Can you be diagnosed with PMOS without being overweight? What women need to know about lean PMOS
Lean PMOS affects about 20 to 30 per cent of all patients and is more common in women who have a normal or low body mass index (BMI) under 25
Lean PMOS, or Polycystic Ovary Syndrome in women with normal body weight, affects a significant portion of patients and is often overlooked due to its atypical presentation. Unlike conventional understanding, lean PMOS is driven by hormonal and genetic factors, particularly cellular insulin resistance, which disrupts the delicate balance of hormones and leads to ovulatory dysfunction.
Lean PMOS, or Polycystic Ovary Syndrome in women with normal body weight, affects a significant portion of patients and is often overlooked due to its atypical presentation. Unlike conventional understanding, lean PMOS is driven by hormonal and genetic factors, particularly cellular insulin resistance, which disrupts the delicate balance of hormones and leads to ovulatory dysfunction.
Lean PMOS, or Polycystic Ovary Syndrome in women with normal body weight, affects a significant portion of patients and is often overlooked due to its atypical presentation. Unlike conventional understanding, lean PMOS is driven by hormonal and genetic factors, particularly cellular insulin resistance, which disrupts the delicate balance of hormones and leads to ovulatory dysfunction.
For ages, PMOS has been associated with overweight, with gaining weight considered to be one of its key manifestations. Although less common, women with normal body weight, or what we call a 'lean body', also suffer from this condition.
Lean PMOS affects about 20 to 30 per cent of all patients and is more common in women who have a normal or low body mass index (BMI) under 25. Many of them suffer in silence as PMOS often goes undiagnosed or is delayed for many years because doctors don’t expect lean girls to have the condition.
Why do lean women get PMOS?
Women with normal or low body weight can still develop PMOS because the condition is driven by hormonal and genetic factors, not body weight per se. Body weight is a common feature or may even be a compounding factor, but it doesn’t define or exclude PMOS.
In lean women, the main cause usually is cellular insulin resistance, wherein cells struggle to process glucose correctly, forcing the body to pump out extra insulin. This excess insulin signals the ovaries to overproduce testosterone, while hyperactive adrenal glands release stress hormones. All of these disrupt the brain-ovary connection, raising Luteinizing Hormone (LH) levels and stopping egg follicles from maturing. As a result, ovulation fails, and the symptoms begin to appear.
Are symptoms different?
Not necessarily. Hidden signs such as irregular/missed periods, acne, excess facial hair, hair thinning, and cyst formation can signal PMOS even without weight gain. But diagnosis is often delayed because it defies the visual stereotype of the condition that we are so accustomed to noticing in most patients. Also, the fact that standard glucose tests often appear normal, which hides the underlying cellular insulin resistance, and a fasting insulin test is rarely recommended. If oral hormonal birth control is prescribed for acne or irregular cycles, that also hides the underlying hormonal imbalance, which is the root cause.
Management of lean PMOS
Unlike PMOS in overweight women, Lean PMOS need not focus on weight loss as part of the care regimen. Hence, management focuses entirely on insulin sensitivity, adrenal calming, and ovulatory support.
Lifestyle changes include adding nutritional and anti-inflammatory foods to the diet such as complex carbohydrates, proteins, and healthy fats. This aims to prevent insulin spikes without restricting calories. Adding to it is regular physical activity: consider strength training to build muscles instead of high-intensity cardiac exercise (to avoid an increase in stress hormones). Stress management through other means such as yoga and meditation can further help regulate hormones.
Along with lifestyle changes, appropriate medical treatment is necessary to improve hormonal balance at the cellular level. Medications may include insulin sensitizers, inositol supplements, and anti-androgen treatments to restore regular, natural ovulation.
(The author is an obstetrics & gynaecology consultant at Manipal Hospital Whitefield)
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.