Bridging the Gap: Addressing Women's Health in the Middle East
Women’s health in the Middle East, particularly in the context of hormonal disorders, remains a critically underserved area in public health. Despite advances in endocrinology and women-centered healthcare, many women in the region face delayed diagnoses, limited access to specialized care, and a lack of culturally competent health services. Factors such as underfunded research, gender disparities in clinical trials, and limited access to femtech innovations contribute to these persistent healthcare inequalities. This article explores the urgent need for gender-sensitive healthcare reforms and integrated care models that center around the unique needs of women in the MENA region.
Understanding Hormonal Conditions
Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS) is a common and complex endocrine disorder that affects an estimated 6–13% of women of reproductive age globally, with up to 70% of cases remaining undiagnosed, according to the World Health Organization (WHO). It is primarily characterized by a triad of symptoms: irregular or absent menstrual cycles (oligo- or amenorrhea), clinical and/or biochemical signs of hyperandrogenism (such as acne, hirsutism, or hair loss), and polycystic ovarian morphology visible on ultrasound. Beyond reproductive concerns, PCOS is associated with a wide range of metabolic disturbances, including insulin resistance, obesity, dyslipidemia, and an increased risk of type 2 diabetes and cardiovascular disease. The condition also has significant psychological implications, with elevated risks of anxiety, depression, and body image disturbances.
The exact etiology of PCOS remains unclear, but it is understood to result from a multifactorial interplay of genetic predispositions, hormonal imbalances, insulin resistance, and environmental influences such as lifestyle and diet. Addressing PCOS as a public health issue necessitates a holistic approach that includes early detection through routine screening, increased public and clinical awareness, and interventions centered around lifestyle modifications, particularly nutrition, physical activity, and mental health support. Comprehensive care can help mitigate long-term complications and improve quality of life for individuals affected by PCOS.
Thyroid Disorders
Thyroid disorders occur when the thyroid gland, a small but vital endocrine organ located in the neck, produces too much or too little thyroid hormone. These hormones regulate essential bodily functions including metabolism, heart rate, menstrual cycles, and mood. Hypothyroidism, or underactive thyroid, can lead to fatigue, weight gain, depression, irregular periods, and fertility issues. Hyperthyroidism, or overactive thyroid, may cause anxiety, weight loss, heat intolerance, and menstrual disturbances. Women are disproportionately affected by thyroid conditions, particularly during reproductive years, with approximately 1 in 8 women (around 12%) experiencing a thyroid disorder in their lifetime (American Thyroid Association). Despite their prevalence, thyroid disorders are frequently misattributed to stress or lifestyle factors, resulting in delayed diagnosis and inadequate management, especially in health systems where routine hormonal screening is not prioritized. In Gulf countries, routine thyroid screening in women remains rare despite high prevalence rates.
Endometriosis
Endometriosis involves the growth of endometrial-like tissue outside the uterus, causing chronic pelvic pain, heavy menstruation, and infertility. Approximately 10% of women worldwide are affected. Despite its prevalence, the average time to diagnosis can span 7 to 10 years, largely due to the normalization of menstrual pain, the variability of symptoms, and a general lack of awareness among both patients and healthcare providers. The cause of endometriosis is still not fully understood, but several theories exist, including retrograde menstruation, immune system dysfunction, genetic predisposition, and coelomic metaplasia. Treatment approaches may include hormonal therapies, pain management, surgical removal of lesions, and lifestyle adjustments.
Premenstrual Dysphoric Disorder (PMDD)
Premenstrual Dysphoric Disorder (PMDD) is a distinct and severe psychiatric condition affecting about 3% to 8% of women of reproductive age, characterized by intense emotional and physical symptoms that significantly disrupt daily life. PMDD is often underdiagnosed due to lack of clinical awareness, the need for prospective symptom monitoring, and frequent misdiagnosis as anxiety or depression. Cultural silence around menstrual mental health also plays a role in delayed diagnosis especially in regions where such topics remain stigmatized.
Systemic Gaps in Healthcare
1. Diagnostic Delays and Misdiagnosis
Women in the Middle East often experience significant delays in receiving accurate diagnoses for hormonal conditions. Healthcare systems in the Middle East often overlook broader health challenges beyond reproductive health issues. As a result, hormonal disorders such as PCOS, endometriosis, and PMDD remain underdiagnosed and underfunded. For example, many women with endometriosis see multiple physicians over several years before receiving a correct diagnosis. Such delays or misdiagnoses allow these chronic conditions to worsen over time, increasing symptom severity and complicating treatment. Early detection, by contrast, enables more effective management, reducing long-term health impacts and improving quality of life.
2. A Reactive, Not Preventive, Approach to Care
A major systemic issue in hormonal healthcare across the region is the predominantly reactive nature of health service delivery. Women often receive care only once their symptoms have significantly worsened or once it has impacted fertility, rather than benefiting from early intervention. Preventive approaches, such as screening adolescents for PCOS, routine thyroid testing in women of reproductive age, or education on menstrual health in schools, are largely absent from national health strategies. This reactive model not only delays care but also leads to avoidable complications, higher healthcare costs, and reduced quality of life. Shifting to a preventive, holistic care model would allow for earlier detection, lifestyle-based interventions, and sustained support, significantly improving long-term outcomes.
3. Cultural and Societal Stigmas
Deep-rooted cultural beliefs and societal norms contribute to the stigmatization of menstrual and reproductive health issues. Many women hesitate to seek medical help due to fear of judgment or misunderstanding. In many cultures in the Middle East, discussing topics like menstruation, contraception, or menopause is considered uncomfortable and/or “taboo”. This stigma particularly affects conditions like PMDD, where emotional symptoms are often dismissed.
4. Underfunded Research, Lack of Funding for FemTech Startups, and Data Gaps
Research into women's hormonal health is underfunded, resulting in a lack of region-specific data. This deficiency hampers the development of targeted interventions and policies. For example, while PCOS is prevalent, comprehensive studies detailing its impact in Middle Eastern populations are scarce. According to Public Health Specialists, women’s health has been severely underfunded and deprioritized in the region for far too long. One article cites that approximately four women go undiagnosed for every woman diagnosed with a women’s health-related condition. Furthermore, globally, only 1% of healthcare research and innovation funding is allocated to female-specific conditions beyond oncology.
While the femtech industry booms, projected to reach $3.8 billion in the UAE alone by 2031, funding gaps continue to persist for women-led startups, especially those focused on women’s health, in the MENA region.
5. Gender Bias in Medical Practice
Gender bias in healthcare begins with the historical exclusion of women from clinical trials and medical research, often justified by concerns about safety particularly for pregnant women, and the variability of female hormones potentially skewing study results. As a consequence, much of clinical knowledge and treatment guidelines have been developed primarily from studies conducted on men. This has led to a persistent lack of understanding of women’s unique health concerns and symptom presentations. These gaps in research and clinical practice contribute to substantial delays in diagnosis and treatment for women, who on average face diagnostic delays nearly four years longer than men.
Initiatives and Innovations
1. Digital Health Platforms
As healthcare systems across the Middle East continue to face structural and cultural barriers in addressing women’s hormonal health, digital health platforms are emerging as powerful tools to help bridge the gap. These platforms have the potential to overcome challenges related to access, stigma, and continuity of care by offering on-demand, user-centered support that extends beyond traditional clinical settings.
Digital solutions can play a transformative role by enhancing early awareness, empowering women with evidence-based education, and providing tools for personalized symptom tracking. For many hormonal conditions, such as PCOS, PMDD, endometriosis, and thyroid disorders symptoms are chronic, cyclical, and nuanced. As a result, women often struggle to communicate the full scope of their experience in short clinical encounters. Digital platforms can fill this gap by enabling longitudinal monitoring, supporting lifestyle interventions such as stress reduction, nutrition, and sleep hygiene, and fostering greater self-awareness and agency.
Moreover, in societies where discussions of reproductive and menstrual health are often considered taboo, these platforms offer a private and stigma-free space for learning, reflection, and self-management. When thoughtfully designed, they can also address linguistic and cultural barriers, offering regionally relevant content that resonates with users’ lived experiences.
Recognizing the need for more localized, science-based digital tools, we are currently developing Ayla, a holistic wellness app tailored for women in the Middle East navigating PCOS and other hormonal health challenges. Drawing from lived experience and public health expertise, Ayla aims to bridge the knowledge and support gaps through culturally sensitive education, personalized symptom tracking, and AI-driven insights. While still in development, Ayla reflects a growing movement toward patient-centered innovation in women’s health and represents a new direction for how hormonal care can be delivered more equitably across the region.
2. Awareness Campaigns
Efforts to raise awareness about hormonal health are crucial. Educational campaigns can challenge stigmas, encourage early diagnosis, and promote healthier lifestyles. Historically, women in the region have reported limited exposure to reliable information about hormonal disorders, both in formal education systems and public health messaging. As a result, many women normalize debilitating symptoms such as chronic pelvic pain, severe premenstrual mood changes, or irregular periods and delay seeking care. This delay contributes significantly to underdiagnosis and poor health outcomes. While some countries in the region have initiated women’s health campaigns, most focus narrowly on maternal health or breast cancer screening, with little attention to chronic, non-life-threatening yet quality-of-life-impacting hormonal conditions. Comprehensive awareness campaigns are urgently needed to fill this gap.
3. Policy Reforms
Governments and health authorities must prioritize women's health by allocating funds for research, training healthcare professionals, and developing comprehensive care models. There have been several policy reforms and government initiatives implemented in recent years to address these challenges, with plans to further the women’s health movement in the near future. For instance, the UAE’s National Policy for the Promotion of Women’s Health, launched in 2024, aims to reduce cancer deaths and overall female mortality, cut medical issues from obesity, and reinform innovation and research capacity in women’s health by the use of data and promoting and researching initiatives and interventions. It builds on the UAE National Strategy for Empowerment of Emirati Women which also focuses on providing healthcare services to enhance physical and psychological health and ensure universal access to sexual and reproductive health. Saudi Arabia's Vision 2030 also emphasises advancements in women's health, through initiation of its Healthcare Transformation Program to create a universal and integrated healthcare system, key initiatives of which include free breast cancer screening for women over the age of 40. However, these policies still lack targeted strategies for managing chronic hormonal disorders that affect a large portion of the female population, conditions that often remain invisible in national health planning.
Recommendations
1. Strengthen Medical Education and Clinical Guidelines
Equip healthcare professionals with updated, evidence-based training on hormonal disorders, including their psychological and metabolic dimensions. Clear diagnostic protocols and referral pathways should be implemented to reduce misdiagnosis and ensure early intervention.
2. Integrate Holistic Wellness into Care Models
Shift from a disease-centered model to one that incorporates nutrition, movement, stress management, sleep hygiene, and emotional well-being into care plans. Women with hormonal conditions benefit significantly from lifestyle-based interventions alongside medical treatment. Public health systems should collaborate with nutritionists, psychologists, fitness experts, and alternative medicine practitioners to provide comprehensive, culturally sensitive care.
3. Improve Financial Accessibility
Integrate comprehensive women’s health care; including screening, diagnosis, and ongoing management of conditions like PCOS and endometriosis; into both public and private health insurance plans. Subsidize essential diagnostic tests (e.g., ultrasounds, hormonal panels, laparoscopies) and fertility-related services to ensure affordability across income levels. Expanding insurance coverage and government-backed health initiatives can reduce financial barriers, promote early detection, and improve long-term outcomes
4. Expand Mental Health Support Services
Acknowledge the psychological burden of living with chronic hormonal conditions by expanding access to mental health professionals and destigmatizing therapy. Include services such as cognitive-behavioral therapy, group support programs, and menstrual health education in primary care settings.
5. Leverage Digital Health and Community Tools
Encourage the development and integration of personalized, culturally relevant digital health tools, such as mobile apps and online platforms that can support self-management, health education, and community building.
Conclusion
Hormonal health equity is critical to improving women's well-being across the Middle East. By investing in digital innovation, evidence-based care, and culturally sensitive public health policy, stakeholders can transform how women experience, manage, and overcome hormonal disorders. The time to act is now, before another generation of women is left behind.
Sources:
World Health Organization. (2025, February 7). Polycystic ovary syndrome. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
World Health Organization. (2023, March 24). Endometriosis. https://www.who.int/news-room/fact-sheets/detail/endometriosis
Mayo Clinic. (n.d.). Premenstrual dysphoric disorder: Different from PMS? Retrieved May 21, 2025, from https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd/faq-20058315
Cleveland Clinic. (2024, March 25). Thyroid disease: What it is, causes, symptoms & treatment. https://my.clevelandclinic.org/health/diseases/8541-thyroid-disease
Mikhael, M. (2025, March 6). Women in the Middle East have unique healthcare needs. And it needs more funding and awareness. Fast Company Middle East. https://fastcompanyme.com/impact/how-can-we-meet-the-unique-healthcare-needs-of-women-in-the-middle-east-more-funding-and-awareness/
Banks, S. (2025, January 21). Rapid development of women’s health in Middle East. Pinsent Masons. https://www.pinsentmasons.com/out-law/analysis/rapid-development-of-women-health-middle-east
American Thyroid Association. (2023, May). Thyroid Disease and Women. https://www.thyroid.org/thyroid-disease-women/
