Can you be underweight with PCOS? It’s time to find out

There is a perception that all women with PCOS are overweight or obese. But can some people also be underweight? Let's find out.
PCOS can increase the risk of heart diseases in women. Image courtesy: Shutterstock
Aayushi Gupta Updated: 30 Oct 2023, 13:52 pm IST
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Can you be skinny and have PCOS? The answer to this question is yes! Of course, you can be underweight, and yet have the condition.This type of polycystic ovary syndrome (PCOS) is known as lean PCOS. For the unversed, polycystic ovary syndrome is a common hormonal disorder that causes multiple cysts in your ovaries. This condition affects women who are in their childbearing years, anywhere between 15-45 years of age. 

More often than not, PCOS is associated with overweight women. However, the cases of lean PCOS are continuously increasing. Why is that so?

Dr Sneha Sathe, Fertility Consultant, Nova IVF Fertility, Mumbai, explains, “Most women with PCOS have difficulty managing their weight. There is a tendency to gain weight easily and weight loss is difficult. Some women with PCOS maintain a normal weight (lean PCOS); but they still face fertility challenges, increased androgens, and an increased risk of diabetes and cardiovascular disease.”

PCOS and weight
You just can’t afford to ignore PCOS. Image courtesy: Shutterstock

Along with that, irregular periods, lack of ovulation or late ovulation, increased facial hair, problems in conceiving, insulin resistance, anxiety, and acne, are some of the symptoms both kinds of patients go through. 

So what is considered lean?

Lean in this case refers to a healthy BMI or body mass index. The healthy BMI ranges from 18 to 24.9. Women with lean PCOS have a healthy BMI, unlike women who are overweight with PCOS. 

How common is it to be lean and still have PCOS?

Most women think that obesity and PCOS have many elements in common. However, one out of three women with PCOS are not overweight or obese, shares Dr Sathe with HealthShots, In spite of having a normal BMI, women with lean PCOS may struggle with irregular periods, fertility problems, blood sugar control, and other symptoms like acne and oily skin. So, it is just another misconception that women with PCOS are overweight.

Take this quiz: It’s World PCOS Awareness Month! Take this quiz, and we’ll tell you if you know enough

But “lean” doesn’t mean better. In fact, having lean PCOS can make it harder to get diagnosed, even though it causes many of the same long-term health complications as other types of PCOS. So if you have an irregular period and are wondering if you could have PCOS despite a BMI within a healthy range, know that it’s possible.

PCOS and weight
PCOS does not discriminate and can affect women of all shapes and sizes. Image courtesy: Shutterstock
Why is weight management with PCOS so difficult?

A significant challenge with PCOS is that, for most of us, our body is resistant to insulin. Dr Sathe says, “Insulin is a hormone which is produced by the pancreas. It helps convert sugar and starch (from the food we eat) into energy. PCOS makes it more difficult for the body to use the hormone insulin (referred to as insulin resistance). As a result of this unconverted sugar, the pancreas produces more insulin, in order to try and maintain normal sugar levels. High amounts of insulin can trigger and accelerate the production of the male hormones (androgens), which can lead to weight gain and many other symptoms of PCOS.”

Not only this, women with PCOS are at a high risk of developing many of the problems associated with weight gain and insulin resistance like diabetes, hypertension, high cholesterol, and heart disease. 

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Is it difficult for women with lean PCOS to get pregnant?

Women with PCOS often find it hard to conceive naturally. The hormonal imbalance prevents the regular cyclical development and release of a mature egg (anovulatory infertility). However, having PCOS does not mean that pregnancy is impossible. PCOS is one of the most common treatable causes of infertility, says Dr Sathe. 

PCOS and weight
A few lifestyle changes can go a long way! Image courtesy: Shutterstock
How can you treat lean PCOS?


  • Eat healthy: Eating a healthy diet is crucial in the management of PCOS. Maintain a diet, which is packed with carbohydrates, whole grains and lots of fruits. 


  • Exercise: To manage PCOS symptoms, try and exercise regularly. With lean PCOS, you don’t need to practice strength training and weightlifting exercises. But following a regular workout routine is important.


  • Stress management: Practice meditation, gentle yoga or practice hobbies that can relax you, including gardening, painting, reading books or anything else that’s a stressbuster for you.
  • Regular check-ups: Regular checkups are important for PCOS management. 




A healthy diet and regular exercise can help regularise the menstrual cycle and improve fertility. So, stay in touch with your doctor and follow their advice to manage your condition. 

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About the Author

Aayushi Gupta is a health writer with a special interest in trends related to diet, fitness, beauty and intimate health. With around 2 years of experience in the wellness industry, she is connected to leading experts and doctors to provide our readers with factually correct information. ...Read More

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