Welcome to part 3 of the PCOS at a glance series, where we will talk about PCOS in adolescence. You can access part 1 here and part 2 here if, first, you would like to get an overview of this hormonal disorder and learn about its association with the development of disordered eating/eating disorders, respectively (highly recommended!).
Menstrual irregularity in the teenage years is often brushed aside as a normal part of adolescence. While it can be perfectly normal, it may indicate further investigation for PCOS is warranted and may be one of the first signs of PCOS. When periods are irregular, oral contraceptives are commonly prescribed, which can actually delay the diagnosis of PCOS, since now the patient may report a regular menstrual cycle. If you have irregular periods, are experiencing body image issues, struggle with food, and have a family history of PCOS, I highly recommend digging deeper with your doctor about a possible PCOS diagnosis. As we’ll discuss later, early detection is very helpful.
This article is based on the book PCOS – The Dietitians Guide [1], written by registered dietitian Angela Grassi, who did such a fantastic job compiling evidence-based information to guide nutrition counseling in the context of this complex endocrine disorder. When discussing PCOS specifically in adolescence, Angela states that the disorder usually goes undiagnosed among teenagers, and most adult women only find out they have it after seeking help with infertility. Early recognition and treatment are crucial and may prevent emotional hardships later in life. In addition, early detection can prevent the development of chronic diseases linked to PCOS, such as metabolic syndrome and type 2 diabetes.
DIAGNOSIS
Signs and symptoms of PCOS usually appear at the onset of puberty and they can have a significant impact on the self-esteem and emotional health of teenage girls. These girls may experience weight gain in the abdominal area and difficulty managing their weight, intense and frequent cravings for sweets and starchy foods as well as excessive hair growth on the face and body, dark patches on the skin (acanthosis nigricans), and acne. This may result in body image struggles, which can lead to irregular eating behaviors (i.e., disordered eating), such as dieting, meal skipping, and preoccupation with food, to name a few; thus, increasing the risk of developing an eating disorder.
Diagnosing PCOS in teens is not an easy task. The diagnostic criteria mentioned in part 1 of this series were developed for adult women, which may not be appropriate for making an accurate diagnosis in adolescents. When piecing together the puzzle, a family history of PCOS can help point you in the right direction. If someone in the family is diagnosed with the disorder, especially a mother or sister, early testing is important. Conversely, when a teen is diagnosed with PCOS, any of her sisters should also be screened.
THE DIETITIAN AS YOUR ALLY
The dietitian can play an important role in screening and recommending further diagnostic testing in teens since more frequent visits can provide them with a better sense of the client’s eating and hunger patterns, cravings, dietary intake, and relationship with food.
Similar to adults, there are no specific dietary recommendations for adolescents with PCOS. However, the dietitian can promote and support lifelong eating habits and lifestyle changes to improve their overall health. The client can be educated on proper dietary management of PCOS and encouraged to pursue a healthy approach to eating and exercise without focusing on weight loss. For instance, educating them on how different foods affect insulin levels can be very beneficial.
Parents may also benefit from nutrition counseling since it can clarify myths and misconceptions about the disorder and provide help on proper dietary changes. They may also be instructed on how to foster their daughter’s positive relationship with food without feeling the need to regulate her food intake.
Lastly – if you are a teen with PCOS, please read carefully! The weight you gained is not your fault by any means; rather, it was due to hormonal imbalances (and some weight gain is also possibly due to just going through puberty and maturation). There are many out there who share the same frustrations and struggles with PCOS; you are not the only one! Also, keep in mind that a PCOS diagnosis does not mean you will not be able to conceive a child because you might not even experience any problems. Improvements in eating and physical activity habits can help fertility, so detecting the disorder during the teenage years is definitely a plus so that you can implement health-promoting lifestyle changes since the early years. The things you learn now will have positive benefits for your health and wellbeing for the rest of your life.
Reference:
1. Grassi A. PCOS: The Dietitian’s Guide. 2nd ed. Haverford, PA: Luca Publishing; 2013;75-94.