Black and Hispanic women have disproportionately high rates of obesity and type 2 diabetes. However there is a lack of knowledge on race-ethnic differences in reproductive disorders such as polycystic ovary syndrome (PCOS). The objective of this study was to compare the prevalence of reproductive (irregular menses, oligomenorrhea, amenorrhea, infertility) and hyperandrogenic (HA) (hirsutism, acne) disorders in premenopausal women of diverse race-ethnicities with and without PCOS. Premenopausal women aged 18-50 years were identified in outpatient clinics in 2011 (n = 20,836) through retrospective chart review; 1,133 (5.4%) had PCOS. Race-ethnicity was self-reported and classified as: Black, Hispanic, White and Other (i.e. Asian/Pacific Islander, Native American/Alaskan and others). The diagnosis of reproductive and HA disorders was determined from the patient’s chart. Statistical analyses for comparisons of groups included Chi² test, analysis of covariance (ANCOVA) and logistic regression (alpha = 0.05) (SAS v9.1). After adjusting for age and body mass index (BMI), overall, Black women had the highest burden of reproductive and HA disorders compared to other groups: irregular menses 8%, amenorrhea 5%, infertility 4%, hirsutism 2%, and acne 7% (p < 0.05, for all). Among women with PCOS, Black women consistently had the highest rates of reproductive and HA disorders including irregular menses (31%), amenorrhea (26%), infertility (19%), and hirsutism (17%) (p < 0.05, for all). Among women without PCOS, reproductive and HA disorders were low in all race-ethnicities (≤ 7%). Black women had the highest rates of irregular menses (7%) and acne (7%), while Other women had the highest rates of infertility (4%) (p < 0.05, for all). In conclusion, Black women with and without PCOS were diagnosed with more reproductive dysfunction than women of other race-ethnicities. Black women may be particularly susceptible to developing PCOS and may have more severe reproductive and HA phenotypes than women of other race-ethnicities.