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PCOS in Teens

December 3, 2018
PCOS in teens, toronto naturopath, naturopathic doctor toronto, teen naturopath, danforth naturopath

Experiencing acne?

Missing a period or two?

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women including teens! Now before you roll your eyes and utter the sentence, “I don’t have cysts on my ovaries,” please note you don’t need to have cysts in order to have PCOS (I’ll talk about that below). 

PCOS is a collection of symptoms – both visual (like acne) and diagnostic (like serum testosterone). It’s also a diagnosis of exclusion among other androgen (male hormone) excess disorder. In teens, PCOS may present differently than it would in adults. 

PCOS Criteria in Teens

To be diagnosed with PCOS, you must have 2 out of 3 criteria, as defined by the Rotterdam Criteria. Criteria includes:

  1. Delayed ovulation or irregular menstrual cycles (anovulation)

  2. High androgenic hormones like testosterone

  3. Polycystic ovaries on ultrasound

In teens however, both irregular menstrual cycles and hight androgens are required. Ultrasound is not recommended for diagnosis. 

High Androgens (aka. hyperandrogenism)

What’s are androgens? It’s a group of male hormones which are present in females. The most common one is testosterone. When androgen levels are high in the body, it can lead to some unwanted symptoms.  

High androgens are the most common criteria seen in teens, because it includes clinical signs like acne and/or hirsutism (male-pattern hair growth) – caused by, you guessed it, high testosterone levels. 

But, just because you see a couple of zits or see some hair – it doesn’t mean you have PCOS. 

We’re talking about moderate-severe acne (ex. more than 11 red zits on your face) that isn’t affected by topical medications. When it comes to hair, you need to score between 4-6 on the modified Ferriman-Gallwey chart. One thing to note is that some ethnicities present with more hair growth, which should be factored in when calculating the score. 


PCOS, toronto naturopath, naturopathic doctor toronto

Source: https://pedclerk.bsd.uchicago.edu/page/hirsutism

You may also notice hair loss, around the frontal area (ie. where your bangs would be), and that can also be a sign of high testosterone.

Another way to determine if you have high androgens (like testosterone) is by testing them. A simple blood test will suffice (no need for the fancy tests) and can be done anytime during your cycle. Shortly after your period begins, serum testosterone reaches adult levels. 

Androgens that you may want to get tested include:

  • Total testosterone

  • Free testosterone

  • DHEA

  • Androstenedione

  • Sex Hormone Binding Globulin

Irregular Periods

Period length can actually vary based on when you first experience menstruation. Irregular cycles are defined as:

  • Normal in the first year of having your period

  • In the first 1-3 years of having your period: Less than 21 or greater than 45 days

  • After having your period for 3 years: Less than 21or greater than 35 days

  • After having your period for 3 years: Less than 8 menstrual cycles per year

Moreover, when you first start getting your period, it’s highly likely that you won’t be ovulating. Approximately 85% of menstrual cycles (in the first year of your period) are ovulatory. Six year in, only 25% of your cycles will be anovulatory (aka. no ovulation is happening).  

Within the first 2 years after your period starts, you may notice period irregularities and anovulation – and that’s okay!

Polycystic Ovaries

In case you missed it, you don’t need to have polycystic ovaries to have PCOS. In fact, the ASRM guidelines state that ultrasound should not be used for diagnosis in women who have had their period for less than 8 years because ovaries tend to have lots of follicles during this time. 

So what does that mean? You need to rely on the other 2 criteria to figure out if you have PCOS. 

Conventional Treatments of PCOS

It’s likely that if you go to your medical doctor, they’ll tell you to take the birth control pill. The pill is considered the first line of treatment. You may hear that the pill will regulate your cycle, but it will actually shut down your body’s natural hormones and replace them with the hormones in the pill – which may be a synthetic estrogen and progestin (depending on which you take). Periods that you experience while on the pill, aren’t true periods at all – they are simple withdrawal bleeds from the hormones. 

Here’s the thing. If you think of the pill as a bandaid, you won’t know if these symptoms are just going to come back once you stop the it. Most women stop the pill around the time they’re ready to start thinking of having kids. But if PCOS is still looming in the background, it may lead to fertility issues down the line. 

Something that you should also be aware of is that severe anxiety and depression is higher in adults with PCOS. And it’s likely also increased in teens. A huge study in 2016 investigated different types of birth control and how they were associated with antidepressants and a diagnosis of depression. Researchers found that teens (between 15 to 19) are more sensitive to depressive symptoms and antidepressants than adults. This was seen when teens were using the combined pill and progestin-only pill. The study did show that the incidence of depression and antidepressants use decreased with age. 

Birth control is not always bad, it’s provided choice and reproductive freedom to many, but it’s important to recognize why you’re taking, and understanding the risks associated with it as well. 

Approaching PCOS Naturally

When we’re dealing with PCOS in teens we want to do a couple of things:

  • Promote a regular menstrual cycle

  • Restore natural ovulation

  • Reduce/get rid of acne and hirsutism

  • Achieve weight loss if necessary (because this may lead to conditions like diabetes)

Yes, there are supplements you can take to help with the above four goals. But one of the main priorities is to promote a healthy diet and exercise in ALL teens with PCOS. I go into that more in previous articles, so please check those out. These have widespread effects in optimizing hormonal outcomes, general health and quality of life.  

This doesn’t mean you should be eating salads and hopping on a treadmill ASAP though. It’s important to take stock of your daily or weekly routine and see which changes can be made. Making some goals, writing things down (ex. a diet and exercise diary, as long as it’s not leading to eating disorder tendencies), problem solving with a parent or health professional, etc. 

Taking things slow is okay. Starting small is okay. One of my favourite quotes (that I usually see when I make a cup of tea) is “The creating of a thousand forests is in one acorn.”

Exercise and PCOS

Exercise guidelines are different between adults and teens. You should be aiming for at least 60 minutes per day of moderate to vigorous intensity physical activity, including activities that strengthen muscle and bone at least 3 times weekly. Group classes can be helpful, because of the social and community aspect. 

Examples of exercises that specifically strengthen muscle and bone are:

  • Dancing

  • HIIT workouts 

  • Hiking

  • Jogging/running

  • Jumping Rope

  • Stair climbing

  • Tennis

For more info on exercise and PCOS, check out my previous article here

Next Steps

Now that you’re familiar on how PCOS is presented in teens, here’s what you can do next:

  • Track your cycle length

  • Pay attention to any clinical signs, such as acne or hair growth

  • Get your blood work done (PS. NDs can order your blood work too!

Once you have these, figure out how you want to approach the solution. Will it be birth control or focusing on the root of the issue?

Now that you have a solid plan, please sign up for my monthly newsletter called The Flow for more informative and useful content like this! I want to make sure that you have a good flow!

References

Teede, H., Misso, M., Costello, M., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R., Andersen, M., Azziz, R., Balen, A., Baye, E., Boyle, J., Brennan, L., Broekmans, F., Dabadghao, P., Devoto, L., Dewailly, D., Downes, L., Fauser, B., Franks, S., Garad, R., Gibson-Helm, M., Harrison, C., Hart, R., Hawkes, R., Hirschberg, A., Hoeger, K., Hohmann, F., Hutchison, S., Joham, A., Johnson, L., Jordan, C., Kulkarni, J., Legro, R., Li, R., Lujan, M., Malhotra, J., Mansfield, D., Marsh, K., McAllister, V., Mocanu, E., Mol, B., Ng, E., Oberfield, S., Ottey, S., Peña, A., Qiao, J., Redman, L., Rodgers, R., Rombauts, L., Romualdi, D., Shah, D., Speight, J., Spritzer, P., Stener-Victorin, E., Stepto, N., Tapanainen, J., Tassone, E., Thangaratinam, S., Thondan, M., Tzeng, C., van der Spuy, Z., Vanky, E., Vogiatzi, M., Wan, A., Wijeyaratne, C., Witchel, S., Woolcock, J. and Yildiz, B. (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and Sterility, 110(3), pp.364-379.

Peña, A. and Metz, M. (2017). What is adolescent polycystic ovary syndrome?. Journal of Paediatrics and Child Health, 54(4), pp.351-355.

Rothenberg, S., Beverley, R., Barnard, E., Baradaran-Shoraka, M. and Sanfilippo, J. (2018). Polycystic ovary syndrome in adolescents. Best Practice & Research Clinical Obstetrics & Gynaecology, 48, pp.103-114.

Can the birth control pill fix my period?

October 29, 2018
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Short answer: No. 

You can’t fix your period with birth control because birth control doesn’t ‘improve’ your hormones. The birth control pill actually shuts off your period. 

How does the pill work?

The pill stops your natural menstrual cycle. More specifically, it prevents follicle stimulating hormone (FSH) and lutenizing hormone (LH) from being produced. This prevents follicles from maturing and releasing estrogen, and it prevents ovulation from happening, which produces progesterone. Because LH is not being produced, this causes cervical mucus to thicken affecting sperm movement and endometrial development (this is the lining that’s shed during your period). 

The birth control pill does have its own hormones: estrogen and progestin. These are not the same hormones that our body produces, but mimic them. 

If you are using a 28-day packet, 21 pills will contain the synthetic hormones and 7 will be placebo. When you take placebos, your body will experience a withdrawal bleed (often mistaken as a period). 

6 ways that these hormones are different

1. They enter your body differently

The hormones from the pill enter your bloodstream through your GI tract and portal vein (an important vein in your liver). Your ovarian hormones enter your circulation through veins in the ovary and the inferior vena cava. 

2. They have different concentrations

When you take the pill everyday, the hormones enter your body in a single, large dose. Your body’s hormones are always being produced based on where you’re at in your cycle. 

3. They have constant levels

Once you take the pill, those hormone levels don’t change. Your body’s hormones levels may change based on what’s going on with your hypothalamic-pituitary-gonadal axis. 

4. They stay in your body longer

Because the pill’s hormones are synthetic, they are designed to be more resistant to metabolism (aka. they don’t break down as easily). Therefore, they stay active in the body longer than your body’s natural hormones. It’s been thought that they can remain inside your body for at least 6 months after discontinuation. 

5. Progestin is not progesterone

Progestin is similar to progesterone, but they’re not the same molecule. Some progestins like levonorgestrel may cause hair loss because they are testosterone-like (and have a high androgen index). Progestins may also cause acne, as they suppress sebum production. 

Some progestins may have a low androgen index, and while may not cause hair loss while on the pill, they may cause hair loss after the pill is stopped because the body’s androgen levels increase. 

6. They have different actions

The hormones from the pill have a different action on hormonal receptors inside the body, compared to our hormones. This is because the structure, type, and concentration of pill hormones are different than your actual hormones. 

Then why use the pill?

The pill is the first line treatment option for many common conditions like PMS, PCOS and endometriosis. And it’s often given with the reasoning that it will regulate your period and stop the problem. But when you stop taking the pill, your problems will likely come back. 

There are times when the pill should be considered. For example, women taking accutane (which is a category X drug) should not be conceiving while on the drug. Or for women who have endometriosis, taking the pill may make the biggest difference for their pain and quality of life. 

How do I fix my period?

Ultimately, it’s important that you understand your symptoms so you can support your body. Especially if you’re using the pill to ‘fix’ the problems. You may want to figure out why these symptoms are happening, and see which dietary and lifestyle changes you can implement to support your longterm health. 

How do I start?

  • Review my articles about PMS, PCOS, and endometriosis

  • Track your symptoms, diet and your period

  • Get some blood work done (if applicable)

  • Find a Naturopathic Doctor to work with (feel free to contact me to find someone in your area)

  • Implement key dietary and lifestyle changes

  • Give your body time to adjust to your treatment plan

When I work with period problems, I figure out why they’re happening. I use information that you give me (diet/symptom/period trackers, blood work, your personal story) to determine the root cause and create a plan from that info. 

It’s not always a quick fix, but change takes time!

If you found this information helpful, check out my handy chart of the nutritional deficiencies caused by the pill!

References

Sims, S. and Heather, A. (2018). Myths and Methodologies: Reducing scientific design ambiguity in studies comparing sexes and/or menstrual cycle phases. Experimental Physiology, 103(10), pp.1309-1317.

Why do my breasts hurt during my period?

November 5, 2018
cyclic breast pain, toronto naturopath, naturopathic doctor toronto

Do you experience tender breasts a few days before your period? But then it’s gone once your period starts?

You’re not alone. Almost 35% of women experience swollen and tender breasts (aka. cyclic breast pain) before their period.

So why is this happening to you?

You might not be producing enough progesterone in the luteal phase. Remember, if you’re not ovulating, progesterone isn’t being made by the corpus luteum (tip: go back and read my ovulation article). When progesterone is ‘low,’ estrogen becomes the dominant hormone in the body. 

Or, you may have enough progesterone, but your breast tissues might be sensitive to estrogen. 

Estrogen dominance

Why is this happening?

  • Excess body fat, because fat makes estrogen

  • Stress 

  • Constipation

  • Not eating enough fibre

  • Liver isn’t detoxing well

  • Exogenous estrogens

  • Nutritional deficiencies

And because you’re probably thinking about the scary ‘C’ word, cyclic breast pain, does not usually happen because of cancer.

Supporting Breast Health

You can start supporting your breasts right now. Cyclic breast pain can be a thing of the past if you start including the following strategies:

Stop introducing estrogen into your body

The only estrogen that belongs in your body is your own. That means no estrogen from plastics, from food chemicals or anything else. 

If you’re putting your leftovers into plastic containers, swap them for glass. Same with your water bottles, choose glass or stainless steel instead. Get familiar with the Dirty Dozen. If you’re buying any products off that list, choose organic instead. If you wear lipstick everyday, choose a version that is green (not the colour, but all the power to you if you can rock a green lip). 

dirty dozen

Help your liver

Once you stop introducing unwanted ‘outside’ estrogen into your body, you gotta deal with the estrogen that’s already there (the estrogen that your body makes and the ones coming from plastic and all that junk). 

Let’s get something straight though, your body needs estrogen. But, when there’s too much circulating around, it’s not helping, it’s hurting. 

Your liver is your body’s most important detoxification organ. And it’s the organ that specifically gets ‘used’ estrogen out of your body. It’s always detoxing.

Think about a cashier at the grocery store on Saturday morning. You have 5 minutes to get out of the store. if you put down 10 items onto the belt, she can scan the items quickly and send you on your merry way. But what if you put 75 items on the belt and wanted to price match each one? It’s probably going to take her longer than 5 minutes. Now what if she didn’t know all the codes to your fruits and vegetables, and had to call out for every code? You’re not leaving in 5 minutes, that’s for sure. 

When your liver has a lot of toxins to get out, it’s harder for it to do its job. And, to be frank, if you don’t have the vitamins, minerals and amino acids that it needs to work effectively, then that’s going to affect it too.

Here’s where you can start:

  • Don’t introduce outside estrogens into your body (unless they’re phytoestrogens)

  • Introduce a B supplement for phase 1 support, and eat protein and your brassica vegetables for phase 2 support

  • Drink a turmeric latte, it’s better than the fake orange pumpkin spice

  • You can also take herbs that are specific for your liver. I like dandelion and milk thistle, but you’ll want to work with your ND for this part here.  

Make sure you poop

When your liver finally detoxifies that estrogen, it doesn’t magically disappear from your body, the products are sent to your large intestine (imagine estrogen with a little tag attached). Everything is going to hang out there until you have a bowel movement. Here’s the thing, if it’s there for too long, bacteria in your large intestine will snip that tag, letting the estrogen circulate back into your body. So all that work your liver did to detoxify it? Yes, it was for nothing. 

So we want to make sure that you:

  • Are having a bowel movement 1-2 times per day

  • Healthy balance of good bacteria 

You might have to:

  • Eat enough fibre – whether it be a combination of fruits and vegetables, and ground flax seeds (these really help with estrogen elimination)

  • Take a probiotic and/or eat more fermented foods like kimchi, kombucha, etc. 

  • Take a magnesium supplement because it promotes bowel movements (talk to your ND about best form and dose)

Other quick tips

  • Drink water instead of coffee or other caffeine-rich drinks (soda, energy drinks, etc.)

  • Cut out alcohol for the time being

  • Skip sugar because it’s inflammatory, and you don’t need any more inflammation in your body right now

  • Consider how much red meat and dairy you’re eating, these contain outside estrogens and hormones that might not be doing your body any good

When to call a Naturopathic Doctor

You don’t need to live with tender breasts for a week every month. 

Use some of the tips I listed above to start you off. And if you need some extra support, give me a call (or for you millenials,  book an appointment online). I can help make sure your hormones are working for you, and not against you. I can also help you figure out the supplements that your body needs. (So you don’t leave a health food store with a bag of everything). And, if you like or are curious about acupuncture, we can do some of that too!

If you found this information helpful, please sign up for my monthly newsletter called The Flow for great and informative content like this!