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Polycystic ovary syndrome (PCOS) is a major public health problem that affects women’s physical and mental health. According to the US National Institutes of Health Office of Disease Prevention, there is a need to improve public awareness of the syndrome among health care providers and the public. Women’s magazines are a type of “edutainment” that publish health content in addition to beauty, fashion, and entertainment content. These media have the potential to expose primarily female readers to content on PCOS and influence readers’ beliefs and attitudes about women with PCOS.
The objective of this study was to explore how digital (online) teen and women’s magazines portray women with PCOS.
We used data from the Alliance for Audited Media to identify popular digital teen and women’s magazines with circulation rates ≥1,000,001. We also included magazines with circulation rates 100,001–1,000,000 directed toward racial and ethnic minority readers. A search of magazine websites over a 1-month period in 2015 yielded 21 magazines (eg, Glamour, Cosmopolitan en Español, Essence, and O, The Oprah Magazine) and 170 articles containing “PCOS” and “polycystic ovary syndrome.” Textual analysis using a grounded theory approach was used to identify themes.
Articles depicted PCOS symptoms as a hindrance to women’s social roles as wives and mothers and largely placed personal responsibility on women to improve their health. To a lesser extent, women were depicted as using their personal experience with PCOS to advocate for women’s health. Experiences of Latina and African American women and adolescents with PCOS were absent from women’s magazine articles.
The findings can inform health education programs that teach women to be critical consumers of PCOS-related content in digital women’s magazines. 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.
In the United States, 35% of adults, or about 1 in 3 Americans, have used the Internet to find out what medical condition they or someone else might have [
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 [
PCOS can begin in adolescence [
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” [
Women with PCOS describe the process of searching for answers to their symptoms as emotional, confusing, frustrating, devastating [
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 [
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 [
Magazines are a type of entertainment-education or “edutainment,” which refers to the placement of educational content in entertainment messages [
So I’m sitting inside the waiting room and I’m reading through and looking through magazines, and I came across an article in the Seventeen magazine: polycystic ovary disease. And a light bulb went off in my head. I’m like, hey, I gained weight for no reason. I have hair all over my face and it’s popping up in places I don’t want the hair to pop up. And so, I took it to my gynecologist and she was like, “That’s what you have” [
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” [
While several health topics have been featured across a range of edutainment [
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 [
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 [
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
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 [
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 [
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 [
Finally, we retrieved magazine media kits from publishers’ websites to obtain magazine readers’ demographic characteristics [
This study used publicly available data and was deemed exempt from review by the University of Michigan Institutional Review Board.
This study examined 3 main themes and 8 subthemes related to women’s social roles and responsibilities, personal responsibility to improve health, and use of personal experience with PCOS to advocate for women’s health. This paper contains limited portions of publicly available magazine articles associated with the themes.
Publishers’ statements (January 30, 2014 to June 30, 2014 statement period) in magazines with articles on polycystic ovary syndrome (PCOS) and readership characteristics.a
Magazine | Field served | No. of articles |
Median age of |
Race/ethnicity |
|
“ |
5 | 51.02 | NAb |
|
“ |
3 | 34.7 | NA |
|
“The assertive magazine for the independent Latin woman. Forward. Innovative. Successful. The Cosmo woman is all this and much more! |
2 | 42.1 | NA |
|
“A lifestyle magazine for today’s African-American Woman.” | 1 | 42.1 | NA |
|
“ |
3 | 55 | NA |
|
“A women’s magazine addressing fitness as a lifestyle.” | 6 | 40 | NA |
|
“Every issue of |
1 | 35.6 | NA |
|
“Woman, Her Home and Her Family.” | 4 | 55.5 | White: 12,940 (83.5%); Black/African American: 1588 (10.2%); Spanish/Hispanic Origin: 992 (6.4%) |
|
“ |
30 | 49 | NA |
|
“ |
4 | 54 | NA |
|
“ |
4 | 50.6 | African Americans: 4095 (34%) |
|
“ |
24 | 34.9 | NA |
|
“Reality-tested ideas and support for moms, by moms.” | 11 | NA | NA |
|
“Women’s magazine with interest in good health and personal fitness. Editorial focus on healthful foods, meal planning and preparation, nutrition, skin and body care, self-improvement and other topics contributing to a healthful lifestyle.” | 16 | 57 | NA |
|
“ |
6 | Women aged 35–49: 1722 (28.6%) | NA |
|
“ |
2 | 42 | NA |
|
“Young, educated, affluent women leading active lifestyles who use fitness, fashion, and beauty to be their best.” | 15 | 39.6 | NA |
|
“A fashion and beauty magazine for teen girls. With a focus on fashion, coverage also includes entertainment and music, health and beauty, and inspiring profiles.” | 1 | 27 | NA |
|
“A women’s beauty, fashion and lifestyle magazine in the U.S. Hispanic market. |
1 | 39 | Country/region of birth: Mexico: 40%; South America: 12%; United States: 11%; Central America: 8%; Cuba: 6%; Dominican Republic: 4%; Puerto Rico: 3% other: 16% |
|
“Woman’s Service Field.” | 10 | 55.5 | NA |
|
“The |
21 | 33 | NA |
aReadership age and race/ethnicity taken from magazine media kits. Readership demographics for digital (Web) issue audiences provided when available.
bNA: Not available.
cMedia kit for
dPublisher’s statement only available for the January 30, 2013 to June 30, 2013 statement period.
eMedian age unavailable.
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.
Childbearing was depicted as a wife’s responsibility. Women’s inability to have children lessened women’s worth as wives.
Today’s topic: Less Than A Wife
Hello Steve, Shirley, and Morning Crew. I am a 39 yr old woman with a wonderful husband. He is a God fearing man, that is an excellent provider, and the best husband that any woman could ask for. He is the most unselfish person that I have ever met. We desperately want to start a family but this past summer I was diagnosed with diabetes and ended up in ICU [intensive care unit] with a blood sugar of 980…... I also have PCOS (Polysystic Ovary Snydrome [sic]) which is already an issue and now this. I feel like less than a wife because I can not give my husband the one thing that he wants the most. [
Use of “wonderful” suggests the writer holds her husband in high regard. Her description of him as “an excellent provider” and as “the best husband that any woman could ask for” also suggest she perceives him as meeting his role and responsibilities as a husband. The writer’s tone becomes somber as she blames her poor health for preventing pregnancy and PCOS as an additional barrier to starting the family she and her husband “desperately want.”
Women’s primary motivation to lose weight and manage PCOS symptoms was to increase their likelihood of pregnancy and form a family. The following excerpt published in
Olivia, who suffers from polycystic ovary syndrome, a condition that causes ovarian cysts and often disrupts the menstrual cycle, went on the show because doctors told her she needed to lose weight if she hoped to improve her chances of getting pregnant. She’s now looking forward to starting a family with Ben. [
The excerpt indicates that Olivia was unable to have children as an obese woman with PCOS. PCOS is depicted as a barrier to starting a family with her husband.
In 2 instances, PCOS was depicted as a barrier to effective breastfeeding. In the following excerpt,
Most plus-size women can breastfeed just as well as other women. However, if you’re overweight because of a hormone or endocrine problem, like polycystic ovary syndrome (PCOS) or thyroid disease, you may have issues with your milk supply, since these conditions can also affect production of the hormones that trigger your body to make milk. But having PCOS, thyroid disease, or other hormone-related illnesses doesn’t necessarily mean you won’t be able to breastfeed. You may just have to supplement more often with formula to keep your baby fully nourished. If you’re worried, it’s a good idea to talk to a lactation consultant to help you and your baby get the hang of nursing if you run into problems. [
The reader is concerned that being overweight could affect breastfeeding. The piece depicts PCOS as a potential barrier to nursing if it limits milk supply, a barrier that can affect the mother’s caregiving and the child’s nutrition.
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.
Magazine articles largely placed personal responsibility on women to improve their health with lifestyle changes. Women’s stories illustrated ways in which women changed their diet and exercise through hard work and dedication. The following piece, titled
The Lifestyle: Courtney dove into daily workouts. She jumped rope, punched bags, and learned how to fight. She fueled up with veggies and lean protein, and gave up ice cream after learning to satisfy her sweet tooth with fruits like pineapple.
The Reward: Boxing also gave Courtney a major self-esteem boost. “I used to be afraid of talking in front of people,” she says, “but now I’m confident.” And although her PCOS is permanent, she feels healthy and has tons of energy. “I know I can face anything,” she says. “Just like in the ring, you can always go one more round. You just have to dig for it.” [
Courtney’s boxing is a metaphor for her “fight” against PCOS, a chronic condition Courtney is confident she can “face” or manage each “round.” Courtney’s hard work and dedication in adopting a healthy lifestyle was akin to training for a boxing tournament, in which she learned to fight an opponent. In this case, poor diet and inactivity were the opponents or barriers to weight loss. “You just have to dig for it” suggests that Courtney views one’s ability to change as a result of hard work.
Articles also largely placed personal responsibility on women to seek good-quality health care. The following piece, titled
The key is to see a health care provider with knowledge of the condition (ask whether the doctor frequently sees patients with PCOS). You can also request a referral to an endocrinologist. And if you do have PCOS, remember: The condition can be controlled, but it takes discipline. [
The piece places responsibility on women to find a knowledgeable health care provider and request referrals to specialists. Additionally, the piece reminds women that PCOS can be controlled with “discipline,” suggesting that self-control is a primary factor in managing health.
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.
Personal stories depicted women’s knowledge of and experience with PCOS symptoms as valuable. Women expressed a desire to share their knowledge and experience with other women.
The following is an excerpt of a YouTube video embedded in a
Infertility can be really lonely. Besides the shame you might feel, there’s a lot of misconception and misinformation floating around. I made it my mission to combat that and give infertility a voice by sharing my journey and educating those around me. I’m really proud of myself that I can look back on my journey to motherhood and know that not only did I become more resilient as an individual, and not only did it strengthen my marriage, but I was able to give hope to other people by educating them about infertility. I wish I hadn’t been so ashamed about my diagnosis, but I’m glad I eventually realized, it’s not my fault. [
Carla characterizes infertility as a lonely and shameful experience. The video suggests that Carla experienced shame as a result of her inability to conceive and fulfill her gender roles as a woman, mother, and wife. The video also suggests that Carla’s distressing experiences with infertility created a sense of duty and responsibility to “give hope” to women struggling with infertility. The excerpt concludes with Carla expressing happiness about realizing she was not to blame for her diagnosis of infertility, a rare contrast to the discourse on personal responsibility for one’s health.
Encouraging women to accept their bodies was another way in which articles portrayed women as advocates for women’s health. For instance,
Her videos became so popular that the now 30-year-old Thore launched the #NoBodyShameCampaign, a movement that encourages self-love and acceptance no matter your size or gender.
Even Thore admits her weight gain wasn’t due solely to PCOS. “Now I’ve gained 200 pounds so certainly I take personal responsibility. That’s not all because of a medical condition,” Thore told the Today Show last year. “But definitely I felt so ashamed once I started gaining weight that I was too embarrassed to even go to a doctor.” If you think you’ve put on too much weight, it’s important to take the time to get it checked out. [
Thore used her knowledge of and experience with PCOS, as well as her popularity, to launch a campaign that promotes love and acceptance of one’s body. Thore’s campaign challenges social norms of what ideal bodies should look like. Use of “personal responsibility" suggests Thore believes personal choices, perhaps lack of self-discipline and control, contributed to her weight gain.
Women’s magazines also featured personal stories of celebrities who, unlike Thore, were thin and had no visible signs of PCOS. This included a piece in
The 35-year-old actress speaks openly about the traumatic process in this week’s People magazine, revealing that she had five miscarriages, endured five rounds of IVF [in vitro fertilization], and 26 rounds of IUI [intrauterine insemination]. She says that a diagnosis of endometriosis and polycystic ovary syndrome were behind her difficulties.
So with a healthy and happy 1-year-old baby in her life, and that suffering behind her, why is she talking about her miscarriage experience now? Because she says she wants to open up lines of dialogue about a topic that can be stubbornly closed for suffering hopeful moms-to-be out there. “I was hiding what I was going through for so long, and I hear about so many women going through what I went through,” she told the magazine. “If I’m open about it, hopefully it won’t be so taboo to talk about it.” [
King publicly discloses her PCOS diagnosis as an underlying cause of her infertility. “Traumatic” suggests that King’s experiences with miscarriage and forms of assisted reproductive technology such as in vitro fertilization and intrauterine insemination negatively affected her physical and emotional well-being. King’s motivation for publicly sharing her experience is to “open up lines of dialogue” about infertility and facilitate dialogue about a topic socially unacceptable or forbidden to discuss publicly.
To our knowledge, this study is the first to explore PCOS content in digital teen and women’s magazines. The presence of PCOS content in digital magazines in this study counters previous findings that women’s magazines tend to feature health content that is “old news,” that is, information the public is generally familiar with [
This study found that digital magazines depicted PCOS as a barrier to having children that hindered women’s roles as wives and mothers. These findings are consistent with Williams and colleagues’ findings that women perceive PCOS as interrupting their plans to start a family and the timing of starting a family [
Portrayals of adolescents with PCOS were largely absent from magazine articles included in this study. This may be because teen magazines such as
The absence of discourse on race and ethnicity, and the absence of PCOS content in magazines directed toward Latinas and African American women, suggests that portrayals of women with PCOS largely focus on the white body. This is cause for concern because Latinas and African American women are particularly at risk for PCOS due to high rates of obesity and metabolic problems (eg, insulin resistance, hypertension) [
Magazine articles included in this study placed considerable demands on women to take responsibility for their own health. The discourse on personal responsibility has been observed in other research with women’s magazines. For instance, a review of readers’ letters to women’s health magazines found that writers tended to attribute their successes and failures in managing their health to individual behavior [
The discourse on economic and environmental barriers to health was largely absent from teen and women’s magazines. These barriers include high levels of food toxins and environmental exposure to industrial products (eg, bisphenol A in plastics) that appear to play a role in the development of PCOS [
Magazine articles depicted women as using their personal experiences with PCOS to be advocates for women’s health. These women attached their names, voices, faces, bodies, emotions, and personalities to PCOS by making their most personal, private experiences with PCOS (eg, infertility, obesity, and poor body image) public. These women appear to have engaged in meaning making, a process in which individuals try to make sense of or comprehend a stressful event and search for the value or significance of the event in their lives. Meaning making can result in acceptance of the event, personal growth, enhanced coping skills, a greater appreciation for life, and a change in identity [
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 [
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
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 [
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 [
Alliance for Audited Media
National Institutes of Health
polycystic ovary syndrome
None declared.