As told to Malkie Schulman
I
couldn’t lose weight. After my first son was born,
I was childless for years. I was having strange symptoms. And then the doctor gave it a name: PCOS.
On the outside, I looked like a typical obese woman — someone who people assumed just couldn’t control herself. Whenever I ventured out to run errands with my toddler, I could feel judgmental eyes darting in my direction. Inside, I was a woman struggling with an incurable disorder and infertility. And while it was true I was overeating, nobody knew about my out-of-whack endocrine system and how it was creating chaos in my body.
I grew up with a health-conscious mom who was a registered nurse, and a dangerously overweight dad. As a child and into my early teens, I was quite hefty; at one point, I weighed 145 pounds at five feet tall. I was one of the heaviest children in my class and I remember feeling freakish about it. I didn’t have many friends, and although my mother tried to teach me healthy eating habits and even brought me to nutritionists, nothing worked until she hit upon the idea to pay me a dollar for every pound I lost. I made a nice chunk of money that year and, thankfully, by ninth grade my weight was healthy.
I married in my junior year of college and had a baby around a year later, with zero complications. But not long after birth, I became depressed. I had stopped school, so I had nothing to keep me in a healthy routine. And we didn’t live in a Jewish neighborhood at the time, so I had no friends nearby.
Because I was home all day, I was around food constantly. In college, I had no time to eat, but now I found myself making hourly trips to the fridge. At the supermarket, I’d see my favorite candy bar and it would be like, “Oh, it’s on sale! Good!” And I’d stock up. I just kept on buying and bringing stuff into my house and eating it. I would think, ‘I’ll just have a little something in the morning, then a little nosh in the afternoon.’ But at a certain point, I lost control. I couldn’t fit into any of my clothes. I had to go out and purchase everything in size extra large.
The more weight I gained, the more depressed I got, which made me want to eat more — it was a vicious cycle. Even when I got a job as a guidance counselor, I continued to turn to food: If I was stressed, the food would relax me. Though eating a candy bar would make me feel better in the moment, my reliance on food — and all the weight I was gaining — made my low self-esteem plummet even lower. When I eventually ballooned to 190 pounds (normal weight for me is 100 to 110), I felt so worthless that I threw out many of my old clothes believing I would never fit into them again.
The weird thing is, I didn’t realize how incredibly overweight I really was until I didn’t recognize myself in a picture. I put myself on a regimen, but to my dismay, after months of strict dieting, I found I’d only lost two pounds. It was also around this time that I began to notice I was growing body and facial hair that was coarse and stiff, similar to a man’s. All I could think was, “I’m fat, hairy — what else is going to go wrong with me?”
Month after month went by, then year after year, and I still didn’t become pregnant. Friends in the frum community where I now lived had two, three, four children at this point and it made my struggle with infertility even more painful. Really humiliating was when people would ask if they should daven for me after learning that I had only one child. My issues affected my son as well. He felt very out of place being the only one in his class without a sibling. Having to tell my son, “Just daven and Hashem will help,” was difficult for me. I barely believed it, but pushed myself to have emunah so I could give him chizuk.
I knew the next step was to visit a doctor. I chose to see my mother’s physician because I felt completely comfortable with her. After asking about my symptoms and history, she performed an ultrasound. She found a series of cysts around my ovaries, which she described to me as looking like a strand of pearls. The ultrasound results confirmed her suspicions: I had polycystic ovary syndrome (PCOS).
Although I’d never heard of it before, I later learned that PCOS is one of the most common endocrine system disorders among women of reproductive age. Most women with the disorder have some or all of the symptoms I had — ovulatory dysfunction, with irregular or absent cycles, acne, obesity, and excess hair growth. Also, women with PCOS may have enlarged ovaries that contain fluid-filled sacs — called follicles — housing immature eggs.
My doctor went on to explain that my difficulty conceiving was likely the result of the eggs in the follicles failing to adequately mature. However, she continued, these follicles do not cause PCOS; they’re merely a possible symptom, so removing them is rarely the solution. In fact, they’re usually surgically removed only if they’re painful.
Everything I heard that day made sense. The presence of PCOS explained my weight gain, my irregularities, and my facial-hair growth perfectly. Still, I was in shock. I considered myself well read on women’s issues yet I had never heard of PCOS. My secondary reaction was relief at the diagnosis. At least it’s not cancer, I thought. My mother is a cancer survivor, and my aunt and other family members died of cancer, so the fear of that is always there.
A few days later, I was inundated with feelings of guilt. I believed I had created my own Gehinnom. I thought of my father who has experienced many health complications due to emotional overeating and smoking, both self-indulgent negative behaviors. I felt I was repeating his mistakes, something I had promised myself I would never do. I was convinced I had failed myself and my family by becoming obese and developing fertility issues.
This didn’t make sense, of course. Obesity does not cause PCOS, though it definitely exacerbates it. In fact, studies indicate that obesity in women has been linked to excess production of androgen, a common symptom of PCOS that can prevent pregnancy. Since maintaining a healthy weight is vital for women like me, my doctor placed me on a low-sugar, low-carb diet. I joined a gym, and started to exercise three nights a week. The doctor also put me on a medication called Metformin, an anti-diabetic agent that helps decrease insulin resistance, another common symptom of PCOS. This was crucial — as opposed to my previous attempt at dieting and not losing more than a pound or two, this time, I went from 190 to 150 pounds in around seven months.
Losing all that weight did wonders for my sense of self. I felt human again. However, the ovulatory issues were not resolved and I still hadn’t gotten pregnant. The doctor prescribed fertility drugs but they also didn’t work.
At that point, I began seeing a reproductive endocrinologist. The first thing she did was raise my dose of Metformin to stimulate production of FSH (follicle-stimulating hormone), but it was ineffective. The next step was to learn how to inject myself daily with the hormone (FSH) in the hope this would do the trick. For three or four days I would go to the lab before work at 6 a.m. for a blood test and ultrasound so the doctor could determine what my dose of the hormone should be for the day. Then I would have a two-week wait.
The first time I injected myself, I almost fainted. (I am mortally afraid of needles.) Thankfully with time, I got used to it. I had to inject myself every night at the same time. If I was late by even a half hour, it could ruin the entire regimen. Once, I was stuck at a pharmacy and panicked because I was afraid I wouldn’t be able to get my hormone shot on time.
My hopes would rise with each attempt, only to crumble again when they failed to materialize. The third time, baruch Hashem, I conceived and stayed under the reproductive endocrinologist’s care until my third month. After that, I returned to my regular doctor and had no PCOS-related complications. Thankfully, my second son was born healthy.
Throughout my journey with PCOS, my husband has been a great support to me. He rearranged his learning schedule so I could go to the gym three times a week after work, and got our son ready for school when I wasn’t able to. One thing he doesn’t like, though, is when I put myself down. I always used to talk about how fat I was and how bad I felt about it. Although it’s important to discuss feelings, I need to be careful about how often I kvetch about my weight.
One time my husband suggested we go out to eat and I started to scream at him, “Don’t you realize I have this condition?” and then I ranted on about how food is poison. That was a mistake. My husband is my ally and we can go out to eat together. There are plenty of foods — things like protein-filled veggies and soups — that I can eat.
Since PCOS is strongly connected to weight (at least in my case), I used to feel terribly guilty every time I ate something I knew I shouldn’t. I felt I was doing great harm to my body by eating the wrong thing. Over time, I realized I can still have a life with PCOS. I just need to be informed about what I’m eating.
Working on overcoming this challenge has been a sort of spiritual awakening for me. It has taught me to be dan l’kaf zechus — to give others the benefit of the doubt. You just never know what is going on with another person.
When I was younger, I used to see the mussar seforim as accusatory. I saw them as constantly reprimanding me for what I was doing wrong. Now I have learned to see them as manuals on how to heal myself. I am still a work in progress. Sometimes I slip. But the knowledge that I can constantly climb higher helps me strive for more.
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A Primer on PCOS
In case you’ve never heard of Polycystic Ovary Syndrome (PCOS), here are the basics:
To start, there’s no test you can take to find out if you have PCOS. In order to be diagnosed with this disorder, a woman needs to satisfy two out of the three following criteria: either an ovulatory irregularity, clinical or biochemical signs of increased androgen production, and/or polycystic ovaries diagnosed with ultrasound. Patients might also complain of other associated features that are sometimes found with PCOS: sleep apnea, fatty liver, insulin resistance, obesity, and metabolic syndrome.
The first step in treating PCOS is to regulate the ovulatory dysfunction. This is usually accomplished through medication. In some women, this is enough to solve all the issues — from acne to excess facial hair to weight. “Of course, sometimes that’s not enough and I will prescribe an anti-androgen to reduce the hair growth,” notes Dr. Shimon Harary of the Endocrine Clinic of Memphis, in Tennessee. If the patient is insulin resistant, a drug called Metformin is prescribed.
Patients are also encouraged to work on adjusting their eating and lifestyle habits. “If they are insulin resistant, they are at a higher risk of developing overt diabetes and cardiovascular complications. Hence we are careful to evaluate and treat cardiovascular risk factors such as dysglycemia, hypertension, hyperlipidemia, and obesity early on,” Dr. Harary adds.
Eating Your Way to Pregnancy
For four years, Rosalind Haney worked as an RN at a fertility center in Austin, Texas. “The clinic was so busy helping women to become pregnant they had no time to address the foundational health of their patients,” she remembers. “I worried that we were sometimes forcing pregnancy on older women who were not healthy enough to support it.” That’s when Rosalind decided to learn more about nutrition and its relationship to reproduction, which ultimately led her to set up her own nutrition practice specializing in fertility.
“A woman does not have to be the ideal weight or in perfect shape to become pregnant,” maintains Rosalind, who is today a certified nutritionist. “She just needs to be moving in the right direction. Her body will work with the smallest changes.”
Studies show, Rosalind explains, that a mere 5 percent change in weight can cause a shift in a woman’s hormone balance and move her closer to achieving a healthy pregnancy. If the woman is still significantly overweight or underweight entering pregnancy she will need to continue working on diet and lifestyle changes, but just that small 5 percent change has been shown to make a difference.
A healthy diet includes a full-fat protein breakfast within an hour of waking. A carb breakfast, Rosalind says, could spike insulin and keep it high the whole day. Increased insulin will cause an increase in the male hormone testosterone, which throws off the woman’s hormonal balance and ovulation. She maintains that breakfast is the most important meal, whether it’s a whole egg or whole-fat yogurt.
Rosalind tries to dispel what she considers the myth of cholesterol as all evil. “It’s been a disservice to many that it gets such a bad rap,” she says. “Hormones like estrogen, progesterone, cortisol, DHEA, and testosterone all come from the dreaded cholesterol, and are vital in reproductive women. I encourage my clients to get their cholesterol from grass-fed beef, pasture eggs, seafood, organic whole dairy, and other hormone-free meats. One thing my clients don’t need is external hormones confusing their own hormone balance!”
Ideally, a woman should be eating every three to four hours, which includes breakfast, lunch, a protein snack midday, and dinner, with absolutely no skipped meals. “Skipping meals is a huge physical stress to the body, throwing it into a breakdown state,” explains Rosalind. “The body wants to be well and have the confidence that it can maintain itself and a rapidly growing fetus. No skipped meals is often the priority change I recommend, along with cooking more of her own meals.”
Exercise is also a key component in keeping one’s PCOS under control. “If my client is underweight and over-exercising, she will need to moderate her routine. For clients needing to lose weight, daily exercise is a must to both encourage weight loss and to lower insulin levels. Studies show that exercise alone (even without weight loss) improves the body’s ability to handle insulin, thereby maintaining a more normal hormone balance that encourages ovulation.”
Rosalind also encourage her clients to take supplements like zinc, multivitamins, and fish oils. Cinnamon extract helps with insulin-receptor function. The drug Metformin, Rosalind explains, may decrease folic acid and vitamin B12 in a woman’s body. “These are both vital nutrients for pregnant women so I will encourage those clients taking Metformin to add these to their diet.” And finally, Rosalind emphasizes, relaxation techniques are important to incorporate if she is under chronic stress, which has its own detrimental effect on hormone balance.
(Originally featured in Family First 448)
