What is Atypical PCOS?

We have written quite a bit about PCOS (polycystic ovarian syndrome) over the years because it is one of the most common causes of female infertility in the U.S. However, some of the “symptoms” clinicians talk about when discussing PCOS are the “typical” ones – such as being overweight in the middle or experiencing male-pattern baldness do not resonate with patients because they don’t exhibit those physical traits.

Atypical PCOS accounts for about 1 in 3 PCOS patients, but that assumes you benefited from accurate diagnosis. Unfortunately, PCOS often goes undiagnosed by OB/GYNs, and the large percentage of those women get lost in the atypical PCOS abyss.

Unfortunately, women with PCOS are at higher risk for other serious health conditions, including type 2 diabetes and heart disease. The sooner you get an accurate diagnosis, the sooner you can take action to treat PCOS naturally and with the help of your physician or fertility specialist.

Do You Have Atypical (Lean) PCOS?

Approximately 30% of women with PCOS have a completely normal weight/BMI. As a result, they (and their physicians) never consider that PCOS could be an issue.

Also called lean PCOS, women who aren’t overweight usually recognize some of these other symptoms of PCOS:

Irregular periods

By and large, irregular or non-existent periods are a factor for almost all women with PCOS. This is because they don’t ovulate. If you are an athlete or dancer, you may assume your missed or absent periods are the result of your intense workout routines. Or, some women with lean PCOS write skipped periods off because of school, work, or life stress.

We can’t emphasize enough that irregular periods are never normal. Anytime your periods are irregular, skipped, or absent – you should check in with your OB/GYN to find out why.

You experience more depression or higher-anxiety levels than others

While both depression and anxiety (related to the hormone imbalance associated with PCOS) are symptoms for typical PCOS patients, studies indicate that women with atypical PCOS are more likely to suffer from them. Anxiety levels seem to be a result of reduced resistance to stress due to higher levels of the hormones ACTH and plasma ghrelin.

So that same stress or anxiety you might blame for your skipped periods may also be a symptom of PCOS.

Heavier hair on the cheeks, upper-lip, or back

While you may not notice thinner hair on top, many patients with lean PCOS do have slightly heavier hair on their upper-lips, the sides of their cheeks, the chin, or the back/chest. This is because nearly 50% of women with PCOS – lean or overweight – have higher male hormone (androgen) levels.

In fact, having your hormone levels checked is an excellent idea if you think PCOS is a potential diagnosis for you. In addition to higher androgen levels, women with PCOS typically have higher levels of AMH and LH.

Insulin resistance

We typically associate insulin resistance and type 2 diabetes with being overweight. In the case of lean PCOS patients, you can be thin and suffer from insulin resistance. This makes you at risk for type 2 diabetes, even if you have a normal BMI. Insulin resistance is present in about 70% of women with PCOS, whether they are overweight or not.

Your doctor can prescribe a fasting insulin/glucose test to check for insulin resistance (high fasting levels of insulin, blood sugar and triglycerides are all indicators). Other signs of insulin resistance include:

• Being hungry even after you’ve eaten a meal
• Excessive thirst/need to urinate
• Sugar cravings
• High blood pressure
• Developing darker patches of skin

You are more prone to insulin resistance and lean diabetes if you eat a poor diet, smoke, don’t get good sleep, or do not get enough exercise.

That’s one reason why preparing your body for pregnancy is so important. The simple act of eating a healthy, anti-inflammatory diet and making positive lifestyle choices can support and manage some of the most common causes of female infertility – including PCOS.

You may have a higher waist-to-hip ratio

Along those same lines, lean women with PCOS tend to have a higher than normal waist-to-hip ratio, even if their BMI is less than 25. Click Here to see if your waist-to-hip ratio is higher than normal. If so, point that out at your next appointment with your G.P. or gynecologist so s/he can investigate further.

You may not have ovarian cysts

The ovarian cysts for which PCOS derives its names are a common symptom, and resemble a “chain of pearls” on an ultrasound. However, not all women with PCOS have the cysts. So, if you’re relying on a former ultrasound as proof you aren’t polycystic, you are trusting an unreliable PCOS diagnostic source.

If you are struggling to get pregnant and you notice any of the above signs or symptoms of lean or atypical PCOS, we recommend getting in touch with a fertility specialist to get confirmation and to create a proactive fertility plan. Schedule an appointment here at the Reproductive Resource Center to learn more.