Is There A PCOS Body Type?

What is PCOS?

Polycystic ovary syndrome, or polycystic ovarian syndrome, affects one in ten women of childbearing age. Women who have it may have excess androgens (male hormones) — hyperandrogenism, irregular or absent periods, and/or small cysts on the ovaries.

The exact cause of PCOS is not known, but experts believe that genetics may play a role as it commonly runs in families. Many people only discover they have PCOS when they try to get pregnant, as the condition commonly causes infertility.

PCOS can be managed, but it cannot be cured. It is a complex endocrine disorder that does not only affect the ovaries but also results in insulin resistance and can increase your risk of other diseases, especially as you get older.

What are the symptoms of PCOS?

Not everyone with PCOS gets all these symptoms, but typical symptoms include:

• Hirsutism (excessive hair) on the face, chin, back, etc. Some people with PCOS grow a full beard.

• Acne on the face, chest, and upper back

• Thinning hair and loss of hair on the scalp

• Irregular menstrual cycle. Some women frequently miss periods, while others have a cycle more frequently than once a month. Other women have intermittent periods.

• Being overweight/obese

• Darkening of the skin (acanthosis nigricans) along neck creases, under breasts, and around the groin and associated skin tags (acrochordons)

As weight gain is a common symptom and obesity can increase the risk of developing PCOS symptoms, there is a perception that only overweight people suffer from PCOS. Weight gain may also be the only symptom of PCOS, and patients often struggle to lose weight.

From a causal perspective, obesity is thought to be a cause of PCOS, yet PCOS does not seem to increase the risk of obesity.

Can a slim person have PCOS?

Obesity is a known risk factor for PCOS, and likewise, the condition can cause weight gain. This can create a vicious cycle where the PCOS causes insulin resistance, then obesity worsens insulin resistance and PCOS. Additionally, having PCOS increases your risk of insulin resistance and type 2 diabetes.

In the US, the percentage of obese PCOS patients is as high as 80%. However, it is lower outside the US, as low as 20% in some areas. This indicates that the high percentage of obesity in the US may reflect higher rates of obesity in general and environmental factors such as high-calorie diets.

Furthermore, while the prevalence of obesity varies globally, the PCOS prevalence is fairly uniform, indicating that obesity may not be as frequent a factor in PCOS as previously thought.

This also suggests that the data showing an extreme prevalence of obesity in PCOS patients may be secondary to referral bias. A study in this context has shown that the prevalence rates of PCOS in underweight, normal weight, overweight, and obese women were 8.2%, 9.8%, 9.9%, and 9.0%, respectively.¹ ²

That said, even in the US, some PCOS patients are not overweight. So-called “lean PCOS” does exist. Due to the myths associated with PCOS and the assumption that being overweight is a defining symptom, it can be challenging for slim people with PCOS to get a diagnosis.³

 A lot more work is needed to understand the presentation of the syndrome, and little seems to be known about why some PCOS patients are overweight/obese while others are not.

Insulin resistance, which is often associated with weight gain, is an important part of PCOS pathology. Some people with PCOS may even be slightly underweight.

The other symptoms of PCOS are similar between the two groups (overweight and lean people), but lean PCOS patients tend to have less severe hormonal and metabolic changes. They are also more likely to ovulate and may be able to get pregnant with less assistance.

Weight gain in PCOS and "PCOS belly"

In the US, at least half of people with PCOS are overweight or obese. PCOS is specifically associated with increased visceral fat (“hidden” fat wrapped around the organs) and a so-called "PCOS belly."

It has been shown that insulin resistance is independent of obesity in PCOS and is also common in patients with lean PCOS. However, many people with PCOS exhibit weight gain and have to adjust their lifestyle to try and bring their weight back down, which can help reduce PCOS symptoms.⁴

This weight loss can be extremely challenging. People with lean PCOS need to prevent weight gain.

Again, it is a myth that all people with PCOS have a swollen or fat belly, although this is a common symptom.

How can you lose weight?

Losing weight is a challenge for most people looking to shed some pounds, but it can be especially challenging for those with PCOS. However, even a small amount of weight loss can result in significant improvement in your PCOS symptoms.

The general recommendations are the same as for most people who are overweight, including regular exercise and a healthy diet. You may benefit from consulting with a dietitian or nutritionist to help you come up with a personalized weight loss plan.

There is no scientific evidence to show the effectiveness of low-carbohydrate diets for people with PCOS. Beware of fad or exclusion diets, which are less effective than normal calorie-restricted diets.⁵

Many people with PCOS are prescribed oral contraceptives, which can help to make periods more regular. If diet and exercise are not helping, your doctor may prescribe other treatments. 

One of the main medications for women with PCOS who would like a more regular menstrual cycle as they want to become pregnant is metformin, which is also used to treat type 2 diabetes. Metformin improves insulin sensitivity and decreases hepatic glucose production and intestinal glucose absorption. It can also enhance weight loss achieved through restricting calories, but it should not be taken for weight loss.⁶

If nothing else works, bariatric surgery can be used for weight loss. This is a last-resort treatment but can be very effective. If you have or are developing type 2 diabetes, your doctor may prescribe semaglutide or liraglutide to help manage your insulin levels and promote weight loss.

Other treatments for PCOS

In addition to lifestyle changes and the medications already mentioned, other treatments and approaches can be effective for PCOS patients who need to lose weight.

These include:

• Hormonal contraceptives and antiandrogens: Commonly prescribed for PCOS patients who need to lose weight and are not currently trying to get pregnant. They include oral contraceptives, antiandrogens, patches, shots, vaginal rings, and hormonal (not copper) intrauterine devices.

• Cosmetic treatment to remove excess facial hair: For example, laser hair removal by electrolysis; a prescription skin treatment, eflornithine HCl, can slow hair growth.

• Medication to support ovulation: For those trying to get pregnant; for example, clomiphene.

• Surgery: If you’re trying to get pregnant and no other method has worked, ovarian drilling surgery might be tried.

• Medication to control PCOS-related acne: Includes topical preparations such as benzoyl peroxide or retinoid cream, and oral treatment with tetracycline antibiotics; in some cases, oral isotretinoin may be needed.

• Androgen receptor blockers: Taken to counter androgenic symptoms; for example, spironolactone or flutamide.

Lifestyle changes remain the best way to control PCOS symptoms. Some patients, especially those who are not overweight, can control their symptoms with lifestyle changes alone.

What are the complications of PCOS?

The most common complication of PCOS is infertility due to the failure of ovarian follicles to mature into eggs. Having PCOS significantly increases your risk of type 2 diabetes, especially if you’re overweight.

You also have a higher risk of:

• Endometrial cancer

• Cardiovascular disease

• Dyslipidemia (imbalance of lipids, such as cholesterol)

• Non-alcoholic fatty liver disease (NAFLD)

The hormonal imbalance that causes PCOS can strain your system, especially as it disturbs the metabolism.

The lowdown

Despite being a common condition, PCOS is poorly understood. There is a myth that only overweight people have PCOS (or that PCOS automatically makes you overweight). It's important to know that slim people can still have PCOS and to advocate for yourself if you have symptoms that might indicate the condition.

In the US, although 40%–80% of people with PCOS are overweight or obese, many are not, so slimmer people are more likely to go undiagnosed or misdiagnosed.

While some people with PCOS have obvious symptoms, such as hirsutism (excess hair), many are not diagnosed until they try to become pregnant, typically in their twenties or thirties. PCOS is a common cause of fertility problems and can be managed, but not cured, with lifestyle changes and sometimes medication.