PCOS directly or indirectly impacts all of your relationships. When you’re talking about romantic relationships, whether dating or committed, issues frequently come up around libido, infertility, self-image, depression, lifestyle, and self-care. From initial conversations to advocating for yourself when making diet and lifestyle changes, Dr. Gretchen Kubacky, the “PCOS Psychologist,” has useful advice. Listen in (or read the transcript) as we discuss:
- Tips for getting your partner on board with your upgraded diet and lifestyle plan
- Learning to be proactive in your self-care
- How dating can help set expectations that support your health
- Impact of emotional trauma and stress on physical well-being
Full transcript follows.
Dr. Gretchen Kubacky, “The PCOS Psychologist,” is a health psychologist in private practice in Los Angeles, California, an inCyst Certified PCOS Educator, and the founder of PCOS Wellness. She is also a PCOS patient! Her goal is to dramatically improve the life and health of every PCOS patient. Dr. Gretchen offers insight, advice, education, and practical approaches on how to deal with the depression, mood swings, irritability, anxiety, sleep and eating issues, frustration, and lack of motivation that plague so many PCOS patients. She is also a member of the PCOS Challenge Health Advisory Board, and a frequent writer and speaker on PCOS and related topics.
Amy: Today, we’re going to tackle a topic that I have yet to address in my 74-plus podcasts so far, but it’s such an important topic. It’s PCOS and relationships. I wanted to bring in a special guest to address this topic. I’m just so thrilled to be speaking with Dr. Gretchen Kubacky, the PCOS psychologist. She’s a health psychologist in private practice in Los Angeles, California and is the founder of pcoswellness.com, and she’s also a PCOS patient herself. Welcome, Dr. Gretchen.
Dr. Gretchen: Thank you so much, Amy. I’m really excited to be here with you today.
Amy: I know we’ve been chatting before the podcast, and I know I’ve known of you and I’ve been following your work for, what do we think, like 10 years now?
Dr. Gretchen: I think it’s been pretty close to 10 years, yes, although we both did some guest blogging on a PCOS blog, and it was like, “Oh, she’s interesting. Let me check her out a little bit more thoroughly.”
Amy: Yes, so I’m just really thrilled to be able to see you face-to-face and to get to chat with you about this really important topic. I know I’ve shared with listeners that I was not diagnosed with PCOS until I was 31 and married with one child and trying to conceive another. Thinking about, and I guess I was thinking relationships, the dating relationships, the love relationships as you’re navigating your PCOS journey. I really didn’t experience that because I didn’t even know I had PCOS when I was dating. I was told at a very young age, I think 17, that they’d have to jump through hoops one day to get me pregnant. I know that, that was something that came up, and the relationship with my now husband that we may have fertility issues, but it wasn’t really … The PCOS topic did not really come into play for me, but I know that it does for many women because I hear from women all the time trying to navigate relationships with PCOS. I would love for you to tell us some ways that PCOS affects relationships and what you see in your practice.
Dr. Gretchen: Sure. It’s interesting that you mention the timeframes on that, because I think for a lot of us who are in our 40’s and 50’s, it was something where we were basically not told that we had a problem and just come back when you want to get pregnant. It was like, “Oh, okay,” and then you put it away, and you go about your business. It’s something that probably wasn’t that much of a factor in dating or in relationships, but I think nowadays, more women tend to know a lot earlier in life. They’re getting diagnosed as teens or in their early 20’s. That is prime reproductive time, and they’re interested in this. It does come up. There’s a lot more awareness about all of the different symptoms that are part of the PCOS package, whereas before, women might say, “Gosh, I know I get really grumpy a lot,” or “It seems like I just have a permanent case of PMS,” or something like that.
Now, you can hop on Google and find out exactly what’s wrong with you and why, and here’s all the brain chemistry around it and just part of your diet, and so on and so forth and a million ways to fix it. I think that it’s something, also, over time, we’ve evolved in having more open conversations about our feelings and our relationships and experiences in that regard.
For women with PCOS, big stuff comes up around the issue of libido, sex drive. Most often, the complaint is that it is too low. Quite often though, the complaint is that sex drive is too high, and it’s driving a partner crazy like the partner can’t keep up with demand. Infertility is another big factor in relationships, and I see a lot of women with those issues going through the process of the infertility treatment with all of the extra layers of hormones thrown in on top of our already messy hormones. The need to time things, the expense, the fact that sex is no longer fun, but obligatory and results-oriented. That’s a really big hit on relationship too. It’s a lot of stress, and then just generally, the things that women complain most about in my practice are a lot about the mood swings and depression and anxiety that comes up. That makes it really hard to be living with other people.
If you are moody, irritable, super depressed, very anxious about things, it’s more depression than anxiety, but all of those things are hard to live with. It’s basically hard to live with somebody who has mental illness. I mean I know that sounds like a negative term, and the psychologist, so we got to put it in that category, but what it is, is it’s just a side effect or a component and the PCOS.
Amy: Well, I’ve been so blessed because I have married the best man in the world for me, and he’s been just a trooper through my ups and downs with PCOS. Early in our marriage, definitely more downs than ups, but he has stuck with me and supported me and really helped me. One thing now, we’ve been married, we just celebrated our 21st wedding anniversary, so it’s been a while.
Dr. Gretchen: That’s great.
Amy: He knows that when I’m moody and grumpy and irritable, usually it means that I need to take some time for self-care, so he knows now. He’ll sometimes actually push me out of the door to go for a walk or go to my Pure Barre class or do something for me, because he knows when I come back, then I will be in a much better mood. The other thing that he’ll ask, and I know this probably might not sound great, but if I’m moody like that, he’ll sometimes say, “Well, what did you eat today,” because usually, it will be something in my diet that has caused irritation, but it’s inflaming my brain and making me less moody and just not myself. I think it’s important that partners work together to come up with these queues and ways of helping the woman with PCOS be able to make better choices for herself.
Dr. Gretchen: Yes, it’s absolutely critical for a partner to be supportive, and that is one of those things where people have a lot of problems because the diets that are best for us, for example, they’re not restrictive, necessarily, but they definitely eliminate a lot of junk food and excess alcohol and sugar and things that people think of as treats, generally. For somebody who doesn’t feel like they need to be on a special eating plan, the idea of limiting foods in the house to only the healthy stuff can be really hard and can sometimes create sabotage. I’m working with one couple right now where the wife is following a low carb plan, and the husband every day brings home pizza and Cheetos and leftover cake and that sort of thing, just really a direct and aggressive behavior.
That’s something, actually, where I ended up working with the couples sometimes, because it is very, very difficult. It is important. Hopefully, if you’re together, you know each other really well. You can gently point out those things, but I think your idea of having a queuing sentence like asking, “Did you eat something a little off your plan today,” is a good one and just having that awareness also and willingness to accept the feedback about it is important.
Amy: Could you give us some more tips about how we can get our partner maybe on our side with our lifestyle plan? I know that when I run, my jumpstart program, that’s probably the number one issue, is not having a supportive partner around the food choices that you now have to make as a PCOS Diva.
Dr. Gretchen: Mm-hmm (affirmative). Okay, so let’s just start with that one. The food choice thing is really hard. Food is really loaded emotionally. It is something that we have come to associate with and symbolize love, affection, caring, concern, nurturing, all of those positive things. The negative side of what comes up, and a lot of this is, if there’s emotional over-eating present, which is often the case with women with PCOS partly because of those mood swings and brain chemical dips are driving a self-medicating. This is where the nasty carb cravings and sugar cravings come in. A lot of times, anger gets stuffed, frustration gets stuffed. It’s hard with the food choices. We want to be pleasing to our partners, and making radical changes is usually not easy for people. It’s probably a little easier when you know you really need to do it, and you’ve bought into it.
In this case, literally. They bought a program about how to make changes. They are already internally changing and saying, “I want to do something different so that I can feel better.” It’s very hard because we have an invisible disease. I’ll refer to it as a disease. I know it’s a syndrome, but I’m thinking of it as a disease. We have an invisible illness. Most people look at us and have absolutely no idea that we have this chronic illness that affects every factor of our life and our health and our being. Even in the person that we’re married to or living with may not really get that. They’ll just say, “Wait a minute. You’re saying no, no, no to all these things we used to do and eat together. That’s not fun anymore. You’re not fun.” That’s a pretty direct hit on who you are and how you are. That’s very painful.
It often leads them to some self-sabotage, slipping off the program and saying, “This is just too hard. I can’t do this. I’m getting the support that I need.” It is important. I think you have a Facebook group, a private Facebook group as part of your program?
Amy: Right, right.
Dr. Gretchen: Yes. That kind of support is really important because you need some shoring up from somewhere. You can’t always just generate the will to do it. It takes a while to see changes in your body and in your brain, depending upon how long you have been dealing with PCOS, how you’ve been treating it. Is your diet high in inflammatory foods and beverages? Are you doing other things that are unhealthy like not getting enough sleep or smoking? All of that takes a while to calm down. It’s also something that is just slow. It requires patience. Again, that idea of, “Wait a minute. You’re calling attention to me doing some unhealthy things too,” can be enough to make a partner engage in some sabotaging behaviors. That’s very common.
Part of the opportunity of it, I think, for women with PCOS is learning how to stand up for our own needs. It’s something … I haven’t talked about this a lot, but I have type two diabetes early on, so type two as a side effect of polycystic ovary syndrome also genetics on one side of my family that I didn’t know about at the time, but when I first was diagnosed with diabetes, I was so embarrassed and so ashamed about having it. I didn’t tell anybody. At the time, the medications were not just Metformin. I was taking medication that caused blood sugar drops, really dangerous drops, actually. I probably could have died, and nobody would have known what was happening with me because I didn’t tell anybody. I didn’t ask for support.
Since then, I’ve obviously changed a lot. I’m telling the whole world about it, but I’ve learned how to do things that were hard like if I had to go to a meeting, I would call ahead and ask, “What sort of food are you serving,” so that I could plan accordingly, take some of my own food with me, ask for a special order. That sort of thing. Learning how to become really proactive in your own self-care can be a positive effect that comes out of these clashes in relationships, I think.
Amy: Something that I found in my coaching is I really think that if you are on this healing path of healing yourself emotionally, physically, spiritually, sometimes that does play a part in relationships. As you’re growing and moving forward, oftentimes, your partner, and I find this, they’re not willing to go along on the ride with you. Then, I find that a lot of women then question, “Is this the right relationship for me for where I really want to go in my life?”
Dr. Gretchen: Mm-hmm (affirmative). That is absolutely true. I mean in relationships, we tend to come together when we’re both at a certain place relative to one another. We’re on the same level, whatever that level is, super high-functioning, super low-functioning, and everywhere in between. Everything is fine and good as long as you’re in the same place, relatively speaking, a little bit higher, a little bit lower, but if one partner starts to grow really rapidly or changes dramatically like say all of a sudden going from no exercise to exercise, learning how to meditate, dietary changes, all the things that we recommend, that can get really uncomfortable for a partner who is happy with the status quo. In this case, obviously, we’re talking about women making the changes, and that threatens on a lot of levels. It’s women taking their power back and saying, “I don’t have to live in misery. I don’t have to feel bad all the time.”
There’s a lot of hidden pay-off sometimes for partners. They can feel superior to the one who has been on the down position. All of a sudden, that’s shifting. It could be threatening in terms of ego in that regard. It’s something also where it’s like you might have to give up stuff you like or change the way you are because if sitting on the couch and watching TV is no longer an option, well, are you going to get out and take the bike ride, or are you going to sit there and get more and more distant and isolated from your partner?
Amy: Yes. It’s really, sometimes, you’re really faced with some hard choices about what you want to do in a relationship, but I do love what you said about healing often can be about claiming your power and advocating for yourself and finally really letting people know what you want and what you need and not being afraid to say no in order to say yes to you.
Dr. Gretchen: Yes, exactly. Saying yes to you often is perceived as saying no to someone else.
Amy: Mm-hmm (affirmative).
Dr. Gretchen: I think also just the culture of bringing it into dating as opposed to marriage or being in a formal partnership. All of our dating rituals revolve around going out to eat and doing passive things, going to a concert, going to a movie. Shifting that is actually a great opportunity for someone who is not yet in a relationship. Again, if you’ve got somebody who only wants to do passive things like, “Let’s sit around and play video games after we eat take-out,” that tells you something about what that person’s preferences are, but if you’ve got somebody who says, “Hey, let’s go take a bike ride and go make salad,” and I don’t know what. It’s somebody who’s like, “Oh, yes. That sounds good too. I’d rather go for a hike than sit behind a screen.” That tells you that a person is oriented in that direction, and that, that will probably be an easier path for you and a more supportive path. Somebody who actually cares about health and is conscious about it.
Amy: Yes, that’s a great suggestion. All right, so talking about dating, a lot of us who have PCOS have hair issues, right?
Dr. Gretchen: Yes.
Amy: That hair where we don’t want it and maybe some extra around the middle. How do you come to terms with that when you’re in a new relationship and sharing yourself with somebody, despite all of our imperfections?
Dr. Gretchen: That is really hard. That’s actually why I see a lot of women. They are really embarrassed about their bodies, that extra fat in the middle and the extra hair, dark hair on their arms or on their bellies and of course, chin and facial hair is a really, really big thing, and you can hide it pretty well when you see somebody once a week, but if you are getting closer with someone, I think it’s something that eventually does have to be addressed. You will be seen, you know? You may be too sick to actually pluck all those extra chin hairs one day, or whatever it is. We’re all really vulnerable about our bodies. This culture is very, very harsh towards women in terms of what our look’s like and what we’re supposed to look like, what the model of beauty is, what the ideal standard is.
In PCOS, it seems like we’ve gotten hit with every single bad thing. The extra weight, the hair, the loss of hair. It’s like how much worse could this seriously get? It’s really devastating. It’s one of those things. I sometimes have women on my couch, and they’re like, “I know this is the first world problem.” It’s like, “Well, yes, it is and it’s still a really important problem because it contributes to depression.” I also want to be really clear about something here. I can’t tell you how many doctors have said, “Of course, you’re depressed. You’re fat and hairy, and you have acne.” That’s not what causes the depression. It’s the chemistry imbalance, the hormonal imbalance that is affecting our brains that causes depression, and those other factors come in and add to the depression. It’s something where I think that you don’t want to talk about. It’s not first date material. Just like you wouldn’t talk about how many children you want to have or whatever that’s scary to someone.
At some point, if you think you’re getting serious, it’s like any serious conversation you would have. The possibility of difficulties getting pregnant, possibility if you need to talk about having an STD for example, would be one of those difficult conversations that you have pretty early on if you want to be a straight-up authentic partner in a relationship. Talking about things like illness, chronic illness is something where you don’t want to share that information necessarily with everyone you meet, but if somebody seems like they’re okay, you want to talk about it because this is something you can’t get rid off. PCOS never goes away. It only gets managed. The response to that will tell you a lot about that person and whether or not you want to proceed in a relationship. With those things, I’ve found that most people are a lot more accepting actually about our bodily imperfections. Very few of us are perfect. They’re the ones that we call supermodels.
The rest of us, do you have cellulite? We have a little patch of bad skin, you know? We’ve got fat ankles, whatever it is that makes us feel like we’re not perfect. This goes for men as well as for women, so being a little bit vulnerable about that can actually be a nice thing. It’s also something for partners to be mindful of. Don’t be commenting on stuff that we can’t change.
Amy: Yes, and I think that’s a good point. I mean I have two teenage boys, and yes, I mean they have their own insecurities around the way they look too.
Dr. Gretchen: Oh, yes, definitely. Yes, it’s just being conscious and kind to one another, but I think that women with PCOS spend a lot of time focusing on our flaws or our perceived flaws. We then assume that everyone else is going to be fixated on our flaws, and they’re not. I always tell people if they’re in a heterosexual relationship, most men are incredibly grateful just to have you naked and willing to have sex. The details, they’re not so fussy about. It’s funny that they give it that way, but it’s true, you know? If they like you, and you guys are both ready, willing and able, then okay. They’re not that interested in the fact that you think that your waist is one inch too big.
Amy: That’s a great point. I wanted to bring something else up. In my experience working with women with PCOS and just my own growth experience, I know there was a time in my life that I felt very much that I wasn’t enough, that I wasn’t worthy. Gosh, I dated some of the worst losers and thinking I was lucky that they were willing to go out with me, but we have to stop that. I mean we are all enough and more than enough. We deserve partners, dates that treat us with, really, the goddesses that we are. I just have to put that out there.
Dr. Gretchen: This is such a common thing for women with PCOS and also for women I see with other medical problems actually, because especially when you’re younger and you have a serious medical problem, the language people use is really telling. Women will come in and they’ll say, “I’m broken. I’m damaged. I’m defective.” Those are awful self-judgements. You can’t help but feel bad with that, and when you feel bad about that like you are broken or damaged or defective, you are going to seek somebody who validates that. I’m not the best person for you, or your self-esteem drops to that point where any date is better than no date, and shut up and be grateful for what you’ve got, even if the person is a total loser, according to most people. It’s all subjective judgment. That is something that really grabbing that back and saying, “No, exactly as I am, I’m perfect right now. I deserve the best in life.” A very important mental shift.
Amy: Yes. I mean if that’s just one thing that you take away from this podcast today, I hope that you can take that away because you are worth it. You deserve the best. If you’re dating somebody or in a relationship where somebody is not treating you the way that you deserve to be treated, then it’s time to look at that relationship.
Dr. Gretchen: It’s very important, and I think also that takes me to another place, which is sometimes, when I’m depending upon where their self-esteem is, if it’s really in a low place, we’ll actually find partners who are abusive. There’s not just the lack of support but that spectrum that goes all the way over to physical, emotional or mental abuse or financial abuse. I’ve seen all of that at different times. Women who are so grateful to be in a relationship that they pay for everything even though they really can’t afford to or who put up with being called names because they figure, “Well, but I am whatever,” fill in the blank. That just perpetuates that self-abuse cycle. Staying out of it, like really choosing not to be in a relationship if that is all that you are finding is a really good part of self-care.
Amy: That’s a great way to frame that. It is self-care, isn’t it?
Dr. Gretchen: It is self-care. It’s very sad and hard to see, and I think that it’s worth devoting a year or two to really proactively taking on your health and working on things like diet, exercise, meditation, going to therapy if you need to go to therapy to work on some of these deeper issues, especially getting into things like … We started talking about eating disorders, which so many women with PCOS have. That is also just a cycle of self-hatred and shame and damage. Getting those things cleaned up as much as you can will put you in so much better of a place for a good, healthy relationship.
Amy: Yes, and I’m going to have you back on the podcast later this year to talk about disordered eating patterns.
Dr. Gretchen: Sure.
Amy: I did want to mention. I think that going to therapists and healing some of the emotional issues that you’ve had in your life goes a long way towards healing your PCOS. I’m talking probably a little woo-woo here, but from a meta-
Dr. Gretchen: I don’t think so.
Amy: Maybe from this meta-physical place. I mean I know I had some emotional wounds that needed to be healed, and when they were, my health started to thrive again. You just can’t push that stuff under the rug and not address it and think that it’s not affecting your body and your health.
Dr. Gretchen: Right. There’s actually something really interesting that I don’t have a lot of data on specific to PCOS because as you know, there’s not a whole lot of research, especially on the psychological part of PCOS. It’s almost non-existent other than to say, “Yes, we have more depression.”
Okay, we knew that, right?
There is a great deal of evidence, however, that trauma leads to physical illness, medical illness. You do have to be born with genes that become PCOS, but if you have any history of trauma, not even include something that we might not call trauma like your parents getting divorced, but it’s also including things like being molested or having domestic violence in the home. Those sorts of things. There is an assessment tool for that. Basically, what it shows is that if you have two or three out of 10 factors of trauma in your history as a child or young adult, you are almost guaranteed to get a medical illness or have an addiction. The numbers are astonishing like an 8,000% increase in things like addiction. I’ve often heard that women’s symptoms get worse or get triggered by some tragedy or trauma in their lives growing up. Those things that hit us developmentally really hard … They get hard-wired in.
If you are verbally abused as a child, for example, that gets wired into your brain. That doesn’t mean that you’re stuck with it forever. You can learn how to override it by doing positive things like meditation or going through therapy and hearing different things, but there’s a lot of that stuff that I think we don’t look at. We’re so focused on things like correcting diet, that it is this other piece of it where it’s like, you may have a lot of other stuff going on that is hampering your ability to actually get well, and all of it has to be addressed. All of those things that happened that are traumatic, tragic, loses, grief, that kind of thing, they are all huge stressors on the body. Women with PCOS, we just don’t respond to physical stressors as well. We over-respond to cortisol. We over-respond to the other stress hormones. It’s a bigger fight for us. If we’ve gotten beaten down in some way metaphorically or literally, then it’s even more of a struggle.
If you imagine getting kicked when you’re already down on the floor, that’s what adding in a layer of trauma does to a woman with PCOS. You’re struggling to get up and get out, but you may need a lot of support to do that.
Amy: Speaking of support, I want you to tell us about pcoswellness.com and how you can support women there.
Dr. Gretchen: Yes, thank you. I have a health psychology practice in Los Angeles, but I realized that there was a need for a lot more psychological support. I created this site called pcoswellness.com, and there are a ton of blog posts there already that are information about how the different psychological aspects of PCOS affect us and things that we can do to help with it. There’s also a site that I have on Facebook for PCOS wellness and a group that you can be added to be in that’s called PCOS Psychology. That’s on Facebook. That’s a place to ask questions about all these emotional health issues. That is what I’ve done to make all of this information accessible. All of that is free. It’s easily available. If you sign up to my mailing list, you can also hear about the fact that I’m coming out with a book some time this year.
Dr. Gretchen: Yea. That’s all about the emotional health aspects of PCOS. I try and do things like public speaking or being on podcasts like this wherein other people will start to get the information and start to connect. Some more points because a lot of times, it’s hard to tell which came first, the chicken or the egg. PCOS, there’s so much going on and so many reasons to be depressed and so many reasons to be anxious when it comes to our physical health, but that emotional and mental health part of it is important to look at. When you work on that, your physical health is going to get better just like working on the physical health will also improve your mental health.
Amy: Yes, absolutely. Well, I so enjoyed our conversation today, Dr. Gretchen.
Dr. Gretchen: Likewise.
Amy: I really look forward to bringing you on again. You’re just really a wealth of knowledge. I love the fact that you’re a Diva. You’re one of us.
Dr. Gretchen: I am a Diva.
Amy: You know, it’s great when you can talk to a clinician that really understands the journey.
Dr. Gretchen: Yes. I thought that using my knowledge as a health psychologist combined with my personal experience over all these years of dealing with PCOS would be ideal, so I’ll definitely be putting out a lot more information that’s interesting and useful, and looking forward to connecting with you again, soon.
Amy: Well, great. Thank you for coming on the podcast. Thank you to everyone listening.