It is diagnosed when there are irregular periods, excessive hair growth and many small cysts on the ovaries.

“PCOS remains an enigmatic condition, its pathophysiology is complex and is the result of interactions between genetic, epigenetic, ovarian dysfunction, endocrine, neuroendocrine and metabolic among other changes” points out Mr. Vasilios Nikas, Obstetrician – Gynecologist, Scientific Associate LITO continues:

“Insulin resistance is thought to be responsible for the hormonal and metabolic disturbances seen in the syndrome. PCOS has two phenotypes, overweight/obese and normal weight/thin, with the latter being the much less common form of the syndrome with 20-50% of women with PCOS being normal weight or thin. In the small but important percentage of patients with a normal body mass index (BMI, ≤25 kg/M2 ), the diagnosis and the therapeutic approach are more difficult. These cases are called normal weight PCOS.

Other endocrine causes and genetic disorders with a similar clinical picture must be excluded in such cases before the diagnosis is made. There is consensus that PCOS is a diagnosis of exclusion. The syndrome must be diagnosed after conditions such as Cushing’s syndrome, thyroid disorders, idiopathic hirsutism, and hyperprolactinemia have been ruled out.

About 80% of people with PCOS have BMI values ​​above normal or high and show typical features such as hyperandrogenism, polycystic ovaries on ultrasound and insulin resistance. These individuals often go undiagnosed until they experience fertility problems as adults.

A smaller but distinct percentage of women with PCOS have a normal or low BMI and may or may not have symptoms, such as irregular periods or acne.

Obese people with PCOS suffer from more severe hormonal and metabolic disturbances compared to their normal weight counterparts. Metabolic changes in lean women with PCOS relative to overweight women, as well as changes in levels of the peptide hormones adiponectin and ghrelin, have been investigated. Lean women with PCOS had significantly greater insulin resistance compared to their BMI-matched counterparts without PCOS. However, the rate of IR (insulin resistance) was even higher in obese women with the syndrome. Although there are hormonal and metabolic disorders in thin women with PCOS, the changes are more serious in obese people”, emphasizes Mr. Nikas.

Treatment of the syndrome

“Weight loss is considered a first-line treatment in women with the obese phenotype of PCOS, but this is not considered in lean women with the syndrome. Caloric restrictions are unnecessary, as thin women do not need to lose weight. In contrast, thin women with PCOS should aim to maintain a normal weight.

Lifestyle modifications with dietary interventions and regular physical activity (resistance training, eg, weight lifting or bodyweight exercises, while running is not recommended) have shown improved insulin resistance and improvement in hyperandrogenism, among other benefits effects.

Psychological and emotional support is also essential, as thin women with PCOS are more likely to experience depression and anxiety problems. Thin people with PCOS should be encouraged to consume vegetables and fruits to ensure they have an adequate supply of various trace elements, vitamins and nutrients.

Metformin is an insulin sensitizing agent. The use of metformin is more successful in restoring menstruation (55%) and ovulation (45%) in lean women with PCOS compared to their obese counterparts.

Administration of myoinositol (3 g/day) appears to have a positive effect on lean women with PCOS. Treatment leads to a decrease in LH, androgens, CRP and insulin resistance. Hormonal profile and ovulation were restored in women with PCOS,” he reports.

“Early diagnosis and personalized therapeutic intervention is necessary to improve the metabolic and endocrinological parameters of Polycystic Ovary Syndrome, both in overweight and normal weight individuals” concludes Mr. Nikas.