Dating with PCOS: How to NOT Freak Out

If you’re new to dating, the whole thing can be kind of strange and terrifying. If you’ve been at it a while, you may be feeling less optimistic, a little jaded, or even have experienced some deep hurt in the process. One of the most daunting things facing women with PCOS is how to handle PCOS-related topics while dating. Here are some tips on how to bring up the subject.

Early Dating: Surface Exploration
If you’re serious about finding a relationship partner, the purpose of a first date is merely to determine if you’re interested enough to have a second date. Because PCOS is an unknown for most people, and it’s a “disease,” treat it the way you would handle any other bad news. You don’t want to talk about your crazy ex, the abortion you had in high school, your mother’s alcoholism, or anything else that might scare someone off. Same with PCOS.

This is not about lying; it’s about becoming more intimate in a gradual and meaningful way that strengthens a growing relationship, while protecting you from injury by someone who isn’t attached enough to be decent and thoughtful, and may just bail out on you.

Next Stage Dating: Getting Intimate
This means getting more intimate emotionally as well as physically. As a health psychologist, I’m all about protecting and promoting your health, so of course I’ve got to throw in a reminder about having a talk about pregnancy and STDs. And what a great opportunity to start opening the lines of conversation around PCOS! You might say something like “I have something called PCOS, which means that getting pregnant is much less likely for me, and…condoms are still a priority for me (or, “I’m on birth control because of my PCOS, but we still need to use condoms to protect both of us.”).

If your partner is female or trans, it’s still good to have the STD conversation, because no one’s exempt. It just changes the conversation a bit. You might say, “Before we go any further, I need to let you know something about my health. I have PCOS.” If it’s your style to be funny or dramatic, feel free to use a dramatic pause so that they’re freaking out thinking you might have a STD; that way PCOS sounds like nothing! If you’re afraid that PCOS will scare someone off, yes, it could. But it’s not likely – and wouldn’t you rather know now than when you’re two years down the line and planning a wedding?

More Mature Relationship: Grooming, Mood Swings, and More
I have a friend who thinks couples should know/do/see everything about the other person. Her husband says: “Mystery! Please, maintain a little mystery!” The more time you spend together, the more likely your partner is to notice any discomfort you have with your body. You can hide your early morning shave for a long time, but eventually a pesky random hair is going to protrude and get noticed. Acne and hair loss are visible no matter what. Most people won’t ask. But if you would feel more comfortable bringing attention to it, do so with kindness to yourself, and like it’s not a big deal, and you’ve got it covered. Something like “You might have noticed that my hair is thinning a little. I’m kind of embarrassed, but I’m seeing a good dermatologist, so don’t worry that I’m going to end up looking like The Rock.” (As you can see, I really like to insert a little humor into painful and uncomfortable situations.)

Deeper subjects, like infertility or PCOS-related depression/anxiety/mood swings, can be approached when you have built trust in your partner. Appropriate timing, respecting your own needs for privacy as well as for self-disclosure, and a little humor will go a long way in easing your new beloved into the subject of PCOS.

Gretchen Kubacky, Psy.D., “The PCOS Psychologist,” is a health psychologist in private practice in Los Angeles, California. She a Certified PCOS Educator, and the founder of PCOSwellness.com. You can contact Dr. Kubacky at AskDrGretchen@gmail.com.

Antidepressants: What are they, and how do they work?

If you struggle with depression or anxiety, you may have heard your psychologist (or a partner, or a particularly nosy friend) recommend taking antidepressant medication. But what exactly are antidepressants, and how do they work? And what might be some other alternatives?

Before we get into the nitty-gritty details of how antidepressants work, we first need to discuss some basic brain anatomy. As you may know, brain cells are called neurons, and while there are many types of neurons, they share a basic structure. Branching off from the cell body are various branches (like on a big oak tree) called dendrites. At various points along each dendrite it will touch the dendrites of other neurons, and these points of connection are called synapses. Think of a synapse as like two hands meeting for a handshake. Neurons communicate together by passing special chemicals called neurotransmitters from one cell to another through these synapses. The neurotransmitters most commonly implicated in depression and anxiety are serotonin, dopamine, and norepinephrine.

Some theories argue that depression and anxiety are caused, in part, by deficiencies of these mood-related neurotransmitters in certain parts of the brain. Antidepressant medications aim to help correct this by boosting levels of these neurotransmitters. When one neuron signals another, it releases a neurotransmitter into the synapse, or into the tiny space between where the two dendrites touch, which then pass into the other neuron. After a short time, excess neurotransmitter molecules are vacuumed back up by the first neuron in a process called reuptake. Antidepressants often work by inhibiting this reuptake process, which boosts the overall amount of neurotransmitter molecules in the synapse, which (in theory) aids neural signaling and can ease depression and anxiety symptoms.

The most common types of antidepressant medications, therefore, are named after this process and the type(s) of neurotransmitters they work on. For instance, the most common type of antidepressant medication is called a Selective Serotonin Reuptake Inhibitor (SSRI). Other common types include Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) and Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs). In addition, there are numerous other less-common types of medications, such as mood stabilizers, tricyclic and tetracyclic antidepressants, and atypical antipsychotics (so named because, at higher doses, they are used to treat schizophrenia and related disorders). Antidepressant medications are generally well tolerated, but common side effects include difficulty with sexual arousal or orgasm, minor weight gain, and upset stomach.

If you are suffering from depression or anxiety, it is important to consult with a licensed and qualified psychiatrist or psychiatric nurse practitioner about the benefits and drawbacks of these medications, and to find the right one for you. Often, several medications may need to be tried in order to find one that works well with no, or very few, side effects. Don’t worry, this is normal! While general practitioner doctors can prescribe antidepressants, they often have less training and knowledge about them than specialists such as psychiatrists.

It is important to note that prescription medications are far from the only effective treatment for depression! First off, psychotherapy with a qualified and licensed psychologist (like me!) has been proven to be effective at treating depression and anxiety. In particular, psychotherapy plus medication are often more effective than either one alone.

Second, regular aerobic exercise has been shown to be practically as effective as antidepressant medications, with the only “side effects” being better health, reduced weight, and improved cardiovascular functioning!

Finally, there are a number of over-the-counter supplements that you can take which have antidepressant effects. These include Sam-E, St. John’s Wort, and 5-HTP. Some of these supplements may have their own side effects or may interact with other medications you are taking, so make sure to ask your doctor or psychiatrist first before starting to take them!

Depression and anxiety are very common problems that many people struggle with at various points in their lives. If you believe you may suffer from these conditions, please know that it does not mean there is anything “wrong” with you, and remember that successful treatment is possible! Speak to your psychologist and doctor about your concerns and get the help you deserve!

 

References:

Bet, P. M., Hugtenburg, J. G., Penninx, B. W. J. H., & Hoogendijk, W. J. G. (2013). Side effects of antidepressants during long-term use in a naturalistic setting. European Neuropsychopharmacology, 23(11), 1443–1451. http://doi.org/10.1016/j.euroneuro.2013.05.001

Blumenthal, J. A., Smith, P. J., & Hoffman, B. M. (2012). Opinion and evidence: Is exercise a viable treatment for depression? ACSM’s Health and Fitness Journal, 16(4), 14–21. http://doi.org/10.1249/01.FIT.0000416000.09526.eb

Circadian Rhythms, Insulin Resistance, and FOOD

A recent article over on CNN offers some excellent insights about one of my favorite topics. Yup, you guessed it: FOOD.

As many of you who, like me, deal with polycystic ovary syndrome (PCOS) have probably experienced, the relationship with food can become…tense. Food becomes less a source of joy and nourishment and more like a threatening opponent we must wrestle into submission in order to control our weight.

Interestingly, according to the research and interviews cited in the aforementioned article, eating in tune with our natural circadian rhythms might actually help us control our weight. So, in other words, it’s not just what you eat, but also when you eat it! The article is a great source of information and I highly recommend that you read it and come back. It’s ok, I’ll wait.

Welcome back! So, in addition to all the nuggets (mmmm, nuggets) of information in the article about weight loss, there was something else very relevant to PCOS hidden in there. Did you catch it? The article mentioned that insulin sensitivity also operates according to circadian rhythms! Why is that important?

Well, our level of insulin sensitivity controls how our body processes and stores glucose, which has a ton of important downstream effects on our health and weight. Unfortunately, more than half of women with PCOS display insulin resistance. This is bad because insulin resistance is a prime factor in developing Type II diabetes, a serious health condition that, if left unchecked, can lead to a runaway breakdown in how your body processes sugar and lead to severe health complications such as cardiovascular disease.

Insulin resistance is also a prime contributor to weight gain, as the lower our insulin sensitivity is, the more likely our food is to be stored in fat cells rather than burned for energy. Controlling weight is a huge component of proper PCOS self-care for a number of reasons. Not the least of which is that even just a 7% reduction in weight is associated with increased fertility among women with PCOS! In addition, weight gain is yet another pathway through which diabetes and cardiovascular disease can occur.

Finally, insulin resistance is also linked with sleep-disordered breathing, such as sleep apnea. This is important because sleep-disordered breathing leads to poorer metabolic function, which leads to weight gain, which worsens sleep-disordered breathing and so on, creating a negative spiral in which weight gain, insulin resistance, and poor sleep are all exacerbated, all of which then increase the risk for developing or worsening (say it with me now) diabetes and cardiovascular disease. Yikes!

So what to do about all of this? Well, as CNN’s article suggests, in order to eat according to our circadian rhythms, it’s important to eat breakfast, make a healthy balanced lunch your biggest meal of the day, and to avoid carbs at dinner. This will help synchronize your food intake when your metabolism in order to maximize energy and feelings of satiety, as well as reduce the tendency to store the food as fat. Your body will thank you for it!

References:
Drayer, L. (May 19, 2017). Weight loss can be tied to when, not just what, you eat. CNN. Retrieved 5/25/17 from: http://www.cnn.com/2017/05/19/health/weight-loss-circadian-rhythms-drayer/index.html
Dunaif, A. (1997). Insulin resistance and the polycystic ovary syndrome: Mechanism and implications for pathogenesis. Endocrine Reviews, 18(6), 774–800. http://doi.org/10.1210/er.18.6.774
Punjabi, N. M., Shahar, E., Redline, S., Gottlieb, D. J., Givelber, R., & Resnick, H. E. (2004). Sleep-disordered breathing, glucose intolerance, and insulin resistance: The sleep heart health study. American Journal of Epidemiology, 160(6), 521–530. http://doi.org/10.1093/aje/kwh261

PCOS and the Spoons

Are you familiar with “spoon theory?” If not, you absolutely want to do yourself a favor and read this article. Go ahead, I’ll be here.

Back? Okay, good!spoons

Spoon theory was written by a woman with lupus, Christine Miserandano, to describe what it’s like to live with a chronic disease. She imagined a person’s level of energy and ability in a given day as represented by a certain number of spoons, and then described how every task, even seemingly mundane ones, cost different amounts of spoons, causing the chronically ill person to have to make difficult decisions about how to spend their few spoons. By contrast, healthy people simply never need to worry about counting their spoons or carefully planning their expenditure.

Although spoon theory was written with lupus in mind, it can easily be applied to other chronic conditions, including polycystic ovary syndrome (PCOS), which many of my patients (as well as I) have. PCOS applies to spoon theory in terms of how we manage emotional and mental stress and anxiety. Chronic disease, of any type, is a huge life stressor that a person must contend with. This leaves that person with far fewer “spoons” to accomplish their daily tasks than those without a chronic illness.

To illustrate how this might work, let’s say a hypothetical woman with PCOS has 12 spoons. Women without PCOS or another chronic condition might have enough spoons that they don’t have to worry about even counting them most days. But for comparison’s sake, let’s say that a different hypothetical woman without PCOS also has 12 spoons.

Both women have to accomplish the same list of tasks every day, with the corresponding costs in spoons:

  • Waking up and getting herself ready for the day. (2 spoons)
  • Preparing breakfast and lunch. (1 spoon)
  • Going to work. (2 spoons)
  • Cooking and cleaning up dinner. (1 spoon)
  • Exercising. (1 spoon)
  • Quality time with partner. (1 spoon)

 
This leaves the woman without PCOS with four remaining spoons for the day that she can spend as she wishes. Perhaps she could grab a drink with a friend after work or make some progress on a household project. Or maybe she’ll have enough spoons left by the end of the night that she feels like having sex with her partner.

The woman with PCOS, however, has other hidden costs that she must spend spoons on throughout her day, in addition to the above, such as:

  • Pushing through feelings of self-loathing at her body, due to the excess mid-section weight she can’t seem to lose, in order to get ready for work. (1 spoon)
  • Checking herself for excess facial hair growth and treating her acne. (1 spoon)
  • Spending her lunch break trying to make appointments with the fertility specialist and endocrinologist. (1 spoon)
  • Resisting the strong cravings to eat food she misses, and instead eating PCOS-healthy meals. (1 spoon)
  • Getting into yet another argument with her partner about her excessively low (or excessively high) libido. (1 spoon)

 
As you can see, this leaves the woman with PCOS with one spoon too few to accomplish her daily tasks, forcing her to make difficult choices. Even worse, all of this happens invisibly, under the surface, and it might be very difficult to explain to partners and friends. This can lead to chronic stress as well as feelings of shame or inadequacy, costing further spoons.

Does this describe your life? If so, there is some good news.

PCOS may cost you a lot of spoons, but there IS a way to gain more spoons on the average day. A qualified health psychologist with expertise in PCOS can help you deal with the physical and emotional struggles of your chronic condition. In addition, reaching out to other women with PCOS to find support and community can help tremendously.

Always remember that you are not alone, and that PCOS can be effectively managed in order to live a full and happy life.

References:

de Ridder, D., Geenen, R., Kuijer, R., & van Middendorp, H. (2008). Psychological adjustment to chronic disease. Lancet (London, England), 372(9634), 246–55. http://doi.org/10.1016/S0140-6736(08)61078-8
https://butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/