When the weight is not the problem

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We think (and I speak on my and my colleagues’ behalf) that PCOS is always and only linked to the excess of weight which is believed to cause and sustain it but, sometimes, things are different. It is true: most of the women suffering from PCOS are overweight or obese, but in this article, I’d like to speak about you who have normal weight, yet you suffer from PCOS. International epidemiological researches have shown that 20-40% of PCOS women are slim, or underweight: a significant percentage! PCOS women who are considered “fit” from the aesthetic point of view and height/weight ratio, show all the same symptoms of the syndrome as the overweight women: insulin-resistance, glycemic instability, irregular periods, acne, hair loss, anxiety and depressive mood. But slim or normal weight women’s journey to the diagnosis and to the following therapy is often longer. Isn’t it?

If you are reading this article you may belong to the category of “light” PCOS women who have taken long time to get to understand what was happening in their body.

You might have been treated with superficiality: your dermatologist might have given you some soft treatments for the acne, or some anti-hair loss ones. What else? Your gynecologist might have prescribed estroprogestinic pill, or more, you might have been told the same advice: cut sugar out and do exercise.

They are clearly useful pieces of advice, but the matter has to be looked into more deeply. First: let’s focus on extreme thinness-what does it mean beyond PCOS? It may be your natural built (maybe your family are like you), or it may be the result of a too strict diet, or too much exercise. However, the result is always the same: your weight and your fat mass may not be enough to support a regular menstrual and physiological cycle.

Although, the adipose tissue is lacking, 70% of thin PCOS women show a clearly located adipose tissue around the abdomen, as a result their belly looks flabby and they can’t button up the jeans easily.

Women need a minimum amount of fat tissue, which is made of primary fat tissue and fat deposit (less than 16-17% of the total weight). It is responsible for our hormonal balance. Below this amount, the majority of women experience a period of amenorrhea which can be seen as a kind of protection against the excessive physical weakening, or more, according to our culture which considers the woman in her procreative role, a sort of protection against a likely pregnancy, the body would not have the energy for.

The ratio between fat and lean mass plays a very important role in the menstrual activity as the adipose tissue turns androgens into estrogens at the peripheral level. That’s why when the period is missing due to weight loss, some symptoms of androgenism may arise or get worse (acne, extra hair growth, hair loss).



When the period is missing (whichever reason may it be), all the production of female hormones stops, and, in detail, the pituitary gland provides an unbalanced secretion of LH (the luteinizing hormone).  As you know very well, when the excess of LH occurs, the ovulation is inhibited or it has got a very low quality.  

When you do too much physical exercise or it is too strong, problems may arise, as well. Here, the body produces an excess of cortisol (the chronic stress hormone) and of other hormones which may alter the balance between hypothalamus-pituitary gland-suprarenal gland. You don’t have to give up doing exercise, but you have to adapt your calorie intake to your consumption (and think about reducing your paces if you can).

Here are my hints.

  • if you are too slim and your period is missing, have an in-depth body mass composition evaluation. Generally speaking, 18-20% of fat mass favor a regular menstrual period, and guarantee a fit body shape.
  • keep on doing exercise, but don’t exaggerate.  Ask only licensed personal trainers for advice about an appropriate recovery, and exercise to reduce the stress, such as yoga or Pilates.  
  • see you gynecologist who may help you with a hormonal treatment to unblock your condition.

But don’t forget your food habit are essential too. Cutting sugar out doesn’t not mean eating less and less, because you would lose more and more weight. Turn to a nutritionist, or dietician which will give you all the information you need and will provide you with a tailored diet planned on your body composition and needs.

In the meanwhile:

  • Don’t exceed the amount of fiber. Although they are very important, but they can’t oppose to the assimilation of the nutrients. That’s not what you need as you have to put on weight.
  • Alternate whole grain pasta and cereal with white ones, and always cook them “al dente”: they don’t affect your glycaemia too much.
  • Keep the glycemic index of your meal low- always combine carbs, proteins, fibers, and fat.
  • Avoid rapidly-digested sugar, carbonated drinks, don’t exceed milk and dairy products: they are not good for you too, even if you have to gain weight.
  • Don’t bother about your servings too much: they may be quite rich, but always take your nutritionist’s advice 
  • You feel like a sweet? Have it at the end of the meal so you will control your glycaemia better.

And then the fat? What fat? Use extra virgin olive oil freely (you don’t have to measure it), vegetal oils, and shell fruit, as well. They contain good fats which fight the insulin-resistance and prevent general inflammations. Keep away from fat meat, margarine, butter, and all the industrially processed oils you find in snacks and ready to eat meals.

Look after your emotions too. Have ever asked yourself if you are serene? Does your weight want to show some inner anxieties?

About Stefania Cattaneo

I am Stefania Cattaneo and I am a Nutritionist Biologist. I have always been fond of sports and nutrition most of all related to the women. I work in my private office near Turin, there I see every sort of patients with really different problems and needs. Actually, I mainly deal with sports people and women who suffer from hormonal ailment linked to the Polycystic Ovary Syndrome. I'll do my best to widen your knowledge (and mine as well) about this hard, difficult awkward but fascinating topic: PCOS.

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