Maggie Baumann, MA: I've been in the healthcare field for over 20 years; first as healthcare writer and now as a therapist working with clients dealing with mental health and relationship issues.
I'm often a "go to" person to people who know my background and they have questions on health related issues or need referrals to health professionals. I've written and interviewed doctors on a wide range of topics from pregnancy, heart disease and diabetes to eating disorders, depression and other mental health issues.
A mom recently asked me about Polycystic Ovarian Syndrome (PCOS) because her adolescent daughter was just diagnosed with the condition. The 18-year-old daughter had missed 5 periods and was experiencing bad acne and luckily her doctor was able to recognize the symptoms and follow up with a blood test to confirm the PCOS diagnosis.
What is PCOS?
According to the National Institute of Health, PCOS is a condition in which there is an imbalance of a woman's female sex hormones, estrogen and progesterone, as well as testosterone, often called the male sex hormone, also present in women. It is the most common hormonal disorder affecting women of the reproductive age.
PCOS, which no one really knows the cause of, is usually diagnosed in women in their 20s and 30s. However, PCOS can also be diagnosed in adolescent females.
A common myth among patients and doctors is that teens and women with PCOS have to be overweight. Actually, many women and teens affected by PCOS are not overweight.
Signs & Symptoms in Teens May Include:
- Irregular or missed periods, known as oligomennorhea
- Elevated testosterone or hyperandrogenism, the male sex hormone
- Hirsutism - extra hair on face and other body parts
- Weight gain (typically in the abdomen) and/or trouble losing weight, and in some cases, obesity
- Patches of dark skin on back of neck and other body areas
- Infertility or impaired infertility due to irregular periods or lack of ovulation
- Thinning of hair on head
- Polycystic ovaries (cysts in the ovaries)
- High blood pressure, high cholesterol
- Diabetes or pre-diabetes. Insulin resistance is a core PCOS symptom that increases the female's risks of developing diabetes
Treating PCOS requires a team approach, consisting of an endocrinologist, gynecologist, registered dietitian (RD) and sometimes a therapist.
Diane Keddy, MS, RD, FAED is a registered dietitian in private practice in Newport Beach, CA, and among her specialties is treating teens and women with PCOS.
Keddy says when treating an adolescent, the RD is responsible for educating the teen about insulin resistance and how it changes her nutritional requirements. "Since many teens with PCOS are overweight and have high lipid levels in the blood, it's important to also teach her how to eat in a healthy way to gradually lose weight without dieting," states Keddy. "If emotional or compulsive eating is occurring, the RD will help the teen develop strategies to reduce these behaviors. Body image work with clients can also be included in the treatment plan."
When asked why PCOS in adolescents is difficult to diagnose, Keddy responded, "PCOS is difficult to diagnose for several reasons. First, the symptoms are masked by birth control pills, and many teens and young women are taking birth control pills. Many women do not know they have PCOS until they stop taking birth control and have difficulty getting pregnant. Second, the symptoms (oligomennorhea, hirsutism and elevated testosterone levels, and/or polycystic ovaries) are common in young women and are frequently considered to be normal and not a concern to parents or medical providers. Lastly, there continues to be a lack of consensus as to the best method to diagnosis PCOS."
Other forms of treatment include prescribing the birth control pill that contain the hormones that her body needs to treat PCOS and its side effects including acne, and lessening excess hair growth. A medicine called Metformin is often used to help the body lower the insulin level, protecting against pre-diabetes and diabetes. Excess hair growth can be treated by a number of options including bleaching, waxing, electrolysis and laser treatments.
A healthy nutrition plan to follow includes:
- Choosing nutritious, high-fiber carbohydrates instead of sugary carbohydrates
- Balancing carbohydrates with protein and healthy fats
- Eating small meals and snacks throughout the day instead of large meals
- Exercising regularly to help manage insulin levels and weight
Eating Disorder and PCOS
Keddy, who is also a specialist in treating eating disorders, says depression may be a link between eating disorders and PCOS. "Teens and young women with binge eating have above average rates of depression, as do teens and young women with PCOS" she notes. "The hypothalamic-pituitary adrenal axis is believed to be dysregulated in both PCOS and depression, so the cause may be biological. Also, teens and women with PCOS may develop disordered eating out of frustration from the unexplained weight gain from PCOS."
Quick Tips if Your Adolescent Daughter is Newly Diagnosed with PCOSKeddy encourages parents to put together a treatment team you trust and feel comfortable with. She says an RD who specializes in PCOS can provide you with the appropriate medical referrals. Also remind your teen to be patient with her body -having PCOS is a journey, and it takes a while for everything to normalize before she will feel that her body is responding like it should.
Resources For More InfoCheck the following websites for more information on PCOS.
The Polycystic Ovarian Syndrome Association
Mayo Clinic - Women's Health Center
The Center for Young Women's Health- Children's Hospital Boston*
*indicates websites dedicated specifically for teens
Registered dietitian Diane Keddy can be reached at DianeKeddy.com.