Lean PCOS: Challenges in diagnosis and management

Updated on Sep 12, 2021 04:31 PM IST  |  34.4K
Lean PCOS: Challenges in diagnosis and management

The most common complications of Polycystic ovarian syndrome (PCOS) include infertility, pregnancy complications, increased risk of diabetes and heart diseases, depression, sleep disturbances, endometrial cancer, etc.


Signs and Symptoms of PCOS


Irregular periods, lack of or delayed ovulation, elevated levels of androgen (male hormone) that may result in excess facial or body hair growth or even loss of hair or baldness, acne, and enlarged ovaries with multiple cysts are some common signs and symptoms of PCOS in both overweight and obese as well as lean women. Comparatively leaner women may or may not necessarily show these symptoms.



Challenges of Management in Lean PCOS


● Delayed diagnosis of PCOS. Leaner girls may or may not show symptoms of PCOS and hence do not consider visiting their gynaecologist compared to their overweight or obese counterparts — who are screened for PCOS as early as in their teenage years — mostly due to irregular menstrual cycles. Leaner women are usually screened for PCOS only when they face problems in periods or in conception during their adult life.


● Delay in the treatment of PCOS. Delayed diagnosis leads to delayed treatment causing consequences like endocrine, metabolic, psychiatric complications.


● Delay in the diagnosis adversely affects the endocrine and metabolic health. The presence of insulin resistance and hyperinsulinemia increases their tendency to develop comorbidities like diabetes, hypertension, dyslipidaemia, cardiovascular diseases, etc.


● Women with lean PCOS are more likely to suffer from many mental health issues like depression, bipolar disorder, anxiety, and binge eating silently due to a lack of timely diagnosis and management.




Diagnosis is based on your symptoms. After taking your complete medical history, your doctor may order tests like:


● A pelvic exam. Your abdomen is palpated for the presence of growths, or masses in your reproductive organs.

● Blood investigations. Your blood sample may be drawn to measure hormone levels, glucose tolerance, fasting cholesterol and triglyceride levels.


● An ultrasound to check the appearance of your ovaries and the thickness of the lining of your uterus.


After confirming PCOS you will be regularly screened for blood pressure, glucose tolerance, cholesterol and triglyceride levels, obstructive sleep apnoea, depression, and anxiety.



There is no definitive prevention for PCOS. However, by following these simple steps it can be effectively managed.



● Maintain body weight. Maintaining a healthy weight is the first-line treatment for PCOS as it improves menstrual irregularities, symptoms of hyperandrogenism (high levels of androgens) and infertility. Following a healthy lifestyle, including consumption of fruits and vegetables as well as regular physical activity is advocated as it helps maintain ideal body weight or normal BMI and improve insulin sensitivity.


Get insulin and glucose levels checked periodically for understanding your risk of insulin resistance. Take your medicine regularly. Your doctor may prescribe medications to regularize your menstrual cycle, and ovulation, to improve insulin resistance, restore normal hormonal levels, etc. 


Medication can offer relief from signs and symptoms of PCOS and increases your chances of a successful pregnancy. Reach out for emotional support. Do not hesitate to seek professional help or support from friends and family if you experience depression and anxiety. It is common in PCOS and can be overwhelming.




One in five women with PCOS has a healthy BMI. In India, most doctors and patients associate PCOS as the consequence of being overweight or obese. Lean PCOS are most likely to miss timely diagnosis and management due to lack of awareness. Timely diagnosis and management of PCOS are of paramount importance to address the symptoms and prevent future endocrine, metabolic, psychiatric, and cardiovascular complications.


About the author: Dr Hemanandini Jayaraman, Consultant - Obstetrics and Gynaecology, Manipal Hospitals, Old Airport Road, Bengaluru


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