Polycystic ovary syndrome (PCOS) is a complex, chronic condition the US National Institutes of Health (NIH) Office of Disease Prevention has described as a major public health problem for women in the United States. PCOS is characterized by a range of symptoms including irregular or no menstrual periods, excess hair growth on the face and body (hirsutism), weight gain, acne, ovarian cysts, and alopecia [5]. PCOS can also increase women’s risk of type 2 diabetes mellitus [6], cardiovascular disease [7], infertility [8], anxiety and depression [9-12], and poor health-related quality of life [13].

PCOS can begin in adolescence [14] and worsen across the life course if untreated or poorly managed [15,16]. The prevalence of PCOS among adult women (18-45 years of age) in the United States is about 7% [17]. However, research with a community sample of women (27-34 years of age) in the United Kingdom suggests that the prevalence of PCOS may be even higher, from 7.8% to 20.6%, depending on which of 3 diagnostic criteria for PCOS is used. Additionally, using 2 of these criteria, NIH and Rotterdam, about 70% of women with PCOS symptoms are undiagnosed [18]. See Goodman et al [19] and Rosenfield [20] for a review of the diagnosis and treatment of PCOS in adolescents and adults.

The 2012 NIH Evidence-based Methodology Workshop on Polycystic Ovary Syndrome recommended establishing “multidisciplinary programs to improve public and health care provider awareness and management for women who currently have the syndrome” [5]. The lack of awareness about PCOS is partly due to the condition’s misleading name, which suggests that it is a problem of the ovaries; however, the presence of polycystic ovaries alone does not indicate that a woman has PCOS [5]. Additionally, although PCOS is a highly prevalent condition, it does not have the “celebrity” status of other well-known conditions [21].

Women with PCOS describe the process of searching for answers to their symptoms as emotional, confusing, frustrating, devastating [22], and exhausting [23]. In addition to seeing several doctors before receiving a diagnosis, women report diagnosing themselves by searching for information online [24]. Women may search the Internet for information on PCOS they cannot find or understand in books or other print sources [25], and when they do not receive sufficient information and support from health care providers [23]. In addition, the Internet provides women with a convenient, private, and accessible way to access information on symptoms such as obesity and hirsutism (excessive hair) that may be too embarrassing to discuss in person [25]. Women communicate and share experiences with PCOS via chat groups, email lists [25], online support groups [23], and social networking sites like Facebook and Twitter [4].

Research on online information about PCOS has primarily focused on accuracy of this coverage. Information on PCOS appears on social networking sites, government health and professional associations’ websites, and nonprofit organizations’ websites [4,26], and websites vary regarding PCOS symptoms, long-term health effects, and management strategies [4,27]. Websites also tend to omit information on authors, editorial review process, publication date, strength of evidence reported (eg, use of randomized controlled trials), PCOS treatment based on practice guidelines [27], privacy and confidentiality of personal data, and sources [4].

Media do not just provide consumers with health information, however; they also create social constructions of health, illness, and medical care that have implications for how consumers view and manage their health [28]. Teen and women’s magazines have traditionally conflated health and beauty [29,30]. For instance, an analysis of body-related content published from 1993 to 2003 in Seventeen, a magazine for adolescent girls, found that content created constructions of desirable bodies as lean, toned, and free of hair and acne [31]. Equating health with beauty can be problematic for readers with PCOS. For instance, teen magazines publish techniques such as hair removal strategies and quick-fix diet and exercise routines readers can follow to achieve the desirable body [31]. Hair removal techniques that do not address the underlying causes of excessive hair growth can mask the severity of PCOS-related hirsutism [32]. Diet and exercise routines to achieve the desirable body in a short amount of time can overlook the importance of long-term lifestyle changes in diet and physical activity needed to manage PCOS. On the other hand, content in women’s magazines that encourages consumers to collaborate with health care providers, be cautious about treatments and medications, and look to friends and family for social support may help consumers manage their health [33].

Magazines are a type of entertainment-education or “edutainment,” which refers to the placement of educational content in entertainment messages [34]. Magazines publish health content in addition to beauty, fashion, and entertainment content. Teen magazines have published health content on topics such as sexually transmitted infections, gynecological visits, and birth control [35], and women’s magazines have published on breast cancer [36], heart disease, osteoporosis, and depression [33]. Interestingly, there is evidence in the literature that magazine readers come across content on PCOS. As an adolescent pointed out,

Research also suggests that women with PCOS relate information they see in the media to their health, as the following quote illustrates: “If you look at how the media portrays what is feminine, lack of body hair, thinness, and a beautiful complexion, you don’t have these with PCOS and wish you did” [22].

While several health topics have been featured across a range of edutainment [34], researchers have not examined content on PCOS in teen and women’s magazines. These media have the potential to expose primarily female readers to content on PCOS and influence readers’ beliefs and attitudes about women with PCOS. In particular, online magazines, also referred to as digital magazines, are capable of reaching large audiences due to the lower cost of production and distribution, compared with print magazines [37].

This study aimed to understand content on PCOS in digital teen and women’s magazines. The following research questions guided this study: (1) Do digital teen and women’s magazines publish articles on PCOS? (2) Which magazines publish articles on PCOS? (3) How do digital teen and women’s magazines portray adolescents and women with PCOS? (4) What is the discourse and ideology related to health, illness, and gender in these media?

This research can provide insight into health communication on PCOS in digital magazines to which readers are exposed. The findings can inform health education programs that teach women to be critical consumers of PCOS-related content in digital women’s magazines.

We used data from the Alliance for Audited Media (AAM) to identify the highest-circulating teen and women’s magazines with digital editions published in the United States. The AAM is a not-for-profit organization founded in 1914 (formerly known as the Audit Bureau of Circulation) that provides audited circulation figures, among other services and data, for newspapers, magazines, and digital media companies in the United States and Canada [38]. Advertising firms use these services and data to obtain details on various media types (eg, magazines, newspapers) to most effectively reach target markets or audiences. AAM is also available to academic institutions with electronic subscriptions to AAM [39]. Researchers, for instance, have used AAM to study the portrayal of gun violence and serious mental illness in news media coverage [40].

Consumer magazines with membership to AAM file publishers’ statements with AAM every 6 months. Publishers’ statements are claims made by consumer magazines that contain information on the publication’s field served and average circulation of print and digital issues. AAM defines field served as the publisher’s description of the markets or occupations whose interest the editorial content is directed toward. In other words, field served describes the publication’s target audience or readership. Additionally, AAM defines digital edition circulation as the distribution of a magazine’s content via electronic means. The digital edition maintains the same identity (eg, the same name and logo characteristics) as the host (or print) publication [38].

First, we identified magazines for this study by selecting AAM’s circulation range of ≥1,000,001. This range was used as an indicator of popular consumer magazines. Second, we retrieved publishers’ statements for magazines that met the circulation criteria. Magazines were selected for inclusion in this study if the publisher’s statement described the field served as women or female teens. This yielded a total of 24 magazines. We also selected magazines with circulation rates 100,001–1,000,000 in an effort to include magazines catering to racial and ethnic minority readers that may not have had the highest circulation rates. Publishers’ statements were also retrieved for these magazines, yielding 3 additional magazines whose target audience or readership was women or female teens.

We independently searched each of the magazine websites from January 22 to February 25, 2015, to identify articles containing the keywords “PCOS” and “polycystic ovary syndrome.” We selected a 1-month search period to determine whether any content on PCOS was published in teen and women’s digital magazines. We compared the websites and number of articles containing the keywords. This yielded a total of 21 magazines and a total of 170 articles containing the keywords. The magazines were Better Homes and Gardens, Cosmopolitan, Cosmopolitan en Español, Essence, Family Circle, Fitness, Glamour, Good Housekeeping, Health, MORE, O, The Oprah Magazine, Parenting, Parents, Prevention, Redbook, SELF, Shape, Teen Vogue, Vanidades, Woman’s Day, and Women’s Health; 2 of these magazines, Essence and Teen Vogue, did not contain the keywords in articles, but rather in the reader comments.

We imported the final 170 articles into NVivo 10 for Windows (QSR International) using the NCapture for NVivo add-on in Chrome (Google). NCapture is a Web browser extension that captures Web content (eg, screenshots of webpages) that can then be imported into NVivo 10 for Windows as PDF sources [41]. In 1 instance, there was a video embedded in a Redbook article that had no text in the article except for the article’s title and caption. The video was a total of 2:51 minutes in length and was streamed directly on Redbook’s site, rather than taking the reader to a video-sharing website such as YouTube (YouTube, LLC). We transcribed the video and included the content in the analysis.

The 2 researchers independently coded each of the 170 articles to identify the following 5 primary content areas published in women’s magazines: medical advice, letters or advice, personal stories, advertisements, and visual imagery. Medical advice pieces discussed PCOS in terms of warning signs, treatment, and prognosis. Letters or advice columns were those where questions about PCOS were asked and answered. Personal stories or narratives were based on women’s own experiences with PCOS. Advertisements included health products and services related to PCOS. Visual imagery included images associated with the articles. We focused on the articles containing medical advice, letters or advice, and personal stories or narratives.

The 2 independent coders, both women, conducted a textual analysis using a grounded theory approach to coding to identify themes. The lead researcher identified as Mexican American and had background in psychology, social work, and public health. The graduate student research assistant, who was unfamiliar with the study aims, identified as white and had a background in social work and public health. The lead researcher was fluent in Spanish and the research assistant was proficient.

During the data collection process, each researcher kept memos in which she documented the date the magazine article was retrieved and the titles of the magazine and article. Reflective information such as thoughts and questions that arose during this process were also noted.

Articles were read repeatedly and inductively, and new themes were noted as they emerged. The units of analysis were the article, title, caption, and user comments. Each researcher independently conducted an initial, unrestricted coding of the text in magazine articles by reading the texts line by line. Then, each researcher developed a coding scheme based on her interpretation of the text and memos. The researchers read the magazine articles as cultural artifacts: as texts that provide insight into social practices, representations, and assumptions about society [42].

We held peer debriefings to compare coding, understand each other’s interpretations of the data, integrate categories, and refine the codebook. The codebook contained the thematic categories, examples of text for each category, and codes associated with each category. During these meetings, we viewed the screenshots of the magazine articles and reviewed the memos to contextualize their interpretations. This approach follows Boellstorff and colleagues’ recommendation that data collected in virtual spaces (eg, screenshots and chat logs) be used in conjunction with field notes, not as a substitute for field notes [43].

Finally, we retrieved magazine media kits from publishers’ websites to obtain magazine readers’ demographic characteristics [44-63]. A media kit is a resource created by a publisher to help prospective ad buyers evaluate advertising opportunities [64].

This study used publicly available data and was deemed exempt from review by the University of Michigan Institutional Review Board.

PCOS was depicted as a barrier to childbearing, starting a family, and effective breastfeeding. In turn, these issues hindered women’s roles as wives and mothers. A total of 28 instances of this theme emerged from 9 magazines.

Women were depicted as responsible for improving their own health through diet, exercise, hard work, and seeking good-quality health care. A total of 109 instances of this theme emerged from 17 magazines.

Women were portrayed as using their personal experience with PCOS to promote women’s health by sharing knowledge and expertise, promoting acceptance of one’s body, and creating dialogue about miscarriage and infertility. A total of 8 instances of this theme emerged from 5 magazines.

A limitation of this study was the 1-month search period that did not lend itself to the study of potential changes in PCOS content over time. Articles on PCOS were included in the study if they were available online during the 1-month search period. As a result, the articles included in this study may not be representative of PCOS content published in these media over a longer period of time. Despite this limitation, the 1-month search period was effective in demonstrating that, indeed, women’s digital magazines publish content on PCOS.

This study also found that, in some cases, articles were published online months and even years preceding the search period. This illustrates how commercial publications such as magazines that once had short shelf lives as hard copies can continue to be accessible online for lengthy periods of time [90].

A second limitation was the method used to search for articles using the keywords “PCOS” and “polycystic ovary syndrome.” We used only these keywords in this study. This may have excluded articles containing other names for PCOS such as “polycystic ovarian syndrome.” In addition, the search method may not have yielded all articles containing the keywords. For instance, an article titled 7 celebrities who manage life with chronic pain published in November 2011 in Prevention magazine containing the keywords was not returned by the magazine website’s search engine using this search method. As a result, we did not include this article in this analysis. This indicates the search bars in digital magazines may not have been sensitive enough to find all articles containing the keywords. Future research should include a more rigorous search method.

Future research should also examine how readers respond to PCOS content in digital teen and women’s magazines. This includes ways in which readers respond to women’s personal stories and manage their health, or not, as a result of exposure to this content. Research in this area is especially important because the number of Internet users of online content to make health and health care decisions is rising [91].

This study highlights how digital teen and women’s magazines can be used to understand health communication about PCOS. Research on popular media content is not readily available in the literature on PCOS, as much of the information on women with the condition comes from medical sources. This study found a lack of representation of adolescents and racial and ethnic minority women with PCOS in magazine articles. In addition, this study found social values and beliefs about women with PCOS embedded in the articles. The findings can inform health education programs that teach women to be critical consumers of PCOS-related content in digital women’s magazines. Critical consumers have the skills to recognize how content is socially constructed and make informed decisions about their health through reflection, questioning, and analysis of media [92]. Future research on PCOS content in digital teen and women’s magazines can help researchers, patients, and consumer groups engage with the media to increase public awareness of PCOS.