Management of lean polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age, typically involving irregular menstrual cycles, elevated androgen levels, and polycystic ovaries. While insulin resistance is a known contributor to the metabolic and hormonal imbalances seen in PCOS, the syndrome presents differently across two primary phenotypes––the more common overweight/obese type and the less frequent lean type.

A new study aimed to summarize the key characteristics and develop diagnostic and treatment pathways for lean PCOS.

This was a literature review that searched PubMed, EBSCOhost, and Google Scholar for terms like “lean PCOS,” “hyperandrogenism,” and “low BMI,” followed by citation searches to identify relevant studies.

It was noted that lean women with PCOS show hormonal, metabolic, and hematologic differences from healthy individuals, though these abnormalities may be less severe than those in overweight PCOS patients. Insulin resistance seems inherent to PCOS – independent of body weight. In fact, lean and overweight PCOS phenotypes share many other clinical characteristics, such as hirsutism and menstrual dysfunction, and display similar hormonal profiles, with insulin resistance and hyperinsulinemia prominent in both groups. Elevated plasma insulin, LDL cholesterol, and other cardiovascular markers also characterize lean PCOS and may heighten risks for cardiovascular disease. Treatment strategies include weight maintenance, ovulation induction with insulin-sensitizers like metformin, and symptom management for issues like hirsutism and menstrual irregularities.

The current evidence on lean PCOS is of moderate to low quality, suggesting a need for further research. Randomized controlled trials are necessary to validate diagnostic and treatment approaches for lean PCOS, helping healthcare providers manage this subset of PCOS. Further study into lean PCOS, with rigorous trials, will enable more effective and individualized treatment pathways, addressing hormonal, metabolic, and hematologic alterations in this group.

Source: Toosy S, Sodi R, Pappachan JM. J Diabetes Metab Disord. 2018;17(2):277-285. Published 2018 Nov 13. doi:10.1007/s40200-018-0371-5