What Is Lean PCOS: 7 Important Facts You Must Know

PCOS 1stands for Polycystic Ovary Syndrome. But what is lean PCOS? In this disease, the reproductive age and reproductive organs are affected. It is because there is a cyst that is formed on the ovaries of the woman, and due to that, the woman is not able to conceive a baby2.

The common effects of this disease are hyperandrogenism, irregular menstrual cycles, impaired glucose tolerance, and polycystic ovarian syndrome3. The patients also develop insulin sensitivity.

There are two types of PCOS in women, which mean PCOS has two phenotypes. Overweight women with PCOS, and the second one is lean women with PCOS. These both have different pathophysiology 4and diagnostic criteria. The lean women have healthy BMI but still develop the disease.

What Is Obese PCOS

Obese PCOS refers to a person suffering from polycystic ovary syndrome, and the patient is overweight. Somewhere, it is concluded that the reason for their PCOS development is their overweight.

But there is a possibility that the patient has gained weight after developing the disease. Obese PCOS patients have more severe effects and hormonal changes than lean PCOS patients. In this case, the doctor advises losing weight. It is also known as the Obese phenotype 5of PCOS disease.

What Is Lean PCOS

It was believed that obese patients could only develop PCOS. Approximately 80% of women remain undiagnosed until they face issues like an irregular menstrual cycle6 or fertility problems.

This is because their healthy body weight and the BMI (Body Mass Index) of lean people are normal, so they remain undiagnosed. But later, after much research, it was concluded that lean women could also develop polycystic ovary syndrome even if they have normal BMI.

1. Statistics Of Polycystic Ovary Syndrome (PCOs)

Endocrionpathy is a disease of the endocrine gland which leads to hormonal problems. So this disease is also referred to as endocrine metabolic disorder.7 PCOS is a heterogeneous endocrinopathy.

This disease affects 4-8% of women of reproductive age. This disease is the common cause of anovulatory infertility, for which 90-95% of women suffer, and later these women are diagnosed with PCOS.

70% of patients develop hyperandrogenism, hirsutism, and excess body hair. Most cases are obese women whose BMI is more than 25 kg per meter square. Both lean and obese women with PCOS face insulin resistance.

BMI (Body Mass Index) is the body weight and height ratio. The mass or weight of the person is divided by the square of her height. Then the result is the BMI of the particular person.

The normal range of BMI is between 18.5 to 24.9. If a person has a BMI, also known as a body mass index, of less than 18.5, then the person is underweight, and if the person has a Body Mass Index of more than 24.9, then the person is said to be overweight.

2. Causes Of Lean PCOS

Polycystic ovary syndrome (PCOS) is a disease that is caused by a hormonal imbalance. When the pituitary gland, the main and very important gland of the human body, cannot perform its functions, its hormones cannot perform their function well.

Sometimes, the hormones are not able to do their function well because the excess fatty tissue and serum androgens will lead to a hormonal imbalance.

And if the hormones cannot function properly, the menstrual cycles become irregular, which causes problems in ovulation, and the women will experience polycystic ovary syndrome.

Another important cause of lean PCOS in women is insulin resistance; insulin resistance plays a major role in developing PCOS in women. Let’s discuss this in brief.

2.1.Insulin Resistance In Lean Women With PCOS

Insulin resistance refers to the difficulty in managing the blood sugar level. Insulin works to store fat in the abdomen of the body. But it may be dangerous when it becomes abdominal fat, increasing the risk of other diseases.

This excess abdominal fat will also lead to insulin resistance. It will affect weight maintenance. According to a study, 20-25% of lean women with PCOS are suffering from insulin resistance.

The right relationship between polycystic ovary syndrome and insulin is not described yet. It would help if you calculated the waist-to-hip ratio to know that women have a higher insulin level. If the waist-to-hip ratio exceeds 0.85,  the woman suffers from a higher insulin level. The insulin resistance in lean women with PCOS is measured by calculating the waist-to-hip ratio. There are specific and important parameters by which anyone can check or calculate women’s waist-to-hip ratio.

2.1.1. Calculation Of Waist To Hip Ratio

The steps of calculation of waist to hip ratio are

  • Take a simple cloth measuring tape and measure the outer boundary, the circumference of your waist from where it is smallest.

  • Now measure the circumference of your hips from where it is most prominent.

  • Divide the measurement of the waist by the measurement of your hips.

  • If the answer is 0.85 or higher, you have a high risk of developing insulin resistance. It may also give rise to other diseases like obesity, and the value of BMI falls from the healthy BMI range.

3. Symptoms Of Lean PCOS Women

The lean PCOS symptoms that are seen in the patients 

  • The Body Mass Index lies between 18-24.9

  • The woman is not able to ovulate.

  • The menstrual cycles will become irregular.

  • Women need fertility treatments to conceive.

  • The women have higher oxidative stress.

  • The women will develop excess hair growth.

  • The androgen concentrations are not up to the mark.

  • The women will develop insulin resistance.

4. Diagnosis Of Symptoms Of Women With Lean PCOS

Polycystic ovary syndrome is the development or occurrence of cysts in the ovaries8. Body weight does not matter in this disease. You may develop this disease even if you have a healthy weight. So, if you are facing some issues in your menstrual cycles, then contact your doctor.

Androgen excess level is the result of polycystic ovary syndrome. This disease is diagnosed based on androgen levels and menstrual cycles. Androgen also checks the blood to know whether the hormones are functioning properly or not.

Some fertility tests are also done to know whether the woman is ovulating or not. Sometimes, it is diagnosed by ultrasound because, in ultrasound, the cysts are observed in the ovaries. But sometimes, this method is failed because the cysts are not easily visible in the ultrasounds.

Patients suffering from polycystic ovary syndrome are highly likely to develop endometrial cancer. Some more imaging tests are also done to check ovulation and cysts. Endometrial biopsies are also done to diagnose endometrial cancer.

5. Pathophysiology Of PCOS

The pathophysiology of this disease is very complex. It is also thought that this disease is related to the genetic and epigenetics of the family background. In this disease, both metabolic and hormonal changes take place.

According to ovarian pathology, a healthy and fertile female can ovulate. There are many primordial follicles, but at a time, a single follicle is mature and undergoes ovulation, and then further stages of pregnancy take place.

But the primordial follicles are selected, and their selection and growth are strictly controlled by the hormones, these hormones androgens, follicle-stimulating hormones (FSH), and anti-Mullerian hormone (AMH).

But if the female suffers from PCOS, these hormones cannot do their work properly, due to which the primordial follicles are not converted into primary follicles. The primary follicles can mature and ovulate.

If the female cannot ovulate properly, there is no chance of pregnancy or conceiving a baby.

6. Treatment Of Lean PCOS Patients

There are many ways to treat polycystic ovary syndrome, but it can not be completely cured. The person can limit the symptoms of this disease by a healthy lifestyle. These are the following ways to reduce PCOS symptoms.

6.01. Exercise

A person with polycystic ovary syndrome is more likely to develop cardiovascular disease due to insulin resistance. So they have to do some common exercises which will help to increase insulin sensitivity it improves insulin resistance.9

Exercise also helps fertility treatment because it improves the blood flow in the body. The other benefit of training is treating mild depression and anxiety patients feel due to the disease. Exercise will reduce the metabolic abnormalities of the body.

Some common exercises which lean patients can practice are cycling, jogging, swimming, and yoga. The patients can also try strength training and lifting weights to build lean muscle mass but only when the body is ready to do this exercise. Do not stress your body to do such exercises.

6.02. Nutrition

Healthy eating is very important in treating any disease or disorder. The women have to take a healthy diet that contains a lot of carbohydrates because carbohydrates help to elevate the blood sugar level.

Especially the low glycemic carbohydrates are given to lean PCOS women because the low glycemic food breaks down slowly and gradually goes into the bloodstream. Due to the long breakdown time and slow digestion will not stress the body and the proper glucose metabolism takes place.

GI refers to the glycemic index, which tells how fast or slow the food will digest as these are healthy foods, so they help in proper insulin secretion and improve insulin resistance. This type of food also helps in weight control. Low GI foods are lean protein, high-fiber fruits, vegetables, and healthy dietary fats.

6.03. Stress Management

In lean PCOS disease, the female body’s hormones are imbalanced, and they cannot regulate reproduction. Due to this, many women take the stress, and the body produces Cortisol.

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Photo by Elisa Ventur on Unsplash

Cortisol home is majorly responsible for the accumulation or deposition of fat around the body’s organs. The increment of fat will lead to more severe symptoms of this disease. The visceral fat deposition will reduce the work efficiency of different organs like the lungs, heart, and digestive system.

The methods of stress management are gentle yoga and meditation. Give some time to your hobbies.

6.04. Dietary Intake

The main dietary interventions are zinc and inositol. Zinc has natural anti-inflammatory and antioxidant properties, which will help to decrease inflammation and stress. At the same time, inositol is a substance similar to glucose that has many health benefits and helps in fertility treatment. These two things will help to increase lean muscle mass.

6.05. Fertility Treatments

The lean women have a higher pregnancy rate after they get the treatment. The first drug which is given to lean patients is Metformin. This is an insulin resistance drug, but it helps the patients to conceive and improves ovulation in women with PCOS.

Clomid (clomiphene) and Femara (letrozole) are other drugs often prescribed. If the above drugs cannot show some effects and treat the disease, then injectable fertility drugs are given to the patients.

7. Disease Observed In Women Due To Delayed Diagnosis Of Lean PCOS

Due to normal weight, lean PCOS remains undiagnosed for several years. But in those years, it gives rise to several diseases. 

7.01. Diabetes Mellitus

According to a study, 3-10% of lean women with PCOS cannot diagnose that they have diabetes also. It is because the health care providers think they have normal weight, so they are not likely to develop this disease.

But it is necessary that if the patient suffers from PCOS, the doctors will do a full body check-up to know which parts and organs are damaged and properly function.

Those diseases also need proper treatment, medication, and prevention. So, if the lean woman suffers from PCOS, then go for every test regardless of her weight.

The obese subjects with PCOS have an increased risk of diabetes Metab Disord in comparison to lean women with PCOS. So, it is necessary to check the insulin levels at the proper period if you are suffering from PCOS.

7.02. Heart Diseases

After several types of research, it was concluded that lean women with PCOS are very likely to develop heart diseases. Researchers have compared cholesterol levels of normal women and lean women with PCOS, and they found that lean women with PCOS have lower levels of good cholesterol and high level of bad cholesterol or saturated fat.

This high level of bad cholesterol will lead to coagulation in arteries, which later forms severe heart disease.

7.03. Infertility

The untreated PCOS, and for a very long period, also make the women infertile. In simple words, infertile means the woman cannot conceive the fetus, or if somehow to conceive, then the uterus cannot hold the fetus. Unfortunately, a miscarriage happens; this is called infertility in women. Those women who have untreated lean PCOS become infertile over some time.

7.04. Depression

It is also observed that women having lean PCOS are most likely to be depression patients. Their depression has many reasons, because of family pressure, feeling of rejection, AND feeling of unacceptance in society. But the main reason behind their depression, according to science, is the hormonal changes or the imbalance of the hormones due to abnormal hormones. These women develop anxiety and depression.

7.05. Anger Issues

Women with lean PCOS also develop anger issues, which are very harmful to themselves and the people living with them. The reason behind this may vary from person to person; in some, it is due to hormonal changes; in some, it is due to the neglection; in some, this is due to ignorance, and many more.

7.06. Obesity

The only difference between lean PCOS and obsess PCOS is obesity, but due to the untreated lean PCOS for a very long period, it can also convert into obese PCOS. Due to depression and anxiety, women cannot follow the proper healthy lifestyle, which ultimately causes obesity.

And obesity brings many other problems with it; obesity makes the condition more complicated to treat. That is the reason it is always advised or suggested by doctors to follow healthy lifestyle practices.

Some Most Frequently Asked Questions

People are very much confused about lean women PCOs, what lean PCOS is, what the symptoms are, whether it is related to blood sugar and male hormones, and what ways we can find out or make a PCOS diagnosis. 

1. Does A Lean Women With PCOS Will Experience The Same Symptoms As Of Overweight Women With PCOS

Polycystic ovary syndrome responds to every patient similarly, irrespective of weight management. Every patient will experience insulin reduction, unwanted body hair, improper ovulation, inability to conceive, and irregular menstrual cycles.

The difference lies in the risk factor. The overweight patients will experience some more diseases and are not treated easily due to the heavy weight gain. But then, lean patients are less likely to develop those diseases, and due to normal weight, they will exercise properly and take proper medication so they can be treated easily.

The overweight patients must lose weight first and then undergo further treatment. Weight loss is caused by doing some exercises, lifting weights, and having a properly balanced diet.

 2. Do Some Treatments Completely Cure PCOS

PCOS can never be completely cured. The hormonal imbalance is treated to some extent so that the women can ovulate and later they can conceive a baby. But sometimes, after medication, it is not possible that the female will ovulate properly and conceive a baby.

Healthy BMI and normal weight play a major role in the treatment of women. Maintaining a healthy weight and taking a proper diet and medication are more likely to overcome the disease.

3. What Are The Medical Problems That Lean PCOS Group Have To Face

The patients are at risk for diseases like hypertension, improper glucose tolerance, endometrial cancer, gestational diabetes, depression, sleep apnea, hypercholesterolemia, high LDL, and low HDL.

If a woman is diagnosed with PCOS, the doctor will also test these diseases because the person suffering from PCOS can also develop these diseases.

4. Can A Woman Suffering From PCOS Will Get Pregnant By IVF And ISCI

Yes, women with PCOS will get pregnant with the help of IVF and ISCI. But first, you have to check the severity of the disease. If the disease is at its initial stage, the patient doesn’t need IVF. Those women can conceive their children by using fertility pills and other treatments.

If women are suffering from a severe disease, then those women can take the help of IVF. Still, if they try to lose weight and their weight comes in a healthy range and reduces insulin resistance, then, in this case, their ovulation is improved, and they can also conceive a baby.

Final Note

What is lean PCOS, the main reasons behind them, and their signs and symptoms with treatment are all discussed in this article. Hope you get the idea of all these things. 

PCOS or Polycystic Ovary Syndrome must not be ignored. If we ignore the symptoms, the disease will get severe. The PCOS characteristics give rise to many other diseases like elevated blood sugar levels, heart diseases, and fat deposition in adipose tissue.

If we have to treat this disease, the main thing is weight loss. If you have a healthy weight and follow a balanced diet, then the symptoms of the disease are limited. Many young women hit by puberty just some time ago can also develop this disease due to heavy weight and improper diet.

To remain healthy, it is important to maintain a healthy weight, exercise properly, and eat healthy food full of proteins and nutrients.

  1. Rosenfield, Robert L., and David A. Ehrmann. “The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited.” Endocrine reviews 37.5 (2016): 467-520. ↩︎
  2. Sweeny, Kate, et al. “Waiting for a baby: Navigating uncertainty in recollections of trying to conceive.” Social Science & Medicine 141 (2015): 123-132. ↩︎
  3. Franks, Stephen. “Polycystic ovary syndrome.” New England Journal of Medicine 333.13 (1995): 853-861. ↩︎
  4. Bron, Anthony J., et al. “Tfos dews ii pathophysiology report.” The ocular surface 15.3 (2017): 438-510. ↩︎
  5. Ortega, Francisco B., et al. “Role of fitness in the metabolically healthy but obese phenotype: a review and update.” Progress in cardiovascular diseases 58.1 (2015): 76-86. ↩︎
  6. Yamamoto, Kazuhiko, et al. “The relationship between premenstrual symptoms, menstrual pain, irregular menstrual cycles, and psychosocial stress among Japanese college students.” Journal of physiological anthropology 28.3 (2009): 129-136. ↩︎
  7. Golden, Sherita H., et al. “Prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review.” The Journal of Clinical Endocrinology & Metabolism 94.6 (2009): 1853-1878. ↩︎
  8. Cheng, Yvonne, and Society for Maternal-Fetal Medicine (SMFM. “Ovarian cysts.” American Journal of Obstetrics and Gynecology 225.5 (2021): B23-B25. ↩︎
  9. Wilcox, Gisela. “Insulin and insulin resistance.” Clinical biochemist reviews 26.2 (2005): 19. ↩︎

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