Issue link: https://www.massageandbodyworkdigital.com/i/68005
efficiency; these are often prescribed to help control type 2 diabetes. In fact, this strategy has been shown to be so effective that women with PCOS who want to become pregnant may be counseled to treat their condition with diabetes drugs: an indirect route to improved ovarian function. WHERE DOES MASSAGE FIT? Any therapist who works with females in their childbearing years may have clients who are living with PCOS and/or metabolic syndrome. And while it is probably false to claim that massage will "fix" this problem, we can, with sensitivity and good information, at least try to contribute to an environment that has the best possible outcomes for our clients. If we have a client who has PCOS, it is important to bear in mind that her ovaries may be enlarged and in a location that is vulnerable to bruising or crushing. A healthy, non-pregnant woman's ovaries are typically located down low in the pelvis (more or less behind where the pubic hair begins to grow). This keeps them out of reach of most types of deep abdominal work. But a woman with PCOS may have ovaries that are located higher and more lateral than we anticipate. If this condition is identified, these clients need to receive bodywork that does not risk impinging or bruising these delicate structures. In other words, deep abdominal work must be conducted extremely conservatively. Some experts suggest addressing abdominal issues indirectly through reflexive techniques, and/or approaching abdominal work for women clients with PCOS by improving the quality of the muscles and fascia of the abdominal wall, working obliquely rather than deeply. The appropriateness of massage in the context of metabolic syndrome depends entirely on the health and resilience of the client. If this person successfully controls his or her condition through diet and exercise adjustments, massage is probably safe and appropriate. If this person has developed any of the serious complications associated with these conditions, judgments must be made to accommodate possible weaknesses of the circulatory and urinary systems. Perhaps the most dependable role for a massage therapist or bodywork practitioner with a client caught in the PCOS/metabolic syndrome tangle is to be a source of compassion and peace in a world of frustration, conflicting and contradictory information, and unanswered questions. We can, through the creation of a welcomed relaxation response, promote and support the self-care that must be at the center of any choices our clients make on their own behalf. WHAT HAPPENED TO MS. X? Ms. X. went on birth control pills to try to regulate her cycle; this was a mixed success. Then, on her doctor's advice, she stopped taking them and began treatment with fertility drugs, to no avail. Her next strategy was to lose weight (she lost 50 pounds through diet and exercise) along with using insulin uptake drugs. She found that this regimen did not regulate her cycle, so she also started acupuncture treatments. With this strategy she had more success: her first child was conceived very shortly thereafter, and her second was born just last summer. Author's note: many thanks to all the women who contributed to the profile of Ms. X. teaches several courses at the Myotherapy College of Utah and is approved by the NCTMB as a provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2009), now in its fourth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com or wernerworkshops@ruthwerner.com. Ruth Werner is a writer and educator who visit massageandbodywork.com to access your digital magazine 115 NOTES 1. Ms. X. is a fictional character: an amalgam of several generous women who allowed themselves to be interviewed for this article. 2. D. Douglas, "Primary Amenorrhea and PCOS Tied to Metabolic Syndrome," Archives of Pediatric & Adolescent Medicine 162 (2008): 521–5. Available at www.medscape.com/ viewarticle/577389 (accessed December 2008). 3. R. Azziz, "How Prevalent is Metabolic Syndrome in Women with Polycystic Ovary Syndrome?" Nature Clinical Practice Endocrinology & Metabolism 2, no. 3 (2006). Available at www.medscape.com/ viewarticle/529294 (accessed December 2008). 4. Ibid. 5. Z. Hopkinson, "Polycystic Ovarian Syndrome: The Metabolic Syndrome Comes to Gynaecology," 1998. Available at www.bmj.com/cgi/content/ full/317/7154/329 and www.medscape.com/ viewarticle/456221 (accessed December 2008). 6. P. Kovacs, "Metabolic Syndrome and PCOS. Ask the Experts About Gynecology and Reproductive Endocrinology," Medscape Ob/Gyn & Women's Health 8, no. 2 (2003). Available at www.medscape. com/viewarticle/456221 (accessed December 2008). 7. "Metabolic Syndrome—Statistics," 2006 American Heart Association, Inc. www.americanheart.org/ downloadable/heart/1136819875357META06. pdf (accessed December 2008). 8. R. Werner, A Massage Therapist's Guide to Pathology, 4th edition, (Baltimore: Lippincott Williams & Wilkins, 2009). 9. T. Cascella, "Visceral Fat is Associated with Cardiovascular Risk and Polycystic Ovary Syndrome," Human Reproduction 23, no. 1 (2008): 153–159. Available at www.medscape.com/ viewarticle/570686 (accessed December 2008). 10. J. Brunzell, "Dyslipidemia of Central Obesity and Insulin Resistance," American Diabetes Association (1999). Available at http://journal.diabetes.org/ diabetescare/FullText/Supplements/DiabetesCare/ Supplement399/C10.htm (accessed December 2008). 11. "Obesity and Polycystic Ovary Syndrome," Clinical Endocrinology 65, no. 2 (2006), 137–145. Available at www.medscape.com/ viewarticle/543518 (accessed December 2008).