Thin With PCOS: “How can I have PCOS if I’m not overweight?”

by Dr. Sari Cohen

From PCOSA Today Newsletter, September/October 2007

Are you confused about your diagnosis of PCOS because you are thin? Many people think that everyone with PCOS is overweight, but this is not the case. In fact, at least half of women diagnosed with PCOS are of normal weight or lean. Some women with PCOS are even underweight.

While insulin resistance is generally thought to be the underlying cause of most cases of PCOS, there is disagreement in the medical community about whether thin women with PCOS suffer from the same degree of insulin resistance as their heavier counterparts.

Some studies support the presence of insulin resistance in both lean and obese women with PCOS. Furthermore, lean women with PCOS do seem to struggle with insulin-glucose regulation, even though it is not classified strictly as “insulin resistance.” Thin women with PCOS have higher insulin levels in their blood than thin or normal weight women without PCOS, according to researcher Vrbikova and associates in the 2004 article “Insulin Sensitivity in Women with Polycystic Ovary Syndrome” published in The Journal of Clinical Endocrinology and Metabolism.

Moreover, even if the serum insulin levels are normal, the ovaries of women with PCOS tend to be over-sensitive to the effects of insulin, thereby leading to increased ovarian androgen output.

Oral contraceptives are commonly prescribed to women with PCOS, regardless of whether they are overweight or of normal weight. However, using oral contraceptives in women with “lean PCOS,” as it is termed, may increase the risk of weight gain in this population and put them more at risk for insulin resistance or other negative effects on insulin and glucose metabolism.

Women with lean PCOS have much in common with their heavier counterparts. For example, lean women with PCOS may still have the same risk factors for cardiovascular disease as overweight women, according to a study conducted by Kravariti and colleagues and reported in the September 2005 issue of The Journal of Clinical Endocrinology and Metabolism. They conclude that all women with PCOS, regardless of weight or BMI, should work to prevent cardiovascular complications.

Another article by Tarkun et al published in The Endocrinology Journal in October 2004 suggests that lean women with PCOS were at higher risk of cardiovascular disease and anovulatory infertility compared to age-and weight-matched healthy women without PCOS. Therefore all women with PCOS should work to prevent complications like hypertension and diabetes mellitus. This can be accomplished through a whole foods, low carbohydrate diet, an exercise plan tailored to you, and certain nutritional and herbal supplements.

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About the author

Dr. Sari Cohen received her doctorate in naturopathic medicine with High Honors from the Southwest College of Naturopathic Medicine, and graduated cum laude from Dartmouth College. A clinical practitioner in New Hampshire, where she sponsors a PCOS support group, Dr. Cohen is the author of the prize-winning article “Melatonin, Menstruation and the Moon” published in The Townsend Letter for Doctors and Patients. A contributing author of the Board Review Study Materials for the Naturopathic Physicians Licensing Examination, she is also a member of Insulite Laboratories’ Medical & Advisory team where she undertakes research and provides professional guidance to individuals with insulin-related disorders. Dr. Cohen has developed the company’s 52-week Customer Protocol and has co-authored The Insulite Guide to Reversing Insulin Resistance and its Related Conditions.

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