Conan Gasque (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children's Hospital of Alabama in Birmingham. I'm Conan Gasque. Thanks so much for joining us today. We're talking about polycystic ovary syndrome, also known as PCOS. It's the most common reproductive condition in women, affecting 3% to 15% of women, and it's also a risk factor for infertility and many metabolic diseases, including diabetes and cardiovascular disease.

Joining us today to talk about this and the PCOS clinic that we have here at Children's of Alabama, Children's of Alabama endocrinologist Dr. Christy Foster. Thanks so much for your time.

Dr. Christy Foster: Thank you for having me. I'm happy to be here.

Host: So, PCOS, I know a lot of people are familiar with it, but for people who are not, what exactly is it and what kind of impact does it have?

Dr. Christy Foster: Absolutely. So, it is a hormone imbalance that is where your ovaries overproduce certain hormones and can lead to increased risk of things like irregular periods, trouble with fertility, and then increased risk of things that are metabolic problems like type 2 diabetes, as you mentioned, increased risk of heart disease, and things like stroke, for example.

Host: And I know a lot of people when they think about it, they really think about it in adults, but it can also affect teens. What does that look like?

Dr. Christy Foster: Absolutely. So even in teens, they can have things that might be undesirable, like extra acne, extra hair growth in places that they don't expect, like on their chin or belly or back. And then, obviously, like we talked about they can still come with trouble with their periods and things like that as well.

Host: So, how is the initial diagnosis made?

Dr. Christy Foster: Yeah, absolutely. So typically, it is made based on their symptoms, like clinical picture, for example. And then, we will a lot of times confirm it or look for it and make sure that we're not missing anything with lab work as well.

Host: You've talked about the impact it can have and all the different symptoms that are there. How difficult can this condition be for people who are dealing with it?

Dr. Christy Foster: Yeah, it can be really challenging. So when I've talked with some of my patients before, they mention a lot of times it can cause difficulty with things like going to school if they have that unwanted hair growth or acne, for example. It can cause them to miss school if they have trouble with their periods, for example. So, it can be kind of difficult with their life if they have it.

Host: It's tough enough being a teenager. But then, when you deal with all these extra things that go with PCOS, I guess that makes it even more challenging.

Dr. Christy Foster: It certainly can. A lot of times these young women can have impact on their mental health as well. They can have increased risk for depression, anxiety, things like that also certainly.

Host: So, we mentioned that you lead the PCOS clinic here at Children's of Alabama. You started it in 2020. What was your thought process in starting that? What did you want to achieve?

Dr. Christy Foster: Absolutely. I wanted to have a place where these young women could go and have the diagnosis made and then have the support for their condition and have things where they could have multiple providers see them in the same clinic space, and then again, hopefully, have that support network where they could have their condition treated.

Host: And I know you take a multidisciplinary approach. What does that mean, and why is that important in a clinic like this one?

Dr. Christy Foster: Absolutely. So as I mentioned, these young women can have multiple different facets to their disease, and so I wanted to make sure that they could have a space where they could see multiple different providers.

For example, we have endocrinology in the clinic. We have also dermatology and pediatric gynecology. We also have other wonderful providers as well, nutrition, and family counseling and social work as well available. So, we really do try to make sure that these young women have support from all angles when they're dealing with this condition.

Host: So, how does that work when they come in for a clinic visit?

Dr. Christy Foster: Yeah. So, they actually are able to see all of the providers back to back. We actually have just recently started a group kind of based learning where they actually get to see the nutritionist and the family counseling at the same part all together and the patient sees them together, and then they actually see the other providers kind of lined back to back. So, we really do, again, try to make sure that they can see them all at the same time.

Hopefully, our thought process there is that the patients get to see them all kind of in the same visit so that, again, it avoids having to miss school multiple days, having to take time off work for the families during that time.

Host: And I guess if you're talking about a patient that's maybe coming two or three hours, I guess that's especially helpful for them not having to make that visit over and over and over.

Dr. Christy Foster: Absolutely. Hopefully cutting down on transportation that they have to do, missed time, like we said, from school and work, that hopefully that streamlines some of that for them.

Host: So if a girl experiences any of these symptoms that you've been talking about, what is sort of the first step in the process to getting this addressed?

Dr. Christy Foster: Absolutely. So, my recommendation typically is to connect with your primary care provider first. I think they can kind of be the gatekeeper in a way to be able to kind of see what's going on, maybe get some history and understanding of what primary concerns you have. And then if needed and if warranted, then they can make that referral to our clinic, or if the family wants to come without that referral, they can certainly reach out to our clinic as well.

Host: How would you say things have gone with this clinic since you've had it over the last few years?

Dr. Christy Foster: I really do feel like the clinic has grown and expanded. Like I said, we've been able to add several different providers to the clinic. We didn't necessarily have family counseling at first. We were able to add that. We didn't have nutrition at first. It specifically designated to the clinic. And now, we've been able to add. And like I said, we've been able to expand that group-based kind of learning experience. We've added that, and it's really grown since then. And I've really gotten to enjoy that experience of getting to see it grow.

Host: I know you've worked hard to help these patients with the many things that they're dealing with. How rewarding is that for you to have these patients and have an impact on their lives?

Dr. Christy Foster: Yeah, I think it's been very rewarding. I have really enjoyed getting to see the patients kind of grow and get to be able to offer this experience to them. And I think from the patients, I think I've learned a lot from them, too, like being able to grow with them and get to see how they've been able to kind of improve I think has been really rewarding and fulfilling for me.

Host: All right. Well, it's good to hear about the work you're doing. Once again, Dr. Christy Foster, endocrinologist here at Children's of Alabama and the leader of the PCOS clinic here at the hospital. Thanks so much for your time.

Dr. Christy Foster: Absolutely. Thank you for having me again.

Host: All right. For more information, you can find it in the episode notes and also at childrensal.org.