PCOS, sometimes known as lean PCOS, is typically diagnosed in women with normal body weight. PCOS was once assumed to be mostly related with obesity, therefore women of normal weight were unlikely to have it.
Polycystic ovary syndrome (PCOS) is a condition that is often diagnosed in women with a normal body weight, which is sometimes called lean PCOS. For a long time, it was thought that if a woman was of normal weight she would not get PCOS, since the condition was considered to be mainly associated with obesity. However, now it is known that PCOS is present in a mixture of metabolic and hormonal conditions, and the body weight factor alone cannot identify who will get the disease.
Fertility and Metabolic Implications
PCOS can be defined as a disorder that is mainly caused by hormone imbalance, with high levels of male hormones and irregular ovulation being the main causes. Women's hormonal changes in the case of lean women could be just as severe as in case of those who are overweight. The same symptoms as in overweight women might appear, i.e., menstrual cycle variations, anovulation, acne, excess facial or body hair, and thin hair on the scalp, etc., in normal-weight women. Past medical practice was to overlook or to categorize these symptoms as stress-related because the woman was of normal weight and had not gained any.
To a varying degree, insulin resistance is a factor in the cases of lean PCOS, but it might be slight. It is not the same as that which comes from obesity, which always ends up with weight gain. The different action that insulin takes in the ovaries is what causes the production of excess androgens that disrupts normal follicle development and, hence, ovulation. It is said that genetic disposition, ethnicity, environmental factors, sleep disorder and chronic stress are the ones that increasingly being linked to this type of metabolic dysfunction.
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In women of normal weight, often, the ovarian alterations typical of PCOS are observed. The ultrasound might demonstrate several small follicles that are developed around the ovary, which indicate the follicle development being arrested rather than huge egg numbers. Increased luteinizing hormone levels are also a frequent occurrence which further effect ovulation and result in irregular cycles or delayed conception. Lean PCOS poses significant implications in the area of fertility.
Irregular or absent ovulation is still the main cause for delayed pregnancy, even when menstrual cycles are relatively regular. Minor ovulatory dysfunction can cause longer time to conception and higher rates of early pregnancy loss. Many women are diagnosed with PCOS only when they seek fertility evaluation.
Apart from that, there are long-term health risks associated with lean PCOS. Being of normal weight does not rule out the possibility of impaired glucose tolerance, abnormal cholesterol levels, or the development of type 2 diabetes in the future.
The increase in the number of lean PCOS diagnoses represents a better understanding of the condition and wider diagnostic criteria instead of a new condition. Hormone testing and ultrasound have already been widely used and they have also facilitated the identification of PCOS based on woman’s reproductive and metabolic features rather than by her physical appearance. As a result, it has uncovered a large group of women who have not been diagnosed before.
Conclusion
Lean PCOS brings to light the necessity to move away from the weight-centered models of hormonal disorders. Both reproductive and metabolic aspects and even the women's long-term health—their being—influenced in one's lifestyle, and hence being—of all body types. It is imperative to acknowledge its existence in the case of normal-weight women so that the reasons behind menstrual irregularities, delays in conception, and metabolic risks which might otherwise be unnoticed could be understood.
-Dr. Ananya Polam Reddy, Consultant - Obstetrics & Gynecology, Rainbow Children’s Hospital, Sarjapur Road
