Episode #98: Navigating PCOS: Teen Edition

PCOS affects millions of teenagers nationwide, presenting unique challenges at a crucial period of physical and emotional development. As we get into today’s topic, it’s extremely relevant whether you are currently a teen, have a teen, or were diagnosed with PCOS as a teen, or if you should have been diagnosed with PCOS as a teen, because what happens during our teen years really shaped how we view our food, our health, and our bodies. In today’s episode, we’re going to take a look at some of the really unique and important factors that go into managing PCOS health with teenagers. So let’s get started.

You’re listening to the PCOS Repair podcast, where we explore the ins and outs of PCOS and how to repair the imbalances in your hormones naturally with a little medical help sprinkled in. Hi, I’m Ashlene Korcek, and with many years of medical and personal experience with polycystic ovarian syndrome, it is my joy to watch women reverse their PCOS as they learn to nourish their body in a whole new way. With the power of our beliefs, our mindset, and our environment, and the understanding of our genetics, we can heal at the root cause.

Welcome back to the PCOS Repair podcast, where today we are going to be discussing PCOS in the teenage years. Now, whether or not you are beyond the teenage years or not, what we’re going to be getting into today is relevant, really, for all ages. First of all, let’s look at what’s going on differently and the same in PCOS for adolescents. PCOS is prevalent among 6-18% of adolescent girls, which is not vastly different than what we see in adult women. Basically, I think what we’re starting to realize is that the female population that’s being diagnosed later, and so the prevalence that we’re seeing as adults, was there as teenagers. We just missed it. The definition of PCOS and its presentation during the teen years is really no different. I think one of the biggest things that we need to acknowledge, though, is that when a teenager is starting their period, it is expected to be abnormal. It takes several years for the female cycle to regulate itself. It is normal for a teen to spot, it is normal for a teen to have lighter or heavier periods. Some teens really get hit with a bang, especially those, I think, that have PCOS.

Just because you have heavy periods, It does not mean you have PCOS, but I think a lot of women that had really heavy cycles during their teenage years may now realize that they have PCOS. Here’s the thing. Our hormones are just getting started. They are ramping up, they’re figuring out their rhythm, and so having some spotting in between is common. Having missed periods, having periods of time where we aren’t regular. We may have short period, long period, short period. It may go back and forth a bit until our bodies figure it out. Now, each and every one of these irregularities is different from girl to girl. It’s important to realize that some girls, they start and they’re immediately regular but maybe they’re a bit heavy, maybe they’re a bit light, maybe they have horrible PMS, maybe they have horrible cramps. These are all things that are fairly common as our bodies are getting used to having a menstrual cycle. That doesn’t necessarily mean that something is wrong. It doesn’t necessarily mean It doesn’t necessarily mean that we should treat it. I highly recommend against going on birth control for these reasons. We’ll get into that a little bit as well and why but ultimately, it is normal for there to be a little bit of a patchy, rough start when it comes to our menstrual cycle in our teen years and just because our moms are concerned about our cycle being off, just because we find it annoying as young girls, or just because your doctor asks you about it and it’s not working like a textbook yet, those are not reasons that we necessarily need to be alarmed.

In addition to the cycle irregularities, PCOS introduces some unique challenges to consider in the teen years. Now, if you think about an adult female, it is bad enough having facial hair, having excess hair growth anywhere on the body, having acne, having extra weight but in the teen years where we are just developing our self-esteem and our confidence, and we are surrounded by individuals that may or may not be as nice or as polite as people may be in life, although I think that people can be mean at any point in time in life but in high school, it is especially stereotypically mean time amongst girls and to be dealing with struggles with your weight. Even if you’re not overweight, you’re not having an easy time maintaining that thin athletic build that may be desirable or promoted as the best by your peers.

You may have acne, which is like bad not enough in teenage years, but hormonal cystic PCOS-type acne is the worst. You may have chin hair, upper lip hair and all of a sudden, instead of being able to just roll out of bed, throw your hair in a ponytail and look cute because you’re a teenager, you’re having to spend extra time with just managing all the extra hair. These are all things that can really affect a teen’s self-esteem, their confidence, and can really pose a serious problem to their emotional and mental well-being as they develop into an adult. That plays into a lifelong challenge. This is where for both physical and emotional reasons, I think it’s really important that PCOS is detected early in adolescence and that we don’t just chalk up abnormal periods to being normal in the teen years, and yet we don’t rush to treat them, but we may look and see what else is going on, what other symptoms are going on? What struggles are going on with this individual? Are they experiencing a lot of the symptoms of extra androgens such as the weight, the hair, the acne. Now, when it comes to PCOS symptoms, they may be more or less exaggerated, so this can be difficult to see but ultimately, I think it’s important to treat and to address this from especially a natural point of view because of the emotional impact. I think the physical symptoms, they really come down to how much of an emotional impact is this having on the individual.

As far as diagnosis goes, this is where your medical professional is going to be really important. You may start with your pediatrician, and it would not be inappropriate. In fact, I encourage you to advocate for yourself or for your child and request being referred to a gynecologist or an endocrinologist. Unless you feel like your pediatrician really has things in hand, this is a little more of an adult problem historically. So pediatricians may or may not, depending on your pediatrician, have a lot of experience with it and that doesn’t mean they’re a bad pediatrician. It’s just we’ve all had different experience of what we spend our time focusing on. If you feel like your pediatrician is brushing something aside, this would be a great place to ask for a referral to either a gynecologist or an endocrinologist. Just to get a little bit more help in the diagnosing, not necessarily treating, but the diagnosing.

Then for teens and parents, this is where you’re going to have to decide how extensive of a workup you want. The traditional workup for PCOS is going to be lab work, history and exam, so basically talking to you, getting a full list of symptoms, and then doing a physical exam, seeing what symptoms they notice, and then doing lab work to see what hormones and so forth are out of balance and what other things could be causing this, so ruling things out through bloodwork. Then the final piece is to do a ultrasound. Now, typically, especially in someone who has not had children yet, this is going to be a transvaginal ultrasound. I don’t know with my daughters if I would have them do that or not. I don’t think personally for PCOS, unless there is pain, unless there’s pelvic pain, unless there’s a concern of some sort, I would skip the transvaginal ultrasound because I don’t really think that cysts on the ovaries are that exciting. That’s my personal bend. It is part of the Rotterdam criteria for diagnosing PCOS, so without it, your physician may be hesitant to give you that diagnosis. They may push you for it or say, we can always revisit it later.

The conversation that I would have is, does everything else add up? If we saw, we don’t want to do this because of age, we don’t want to do this because they’re not sexually active, but overall, is everything else lining up to show the diagnosis of PCOS? If yes, then that may be enough. We may not need to have this label as much as, what does it look like we’re dealing with? Is there anything else that we need to be rolling out? To really not allow yourself to be forced into a certain, this is how we diagnose things, but more of a conversation of gathering information to see what you’re up against. That’s really the extent of what the medical system is going to be able to assist with in the teenage years anyway, unless you want to be put on birth control. This is where we’ll get into my philosophy of care. If you need birth control for contraceptive reasons, by all means, that can be a very good idea, especially in the teen years, we don’t want an unplanned pregnancy. However, aside from contraceptive use, the problem with birth control. You know how we were talking about your hormones are just getting started, your cycle is just figuring out its rhythm, to introduce synthetic hormones in the form of birth control at this stage of the game can be very detrimental to your hormone development and your ability to regulate your cycle. No wonder, my generation, so those that are now in their 30s, are struggling to regain their cycle when in their teens, they were put on birth control to regulate their cycle. Their cycle essentially never fully got to develop and because basically what happens with birth control is it takes over the control. It’s like it takes over the control central and it overrides your body and your body just basically goes back to sleep. Now, for someone who never fully woke up and took charge of their menstrual cycle and got their hormones functioning in a rhythm, this can be very problematic when all of a sudden we take that birth control away and your body’s like, wait, what? that was my job? I didn’t know that was my job. Essentially, it has a very difficult time getting its own rhythm. This is where, unless needed, I recommend against birth control but what I do recommend for the care of PCOS in the teen years is to really treat based on lifestyle, based on environment, and based on emotional and mental components of how is this affecting their overall light.

When you think about how we approach PCOS in other episodes of the PCOS Repair Podcast, knowing your root cause is really, really important. This does not change in your teen years. All the same causes are the same. Now, I will say labs are likely to be less helpful in the teen years. You may have weird elevations and things like that. Probably symptoms are going to be one of your best bets to really gage some of this and because you’re so young, when it comes to things in your metabolic health, like insulin, cortisol, things like that, your body is likely compensating really well for that at this age. You’re not going to see a lot of abnormals. Along with that, though, the root causes are the same. Understanding them is very important. However, the strictness in which I would follow a health care protocol for PCOS in the teen years is really going to vary on what are we trying to accomplish right now. We’re not trying to achieve a pregnancy, so we don’t necessarily need to be as strict as we would be in our 30s when we’re trying to optimize fertility. Unless we’re trying to lose weight, a lot of times here, we’re trying to prevent weight gain.

Again, we can be more in maintenance mode. We can really focus more on the psychological lifestyle of the teen. What is it that the teen is into? What does the teen love and what are they frustrated with and where are they feeling stuck? This is where I tend to focus when I’m working with teenagers. It starts with, what do they love? Let’s do more of that. Then we look at what is concerning them, and then we focus on where the root causes are leading towards that. Education, I find with teens, is really the most important. These are the strategies that I follow. One, we want to preserve fertility and reproductive health of the future. We want to make sure we’re not doing anything harmful there. That’s where, again, I recommend against starting hormonal birth control unless needed for contraceptive use. The overarching thing here is we want the teen to be aware of what they’re choosing for their health, understand what’s going on with their health, their hormones, their root causes, and then helping us determine what matters to them, what effort are they willing to put into it, and where does the balance fall in managing their PCOS and their lifestyle.

When it comes to lifestyle management, a teen’s life is very different than an adult life. Their self-esteem, their friends, their entire social network, their coming of age and becoming their own person and creating their own autonomy and everything, it’s all intertwined in this lifestyle. They may not even be cooking their own food yet, so it can be very difficult for them to take full ownership but this is where we start in baby steps towards them, figuring out how to take ownership of their health, why, and to what extent does it matter to them, because that’s where we find that balance. If someone else is wanting this for them, we may need to do more education based on, if this is concerning you, this is why, this is how to take care of it, rather than just forcing certain things on them but we can support them by having them help create their health plan or their path to PCOS health, and then supporting them by helping have the right foods in the house, helping to create meals that support that, and to encourage them to continue learning and become really curious about health and wellness, and nutrition and learning about the foods that they’re eating so that this becomes something that they’re very invested in more than just frustrated with their bodies.

Then as far as navigating the medical care, this is where teaching your teen that it’s okay to advocate for themselves. As a young person, it can be very difficult to speak up to somebody. It can be very difficult to speak up to an adult in general, let alone someone who’s in a position of higher education, such as a medical professional. Going to appointments with your teen or helping your teen to think through how they’re going to advocate for themselves if they want to go on their own first, being willing to repeat the appointment if they didn’t feel like they got heard, seeking out care from somebody else if they feel like this person simply won’t hear them even they do their best. So these are all ways that you can support your teen in navigating their medical care and getting assistance that they need but again, the medical teams in traditional medicine are going to be best at diagnosing and then helping them to manage risks for future problems and then the other thing is just for teens out there that are dealing with PCOS, and when you think back to yourself, if you’re not a teenager anymore, of how it was to deal with PCOS as a teen, especially if you didn’t even know what was going on, that this is not the end of life.

This is the beginning of you learning about your adult body and that your adult body is going to need some extra tender, loving care every once in a while, and that you’re going to need to learn how to care for your body in the way that it needs and that’s not unique to PCOS. This is something that is true for all adults, all humans. We all have bodies that need to be cared for. PCOS definitely requires us to care for it in particular ways, and that’s where you’re going to have to learn that for yourself. It starts with the root cause, learning what your body needs. Then in the teen world, it really comes down to balancing the lifestyle with nurturing your body, nourishing your body, learning to enjoy physical activity. One of the things that, as we wrap up today, that I love about, and I got a positive note here, what I love about working with teenagers with PCOS is that they haven’t learned years and years and years of negative ways of trying to manage their health, of trying to force their health into a certain way. Teens, I think, have a really awesome openness to learning, and especially in today’s world where there’s more awareness of learning a good way, a healthy way, and not just about forcing the body to cooperate and act a certain way.

This is where teens that get the support that they need for PCOS health, they have such an opportunity to set themselves up for such huge success and so much less frustration and suffering along the way by not knowing or not knowing what to do about it or feeling like there’s really nothing to be done about it and being able to just learn what their body needs and live in a body that feels good, functions the way they want, and that they understand what it needs and they can decide to what degree they are wanting to devote their time and energy towards it.

So with that, for anyone who is currently struggling as a teenager or who’s young and doesn’t really feel like they were given the support that they needed, or if you are dealing with PCOS later in life and wondering, why was this missed? Because when you think back, you did have the signs and symptoms all along. I would love to hear some of your stories about what happened in your teen years and what you would like teenagers to know because we can put some things here on, can be anonymous, but just some topics that would be helpful to support teens because I’m seeing this as a more and more increasing area where medicine is falling short because we’re not assisting teens to the health that they need in regards to their PCOS.

I would love to hear from you on Instagram this week. You can find me at @Nourishedtohealthy. I would love to hear any takeaways from today’s episode or how you would go back in time and what you would tell your teenage self. If you could go back there and tell your teenage self with PCOS what to do differently or how you would support your teenage self, and until next time, bye for now.