Living With & Understanding Lean PCOS

 
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If you’ve ever googled ‘how to manage PCOS’ I’m sure you’ve come across one of the following treatment strategies:

  • Diet, and perhaps even restrictive dieting

  • Exercise, and most notably, HIIT

  • And most suggested, weight loss

 Unfortunately, the bulk of PCOS treatments, PCOS research, and our understanding of how to even diagnose PCOS properly, is based on only one type of PCOS: overweight, or what I prefer to call ‘Classic’ PCOS.

The truth is that PCOS is a spectrum condition

That means some individuals with PCOS fall into that classic presentation of ‘trouble losing weight, not getting a regular period, losing hair, etc’. But on the other side of the spectrum, there’s a very different person. This person might actually have a hard time gaining weight, they might get regular periods, they might not be insulin resistant, BUT they might be struggling with acne, or infertility, or severe anxiety. This person is likely to feel worse with restrictive dieting, HIIT, and weight loss.

This is Lean PCOS. Sadly, lean PCOS is like the ‘forgotten’ PCOS. There’s very little we know about why it happens, how to improve diagnostics, and most importantly, how to go about treating this type of PCOS most effectively.

Here’s what we do know about lean PCOS:

  • 20-30% of women with PCOS are average weight or lean.

  • Individuals with lean PCOS face more misdiagnosis issues. It takes longer to receive an accurate diagnosis of PCOS, and down the line, diabetes is often missed in these individuals because they are not screened appropriately at the time of their PCOS diagnosis.

  • Individuals with lean PCOS have much higher rates of depression, anxiety, and lower resiliency to stress. This is likely due to hormone differences, as this population has higher levels of DHEA, ACTH, and cortisol levels. These are hormones that reflect a heightened stress response in the body. Clinically, I have found a lot of these ‘lean’ PCOS individuals may also have lower estrogen levels.

In many cases, lean PCOS can feel like a completely different condition than classic PCOS. Taken together, someone with lean, non-insulin resistant PCOS, isn’t left with very many treatment options or practitioners that understand the unique nature of their condition.

My Essentials for Lean PCOS

Having struggled with PCOS (and lean PCOS) myself, I have committed myself to understanding all aspects of this condition fully. Based on the research that HAS been completed on this type of PCOS, and through my clinical experience, here are the things I consider ESSENTIAL for someone struggling with lean PCOS.

stress Reduction Strategies

This is my number one, and non-negotiable for lean PCOS. It’s been proposed that increased sensitivity to cortisol (our stress hormone) kicks off the hormonal dysfunction and imbalance we see in lean PCOS. In simpler terms, it’s been theorized that heightened stress is the underlying driver of lean PCOS.

Studies are emerging on stress reduction strategies and PCOS and the results so far seem extremely promising! Mindfulness meditation, mindful yoga, CBT, and acupuncture have all been found to provide benefit.

Living Life in Moderation

Restricting calories, restricting types of foods, and engaging in high intensity workouts, have all been shown to elevate cortisol levels which is exactly what we are trying to avoid in this PCOS type. Although this approach may provide benefit in a ‘Classic’ PCOS population, it doesn’t necessarily translate to benefits for lean PCOS. Approaching food and exercise with moderation in mind is a much better place to start.

Targeted Supplementation

Clinically, I have found that Classic PCOS can manage their PCOS through lifestyle modifications alone. Sadly, I don’t find that to be the case with lean PCOS.

Supplements aimed at normalizing our stress response, normalizing hormone imbalances such as elevated DHEA/testosterone, and improving estrogen and progesterone levels are often required.

Targeted supplementation should always be prescribed by a Naturopathic Doctor with a strong understanding of PCOS.

A Final Word

If you’re struggling with lean PCOS, know that there are options available to you! They just look and feel VERY different than what’s mentioned online for PCOS treatment. When in doubt, always speak with your Naturopathic Doctor or primary care provider to learn more, and to help you understand what’s required to approach your PCOS in the most optimal way!


dr alessia milano

Ready to make a change?

If you’re looking for more information on how we approach PCOS here at The Clara Clinic, you can read up on our Perfect PCOS Program here, or if you’re ready to get started, you can book a complimentary consult with me here..

With loving compassion,

Dr. Alessia Milano, ND