PCOS is an endocrine disorder which affects women of reproductive age group. The common features of this disorder are menstrual irregularities,increased androgen levels and polycystic ovarian morphology. 


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According to Dr B Ramesh, Chief Obstetrician and Gynaecological Laparoscopic Surgeon, and Founder and Medical director, Altius Hospitals, "It is also one of the most common causes for anovulatory infertility. Around 90 to 95 percent of women who do not ovulate during their menstrual cycles, it might be because of PCOS."


There are two types of PCOS, one being the obese or due to being overweight and another is lean PCOS. 80% of them will belong to the obese PCOS category and 20% to the lean category.


It is called Lean PCOS, when a lady's BMI (Body Mass Index) is less than 25 kg per meter square and she has features of PCOS. Since, it is a small proportion of patients which present to us with normal weight, it makes diagnostic workup and therapeutic approach more difficult.


"Obstetricians are known to advise weight loss for PCOS patients which is very effective in controlling the disease and improving the outcomes, but in case of a lean PCOS weight loss might not be the solution," comments Dr B Ramesh.


Diagnosis of Lean PCOS


There are other endocrine and genetic disorders which are with similar clinical picture that need to be excluded to make a diagnosis of lean PCOS. Thus, lean PCOS would be a diagnosis of exclusion.


There is a strict criteria that is followed to diagnose any case of PCOS and if everything fits in and other causes are ruled out, like Cushing syndrome or any other thyroid abnormalities, then it can be said that a woman is suffering from lean PCOS. However, people having obese PCOS suffer from more severe derangements than their lean counterparts. This does not mean that lean PCOS does not have insulin resistance, or further risk of developing diabetes or having infertility due to anovulation. It is just that it is less severe than obese PCOS. So, these women suffer from infertility as they do not ovulate.


They also have hormonal imbalance. There are two ovarian hormones which are secreted by the ovary named Follicle Stimulating Hormone that is FSH and luteinizing hormone that is LH. In lean PCOS women, like the obese PCOS, the proportion to these hormones is reversed, that is the LH is more prominent than FSH and in the ratio similar to 2: 1. So, when this happens the ovarian function is hampered.


Treatment Protocol for Patients who are Trying to Conceive


● Ovulation induction: Drugs can be given which cause ovulation in these patients and also can regulate their menstrual dysfunction by adding progesterone or Oral Contraceptive Pills which will help regularize their period post which they can try conception.
● For Acne and hirsutism: Patients are advised topical treatments, shaving or laser therapies.
● Surgery: The ovarian volume in these patients increases and hence, they can undergo laparoscopic ovarian drilling which will cause ovulation.
● In case all modalities fail then there is an option of IVF
● When it comes to lean women, they should aim to maintain their weight. Lifestyle modifications by regular physical activity has demonstrated to show improved insulin resistance, decreased hyperandrogenism and has had a beneficial effect on other PCOS symptoms as well.


Emotional and Psychological Aspects of Dealing with Lean PCOS-Related Infertility


Lean PCOS can cause infertility issues and this can have an impact on a woman’s mental health. From stigma around Lean PCOS to strain on relationship with partner, women can experience anxiety and disappointment. It is important to recognize these symptoms and seek appropriate help.


Below are a few suggestions


● Visit your gynaecologist and seek proper treatment
● Empower yourself with the right knowledge
● Build a support network of women who are going through a similar experience