By Victory Onyenekwe. B.Sc.Ed Physical and Health Education. Freelance Health Writer and Datelinehealth Africa volunteer. Medically reviewed by: Dr. Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), MSc (Public Health),
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A gathering of African women seating outdoor under a tree
Hormone-linked disorders pose significant health concerns for women in Africa, with various hormonal disorders affecting their health. Exploring common disorders associated with hormonal imbalance in African women helps to address critical aspects of women’s health in the region.
Before delving into specific conditions associated with hormone-linked disorders in African women, let us get to know what hormonal imbalance is.
Hormonal imbalance is a common feature of hormone-linked disorders and refers to the disruptions in the normal levels of hormones in the bloodstream. Hormones are chemical substances produced by special glands in the body that perform regulatory functions in the cells and organs, examples of hormones are estrogen, testosterone, adrenaline, etc.
When hormones like estrogen, testosterone, progesterone, thyroid hormones and insulin are not at optimal levels, it results in a range of symptoms and health issues.
Hormonal imbalance can be caused by various factors such as medical conditions, ageing, stress, diet and lifestyle.
Hormones play an important role in the regulation of various functions in the body. This includes reproduction, metabolism, mood and growth. When an imbalance in hormonal levels occurs, it can lead to a wide range of health problems in women. These problems include irregular menstrual cycles, infertility, weight gain, mood swings and increased risk of certain diseases such as breast cancer, and diabetes.
As hormone-linked disorders in African women imay be partly affected by modifiable factors such as diet, general lifestyle, and environmental influences that you can control, improving your awareness and education about the condition could support your needs for improved reproductive health, general well-being and quality of life.
Also, with improved awareness and education of the varied symptoms of hormone-linked disorders, you will be better placed to seek early diagnosis and treatment from your healthcare provider.
Polycystic Ovarian Syndrome [PCOS] is a genetic disorder that affects the normal function of the ovaries. It is a condition that is characterized by the development of multiple pockets of fluids of different sizes called cysts in the ovaries. This is as a result of excess production of androgen (male hormones). The condition affects ovulation and can cause infertility in the long run. It can increase the risk of several other health issues like diabetes, pregnancy induced high blood pressure, miscarriages, mental health, cancer of the inner lining of the womb, etc. [1]
The symptoms of Polycystic Ovarian Syndrome include:
Long-term risks include:
According to the World Health Organization [WHO], Poly Cystic Ovarian Syndrome affects 8% to 13% of women of reproductive age. [2] Series of studies conducted in Sub-Saharan Africa estimates the prevalence of PCOS to be between 16% and 32%. [3]
However, PCOS may be underdiagnosed in African women due to the cultural norms and stigma that surrounds reproductive health and varying healthcare access issues across different African regions.
Genetics, lifestyle and environmental influences contribute to the prevalence of PCOS in African women. Healthcare systems must raise awareness, provide adequate resources and offer culturally sensitive care to address Polycystic Ovarian Syndrome in African communities.
This is the implantation of endometrial tissue [lining of the uterus] outside the uterus. [4] The location may vary but the most frequent locations are in or near the ovaries, fallopian tube, ligaments around the uterus, and the outside surface of the uterus.
The abnormally located endometrial tissue responds to the hormones of the ovarian cycle and also bleeds similar to the endometrium [lining of the womb]. This can cause considerable pain.
The exact cause of the condition is not known but hormonal imbalance is one of several risk factors in consideration, an excessive production of the hormone estrogen, can lead to the growth of both normal and abnormal endometrial tissue resulting in inflammation and pain, while a lower level of the progesterone hormone, prevents the proper regulation of endometrial tissue allowing it to grow abnormally.
These include:
The current view is that endometriosis rarely affects women of African descent, however, this may be due to a low level of awareness, under-research and diagnosis of the condition in Africa.
Related: Endometriosis: What you need to know
This is a chronic metabolic disease that is characterized by elevated levels of blood glucose [or blood sugar]. The common types of diabetes include Type 1, Type 2 and gestational diabetes with Type 2 diabetes being the most common.
Though diabetes is a disease caused when the body isn’t producing enough insulin or has developed insulin resistance, it is also caused by an imbalance in these other hormones: glucagon, amylin, epinephrine and cortisol. In women, the hormone estrogen and Type 2 diabetes are linked. Changes in estrogen can cause either a rise or fall in blood sugar. [5]
As women experience menopause there’s a reduction in the production of estrogen which may lead to increased insulin resistance. During pregnancy, progesterone and other pregnancy hormones increase insulin resistance.
How common is Diabetes in African women?
Due to factors such as obesity, lifestyle, access to healthcare and socio-cultural beliefs the occurrence of especially Type 2 diabetes is quite high in African women. [6]
Related: Type 1 Diabetes Mellitus: An Explainer for Africans and Type 2 Diabetes: What Africans Need to Know
This is the growth of cancerous cells in the breasts which results in an unhealthy mass of cells called a tumor. Although breast cancer is linked to ovarian hormones, especially estrogen. [7] Hormonal imbalance is not the specific cause of breast cancer.
Breast cancer is increasingly common among African women, due to lack of awareness, access to care and genetic factors, lifestyle changes and reproductive factors.
Incidence rates are still generally low in Africa, estimated below 35 per 100,000 women in most countries. [8] However, this is because of the lack of information resulting in insufficient data on the actual prevalence of breast cancer among African women.
Related: Breast Cancer in Africa: What you need to know
Uterine fibroid is an abnormal, non-cancerous growth in or on the uterus. It can grow to be quite large and cause severe abdominal pains.
The female sex hormones estrogen and progesterone play a vital role in the growth of uterine fibroids. An excess of estrogen in the body can cause uterine fibroids to grow while a limited production of progesterone causes the body not to be able to reduce the growth and size of the fibroid.
African women have some of the highest occurrence of uterine fibroids in the world [more than 80%] with an average age of diagnosis between 30-44 years.[9] There are however variations across different African countries due to factors such as genetics, lifestyle, access to healthcare, and environmental influences.
Related: Fibroid: What every African woman should know
This is the inability to conceive after 12 months of regular unprotected sexual intercourse. Infertility in women can be caused by various factors that include an impairment of ovarian function which interrupts ovulation as in PCOS, thyroid disorders, anovulation [no ovulation] etc.
Infertility is of particular concern in African women, because of the extent of social stigma attached to it. The overall prevalence of infertility among African women is estimated to be around 10.1% but the figure can vary depending on countries and local factors. [10]
Related: Infertility in African Women: All You Need to Know
These are a range of conditions that disrupt the normal menstrual cycle, and affect women physically and emotionally. There are various types of menstrual disorders and these include:
Specific hormonal conditions like PCOS can also result in menstrual disorders.
In a range of different studies conducted in different African countries, it has been estimated that between 50% to 90% of women in Africa are affected by dysmenorrhea, 20% to 30% experience irregular menstruation and over 93.8% experience premenstrual stress symptoms. [11, 12, 13]
Menstrual disorders affect the quality of life of African women. Although there are regional variations based on educational levels, cultural perceptions and access to healthcare but the occurrence of menstrual disorders in African women is generally high.
Related: Demystifying the Menstrual cycle for African women
These are disorders or diseases that occur as a result of excess or low secretion of thyroid hormones and a change in the size of the thyroid gland. Various types of thyroid disorders include;
The thyroid gland has a big effect on a female reproductive system, it can cause problems when it is overactive [hyperthyroid] or underactive [hypothyroid] leading to an imbalance in hormonal levels which in turn affect puberty, menstruation, fertility, pregnancy and the postpartum period. [14]
Hyperthyroidism
Hypothyroidism
How Common are Thyroid Disorders in African Women?
Hyperthyroidism and Hypothyroidism are notably more common in women than men, [15] and Graves’ disease is more prevalent among women aged 20 to 50 years. Thyroid disorders pose considerable health challenges for women in Africa due to nutritional deficiencies [lack of Iodine], and autoimmune disorders.
Related: Hyperthyroidism in Nigeria: Causes, Symptoms, Diagnosis and Treatment and Hypothyroidism in Nigeria: Symptoms and Treatment
These are disorders that occur as a result of the adrenal glands producing too much or too little hormones such as cortisol, adrenaline, and aldosterone. Common adrenal disorders are Addison’s disease [adrenal insufficiency], Adrenal gland suppression due to drug use, Cushing’s syndrome [high level of cortisol in the body], and Congenital Adrenal Hyperplasia.
Adrenal disorders such as Addison’s disease can affect the menstrual cycle of women and reduce libido due to the imbalance in the hormones produced by the adrenal gland.
Cushing’s syndrome can result in facial hair growth and irregular menstrual cycles among other symptoms.
Congenital Adrenal Hyperplasia results in hirsutism, acne, irregular periods and infertility, weight gain and psychological effects.
Cushing’s syndrome
Addison's disease
Data on the prevalence of adrenal disorders in Africa generally and in African women specifically is limited and underreported. Tuberculosis and autoimmune diseases have an impact on adrenal insufficiency. More research is needed on this subject.
This is a bone disease that develops when the structure and strength of the bone changes. This can lead to a decrease in bone strength that increases the risk of fractures [broken bones]. [16]
Osteoporosis is much more common in women [especially postmenopausal women] than men. This is due to reasons such as:
1. Women tend to consume less amounts of calcium than men,
2. Women have lesser amount of minerals [i.e., calcium and phosphorus] in the bone,
3. Pregnancy and breastfeeding reduces the amount of minerals in a woman's bone unless she consumes enough calcium during the period of pregnancy and breastfeeding.
Osteoporosis in women can occur as a result of hormone changes as seen for example in the low levels of oestrogen in women after menopause, low levels of oestrogen from the absence of menstrual periods in premenopausal women and due to hormone disorders such as Cushing's syndrome that is associated with high level of the hormone cortisol. However, the link between oestrogen, cortisol and osteoporosis may not be a direct cause and effect relationship.
Osteoporosis in African women is generally believed to be lower than their Western counterparts, due to their high bone mineral density. But this does not mean that African women do not have the disorder. [17] There is however a limited data on the prevalence of osteoporosis in African women, especially in Sub-Saharan Africa.
Risk factors such as nutritional deficiencies, lactose intolerance, physical activity and health disparities are considered to affect the prevalence of osteoporosis in African women. Disparity exists however between rates of osteoporosis in regions of Africa.
A 2016 report drew attention to the low rate of osteoporosis in non-dairy farming regions of West Africa compared to the high osteoporosis rate found in dairy farming East Africa and proposed a hypothesis based on the differential levels of lactase persistence genotype to explain this disparity. [18]
Hormone-linked disorders pose a serious risk to the health of women and the prevalence of these disorders in African women is a significant public health concern.
Hormone-linked disorders are influenced by various factors that include genetic, cancers, infections, environmental, lifestyle, socio-economic and cultural. There is a need to create awareness and proper public health strategies to deal with hormone-linked disorders in African women.
REFERENCES
1. Lewis SL, Bucher L, Heitkemper MM, Harding MM, Kwong J & Roberts D. Female Reproductive and Genital Problems. In: Medical – Surgical Nursing: Assessment and Management of Clinical Problems. St Louis Missouri: Elesevier: 2017.p.1255
2. Oriji KO, Onwuegbulam C. Prevalence of PolyCystic Ovarian Syndrome [PCOS] Among Infertile Women Attending Fertility Clinic at a University Teaching Hospital in Nigeria. J Gynecol Women's Health. 2019: 15[5]: 555922. Doi: 10.19080/JGWH.2019.15.555922. Available from here.
3. World Health Organization. Polycystic Ovary Syndrome. [Internet] 28 June 2023. [Accessed 31 July 2024]. Available from here.
4. Watson JE, Royle RJ. Disorders of the Reproductive System. In: Watson’s Medical – Surgical and Related Physiology. London: Bailliere Tindall; 1987.p.903 – 904
5. Alemany M. Estrogens and the Regulation of Glucose Metabolism. World J Diabetes. 2021 Oct 15;12(10):1622-1654. doi: 10.4239/wjd.v12.i10.1622. Available from here.
6. Goedecke JH, Mtintsilana A, Dlamini SN, Kengne JP. Type 2 diabetes mellitus in African women. Diabetes Res Clin Practice. 2017 Jan;123:87-96. doi: 10.1016/j.diabres.2016.11.017. Available from here.
7. Watson JE, Royle RJ. Nursing in Disorders of the Breast. In: Watson’s Medical – Surgical and Related Physiology. London: Bailliere Tindall; 1987. P.945 – 947
8. Lamptey – Cleggy J. Epidemiology of Breast Cancer in Africa. European Society for Medical Oncology [Internet, n.d.]. [Accessed 31 July 2024]. Available from here.
9. Edzie EKM, Dzefi-Tettey K, Brakohiapa EK, Quarshie F, Ken-Amoah S, Cudjie O, et al. Age of first diagnosis and incidence rate of uterine fibroids in Ghana. A retrospective cohort study. PLoS ONE 18(3): e0283201. doi: 10.1371/journal.pone.0283201. Available from here.
10. Gerais AS, Rushan H. Infertility in Africa. Popul Sci. 1992 July; 12: 25-46. Available from here.
11. Igbokwe UC, John-Akinola YO. Knowledge of Menstrual Disorders and Health Seeking Behavior Among Female Students of University of Ibadan, Nigeria. Ann Ib Postgrad Med. 2021 Jun;19(1):40-48. Available from here.
12. Odongo E, Byamugisha J, Ajeani J, et al. Prevalence and Effects of Menstrual Disorders on Quality of Life of Female Undergraduate Students in Makerere University College of Health Sciences, a cross sectional survey. BMC Women's Health. 2023 Mar 30;23(1):152. doi: 10.1186/s12905-023-02290-7. Available from here.
13. Ayamolowo LB, Ayamolowo SJ, Olayinka EO, Olowokere AE. Prevalence of Menstrual Disorders and Self-Care Practices Among Female Undergraduates in a South-Western Tertiary Institution, Nigeria. Int J Reprod Contracept OBstet Gynecol 2024; 13: 817-25. Doi: 10.18203/2320-1770.ijrcog20240771. Available from here.
14. John Hopkins Medicine. Thyroid disorders in women. [Internet, n.d.]. 2024 [Accessed 31 July 2024] .Available from here.
15. Sidibe El H. Thyreopathies en Afrique Subsaharienne [Thyroid Diseases in Sub-Saharan Africa]. Sante.2007 Jan-Mar;17[1]:33-9.French. English abstract available from here.
16. NIH. National Institute of Arthritis and Musculoskeletal and Skin Diseases: Osteoporosis. [Internet]. Last reviewed December 2022 [Accessed 31 July 2024]. Available from here.
17. Aloia JF, Vaswani A, Yeh JK, Flaster E. Risk for osteoporosis in black women. Calcif Tissue Int. 1996 Dec;59(6):415-23. doi: 10.1007/BF00369203. Available from here.
18, Hilliard CB. High osteoporosis risk among East Africans linked to lactase persistence genotype. Bonekey Rep. 2016 Jun 29;5:803. doi: 10.1038/bonekey.2016.30. Available from here.
Additional Related Sources
Management of type two Diabetes in Nigeria
Goiter in Nigeria: What you need to know
Published: September 19, 2024
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