Welcome to Episode 12 of Season 6 of The PCOS Revolution Podcast:
Addressing PCOS in Teens with Dr. Jessica Drummond
Do you have a teenager with PCOS? Maybe you need help knowing where to start or would like more information regarding PCOS and how to help your child. This episode dives into important information regarding birth control for teenagers, managing PCOS and parenting a child with PCOS.
This week on PCOS Revolution Podcast, I am having a conversation with Dr. Jessica Drummond. Jessica is a pelvic floor specialist with two decades of experience in women’s and pelvic health as a physical therapist and a functional nutritionist. Additionally she owns a private women’s clinic health and nutrition coaching practice.
In this episode, Jessica and I talk about how she got involved in women’s health, important information parents of children with PCOS need to know and great ways to get started and help your child.
READ the entire transcript here:
Farrar Duro [0:01]
Hello, everybody and welcome back to The PCOS Revolution podcast. I’m here today with Jessica Drummond, who is a pelvic floor specialist and she has two decades of experience in women’s and pelvic health as a physical therapist and a functional nutritionist. She’s got a ton of knowledge when it comes to hormones and PCOS. Plus, she owns a private women’s health clinical nutrition and coaching practice, giving her a unique perspective on integrative conservative options for pelvic pain management, hormone balance, preconception and fertility support, along with postpartum recovery, chronic pain and fatigue management in active and athletic women. She regularly lectures on topics such as integrative pelvic pain management, natural fertility options, optimal hormone health, female athletes and functional and integrative nutrition for rehabilitation, nutrition, wellness, fitness and medical professionals. She was educated in the University of Virginia, Emory University, Duke Integrative Medicine and Maryland University of Integrative Health. So, so glad to have you here, Jessica!
Dr. Jessica Drummond [1:09]
Thank you so much for having me. It’s my pleasure.
Farrar Duro [1:11]
Tell us a little bit about how you got started working with women’s health in general and what drew you to that?
Dr. Jessica Drummond [1:18]
I began my career in orthopedics and sports medicine as a physical therapist, and pretty quickly, I began to specialize within orthopedics, working with women with particular women’s health concerns that were then related to musculoskeletal issues like for example, having breast cancer surgery, and then a related shoulder injury, or being pregnant or postpartum and having related rib and pelvic pain. That progressed to an interest in public health in general. I took a lot of additional study in incontinence and pelvic pain, and I worked with men and women for many years. Then, after the birth of my first daughter, I got sick myself and knowing what I know now, I think what happened to me was that I had a reactivation of the epstein barr virus.
Dr. Jessica Drummond [2:13]
I had really extreme fatigue, I had significant anxiety, lots of panic attacks, lots of colds, and flus, and everyone’s kind of just like, “Oh, take a nap, this is normal when you have a new baby, try some antidepressants,” the usual stuff, which clearly didn’t help. After about four years of really struggling with this and ignoring it and trying to get some help, I finally stumbled into functional medicine around 2006 or 2007, when no one was really talking about hormones, that can be modified nutritionally and even at that time, I’d been practicing as a women’s health physical therapist for more than 10 years and even working in the hospitals I was working with nutrition, lifestyle, stress, none of that was really considered to be part of the equation. Fortunately, I learned that it was a big part of the equation. I realized that if I could make such significant and beneficial changes in my own health, with nutrition, with stress management, with completely changing how I was exercising, sleep, all of these things, that my patients with chronic pelvic pain, which were always the most challenging. There were some that would see improvement pretty quickly, or at least reasonably quickly with simply using physical therapy strategies. But there were always some that would plateau. Often times there’s a hormonal issue, there could be gut microbiome issues, immune issues, digestive issues. I was able to then incorporate kind of everything full circle with my patients as well.
Farrar Duro [4:12]
Very nice. And today, we decided to talk a little bit about PCOS and teenagers because I have been wanting to talk about this for a long time. We have quite a few teenagers that come to our practice for acupuncture. The main reason was that the parents did not really want to see them going on birth control at such a young age. I read an article that you had in a PCOS blog about how there was a recent study showing how birth control could increase suicide rates in teenagers, can you expand a little bit on that? And why do you think that maybe there should be other options as far as with teenagers with birth control?
Dr. Jessica Drummond [4:52]
Birth control is used widely around the world. About 80% of women in the United States are at some point on hormonal birth control. Now, that is a useful thing in some cases, in many cases, even. But I think what’s challenging about birth control being such a widely used medication is that there is not really in-depth, informed consent around what risks there are. And some of these risks are fairly low in number, but they’re very serious. One more teenage suicide to me is very serious, one more teenager dying of a blood clot is very serious. The challenge is that the rates of some of these really extreme side effects are quite low. But still they increase and they’re deadly side effects. Now, the other challenge with hormonal birth control is that there are wide spread side effects that are sort of vague, that are somewhat easily brushed off. Things like depression, headaches, mood swings, acne can get better or worse with hormonal birth control…weight gain, weight challenges, fatigue, there are lots of things that. It’s interesting, because recently, a study for male hormonal birth control was stopped because too many of the men in that study were showing signs of depression. Well, the exact same thing happens in female birth control, we just say, “oh well.” Just society is like, “Oh, that’s fine. Women are generally depressed anyway, I guess.”
Farrar Duro [6:46]
And teenagers have mood swings. And so they’ll just brush that off.
Dr. Jessica Drummond [6:51]
For me, I think that it’s a matter of informed consent. When you go on birth control younger, you also can increase your long term rates of cancer, there are some infertility risks. I think these are important risks to be at least knowledgeable about and mitigated and aware of, so that if the mood swings get worse, the depression gets worse, we can be really aware. Ultimately, the important thing is that, especially if you’re just using birth control to “treat PCOS,” it’s not really even the best option. Certainly, hormonal contraception is great for contraception, it’s quite effective. And there are reasons to use that. But if you’re using it to just mask the symptoms of PCOS, you’re not even giving someone the best possible outcome, because you’re not dealing with the condition at its root cause.
Farrar Duro [7:59]
I agree. I was just looking at your bio, that you actually wrote a chapter on adolescent hormone health for a textbook for physical therapy. I think that seems to be that there’s a lot of confusion around the diagnosis of PCOS still, in teenagers and preteens. We have 12 year olds with PCOS, and they just are on that cusp of having their period maybe for two years. They’re definitely showing the signs of it, but yet there’s a reluctance to tell the parents about what the options are and how to help them. I’m not sure if that’s just because they don’t want to label them right now, at this age, but I’m seeing this, it’s concerning to me, because it seems like we’re seeing younger and younger girls coming in with hormonal changes that we usually don’t see until you’re 14,15, 16, as far as pre-puberty. I don’t know if it’s a question of environment, or if it’s just because they’re more aware now but definitely, I think it’s important to let parents know that there’s options and if you’re listening to this right now, and you have a daughter who is just newly diagnosed with PCOS, or that gray area where they have not told you, but it’s sure looks like it as far as her periods a bit irregular, it hasn’t regulated for the first two years that she started having a period, and there’s weight gain issues, and there’s mood swings, and definitely could be depression…those are some symptoms that we don’t need to ignore. I think there’s definitely a need to address this. I appreciate what you’re doing. If you could give advice to parents out there, like where to start, what would you recommend?
Dr. Jessica Drummond [9:55]
Yes, I have a 15 year old daughter, I understand how challenging it can be to implement some of these recommendations. But the truth is that the earlier your teach your daughter, and it’s actually easier if you start doing it when they’re younger, my youngest daughter is eight. You start talking about this, in general, when they’re 5,6,7, about how they can use food to nourish their bodies and feel calmer, that is a place to begin. The thing about PCOS, and some of these early stage symptoms, it’s very similar to pre-diabetes, right? It’s actually not less dangerous. It’s just not clearly defined yet. When you have an early stage metabolic syndrome, which PCOS is, you have a strong opportunity to really get in on the ground floor of prevention, for so many other long term issues, and especially the younger you do this. Essentially, the nutrition plan for PCOS is to balance blood sugar, if we’re trying to do that in an 8, 10, 12 or 15 year old, that’s really hard because all they eat is pizza and ice cream, right? But at home as a family, and I did this very deliberately with a young 12 year old, 11 year old patient of mine. Both parents come into the meeting with the nutritionist. You all sit together, siblings are involved as much as possible, friends are even involved, this is the kind of food that we have at our house. You create an environment of success. Lots of raw veggies with guacamole and hummus and healthy fats, proteins. They’re coming into the house starting their day with a savory protein-heavy, veggie-heavy breakfast so you might make omelets, you might make them a muffin cup. It’s really easy to make, to warm up and eat them in the car on the on the way to school or walking to the bus stop. Omelets with veggies are good, high-protein yogurts with nuts and not necessarily dairy yogurts, coconut milk, almond milk and cashew milk. Protein-heavy, healthy-fat heavy, and fiber-heavy breakfast, which include essentially a protein, fats like coconut milk, or olive oil or avocado. The kind of avocado gluten-free toast trend is pretty good. You can put a little turkey on that, basically it’s like open-face sandwich for breakfast.
Dr. Jessica Drummond [12:47]
It isn’t too difficult. Vegetables for breakfast, green smoothies, berries for breakfast for fiber and phytonutrients. It is about really starting the day with a strong nourishing breakfast and then continuing throughout the day. The food plan in general for PCOS will be plant-heavy, cruciferous vegetable-heavy, vegetable-heavy in general. We can challenge our kids to eat a wide variety of colors, you can check off the colors that you ate that day, have them chew more slowly so that they’re absorbing nutrients better and optimizing digestion. The research on chewing shows that we need to chew each bite of food 40 times. Nobody does that. So at home, you can have a little contest of how slow can we chew this dinner.
Dr. Jessica Drummond [13:42]
High-quality animal proteins, not as the only basis of the meal, but as kind of a solid foundation of protein for each meal. And plant based proteins, beans, nuts, seeds and some whole grains. Because these kids are growing, and they should be physically active. I was talking with my young patient and his family. There was this shift away from sugar, adding lots of veggies, lots of healthy proteins, lots of healthy fats, and then hydration. So even just shifting from any sugary drinks at all, to water and you can float strawberries in it. You can float lemon and grapefruit in it to kind of give it some flavor, but lots of hydration and then getting outside as a family to play because our kids are not physically active. And strength training is about climbing ropes and swimming and jumping over things and lifting up stuff and throwing it. It’s it’s sort of the old-fashioned outdoor CrossFit. Or as a family doing sports, gym activities. For PCOS, that physical activity is really, really important. The key with teenagers and children that’s really different from adults, is that this has to be a whole family, ideally, more extended family, even friends, neighborhood kind of activity, because there is significant risk, especially in young teenage girls of inciting an eating disorder, which is actually even more deadly than PCOS or being on birth control.
Dr. Jessica Drummond [15:30]
It’s a very high statistic of people who never recover from things like anorexia. We want to be thinking of this as a mindset of eating for pleasure, fun, activity, home cooking, energy, balanced mindset, and not completely throwing out all the “fun foods.” The good thing is that you can make coconut ice creams really easily and much less sugar at home, you can make paleo desserts from time to time, and it’s okay to integrate some of that in there, especially with kids so that they feel part of the social fabric of their sports teams dinner, and you can offer those things and have grass fed burgers on the grill at your house, rather than ordering 20 pizzas for the team. It’s really that shift, that’s more how you implement it than what the food is. I can basically tell you that a plant-heavy, high-quality Paleo food plan is where we would begin with most people in PCOS. But with kids, what you’re really thinking about is how you do that in the context of their lives without making food such a focus that they that you risk triggering an eating disorder.
Farrar Duro [16:54]
And that goes against the SAD. The standard American Diet is cereal and milk for breakfast and pancakes and waffles and heavy on the carbs. Trying to get them to have that shift is important. It’s not an easy thing, it’s not a common thing in our culture, we’re surrounded by carb-heavy, fast food places. I just actually had this discussion the other night with two reproductive endocrinologists we work with on a Facebook Live, and they’re saying, we’re kind of up against a wall with our patients. I’m telling them, this is something you should do. And yet everybody gets to the end of the day, they get home from work, and they’re just completely burned out and just order a pizza or whatever. And it becomes really difficult to do that. I’m trying to teach my kids this summer how to cook, and having them participate in the meal prep is good, and they want to, actually. They think that it is fun to learn how to make things for themselves and cook and all that. Sort of making it an activity, like you said you can do together I think is good. And have the whole family be part of it instead of just having one meal for them, and then everybody else is eating whatever they want, it’s kind of not fair.
Dr. Jessica Drummond [18:10]
Absolutely, and the parents really have to take ownership. The only time this doesn’t work is when Mom and Dad are saying to me, do I have to drink green smoothies? And I’m like, yes you do! Really having that meal planning is helpful. Yes, kids can get on board a lot younger than we really think I mean, look at all the like cooking shows that are on.
Farrar Duro [18:35]
Those kids are incredible on those cooking shows.
Dr. Jessica Drummond [18:37]
And they’re so young, they’re like nine years old. If they can do it, it’s possible, and they don’t have to be at that level, they just have to be safe and be able to cook something. I think kids are very organized in their fitness now. They either have almost none because they’re kind of in front of TVs and games and things like that, or they’re in every sport activity. but that can really lead to kind of burnout. What we know from the physical therapy literature, and the orthopedic literature is that diversity in play and exercise in different sports should last as long as possible through childhood and early adolescence. So over-specialization to where your kids hate baseball, by the time they’ve done it, or softball by the time they’ve done it for 12 years isn’t good. We want them to really be embracing the play and as a family if you have a relatively sedentary kid, what kinds of things can you agree on? That’s where the coaching skills come in where for us as practitioners. The easy thing to do is go home from work, turn on Netflix and order pizza or stop a drive thru on the way home, right, but if our clients invest in a little bit of time, over the weekend, about how things will be prepared, and get help. If you’re a full time two busy working parents family, maybe you do need to hire someone to help you cook, and then some of the pressure’s off and then every day after dinner, especially now that it’s summer, there’s a family walk, there’s a family playground, 15 minutes, little things like that, that are part of the family culture, especially if you’re willing to receive some more help. We have people help clean our homes, sometimes we have people help with carpool, we have people help with childcare. Let’s start thinking about some help with cooking and some neighborhood playing outside. We have to reintegrate community with us because we don’t want kids to feel isolated like they’ve got more homework to do, like, I have to do my 15 minutes of running outside.
Farrar Duro [21:07]
Sports can be over scheduled, like you said, or can be something fun. I think that getting back to just making it enjoyable for adults is the same thing. You want to exercise, but maybe it’s a dancing or salsa lessons or something that you enjoy, instead of just grinding through it, like I gotta do this workout. Same for kids, And I think that that’s important, having them part of the process of the meal planning. And, like pick five meals that you really like, that we can try this week or something like that. Make it fun. We have sometimes a little meal prep sheet that we put on the refrigerator like, “this is what we’re eating.” And our oldest is really into health and exercise, he’s 14 and he’s 6 foot 4, he’s very into basketball and wants to make sure that he eats really, really healthy every day, the youngest not so much. He could probably live off carbs. We try different approaches to see what works, but I think the more fun you make it, sometimes the easier it is and that’s really good advice to start with the nutritional part of it. As far as if you are already having your teen on birth control, and that’s the route that you’re doing, you can still implement, of course, all these strategies. The fact is that sometimes birth control will also make insulin resistance a little bit worse. If you’re not taking anything for that, like inositol powder, or Metformin, that sort of thing, the diet is even more crucial for sure. It’s not that birth control is actually fixing the insulin resistance, it’s actually worsening it sometimes, that’s even more crucial at that point, would you agree with that?
Dr. Jessica Drummond [22:53]
Yes. I think we have a lack of understanding, in general about the relationship between estrogen and insulin resistance. For women, we actually have beneficial support of our estrogen levels to make us more insulin-sensitive, which is really lucky. That happens for us on roughly day three of the menstrual cycle to about ovulation, day 14-15 if you have an average cycle. Now, birth control works by releasing a protein called sex hormone binding globulin, which ties up a lot of our reproductive hormones, all of our reproductive hormones, but not completely. It reduces the levels and then the hormonal birth control adds back some of those reproductive hormones, so that our brains and bones and hearts can continue to function.
Dr. Jessica Drummond [23:51]
If you’re on birth control, your hormones are pretty steady throughout the whole month. And then when you kind of stop the pills, you take this placebo pills, you have this like breakthrough believe it’s not a real period, because you haven’t actually ovulated. And then with a regular cycle, your estrogen goes up in the first half, and then it goes down in the second half. Even in the second half of the menstrual cycle, your daughters will be a little bit more insulin resistant, compared to the first half. Which is interesting to know, because they can tolerate little bit more sugar, potentially when they have that little bit extra boost of estrogen. Now the other place that’s really important to make sure we’re getting adequate amounts of sex hormones, is that the body is not too overly stressed, because cortisol and insulin also sort of play together. Cortisol is your stress hormone. And that can, in essence, stop energy from your reproductive hormones. If your daughter is under a lot of physical stress, she’s very inflammed, lots of sugar, lots of chemical exposure…teenage girls get a lot of chemical exposure, just from things like makeup and skincare and shampoo, so really looking for organic brands and things like that.
Dr. Jessica Drummond [25:12]
One thing that really surprised me: I had a client who’s estrogen we couldn’t get modulated. She lived in the Middle East, it was really hot, and she was wearing plastic flip flops every day. Just like plastic water bottles, she was getting this plastic exposure all the time. Don’t wear hot rubber, or plastic flip flops. Don’t drink water out of plastic bottles, try to limit plastic exposure in general, because that messes with your sex hormones. If you’re stressed, physiologic stress would be a lot of chemical exposure, a lot of sugar exposure. And then of course, teenagers are under a lot of emotional stress, a lot of pressure. How are we balancing that? How are we as parents talking to our kids? what are their goals? there’s lots of paths to get there. My daughter goes to a really competitive high school, and it’s very stressful,all the kids…where are you going to college? That’s important, and it’s challenging, because they do have to really achieve at a very high level to get where they want to go.
Dr. Jessica Drummond [26:26]
If you keep taking the pressure off, there’s lots of ways to get there and keep reminding my daughter, they always say President Obama graduated from Columbia and Harvard, but he started at like a two year liberal arts college. Nobody mentioned that, right? Totally fine. There are lots of paths to get there. I think that helps take the pressure off, do your best, celebrate it, but kids are going to have different paths, and we have to as parents, get comfortable with letting them make mistakes, with being messy. Teenagers are so messy, and there’s not much room for that in kind of normal teenage life, they have to be great basketball players and straight A students and perfect SAT scores. But if we step back, that’s not sustainable in the long term. How are we modulating their stress? How are we allowing them to be messy and make mistakes and try things? And then there still is going to be a lot on their plate? How can we balance that? Do you have a mindfulness practice in your family? Do you have some kind of spiritual practice? There are lots of ways meditation, yoga, slow walking, a religious community, whatever works for you, is there a place that they’re balancing out that day to day stress, because stress really impacts estrogen, which is going to make us more insulin resistant. And we have to be really mindful of that, because in the end of the day, PCOS is really a metabolic issue.
Dr. Jessica Drummond [28:04]
Yes, this is so good. I hope that if you’re listening to this, right now you have this conversation with your teen daughter, or if you’re also a teenager listening to this, talk to your parents about this, because maybe you are under a whole lot of stress. And these other factors are just you know, exacerbating things. And definitely, I just feel that there is we’re a little bit more sensitive as one with PCOS to stress in our environment, a lot of times and due to our sympathetic nervous system being a little bit on overdrive, too. So just know that there are things in your control that you can do. And definitely you can start with making those choices at home. The earlier you learn this, the easier it will be on down the road in whatever stage of life you’re in. Such good information here. If you could think of a good book for for women listening, what would that be one of your favorite books, I guess, for women with PCOS, or even thinking of trying to balance hormones?
Dr. Jessica Drummond [29:01]
One of the books that I love for a cookbook that’s kid friendly, is it’s called “Run Fast, Cook Fast, Eat Slow.” And it’s not 100% perfect in terms of the food plan that I would recommend, but there’s a lot of really good tips in there. A lot of dairy-free, gluten-free, low-sugar, sugar-free kinds of options, but the focus is on eating for fueling something you love to do. The women who wrote this book are runners, and it’s about fueling up for activity, it’s kid-friendly, easy-to-make food. There’s a lot of like bowls that a lot of my young patients love that you can kind of put them together out of different, you know, it’s a creative, but easy way to cook.
Farrar Duro [29:55]
Okay, say that title one more time. We’ll definitely link to this in the show notes too.
Dr. Jessica Drummond [29:59]
Yes it’s called “Run Fast, Cook Fast. Eat Slow”
Farrar Duro [30:06]
Oh, very cool. I will be checking that out. So, it can actually give them recipes and easy to make things for kids is what you’re saying?
Dr. Jessica Drummond [30:15]
Farrar Duro [30:17]
Very cool. Well, this has been so helpful. How can our listeners find out more information about you, Dr. Drummond?
Dr. Jessica Drummond [30:24]
Our website is www.integrativewomenshealthinstitute.com. And my book is published. It’s “Nutrition For Relieving Pelvic Pain.” We didn’t talk a lot about that today, but sometimes women with PCOS also have pelvic pain. That’s a good place to start, and it’s about talking with your practitioner about how to help you better resolve your pelvic pain and PCOS from the root cause rather than just masking it with something like birth control.
Farrar Duro [30:57]
Love it. Awesome. I am so thrilled that you took time today to talk to us and we’ll definitely throw those links up in our show notes for your book and how to reach you. Thank you so much for being with us today. And thank you everybody, for listening. We’ll see you next time. Have a great one.
- How Dr. Drummond got started working with women’s health ([1:13])
- Teenagers with PCOS taking birth control ([4:50])
- Advice to parents on where to start ([9:47])
- Starting the day with a strong, nutritious breakfast ([12:00])
- Staying hydrated and getting outside ([14:20])
- Taking ownership as a parent ([18:10])
- Lack of understanding of the relationship between estrogen and insulin resistance ([23:00])
Resources Mentioned In This Episode:
- Learn more about Jessica at integrativewomenshealthinstitute.com
- Check out Jessica’s book Nutrition for Relieving Pelvic Pain
- Read Run Fast, Cook Fast, Eat Slow for recipes and tips
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