Guest post by Dr. Felice Gersh
Your daughter got her period at age 12 and is now 15. Her periods have never become regular. She has moderate acne and is gaining weight. In fact, she is now 25 pounds overweight. You’ve heard about polycystic ovary syndrome (PCOS), the most common female endocrine disorder. Perhaps you even have it yourself, and you’re wondering, “Does my teen have PCOS?”
The incidence of PCOS is growing and currently affects at least 10 percent of American women, possibly as many as 25%. There is a genetic component, so if you have PCOS, the probability is as high as 50% that your daughter will develop PCOS. But even the daughters of non-PCOS mothers can develop PCOS.
Diagnosis in Teens
If you are concerned about PCOS for your teen, you should know that we doctors cannot definitively diagnose PCOS during the teen years. An official PCOS diagnosis requires at least 2 of the following 3 issues:
- irregular or absent periods
- clinical evidence of high levels of androgens (testosterone and/or DHEAS) or lab testing confirming high levels
- pelvic ultrasound showing the presence of multiple small cysts around the outside rim of the ovaries.
Additional clinical manifestations of PCOS include severe acne, excessive facial or body hair (hirsutism), and scalp hair loss — the female version of male pattern baldness (androgenic alopecia). All these symptoms can exist temporarily in normal teen girls; consequently, they can’t be used to definitively diagnose PCOS. However, the presence of these symptoms raises a red flag for PCOS, so a doctor who is treating your daughter may give her a diagnosis of “high risk for PCOS.” Of note, adrenal diseases such as acquired adrenal hyperplasia and Cushing’s Syndrome must be always considered and ruled-out in any girls with issues consistent with those diagnoses.
Girls at risk for PCOS can use lifestyle medicine to decrease their risk of ultimately developing PCOS, and even if they do develop PCOS, lifestyle interventions can dramatically lessen the chances that they develop a severe version of this disorder.
The first step always involves the intestinal tract, or the “gut,” and more specifically, the vast microbial life forms that comprise the gut microbiome. In all women, the gut microbiome responds to reproductive hormones, and in pre-PCOS teens and in PCOS women, it becomes unbalanced and abnormal due to low levels of estradiol (ovarian estrogen) and impaired function of estrogen receptors. This gut dysbiosis is greatly exacerbated by the “Standard American Diet,” a diet high in processed foods and deficient in healthy nutrients and fiber.
Gut microbiome repair starts with a diet high in plants — all sorts of vegetables, beans, lentils, nuts, seeds, and whole grains. These foods are high in fiber and healthy fats. Couple this with eggs and lean, organic meats. The microbiome has a daily rhythm, so it is essential to eat all meals at the same times each day. Have a large, healthy breakfast, a moderate lunch, and eat an early dinner. Carefully balance afternoon snacks. The microbiome responds to many other bodily cues, so your teen should address stress and mood disorders if a concern. Taking an excellent probiotic is also a good idea.
Next Step – Sleep
The next step is to ensure adequate sleep, which young people desperately need to stay healthy and often do not get. On average, teens need just over nine hours of sleep every night. It is no easy feat, but teens need to establish healthy bedtime routines that begin several hours before bedtime. Get out in the sunshine during the day and then limit exposure to all screens for one to three hours prior to bedtime. About two hours before bedtime, transition to relaxing (non-electronic) activities such as pleasure reading from a paper book, taking a relaxing bath, working on a craft, or listening to music, podcasts, or audio-books. A gratitude journal or guided imagery are other great choices.
Step 3 – Movement
Exercise is powerful medicine! Be sure your daughter gets moving for at least 30 minutes, at least five days a week. All exercise is good exercise. The most important thing is that she engages in an activity that she enjoys.
Certain supplements can also be helpful. Foundational ones include an excellent multivitamin, Omega 3, and Vitamin D. For girls at risk of PCOS, additional supplements can be very helpful in improving metabolism and lowering inflammation, but these should be individualized, especially in teens. Some of my favorites include N-acetyl cysteine, myo-inositol with perhaps lesser amounts of D-chiro inositol, quercetin, berberine, curcumin, small doses of melatonin, and CoQ10. There are other great products that help heal the gut and improve liver functionality, such as L-glutamine, ginger, resveratrol, marshmallow root, slippery elm, DIM, and licorice. I would never give all of these supplements to one person, so I recommend that each young woman discuss her case with a healthcare professional who is knowledgeable about PCOS and supplements to find the right supplement regime for her.
A Word About “The Pill”
Oral contraceptives are an important discussion that must occur in depth on another day, but for now, at a minimum, please know that their use in no way regulates menstrual cycles. People say this, but it is a gross oversimplification of the actual function of birth control pills. These pharmaceuticals are composed of hormone-mimicking chemicals that eliminate a young woman’s own hormonal production and replace it with chemical endocrine disruptors that carry side effects and risks of their own. Many women take oral contraceptives starting in their teens and are on them for decades, a use pattern for which there is no safety data and much concern. This approach may temporarily hide irregular cycles and decrease acne, but it never addresses the real underlying reasons for the symptoms. And it introduces the risk of long term oral contraceptive use. Basically, it is symptom suppression, not a treatment.
Having signs and symptoms of PCOS while still a teen does not determine the future outcome for your daughter. Acknowledge her risk. Then, embrace lifestyle medicine and work with her doctor to select supplements to optimize health outcomes. This is the best path for addressing PCOS symptoms in teens.
Felice Gersh, M.D. is a multi-award winning physician with dual board certifications in OB-GYN and Integrative Medicine. She is the founder and director of the Integrative Medical Group of Irvine, a practice that provides comprehensive health care for women by combining the best evidence-based therapies from conventional, naturopathic, and holistic medicine. She taught obstetrics and gynecology at Keck USC School of Medicine for 12 years as an Assistant Clinical Professor, where she received the highly coveted Outstanding Volunteer Clinical Faculty Award. She now serves as an Affiliate Faculty Member at the Fellowship in Integrative Medicine, through the University of Arizona School of Medicine, where she lectures and regularly grades the case presentations written by the Fellowship students for their final exams. Felice Gersh, M.D. is the bestselling author of PCOS SOS and the PCOS SOS Fertility Fast Track. She is a prolific lecturer and has been featured in several films and documentary series, including The Real Skinny on Fat with Montel Williams and Fasting with Valter Longo, Ph.D.You can follow her on social media at: