Endometriosis & PCOS – Clinicians

đź©ş Clinician Information Sheet

Endometriosis & PCOS in Young Asian Women: Implications for Reproductive Health

  1. Epidemiology & Ethnic Predisposition

Endometriosis

  • Higher prevalence reported among East and Southeast Asian women (e.g., Japanese, Chinese, Malaysian) compared to Caucasians.
  • Studies suggest 1.5–2x higher risk for Asian women, potentially due to genetic susceptibility, immune response differences, or diagnostic bias.

PCOS

  • PCOS is underdiagnosed in Asian populations, yet emerging data suggest comparable or higher prevalence (up to 15–18% depending on criteria).
  • Asian women with PCOS often present with less hirsutism but more pronounced metabolic dysfunction (e.g., insulin resistance, central obesity).
  1. Pathophysiology & Contributing Factors
  • Genetic factors: Shared familial risk and polymorphisms affecting steroidogenesis, inflammation, and insulin signaling.
  • Environmental influences: Urbanization, high-glycemic diets, sedentary lifestyles.
  • Cultural barriers: Menstrual pain and irregularity often normalized; delayed diagnosis is common.
  1. Impact on Fertility

âś… Endometriosis

  • Infertility mechanisms:
    • Anatomical distortion (adhesions, tubal blockage)
    • Inflammatory peritoneal environment impairs gamete transport and implantation
    • Ovarian endometriomas may reduce ovarian reserve
  • Up to 50% of women with endometriosis experience infertility.
  • Severity (Stage III/IV) correlates with lower fecundity.

âś… PCOS

  • Anovulation and irregular cycles are hallmark features.
  • Insulin resistance and hyperandrogenism impair folliculogenesis.
  • Obesity compounds ovulatory dysfunction and reduces ART success.
  • Long-term risk of subfertility without early ovulation induction or metabolic control.
  1. Clinical Considerations in Asian Populations

Clinical Feature

Asian Women with Endometriosis/PCOS

Symptom presentation

Often subtle; less hirsutism; more central adiposity

Help-seeking behavior

Often delayed due to stigma, normalizing of pain

Diagnostic delay

Average delay of 7–10 years (esp. for endometriosis)

Fertility impact

May be under-recognized until late 20s or 30s
  1. Management Recommendations

🔍 Early screening in high-risk patients with:

  • Severe dysmenorrhea, chronic pelvic pain
  • Irregular cycles, acne, or weight gain
  • Family history of PCOS or infertility

đź’Š First-line treatment:

  • OCPs for cycle regulation & endometriosis suppression
  • Metformin + lifestyle change in PCOS with insulin resistance
  • Fertility preservation discussion (AMH testing, egg freezing in select cases)

🤰 Preconception care:

  • Timely referral for ovulation induction, ART as needed
  • Manage BMI, glycemic control, and comorbidities
  1. Key Takeaways for Clinicians
  • Be vigilant: Symptoms in Asian women may be subtle or dismissed.
  • Diagnose early: Preserve fertility options and reduce long-term morbidity.
  • Educate and support: Address cultural barriers and normalize conversations around reproductive health.

 

Dr Sharad ObGynae
+60 11-1656 6659