LEAN VS OBESE PCOS Myths & Facts Dr Sharda Jain & Dr Jyoti Agarwal

1. Myths &
FACTS
Dr Shada Jarin
Dr Jyoti Agarwal
LEAN VS OBESE

2. PCOS
• Commonest Endocrinopathy of reproductive AGE
• INCIDENCE :1 IN 5
• Commonest cause of Anovulatory Infertility (WHO
group 2 )
• Most Women are Obese , but 20-30 % belong to
Lean phenotype

3. Myths 1
OBESITY CAUSES PCOS

4. Answer
Obesity is not the only factor that plays a role in PCOS
causation . There are other factors such as genetics,
epigenetics , exposure to androgens in utero and
environmental factors which interplay causing PCOS .
Obesity & weight gain helps in sustaining PCOS.
Moreover Obese PCOS women find it difficult to lose
weight thus forming a vicious circle.

5. Myth 2
SYMPTOMS IN LEAN PCOS ARE
DIFFERENT FROM OBESE PCOS

6. Answer 2
The symptoms in both the phenotypes of PCOS are more or less
the same like
mentrual irregularity, acne , hirsutism , thinning of hair .
Weight gain is seen in obese PCOS alone .
The incidence of severe menstrual irregularity . like amenorrhea ,
dysfunction uterine bleeding and hirsutism is more commonly seen
in the obese PCOS.

7. Myth 3
AMH levels can be used to
diagnose PCOS.

8. Answer 3
AMH levels are significantly higher in
PCOS than the non PCOS counterparts
. Serum AMH >5.03ng/dl has been
suggested as a cut off.

9. Answer 3
• For diagnosis PCOS: However it does not find any place
in the Rotterdam's Criteria.
• It cannot be used as an independent marker but only
as an adjunct marker .
• Interestingly lean PCOS have a higher AMH level, which
could be explained by the fact that lean PCOS may have
a higher LH levels and thus a high LH : FSH ratio which
positively correlates with AMH levels

10. Myth 4
Insulin sensitizes should be
prescribed to obese PCOS alone

11. Answer 4
• Obese PCOS have a higher incidence of insulin resistance
(90%) as compared to lean PCOS (50%).
• Insulin Resistance Hyperinsulinemia & Hyperandrogenemia
are the key players in the pathophysiology of PCOS.
• It has been found that in at least 50% of PCOS women
insulin resistance appears to be related to Insulin Receptor
Defect to both the phenotypes of PCOS with insulin
resistance.

12. Myth 5
Obese PCOS more at risk of developing
Metabolic Syndrome (MBS) than Lean PCOS.

13. Answer 5
CENTRAL ADIPOSITY which is a component of
MBS is seen more often in the Obese PCOS,
although lean PCOS are also not spared.
Metabolic syndrome includes
central obesity ( waist- hip ratio > 0.8)
hypertension (BP>130/85), dyslipidemia and
impaired glucose as its components .
MBS affect 33% of women with polycystic
ovarian Syndrome patients mostly Obese.

14. Myth 6
Life style modification are only for
the obese phenotype

15. Answer 6
Lifestyle modification are advised to
both the phenotypes . These include
diet , exercise and weight
management .
Even 5-10% of weight loss can help
the obese PCOS.

16. Answer 6
Whereas LEAN PCOS are advised
weight maintenance.
Both the categories advised to refrain
from unhealthy diets such as high
carbohydrate diet, saturated fats such as
cream or cheese and fatty red meats as
well as processed or fried foods.

17. Answer 6 contd.
• These unhealthy fats increase estrogen
production worsening the PCOS symptoms .
• Instead they are advised the Mediterranean
diet which includes fresh fruits , vegetables ,
nuts seeds and oils.
• OUR modification : Fruits 10 x your weight in
grams till 12 noon , SALAD 5X WT  DIET

18. Answer 6 contd
• Both the phenotypes of PCOS are advised to
EXERCISE which helps in weight loss , improving
muscles mass , improving capillary circulation ,
reduce body fat % and insulin resistance .
• Obese PCOS are advised thirty minutes of
moderate intensity exercise at least three times a
week which includes aerobic exercise .
• Lean PCOS are advised strength training to build
up their muscles mass.

19. Myth 7
PCOS drilling benefits the lean
PCOS More than Obese

20. Answer 7
• PCOS drilling benefits the LEAN PCOS more
than the obese.
• In today’s scenario LAPAROSCOPIC PCOS
drilling is no longer the preferred line of
managing PCOS but can be done if
laparoscopy is done for some other reason
like tubal factor with coexisting PCOS or
clomiphene resistant PCOS.

21. Myth 8
Lean PCOS tend to
HYPER STIMULATE more than obese PCOS

22. Answer 8
• Lean PCOS are more at risk of hyper
stimulation than the Obese .
• So the dictum of using low dose step up
protocol with gonadotropins seems to
be the right choice for LEAN PCOS for
ovulation induction in clomiphene
resistant patient .

23. Answer 8
In IVF cycles in LEAN PCOS 
the antagonist cycle with agonist trigger &
freeze all strategy seems to work avert
ovarian hyper stimulation syndrome (OHSS)

24. Myth 9
Obese PCOS are more at risk of
developing cancers in later life

25. Answer 9
OBESE PCOS are more at risk for
developing endometrial hyperplasia and
endometrial cancer
more than their Lean counterparts .
phenotype.

26. Answer 9
This could be explained by the high estrogen
and low progesterone levels
seen in Obese PCOS patients.
The risk are accentuated by the higher risk of
Metabolic Syndrome in the obese phenotype.
However, the association between PCOS and
either breast or ovarian cancer is more complex
& requires more well designed studies

27. MYTH 10
Dysbiosis & Inflammation plays
Major Role In PCOS

28. Answer 10

29. Answer 10