My Journey with PCOS

by Karen L.

Dramatic changes have taken place in my life over the past couple of years. My greatest wish in sharing this story is that someone reading it may experience some of the happiness and sense of greater control I now have as a result of being better able to manage PCOS.

As a teenage girl I often expressed concerns to doctors about irregular cycles, weight problems and acne. By the time I was finished high school, I had seen GPs, dermatologists and dieticians about all of my issues! They prescribed a whole range of antibiotics, skin creams and diets. Some of them told me it was stress. Oh, and that I should exercise and diet. (Heard that before?)

My weight has always been very 'up and down', but more 'up' than 'down' over most of the last two decades! I have never been a lazy or inactive person, and have always enjoyed healthy eating. I've never liked eating greasy foods, rarely drink alcohol, have never smoked, have always tried to eat a low fat diet and have been the type to read nutrition panels for many years. However, I went from being Size 12 in high school, to 14, 16, 18, 20, 22! I hit the all time heavy weight of 110 kilos (242 lbs.) in 1997. (Actually, it was probably higher, but by the time I had the courage to weigh in at Weight Watchers, that's what it was down to!) While I sought out low fat, nutritious foods, I suppose I ate lots of it! Lots of nutritious low fat pasta meals, lots of nutritious low fat everything....yep, lots! Someone close to me once said, 'if you're going to eat like an athlete, then you should train like one!' (Eventually I did just that, but more of that later...) It's fair to say that I did my stints of walking for 30 or 40 minutes, aerobics classes, Pilates, Yoga, Dancing....whatever I felt like at the time. But, my weight was still consistently a problem.

I think one of my most humiliating moments must have been the day in early 1994 when I was traveling on a bus to see the gynecologist to whom I was sent after a local female GP suspected I had PCOS. I had just moved to Sydney, so had to ask the driver to let me know where to alight for the Royal Women's Hospital. As soon as I told him where I was going, he kept shouting out to the passengers, "hey everyone, this lady's got a bun in the oven". Of course, I was not pregnant, just fat. Normally, I'm pretty outspoken and would have told him off, but that day, I was just too down.

As far as my skin went, I eventually ended up pretty much getting that under control a few years ago after a nine month course of Roaccutane, using the Pill (Diane/Brenda 35) and getting laser treatment for acne scarring and broken capillaries. Eventually I had to come off Diane 35 because of worries with aura migraines, which are no longer a problem when not using the Pill. Using Differin gel on my skin regularly keeps any skin problems under control in times of stress. Although a change of diet over the past few months to exclude foods containing Dairy (including soy products made with Dairy Protein), has lead to almost spotless skin and I have not had to use the Differin much!

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Depression and low self esteem had been issues at various times and my weight and skin problems were contributing significantly to these problems. With the extra weight piling on, my blood pressure had become borderline high, my moods more 'down' than 'up' and I decided that the only way to go had to be 'up'! The loss of control over my health and my inability to cope became too much for me to bear. I was only in my mid-thirties and something rather drastic had to be done. I had been prescribed anti-depressants on three occasions but never took them because I felt that if I could get over my self-esteem and weight issues, then I probably wouldn't feel depressed!

In 2002, during a particularly busy and stressful period, I had a big scare when my skin went completely haywire and had fainting spells and the aura migraines I referred to earlier for the first time. I was told by a very good GP specializing in women's health that until my weight came within Healthy Range that it was not wise to come off the Diane (Brenda) pill. However, apparently my risk of stroke was higher now that these migraines had started! So, I was very keen to get off it, particularly as the next two months brought with it more migraines. The threat of diabetes is always there for overweight women with PCOS, so that potential health problem was worrying me sick too! My ability to cope with stress was poor and I admitted to myself that I needed help, but was sick of doctors, Chinese herbalists, dieticians, acupuncturists and the rest of them!

Some of the girls at work who don't have PCOS, work very hard at keeping themselves fit. I told myself that until I worked as hard as them, I really couldn't say I'd done everything I could to change my situation! So, I rocked up to my local gym one day and asked about the possibility of working with a Personal Trainer. I knew a couple of girls who looked completely different after having worked with one, so it was worth a try.

Despite years of seeking advice on weight from a range of medical practitioners, finally it was my trainer who helped me to finally drop about 23 kilos (51 lbs.)! I lost some on my own too, so altogether, around 33 kilos (73 lbs.) over a 2 year period. In doing so, my PCOS symptoms have reduced dramatically to the extent that I can live without medications except for Differin gel to treat the occasional pimples! I have been able to keep my weight pretty much stable and am a size 12/14 (am 179cm or 5' 10.5" tall) for the first time in about 20 years! I was so impressed that finally someone was able to help me manage a lifelong problem, that in 2003 I decided to enroll in a Certificate in Fitness at TAFE to learn more about how my body works. Doctors can treat symptoms of PCOS, but none of the ones I saw at least, ever gave me the kind of life changing advice that my Personal Trainer was able to offer. Anyway, I am now a qualified Gym Instructor, Aerobics Instructor and probably by the time this article gets printed, Personal Trainer. A big change from the size 22, 110 kilo girl from 1997! There are some basic fitness principles that I followed that still work for me today. I would encourage you to make these changes if you are having trouble losing weight and/or dealing with PCOS.

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Why Fitness is the one thing that has really worked in helping me manage PCOS

Fitness is my happy drug! Being fit solves a lot of problems when they arise. When I'm fit, I feel confident, attractive, calmer and on top of things. It costs me way less to be fit than to correct the problems that result from a lack of fitness. Being down, stressed, anxious, lacking in confidence, feeling unattractive, having to deal with PCOS symptoms, have all cost me dearly in the past, not just financially, but socially and in my career. Sitting in medical waiting rooms is a waste of my precious time, and although I still have to be there occasionally, would rather spend that time in the gym, or at a Fun Run and not have to pay out lots of money for scripts that I can live without. It's hard work though. I still put on weight easily if I can't or don't get my particular diet/exercise formula right. Sometimes getting up and working out is a big hassle....it hurts and sometimes you just don't feel like it. But, feeling bad about myself and depressed is worse.

What the doctors say is true....."Exercise and diet!" BUT, the information they give is often not specific enough. After I lost all my weight, I was amazed how many doctors asked, 'so how'd you do it?' They were wanting advice for other patients who, like me, swore black and blue that they had tried everything.

For me, many answers to my PCOS problems came from learning more about how my body works! The most important changes I made were:

• Using a heart monitor during aerobic exercise to ensure I was reaching a high enough heart rate for the duration of my session. Previously, when walking or doing pilates or yoga, my heart rate was way slower than what ended up being effective for me in weight loss. During my weight loss period, I needed to be working at around 120 - 160 beats per minute for around 30 minutes to make any difference. I didn't find this overly difficult and was able to achieve this by walking up hills and eventually needed to jog to keep my heart rate high enough. For many years, I wasted a lot of time in exercise by not getting my heart rate high enough during my sessions. Even if I had made this one change, I could have avoided many years of being overweight and unhappy. (The maximum heart rate you should be working at is about 225 minus your age. Try to work at around 60 - 80 per cent of that figure for the duration of your session. If you are very unfit, you may achieve this by just walking. If you are like me and have some exercise background, just walking on flat ground may not be enough to achieve a high enough heart rate.)
• Strength training: I work with reasonably heavy weights in 'compound' exercises ie working several muscles at once, using large muscle groups (not isolated, smaller muscles). For example lunges, chest press, seated row, etc (2 sets of 12 - 15 repetitions). I followed the principal of Progressive Overload and continually increased weights when I could achieve both sets at the one weight. This is very important in fitness, as your body adapts to exercise and must be continually challenged!
• Diet: I eat smaller portions of food very regularly throughout the day with an emphasis on Low GI foods, lots of fruit and vegetables, and low fat/low sugar foods generally. Basically I ate a very balanced, healthy diet with small treats. When I was big, I tried to avoid all treats. Now, I eat much smaller portions of food and can now enjoy a small treat every day. I find not having to deprive myself of treats helps me stick to a healthy diet overall. (I followed the Weight Watchers program, although with all the exercise I was doing, I was always able to eat more food than allowed and still lose weight. So much for the girl who always told everyone that it was extremely difficult for me to lose weight!)

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We are all in different situations, with different pressures in life, likes and dislikes in food and exercise, and medical histories (PCOS and other conditions). So, there's definitely not a 'one size fits all' approach here. However, in understanding that we are all different, I thought that some of the things that worked for me, may also work for someone else! My own choice is to stay fit for as long as I am able.

1. Burn more than you consume

Okay, I admit with PCOS, there are many considerations. Dealing with PCOS symptoms can cause a lot of stress and worry, which has got to affect your hormones and how your metabolism functions. However, despite what many overweight women will tell you, particularly those with PCOS, the 'burn more than you consume' thing still applies!

I like to eat! I can't stand deprivation or low carb dieting and personally would rather increase my intensity of exercise so that I can eat more! Despite this, I know I cannot eat anything I want, ever, no matter how hard I train. There is a limit to how much training I am prepared to do, and therefore, when I train less, I also try to eat less kilojoules. When I eat too much, I know I have to train harder to stay on top of things. If I get injured, I can't train as hard, so have to make adjustments and eat less. That's my reality and I have to accept it!

2. Combine resistance training with aerobic training.

Developing more muscle strength will assist you in increasing your metabolism. And no, you will not turn into a Muscle Woman just by doing a couple of weights sessions per week! The more muscle I've developed, the easier it has been to keep my weight down. When I stop weights, it all becomes harder and I put on weight immediately! The good news is that there is such as thing as muscle memory as well and even if I put on weight, if I go back to my strength training programme, I get stronger way quicker than the first time I tried! (And therefore, lose weight quicker than before too!)

Muscle weighs more than fat, so when you start weight training, the scales may not show a weight loss, but you are sure to see a positive change in your shape! With more lean muscle mass, the fact is, you can burn kilojoules 24/7! For me, I lift fairly heavy weights (2 sets of 12 - 15, depending on the exercise.) As I mentioned before, stick to using several larger muscles at one time, ie lunges/leg presses (compound exercises). While they hurt quite a bit, they are much more effective for weight loss than working isolated muscles. I used to just get a pair of little weights and do bicep curls and other isolated muscle exercises which I now realize is almost a complete waste of time for weight loss! Get some advice from a good gym instructor on suitable exercises for you, especially as you may have other medical conditions or injuries that need to be considered in the programming.

3. All exercise is not the same!

If you choose a lower intensity form of exercise, then you may need to eat much less. That's your decision. Sometimes I don't feel like jogging or doing aerobics. But, if I make that decision, then I need to accept that I can't eat as many kilojoules because I'm not burning as much energy. Don't think that just because you are exercising then you can eat what you want. We all know people who can basically eat what they want. (Sickening, hey?) For some people, all they have to do is not eat junk food all day, and that's their key to losing weight! Women with PCOS don't usually have it that easy and there a much more complicated formula involved!

Even so, I know a whole lot of other people, who don't have PCOS, who do train hard, and who still have to watch what they eat. PCOS doesn't cause ALL of our problems! Take control of your diet and don't fall into the trap of thinking that having PCOS means you can't be slim. Bear in mind that exercises like Pilates and Yoga, while fantastic for some aspects of fitness (ie core stability and flexibility), are not the best kilojoule burners for many overweight people. They may help in the early stages of weight loss if you are carrying a lot of weight, but eventually you will need to add some aerobic exercise into your programme. The higher you can get your heart rate for a duration (ie 30 minutes continuously), is the way you will burn the most kilojoules. If the heart rate gets too high, you will find it difficult to keep the exercise continuous for that length of time. By using a heart monitor, you can make sure your heart rate stays at the right level.

4. Eat small amounts of food regularly throughout the day.

Try to stay feeling light all day. Eat small portions every couple of hours, such as a piece of fruit, a low fat/low sugar yogurt like Nestle Diet Yoghurt, skim milk (or soy or rice milk) fruit smoothie, a small bowl of cereal with skim milk, a toasted multigrain sandwich with ham, tomato and pineapple (no butter needed!), and so on. Always have a small portion of main meal and fill the rest of the plate with salad or veggies.

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5. Keep a nutritional balance and choose a diet that you can maintain for your whole life.

For me, deprivation leads to misery! I lost 33 kilos (73 lbs.) without eating low carb! In fact, I can't stand the thought of low carb but always try to keep the carbs in reasonable portions. Often I will eat a stir fry with veges and tofu or seafood and leave out the carbs. I definitely feel better if I don't overload on carbs, particularly the grain varieties.

6. Learn what balance means!

Balance is NOT sitting down to eat a big plate of pasta. (Unless you happen to be running a 10 k race tomorrow!) I used to do it all the time when I was bigger. Instead, I now have a portion of pasta and eat lots of salad or steamed veges with it. Runners do something called "carb loading" the day before a race. Think about that. The carbs are for fuel or energy, so if you truly know you can burn it off, then feel free to carb load! But, if you know you can't, then don't make things tough for yourself....keep the carbs in moderation. I have seen so many women who complained about weight problems with PCOS who sit down and eat meals that they will never be able to burn off. Be careful! Even when I'm doing heavy exercise, I try not to eat a big plate of carbs anymore. If I do, I find myself in trouble with weight again. In now way, however, do I recommend low carb eating, because I need carbs for energy to exercise.

General diet tips:

• Eat low GI foods
• Eat lots of fruit and veges (go easy on the bananas and potatoes though!)
• Keep it well balanced
• Buy organic if you are able. Buy direct from your local markets where these foods can sometimes be bought cheaper than regular produce.
• Eat protein at every meal
• Drink lots of water
• Reduce processed food intake
• Reduce intake of food additives and chemicals
• Learn stress management techniques

7. Do the best you can with your situation.

There are some things we can't change, but there is a great deal we can. Instead of being depressed, do the very best you can to fix those things that can be fixed! This will give you a greater sense of control over your health and life in general.

8. Be inspired by people who work hard to keep fit.

Don't constantly look at the examples of the stick figures who seem to be able to eat whatever they want. There are very many people in this world who can't eat whatever they want, and do work very hard to stay trim and fit (who do not necessarily have PCOS) and they are my inspirations.

Where I am now

It's funny how more people comment on my weight now than ever before! 'Don't get too skinny Karen!' was something I have had to endure at various stages of losing weight! The fact is that the lowest weight I have reached in these past few months is still much closer to the top of my healthy weight range and BMI than the bottom! Then there are the kill joys who say, 'You shouldn't be running...think about all the pounding on the joints.' It's funny how all these people are suddenly concerned about my well being, when a couple of years ago, no-one mentioned anything to me about my extra 33 kilos (73 lbs.) and how much more at risk I was of a whole host of more serious illnesses, like depression, diabetes and cardio-vascular disease!) The fact is, running and other fairly intense cardio sessions, in combination with weight training keeps me feeling confident, strong, happy and in control of my life. I don't have to be quite so careful with what I eat if I keep fit like this. Honestly, I'd rather do some harder physical work, than to deprive myself of food! But that's my way. I'm not trying to tell anyone what to do, but if it works for me, the point is, it could work for you, so if you feel like trying it, then go for it. We all have different preferences and we have to find our own way.

My main challenge now is learning to deal with injury! It's inevitable that if you are working your body hard, that one day you will get injured. It's hard not eating as much if I can't run for a while. It's all just part of learning and part of the journey! Fitness is a transitory state, and where I am today isn't where I'll be in two weeks if I don't exercise and eat properly! There's no way I'm going back to the bad old days! I get away with eating a higher level of carbs when running, but it's hard to stop doing that if at any time I am not involved in high intensity exercise....that's where I am fully aware that PCOS remains with me and that I am not cured. Good management is the key to being in control of PCOS and that takes organization of time. My challenge!

Hopefully there is something in my story that will inspire you to make some changes to your lifestyle that could help you deal better with PCOS.

- Karen L.
Queensland, Australia

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