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Lean PCOS and More Polycystic Ovary Syndrome Symptoms

Although lean polycystic ovary syndrome (PCOS) affects a smaller proportion of the population, it can go undiagnosed for years. Since PCOS is so strongly associated with body weight, we often tend to overlook those who are at a normal weight. This is also a perfect example that shows the nature of this condition — that PCOS can affect anyone.

Women who have lean PCOS also need proper treatment and medical care. That’s why early screening and getting the right diagnosis are important in the prevention of future health complications. Read on to find out all there is to know about lean PCOS.

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What Is Lean PCOS?

When we think of PCOS, we often associate this condition with women who fall in the overweight or obese category. Women with PCOS do have a higher risk of developing unhealthy weight gain, with nearly 60% being at an unhealthy weight.

Although the association between PCOS and weight is strong, not every woman who has PCOS is overweight or obese. The body mass index (BMI) is used to measure healthy body size. Some women who have a healthy weight or healthy body mass and a BMI of less than 25 can still develop PCOS. This type is called lean PCOS.

Although the proportion of women with lean PCOS is less than that of overweight women with PCOS, women with lean PCOS face the same challenges and health complications that come with the condition. This makes it important to remember that weight is only a risk factor for PCOS and not a diagnostic criterion.

Common Signs and Symptoms

Despite maintaining a healthy weight, women with lean PCOS experience the same symptoms that are seen in overweight women. However, since women with lean PCOS aren’t typically regarded as someone who might have PCOS, the symptoms often go overlooked until they become very obvious or serious.

Some of the symptoms associated with lean PCOS are:

  • Irregular periods
  • Acne
  • Excess facial or body hair
  • Scalp hair loss
  • Trouble conceiving
  • Insulin resistance

Understanding the Body Mass Index (BMI)

The BMI is the most commonly used health measure that takes into account your height and weight. Based on your score, you will fall somewhere in the underweight, normal weight, overweight, or obese categories. Using your height and weight as a factor, the BMI tries to estimate your body fat.

However, like any other measure of health, the BMI is not perfect. It does not take into account factors such as body composition, sex, or age. For example, in certain populations, such as athletes who have higher muscle mass, the BMI might overestimate body fat. This can also be the case with pregnant people, children, and older adults.

In general, if you have a higher BMI score, you have a higher risk of developing a range of health issues that include diabetes, heart conditions, sleep apnea, and liver disorders. Your BMI alone is not a perfect measure of health, but the BMI is a good place to start if you are looking to manage your weight and want to know which category you fall in.

Even though knowing your BMI is helpful, it is also important to be aware of its limitations and other, better ways to measure your body fat percentage and composition.

The Impact of Androgen Levels

Although insulin resistance is often linked with obesity, women with lean PCOS are also at an increased risk of developing insulin resistance despite maintaining a healthy weight. If left untreated, higher levels of insulin in the blood can increase the production of androgens.

Androgens, or male hormones, are present in both men and women — although in much lesser amounts in women. Although all women do produce a small amount of androgens, it is when this level of androgens is increased that many symptoms of PCOS, such as excess facial or body hair, acne, and scalp hair loss, can show up. Excess levels of androgen also contribute to irregular periods and ovulation cycles.

Hyperandrogenism (elevated level of androgens) is one of the clinical features of PCOS and is also seen in lean women with PCOS.

Other Factors That Affect How Much You Weigh

PCOS is one of the many conditions and situations where weight gain can be a symptom. That’s why being overweight or obese is only a risk factor and not a diagnostic criterion for PCOS. Several factors can play a role in weight gain and retention.

Some of the factors that can influence your weight are:

  • Diet
  • Level of physical activity
  • Genetics
  • Existing health conditions
  • Medications
  • Stress levels
  • Poor sleep

Common Challenges Women With Lean PCOS Experience

PCOS is so strongly associated with obesity that lean PCOS often goes undiagnosed for years. But because being overweight or obese is only a risk factor for PCOS and not a diagnostic factor, PCOS can affect anyone regardless of weight. Although lean women with PCOS are not obese, they still show signs of difficulty in losing weight, insulin resistance, and elevated androgen levels.

All women who suspect they have PCOS should be screened for insulin resistance, regardless of their weight. And since symptoms of insulin resistance are not obvious to spot in lean women, this increases their chances of developing PCOS-related health complications if insulin resistance is left untreated.

Testing and Diagnosis

PCOS is a complex condition that has a range of symptoms that can show up in varying degrees in women. Since many of the symptoms are nonspecific, PCOS can take years to get diagnosed. And if you have lean PCOS, the diagnosis can be delayed even longer, since PCOS is often associated with weight gain.

If you are lean and suspect you have PCOS, you should speak to a doctor who can help you get a proper diagnosis based on the results of specific tests. Lean PCOS is diagnosed just like other forms of PCOS — often by using the Rotterdam criteria, which were developed by a panel of medical experts.

Under the Rotterdam criteria, you need to present two of the following three findings for a diagnosis of PCOS.

  • Irregular or no periods
  • High androgen levels, as shown in test reports or by symptoms like excess facial or body hair
  • Polycystic ovaries

PCOS cannot be diagnosed solely on the basis of physical symptoms; blood reports and scans are always required to confirm the diagnosis based on the person’s hormonal profile. Even in women with lean PCOS, it is important to check all the key hormones related to this condition.


Lean women with PCOS experience similar challenges with the symptoms of the condition — with one of the major drivers being insulin resistance. And carrying excess weight can increase the levels of two main hormones associated with PCOS, insulin and androgens.

Following a healthy lifestyle has been shown to be the most effective form of treatment in managing this underlying hormonal imbalance. We’ll explore some of the components of a healthy lifestyle below.

Diet: Your diet is an important part of your PCOS treatment. Eating a healthy, nutritious diet that has all the food groups can help correct hormone levels. Carbs, protein, healthy fats, and fibre all form a part of a balanced diet. Increasing your intake of whole and fresh foods and limiting the intake of processed or packaged food can help maintain weight and also prevent insulin resistance from worsening.

Exercise: Exercise can help improve symptoms of PCOS while maintaining weight. ⁣Cardio and resistance training are both helpful in reducing PCOS symptoms — especially resistance training. This is a form of exercise where you make your muscles work against external resistance. Basically, adding resistance makes any movement harder to perform. ⁣⁣For example, while lifting dumbbells, your body has to work harder to lift the weight, or while doing a pushup, you’re going against gravity to lift your body. Resistance training particularly helps decrease visceral fat (fat surrounding the abdomen), decrease male hormone levels, and improve the menstrual cycle.

Medications: Depending on your symptoms and concerns, your doctor might prescribe you certain medications to improve symptoms. These may include birth control pills, which can help in regulating period cycles and decrease androgen levels, and metformin, which is an insulin-sensitising drug that can help improve insulin resistance. For women who are having trouble conceiving, doctors may prescribe ovulation-inducing medications in addition to making the required lifestyle changes.

Ayurveda and Natural Remedies

There is no natural remedy or ayurvedic treatment for lean PCOS. However, women may benefit from using myo-inositol supplements, which can help improve insulin resistance and regulate the menstrual cycle. There are other natural therapies such as cinnamon and chromium that can also help with insulin resistance and hence help with weight management and other symptoms.

Talk to a PCOS Professional

Lean PCOS, like any other form of PCOS, should be taken seriously and requires prompt medical care. Since lean women do not exhibit excess weight, it can be difficult to diagnose PCOS immediately. However, if you suspect you have PCOS or are showing unexplained symptoms such as irregular periods, acne, excess facial/body hair, and scalp hair loss, speak to a doctor who can help you understand the root cause of your symptoms. Because other conditions can also cause similar symptoms, it is important to rule out such causes.

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