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Cited by 156Ovarian function and disordersDiabetes, Cardiovascular Risks, and LipoproteinsEndometriosis Research and Treatment

Lean polycystic ovary syndrome (PCOS): an evidence-based practical approach

Open access
Toosy, Sehar, Sodi, Ravinder, Pappachan, Joseph M.·2018·Journal of Diabetes & Metabolic Disorders
DOI 10.1007/s40200-018-0371-5PMC PMC6405408
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Abstract

Background Polycystic ovary syndrome (PCOS) is a common endocrinopathy affecting women of reproductive age. Common features include menstrual irregularities, hyperandrogenism and polycystic ovarian morphology although the presentation can be heterogeneous. Insulin resistance is thought to be responsible for the hormonal and metabolic derangements observed. PCOS has two phenotypes, overweight/obese and lean, the latter being a much less common presentation of the syndrome.Aims The aim of the present review is to summarise cardinal features, and to devise diagnostic and treatment algorithms for lean PCOS based on recent literature.Methods We searched PubMed, EBSCOhost and Google Scholar using search terms such as 'lean polycystic ovary syndrome' OR 'lean polycystic ovarian syndrome' OR 'lean PCOS' OR 'lean polycystic ovary disease' OR 'lean polycystic ovarian disease' OR 'lean PCOD' OR 'hyperandrogenism' AND 'low BMI OR 'low body mass index' to identify potential articles to be included in the review. Citation searches were subsequently performed in order to find relevant literature.Results Hormonal, metabolic and haematological profiles were altered in lean women with PCOS compared to healthy counterparts. However, the derangements were either comparable or less obvious compared to obese women with the syndrome. Insulin resistance seemed inherent in PCOS independent of obesity. Treatment options included weight maintenance, restoration of ovulation with insulin-sensitizers such as metformin, relief of symptoms such as hirsutism, acne and menstrual dysfunction, and assisted reproductive technologies in refractory cases, all of which showed promising results. The literature with evidence on lean PCOS is of low to moderate quality and there are still some uncertainties in the evidence base.Conclusion Carefully designed randomised controlled trials are required to confirm findings of previous studies in lean PCOS and to consolidate diagnostic and management algorithms proposed in this review. This paper will aid health professionals to improve their clinical approach in managing lean women with PCOS.

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  • The majority of women with PCOS are overweight or obese, with reported prevalence ranging from 38% to 88%.

    “The majority of women with PCOS are overweight or obese and evidence indicates that the microbiome of obese individuals is capable of extracting more energy from the host diet compared with the microbiome of lean individuals [132].”

    From Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment (2022) · cites this paper as [152]

    The Introduction says a majority of people with PCOS are overweight or obese, and the “Lean polycystic ovary syndrome” section estimates that approximately 80% have above-normal or high BMI. Our copy does not report the claimed 38%–88% prevalence range or address the citing sentence’s claim that obese individuals’ microbiomes extract more dietary energy. (LLM, conf=0.88)

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  • Physiological regulation of insulin function can be viewed as an adaptive mechanism to regulate the metabolic pathway of insulin signaling (PI-3K) in response to changing environmental conditions or during normal alterations of internal states.

    “Physiological regulation of insulin function can be viewed as an adaptive mechanism to regulate the metabolic pathway of insulin signaling (PI-3K), in response to changing environmental conditions [starvation, fear, stress] [164,165] or during normal alterations of internal states (pregnancy, lactation, adolescence) [65,146,152].”

    From Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment (2022) · cites this paper as [152]

    The Pathophysiology of PCOS section says puberty may temporarily increase insulin levels and insulin resistance, supporting adolescence as an example of a normal internal change. It does not describe pregnancy or lactation in this connection, or identify PI-3K regulation as an adaptive mechanism. No page number is available in our copy. (LLM, conf=0.84)

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  • It is likely that all women with PCOS, whether obese or lean, have reduced insulin sensitivity.

    “When the physiology of insulin function is considered to be a quantitative or continuous variable from an evolutionary perspective, it is likely that all women with PCOS, whether obese or lean, have reduced insulin sensitivity [152,155,166].”

    From Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment (2022) · cites this paper as [152]

    The section on clinical signs in lean and overweight PCOS (page unavailable) reports greater insulin resistance in both groups than in controls. It does not establish reduced insulin sensitivity in all women with PCOS: it reports insulin-resistance prevalence of 83.3% and 93.1% in one comparison, and 44–70% in others. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Reported prevalence rates of insulin resistance in obese and lean women with PCOS vary widely.

    “reported prevalence rates in obese and lean women vary widely [147,152]”

    From Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment (2022) · cites this paper as [152]

  • Lean PCOS patients have increased plasma insulin 2 h after glucose administration compared with lean healthy participants.

    “Several reports showed the different metabolic disturbances characteristics in PCOS patients, like increased plasma insulin levels 2 h after glucose administration to lean PCOS patients, correlated with the lean, healthy participants.”

    From PCOS and nutritional approaches: Differences between lean and obese phenotype (2021) · cites this paper as [30]

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Authors
Toosy, S., Sodi, R., & Pappachan, J. M.
Affiliations
  • Lancaster University (GB)
  • University Hospitals of Morecambe Bay NHS Foundation Trust (GB)
  • Pilgrim Hospital (GB)
Corresponding author
Pappachan, Joseph M.
ORCID
Venue
Journal of Diabetes & Metabolic Disorders
Publisher
Springer Science and Business Media LLC
Published
2018-11-13
Volume
17
Issue
2
Pages
277-285
ISSN
2251-6581 (ISSN-L)
DOI
10.1007/s40200-018-0371-5
PMC
PMC6405408
OpenAlex
W2900701301
Cited by
154
References
78
Citations by year
2026: 28 · 2025: 21 · 2024: 34 · 2023: 27 · 2022: 22 · 2021: 16 · 2020: 3 · 2019: 2 · 2017: 1
FWCI
5.59
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Diabetes & Metabolic Disorders (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
Keywords
polycystic ovary syndrome, hyperandrogenism, insulin resistance, menstrual irregularity, PCOS phenotypes, metformin, ovulation induction, hirsutism, acne, assisted reproduction, diagnostic algorithm, treatment algorithm, low body mass index

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