So, I am a woman with ‘lean PCOS’ (Polycystic Ovarian Syndrome). What this means, technically, is that I fall into the 1/3 of women who have PCOS who are not overweight or obese. This is no small feat as maintaining a normal weight is difficult with this disorder.

Lean PCOS

A large number of women don't fit the stereotypical image of a PCOS patient. When you think of PCOS, you think of symptoms such as being overweight or obese, having acne and facial hair, etc. Some women have symptoms that are not so pronounced. Even though they are not overweight and have few of the typical signs or symptoms of a woman with PCOS, lean women with PCOS are still prone to having the biochemical changes that are inherent with PCOS.  However, there are differences in the intensity and types of androgen hormones that affect them causing differences in their appearance and symptoms. 

Here’s why weight management with PCOS can be so difficult.

One significant challenge with PCOS is that your body is insulin resistant. This means that insulin is being produced but your cells aren’t sensitive to it, causing insulin to be over-produced, and still not doing the job effectively. Since insulin is a storage hormone and one of the primary purposes is to store fat (yes, I know, so seemingly unhelpful to us women, but was necessary when food was scarce) an excess of insulin means that your body works hard to store fat, particularly in your abdomen. Abdominal fat, then, contributes to insulin resistance by producing substances that decrease your body’s sensitivity to insulin. This becomes one of the vicious cycles of PCOS where your body acts as if it wants to gain weight or maintain an unhealthy weight. Oh, and by the way, central insulin resistance messes with your satiety and hunger hormones skewing them so that you feel that you can’t eat intuitively because you are always hungry. Nice. Well, obviously, since I am lean (I get to say that again) I have found a way to combat this. But, it took me many years and my college years, due to the carb-laden meal plan food, were a wake-up call for me. What it comes down to, for me, is one simple sentence: I have to manage my life differently due to PCOS. 

My life is different because of PCOS

It’s just true. Even though I maintain my weight, my life is different with PCOS than if I didn’t have it.

First of all, I’m still at risk for high cholesterol and the accumulation of bad lipids in the blood stream. I am still at risk for insulin resistance and its evil stepsister, type 2 diabetes mellitus. Also, I don’t ovulate regularly, so I needed help conceiving (but I did conceive successfully, carried, and delivered, 4 children). Those are just the large-scale effects of PCOS. 

What about the day-to-day PCOS management?

 After much experimentation, I know what foods are good for my body and which aren’t. I’m not just referring to weight maintenance. The foods I eat change how I feel that day and often the next day as well. When I eat well, combining a ‘slow’ carb (brown rice, quinoa, sweet potato) with a protein and healthy fat, I feel satisfied and happily satiated (as opposed to grossly full). When I stray, and I do stray because this is a lifestyle change, not a diet, I pay for it with a carb hangover. For example, if I stay at a hotel for a conference, they offer a Continental Breakfast. This is the enemy of the PCOS patient since it mostly consists of pastries, bagels, sugary yogurt and fruit. I bypass these and eat my own package of nuts or one of my nutrition bars and feel good. But if I choose to eat the muffins and fruit that day, I find myself dozing off around 2-3 pm and having sugar lows the rest of the day. You may know how these feels; shaky, sometimes sweaty, hurriedly needing to eat to relieve the feeling. Most of us don’t grab a protein snack, like a hardboiled egg, we grab crackers or a carb and the low-high-low sugar cycle begins again. 

So, I’ve become that person that brings my own snacks on planes (even hard-boiled eggs, to the horror of my seat mate) and on trips. I am fully prepared with my own food and am happily surprised if the food at my destination is PCOS-certified. And I’m annoying at restaurants. “I’ll have the roasted salmon with no butter and steamed vegetables and no bread”. And I don’t care that I seem like “that person” because I realize that it’s usually not worth the physical response that my body gives me when I eat poorly.

Do I resent PCOS?

You might wonder about that!  And at one point, when all of my college roommates were scarfing down pizza and not gaining a pound and I didn’t fit into my jeans, I was resentful of PCOS. But now, I’m actually grateful. I have learned to (ok -maybe been forced to) eat in a way that is good for me for the rest of my life. I have learned to pick up cues from my body that tell me when what I am doing is good for me vs not good. And, sometimes, I choose the “not good”. But I do it with the knowledge that I will pay for it for a short bit later, then get back on track.  Then, I enjoy and savor it. Like French fries. Can’t give those up. I am now in my forties and many people tell me I look much younger- my years of healthy eating and exercise have attributed to this. I realize that physical activity and combining whole foods are essential to sensitizing your body to insulin. I used to have to force myself to run, now I do it as a form of stress release and can’t imagine not having it as an outlet for stress relief. I can tell you that the benefits of it far outweigh that of eating a donut (but not fries, those have no drawbacks, said with tongue firmly in cheek). 

I’m not like other people- I have PCOS & I’m healthier because of it

I’m am not like other people “my age”, a comment I’ve hear numerous times by many & varied health care providers. And, I agree. I’m better. I’m more disciplined, more resilient, and way more tenacious. 

Today, I went to my internist for a visit and she wanted to “clean up” my medical history, deleting the problems and illnesses that I no longer have. She wanted to delete PCOS because “clearly I am not suffering from it anymore”. Well, that’s true, I am not suffering from it, I’m living better because of it. And, I asked her not to delete it. Just like it is now October and PCOS month was in September, PCOS does not only affect me only at certain times, it will always be a part of my life. And I wear my “living with PCOS” as a badge of honor, hopefully inspiring others who have to do the same. So, maybe today you put on your combat boots and eat well and exercise and fight insulin resistance. Maybe today, you put your combat boots under your bed and eat fries and binge-watch TV shows. Whichever you choose is the right decision for you that day, then you move on tomorrow to living healthfully again. Because, you are not like people your age. You’re better.

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Monica Moore
As a nurse practitioner, Monica received advanced nursing education in addition to being a registered nurse. She is a fully licensed registered nurse and Advanced Practice Nurse Practitioner in the state of Connecticut and is certified by the board of the American Academy of Nurse Practitioners. Monica’s nursing work experience spans nearly two decades in the field of fertility treatment. Monica’s passion lies in taking care of the whole patient. Monica works with patients and stresses the importance of integrating comprehensive care – including yoga, acupuncture, massage therapy and nutrition – with fertility treatment.
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