As mentioned above, metformin is sometimes used to help women with PCOS conceive. However, it may improve ovulation in women with PCOS. One study found that, when compared to obese women with PCOS, lean women with the condition treated with metformin were twice as likely to have menstruation and ovulation return. They also found that testosterone levels decreased and fasting glucose improved in lean women with PCOS.
These improvements were not seen at all in the obese women with PCOS. But, you are more likely to have success when compared to those who are overweight or obese with PCOS. There are lifestyle habits and changes lean women with PCOS can make to improve their overall health and support positive outcomes.
Maintaining a healthy weight matters for all women with PCOS—it can help improve overall outcomes. Research has found that as women with PCOS age, they are more likely to develop insulin resistance—although that risk was lower for lean women. One possible solution to this could be resistance exercise. Progressive resistance exercise is weight training specifically intended to increase strength and muscle mass. This is done by slowly increasing the weight being lifted or the repetitions being completed.
A study of lean women with PCOS found that adding resistance training helped decrease visceral fat the abdominal fat that increases your risk of insulin resistance , decreased elevated androgen levels, improved menstrual and ovulatory irregularities, and increased lean muscle mass.
The muscle mass element is especially important. The more muscle mass one carries, the more calories they require to maintain your weight. Another way to improve your quality of life when living with PCOS is receiving professional counseling, especially if you experience anxiety or depressed moods. While therapy may not completely eliminate these emotional struggles, it can help significantly. If you have PCOS and you're at a normal weight, what are the best things you can do for your health?
Being diagnosed with PCOS and finding most information targeted to overweight women can be frustrating and invalidating. Know that you are not invisible, and normal weight and thin women with PCOS do exist. You're not the only one. PCOS diagnosis involves a physical exam, bloodwork to test hormone levels and to see if the patient is ovulating, and imaging tests, such as a transvaginal ultrasound.
Healthcare provider sometimes also perform an endometrial biopsy to check for endometrial cancer, which is more common in those with PCOS. These symptoms include unwanted body hair, irregular or missed periods, and insulin resistance. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life.
Metformin monotherapy in lean women with polycystic ovary syndrome. Reprod Biomed Online. Goyal M, Dawood AS. Debates regarding lean patients with polycystic ovary syndrome: a narrative review. J Hum Reprod Sci. Hum Reprod. Marshall JC, Dunaif A. Should all women with PCOS be treated for insulin resistance?
Fertil Steril. Insulin resistance of normal weight central obese adolescents in Korea stratified by waist to height ratio: results from the Korea National Health and Nutrition Examination surveys Int J Endocrinol. Differences in the psychological and hormonal presentation of lean and obese patients with polycystic ovary syndrome. Neuro Endocrinol Lett. Assisted reproductive technologies are reserved for women who do not conceive despite the restoration of ovulation or couples with additional factors contributing to their infertility.
This review will outline treatment strategies for achieving a healthy pregnancy among lean and obese women with PCOS and infertility. In addition, overweight women with PCOS are less likely to respond to the pharmacological induction of ovulation.
Popova et al. A significant decrease in testosterone level from 3. There was no change in BMI and waist circumference in both groups. They concluded that treatment with metformin mg daily was more effective in lean than in obese women with PCOS.
Its efficacy was independent of the initial surrogate markers of resistance to insulin. Krohn et al. A similar but nonsignificant trend was identified in women undergoing oral ovulation induction—IUI.
It is still unclear whether metformin is also beneficial for lean women with PCOS. A previous study showed that metformin improved hirsutism scores and ovulation and decreased dehydroepiandrosterone sulfate levels in lean women with PCOS. A study suggested that metformin use in patients with PCOS should be restricted to women with glucose intolerance,[ 49 ] but others disagreed with this suggestion.
Another study was conducted to compare the ovulation and pregnancy rates in response to metformin therapy in lean and obese women with PCOS. Comparison between lean and obese women was found to be statistically significant. Metformin monotherapy is very effective in improving the ovulation and pregnancy rates in lean women with PCOS as compared with obese women. Metformin can be given as a first-line drug to all women obese and nonobese with PCOS and anovulatory infertility.
Although there have been concerns expressed about the risk of hypoglycemia in lean anovulatory women with PCOS on metformin treatment, this risk is low. The risk of hypoglycemia should be extremely unlikely, particularly because IR is linked with anovulation in PCOS, even in lean women.
It is, therefore, recommended that all women using metformin must be advised to look out for the signs of hypoglycemia and stop treatment if this is suspected. Studies proved that the administration of myoinositol 3 g per day reduced luteinizing hormone LH , high-sensitivity C-reactive protein hs-CRP inflammation , and androgens, as well as improved insulin tolerance test, in lean patients with PCOS. The administration of myoinositol, acting as a direct messenger of insulin signaling and improving the glucose uptake in tissues, could improve the IR status of women with PCOS, restoring their hormonal status and restoring the ovulation process.
Although some studies discouraged the use of myoinositol in lean patients with PCOS and stated that it may not be suitable or effective for lean patients with PCOS, especially if they do not have IR. Celik et al. They recommended that l-carnitine could be used as an adjunctive therapy in the management of IR or obesity in women who have PCOS.
Orvieto et al. Lifestyle modification is very important in the treatment for PCOS, because weight loss and exercise have been shown to lead to improved fertility and the lowering of androgen levels. It also reduces the long-term risk of diabetes, heart disease, and possibly endometrial cancer. Evidence-based guidelines recommend that lifestyle modification regimens should incorporate a dietary intake consistent with usual dietary guideline recommendations with modified macronutrient composition.
This can be followed by weight maintenance, that is the prevention of weight gain in lean women with PCOS. Tehrani et al. Lifestyle intervention improves body composition, hyperandrogenism high levels of male hormones and clinical effects , and IR in women with PCOS. There was no evidence regarding the effect of lifestyle intervention on improving glucose tolerance or lipid profiles and no literature assessing clinical reproductive outcomes, the quality of life, and treatment satisfaction.
It is extremely important that lean women with PCOS get a variety of nutrients, minerals, and vitamins in their diet; therefore, they need to make sure that their diet contains plenty of vegetables and some fruit.
In addition, because lean patients with PCOS do not need to lose weight, they do not need to restrict their caloric intake. Complementary to the dietary and lifestyle changes, patients need to focus on supporting their body by promoting healthy hormonal balance, a healthy uterine lining, regular ovulation, improving estrogen metabolism, and ultimately a healthy pregnancy This could be achieved by vitamins and minerals such as calcium and vitamin D, as well as herbs that promote hormonal balance and support regular ovulation such as Vitex Vitex agnus-castus and maca Lepidium meyenii , licorice root Glycyrrhiza glabra , and white peony Paeonia lactiflora.
Additional nutritional supplements such as essential fatty acids in evening orimrose oil and cod liver oil, saw palmetto Serenoa repens , and d-chiro-inositol and myoinositol improve the previously mentioned benefits of a healthy diet. Lean women populations with PCOS are a unique group and have different phenotypic, metabolic, hematologic, and neurologic characteristics than obese participants with PCOS.
Till recently, there was an ongoing debate regarding the previously mentioned characteristics; in addition, the existing management options are mostly not appropriate for this category of patients with PCOS. Further studies are required to clear and solve this debate. National Center for Biotechnology Information , U.
J Hum Reprod Sci. Manu Goyal 1 and Ayman S. Dawood 2. Ayman S. Author information Copyright and License information Disclaimer.
Address for correspondence: Dr. E-mail: ge. This article has been cited by other articles in PMC. Metabolic and hematological abnormalities Sharma et al. Hormonal abnormalities in lean women with PCOS Leptin levels are increased in lean women as evidenced by a study conducted by Chen et al.
Management options for lean women with PCOS Weight loss Weight loss is first-line therapy for obese women with PCOS, but is not a therapeutic option for nonobese women with the disorder. Ovulation inducing agents Lifestyle modification is recommended as first-line therapy among obese women with PCOS to optimize their outcomes.
Myoinositol Studies proved that the administration of myoinositol 3 g per day reduced luteinizing hormone LH , high-sensitivity C-reactive protein hs-CRP inflammation , and androgens, as well as improved insulin tolerance test, in lean patients with PCOS. Diet and lifestyle in lean PCOS Lifestyle modification is very important in the treatment for PCOS, because weight loss and exercise have been shown to lead to improved fertility and the lowering of androgen levels.
Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Exp Clin Endocrinol Diabetes. Nestler JE, Jakubowicz D.
J Clin Endocrinol Metabol. Polycystic ovarian syndrome during puberty and adolescence. Mol Cell Endocrinol. Gynecol Endocrinol. The impact of insulin resistance on clinical, hormonal and metabolic parameters in lean women with polycystic ovary syndrome.
J Obstet Gynaecol. Kar S. Metabolic risks of the lean PCOS woman. Fertil Steril. Assessment of insulin resistance in lean women with polycystic ovary syndrome. Relation of intra-abdominal fat distribution to metabolic disorders in nonobese patients with polycystic ovary syndrome. Global adiposity rather than abnormal regional fat distribution characterizes women with polycystic ovary syndrome.
J Clin Endocrinol Metab. Kirchengast S, Huber J. Body composition characteristics and body fat distribution in lean women with polycystic ovary syndrome. Hum Reprod. Body composition, fat distribution and metabolic characteristics in lean and obese women with polycystic ovary syndrome.
J Endocrinol Invest. As such, eating foods high in probiotics — such as yogurt, kefir, sauerkraut, and other fermented foods — may help increase the number of beneficial bacteria in your gut. Women with PCOS have often tried many diets and are three times more likely to have eating disorders Mindful eating is one potential solution. It promotes an increased awareness of bodily cues, such as hunger and fullness. Mindfulness-based approaches to food may help address problematic eating behaviors — especially binge eating and emotional eating Processed foods and added sugars may raise blood sugar levels and increase your risk of insulin resistance, which is linked to obesity Research shows that women with PCOS experience larger spikes in blood sugar and insulin levels after consuming the same amount of sugar as women without this condition Studies indicate that minimally processed, real foods not only raise blood sugar less than highly processed foods but are also more satisfying Furthermore, experts recommend that women with PCOS limit their consumption of added sugars and refined carbs to manage symptoms and maintain a healthy body weight 2 , But chronic inflammation — which is common in women with PCOS — is linked to obesity.
Sugar and processed foods may contribute to inflammation In one study, 16 women with PCOS who took a one-time dose of 75 grams of glucose — a particular type of sugar — had higher blood markers for inflammation, compared to women without this condition A diet like the Mediterranean diet — which is high in fruits, vegetables, whole grains, olive oil, and omegarich foods, such as fatty fish — may protect against inflammation Long-term calorie restriction may slow down your metabolism.
Although calorie restriction is likely to lead to short-term weight loss, over time, the body adapts to this restriction by reducing the number of overall calories it burns, which can lead to weight regain For example, in one study, restrictive dieting was found to modify the hormones leptin, peptide YY, cholecystokinin, insulin, and ghrelin, which increased appetite and led to weight gain Instead of restricting calories, it may be best to focus on eating whole foods and cutting out unhealthy products.
For example, a study in over people suggested that eating more vegetables and whole foods — while reducing consumption of processed foods, refined grains, and added sugars — may help promote weight loss without restricting calories Exercise is a well-known strategy to improve weight loss.
In a week study in which 16 women did 45—60 minutes of cardio 3 times per week, those with PCOS lost 2. While women with PCOS lost less fat than those without this condition, the exercise regimen did result in loss of belly fat and improvements in insulin sensitivity. In one study, 45 women with PCOS did weight training 3 times weekly. After 4 months, they lost belly fat and gained lean body mass while reducing testosterone and blood sugar levels If you have PCOS, you may experience sleep disturbances, including excessive daytime sleepiness , sleep apnea, and insomnia Lack of sleep has been shown to increase the activity of hormones that drive hunger, such as ghrelin and cortisol, which may cause you to eat more throughout the day In fact, insufficient sleep is associated with a higher risk of being overweight or obese A review of 18 studies found that those who slept less than 5 hours per night were significantly more likely to be obese.
Furthermore, the study demonstrated that every hour of additional sleep per night was associated with a decrease in body mass index BMI of 0. Additionally, studies have linked better-quality sleep to fat loss.
Because stress is a risk factor for weight gain, managing your stress can help manage your weight. Stress increases levels of cortisol, a hormone made by your adrenal glands. Chronically high cortisol levels are linked to insulin resistance and weight gain Chronic stress also increases your risk of developing belly fat.
In turn, belly fat increases inflammation, which triggers your body to make more cortisol — creating a vicious cycle Studies note that techniques like meditation, yoga , and spending time in nature can help lower cortisol levels 41 , 42 , Myo-inositol is a supplement that may lead to weight loss in women with PCOS. Inositol is a compound related to B vitamins that helps improve insulin sensitivity.
Myo-inositol is a specific form of inositol. In a randomized study in 92 women with PCOS, half were given 4 grams of myo-inositol per day for 14 weeks.
While those in the inositol group lost weight, those in the placebo group gained weight In a week study in 60 overweight women with PCOS, those who took mg of carnitine per day lost an average of 5. Losing weight can be a struggle for women with PCOS.
A balanced diet — low in inflammatory foods like refined carbs and highly processed foods but rich in whole foods, protein, healthy fats, and fiber — may aid weight loss.
Certain supplements may help as well.
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