The findings in this study are probably not news to you if you have PCOS, but it's nice to see your emotional PCOS finally validated with a scientific study.
480 women with PCOS participated in the psychological evaluation portion of this study.
Women who were not menstruating were more likely to have lower self-esteem, and to have a greater fear of being negatively viewed with regard to their appearance. These women also appeared to have an earlier onset of maturity.
High androgen levels and acne were associated with poorer body satisfaction. The greater the degree of hirsutism and BMI (body size), the lower the scores on psychological tests.
The obvious social explanations for these findings have been covered elsewhere. I believe that hormones have a huge part to play in these tendencies…I've worked in eating disorders and I've seen literally thousands of women lose the weight and remove the hair…and STILL be unhappy. Women with PCOS need help in understanding how hormones affect mood (and that hormones ARE mood) and to have access to qualified professionals who can help with that aspect of PCOS.
It's why I'm so happy Gretchen Kubacky and Anna Ahlborn are in the inCYST Network. They are here to help us better understand these conditions and what can be done to minimize any potentially negative influence they may have on your quality of life.: )
de Niet JE, de Koning CM, Pastoor H, Duivenvoorden HJ, Valkenburg O, Ramakers MJ, Passchier J, de Klerk C, Laven JS. Psychological well-being and sexarche in women with polycystic ovary syndrome. Hum Reprod. 2010 Mar 31. [Epub ahead of print]
This abstract caught my eye because finasteride is sometimes used to treat the hirsutism (hair growth in women) that PCOS often causes. It has now been observed to have antipsychotic properties and is being proposed as a treatment for psychosis.
Antipsychotics are increasingly being used to treat depression, and at least 85% of women with PCOS have some kind of anxiety, depression, or other mood disorder associated with this diagnosis. If you have PCOS, please do not jump to the assumption that I am saying you are psychotic. What I am trying to point out here is that there is a huge mind-body connection in the syndrome that is often ignored. Physicians can be so compartmentalized with their treatments that they focus on the acne, the hair, the infertility…and completely ignore the moods, the mood swings, the associated disrupted eating patterns…and then they and their patients wonder why treatment is not successful.
I am posting this abstract to challenge anyone who treats PCOS to figure out what is going on in the brain of the woman with PCOS since it is, after all, the brain that controls hormones. Rather than mess with hormones and create even more problems, why aren't we going to the source and looking THERE for potential solutions? Let's make this the day we shift our thinking.
Bortolato M, Frau R, Orrù M, Bourov Y, Marrosu F, Mereu G, Devoto P, Gessa GL. Antipsychotic-like properties of 5-alpha-reductase inhibitors. Neuropsychopharmacology. 2008 Dec;33(13):3146-56. Epub 2008 Mar 19.
I chose the photo I did not to be funny, demeaning, or hurtful. I did it for the benefit of those who truly do not understand what many women go through because of their PCOS. Hair growth can be devastating and lead to horrible issues with self-image. Long ago it was often called"diabetes of the bearded ladies". If you can imagine what it's like to look in the mirror and feel as though you're losing your femininity, often at a time when you're trying to conceive and desiring to be attractive to your partner…it's a situation deserving of much more attention than it often gets by physicians.
It's not uncommon to read blog posts, tweets, and chat room conversations in which women with PCOS describe their depression, and attribute it to the weight gain and appearance that their PCOS has promoted. It can be easy to blame the discomfort, fatigue, restless, and anxiety that depression provokes, on tangible and unwanted physical changes
A recent study helps to verify what I've believed all along…that depression, like hirsutism, weight gain, and infertility, is another condition that PCOS has potential to create. It is not the result of other symptoms associated with PCOS.
Here's the study.
Thirty women with PCOS and thirty women without PCOS participated in this study. All subjects had similar BMI's/weights. Only women who were not on any psychotropic medication were included. Women with PCOS scored higher on an anxiety scale than women without PCOS. They also slept less, worried more, and experienced more phobias than women without PCOS. Weight was not associated with any of the symptoms, except for sleep.
In other words, regardless of your weight, you can be depressed if you have PCOS.
If you attach or blame your depression on your weight, your appearance, or your infertility:
--you can set yourself up for an eating disorder…if you actually lose weight and discover it didn't change how you feel. --you can feel even worse if you spend time and money on cosmetic surgery, only to realize you don't feel as good as you hoped you would. --you can put yourself through the tremendous stress of infertility treatment, and get the baby, only to discover that you still feel depressed, and now you've got a baby who isn't sleeping through the night who is dependent on you.
That's the bad news. The good news is that the inCYST program is very helpful at reducing anxiety and depression. So in addition to helping you normalize your weight, reducing the progression of testosterone-related programs, and increasing your fertility, it helps you to feel better. It literally rebuilds your nervous system so it can reduce the influence depression can have. And in rebuilding the nervous system, it helps to balance hormones so that symptoms can lessen.
We like to focus on feeling better, since we know that in women who do, the other problems tend to fall into place. That's not to say that being anxious about your PCOS doesn't worsen when you focus on your symptoms, and that when you learn better coping skills you won't feel even better. Gretchen Kubacky has done a great job of discussing that here, on her blog, and on PCOS Challenge.
It's just that you want to be sure you're tackling the core cause of the problem, and not simply putting band-aids on the symptoms. Nothing can be more frustrating than investing all your time, resources, and money into diets and medical procedures, only to feel the same or even worse once you've done so.
Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index
REFERENCE E. Jedel1, M. Waern2, D. Gustafson2,3, M. Landén4, E. Eriksson5, G. Holm6, L. Nilsson7, A.-K. Lind7, P.O. Janson7 and E. Stener-Victorin8,9 Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index
1 Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden 2 Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 3 Rush University Medical Center, Chicago, IL, USA 4 Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden 5 Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 6 Department of Metabolism and Cardiovascular Disease, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 7 Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 8 Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 434, 40530 Gothenburg, Sweden
A client recently handed me a supplement called"DIM" and told me her physician gave it to her. The physician said it would help her hyperestrogenemia. She had stopped taking it, and asked if I thought she should resume with it.
Here's the lowdown on DIM, which is the abbreviation for diindolylmethane.
DIM occurs naturally in cruciferous vegetables, such as cabbage, cauliflower, and Brussels sprouts. It was first researched for its cancer-fighting properties; we all know that these vegetables have this quality.
Soon after that, it was discovered that DIM influences estrogen metabolism, promoting the creation of estradiol, or beneficial estrogen (E2) and inhibiting the creation of estrone, or cancer-related estrogen (E1).
DIM may also be an anti-androgen. Although the research I was able to find looked at DIM in the prostate, not in women with PCOS, there is much information on websites selling DIM promoting it as a natural way to reduce facial hair.
If you are considering taking a DIM supplement, be sure to consider the following warnings found on the WebMD website: Special Precautions & Warnings:
Pregnancy and breast-feeding: Diindolylmethane is safe when consumed in the small amounts found in foods. But don’t take larger amounts. Not enough is known about the safety of larger amounts during pregnancy and breast-feeding.
Hormone-sensitive conditions such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids: Diindolylmethane might act like estrogen, so there is some concern that it might make hormone-sensitive conditions worse. These conditions include breast, uterine, and ovarian cancer; endometriosis; and uterine fibroids. However, developing research also suggests that diindolylmethane might work against estrogen and could possibly be protective against hormone-dependent cancers. But stay on the safe side. Until more is known, don’t use diindolylmethane if you have a hormone-sensitive condition.
The client who asked the question feels the supplement may actually have helped her facial hair. Note, this is a one-person observation and a testimonial only, it is NOT an endorsement of the supplement.
What I would recommend to this client, and to others who are interested in using DIM:
1. Start with your diet: eat more cabbage, cauliflower, brussels sprouts, and broccoli. (Click herefor a cauliflower curry recipe).
2. Be sure your diet contains adequate omega-3 fatty acids and is not high in omega-6 fatty acids (discussed many times in other posts on this blog). Omega-3 fatty acids found in both fish and flax have similar effects on estrogen metabolism.
3. Be scientific about the supplement use. Have your hormone levels measured for a baseline, and have them remeasured 6 months after consistent use of the supplement. Too many times, supplements are recommended without any way to evaluate whether or not they are having any effect. In the case of my client, the supplement was sold to her by her physician and there was never any followup scheduled to evaluate how well it was working. (You'd never do that with a blood pressure medication or antipsychotic, would you?!?!?)
4. Don't assume that once you start taking the supplement you do not need to follow a healthy diet. Supplements usually seem to work better in a healthy body where the biochemistry promotes their effectiveness.
5. Even though eating these foods has never been found to be dangerous to pregnant women, because the supplemental form is much more concentrated than what is found in food, it is strongly recommended not to take this supplement if you are trying to conceive or if you are pregnant. As it's been with us since we've been in existence, we are of the opinion that it is not appropriate to be treating hirsutism while you are trying to conceive. There is time for that later.: )
Wattenberg LW, Loub WD, Lam LK, Speier JL. Dietary constituents altering the responses to chemical carcinogens. Fed Proc. 1976 May 1;35(6):1327-31. Jellinck PH, Makin HL, Sepkovic DW, Bradlow HL. Influence of indole carbinols and growth hormone on the metabolism of 4-androstenedione by rat liver microsomes. J Steroid Biochem Mol Biol. 1993 Dec;46(6):791-8.
Chen I, McDougal A, Wang F, Safe S. Aryl hydrocarbon receptor-mediated antiestrogenic and antitumorigenic activity of diindolylmethane. Carcinogenesis. 1998 Sep;19(9):1631-9.
Lord RS, Bongiovanni B, Bralley JA. Estrogen metabolism and the diet-cancer connection: rationale for assessing the ratio of urinary hydroxylated estrogen metabolites. Altern Med Rev. 2002 Apr;7(2):112-29.
Le HT, Schaldach CM, Firestone GL, Bjeldanes LF. Plant-derived 3,3'-Diindolylmethane is a strong androgen antagonist in human prostate cancer cells. J Biol Chem. 2003 Jun 6;278(23):21136-45. Epub 2003 Mar 27.
Tadi K, Chang Y, Ashok BT, Chen Y, Moscatello A, Schaefer SD, Schantz SP, Policastro AJ, Geliebter J, Tiwari RK. 3,3'-Diindolylmethane, a cruciferous vegetable derived synthetic anti-proliferative compound in thyroid disease. Biochem Biophys Res Commun. 2005 Nov 25;337(3):1019-25. Epub 2005 Oct 3.
If you've been enjoying the PCOS Challenge Radio Show, you'll love Sasha's latest venture! Dr. Van Dyke, Ellen Goldfarb, Gretchen Kubacky, and myself will be presenting more in-depth seminars on our areas of specialty.
Topics to be covered include:
Nutrition Essentials for PCOS--Monika M. Woolsey, MS, RD Tuesday, October 20
Eating Disorders and PCOS--Ellen Reiss Goldfarb, RD Tuesday, October 27
Living Happier and Healthier with PCOS--Gretchen Kubacky, PsyD Tuesday, November 3
Hair Removal Solutions for Women With PCOS--Susan Van Dyke, MD Tuesday, November 10
The Natural Solution to Overcoming PCOS--Julie Walsh, ND Tuesday, November 17
All webinars will be held from 8:00 — 9:00 Eastern Time.
Space is limited for the live sessions, but if you can't make any of the live sessions, they will all be recorded and made available on CD.
Please join us! We've all been working hard on this project and it's all been especially for YOU!
If you want to learn the latest about hair removal, don't miss this interview with Dr. Susan Van Dyke, a board certified dermatologist!
Here is a video demonstrating Light Sheer Duet, a newer, faster, less painful laser hair removal treatment that was discusssed in the interview.
Hirsutism is such a devastating condition, worthy of understanding and treatment. Here are some explanations about how to get started and how to find the best practitioner to help you.
I spent some time with Susan Van Dyke, MD, yesterday, a board certified dermatologist interested in PCOS, who will soon be in our network. She demonstrated a new laser hair removal technique, LightSheer DUET, which is quicker and less painful than older laser techniques.
I know virtually nothing about what dermatologists do; in fact, the only thing I knew about laser treatments before yesterday was that people I know who have had them hated them because they were so painful. So I was curious to find out what this new procedure offered to inCYSTERs.
The pain from laser treatments comes from the heat in the laser beams. The earlier machines apparently had small surface areas, meaning quite a few laser shots had to be applied in order to cover a skin area. The newer"gun" is quite a bit larger, meaning far fewer"shots" need to be applied in order to do the job. In addition, the older machines were not as precise at hitting their target (the hair follicle), so a lot of the laser heat didn't hit the target and was wasted on surrounding tissue. The newer, more precise technique zaps pretty much what only needs to be zapped, meaning less skin heat…therefore far less pain.
I actually observed a procedure (which happened to be a man's back), a large surface area. The patient was relaxed and talked to us throughout the entire treatment, and a half hour later, had hardly any red skin. A very different experience than what friends of mine have described with the old technique.
When I tweeted yesterday that I was going to observe this procedure, an inCYSTER responded that laser hair removal was a useless exercise, because the hair grows back. That's likely true, if that's all you do! Laser hair reduction is permanent hair removal for currently existing hair, but there is still a need to work to balance hormones in order to alter the environment that promotes hair growth. What Dr. Van Dyke and I would like to do, is work together in a way that hair that is already there is removed with her DUET procedure, and then help these women learn new lifestyle choices that help to discourage the appearance of future hair.
It's going to be fun to work together, as I know this is a very distressing aspect of PCOS that affects self esteem, mood, etc…and that can lead to binge eating, which can only worsen the hair growth. The possibility that a simple dermatological procedure can help break this vicious cycle and jump start PCOS management in a positive direction, is very exciting.
You can learn more about Dr. Van Dyke at this link.
Many of you living in Los Angeles saw the story on PCOS the past two nights. For those of you who didn't see it, I'm posting the first half of the story here.
I found this piece moving and was especially thankful to the women for letting LA (and the Internet) into their lives. Los Angeles can be such an appearance-focused community, and to talk honestly about how it feels to live with a syndrome that doesn't allow you to live up to your community's unspoken code of appearance…well, I'm not so sure I would be that brave.
A crucial component of my professional PCOS training is to invite women with PCOS to come tell their stories to the health professionals aspiring to help them. I never cease to be amazed at the unsympathetic, uninformed, and even abusive things that are said to"cysters" that is intended to be advice, but only leaves the women feeling even more hopeless. At one conference in particular, every physician in the room personally apologized to the"cysters" who spoke, not just for themselves, but on behalf of the colleagues who were not there to hear their stories.
I know it's really hard to reach out for help if insults, condescension, and not being believed are what you've experienced when you tried. As you can see in these videos, there are people who care, who understand, and who can help. We hope you reach out to them.
The second half of the story is here. I wish there had been more time for more nutrition information, as there is so much that can be done that was not mentioned. And, as many of you know, if not done wisely, well-intentioned dieting can easily flip into a vicious eating disorder. If you like the story, please email Fox News and let them know. If they know these kinds of honest portrayals are what bring them viewers, they are much more likely to give you more of what you like!
Yesterday I had the honor and pleasure of speaking to a group of eating disorder professionals in Santa Monica, California, about what happens when an eating disorder and PCOS collide in the same person.
Here are some of the statistics I shared with them:
**Women with PCOS have a higher lifetime incidence of depressive episodes, social phobia, and eating disorders than controls.
**Suicide attempts are seven times more common in women with PCOS than in other women.
**In a sample of women with facial hirsutism, the prevalence of eating disorders is 36.3% (Compared to about 10% in the general female population).
**Depression, anxiety, low self-esteem, and poor social adjustment are more common in participants suffering from an eating disorder, and the presence of PCOS was universal in eating disordered cases.
Those are some pretty heavy statistics…and the points I was making to the audience were that medical doctors who treat PCOS need to understand its emotional and behavioral components, and professionals who treat eating disorders cannot be effective if they don't understand the hormonal implications of PCOS. You need to know how to treat both.
The good news is, the professionals in the room were interested in helping. And inCYST dietitians happen to be very interested in disordered eating as well as PCOS. So we're ready and very eager to help you negotiate your way to solutions for both. inCYST providers Ellen Reiss Goldfarb, Diane Whelan, and Mary Donkersloot were with me in Santa Monica, putting a friendly face onto PCOS and eating disorder help and networking with capable and sympathetic doctors and psychologists. With the teambuilding that happened, I have to say, anyone in SoCal who needs help, is going to be in very capable hands!
Please check out our referral list and reach out to someone who can help.
If the topic of eating disorders and PCOS interests you, be sure to catch Ellen Reiss Goldfarb, RD, (West Los Angeles) in her interview on the topic on PCOS Challenge, Wednesday, June 24, 6 pm EDT.
REFERENCES
Mansson M, Holte J, Landin-Wilhelmsen K, Dahlgren E, Johansson A, Landen M. Women with polycystic ovary syndrome are often depressed or anxious--a case control study. Psychoneuroendocrinology. 2008 Sep;33(8):1132-8. Epub 2008.
Morgan J, Scholtz S, Lacey H, Conway G. The prevalence of eating disorders in women with facial hirsutism: an epidemiological cohort study. Int J Eat Disord. 2008 Jul;41(5):427-31.
…you've got to hear Carmina McGee's interview she did today! It's packed full of information on everything from acne to acanthosis nigricans to facial hair and what to do about it.
