Is It A Pubertal Phase Or Is It PCOS?

Entering your teens can be a monumental change for girls. The roller coaster of a journey- full of highs and lows- literally! It’s no secret that adolescence is exciting but is also one of the most difficult phases in someone’s life. But what if these pubertal changes were just masked symptoms of PCOS? Read on to find out about how symptoms of puberty overlap with PCOS!

Who is an Adolescent?

The WHO has defined Adolescence as the period between 10 & 19 years of age that includes critical changes in growth, development and puberty for a young girl. While there is an idealised association of becoming a teenager in the media and movies- girls cannot wait to reach this milestone – hanging out with your friends, going on dates, going to high school prom or actually having a boyfriend. The list is endless. But the reality of your teenage years is quite different. This stage is marked by increasing independence from your parents, over-reliance on your friends circle and you are often peer pressured into trying or engaging in risky behaviours like drinking alcohol, trying drugs.There are difficulties associated with moving away from home, competition in almost all spheres of life – academics, sports, college admissions and even pretty lists or ugly lists – I know that’s a thing? Girls face numerous encounters of peer pressure and shaming, bullying, being betrayed by friends, social and academic anxiety and general teenage drama – these years have it all! 

Change is the only constant

A wide host of emotional and bodily changes also accompany this stage. As an adolescent, you can find yourself growing in height and weight. You also get your first menstrual period- the so-called landmark of being an adolescent and even wear your first bra. While you may be concerned with the way you look, external triggers and societal pressures from your family, friends and the media urge you too as well. The pimples erupting, the hair growing all over your body can leave you feeling embarrassed, conscious and even concerned. Moving into hostels or PGs can cause a 180 degree change in your lifestyle – whether it’s staying up late, eating junk and processed food or even difficulties adjusting to living life on your own.  And of course, your mood fluctuates like a pendulum, and this stage is often called the “storm of stress” where your emotions are heightened and you often find yourself not understanding why you feel a particular way.

PCOS in Adolescents

Growing up, girls have always been shunned away from talking about female health- whether it’s discomfort with periods or any other “female issue”.The maximum you would learn would be from what your parents told you, discussions with your friends or reading up about it on the internet. Exposure to guided gynaecological, women health education or even support has not been encouraged in our culture.

With the lack of knowledge, understanding and discomfort of pubertal changes for adolescents , it can be scary and frustrating. But when your symptoms seem to pile up and you can’t seem to figure out what’s going on, turn to knowing a little more about PCOS. Polycystic ovary syndrome (PCOS) is recognized as the most common endocrinopathy in reproductive-aged women. It is a fairly common condition, thought to affect somewhere between 5-10 percent of young women. And studies have shown that between 3 and 26% of adolescent girls are diagnosed with PCOS. PCOS in adolescents has a serious impact on multiple levels of their lives—hormonal imbalances that affect their female health and fertility, disfiguring bodily changes lowering self-image and confidence levels and causing lifelong metabolic health consequences.

Diagnosing PCOS in Adolescence 

Acne. Hair growth. Irregular periods. Weight gain. Sounds like the usual issues teen girls deal with during puberty. However, like puberty, some of the central, emotional and metabolic changes are associated and can be symptoms of PCOS. Due to the overlap in signs and symptoms of PCOS and puberty, diagnosing an adolescent with PCOS is often complicated and remains a challenge. During this stage of adolescents, diagnosing PCOS presents for a different case, where the years since your menarche (onset of your menses or the first cycle) plays a critical role. The widely accepted International evidence-based PCOS Guideline suggests that this criteria aimed to promote accurate and timely diagnosis, optimise consistent care, and to improve quality of life and health outcomes for adolescents with PCOS. The table below captures the elaborate criteria. 

Irregular menstrual cycles post menarcheFor > 1-year post-menarche prevalence of > 90 days for any one cycle
For > 1 to < 3 years post-menarche; prevalence of cycles of < 21 or > 45 days cycles
For > 3 years post-menarche, prevalence of < 21 or > 35 days (and primary amenorrhea by age 15 or > 3 years post-thelarche.
HyperandrogenismHirsutism, Alopecia & severe acne and/or biochemical hyperandrogenemia [testing for free testosterone, free androgen index]
Exclusion of other disordersAny other conditions that mimic PCOS symptoms such as Hypothyroidism, hyperprolactinemia, glucocorticoid excess, glucocorticoid resistance, and androgen-secreting ovarian or adrenal tumours
You can even click on this link to read more about the criteria and diagnosis. 

To address this difficulty, recent diagnostic guidelines have worked to modify adult diagnostic criteria for use in adolescents. These guidelines stress that a definitive diagnosis of PCOS is not needed to initiate treatment. Deferring diagnosis, while providing symptom treatment and regular follow-ups and longitudinal monitoring is a recommended option.Treatment options for PCOS should be individualized to the presentation of symptoms, needs, and preferences of each patient. 
Although overall incidence of PCOS in adolescents is low but the incidence of PCOS among adolescents has seen an increasing trend. While an early diagnosis in the adolescent age group is important to inculcate early life style modifications and can allow for earlier treatment and even prevention of PCOS-associated morbidity. It should be kept in mind that premature diagnosis or misdiagnosis carries risks of psychological distress and unnecessary treatment

PCOS Management in Adolescents

A holistic approach towards the PCOS management is the most favoured amongst young girls. Let’s look at some of the ways you can manage your symptoms. 

1.Emotional Well Being The emotional wellbeing of adolescents is often neglected. We have realised the need to spread more awareness to identify and address the emotional and social aspects of managing PCOS. Girls with PCOS have a high prevalence of moderate to severe anxiety and depression symptoms. Symptoms of PCOS like acne, weight gain, and excessive hair growth can leave you experiencing negative feelings about yourself and your body. Moreover, identify your trigger points or the situations that make you anxious, lonely and that make you spiral into an indulging in for example inflammatory alcohol consumption, smoking or even binge eating phase is beneficial to manage your symptoms. Check out this blog on how you can improve your self confidence and esteem with PCOS.  If you don’t manage your emotional well being, there are high chances of your symptoms reappearing. 

2.Lifestyle Modifications: With the outbreak of Covid-19 and the imposed lockdowns, we find ourselves in a virtual sedentary bubble. Exercise, a good night’s sleep and a balanced diet are the three pillars found to help manage symptoms of PCOS (irregular menstrual cycles and/or hyperandrogenism) and are vital in preventing excess weight gain during adolescence. You can also incorporate natural herbs. They play a crucial role in balancing hormones and in turn improving your symptoms. Check out the herbs effective for PCOS here

3.Engage in Self care activities  Be kind to yourself and Practice self-compassion and mindfulness. Engage in self-care activities that make you feel happier. Doing activities you enjoy or developing a new hobby will help increase your confidence and nourish your body and mind.  

4.Seek support from your friends- Psychological and social needs are often inadequately recognized by doctors, therapists and other health-care providers, causing many adolescents with PCOS to peers and the internet for guidance and support. Share your vulnerabilities and ask your friends, partners and loved ones for their support to spend time with you and be there for you.

5.Families are your backbone of support We know some of them might not understand what you are going through. But try talking to them and explaining your experiences and having their support will make your journey easier. A study found that a mothers level of education of PCOS is associated with quality of life in adolescent girls with PCOS. 

6.Talk to a professional-  If you feel like PCOS is affecting your life, it is overwhelming and you may feel alone, don’t be afraid to talk to your doctor. You can even seek help from a psychologist, nutritionist, dermatologist, gynecologist . Check out this carefully curated list of health practitioners. 

While there are multiple cases of delayed, under or over diagnosis of PCOS, focus on managing your symptoms rather than waiting for a diagnosis. Educate yourself and empower yourself to evaluate your symptoms, feelings and experiences and take  actionable steps to manage them. Lifestyle modifications for weight reduction, dietary modifications and psychological counselling plays an important role. Focus on these three and you will begin seeing a lot of improvements in your symptoms and they will help in preventing long term complications. Many young girls are able to reverse their PCOS symptoms and recover from them. Don’t give up, we are here to support you! Remember you are not alone, and you can join our support group at Telegram which is free to join by clicking Link————- PCOS Support Group .

About the Author

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The above detailed blog post has been contributed by Nainika Seth.
(blogger at pcosclubindia)