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Polycystic Ovarian Disease (PCOD) is one of the hormonal disorders that affects many women of menstruating age. As per a February 2025 report from the World Health Organization (WHO), PCOS impacts at least 6-13 per cent of reproductive-aged women. But those are just official diagnosis numbers, as globally at least 70 per cent of women are undiagnosed, unaware that they may have PCOS. It shows how the reproductive, metabolic disorders like PCOS, PCOD remain undiagnosed in women to such a large extent.
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One of the reasons is that these disorders sometimes show up in different ways. Commonly, being overweight or obese is associated with PCOD. In fact, it is seen as one of the signs, too. But not all cases may be the same, as even thin women may have PCOD.
To understand this unique form of PCOD, Dr Tejal Kanwar, consultant gynaecologist at Ujaas, an initiative by Aditya Birla Education Trust, told HT Lifestyle more about it. In fact, there’s a name associated with it, called ‘lean PCOD,’ indicating it is not an anomaly but a medically recognised variation of this condition.
Sharing her own clinical experiences and busting the common stereotypes around PCOD, she said, “Polycystic Ovarian Disorder (PCOD) is frequently linked with weight gain or obesity. Yet, many women who are lean or of ‘normal’ weight also live with PCOD, often undiagnosed or dismissed because they don’t fit the common stereotype. As a gynaecologist, I often hear: ‘But I’m thin, how can I have PCOD?’ This misconception delays evaluation, disrupts fertility planning, and can even harm long-term metabolic health.”
Why thin women may have PCOD
The gynaecologist debunked that PCOD does not happen because of being overweight, but due to hormonal and metabolic issues. She called it a ‘hormonal and metabolic disease.’
Dr Kanwar further explained, “Genetics is important for lean women because a family history of metabolic syndrome or PCOD can raise their risk. Even with low body fat, insulin resistance can still develop because lean PCOD patients may have decreased muscle insulin sensitivity or visceral fat surrounding internal organs. Ovulation can also be disrupted by hyperandrogenism (excess androgens) or hypothalamic-pituitary-ovarian axis abnormalities.”
Hormonal imbalances further exacerbate because of both internal and external conditions. She added, ” Hormone imbalances can be made worse by environmental and lifestyle factors, such as exposure to chemicals that disrupt hormones, sleep deprivation, and ongoing stress.”
Symptoms of Lean PCOD
While there may not be a prominent weight gain, which usually becomes one of the telltale signs but Dr Kanward urged to pay attention to these signs:
- Missed or irregular periods: Cycles may be skipped completely or be longer than 35 days.
- Oily skin and acne: Adult acne, particularly around the jawline, is a common indicator.
- Hirsutism: Excess hair on the chin, upper lip, chest, or abdomen is known as hirsutism.
- Scalp thinning: Widening of the part line or diffuse hair loss.
- Infertility: Even with a normal BMI, irregular ovulation can lead to infertility issues.
- Dark skin patches: Some women exhibit changed lipid profiles, acanthosis nigricans (darkened skin patches), or mild insulin resistance.
How to manage?
Since weight management is not applicable here, how do you manage? As per the gynaecologist, you need to manage the hormones and metabolism. She suggested these 4 tips:
- Frequent cycle and hormone level monitoring: Even when BMI seems normal, check lipid profiles, thyroid, insulin, and androgens, as well as menstrual patterns.
- Low-GI, balanced diet: Give priority to whole grains, lean proteins (legumes, chicken), high-fibre vegetables, and healthy fats. Steer clear of severe diets or meal skipping, as these can exacerbate hormone imbalances.
- Regular exercise for 150-300 minutes per week: Aim for 150–300 minutes per week of moderate exercise that combines strength and cardio training. While moderate cardio supports overall metabolism, strength training increases insulin sensitivity. Steer clear of excessive exercise as it can throw off cycles.
- Stress and sleep management: Yoga, mindfulness, meditation, and good sleep hygiene all help to promote ovulation and reduce cortisol.
Because there are more serious issues around infertility and even otherwise, Dr Kanwar suggested visiting a gynecologist or endocrinologist to discuss treatments such as insulin sensitisers (like metformin), ovulation induction drugs, or targeted skincare for hirsutism and acne.
In the end, Dr Kanwar cautioned clearly that PCOD is not just a weight issue. It’s a complex interplay of hormones, genetics, and metabolism.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
