and symptoms were often dismissed or downplayed. This contributed to a sense that her voice was not fully heard or validated during the critical early stages of her healthcare journey.

3.0 Cultural & Community Factors

3.1 From the age of 16, B.AA began experiencing hirsutism, noticing coarse hair growth on her chest, breasts, and chin. This deeply affected her confidence, particularly when her mother would make light-hearted yet hurtful comments such as, “I always knew I was meant to have a son.” These remarks reinforced B.AA’s internalised shame, as she already felt self-conscious about her appearance. She attempted to manage the hair through shaving, waxing, threading, and depilatory creams, which led to increased skin sensitivity, irritation, and scarring. Alongside this, she experienced severe hormonal acne.

During consultations in her early 20s, B.AA was prescribed oral contraceptives and later the contraceptive injection to regulate her menstrual cycle. Although these treatments provided some relief, she expressed concerns about relying on birth control indefinitely. When she questioned the long-term treatment plan, healthcare professionals advised her to return when she was ready to conceive. However, she was also cautioned not to “set her expectations too high,” as many women with PCOS struggle with fertility. This comment, while possibly intended as a precaution, felt discouraging and insensitive to B.AA.

Her mother, upon learning about the potential fertility challenges associated with PCOS, responded with disappointment. In their cultural context, the ability to conceive and bear children is considered a mark of honour and womanhood, adding another layer of pressure to B.AA’s experience. These expectations caused B.AA to feel further guilt and shame, particularly when considering treatments like hormonal contraception, which she did not disclose to her mother due to religious and cultural concerns surrounding premarital sex.

Between the ages of 20 and 22, B.AA successfully lost 5–6 stones (approx. 31–38 kg) and reported this achievement to her GP, expecting improvements in her cycle based on earlier medical advice. However, no significant changes occurred, and she was simply told that “not every woman is the same.” The lack of follow-up care and support was disheartening.

Socially and culturally, B.AA found it difficult to discuss her condition. Her hirsutism, irregular or absent periods, and the stigma associated with infertility created barriers to confiding in friends or extended family. She feared judgment and felt misunderstood, often avoiding even basic conversations with her mother about her menstrual cycle.

3.2 Healthcare system barriers also significantly impacted B.AA’s journey. She noted long waiting times for GP appointments, rushed consultations due to the 15-minute time limit, and delayed referrals to specialists. It took over a year to see a gynaecologist, and several appointments were cancelled, leaving her feeling deprioritised and invisible within the system.

A particularly distressing incident occurred during an ultrasound scan conducted by a young Black male sonographer. During the procedure, he joked, “Oh! Do you know that you are pregnant?” and then laughed, saying he could see a fetus shape on the screen. Although he quickly retracted the comment, B.AA found the joke highly inappropriate, especially given her condition and personal anxieties around pregnancy. She later expressed her disappointment, especially as she had expected more sensitivity from a practitioner who shared her cultural background.

In an effort to access better care, B.AA obtained private health insurance, assuming this would offer faster and more comprehensive support. However, she soon discovered that pre-existing conditions such as PCOS were excluded from coverage. Consultations and scans would have to be self-funded, with costs amounting to thousands of pounds—another substantial barrier to effective care.

3.3 Reproductive health and conditions like PCOS are not commonly discussed within B.AA’s cultural community. At the time of her diagnosis, there was limited awareness or dialogue about PCOS within her family. However, as B.AA has grown older, she has made a conscious effort to open up conversations with her younger sister in hopes of breaking the cultural taboo and fostering greater transparency.

It was only later that B.AA discovered that her mother had experienced fibroids—a condition also present in her grandmother and aunts. These reproductive health issues had never been openly discussed within the family, and each woman had navigated her own diagnosis and treatment in silence. This lack of openness contributed to a generational gap in awareness and support around women’s health.

3.4 Within Ghanaian culture, the onset of menstruation is traditionally marked by a celebratory ceremony. Shortly after a girl’s first period, female elders in the community gather to honour her transition into womanhood and share wisdom for her journey ahead. B.AA recalls her own ceremony fondly, but it was soon followed by confusion and concern as she began to realise that her menstrual cycle did not align with what she had been told to expect. This cultural expectation of normality, paired with the silence around reproductive health challenges, left her feeling isolated and unsure.

4.0 Social Relationships, Disclosure & Community Support

4.1 B.AA did not begin discussing her PCOS diagnosis with friends until her late twenties. Prior to that, the stigma, lack of understanding, and personal shame around her symptoms made it difficult for her to open up. In romantic relationships, B.AA found it particularly challenging to explain how the condition could impact intimacy and her overall sexual health. She shared that during periods of sexual activity, she would often resume taking the contraceptive pill or receive the injection in an effort to manage her symptoms and maintain a healthy relationship with her partner.

4.2 One pivotal moment in her journey occurred when she was around 22 or 23 years old and regularly attending the gym. During this time, she would wear long weaves and makeup to conceal facial hair, shaving scars, and bumps caused by hirsutism. After one of her classes, a woman approached her and, in a sensitive and non-judgmental way, asked if B.AA had PCOS. Surprised, B.AA confirmed she did. The

woman revealed that she also had PCOS and showed B.AA the marks and pigmentation on her own face. She then suggested laser hair removal as a possible treatment for the hyperpigmentation and offered a recommendation based on her own experience.

Encouraged by this encounter, B.AA pursued laser hair treatment despite the high cost—approximately £300 for the lower face alone. Though it was a significant financial investment at a young age, she saw a marked improvement in her skin and confidence. B.AA still remembers that woman with gratitude, as her kindness and openness were instrumental in helping her address one of the most visible and emotionally distressing symptoms of PCOS.

4.3 This experience at the gym was a turning point. It made B.AA realise that others shared her condition and that connection through shared experience could be powerful. Inspired, she took to Twitter and publicly disclosed her PCOS diagnosis for the first time. The response was overwhelming. Friends and acquaintances, many of whom she didn’t know were living with PCOS, began reaching out. They shared their own challenges—ranging from hair loss and severe menstrual pain to irregular cycles—and expressed how isolated they had felt.

The volume and depth of the responses highlighted how many people were silently managing the condition alone. This engagement motivated B.AA to become more vocal and involved in raising awareness. It marked the beginning of her social media advocacy and desire to help others feel less alone in their PCOS journey.

5.0 Body Image & Weight-Related Pressures

5.1 B.AA has felt pressure about her weight because you are always told the reason for PCOS is because of your weight. She felt pressure about her body image especially when it came to facial hairs and hormonal acne.

6.0 Support and Information

6.1 B.AA did not initially have access to reliable information about PCOS and only began to understand the condition once she took the initiative to educate herself. Her journey toward gaining knowledge began when she enrolled in a programme led by a South Asian PCOS coach. The programme was designed specifically for people of colour, which helped B.AA feel more seen and understood in a culturally relevant context.

6.2 In addition, B.AA attended women’s health events focused on reproductive conditions such as PCOS and endometriosis. These spaces offered her the opportunity to engage with others facing similar challenges and to speak directly with medical professionals. At one such event, she was particularly impacted by a doctor who held an open Q&A session. The doctor not only offered practical advice on how to advocate for oneself within the healthcare system but also shared candidly about the limitations of medical training when it comes to PCOS.

The doctor acknowledged that many healthcare practitioners receive minimal education on PCOS and, as a result, are often unable to provide comprehensive support. This medical professional had taken it upon

themselves to pursue additional training to better serve patients with the condition—an act B.AA found inspiring and affirming. She appreciated the transparency, empathy, and actionable guidance provided in an informal and approachable setting.

6.3 Reflecting on her experiences, B.AA shared three key areas where she believes healthcare must improve:

1. Acknowledge the complexity of PCOS – Understand that the condition can be frustrating, prolonged, and emotionally distressing, even when symptoms are not externally visible.

2. Avoid dismissiveness based on appearance – Recognise that a lack of visible pain or distress does not equate to a lack of seriousness.

3. Expand treatment options – The common solution of prescribing birth control as a blanket treatment is insufficient. B.AA has researched the side effects and believes this approach may offer temporary relief but is not sustainable or healthy in the long term.

She believes a more compassionate, informed, and patient-led approach is essential in addressing the real-life impact of PCOS.

7.0 Looking Ahead

7.1 B.AA’s advice to other women of colour navigating PCOS is to not rely solely on doctors for answers. She feels that the physical and emotional wellbeing of women with PCOS is often not prioritised within the healthcare system. As a result, she encourages individuals to take ownership of their health, become well-informed, and make lifestyle changes that support long-term management of the condition.

B.AA has adopted a holistic approach to managing her PCOS, working with a holistic health coach who helped her understand the root causes of hormonal imbalance. Through this guidance, she became more educated about her body, the condition, and practical steps she could take to improve her wellbeing. She advises others to:

● Be intentional about nutrition and dietary choices.

● Incorporate fitness strategies that are effective for PCOS—such as reducing excessive cardio and focusing on high-intensity interval training (HIIT) to support insulin sensitivity.

● Explore natural remedies and herbal support—such as peppermint—that may aid hormonal balance.

She notes that, since making these changes, she has seen a positive shift in her menstrual cycle over the past six months. However, she emphasises that these results take time and consistency. Her key message: do your own research and advocate for your body.

7.2 From a healthcare improvement perspective, B.AA believes the system would benefit from implementing a sustainable and personalised investigative pathway for PCOS patients. This could include:

● Comprehensive blood testing to assess vitamin levels and hormone profiles.

● Regular ultrasound scans to monitor ovarian and uterine health.

● A consolidated, patient-specific approach that acknowledges the unique presentation of PCOS in each individual.

She strongly advocates for tailored healthcare support, recognising that no two people with PCOS are the same.

In addition, B.AA calls for reduced-cost period products for those who experience prolonged or heavy bleeding—an often overlooked burden of the condition. She hopes to see a future where PCOS care is more empathetic, accessible, and personalised for every woman, particularly those in marginalised communities.