Polycystic ovary syndrome (PCOS) varies from woman to woman. As a syndrome, it can show up with a variety of symptoms, so not all women with PCOS will experience all symptoms and the level of severity will vary. One of these symptoms is weight gain above the healthy BMI. Losing this excess weight is often the first step in seeking a healthier lifestyle to manage PCOS. This can be disheartening and confusing to read if you have PCOS and you’re desperate to relieve some distressing symptoms or boost your fertility but you already have a normal body mass index (BMI). Where do you go from there? We explain what lean PCOS is and how you can make changes to ease your symptoms.
What is lean PCOS?
Lean PCOS is PCOS in women of normal weight; they make up a small but significant amount of those diagnosed. Because PCOS symptoms copycat symptoms of other hormonal diseases, diagnosing a woman with lean PCOS always needs to be based on a diagnosis by a GP or Specialist such as a Gynaecologist or Endocrinologist.
What is the difference between lean PCOS and PCOS?
Both lean and overweight women with PCOS can struggle with the same symptoms such as acne, unstable moods and facial hair. Overweight women with PCOS have a higher chance of suffering from more intense symptoms, and higher likelihood of experiencing more severe hirsutism, hair loss, irregular or absent periods with rare ovulation and anxiety or depression.
What are the challenges faced by lean women with PCOS?
Delayed diagnosis
Being obese or overweight affects between 38 and 88% of women with PCOS and so this is why so much advice and support regarding PCOS focuses on women with PCOS who are overweight. But this also means that those women with lean PCOS can receive a delayed diagnosis — often by years. Some women with lean PCOS may not even receive a diagnosis until they start trying for a baby. Unfortunately, undiagnosed PCOS also means that related heart disease and diabetes can be diagnosed later too. If you have irregular periods, acne and facial hair and suffer from PMS as well, you should speak to your GP or see a Specialist to ensure that your symptoms are assessed properly.
Insulin resistance
The correlation between PCOS and insulin levels is not fully understood, but we know that being overweight independently increases your risk of insulin resistance and diabetes, especially abdominal obesity (where the weight is around your middle). Abdominal obesity is common in those who are obese in general, but it can also appear in women who are a normal weight. However, women with lean PCOS also have an increased risk of insulin resistance even if they’re not overweight in any way. In fact, research has shown that lean women can be insulin-resistant, with one study citing 20–25% of lean women with PCOS exhibiting insulin resistance (those with a BMI of less than 25).
Impaired fertility
Women with untreated PCOS regardless of their weight may experience irregular periods and anovulation. Your GP may refer you to see a Specialist to assess this and improve your cycles and restore ovulation, which can often occur with non-invasive treatment options.
How can you treat lean PCOS?
Exercise
There are so many benefits to exercising with PCOS — it’s not just about losing weight. Whether you have PCOS or lean PCOS, you can experience low moods and fatigue, regular light exercise can help to elevate these symptoms. As you exercise, your body will release endorphins which will make you feel good and give you an energy boost. Light swimming, jogging, brisk-walking or cycling can also increase your insulin sensitivity (halting insulin resistance and preventing pre-diabetes). It can also improve the blood flow to your reproductive organs to aid fertility. Those with lean PCOS can benefit from strength training to help manage PCOS symptoms. Strength training keeps your metabolic rate healthy, lowers androgens and improves insulin resistance.
Nutrition
A PCOS diet and lifestyle can have a huge impact on managing PCOS symptoms successfully and good nutrition plays a big part in this. Not only should your diet be nutritious but you also need to know what to avoid. Eating refined sugar and fatty meats can worsen your symptoms. A diet high in salt is also linked to heart disease so a low-sodium diet will reduce your risk of high blood pressure. But this doesn’t mean going without, you can enjoy plenty of fresh fruit and veg and lots of whole grains (rye, barley, brown rice and bread) lean proteins (white fish, tofu, chicken, beans for example) and unsaturated fats (like avocados, nuts and seeds).
Stress management
Stress can be a common PCOS symptom due to the increased production of stress hormones such as cortisol. Elevated stress can lead to higher levels of insulin resistance, so it’s important to treat any feelings of stress or anxiety for the benefit of your physical and mental health. Ensure that you get plenty of sleep (8-10 hours a night) and regular exercise — both will lower your stress levels. You can also try some alternative therapies such as aromatherapy, reflexology or meditation — see what works for you.
PCOS supplements
As discussed, good nutrition is vitally important whether you have PCOS or lean PCOS. Macro and micronutrients are always more comprehensive than supplements alone. However, some patients with PCOS are deficient in inositols, which are an essential factor for proper ovulation and insulin metabolism. This is where PCOS supplements can help.
In Summary
Women with lean PCOS can feel as if they are invisible until they receive a long-awaited diagnosis and even then all the PCOS advice provided can be tilted towards those who are overweight. Fortunately, as soon as you’re diagnosed, you can take action: there are many changes you can make to your lifestyle to manage your symptoms and being a healthy weight will benefit you in the long run.
References
Barber TM, McCarthy MI, Wass JA, et al. Obesity and polycystic ovary syndrome. Clin Endocrinol (Oxf) 2006.
Marshall JC, Dunaif A. Should all women with PCOS be treated for insulin resistance? Fertil Steril. 2012.
Toosy, Sehar et al. Lean polycystic ovary syndrome (PCOS): an evidence-based practical approach. J Diabetes Metab Disord. Dec 2018.
