After a few deep breaths and some common sense talk from The Italian, I started to calm down. I do not, nor have I ever had a mustache, I've been blessed with pretty decent skin (most of the time) and he assured me that I was far from being obese. I felt better however that did NOT stop me from continuing my internet research. It is VERY hard to find information about LEAN PCOS on the internet - most studies and information that you find is related to obese or overweight women diagnosed as PCOS. Us Lean PCOSer's are the forgotten soulcysters - even though 40% of all women diagnosed as PCOS are lean (ie at or below normal weight/BMI).
It took several hours of searching, but I did find this post that helped to explain a lot to me. I've included a few of the excerpts pertaining to Lean PCOS below with my comments in bold...
- For heavier women, PCOS occurs because of the excess production of male hormone, which results in the abnormal androgen/estrogen ratio. Thin women don’t really have excess androgen production. Instead, they typically have normal androgen levels. However, at one point in time their estrogen levels were low.
- (Estrogen comes from two places – the ovaries and the fat cell.)
- In young, thin athletic women with very low percent body fat, estrogen levels are low.
- The end result of this is that the androgen/estrogen ratio is altered just like that in the heavier women (the androgen level is normal but he estrogen level is low).
- The absolute levels are lower in the thin women, but the ratio is still altered.
- Two of the standard questions we ask are
- “What is the least you have weighed in your adult life?” and
- “were you an athlete?”
- We want to know if there was a time of low estrogen production that may have “set up” the pattern of PCOS. There is excellent evidence that once this ratio is altered, it sets up a pattern of functioning in the ovaries that will persist into adulthood, i.e., PCOS.
- I was always a skinny minnie as a child. I hated how boney my legs were...I could (and did) eat 10-12 Taco Bell crunchy tacos in one sitting and never gained an ounce.
- I was in dance classes 4-6 days a week so that would definitely qualify as an athlete (no smart comments - unless you've spent 4-7 hours a day (after school mind you) in a leotard and tights in a dance studio, you are NOT allowed to begin to insinuate that dancers are not athletes - I've got a grand battement that will knock you across the room, so don't mess with me.).
- Even going into adulthood, I have experienced times where my weight would drop near 100 lbs without any effort. (I'm 5'7" so that is not a good or even remotely normal thing).
- PCOS can often occur in women with normal androgen levels and no evidence of hirsutism (excess hair growth). Praise the Lord - no excess hair growth or mustaches for me!!!!
- Many thin women with PCOS exhibit only irregular periods or less than optimal ovulation. True
- Unfortunately, clomiphene does not work very well in thin women with PCOS. The anti-estrogen effects are profound enough that although egg development and ovulation may occur, pregnancy will not. (This is just an observation, but women that experience side effects from clomiphene such as hot flashes will not conceive on clomiphene.) Well that would have been handy dandy info to have had back in 2009 when my GYN/OB first started me on Clomid....
- It is pretty clear that if pregnancy does not result within the first four cycles of clomiphene use, it probably is not going to – something else has to be tried. 85% of all clomiphene pregnancies occur within the first three months of treatment with clomiphene. After four months, very few additional pregnancies result. My GYN/OB kept me on Clomiphene (aka Clomid) for nearly 9 months before I referred myself to REACH! YIKES!