Polyendocrine Metabolic Ovarian Syndrome (PMOS) is a hormonal disorder common among women and adolescents of reproductive age. Women and adolescents with PMOS may have infrequent or prolonged menstrual periods or excess male hormone (testosterone) levels. The ovaries may develop numerous fluids filled cysts and may fail to regularly release eggs. 

What are PMOS signs and symptoms?

• Amenorrhoea (missed periods) or irregular periods

• Unwanted hair growth or male pattern hair growth (excessive facial hair)

• Thinning hair on the head

• Acne

• Infertility

• Weight gain

• Can be associated with many non-specific symptoms such as: fatigue, sleep apnea, sleep problems, depression, mood changes 

There’s no test to definitively diagnose PMOS. It is diagnosed using a cluster of symptoms including menstrual dysfunction, signs of or blood excess testosterone and/or polycystic ovaries. Your doctor is likely to start with a discussion of your medical history, including your menstrual cycle and body weight changes. A physical exam will include checking for signs of excess male hormone testosterone such excess hair growth and acne.

Your doctor might then recommend:

• Blood tests:  Your blood may be analyzed to measure hormone levels. This testing can exclude possible causes of menstrual abnormalities or testosterone excess that mimics PMOS. You might have additional blood testing to measure glucose, insulin, cholesterol, and triglyceride levels.

• An ultrasound:   Your doctor checks the appearance of your ovaries and the thickness of the lining of your uterus. A wand-like device (transducer) is placed in your vagina (transvaginal ultrasound). The transducer emits sound waves that are translated into images on a computer screen.

The exact cause of PMOS is unknown. Factors that might play a role include:

• Excess androgen or testosterone:  The ovaries may produce abnormally high levels of testosterone (male hormone), resulting in
  hirsutism (excessive facial hair) and acne.

• Heredity:  Research suggests that PMOS is heritable and certain genes might be linked to PMOS

• Excess insulin:  Insulin is the hormone produced in the pancreas that allows cells to use glucose, the body’s primary energy supply. If cells become resistant to the action of insulin, then blood sugar levels can rise and the body might produce more insulin to compensate. This can lead to pre-diabetes and diabetes. Insulin also increases body fat storage and may effect testosterone production by the ovaries.

• Low-grade inflammation:  Research has shown that women with PMOS may have low-grade inflammation that can contribute to heart and blood vessel disease.

PMOS cannot be totally prevented or cured as it is a multifactorial disease. But early diagnosis and management of the reproductive, hormonal, and metabolic symptoms may prevent long-term complications, such as infertility, pre-diabetes, obesity, diabetes, and heart disease. 

Acne has many causes and trying to understand what foods or other causes impact your acne is important. For example, food allergies can cause acne.

Try avoiding dairy products such as skim milk or 0%, as these are sometimes linked to causing acne in comparison to whole milk fat products.

Also, any foods that spikes your blood sugar and raises your insulin may impact your testosterone levels which can contribute to acne.

Keep the face and/or other affected skin areas clean with a facial cleanser e.g., Cetaphil, has been recommended by some Dermatologists.

Depending on the person’s age, there are several medications that may help to reduce acne and other skin conditions. E.g., topical vitamin A preparations, oral contraceptive pill, estrogen with anti-androgen medication.

Note, anti-androgen has been known to either exaggerate or make the acne better, so it is trial and error.

You can also ask your family physician for a referral to a Dermatologist or Allergy/Immunologist.

Yes, there is a link with PMOS and hyperpigmentation.

The common one is called Acanthosis, which is a clinical sign of insulin resistance. People that have a very high level of insulin in the body and insulin resistance can have a thickening and velvety texture of the skin in a few areas e.g., around the neck area, under the arm area.

Sometimes if the patient’s insulin improves (through weight loss, exercising  more and/ or eating a healthier diet) this can also improve their hyperpigmentation.

Yes, fertility and becoming pregnant is a common problem in PMOS. One of the main reasons why women with PMOS experience difficulties  getting pregnant is related to ovulatory dysfunction. 

In Edmonton there is a reproductive endocrinology unit at the Royal Alexandra Hospital which is covered by Alberta Health. There are also private fertility clinics. You require a referral from your family physician or endocrinologist to see a fertility specialist. A fertility specialist will establish if your fertility is related to PMOS or another health issue and/or if it is related to partner factors. 

The upper normal limit for total testosterone for a female is 2 nmol/L.

However, an endocrinologist examines all factors, not just the total testosterone value, as there are many other causes of high testosterone levels, not just PMOS.

Not all PMOS patients have high total testosterone, but they may still have symptoms of high testosterone such as excess body hair growth and irregular cycles, so blood testosterone is not used alone to diagnose and treat symptoms of PMOS.

Evidence from research studies shows that some PMOS patients have normal androgens or testosterone levels but have an  increased sensitivity to androgens or testosterone, so they develop symptoms of excess androgens.

Testosterone in PMOS women can be high, low or normal and how it may affect symptoms in PMOS depends on the individual.

The best advice is to speak with your family physician or referred endocrinologist who can help with treating symptoms of high androgens and may recommend anti-androgen medications.

Many women with PMOS say that excess body hair (hirsutism) is one of the more difficult symptoms to deal with. This may be because facial or body hair can be seen by others and because excess body hair challenges our idea of how girls and women should look. The good news is that treatments for body hair have improved greatly and are increasingly easy to find and less expensive.   

Waxing, threading, depilatory creams, plucking, laser hair removal and electrolysis can be useful ways to remove hair and reduce hair growth. Laser hair removal is now cheaper and more effective and a good option for many women.   

There are a few medications that may help to reduce excess body hair. E.g., anti-androgen medication, contraceptive pill. Speak with your family physician or get a referral to an endocrinologist to help with your choice of medication to treat excess body hair growth.

There is not a direct correlation with thyroid issues and PMOS.

In the process of an endocrinologist establishing a diagnosis of PMOS, the thyroid hormone levels are checked.

Many symptoms of PMOS are tied to different hormone abnormalities and can look somewhat like PMOS

Yes, see your family physician first and they can refer you to an endocrinologist, gynaecologist or other health professional as needed.

Routine blood tests include testosterone, SHBG, prolactin, thyroid function, kidney and liver function, estrogen, LH, FSH, blood fats (cholesterol, LDL-C, HDL-C, and triglycerides), insulin and glucose/Oral Glucose Tolerance Test. ApoB can also be tested. Blood pressure is routinely measured. Other cardiovascular risk biomarkers such as ApoB and cholesterol remnants, and heart and blood vessel function are currently not routinely measured. These may only be tested in research studies (PMOS Together) and if there is symptoms, evidence or family history of altered function that may need to be investigated. 

PMOS patients are often referred to one and/or both of the following depending on health care needs and symptoms:

1. Endocrinologist: Specializes in the function and disorders of the endocrine system of the body.

2. Gynecologist: Specializes in the health of the female reproductive system.

If in doubt you can always ask your GP for a referral to a specialist depending on your health concerns.

Start with talking to your family physician and ask if they can refer you to an endocrinologist, gynecologist or other health professional as needed.

This may depend on the severity of your PMOS symptoms and ovary-uterus health. Referral to an endocrinologist or gynecologist or fertility specialist may be necessary.

To help you with diet and lifestyle factors, and hormone factors that may be impacting your PMOS symptoms asking for a referral to a specialist is important so that you get all the advice and help you need.

Homocysteine is one biomarker and can be used collectively with other biomarker tests for heart and vascular disease risk. It is not used in the clinical setting in patients with PMOS.

• Oral Contraceptive Pills to regularize menstruation. Estrogen in these pills also helps to reduce hair growth.

• Anti-androgens to target excess testosterone symptoms including menstrual-ovarian dysfunction, excessive hair growth and acne may include Spironolactone

• Control blood sugar and prevent diabetes: Prescription to help control blood sugar levels and prevent diabetes can include Metformin and Liraglutide

Metformin is generally well tolerated for extended periods and is used in the prevention of diabetes. Common side effects initially include diarrhea, nausea, and abdominal pain.  Take metformin with food-drink to help with the taste and swallowing the tablet.

There is limited rigorous scientific evidence for the use of inositols in PMOS. However, there are reports of effects on improving menstrual cyclicity-ovarian function and hormone levels. Inositol is not approved in Canada for use in PMOS.

Metformin and fish oil are not available in one tablet. These can be taken together with food-drink.

Fish oil may help reduce blood fats or triglycerides which are a risk factor in heart disease. Fish oil contains long chain lipids or fatty acids (EPA and DHA) that help to lower blood triglycerides. The dose used in studies that lower blood triglycerides include approximately 2.5 g EPA and 1.6 g DHA/day. This dose equals about 6g/day of fish oil and will depend on the concentration of these fatty acids in a fish oil natural health product. Webber/ Equate/NutraSea are brands that we have used in clinical studies in PMOS.

There are algae sources of these long chain fatty acids. There is limited scientific literature on the effectiveness of these sources at the dose needed to reduce blood triglycerides.

Other patient partner recommendations include, NutraVege, Nordic Natural’s Omega 3 and Freshfield’s Vegan Omega 3.

There is not a lot of good quality research published on all the natural health products and use in PMOS for treatment of different symptoms. These products should be recommended on a case-by-case basis in consultation with your family physician, specialist(s), registered dietitian, and/or pharmacist.

There are mixed reports of metformin inducing B12 deficiency in those with and without diabetes.  It may depend on the individual, dietary intake, other autoimmune disease, and other factors.

The use of natural treatments depends on the symptoms and these treatments may have limited in scientific evidence for their use.

Androgen Excess & PCOS Society (AE-PCOS) is an international organization, and it recommends* implementing a balanced diet approach following the general population guidelines (for more information, click here Canada’s Food Guide

There is no single diet that works better than a balanced, healthy diet.  Eat a variety of healthy foods each day:

• Eating fresh fruit and vegetables (50% of diet)

• Eating lean meats and other proteins (25% of diet)

• Eating whole grain foods (25% of diet)

• Cutting out or reducing food such as sugary drinks and foods high in sugar, salt, and unhealthy fats

• Making water your main drink
  
  

*AE-PCOS is currently reviewing their recommendations. To learn more, visit there: Home – Androgen Excess & PCOS Society (ae-society.org)

There is not a lot of research done on milk and dairy products as it relates to PMOS. However, whole dairy-full fat dairy products can support satiety/feeling full and satisfied, because of the fat and the protein content. If you enjoy full fat dairy then have less (½ cup vs 1 cup) and enjoy.

There are good fats, vitamins and minerals in dairy products that are important in immune and anti-inflammatory function and bone maintenance. Dairy products are recommended as part of a well-balanced diet.

Some dairy products may have a high amount of added sugars. It is recommended to read labels closely and choose dairy products that don’t have added sugars or have low added sugar content.

Note: See below question on “Acne” for more information to consider.

The use of these dietary interventions depends on the individual. For example, if the individual has a dairy or gluten allergy.

A KETO diet may restrict carbohydrates and increase energy from fat. There are many types of KETO diets and KETO diets need to be implemented under the supervision of a dietitian to ensure nutritional adequacy and healthful use of this dietary approach. KETO diet can increase triglyceride/fat in blood.

Some faiths do allow exemptions in terms of fasting which is based on the individual’s medical health situation e.g., diabetes, pregnancy, health issues and symptoms and the duration of the fasting.

In addition, feasting at the end of a fast, may elevate and/or exacerbate your health symptoms, such as elevate blood glucose and insulin levels. To help prevent this, consider meal planning and foods of high nutrition quality before and after a fast, and this may help minimize blood sugar spiking.

Depending on your health status and your situation you may need to take the above factors into consideration. It is also recommended that you consult with both your faith practitioner and your family physician.

A Registered Dietitian does not have to specialize in PMOS. A dietitian can give you guidance with designing a personalized diet-lifestyle intervention that meets your nutritional needs and food preferences, and personal health goals. Your family physician can refer you to a registered dietician through a primary care network.

No, you do not need a referral to see a Registered Dietician. Your family physician may be able to give you a referral to a Registered Dietician through a primary care network.

Letisha Hodges, Registered Nutritionist

Email: letisha@edgenutritiongp.com

Website: Edge Nutrition & Performance (edgenutritiongp.com)

Trista Chan RD, MHSc (thegoodlifedietitian.com) 

PMOS occurs in normal healthy weight and overweight individuals. The of PMOS may be different in a normal weight vs an overweight individual. For example, in a normal weight individual the ovary may overproduce testosterone whereas in an overweight individual with high insulin, the high insulin may drive increased production of ovarian testosterone.

This is a common observation made in PMOS. Women with PMOS are resistant to losing fat mass due to higher hormone levels of testosterone and insulin. No change in body weight may also mean a shift to higher lean-muscle mass and less fat mass. Consulting with a dietitian may help address your specific diet and exercise needs in changing your body composition.

This is a common observation made in PMOS. Women with PMOS are resistant to losing fat mass due to higher hormone levels of testosterone and insulin. No change in body weight may also mean a shift to higher lean-muscle mass and less fat mass. Consulting with a dietitian may help address your specific diet and exercise needs in changing your body composition.

Many women with PMOS are at risk of having an unhealthy body weight (body mass index – BMI over 25) – BMI is calculated from weight (kg)  / height x height (metres). BMI is used as a tool to categorize body weight for health recommendations. Body composition, your fat mass and lean mass (muscle) mass, are important factors in your total body weight. If you are an unhealthy weight aim to;

• Monitor your body weight and waist circumference regularly (if your comfortable to do so)

• Seek the support of a health professional (family physician, dietitian)

• Follow the healthiest lifestyle you can and aim to not gain more body weight

• Be as active as you can

• Reduce overall food intake if necessary, so that you are only meeting your energy requirements

• Reduce intake of foods that are highly processed and have added sugars or ‘empty calorie’ foods

Monitor how your emotions may influence your eating patterns. 

Don’t focus on the weight you want to be. A small amount of body weight loss can make a big difference to your health. In general, our body weight is the result of many factors, some of which we don’t have direct control over. Try to focus instead on what you have more control over such as your eating habits and behaviour. Take a break from weighing yourself. Set small goals to make lifestyle changes. These small achievements will provide you with a sense of accomplishment and over time will add up to lifestyle changes that help with weight loss and well-being in the long-term. Women with PMOS have an increased risk of anxiety, depression, poor self-image, and low self-esteem.  Try your best to be mindful of the following:

1. Awareness:  Awareness, early action and a healthy lifestyle are the best ways to reduce this risk.

2. Monitoring:  Monitoring your emotional well-being is important to know when to take action.

A healthy lifestyle is vital for all women with PMOS and is the best approach to reducing the severity of many PMOS symptoms. A healthy lifestyle includes:

• Being as active as possible.

• Eating a balanced, nutritional diet.

• Not sitting for long periods by getting up hourly to move and stretch.

• Stopping smoking and reducing alcohol consumption, if needed.

Maintaining body weight and avoiding weight gain, no matter where you’re starting at. 

A healthy diet and lifestyle can:

• Improve how you feel about your body

• Make insulin work better and prevent diabetes

• Make your periods more regular

• Improve energy levels

• Improve fertility

• Improve fitness and muscle mass/tone

Improve mental health and emotional wellbeing. 

• Monitoring weight and/or waist circumference

• Eat a balanced healthy diet

• Pay attention to portion control

• Incorporate protein sources into the diet, especially at breakfast

• Reduce soft drink, fruit juice and sugar sweetened drinks

• Replace “empty calorie” and processed foods with whole foods

Incorporate exercise or some sort of activity into your life every day. Exercise that raises your heart rate is recommended. For example, vigorous walking. 

Move at every opportunity!

Take advantage of opportunistic activity:

• Take the stairs

• Park further away

• Walk to the shops instead of driving

• Sit less, move more

• Take a break from sitting for long periods by getting up and doing something else at regular intervals

Any activity is good activity:

1. Light:  40-50% of max heart rate – e.g., yoga, walking, dancing

2. Moderate:  55-70% of max heart rate –  e.g., tennis, swimming, hiking

3. Vigorous: 70-90% of max heart rate – e.g., running, biking, exercise training.

Weight maintenance for adult women:

1. 150+ mins/week Moderate activity OR

2. 75+ mins/week Vigorous activity OR

3. a combination of both and include weight training 2x/week.

Weight loss for adult women:

1. 300+ mins/week Moderate activity OR

2. 150+ mins/week Vigorous activity OR

3. a combination of both and include weight training 2x/week.

Adolescents:

• 60+ mins/day Moderate to Vigorous activity and include weight training 3x/week

Weight loss of 5-10% has shown improvements in some PMOS symptoms including menstrual function, hormones and blood fats and glucose in some individuals.  Strategies that include caloric restriction, healthful and mindful eating habits, physical exercise and consultation with a dietitian and lifestyle counsellor are effective. These strategies work even more effectively in combination with medications for treatment of PMOS including metformin, liraglutide and others. 

• Women in Canada with PMOS have a 4-fold and 2-fold higher incidence of Type-2 Diabetes (T2D) and cardiovascular disease (CVD), respectively.

• Women in Alberta with PCOS:

  • 3-fold higher incidence Type-2 Diabetes (T2D)

  • 2-fold higher incidence of cardiovascular disease (CVD)

    • Based on risk factors of increased body weight and altered blood glucose and fat metabolism.

  • Increased incidence of other adverse health outcomes.

    • Respiratory disorders and mental health.

Mental health and quality of life is a major concern in PMOS due to physical symptoms, hormones, long term medical health concerns.

Early onset of mental health issues in childhood/adolescence (anxiety, depression, sadness, insecurity, stigma, shame, symptoms of PMOS, PMOS stages of grief following diagnosis, stress of medication management etc).

According to research there is an increased prevalence of clinical depression, anxiety, and other psychological distress in women with PMOS compared with women without PMOS (Damone et al., 2018)

Women with PMOS have a greater risk of emotional challenges such as anxiety and depressive symptoms.  These challenges may be due to a combination of hormonal influences and dealing with the symptoms of PMOS.

Symptoms such as acne, weight gain and excess hair may cause girls and women with PMOS to feel they do not fit an image of how females are maybe supposed to look. Difficulties getting pregnant can also cause anxiety and depression.  Feeling different from others  may affect overall quality of life for girls and women with PMOS.  Women with PMOS also say they experience challenges with intimate relationships.

• Information on Stress by (Damone et al., 2018):

  • Chronic stress is associated with depression and anxiety in the general population.

  • Chronic illness is a stressful condition.

  • Low levels of perceived stress may have a clinically significant impact in women with PMOS.

  • Women with PCOS report a significantly increased physiological reaction to stress:

    • Pathophysiological features of PMOS:

      • Hypothalamic-pituitary-adrenal axis (HPA) and sympathetic nervous system (SNS) hyperactivity.

      • Low-grade immune system inflammation.

• Yes, it’s important to seek help, because it can lead to a variety of emotional and physical problems and can reduce your ability to function. It is very important to recognize the signs of stress and seek help early.

Yes, stress is treatable, and there are a number of effective strategies available so it’s important to seek help early.

(Strategies adapted from Paterson, 2000)

Sleep:

• Sleep deprivation is a contributor to being vulnerable to stress.

• Most people need between 7 and 9 hours of sleep.

• Examples of sleep hygiene:

  • Maintaining a regular bedtime and rising time

  • Having appropriate darkness and quietness to ensure that your environment is conducive to sleep

• For more information: ca / Health Information and Tools > Sleeping

Awareness:

• Coffee, tea, caffeinated soft drinks, and chocolate can increase the body’s level of cortisol, or “stress hormone”.

Balance:

• Delegating, asking for help, knowing your limits and boundaries.

Exercise:

• Consult with your physician.

Nutritionally Balanced Meals:

• “Some people find that the simple sugars found in sweets cause roller-coaster changes in mood ranging from speediness to lethargy”(p.35).

Additional exercises:

• Breathing exercises, Progressive muscle relaxation exercises, visualization exercises.

• Anxiety (according to the APA): https://www.apa.org/topics/anxiety

  1. An emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.

  2. Recurring intrusive thoughts or concerns.

  3. There may be avoidance of certain situations out of worry.

  4. There may also be physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat.

Yes, it is important to seek help as early as possible because PMOS patients commonly experience higher levels of anxiety.

Anxiety can interfere with the quality of your life and may require the support of health professionals and, in some cases, treatment.

Yes, anxiety disorders are treatable, and a number of effective treatments are available so it’s important to seek help early.

One well-known, supported, evidenced-based treatment for anxiety would be the use of Cognitive Behavioral Therapy (CBT). It is a therapeutic modality that can be used in counselling. Alongside talk therapy, you can take a look at a website that has great, valuable information on anxiety and the use of CBT: anxietycanada.com

• Depression (according to the APA): https://www.apa.org/topics/depression

  • More than just sadness.

  • People with depression may experience a lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide.

Yes, it’s important to seek help, because it can lead to a variety of emotional and physical problems and can reduce your ability to function. It is very important to recognize the signs of depression and seek help early.

Yes, depression is treatable, and a number of effective treatments are available so it’s important to seek help early.

CBT–once again, is a therapeutic modality that can be used in psychotherapy. Behavioral activation has strong research support, and that is a component of CBT. Alongside talk therapy, patients can obtain a copy of Mind Over Mood–Authors, Dennis Greenberger & Christine A. Padesky. It is accessible at the library for instance. Mind Over Mood is a hands-on workbook that teaches CBT skills in a clear, step-by-step format.

There is also a CCI website (Centre for Clinical Interventions – Australian website).

Infertility can be viewed from a grief and loss perspective:

• Grieving the loss of the ability to conceive.

Yes, it’s important to seek help, if left untreated it can lead to a variety of emotional and physical problems and can reduce your ability to function. It is very important to recognize the signs of grief and loss due to infertility issues and seek help early.

When infertility comes up, we can address it in different ways in counselling:

We can look at it from a grief and loss perspective.

Working with a therapist who has experience with grief.

You can also work with a therapist who is trained in ACT (Acceptance and Commitment Therapy) in order to do some values work and explore meaning in one’s life.

Some ideas of questions that can be explored in session: (e.g., What matters to you in the “big picture”?; What do you want to stand for?)

Another way to address infertility can be through the use of EMDR to help address certain limiting beliefs/negative cognitions: it can be belief about doing something wrong, excessive guilt, not deserving. Providing room for the adaptive belief and instilling the adaptive belief (e.g., I can accept myself; I am good enough)

Yes. Body Acceptance/Self-Acceptance:

• Themes: acceptance, respect, appreciation, liberation, empowerment.

• Working with shame, insecurities.

• Working with beauty ideals (i.e. culturally, society).

• Body neutrality, body positivity.

• Self compassion.

Dealing with a chronic medical condition, such as PMOS can be challenging and so it’s important that you do give room for self compassion.

The three components of self-compassion:

1. Self-kindness rather than self-judgment:

• Providing ourselves with warmth and understanding when we suffer, fail, or feel inadequate.

• Imperfection, failure, being confronted with life difficulties is inevitable

• Being gentle with ourselves rather than getting angry when life falls short of set details.
  
  

2.  Common humanity rather than isolation:

• Feeling connected to others in our shared struggles.

  • e.g., social media: Facebook support groups.

• Recognizing that suffering and personal inadequacy is part of the shared human experience.
  
  

3.  Mindfulness:

• Awareness of our thoughts and feelings.

• We are not minimizing or exaggerating our difficulties, emotions and thoughts.

• “Mindfulness is a non-judgemental, receptive mind state in which one observes thoughts and feelings as they are, without trying to suppress or deny them. We cannot ignore our pain and feel compassion for it at the same time.  At the same time, mindfulness requires that we not be “over-identified” with thoughts and feelings, so that we are caught up and swept away by negative reactivity”.
  
  

Note: The above information was taken from Dr. Kristin Neff’s website.  Her website provides different ways of practicing self-compassion, putting it into practice through exercises, guided practices and tips for practices.

For more information:  selfcompassion.org

The following information is ‘under License with Craving Change Inc.’:

Increase your awareness of why you are eating.  Types of hunger:

Stomach Hunger:  This is the physical need for food.  It’s been five or six hours since you’ve eaten.  Your stomach is growling.  Stomach hunger also refers to times when you might eat for a medical reason, for e.g. to prevent low blood sugar if you’re on insulin.  You are eating for the well-being of your body.

Mouth Hunger:  Have you ever stood in front of the fridge or cupboard looking for something to eat with a certain taste, texture, or smell?  “Where are those salty, crunchy chips?  No that’s not it, I want creamy…where’s the ice cream?”  You crave pleasure in food.  This describes mouth hunger.

Heart Hunger:  This type of hunger refers to when you are eating in response to your emotions or how you’re feeling mentally, not physically.  Heart hunger can also refer to a learned behaviour around food or eating such as having dessert after every meal.

For PCN workshops on relationships with foods, see below PCN Workshop and Services section.

Use your voice, assert your needs effectively and know what to ask for.

Arrive at your appointment early, that way you are calm and composed.

A visit to a doctor should be a two way conversation, and not one where the doctor is doing all of the talking.

If you have a question that hasn’t been answered or a concern that hasn’t been addressed, bring it up.  If you’re confused about something, ask the question and if you’re concerned about a particular course of treatment ask about alternatives.

Remain consistent and persistent in what is important to you.

The Alberta Health Services website recommends the following regarding Advocating For Yourself-Well on Your Way:

1. Learn how to explain your health condition clearly.

   • Practice speaking about your health condition with a parent, friend, or someone else you trust.

2. Write down your concerns or questions before you go to your healthcare provider. It reminds you to talk about them at your appointment.

3. As whatever questions you need answers to. It is your body and you need all the information to make informed decisions about your health.

4. Keep track of all your doctors, nurses, and other healthcare providers including who you see, when you see them, and what you talked about.

5. Stay calm and polite, but assert yourself to get the support or information you need.

6. Speak up if you don’t agree with your healthcare provider. You are the boss of your own healthcare; no one knows your body better than you do.
   
   

If you think you have communicated clearly but do not feel the healthcare provider ‘heard’ you, or you do not agree with the choices for treatment, you can get a second opinion.

For more information or support, you can contact Alberta Health Services Patient Concerns and Feedback or the Alberta Government Health Advocates.

It can also be frustrating when you want to feel heard, but you feel that all you are getting is advice.  Do not be afraid to ask others to just listen and be supportive.

The above was taken from the Alberta Health Services website: Advocating For Yourself | Alberta Health Services

CNs are groups of family doctors who work with Alberta Health Services and other health professionals to coordinate the delivery of primary care services for their patients.

PCNs are reducing the use of emergency rooms and wait time through extended and after-hours service; providing comprehensive patient education; and optimizing the skills of clinical care teams through outreach programs.

There are 40 PCN’s in Alberta.  Together they represent more than 3,800 doctors and 1000 health care providers & serve close to 3.6 million Albertans.

PCNs strive to achieve 5 goals:

1. Increasing the proportion of Albertans with ready access to primary care.

2. Managing access to appropriate round-the-clock primary care services.

3. Increasing the emphasis on health promotion, disease and injury prevention, and care of patients with complex problems or chronic disease.

4. Improving the coordination and continuity of primary care with hospital, long-term and specialty care.

5. Facilitating the greater use of multi-disciplinary teams in primary health care.

If your family doctor belongs to a PCN, you are already a member!

If you are not sure what PCN that your family doctor belongs to, you can ask them, they might have posters around the office or check on the Alberta Find A Doctor website – directory – physician – type in physician name.

Website: albertafindadoctor.ca

Most family doctors in Alberta belong to a PCN and you can access care, services, and workshops through that PCN.
|

You can either ask your family doctor which PCN they belong to or look it up yourself on PCN Find A Doctor:

Website: albertafindadoctor.ca

There are many free public on-demand (pre-recorded) online mental health and other types of workshops and resources that you can access without a referral, regardless of which PCN your family doctor is affiliated with or not:

• Website: ca/workshops/home
  (Search, filter by category “Mental Health, Nutrition etc”)
  
  

For other PCN mental health  and other types of workshops and/or services e.g. virtual/live classes, ongoing one-on-one therapy, your family doctor will need to provide you with a referral and some are free and some are not.

Mental health services offered at a PCN can be beneficial to address some of the mental health concerns presenting for PMOS patients.

And at the same time, internal referrals can also be made to connect the patient with a registered dietitian, for instance, to review blood work general heating general healthy eating internal referrals can also be made.

In addition, to access an exercise specialist to help with weight management and appropriate exercises, PCN at O-day-min (formerly Oliver) can also offer the Craving Change program.

Each PCN has an entire team of healthcare professionals who work with you and your family doctor to help you manage your health, through one-on-one appointments and group classes, they can help you:

• Eat healthier

• Get active

• Managing a chronic condition

• Improve your mental health

• Understand your medication

• Reduce your tobacco use

• Get support for adult autism

• Take care of problem feet

• See a specialist

• Thrive in your senior years
  
  

There are many free public on-demand (pre-recorded) online workshops, resources and other activities that you can access, regardless of which PCN your family doctor is affiliated with or not.

For other PCN mental health  and other types of workshops and/or services e.g. virtual/live classes, ongoing one-on-one therapy, your family doctor will need to provide you with a referral and some are free and some are not.

Check the website or contact the PCN directly to find out all the details:

Website:  albertapcns.ca/workshops/home
(Search, filter by category “Mental Health, Nutrition etc”)

The Craving Change® program is a how-to workshop for changing your relationship with food offered:

• Understand WHY you eat the way you do.

• Comfort yourself without food.

• Change your thinking, change your eating.
  
  

Improving what, when, or how much you eat (adapted from website: https://www.cravingchange.ca/public/)

• Craving Change® is a cognitive-behavioural program for people who struggle with their eating habits.

• It is a practical, skill-based approach that help in the following:

  • Understand why you eat the way you do.

  • Learn how your eating decisions are influenced by your surroundings, your body, and what you learn while growing up.

  • Become more aware of your problematic eating triggers.

  • Tune into your thoughts and emotions that steer you off track.

  • Use 16 ‘change and maintain’ strategies and resources to change your eating for good.

  • Have a healthier relationship with food.
    
    

All you need is your mind—That’s because it’s our thinking habits that guide our eating habits.

The Craving Change program is a virtual course, facilitated live and free for patients whose GP doctor is affiliated with O-day’min PCN:

• Once a week, 2 hours in length, for a duration of 4 weeks.

• Facilitators: Registered Dietician and mental health clinician.

• Sometimes this course is offered to the general public.
  
  

For more information:  eopcn.ca/classes/nutrition-classes/craving-change-nutrition

On-Demand (Pre-Recorded):

Free open to the public online classes that are pre-recorded.

• Healthy Eating 101

• Centering Your Meals with Plants

• Protein & Fibre: Am I Getting Enough?

• Label Reading
  
  

Virtual Classes (Facilitated Live):

Free for patients whose GP doctor is affiliated with O-day’min PCN

• Eating Well the Mediterranean Way

• Cooking with Beans

• Cooking for One

• Healthy Meal Planning

• Craving Change®

• Weight Management
  
  

For more information:  eopcn.ca/classes/nutrition-classes

On-Demand (Pre-Recorded):

Free open to the public online classes that are pre-recorded.

• Active Living 101

• Exercise Prescription 201

• Beginner Rubber Tubing Exercise Class

• SMART Goal Setting

• Beginner Shoulder Health
  
  

Virtual Classes (Facilitated Live):

Free for patients whose GP doctor is affiliated with O-day’min PCN

• Beginner Exercise Classes

• Weight Management
  
  

MOVE Walk Group:

Free open to the public in-person.

• MOVE is offered once a week

• Tuesdays @ 1:30 – 2:30 PM

• Allin Clinic
  10155 120 Street
  Meet outside the main doors.

• 60-minute walk along various paths in the neighbourhood or Edmonton’s River Valley which may include some hills or stairs.
  
  

For more information:  eopcn.ca/classes/#

PCN:

• Website: https://albertapcns.ca/pcnca/pcn
  
  

PCN Workshops & Programs:

• Website: albertafindadoctor.ca/workshops/home

Monash University:

• PMOS Guideline 2023: monash.edu/__data/assets/pdf_file/0003/3379521/Evidence-Based-Guidelines-2023.pdf

• AskPCOS App:  AskPCOS App - Monash Centre for Health Research and Implementation (MCHRI)

• YouTube Video, Connecting PCOS & Cardiovascular Disease interview with Dr. Helena Teede:  #Heart4PCOS #interview with Dr. Helena Teede - YouTube

• free PDF booklet:  monash.edu/__data/assets/pdf_file/0005/1429772/ASK-PCOS-Evidence-based-information-for-women-with-Polycystic-ovary-syndrome.pdf
  
  

Centre for Clinical Interventions (CCI):

• Australian website: cci.health.wa.gov.au
  
  

Centre for Disease Control and Prevention (CDC):

• United States of America website:  cdc.gov/diabetes/basics/pcos.html

Depression, anxiety and perceived stress in women with and without PMOS: a community-based study:

• Psychol Med. 2019 Jul;49(9):1510-1520.

• doi: 10.1017/S0033291718002076.
  
  

Book:  Mind Over Mood:

• Website: https://www.mindovermood.com

• Authors, Dennis Greenberger & Christine A. Padesky.

• Also available at the Edmonton Library
  
  

American Psychological Association:

• Website:  apa.org/topics/depression

Anxiety Canada:

• Website:  https://www.anxietycanada.com/
  
  

American Psychological Association:

• Website:  apa.org/topics/anxiety

Self-Compassion (Neff, K. 2022):

• For more information:  selfcompassion.org

Government of Alberta-My Health:

• Website: Myhealthalberta.ca / Health Information and Tools > Sleep Better

The Assertiveness Workbook: How to Express Your Ideas and Stand Up for Yourself at Work and in Relationships (Paterson, R. 2000):

• Overcoming the stress barrier (pp. 34-35)

• For further information on this book, click here.  To view it at amazon.ca, click here.

Alberta Health Services:

• For more information or support, you can contact Alberta Health Services Patient Concerns and Feedback or the Alberta Government Health Advocates.

• Website: Advocating For Yourself | Alberta Health Services

If You Always Get Tongue-Tied at the Doctor, It’s Time to Work on Self-Advocacy-Here’s How (Lanquist, L. 2021):

• Website: realsimple.com/health/preventative-health/self-advocacy-at-doctor-appointments

Alberta Women’s Health Foundation’s Surveying the Silence:

• Report:  AWHF Surveying the Silence Report 

• Website:  albertawomenshealthfoundation.org

Rivers Edge Counselling Centre:

• Grant Wardlow (works with EMDR, Trauma, Anxiety, Depression, LGBTQ+ and more)

• Website: https://www.riversedgecounselling.com
  
  

University of Alberta Hospital:

• Outpatient Psychiatry Clinic

Tiffany Roe:

• Instagram: @heytiffanyroe

• Website: https://tiffanyroe.com
  
  

The Food Psych Podcast:

• All episodes: https://christyharrison.com/all-episodes

• Website:  https://christyharrison.com
  
  

Michaela Putala, RDN

• Instagram:  @food.peace.nutritionist

Shelby Eckard:  Instagram @pcossupportgirl 

Trista Chan, RD MHsc:

• • PMOS Recovery Program —  (thegoodlifedietitian.com)

  • Free PMOS Toolkit

  • Website:  The Good Life Dietitian.com
    
    

Letisha Hodges, Registered Nutritionist:

• Email: letisha@edgenutritiongp.com

• Website: Edge Nutrition & Performance (edgenutritiongp.com)
  
  

Alyssa, RD:

• Instagram: @pcos_nutritionist
  
  

Erin Nesbitt, RD (Edmonton) IE & PCOS:

• Website:  erinnesbittrd.com
  
  

Aimee Prinsen, RD:

• Email:  pcos.dietitian.aimee@gmail.com

PMOS Support Group:

• Facebook:  https://www.facebook.com/groups/151108921766116
  
  

PMOS Challenge – The National Polycystic Ovary:

• Facebook: PCOS Challenge:  The National Polycystic Ovary Syndrome Associate

• Website: https://pcoschallenge.org
  
  

You Can Totally Cyst With Us - The Happy Gurls PMOS Support Group:

• Facebook:  You Can Totally Cyst With Us:  The Happy Gurls PCOS Support Group

Go to: https://myhealth.alberta.ca/myhealthrecords to access all your results. Your doctor or our study endocrinologist can also access your results to discuss them with you as needed. If results require medical attention, you would be contacted by one of our study clinicians: endocrinologist, cardiologist. 

Please visit our webpage "Studies":  PMOS Together