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- Herausgeber: John Wiley & Sons
- Kategorie: Ratgeber
- Sprache: Englisch
Answers to your questions about polycystic ovarian syndrome
PCOS For Dummies, 2nd Edition is a trustworthy resource for information on polycystic ovarian syndrome, a condition caused by hormone imbalance. Many cases of PCOS go undiagnosed—learn to spot the symptoms and get tested. If you've been diagnosed, this book helps you consider available treatment options, including both traditional medical treatments and alternative therapies. It also debunks common myths and misinformation. This reliable guide helps you manage symptoms, reduce your risk of complications, and find a path forward.
Inside:
- Learn about PCOS, including symptoms, causes, treatments, and long-term effects
- Find doctors and organizations that can support you on your health journey
- Find out what diet and lifestyle changes you can make to reduce symptoms and feel your best
- Discover new medications, fertility treatments, and more for PCOS
Anyone living with PCOS—or supporting a loved one who has it—can benefit from PCOS For Dummies, 2nd Editon.
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Veröffentlichungsjahr: 2026
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PCOS For Dummies®
To view this book's Cheat Sheet, simply go to www.dummies.com and search for “PCOS For Dummies Cheat Sheet” in the Search box.
Table of Contents
Cover
Table of Contents
Title Page
Copyright
Introduction
About This Book
Foolish Assumptions
Icons Used in This Book
Beyond the Book
Where to Go from Here
Part 1: Getting Started with PCOS
Chapter 1: Sensible Solutions for a Difficult Condition
Understanding PCOS
Taking Your First Steps toward Living with PCOS
Planning a Three-Pronged Attack
Trying Medications and More
Living a Lifetime with PCOS
Chapter 2: Identifying Potential Signs of PCOS
Recognizing Common Symptoms and Side Effects of PCOS
PCOS through Life’s Changes
Seeing Your Doctor for a Diagnosis
Part 2: Taking Control of Your Symptoms
Chapter 3: Coping with Insulin Resistance and Its Effects
Defining Insulin Resistance
Diagnosing Insulin Resistance
Diabetes and Insulin Resistance
Developing Type 2 Diabetes
Metabolic Syndrome: Insulin Resistance Plus a Whole Lot More
Chapter 4: Eating Healthfully
Identifying the Ideal Diet for PCOS
Exploring Proteins, Fats, and Carbohydrates
Fighting Inflammation through Diet
Reducing Your Cancer Risk through Diet
Taking Care of Your Heart
Chapter 5: Waving Goodbye to Extra Weight
Deciding How Much to Lose
Considering Key Factors — Before You Begin to Trim
Following a Weight-Loss Diet
Avoiding Food Addiction and Cravings
Dieting Do’s and Don’ts
Staying Strong When the Going Gets Tough
Chapter 6: Getting Physical
Searching for Reasons to Get Physical
Setting Ground Rules before You Start
Not All Exercise Is the Same
Eating for Exercise
Chapter 7: Taking Medications
Following the Current Medical Approach
Treating Insulin Resistance
Reducing Blood Glucose Levels
Regulating Periods with Oral Contraceptives
Treating Acne and Hairiness
Stopping Endometrial Buildup
Treating Weight Loss and Obesity
Chapter 8: Giving Alternative Treatments a Shot
Supplements: Taking Care Not to Overdo It
Taking a Leaf from Herbal Medicine
Trying Complementary Therapies
Avoiding Alternative Diets
Chapter 9: Balancing Body, Mind, and Spirit
Psyching Up for the Task
Managing the Holistic Balancing Act
Talking about It
Part 3: PCOS’s Effects on Menstrual Cycles, Fertility, and Pregnancy
Chapter 10: Tracking Your Periods: How PCOS Affects the Menstrual Cycle
Reviewing the Menstrual Cycle
Identifying the Effects of Hormone Changes in PCOS
Recognizing Abnormal Periods
Dealing with Ovulation Problems
Chapter 11: Getting Pregnant: Infertility Treatments for PCOS
Taking Some Initial Steps on Your Own
Seeing Your Doctor
Examining You (and Your Partner) with Tests
Using Medications to Improve Fertility
Moving On to a Fertility Specialist
Going through Fertility Treatment
Evaluating Types of Fertility Procedures
Coping with Disappointment
Chapter 12: Pregnancy Complications and PCOS
Choosing a Doctor
Getting the Nutrients You Need to Prevent Pregnancy Complications
Early Pregnancy Complications and PCOS
Dealing with Diabetes
Handling High Blood Pressure and Gestational Hypertension
Preterm Delivery
Part 4: The Part of Tens
Chapter 13: Ten Signs to Avoid a Diet
It Excludes Certain Foods
It Lets You Eat Only a Few Foods
It’s High in One Particular Food Element
It Relies on Taking a Supplement or a Particular Substance
It Says You Have to Eat Loads of a Particular Food
It’s Very Low in Calories
It Has Strict Rules on What You Can and Can’t Eat
Your Family and Friends Wouldn’t Touch It
You Can Eat Too Much of a Good Thing: Protein
You Can’t Follow It for Life
Chapter 14: Ten PCOS “Superfoods”
Whole-Grain Breakfast Cereals
Whole-Wheat Pasta
Sweet Potatoes
Beans
Lentils
Nuts and Seeds
Berries
Yogurt
Green Vegetables
Sardines
Chapter 15: Ten Ways to Eat Mindfully
Take Pleasure in Planning Your Meals and Snacks
Don’t Prepare Meals at the Last Minute
Enjoy Preparing Your Food — and Get Creative
Set a Place for Yourself to Eat
Notice Each Mouthful While You Eat
Allow Yourself Enough Time to Eat
Focus on Your Food (and Avoid Distractions)
Ensure Your Food Is Nourishing
Remember What You Ate
Pay Attention to When You Finish
Chapter 16: Ten (Plus 2!) Sources of Information and Support
Polycystic Ovarian Syndrome Association
WomensHealth.gov
The American College of Obstetricians & Gynecologists
American Association of Clinical Endocrinologists
American Association of Gynecologic Laporoscopists
The American Society for Reproductive Medicine
SoulCysters
Reddit PCOS Forum
Verity
PubMed
Other PCOS Sufferers’ Blogs
Your Medical Providers
Index
About the Authors
Dedication
Author’s Acknowledgments
Connect with Dummies
End User License Agreement
List of Tables
Chapter 4
TABLE 4-1 Anti-Inflammatory Foods and Inflammatory Foods
Chapter 5
TABLE 5-1 Recommended BMI Chart
TABLE 5-2 Rapidly Absorbed Low-Cal Foods and High-Cal/Slow-Release Carbs
TABLE 5-3 Weight Maintenance/Loss: Recommended Daily Amounts
TABLE 5-4 Recommended Food Portions on a 1,500-Calorie Diet
TABLE 5-5 Spread of Portions for Each Meal
TABLE 5-6 Recommended Body Fat Percentages for Women
TABLE 5-7 Energy Density of Foods
Chapter 6
TABLE 6-1 Energy Costs of Various Activities
TABLE 6-2 Barriers to Physical Activity and How to Overcome Them
Chapter 7
TABLE 7-1 PCOS Symptoms and Treatments
Chapter 8
TABLE 8-1 Complementary Therapies Potentially Helpful in PCOS
Chapter 9
TABLE 9-1 Ways to Stick to Your Weight-Loss Goals
TABLE 9-2 Lifestyle Change Excuses and Solutions
Chapter 11
TABLE 11-1 Success Rates of IVF Based on Age
Chapter 13
TABLE 13-1 Food Groups and What They Provide
TABLE 13-2 What Can Happen If You Overconsume Certain Foods
TABLE 13-3 Substances That Claim to Aid Weight Loss
List of Illustrations
Chapter 5
FIGURE 5-1: A dinner plate that has healthy portions of vegetables, proteins, a...
Chapter 10
FIGURE 10-1: The menstrual cycle involves a complex interplay between hormones.
FIGURE 10-2: The ovaries in women who have PCOS contain many small cysts.
Guide
Cover
Table of Contents
Title Page
Copyright
Begin Reading
Index
About the Authors
Dedication
Author’s Acknowledgments
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PCOS For Dummies®, 2nd Edition
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Introduction
When you’re first diagnosed with polycystic ovary syndrome (PCOS), you may have a million questions about how this disorder will affect your life. No one wants a disease that doesn’t have a cure! However, the good news is that you can, with work, keep your PCOS symptoms more or less completely at bay. You can’t control the symptoms simply by taking a pill or two — you have to put in the effort yourself, and you’re not going to see results overnight. But you get some huge rewards — you get your life back, and you feel so much healthier that you don’t want to return to your old lifestyle.
Put simply, you need to live a healthy life to keep PCOS under control. Lose any excess weight, get fit, reduce stress, and eat food that’s going to give your body the biggest bang for the buck. In some cases, medications can help prevent complications and get your symptoms under control.
For many women who have PCOS, pregnancy is a huge concern. Getting pregnant may not be as easy for you as it is for some women, but this book gives you all the info you need on the help that’s out there. If you need fertility treatments, we give you the basic rundown on what to expect.
You may have looked up PCOS online or leafed through a few books about it. You may even have read articles about it in popular magazines, or read about some celebrity who cured herself by eating nothing but peanut butter sandwiches. What’s a woman to do when faced with the garden of misinformation, half-truths, and dire predictions about PCOS available 24/7 online and elsewhere?
This book gives you advice that’s down to earth (but based on expert research and recommendations) and up to date. It tells you what has worked and what hasn’t for PCOS sufferers and takes you through what you can do for yourself to help reduce your PCOS symptoms, as well as what medical treatments are available for PCOS. Being able to discuss your medical condition knowledgably with your doctor helps you to be a proactive patient.
About This Book
The great thing about For Dummies books is that you don’t have to read them all the way through. This is a reference book, something you can dig into until you find just the information that you need when you need it. You can simply turn to the bit you want — a chapter, a section, even just a paragraph. The Table of Contents and the Index can help you find exactly what information you’re looking for. We organize the book into these four parts to help you navigate living with PCOS:
Part 1: Getting Started with PCOS:
When you’re initially diagnosed with any condition, the first order of business is getting a good enough understanding so that (1) you’re not terrified or panicky and (2) you can make good decisions about how to take care of your health. So, in this part, we give you basic information about PCOS: what it is, what causes it, what symptoms may accompany it, what changes you can expect while you age, and — most importantly — how you can take control and manage it.
Part 2: Taking Control of Your Symptoms:
In this part, we talk in more depth about the underlying causes of PCOS so that you know what you’re dealing with and how to approach taking control. Then it’s time to discuss all the nitty-gritty topics of everyday life — diet, exercise, medications, supplements, and keeping your mind and body balanced so you don’t go over the edge dealing with it all.
Part 3: PCOS’s Effects on Menstrual Cycles, Fertility, and Pregnancy:
PCOS can really turn your hormonal life upside down, and your menstrual cycle and fertility can take a beating in the process. This part shows you how to turn your menstrual cycle right-side up again and discusses fertility issues that can loom large when you have PCOS. We also look at the effects of PCOS on pregnancy and give you tips on how to get pregnant, with or without medical help, and how to deliver a healthy baby at the end of it all.
Part 4: The Part of Tens:
In this part, you can discover how to distinguish the good diets from the bad and identify ten superfoods that you can incorporate into your diet to help reduce your PCOS symptoms. We also talk about how to eat mindfully, which can help you appreciate your food more and eat more healthily. Finally, the last chapter lists ten sources of support and advice for people who have PCOS or have a close friend or relative who has it.
Foolish Assumptions
We wrote this book with a particular reader in mind — you. And so we made a few basic assumptions about you:
You’re not a doctor, so you don’t have (or want) really technical understanding about the PCOS condition, but you do want to get a basic understanding of it.
You — or your friend, loved one, or relative — have PCOS, and you want to know how to reduce the symptoms so that you can see an improvement in quality of life.
You’re confused about the right dietary and exercise route to take to help reduce your symptoms.
You’re dissatisfied with quick fixes, fads, and wonder diets and treatments; and you need a realistic alternative that works.
You want straight-talking, understandable information. You want to find out about possible complications and issues that women who have PCOS face so that you can deal with them intelligently, but you don’t need to become an expert on PCOS.
You may want to get pregnant, either now or at a later point, and have heard that women who have PCOS can struggle to get pregnant.
You don’t want to spend hours digging around for information, but you do want a one-stop shop that cuts to the chase but doesn’t mislead you.
Icons Used in This Book
Icons are a handy way to catch your attention while you slide your eyes down the page. We use the following icons, and each has its own unique symbol and meaning.
This icon draws your attention to an important point to keep in mind when dealing with PCOS.
These details add to your understanding of PCOS. You can get on in life perfectly fine without them, so skip them if you want to. But try a few first — they may give you some facts that can help you answer the questions on obscure quiz shows!
The Tip icon does exactly what it says — cherish these little nuggets because they’re there to make your life a little easier.
This icon points to certain pitfalls or things that may actually harm you. Ignore at your peril!
Beyond the Book
In addition to all the information, guidance, and resources related to living with PCOS that this book provides, you can find even more information at Dummies.com. Check out this book’s online Cheat Sheet: Just go to www.dummies.com and search for “PCOS For Dummies Cheat Sheet.”
Where to Go from Here
Where to go from here? Wherever you like! You certainly don’t need to read from cover to cover (unless you like to follow tradition). You can dive right in anywhere in the book because each chapter (and even each section) delivers a complete message. The Table of Contents can help you pinpoint the topic that you want to know more about.
For example, if you want to know more about exercising to achieve weight loss, go straight to Chapter 5. If pregnancy is foremost on your mind, jump in at Chapter 11. If you’re really not sure where to start, read Chapter 1, which gives you all the basic information about PCOS and helps you decide which area you want to home in on next.
Part 1
Getting Started with PCOS
IN THIS PART …
Understand what it means to have PCOS.
Determine whether you really have PCOS and recognize the symptoms.
Chapter 1
Sensible Solutions for a Difficult Condition
IN THIS CHAPTER
Understanding PCOS and its symptoms
Taking the initial steps when you think you may have PCOS
Tackling PCOS through diet, exercise, and emotional well-being
Looking at treatment options
Making changes to help yourself for the long haul
This chapter can help you get on the right course if you suffer — or suspect that you suffer — from polycystic ovary syndrome (PCOS); or if you have a friend, relative, or partner who has the condition and you want a quick overview of the most important things that you need to know about PCOS.
This chapter gives an overview of the entire book, so you get a feel for what PCOS really is, as well as treatments and lifestyle changes aimed at reducing the symptoms.
Note: PCOS may be renamed in the future to metabolic reproductive syndrome, or something similar, so as to better reflect its true nature as a complex, multi-system endocrine disorder, rather than primarily a gynecological condition focused solely on ovarian cysts. Experts believe there is a need to more accurately represent the underlying pathophysiology and systemic implications of the condition, encouraging a more comprehensive approach to management and research. The new name is expected to be finalized and adopted by the end of 2026, following a global consensus process. The official name change within the International Classification of Diseases (ICD) could take a few more years after that.
Understanding PCOS
Polycystic ovary syndrome (PCOS) is the most common ovarian-function disorder in premenopausal women. Yet, until recently, it was one of the least-understood conditions. Research into the causes and symptoms of PCOS has shown it to have consequences more far-reaching than the obvious physical symptoms; the long-term effects extend into menopause and beyond.
Defining the condition
According to the American Society for Reproductive Medicine, PCOS is defined as having any two of the following signs and symptoms:
Oligo-ovulation
(irregular ovulation) or
anovulation
(a complete lack of ovulation)
Clinical or biochemical signs of high
androgen
(male hormone) levels
Polycystic
ovaries, which means ovaries that have many small cysts (normal ovaries have five or six
follicles,
small, fluid-filled sacs that contain immature eggs), whereas polycystic ovaries have ten or more
The hormones involved in controlling periods and, ultimately, reproduction, are produced in the pituitary gland, located in the brain. In women who have PCOS, two of these hormones — luteinizing hormone (LH) and follicle-stimulating hormone (FSH) — are produced in abnormal proportions. The imbalance of these two hormones prevents the follicles in the ovary from developing properly: The follicles tend to remain small and don’t mature enough to release an egg. As a result, a string of small follicles, or cysts, form on the ovary, giving rise to the characteristic polycystic ovary that gives the disorder its name.
Polycystic ovaries alone can’t lead to a diagnosis of PCOS. If the symptoms of PCOS do develop, that marks the change from simply having symptom-free polycystic ovaries to having PCOS. Around 20 percent of women have polycystic ovaries but no symptoms of PCOS.
PCOS STATISTICS
The rates of PCOS appear to be increasing, which is most likely related to the rise in obesity rates in the United States. Around 68 percent of all adults in the United States are now overweight or obese, and, even more alarming, 20 percent of children ages 6 to 11 and 18 percent of teens are overweight. The potential increase in being overweight, even in children, could herald the development of even more women developing PCOS in the future.
These PCOS statistics offer more on how this disorder affects women of nearly all ages:
Around 5 to 6 million American women and 110 million women worldwide have PCOS.PCOS can start in girls as young as age 11.About 8 to 13 percent of American women of childbearing age have PCOS.Around 50 percent of women who have PCOS don’t know that they have this condition.IT’S IN THE GENES
Researchers in the United States studied 215 mothers of women who have PCOS and compared them with mothers of women who didn’t have PCOS. Results showed that mothers of women who have PCOS themselves had some of the symptoms of PCOS, including high cholesterol levels, insulin resistance, and other metabolic abnormalities associated with PCOS.
In addition, a high proportion of these mothers who had daughters who have PCOS reported that they had had menstrual irregularities. Those mothers who reported menstrual problems had higher male hormone levels than those who didn’t report irregularities.
All this data points to the fact that the mothers of daughters who have PCOS have a much higher incidence of PCOS symptoms than mothers of non-PCOS daughters. Whether the mothers were diagnosed with PCOS or not, the data suggests that PCOS has a genetic tendency.
Knowing you’re at risk
Researchers haven’t yet identified the exact cause of PCOS, but certain conditions do predispose women to developing it:
Being obese, especially if obesity began before puberty:
Being overweight before puberty appears to increase male androgen levels.
Elevated insulin levels:
High insulin levels stimulate increased male hormone production.
Genetics:
You’re at increased risk if your mother or sister has the condition or if your father has female family members who have PCOS.
Here are the stats showing the genetic tendency toward PCOS (you can read more about this link in the sidebar “It’s in the genes,” in this chapter):
Twenty to forty percent of PCOS sufferers have mothers who also have PCOS.
Women may also inherit the tendency to develop PCOS from their father.
One study showed that 20 percent of women who had PCOS had relatives on both sides of their family who had PCOS.
In another study, 77 percent of women who had PCOS had a close relative who also had PCOS; 50 percent had a mother or sister who had the disorder, and 25 percent had a maternal or paternal aunt who had PCOS.
As many as 20 to 30 percent of women who have PCOS are at normal weight, a condition called
lean PCOS.
Additionally, studies have shown that women with PCOS have multiple genes associated with insulin resistance, abnormal ovarian and adrenal production, and other enzyme abnormalities.
Research hasn’t identified a single gene responsible for PCOS. Developing PCOS may be a complex issue that involves genetic, environmental, and lifestyle components, such as early diet.
The most common PCOS symptoms include the following:
Weight gain, especially around the belly:
Turn to
Chapter 2
for more on the causes and effects of weight gain in women who have PCOS, and check out
Chapter 5
for help with losing weight.
Increased hairiness on the face and other regions (called
hirsutism
):
Excess
androgens
(male hormones) cause these symptoms. We talk more about the effects and treatments of excess hair where you don’t want it in
Chapter 2
.
Male pattern baldness or thinning hair:
Chapter 2
also talks about this symptom, another side effect of increased male hormones.
Oily skin with acne:
Another side effect of androgen production that we cover it in greater detail in
Chapter 2
.
Absent or irregular menstrual cycles:
This condition can lead to infertility. You can find out more about the issues of the menstrual cycle in
Chapter 10
and ways to improve fertility in
Chapter 11
.
Insulin resistance:
Being
insulin resistant
means that your body can’t use insulin efficiently. This condition leads to high circulating blood levels of insulin (called
hyperinsulinemia
). High levels of insulin in the blood may cause PCOS symptoms to worsen gradually. If you have insulin resistance, you have a greater chance of being diagnosed with PCOS and also developing type 2 diabetes. See
Chapter 3
for an in-depth discussion of insulin resistance and its role in PCOS.
Taking Your First Steps toward Living with PCOS
If you suspect that you have PCOS, your first reaction may be panic, followed by anger or depression. Without proper care, PCOS can impact nearly every aspect of your life, so fear, anxiety, and worry are normal reactions — but don’t hold onto them for too long! Be proactive in your care by taking positive steps toward improving your health and finding a medical care partner who can guide you on the way.
But also remember, first and foremost, that this is your medical condition and your life. No one has more motivation or more to gain from getting PCOS under control than you do. Take these first steps:
Find a knowledgeable medical practitioner.
This may or may not be your current family doctor or gynecologist. Finding someone who has a real interest in PCOS may take some sleuthing and involvement in support groups (group members normally have the inside track on who’s good at treating the condition), which leads to the next point.
Get involved with a support group.
If you can find support groups in your area, tap into their resources because they’re your best source for competent and concerned medical care. If you have no local support groups, connect with people online.
Chapter 16
has a list of resources on PCOS, including helpful websites if you don’t have any active groups in your area (or you’re not the joining type).
Do your research. Some practitioners may not be up on the latest info on PCOS, so make sure you are. Read everything that you can find online, particularly from reputable organizations such as the American College of Obstetricians and Gynecologists (www.acog.org), The American Association of Gynecologic Laparoscopists (AAGL.org), Mayo Clinic (www.mayoclinic.com), or the Polycystic Ovarian Syndrome Association (www.pcosupport.org).
Take with a grain of salt anything that you read on lesser-known sites — the Internet is home to a number of charlatans with questionable medical practices. Check out applicable books from your library, but pay attention to the publication dates to make sure you’re getting the latest info. Invest in a few well-recommended books (you’re on your way with this one!).
Stay active and involved with life.
PCOS isn’t life-threatening, but it can cause dangerous complications if it gets out of control. Letting PCOS become your whole life is as unproductive as ignoring it completely.
Find ways to cope with stress.
After you’re diagnosed, you may feel some relief because you have confirmation that the symptoms aren’t just in your mind. But then you’re left with the stress of knowing that you have to cope with a long-term condition. Empower yourself by knowing what PCOS is and what you can do about it so that you’re in control — this strategy can help to lessen the emotional frustrations.
Planning a Three-Pronged Attack
Unfortunately, no cure exists for PCOS, but you can control the symptoms so that the effect of PCOS on your body is minimal. To decrease symptoms of PCOS, you need to tackle the following issues:
Improving insulin sensitivity:
This improvement prevents the whole cascade of later problems, such as developing type 2 diabetes and abnormal blood fat levels, which can give rise to heart disease. (See
Chapter 3
for the details on how insulin resistance develops and how it causes many of the symptoms associated with PCOS.)
Restoring normal ovulation, which helps restore normal fertility:
Chapters in
Part 3
tell you how to improve menstrual symptoms and increase your chances of getting pregnant.
Stopping androgen levels in the blood from rising:
Elevated androgen levels can cause the physical symptoms of PCOS, such as acne and hairiness, in addition to interfering with hormones responsible for fertility. (See
Chapter 2
for more in-depth detail on androgen levels and PCOS.)
Although medications may help, you also can do your part by mounting a three-pronged attack with the following tools at your disposal:
Diet:
Follow a diet that allows a steady trickle of
glucose
(a sugar that the body uses for energy) into the bloodstream. Choose wholegrain, high-fiber foods, plenty of fruits and vegetables, and a minimum of processed and sugary foods. See
Chapter 4
for more on a PCOS-friendly diet.
Exercise:
Strive to be more physically active on a day-to-day basis and throughout the day. Exercise both improves mood and helps with weight loss. See
Chapter 6
for more on getting and staying active.
Emotional well-being:
If you lack motivation or are moody and/or depressed, try some techniques for mood lifting and motivation. Maintaining a positive attitude can have a positive effect on your physical, as well as your mental, health.
Chapter 9
offers ways to keep your spirits up while you deal with PCOS, and
Chapter 15
has tips on being mindful of your eating habits.
Even if you’re at a normal weight, research shows that if you have PCOS, you still have a tendency to have higher blood concentrations of insulin compared to women of the same weight who don’t have PCOS. So, eat a balanced diet that releases glucose in a steady way and stay physically active, even if you don’t have a weight problem.
Your doctor, health practitioner, or a dietitian, and you need to tailor your treatment to your lifestyle and the symptoms that you’re experiencing; but you all also need to take into consideration whether you want to get pregnant. If you’re not planning on having a baby just yet, treatment needs to focus on the following issues:
Correcting abnormal hormone levels
Losing weight (or maintaining a healthy weight if you aren’t overweight)
Managing cosmetic concerns (such as increased hairiness where you don’t want hair and the loss of hair on your head where you do want it)
If you’re hoping to get pregnant, treatment needs to focus on
Losing weight to help you ovulate more regularly (because a healthy diet with increased physical activity allows more efficient use of insulin and decreases blood glucose levels, both of which can help regulate female hormone levels responsible for a normal menstrual cycle)
Promoting ovulation with ovulation-induction medications
Maximizing your health before you conceive and normalizing blood glucose and blood insulin levels help ensure that, if you do conceive, you have less risk of miscarrying or having a baby with birth defects, preterm delivery, or any of the other problems outlined in Chapter 12.
Putting diet under the spotlight
The high insulin levels commonly found in PCOS sufferers is to blame for the tendency to gain weight and the inability to lose it. That’s why, when you have PCOS, your diet is of vital importance. You have to balance various factors: calorie intake (to avoid excess weight gain), the types of carbohydrates that you eat (to stabilize blood sugars), keeping saturated fat and salt intake down, and so on.
A PCOS-friendly diet helps you to
Maintain a healthy weight or lose weight so that you can achieve a healthy weight.
Reduce insulin resistance and the risk of developing type 2 diabetes.
Reduce the risk of cardiovascular disease.
Ensure a balanced and nutritionally adequate dietary intake.
For detailed information on developing a PCOS-friendly diet and how to lose weight successfully, head to Chapters 4 and 5.
Avoid diets that restrict the intake of certain groups of foods or ban them completely. Also, avoid diets that advocate that you take certain supplements because such diets probably are unbalanced (if you’re eating a balanced diet, you probably don’t have a need for supplements, except for ones you have been prescribed by a health practitioner). Low-carb diets are often advocated in popular books and websites for PCOS, but most doctors and dieticians don’t recommend them for a variety of reasons. We devote Chapter 13 to helping you identify signs of diets that we recommend you avoid.
Getting physical
The good news about getting more active is that it offers huge benefits to symptom reduction in PCOS. The benefits extend well beyond PCOS and into many other areas, from cancer prevention to improving your mental state. Chapter 6 tells you everything that you need to know about the benefits of exercising, including different ways to exercise and how to vary your routine.
Benefits of exercise
The reasons to exercise if you have PCOS (and for general health) include the following:
To help maintain weight loss and allow you to have a few more calories while on a weight-loss diet. The ideal combination is to lose weight by following a sensible weight-control diet, along with a minimum of half an hour of physical activity a day.
To improve the relative amount of muscle to fat, as well as overall body shape.
To improve insulin sensitivity.
To increase the levels of high-density lipoprotein (HDL), or “good” cholesterol, in the blood.
To reduce blood pressure.
To decrease your risk of developing heart disease and diabetes.
To improve bone density, reducing your risk of developing osteoporosis.
To improve your psychological health, such as self-confidence, well-being, and self-image.
To maximize the advantages of doing exercise, you need to combine aerobic exercise (which causes you to get a bit breathless) with some resistance training (such as lifting weights) and some stretching and flexibility work to maintain strain-free movement. Chapter 6 explains what you need to know about the benefits of physical activity and how best to do it.
Tips for exercising success
People who take up exercise have a high dropout rate. To avoid becoming one of these statistics, plan ahead and keep a few things in mind:
Don’t be too ambitious, or you can never keep it up.
Instead of swearing that you’ll swim for 30 minutes, run for 30 minutes, and bike for 30 minutes every day, shoot for something manageable, like a 30-minute walk.
Plan to do a form of exercise that fits into your lifestyle and that you enjoy doing.
If getting to a gym is difficult for you, choose an exercise that you can do at home. When in doubt, opt for walking — you can do that anywhere, and you don’t need anything other than a good pair of shoes.
If you don’t have time to exercise — and who ever does, unless they’re motivated enough to make time for it? — incorporate exercise into your daily routine.
For example, if you normally stop in at the grocery store to pick up a few things every day, think about walking or even bicycling there, instead of driving or taking the bus.
The amount of moving about that you do throughout the day is as important as any formal exercise session that you do. So, think about how you can build in more activity throughout the day (take the stairs instead of the elevator, park far away from the mall entrance, and so on).
Looking after the inside
Knowing the wonderful results that you can achieve by diet and exercise can help motivate you, but if an overload of stress, anxiety, or depression is preventing you from following through, having an encyclopedic knowledge of PCOS doesn’t really do you a lot of good. To act on your knowledge about what you should do, you need to feel empowered with the knowledge that you understand your condition, feel ready to take action, and feel on a fairly even keel, emotionally speaking.
An important key to getting well is to treat yourself kindly. Recognize that PCOS is a major stressor in your life and give yourself permission to work through the feelings associated with it. To diminish the symptoms associated with PCOS, you must also recognize the emotional effects of PCOS, accept them, and figure out how to deal with them in a healthy way.
PCOS often leads to feelings of anxiety, low self-esteem, and loss of control. The emotional effects of PCOS can start in the teenage years, when the symptoms such as weight problems, excess facial or body hair, and acne start to emerge. To make matters worse, you may face a long and painful journey to a diagnosis.
Chapter 9 explains in more detail the effects of PCOS on your emotional well-being and offers strategies and advice on how to avoid or lessen the effects of the most common emotional pitfalls.
Trying Medications and More
Paying attention to your diet, your exercise levels, and your emotional health are things that you can do yourself, with a bit of support from friends, family, and some relevant experts, such as personal trainers and dietitians. (We discuss these factors in the section “Planning a Three-Pronged Attack,” earlier in this chapter.) However, sometimes you can’t control all your PCOS symptoms with just diet and exercise, so in this section, we discuss other ways you can get extra support.
Medications
Even if you get to work on the diet, exercise, and motivational advice in this book, your doctor may think that you also need some medication to help reduce your symptoms, especially if you’re at risk of developing other diseases, such as diabetes, heart disease, or possibly even endometrial cancer (cancer of the uterine lining).
Only take medication that your doctor or specialist prescribes especially for you.
Depending on your symptoms, medications can play an important part in your PCOS treatment. If you’re having trouble getting pregnant, medications often become a necessity. Medications also can help with hair loss and acne, as well as insulin resistance (and treating insulin resistance can decrease your chance of developing diabetes, as well as long-term complications such as high cholesterol and heart disease). Chapter 7 is loaded with information on the types of medications used to treat aspects of PCOS.
When you read up on PCOS, you may find that some authors recommend a whole plethora of herbal remedies and supplements to help treat PCOS. Most of the claims for their efficacy cannot be substantiated. Go to Chapter 8 for more information about supplements and herbals.
Be wary of advice from unproven sources. Supplements and herbal remedies are not regulated as strictly as drugs by the FDA, and some can be harmful, especially if you decide to take them without the backing of a professional, medically qualified practitioner. Before you take any herbal or supplement, consult your doctor.
Alternative/complementary therapies
Try natural remedies only if you follow the advice of an experienced, qualified practitioner who has an interest in women’s health, including fertility. At present, no thorough clinical trials have been completed on alternative therapies which result in them being allowed to make outright claims that they work in this area.
However, you can try some treatments that may help you relax and that should be relatively safe, including acupuncture, massage, and reflexology. Chapter 8 discusses alternative therapies — both good and bad.
What about surgery?
Medical professionals rarely recommend any form of surgery to treat PCOS. In some cases, however, a technique known as ovarian drilling may help women who are trying to get pregnant but who don’t respond to medications given to regulate menstrual cycles and start ovulation. During this procedure, a doctor punctures a small hole in the ovary by using an electric needle or laser that destroys part of the ovary. This is done under anesthesia. In most cases, drug therapy is tried before ovarian drilling would be considered.
Ovarian drilling can help decrease male hormone levels by reducing the number of cells producing those hormones; but the effect is usually short-lived, and the procedure can cause scarring in the ovary and negatively affect fertility, which is why doctors use it only as a last resort, if even then.
Living a Lifetime with PCOS
Unfortunately, menstrual irregularities and the metabolic symptoms (such as insulin resistance and abnormal blood fat levels) caused by PCOS can lead to diseases that persist throughout life. Also, unfortunately, neither the removal of ovaries nor going through menopause seems to eliminate the symptoms. However, you can look for a light at the end of the tunnel: the fact that by adopting a healthy lifestyle, you can reduce most symptoms to levels that don’t have a significant impact on your daily living.
No cure exists for PCOS, but in many cases, you can control the symptoms. Treatment involves breaking the vicious cycle of insulin resistance and being overweight, which leads to even higher insulin levels and triggers worsening PCOS symptoms. Remember, too, that not all women who have PCOS are obese or even overweight — you can have PCOS symptoms, even when you’re at a normal weight.
If you know that PCOS runs in your family (it may be an inherited condition), you can try to prevent it from developing in the first place or minimize its effects by staying within the right weight range. A ratio called the body mass index (BMI) can provide a measure of your ideal weight. To figure your BMI, go to www.nhlbi.nih.gov/calculate-your-bmi. (Chapter 5 has more information on BMI.)
You can also check how much fat you’re carrying, particularly in the danger area around your middle, by measuring your waist circumference. You’re in the danger zone (as a woman) if your waist circumference is more than 31½ inches. See Chapter 5 for more on this and other weighty issues of PCOS.
Monitoring mood and motivation
Vicious cycles commonly occur for women who have PCOS. Getting into shape and reducing the symptoms can seem such an uphill struggle that you may want to just give up. But in giving up, you feel more and more depressed and believe that you need to take extreme actions. However, extreme actions just set you up for failure again — and the circle continues.
To help you avoid the PCOS merry-go-round, keep the following in mind:
Everyone trips up from time to time.
When it happens to you, pick yourself up and set yourself back on the road.
Keep a food/exercise/mood diary.
If keeping a diary permanently seems like too much for you to take on, just fill it in for a week or two initially, and then go back to the practice if you feel your resolve is slacking. A diary can remind you what you did when things were going well, but it can also reveal problems when things don’t go so well.
Start gradually.
Maybe begin with a ten-minute walk every day — everybody has ten minutes to spare, right? — and work your way up gradually to your goal. Adding a minute to your walk every few days probably doesn’t seem that hard. And before you know it, you’ll be walking 30 minutes or more.
Set yourself mini goals along the way.
Reward yourself with something other than food (maybe a day at the spa or a trip to the theater) each time that you achieve a mini goal.
Make sure that you can incorporate the changes easily into your lifestyle and that you can keep them up long term. Starting small, building up over time, and setting mini goals to achieve — and be rewarded for achieving them — can help ensure you stick with healthier habits for the long term.
Avoiding eating disorders
With so much emphasis placed on staying at a normal weight if you have PCOS, some women fall into the pattern of thinking that if a little weight loss is good, a lot is better. Or they begin to think that weight loss is the overarching goal, rather than one part of a healthier lifestyle. Beliefs like these can lead to eating disorders.
If you have a distorted pattern of thinking about and behaving around food, you may have an eating disorder. If you have an eating disorder, you also have a preoccupation and/or obsession with food, and you probably have little to no control over your eating (or lack of eating).
Any eating disorder requires professional help. And you need to acknowledge the triggers for this behavior — they’re frequently mood-based, especially feelings of low self-esteem.
Chapter 2
Identifying Potential Signs of PCOS
IN THIS CHAPTER
Checking out the symptoms and side effects of PCOS
Knowing what to expect throughout your life
Getting a medical diagnosis
If you have polycystic ovary syndrome (PCOS), you have the most common hormonal and reproductive problem affecting women of childbearing age. The actual percentage of women affected varies according to which criteria you use: the National Institutes of Health (NIH) criteria or the broader Rotterdam criteria (developed in 2003 at a joint conference of the American Society for Reproductive Medicine [ASRM] and the European Society of Human Reproduction [ESHRE]). Statistics also vary by country. But generally, the medical community recognizes that between 10 and 20 percent of women suffer from PCOS, a number much higher than previously thought.
In the past, medical professionals diagnosed only women who had the most severe symptoms of the condition now known as PCOS. Doctors today, who have much more advanced diagnostic tools (such as ultrasound) available, can better recognize the condition, even if the patient has only mild symptoms.
In 1935, the medical community first called the condition polycystic ovarian disease or Stein-Leventhal syndrome (after the two doctors who discovered it). In the future, it may yet get another new name, such as metabolic reproductive syndrome.
This chapter spells out how you can recognize whether you have PCOS by exploring the physical, emotional, and hidden symptoms of PCOS. It also looks at how you or your doctor can spot PCOS and touches on how to cope with PCOS through your life stages.
Recognizing Common Symptoms and Side Effects of PCOS
If you judged solely by the name polycystic ovary syndrome (PCOS), you might think that the most important symptom of PCOS was multiple cysts on the ovaries (sometimes described as looking like a string of pearls). These cysts begin as immature, or preantral follicles, the egg-containing structures in the ovary, one of which grows monthly to ovulate (release an egg) during the regular reproductive cycle. The cysts themselves are harmless, but they’re a symptom of the hormonal issues that often cause infertility in women who have PCOS. PCOS also has a host of other symptoms. (The word syndrome actually means “a group of symptoms.”) The following sections outline the obvious and not-so-obvious symptoms of PCOS.
You and your PCOS are unique. Quite a few different symptoms occur with PCOS, but your combination of symptoms probably differs from someone else’s symptom profile. Some symptoms are more common than others — namely, weight gain (especially around the middle), skin problems, hirsutism (hairiness), and a tendency toward diabetes and infertility. In fact, PCOS can fall into several different classifications, depending on the traits, or phenotypes, that affect an individual. Reproductive phenotypes, for example, affect hormone levels and ovulation, while metabolic phenotypes affect insulin levels and lead to weight gain and high cholesterol levels.
Because many of the symptoms of PCOS don’t affect the way you look, other people may not understand why you’re not up to doing things or why you don’t feel well. Other symptoms, such as weight gain, are all too visible. The situation isn’t all doom and gloom, though — these symptoms can start to lessen if you talk with your doctor and act on the advice in this book.
Experiencing hormonal effects
As a PCOS sufferer, you’re more likely to have higher-than-normal levels of androgens wreaking havoc around your body. (Androgens are male hormones — the best known being testosterone — which all women produce [in a much lower level than males] in their ovaries.) The abnormal level of these male hormones, along with other hormonal disruption, cause the period problems that you may be experiencing. Several factors can lead to an increase in male hormones if you have PCOS, including the following:
Increased levels of AMH (anti-Mullerian hormone), produced by immature or preantral follicles on the ovary. Since women with PCOS have larger than normal numbers of these immature follicles, they may have high levels of AMH, which increases androgen levels.
High insulin levels (hyperinsulinemia), which increase testosterone levels in your blood by preventing the liver from making SHBG (sex-hormone binding globulin) a protein that binds to testosterone, controlling the amounts in the bloodstream.
Increased levels of luteinizing hormone (LH), common in PCOS, foster increased androgen production.
Estrogen (a female sex hormone) levels are also often increased if you have PCOS. While having more female hormones might seem like a good thing, too much estrogen can cause menstrual irregularities and can also lead to decreased production of hormones essential to fertility, such as progesterone and follicle-stimulating hormone (FSH).
Overcoming period problems
Not all women who have PCOS have problems with their period. If you don’t, consider yourself to be one of the lucky 20 percent of women who have PCOS who experience perfectly normal menstrual cycles. In PCOS, your period may be
Amenorrhea:
Absent altogether
Menorrhagia:
Heavy, lasting longer than 7 days or characterized by passing large clots
Metrorrhagia:
Complicated by bleeding or cramping between periods
Oligomenorrhea:
Infrequent, with more than 35 days between cycles or fewer than 9 cycles in a year
See Chapter 10 for more detail on the effects of PCOS on menstrual periods.
Facing fertility issues
Your doctor may first have diagnosed PCOS because you’re trying to conceive but can’t. If your ovary doesn’t produce an egg, you can’t get pregnant. If you have PCOS, your ovaries don’t produce mature eggs, or do so irregularly, because your hormones are out of balance.
Infertility is quite common, especially as symptoms advance. Around 90 to 95 percent of women who attend infertility clinics because of lack of ovulation have PCOS. You can help to restore your fertility by adopting the lifestyle changes outlined in this book. See Part 3 for more on the menstrual cycle, fertility treatments that can help you, and the risks of pregnancy if you have PCOS.
Having hot flashes
Most people associate hot flashes (a sudden feeling of warmth sometimes accompanied by intense sweating), as a sign of a hormonal imbalance, caused by the menopause. However, hot flashes can also occur because of PCOS (re-worded some of this as it felt very clunky! GB). Hot flashes themselves don’t cause any harm, but they are a nuisance and can disturb your sleep. Hot flashes are characterized by
Rapid heartbeat
Rise in body temperature
Clammy palms
Sweating
Coping with endometriosis
Women often have both PCOS and endometriosis, but no one really knows whether the two conditions are linked.
Endometriosis is a condition in which tissue that’s similar to the lining of the uterus grows outside the uterus. Endometriosis most commonly develops on the pelvis, the ovaries, and the bowel. These endometrial growths react to estrogen just like they’re part of the endometrium in the uterus. The tissues swell and then become painful during the month when the endometrium (which is normally found only lining the uterus) builds up. The endometrial tissue then bleeds during menstruation, regardless of where that tissue is. Scarring can occur in the areas outside the uterus where bleeding occurs repeatedly. Scarring can also cause adhesions to form, where internal organs stick together; this can cause quite a bit of pain.
If you have PCOS, you tend to have a lot of estrogen in your system and very little progesterone. Estrogen normally builds up the uterine lining, and progesterone causes changes that enable that lining to accept an embryo. When the corpus luteum, the ruptured follicle that released the mature egg, stops producing progesterone, that absence triggers the monthly bleed. If you have PCOS, you don’t ovulate and, thus, there’s no corpus luteum to produce progesterone. You definitely don’t need the continual buildup of uterine tissue (without the effects of progesterone to shed that tissue) if you have endometriosis because that tissue buildup can lead to irregular, very heavy periods and an increased risk of developing uterine cancer.
Risking endometrial cancer
The lining of the uterus, known as the endometrium, varies in thickness throughout a normal monthly menstrual cycle. At the start of a normal menstrual cycle, the lining is thin, and then builds up in preparation for the implanting of a fertilized egg. However, if the egg isn’t fertilized, the uterus sheds this extra lining.
Often, if you have PCOS, your ovary doesn’t release an egg, but the lining of the uterus still builds up under the influence of estrogen. However, because ovulation never happens, the uterus never sheds this lining, so it just keeps building up. Known as endometrial hyperplasia, this condition can increase the risk of developing endometrial cancer. (But even people who have PCOS don’t commonly get this cancer.)
You want to restore a normal menstrual cycle, not necessarily to restore fertility, but so that you can reduce the risk of developing endometrial cancer. See Chapter 10 for more on the risk of endometrial cancer in PCOS.
Wondering why you can’t lose weight
Women who have PCOS very often have weight issues; as many as 70 percent of PCOS sufferers also suffer from the constant battle of the bulge. Doctors think that the main causes of weight gain are insulin resistance and the increased levels of male hormones that occur in PCOS due to the increased number of follicles on the ovary releasing the hormone AMH (anti-mullerian hormone). Many people who have PCOS find not being able to control weight gain, which occurs particularly around the middle, the most distressing symptom of the condition. (See Chapter 5 for ways to battle the plague of weight gain in PCOS.)
Your liver releases glucose into your bloodstream after you eat any carbohydrates (carbohydrates are starches and sugars; see Chapter 5
