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Lean polycystic ovary syndrome (PCOS): an evidence-based practical approach
Open accessAbstract
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 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]
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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 [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]
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“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]
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“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]
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“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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“These lean PCOS patients may or may not have the cardinal symptoms such as irregular menstrual cycles and acne [30].”
From PCOS and nutritional approaches: Differences between lean and obese phenotype (2021) · cites this paper as [30]
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“Also, important risen low-density lipoprotein (LDL) and total cholesterol have been associated in lean PCOS women versus controls [1,30,55].”
From PCOS and nutritional approaches: Differences between lean and obese phenotype (2021) · cites this paper as [30]
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Metadata
- 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.
- Venue
- Journal of Diabetes & Metabolic Disorders
- Published
- 2018-11-13
- Volume
- 17
- Issue
- 2
- Pages
- 277-285
- ISSN
- 2251-6581 (ISSN-L)
- 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
- FWCI
- 5.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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