3 Steps to treat Lean PCOS

By Clare Goodwin

Last updated: September 3, 2020

A few years ago Stephanie came to see me. Steph had just been diagnosed with PCOS after not being able conceive after 12 months due to cycles that were more than 90 days long. Following the diagnosis, she was told that because she wasn’t overweight, there was nothing that she could do, and the only other option was IVF.

Steph was very lean and had always had a perfect BMI and no weight issues. In her intake paperwork, Steph wrote that she felt lucky that she didn’t suffer from the weight gain or pre-diabetes that many women suffer with…..but when I looked at her bloodwork, it was a different story.

While Steph was a optimal weight, it didn’t mean that she had optimal insulin. Her blood sugar and insulin, while not outside of the medical reference range, were not optimal, meaning that she had some insulin resistance.
Steph was baffled, “How can I have insulin resistance? I’m not overweight!”
This is one of the biggest misconceptions in Lean PCOS and insulin resistance (even by doctors).
While it’s true that many people gain weight with insulin resistance, especially around their belly, many do not. In fact up to 75% of ‘Lean PCOSers’ have insulin resistance.

The great news for Steph is that after we made some small tweaks to her diet, exercise, supplements and lifestyle her cycles went from 90 days to 30 days in just one month and within 3 months she was pregnant.

In this article I’m going to go over the 3 steps to treat lean PCOS, of which, one is getting the right tests for your PCOS, so if you just want to jump to that, you can download my tests for insulin resistance below.

What is ‘Lean PCOS’

20-30% of women with PCOS are ‘lean’ or normal weight. Lean PCOS means that you have PCOS, but you don’t have a BMI over 25. That’s it. I really don’t think it’s a particularly helpful categorisation as it tells you nothing about what lifestyle factors could be contributing to your PCOS. This is why I told you Steph’s story to start with.

There is not one PCOS, or even one ‘Lean PCOS’- we are all different, both in terms of our symptoms, but also the genes that predispose us to developing PCOS and the factors in our environment that turn on these genes.

However what’s common among almost all of us, is that we have high levels of testosterone, DHEA-S and/or androstenedione which make up the Androgen family of hormones.

These are sometimes referred to as the male hormones, as males have more testosterone than females. But testosterone is crucial for females too as we need it for strong bones and libido

However, in excess, the androgens cause some issues for us. They cause acne, irregular periods, facial and body hair and hair loss.

We now know that genes can be turned on and off by factors in our lifestyle and environment. The most common factors in PCOS are:

  • High blood sugar or insulin
  • High stress
  • Environmental toxins like plastics and pesticides
  • Over or under exercising
  • Hypothyroidism

Do you really have PCOS or is it something else?

One thing I do find is that Lean PCOSers are often misdiagnosed. Up to 25% of all women have ‘cysts’ on the oviaries, but only 10% have the polycystic ovary syndrome. This is because the ‘cysts’ aren’t really cysts at all, they are just eggs (follicles) that haven’t been released when you didn’t ovulate.

Women with Hypothalamic Amenhorrea (HA) also don’t ovulate and can therefore have ‘cystic’ ovaries and they can also have facial or other body hair. However in the case of HA it’s not due to high testosterone or androgens as in PCOS.

Non- Congential Adrenal Hyperplasia (NCAH) is another condition that mimics PCOS. NCAH is a genetic condition and is almost impossible to distinguish from PCOS from symptoms alone. I’ve written an article on NCAH which you can read here.

But if it truly is PCOS, then here are 3 steps to treat Lean PCOS.

Manage your stress

Although I started with a story about insulin resistance, it’s actually high stress hormones that I see most commonly in ‘Lean PCOSers’. Stress can cause your body to over produce DHEA-S. DHEA-S is like a brother from another mother to testosterone- it does the same thing in terms of causing our PCOS symptoms like acne, hair growth or loss, and irregular periods, but it comes from a different place- our adrenal glands. Up to 50% of women with PCOS have high DHEA-S

Stress doesn’t just come from trying to fit ALL of our work, family, health and social commitments into one tiny 24 hour day. It also comes from internal infections in the body, or the biggest factors I see: lack of sleep and to much high intensity exercise.

  • ACTION: You might need a lot more sleep than what you think. Try going to sleep with enough time to sleep for 10 hours and see how long you sleep for. Repeat this for a week, and see by the end of the week how long you are sleeping for. You may be surprised to see if close to 9 hours or more!

Get your insulin checked

Insulin resistance: Up to 75% of women with ‘Lean PCOS’ have insulin resistance. Insulin resistance is your hormone that stores blood sugar in our cells, similar to how a key fits into a lock. However, our cells can become resistant to insulin and our body has to produce more and more insulin to do the same job. This increased insulin also increases testosterone which causes our PCOS symptoms: irregular periods, acne, unwanted hair growth or hair loss. If left untreated, it can also progress to Type 2 Diabetes.

The tests commonly used for picking up insulin resistance often miss early stage insulin resistance. The most common test, HbA1c (A1c) misses up to 82-94% of cases insulin resistance or prediabetes. Instead, you need to get much more sensitive tests for early stage insulin resistance, so I’ve compiled a download for you of the tests that will detect early stage insulin resistance.

  • ACTION: Download my tests for insulin resistance now.

Detox from toxins

Toxins especially plastics and pesticides can wreck havoc with our hormones. The chemicals in plastic, like BPA, are known as endocrine disruptors. All of our hormones, like testosterone and oestrogen are like keys, that fit into a lock on our cells. Endocrine disruptors mimic the shape of the key and fit into this lock, artificially raising the amount of Testosterone in our body.
Some of the most common toxins come from pesticides on our fruit and vegetables, and also in our personal care and makeup.

  • ACTION: Start to replace your makeup and personal care items with natural alternatives. The Environmental Working Group have done a great job of compiling the natural alternatives in the ‘Skin Deep’ collection. You can check it out here.

This is not an exhaustive list by any means. We are all different and you might need to do some further investigation for your personal situation.