tag:theconversation.com,2011:/us/topics/polycystic-ovary-syndrome-69860/articlesPolycystic ovary syndrome – The Conversation2023-09-19T11:13:48Ztag:theconversation.com,2011:article/2109332023-09-19T11:13:48Z2023-09-19T11:13:48ZPolycystic ovary syndrome and gut health: what you need to know<p><a href="https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/">Polycystic ovary syndrome</a> (PCOS) affects around <a href="https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome">8% to 13%</a> of women during their reproductive years. <a href="https://theconversation.com/explainer-what-is-polycystic-ovary-syndrome-37203">Symptoms</a> include irregular menstrual cycles, acne, excessive facial hair growth, voice changes, ovarian cysts and challenges in conception. It can also increase your risk of developing Type 2 diabetes and heart disease.</p>
<p>Despite its prevalence, a significant number – <a href="https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome">up to 70%</a> – of PCOS cases worldwide go undiagnosed. This is in part because there isn’t one specific test for diagnosis. </p>
<p>The cause of PCOS remains unclear – it’s a complex condition influenced by both genes and environmental factors. But what we do know is that it can take a huge emotional toll on women, particularly in relation to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858949/">body image</a> and fertility.</p>
<p><a href="https://www.mdpi.com/2077-0383/12/4/1454">In recent years</a>, scientists have started looking at PCOS and the gut microbiome of sufferers to see if there’s a link. These studies have found that the gut microbiome in women with PCOS is different from those without the condition. </p>
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<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
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<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
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<p><a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0124599">Women</a> tend to have <a href="https://www.frontiersin.org/articles/10.3389/fendo.2022.933110/full">more diverse</a> gut microbiomes, compared to men. But females with PCOS have fewer types of bacteria in their stool and that mix of bacteria is different compared to <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168390">women without PCOS</a>. </p>
<p>Lower diversity of gut bacteria is linked to <a href="https://www.frontiersin.org/articles/10.3389/fendo.2022.933110/full">higher testosterone levels and excess hair growth</a>. It’s also connected to problems like <a href="https://www.mdpi.com/2079-7737/11/11/1586">abnormal cholesterol levels</a> and being overweight – as well as insulin resistance, which is when cells in your muscles, fat and liver don’t respond well to insulin and can’t easily take up glucose from your blood. All of which are seen with PCOS.</p>
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Read more:
<a href="https://theconversation.com/weight-loss-improves-polycystic-ovary-symptoms-but-dont-wait-until-middle-age-start-now-113449">Weight loss improves polycystic ovary symptoms. But don't wait until middle age – start now</a>
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<h2>Gut health and PCOS</h2>
<p>Many things can affect the types of microbes living in our gut – what we eat, sex hormones, our sleep quality, where we live and our weight. But while the gut microbiome was once viewed primarily as a digestion aid, it’s now acknowledged as an intricate player in our overall health. </p>
<p><a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-02173-y">Research</a> has found that women with PCOS are more likely to have <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127094">unhealthy dietary habits compared to women without PCOS</a>. Women with PCOS are also <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2265.2006.02587.x">more likely</a> to be <a href="https://academic.oup.com/bmb/article/143/1/4/6547855">overweight or obese</a>.</p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0306987712001703?via%3Dihub">One recent theory</a> as to the role that gut microbiome plays with PCOS is that an unhealthy diet can upset the balance of bacteria in our gut. This is known as <a href="https://www.frontiersin.org/articles/10.3389/fcimb.2023.1142041/full">gut dysbiosis</a>. <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-02975-8">The theory</a> suggests that <a href="https://www.frontiersin.org/articles/10.3389/fcimb.2023.1142041/full">this imbalance</a> might make the lining of the gut permeable allowing harmful substances from certain bacteria to leak into the bloodstream – also known as leaky gut.</p>
<p>This, in turn, can trigger the immune system and mess with how insulin works, leading to high insulin levels, more male hormones being made in the ovaries and problems with how the ovaries make eggs. </p>
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<img alt="Woman standing in a room in front of a mirror." src="https://images.theconversation.com/files/547495/original/file-20230911-20-4fhhf3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547495/original/file-20230911-20-4fhhf3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547495/original/file-20230911-20-4fhhf3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547495/original/file-20230911-20-4fhhf3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547495/original/file-20230911-20-4fhhf3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547495/original/file-20230911-20-4fhhf3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547495/original/file-20230911-20-4fhhf3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Several studies have reported that women with PCOS have a worse body image than those without PCOS.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-standing-in-front-of-a-mirror-near-a-window-8433395/">Mart Productions/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p><a href="https://www.frontiersin.org/articles/10.3389/fendo.2023.1239276/full#:%7E:text=Our%20investigation%20revealed%20that%20within,hyperandrogenism%20in%20PCOS%20(34)">New research</a> has found that there seems to be a link between PCOS and some of the chemicals made when good bacteria in the gut digest fibre from food. These chemicals influence the metabolic and hormonal aspects of PCOS and when their production is increased through fibre intake, it seems to improve PCOS symptoms. </p>
<p><a href="https://www.frontiersin.org/articles/10.3389/fendo.2023.1239276/full">A 2021 study</a> also discovered that specific types of bile acids – which play a role in fat digestion – are present in larger amounts in people with PCOS. In those with PCOS, two types of bile acids are much higher. One of those acids, deoxycholic acid, is linked to how the body stores fat and insulin levels before and after meals and is also affected by testosterone. </p>
<p>So it may be that altered bile acid in people with PCOS negatively affects the gut bacteria. And that these changes weaken the gut walls, contributing to a leaky gut – which then worsens PCOS-related symptoms. But it’s also important to note that the relationship between bile acids, insulin and hormones like testosterone is complex and can vary from person to person.</p>
<h2>Gut help</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918443/">Probiotics</a>, which introduce beneficial microorganisms to the gut, have <a href="https://journals.asm.org/doi/full/10.1128/msystems.00017-19">been shown to be helpful</a> in restoring microbial equilibrium. <a href="https://journals.asm.org/doi/full/10.1128/msystems.00017-19">A 2019 publication</a> found that when women with PCOS took a <a href="https://www.frontiersin.org/articles/10.3389/fmicb.2016.00925/full">specific probiotic</a> called <em>bifidobacterium lactis</em> V9, it led to an improvement in gut health. </p>
<p><a href="https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-023-01294-6">A study that’s currently underway</a> is looking at whether probiotics or metformin (a diabetic medication used in the treatment of PCOS) can lower the levels of a hormone called free testosterone, which is often high in PCOS. The researchers are also checking other things related to PCOS, like metabolism as well as looking at gut bacteria to see if that changes too. </p>
<p>Other things that have been shown to be good for gut health more broadly are <a href="https://www.bbc.co.uk/food/articles/what_should_you_eat_for_a_healthy_gut">eating healthily</a>, getting <a href="https://www.kcl.ac.uk/news/irregular-sleep-patterns-harmful-gut-bacteria#:%7E:text=Sleep%20is%20a%20key%20pillar,unfavourable%20associations%20with%20your%20health.">enough good quality sleep</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513683/">limiting or avoiding alcohol</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357536/#:%7E:text=Exercise%20is%20able%20to%20enrich,mucosal%20immunity%20and%20improve%20barrier">exercise</a>. Indeed recent research shows that a <a href="https://academic.oup.com/jes/article/7/10/bvad112/7259972?login=false">keto diet</a> – which involves eating low carb high-fat foods – may also help to reduce testosterone levels in women with PCOS.</p><img src="https://counter.theconversation.com/content/210933/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Goitseone Thamae does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Studies have found that the gut microbiome in women with PCOS differs from those without the condition.Goitseone Thamae, Senior Research Lab Coordinator , School of Clinical Medicine, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1876722022-09-26T12:31:12Z2022-09-26T12:31:12ZTransgender men and nonbinary people are asked to stop testosterone therapy during pregnancy – but the evidence for this guidance is still murky<figure><img src="https://images.theconversation.com/files/486337/original/file-20220923-214-dia4h.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2048%2C1020&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Diane Rodríguez and her husband, Zack Elias, are a trans couple in Ecuador.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Diane_Rodr%C3%ADguez_abraza_a_su_esposo_embarazado_Zack_Elias_en_Guayaquil_-_alta_resolusi%C3%B3n.jpg">Chichicko/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>When I talk about our research team’s work on <a href="https://doi.org/10.1080/15532739.2020.1808554">pregnancy in transgender people</a>, people often recall <a href="https://people.com/tv/people-oprah-exclusive-the-pregnant-man-speaks-out/">Thomas Beatie</a>, a pregnant man who appeared on “Oprah” and in People magazine in 2008. The media focus on Beatie and his pregnancy provoked public fascination that tended to overshadow the everyday lived realities of being pregnant as a trans person. </p>
<p>Transgender people, as opposed to cisgender people, have a gender identity that is different from the gender they were assigned at birth. Some may go on hormone therapy to help align their body with their gender identity. Like most trans men, Beatie went off testosterone during his pregnancy because it was medically advised as standard practice. But <a href="https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy">testosterone therapy</a> is often essential to the mental and physical health of many trans men as well as some nonbinary people whose genders don’t fit within the categories of man or woman. What is the experience of pausing treatment like for them? Why do medical guidelines recommend going off testosterone?</p>
<p>As a <a href="https://scholar.google.com/citations?user=JF-zRXYAAAAJ&hl=en">sociologist</a> who studies sex, gender and sexuality, and trans experiences of family, health and well-being, these questions piqued my interest. I work with an <a href="https://transpregnancy.leeds.ac.uk">international team of researchers</a> on a project about trans men and nonbinary people’s experiences of pregnancy. We interviewed 70 trans and nonbinary people who were either currently or intending to become pregnant, as well as 22 health care providers specializing in working with these communities, across seven countries.</p>
<h2>Testosterone therapy</h2>
<p>While testosterone is widely considered a “male hormone,” <a href="https://www.medicalnewstoday.com/articles/323085">all people produce testosterone</a>. Physicians consider a <a href="https://doi.org/10.1210/endocr/bqaa014">wide range</a> of testosterone levels to be “normal.”</p>
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<a href="https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Thomas Beatie holding his two children" src="https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=878&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=878&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=878&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1103&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1103&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1103&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Thomas Beatie is a trans man who received widespread media attention during his pregnancies.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/thomas-beatie-with-his-daughter-susan-and-son-jensen-enjoy-news-photo/120564551">Christopher Hunt/TB via Getty Images</a></span>
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<p>Many transgender and nonbinary people take <a href="https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy">testosterone</a> as part of their mental and physical health care. Testosterone therapy often results in a more masculine appearance through facial hair and muscle growth, fat redistribution and lowered vocal pitch.</p>
<p>In addition to physical changes, many of our study participants spoke of positive mental health improvements while on testosterone therapy, including feeling calmer, balanced and more fully themselves – sometimes for the first times in their lives. This is a <a href="https://theconversation.com/transgender-youth-on-puberty-blockers-and-gender-affirming-hormones-have-lower-rates-of-depression-and-suicidal-thoughts-a-new-study-finds-177812">common finding</a> across research on hormone therapy and trans and nonbinary people. </p>
<p>While there’s no universal dosing protocol for trans or nonbinary people undergoing testosterone therapy, the <a href="https://www.endocrine.org/clinical-practice-guidelines/gender-dysphoria-gender-incongruence">Endocrine Society’s treatment guidelines</a> recommend supplementing testosterone until blood ranges fall within those for cisgender men. By basing clinical standards on cisgender men, these guidelines can <a href="https://doi.org/10.3390%2Fjcm9061609">reproduce sex and gender binaries</a> that may not fit with actual desires of many trans and nonbinary people. Some resist this prescriptive medical model by <a href="https://www.sfaf.org/collections/beta/microdosing-hormones-expands-gender-affirming-care-options-for-non-binary-folks/">microdosing</a> testosterone, with or without health care provider support.</p>
<h2>Testosterone and pregnancy</h2>
<p>When my team and I analyzed our research interviews, we learned that the health care providers in our study typically told their trans patients to stop testosterone therapy either six months before trying to get pregnant or immediately upon becoming aware of pregnancy. They also advised continuing to withhold testosterone therapy until either after birth or stopping chestfeeding (nursing their babies). This could mean a pause in testosterone therapy for up to two years.</p>
<p>Why do doctors tell trans and nonbinary patients to stop testosterone therapy during pregnancy? </p>
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<figcaption><span class="caption">Trans artist Chella Man weighed the decision of stopping testosterone therapy during pregnancy in a 2022 performance piece.</span></figcaption>
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<p>The health care providers we interviewed expressed concerns about patients continuing testosterone while pregnant or chestfeeding. When we asked them what risks they were most concerned about, they often noted that there is either not enough or inconclusive research on using supplemental testosterone during pregnancy. Despite this, nearly all of the providers we interviewed routinely advised patients to pause testosterone therapy without reservation. </p>
<p>Some providers compared continuing testosterone therapy during pregnancy to illicit drug use during pregnancy, perceiving it as a future risk to the child. Others suggested that testosterone use during pregnancy is selfish because it prioritizes the parent’s own health and well-being in the present over the potential health and well-being of their child in the future. Some providers even suggested that trans and nonbinary patients shouldn’t have children if they are unwilling or unable to pause testosterone therapy during pregnancy. </p>
<p>In contrast, the trans men and nonbinary people we interviewed described grappling with difficult and weighty decisions around pausing testosterone during pregnancy. These decisions often involved choosing between their own mental health and well-being against the potential health and well-being of their child. As one participant described their experience going off testosterone during pregnancy:</p>
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<p>“My lows were miserable, depressed, to the point of suicidal. … I knew that going back on testosterone would help. I didn’t really know whether [my doctor] would be happy to re-prescribe me testosterone … and there was a fear there that it would be withheld from me … that they were going to say, ‘Well, sorry, you came off it, you’re not getting it back.’”</p>
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<h2>PCOS and producing ‘normal’ children</h2>
<p>Despite it being fairly standard medical advice, there remains relatively <a href="https://doi.org/10.1080/26895269.2022.2035883">scant empirical evidence</a> guiding the practice of pausing testosterone therapy for trans men and nonbinary people during pregnancy and chestfeeding. There is also currently no published work on microdosing testosterone during pregnancy.</p>
<p>Instead, much of the medical literature on the potential developmental effects of “excess androgen” exposure in the womb focuses on pregnant people with <a href="https://www.verywellfamily.com/what-is-polycystic-ovarian-syndrome-pcos-1959930">polycystic ovary syndrome</a> who have testosterone levels that generally <a href="https://doi.org/10.1210/jc.2010-1123">fall between those for cisgender women and men</a>. These studies center on the likelihood of the baby later developing <a href="https://doi.org/10.1210/en.2016-1801">intersex conditions</a>, or having biological traits that do not fit binary definitions of male or female characteristics; later self-identification as <a href="https://doi.org/10.1093/humupd/dmi013">lesbian</a> or <a href="https://doi.org/10.1093/humrep/del474">trans</a>; <a href="https://doi.org/10.1093/humrep/deab112">metabolic and cardiovascular dysfunction</a>, such as obesity; and <a href="https://doi.org/10.1038/s41398-021-01699-8">neuropsychiatric disorders</a>, such as autism and attention-deficit disorder. Most of these concerns have involved children categorized as female at birth.</p>
<p>People with polycystic ovary syndrome, however, are <a href="https://doi.org/10.1016/s0015-0282(01)02995-8">not routinely placed on testosterone blockers</a> during pregnancy or discouraged from feeding their infants milk they produce.</p>
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<figcaption><span class="caption">Pursuing parenthood as a trans person in an anti-LGBTQ environment comes with many challenges.</span></figcaption>
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<p>In my review of our interviews and the medical literature, I became increasingly concerned that this focus on producing “<a href="https://theconversation.com/how-pregnancy-can-be-made-more-difficult-by-maternity-cares-notions-of-normal-117223">normal</a>” children fails to attend to both natural human diversity in cognitive processing, bodies and identities, and the mental health of trans and nonbinary parents. It may also echo <a href="https://theconversation.com/forced-sterilization-policies-in-the-us-targeted-minorities-and-those-with-disabilities-and-lasted-into-the-21st-century-143144">eugenicist policies</a> that attempt to eliminate human characteristics and communities that society deems inferior or bad. But <a href="https://autisticadvocacy.org/wp-content/uploads/2016/06/whitepaper-Increasing-Neurodiversity-in-Disability-and-Social-Justice-Advocacy-Groups.pdf">people</a> <a href="https://www.thetaskforce.org/">from these</a> <a href="https://naafa.org/">communities</a> have done a great deal of work over the past several decades to ensure they are granted equal rights and protections.</p>
<p>Paradoxically, the desire to protect offspring from testosterone exposure during pregnancy and chestfeeding may become a method to prevent the reproduction of some of the very same characteristics held by trans and nonbinary parents themselves. As one participant noted:</p>
<blockquote>
<p>“There’s a bunch of research around androgen exposure in utero and intersex conditions. … I did have complex feelings around working hard to not have an intersex child. … As someone who is a gender ‘other,’ to work hard to not create a different body that is a gender ‘other’ feels weird. It feels hypocritical.” </p>
</blockquote>
<h2>Moving beyond one-size-fits-all</h2>
<p>While concerns about “androgen excess” during pregnancy for trans men and nonbinary people parallel those for people with polycystic ovary syndrome, doctors treat these cases differently. This discrepancy in clinical approach indicates that there may be other pathways forward that don’t require stopping testosterone therapy completely. </p>
<p>I believe that careful attention to the physical and mental health and well-being of trans and nonbinary people before, during and after pregnancy is long overdue in medicine. Instead of approaching testosterone therapy during pregnancy as a binary yes/no question or a one-size-fits-all standard, investigating how various dosages of testosterone may affect all stages of pregnancy and chestfeeding could lead to better outcomes for both trans parents and their children.</p><img src="https://counter.theconversation.com/content/187672/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carla A. Pfeffer received funding from the Economic and Social Research Council for her work on the Transgender Pregnancy Project.
The Trans Pregnancy Project team includes: Sally Hines (PI), Ruth Pearce, Carla A. Pfeffer, Damien W. Riggs, Elisabetta Ruspini, and Francis Ray White.</span></em></p>Testosterone therapy is often essential for the health and well-being of transmasculine people. The choice to stop it to pursue pregnancy can be a difficult one.Carla A. Pfeffer, Associate Professor of Social Work, Affiliate Faculty in Sociology and the Center for Gender in Global Context, and Director of the Consortium for Sexual and Gender Minority Health, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1895622022-09-11T08:24:43Z2022-09-11T08:24:43ZOvarian condition that can cause missed menstrual periods and infertility is going undetected in Nigeria<figure><img src="https://images.theconversation.com/files/483220/original/file-20220907-15-1d1rn.jpg?ixlib=rb-1.1.0&rect=50%2C42%2C5615%2C3690&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women with Polycystic Ovarian Syndrome often battle infertility and may not conceive easily. Photo by Florian Plaucheur/AFP via Getty Images.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/young-nigerian-girl-who-fled-maiduguri-to-kano-with-78-news-photo/463348590?adppopup=true">from www,gettyimages.com</a></span></figcaption></figure><p><em>Polycystic ovary syndrome is the most common gynaecological endocrine disorder in women of reproductive age. It affects between <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879843/#:%7E:text=Background%3A,women%20of%20reproductive%20age%20worldwide">4% and 20% of women globally</a> and is influenced by genetic and environmental factors. Despite its prevalence, it remains a conundrum amongst clinicians and allied health professionals. The Conversation Africa’s Nigeria based commissioning editor Kofoworola Belo-Osagie asked public health lecturer Ajike Saratu Omagbemi to explain the syndrome and the challenges around how it’s being detected.</em> </p>
<h2>What is polycystic ovarian syndrome?</h2>
<p><a href="https://www.nichd.nih.gov/health/topics/pcos/conditioninfo">The condition</a> refers to the presence of small, benign and painless cysts in the ovaries, which result in a range of symptoms and changes in hormonal levels. </p>
<p>It is characterised by elevated androgen levels. In turn this leads to <a href="https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome">excessive body and facial hair</a> and menstrual irregularities (no period or a long period).</p>
<p>It’s called a <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/syndrome">syndrome</a> because it’s a collection of signs and symptoms which occur consistently together. </p>
<p>Polycystic ovary syndrome <a href="https://academic.oup.com/humrep/article/17/9/2219/563943">can</a> mildly or severely disturb the reproductive, endocrine and metabolic functioning of a woman. </p>
<h2>How big a problem is it in Nigeria?</h2>
<p>Polycystic ovary syndrome affects <a href="https://pubmed.ncbi.nlm.nih.gov/24283091/#:%7E:text=Conclusion%3A%20PCOS%20is%20fairly%20common,are%20the%20commonest%20presenting%20features">one in six</a> infertile women in Nigeria. Local <a href="https://www.itmedicalteam.pl/articles/prevalence-of-polycystic-ovarian-syndrome-pcos-in-women-of-child-bearing-age-within-port-harcourt-metropolis-in-nigeria-.pdf">studies</a> have reported rates of between <a href="https://www.scirp.org/journal/paperinformation.aspx?paperid=87687">13.8%</a> and <a href="https://www.researchgate.net/publication/258956774_Prevalence_presentation_and_management_of_polycystic_ovary_syndrome_in_Enugu_south_east_Nigeria">18.1%</a>, amongst study populations of women in their reproductive age. </p>
<p>Local studies have mostly focused on determining its prevalence, treatment and management techniques. Only a couple of studies have focused on knowledge about the condition; and their findings were mixed. It’s not clear how much people know about polycystic ovarian syndrome in Nigeria. </p>
<p>It’s important to close the knowledge gap on the condition in Nigeria. The country <a href="https://www.researchgate.net/publication/288971582_Double_Burden_Non-Communicable_Diseases_And_Risk_Factors_Evaluation_In_Sub-Saharan_Africa_The_Nigerian_Experience">suffers</a> from a double burden of infectious and non-infectious diseases such as HIV/AIDS, tuberculosis, cardiovascular disease, diabetes and obesity. There is growing <a href="https://academic.oup.com/jcem/article/91/2/492/2843344">evidence</a> that these are linked to polycystic ovarian syndrome.</p>
<h2>What is the impact?</h2>
<p>Polycystic ovary syndrome can greatly affect the health and well-being of girls and women in the short, middle and long term, leading to deterioration of the quality of life. </p>
<p>It can begin as early as the start of puberty. A girl may not understand what she is experiencing or be aware of her risk of ill health. Older women may not seek or receive targeted care early enough. They may have years of <a href="https://journals.lww.com/progprevmed/fulltext/2020/06000/cross_sectional_study_on_the_knowledge_and.1.aspx">unrecognised ill health</a> before getting a diagnosis. </p>
<p>Symptoms are often related to a deterioration in a woman’s self-esteem and self-image and may thus affect her <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941334/">psychosocial</a> health.</p>
<p>Infertility, a classic symptom of polycystic ovarian syndrome, remains a critical concern in many African societies. There’s a great deal of stigma attached to women in Nigeria if they <a href="https://www.researchgate.net/publication/261903427_The_Social_meaning_of_meaning_of_infertility_in_Southwest_Nigeria">can’t become pregnant</a>. Th psycho-social and other <a href="https://www.ajol.info/index.php/njfp/article/view/157342#:%7E:text=The%20main%20negative%20psychosocial%20effects,confidence%20in%20oneself%20(7.7%25">consequences</a> may include deprivation and neglect, violence, marital problems and mental health issues. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Secondary school students sit in a group outside their classroom" src="https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It is often difficult for teenage girls to recognise the symptoms of Polycystic Ovarian Syndrome at puberty.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/public-school-for-girls-in-mainland-area-on-march-17-2016-news-photo/648348944?adppopup=true">from www.gettyimages.com</a></span>
</figcaption>
</figure>
<h2>Why is the syndrome difficult to recognise?</h2>
<p>Polycystic ovary syndrome is most often diagnosed two or three years <a href="http://dx.doi.org/10.1097/GCO.0b013e3282f10e22">after</a> the start of puberty because the menstrual patterning stabilises around that time. There are different manifestations at this stage of development. Some adolescents more frequently experience menstrual irregularity – a good marker of a heightened androgen level. That in turn leads to unwanted developments such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835258/#:%7E:text=Hyperandrogenemia%20is%20a%20salient%20feature,resistance%20in%20women%20with%20PCOS">male-pattern hair growth on the chest, back and face, male-pattern baldness</a>, and acne. It’s thought that heightened androgen results in the development of polycystic ovary syndrome in adulthood.</p>
<p>The syndrome is not the only cause of missed ovulation in the menstrual cycle, but is strongly associated with menstrual irregularities.</p>
<p>Other manifestations are a skin condition known as <a href="https://www.mayoclinic.org/diseases-conditions/acanthosis-nigricans/symptoms-causes/syc-20368983#:%7E:text=Acanthosis%20nigricans%20is%20a%20skin,the%20armpits%2C%20groin%20and%20neck">acanthosis nigricans</a>, which causes darker skin in the folds of the body, and <a href="https://pubmed.ncbi.nlm.nih.gov/18502254/">premature pubarche</a>, where pubertal changes take place too early – often before eight years of age.</p>
<p>It is easy to miss the condition in adolescents. And in the transition between adolescence and adulthood, normal changes can mimic the syndrome’s characteristics. </p>
<h2>Why are older women not likely to seek treatment early?</h2>
<p>Polycystic ovarian syndrome shows up in multiple ways and so it’s usually treated as different things. Health professionals still struggle with understanding it themselves, so they can’t always give women the information they need. Sometimes women eventually just try to treat their symptoms themselves. </p>
<p>Women who are using contraceptives may not realise that the hormonal changes they are experiencing are actually <a href="https://pubmed.ncbi.nlm.nih.gov/14748678/">symptoms</a> of polycystic ovarian syndrome. Only when they are off the contraceptive and trying to conceive without success do they seek help. </p>
<h2>What social and lifestyle factors may cause the syndrome?</h2>
<p>The exact cause is not known. Factors such as genetics and lifestyle have been linked to the development of polycystic ovarian syndrome. One can inherit the risk. Studies have <a href="https://www.endocrineweb.com/conditions/polycystic-ovary-syndrome-pcos/what-causes-pcos-how-will-it-affect-body">found</a> familial links.</p>
<p>Women with polycystic ovarian syndrome have an imbalance of insulin and androgens. Higher levels of insulin are suggestive of a high caloric diet and sedentary lifestyle. Up to 85% of women with polycystic ovarian syndrome also experience <a href="https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline">insulin resistance</a> – when their body’s cells stop responding normally to insulin, and instead block the entry of glucose into the cell and thus cannot maintain normal glucose levels. Insulin resistance is brought on by certain <a href="https://www.jeanhailes.org.au/health-a-z/pcos/symptoms-causes">lifestyle factors</a> such as poor diet and physical inactivity. Physical activity plays a <a href="https://pubmed.ncbi.nlm.nih.gov/1681160/">role</a> in insulin resistance disorders such as diabetes.</p>
<h2>What needs to be done?</h2>
<p>The big challenge is to fill the knowledge gaps about the condition. Then people can manage the disease better, prevent complications, and be less anxious about fertility. </p>
<p>Women and girls with the condition and those at risk need to be educated about the possibility of <a href="https://academic.oup.com/jcem/article/91/2/492/2843344">metabolic complications</a> so they can make lifestyle changes.</p><img src="https://counter.theconversation.com/content/189562/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ajike Saratu Omagbemi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Polycystic Ovarian Syndrome is common among women and girls in Nigeria but not many know its impact on their lives and reproductive health.Ajike Saratu Omagbemi, Lecturer, Babcock UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1134492019-04-28T20:16:12Z2019-04-28T20:16:12ZWeight loss improves polycystic ovary symptoms. But don’t wait until middle age – start now<figure><img src="https://images.theconversation.com/files/271331/original/file-20190429-194616-1xlihxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women with polycystic ovary syndrome are more likely to be overweight or obese. But it’s easier to maintain a healthy weight while young than wait until later to shift the kilos. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/back-view-portrait-young-obese-woman-589121366?src=dwhdGRzUZ3ld_4j6I6plKw-1-27">Pressmaster/Shutterstock</a></span></figcaption></figure><p>Women with polycystic ovary syndrome (PCOS) are more likely to be overweight or obese and their symptoms worsen the heavier they are.</p>
<p>What causes this weight gain? How can losing weight help? And how can women shed the extra kilos to improve what they describe as distressing symptoms?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-polycystic-ovary-syndrome-37203">Explainer: what is polycystic ovary syndrome?</a>
</strong>
</em>
</p>
<hr>
<p>PCOS is the most common hormonal disease in women of childbearing age. Symptoms include irregular periods, or signs of high male hormone levels, such as excessive hair growth or severe acne.</p>
<p>Women find it distressing to deal with these symptoms as they feel their <a href="https://www.ncbi.nlm.nih.gov/pubmed/24719724">feminine identity is challenged</a>. They also report a lack of support from health professionals and peers, and worry about long-term risks, such as developing type 2 diabetes.</p>
<p>Women with PCOS are two to three times <a href="https://academic.oup.com/humupd/article/18/6/618/628147">more likely to be overweight or obese</a> (having a body-mass index of 25 kg/m² and above) compared to women without the condition. And they <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/oby.20213">gain more weight a year (260g more)</a> than women without PCOS of the same age. Many women with PCOS also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4013493/">have trouble losing weight or keeping it off</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a>
</strong>
</em>
</p>
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<h2>Does weight gain make PCOS symptoms worse?</h2>
<p>Heavier women with PCOS <a href="https://www.ncbi.nlm.nih.gov/pubmed/23114091">tend to have worse symptoms</a>. The question is whether gaining weight worsens symptoms or PCOS itself causes women to gain weight.</p>
<p>To prove gaining weight worsens PCOS symptoms, we need studies in which women are made to gain weight and their symptoms monitored for changes. We doubt if such a study has been done because of ethical issues relating to the potential harm to participants. That’s not to mention the challenges in recruiting women for a study where they would gain weight. So we need to look for other forms of evidence. </p>
<p>An <a href="https://www.ctu.mrc.ac.uk/patients-public/about-clinical-trials/what-is-an-observational-study/">observational study</a> in Finland found an increase in BMI in women from the age of 14 to 31 <a href="https://academic.oup.com/jcem/article/101/2/739/2811201">was associated with</a> greater likelihood of having irregular periods, excessive hair growth or being diagnosed with PCOS.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/in-defence-of-observational-science-randomised-experiments-arent-the-only-way-to-the-truth-49807">In defence of observational science: randomised experiments aren't the only way to the truth</a>
</strong>
</em>
</p>
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<p>And when women with PCOS lost weight through lifestyle changes such as eating less or increasing physical activity, a <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007506.pub4/full">Cochrane review</a> showed a reduction in male hormones and excess hair growth.</p>
<p>Given the above evidence, we could conclude that weight gain is likely to make PCOS symptoms worse.</p>
<h2>Does PCOS cause weight gain or stop you losing weight?</h2>
<p>Many women with PCOS say they find it <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4013493/">very hard to lose weight</a>, but we don’t fully understand why that is.</p>
<p>Women with PCOS have the <a href="https://www.sciencedirect.com/science/article/pii/S0261561415000497">same metabolic rates</a> as women without PCOS. They eat <a href="https://www.fertstert.org/article/S0015-0282(13)01602-6/fulltext">a few more calories</a> (about 200 kilojoules a day, or the equivalent of one cube of cheese) than women without PCOS. This could lead to putting on an extra 2-3kg over a year. </p>
<p>Women with PCOS may have different levels of <a href="https://academic.oup.com/jcem/article/89/7/3337/2844354">hormones that control appetite</a>, and the high levels of male hormones could <a href="https://www.sciencedirect.com/science/article/abs/pii/S0031938409002200?via%3Dihub">increase cravings</a> for high-fat foods.</p>
<p>But when provided with similar levels of support, women with and without PCOS <a href="https://www.ncbi.nlm.nih.gov/pubmed/28885578">lose the same amount of weight</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">When provided with similar levels of support, women with and without PCOS lose the same amount of weight.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/120882769?src=oLgOb28-_3y0NWNu_mMV4g-1-60&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>Looking beyond PCOS, all women of childbearing age seem to put on small but persistent amounts of weight. Women, on average, <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwjzzILehOjhAhWJA3IKHYcRA3AQFjAAegQIBRAC&url=https%3A%2F%2Fwww.alswh.org.au%2Fimages%2Fcontent%2Fpdf%2Fmajor_reports%2F2007_major_report_b.pdf&usg=AOvVaw0nEjxJbcOE4vnxhMKKME95">gain up to 600g a year</a> from the age of 18. Women who are married or partnered, start work or have children are <a href="https://www.nature.com/articles/0802150">more likely to gain weight</a>.</p>
<p>The reasons women gain weight could relate to <a href="https://www.sciencedirect.com/science/article/pii/S0168822716317752">challenges</a> maintaining a healthy lifestyle due to lack of time, energy, motivation and supporting family and friends. </p>
<p>These reasons tend to be similar for women with and without PCOS. However, women with PCOS may face additional challenges as they describe ongoing stress living with PCOS symptoms such as unpredictable periods.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-choose-the-right-contraceptive-pill-for-you-87614">How to choose the right contraceptive pill for you</a>
</strong>
</em>
</p>
<hr>
<p>Women with PCOS also have <a href="https://link.springer.com/article/10.1007%2Fs11920-017-0834-2">higher levels of anxiety and depression</a> and lower quality of life, all of which may compromise their ability to adopt a healthy lifestyle. </p>
<p>Recent focus groups we conducted revealed women with PCOS reported “a lifetime of yo-yo dieting” with repeated cycles of weight loss followed by weight regain. Often these cycles result in an overall weight gain over the years.</p>
<h2>What should I do if I have PCOS?</h2>
<p>Instead of going on unsustainable diets, which could lead to weight cycling and a sense of defeat, aim for small (and therefore sustainable) changes in diet and exercise. </p>
<p>Find something you enjoy. Set yourself the overarching goal to maintain your weight and improve your health, whatever that is now. </p>
<p>Keeping track of your weight by weighing yourself regularly (say, once a week) can help. If you have regular medical appointments, having your doctor monitor your weight changes between visits can also help you maintain your weight. </p>
<p>If you are 25 years old now, simply holding on to your current weight would be equivalent to permanently losing more than 20kg when you are 50. We know that is next to impossible. Staying the same weight is a far more achievable goal, and just as beneficial.</p><img src="https://counter.theconversation.com/content/113449/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Siew Lim has received funding from NHMRC for Early Career Fellowship. </span></em></p><p class="fine-print"><em><span>Carolyn Ee has received funding from the NHMRC Centre for Research Excellence in PCOS. </span></em></p>Women with polycystic ovary syndrome say they find it hard to lose weight. Here’s what they can do to improve their symptoms and long-term health.Siew Lim, NHMRC Early Career Fellow/ Monash Health dietitian, Monash UniversityCarolyn Ee, Senior Research Fellow, NICM Health Research Institute, Western Sydney University, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.