So, you have been diagnosed with PCOS and everyone is telling you to “lose weight to fix your symptoms”, but you’re thinking “hang on a second, I am actually below a healthy body weight for me?”

Can diet and lifestyle make a difference when it comes to managing “lean” PCOS without achieving a change in weight?

What is lean PCOS?

I have talked a lot about PCOS, but what is lean PCOS? Nearly 80% of women with PCOS also present with weight concerns.

However, 1 in 5 women with PCOS don’t struggle with their weight.

Unfortunately, women with lean PCOS still suffer from symptoms similar to those women who are not a healthy weight. These include:

  • Irregular menstrual cycles
  • Anovulation, the lack of ovulation during a cycle
  • Ovarian cysts
  • Excessive hair growth
  • Acne and other skin changes
  • Anxiety and depression
  • Insulin resistance
  • Difficulty falling pregnant

This usually means you have high levels of the male androgen, testosterone, circulating in your body. It could also mean you have low levels of estrogen. Unfortunately, as a syndrome refers to a collection of symptoms, it can look different on every woman!

Insulin resistance is still a common symptom of lean PCOS. Actually, 75% of women with lean PCOS are insulin resistant. I spoke about Insulin Resistance (IR) recently, but put simply this means your body does not respond to insulin normally and leads to elevated blood glucose (or blood sugar) levels. This can be due to those insatiable sweet and carbohydrate cravings which can quickly cause your blood glucose levels to rise meaning insulin has a lot of work to do to move it into your cells.

It is really important to stay on top of IR as it can increase the risk of gestational diabetes in pregnancy and Type 2 Diabetes later in life, so it is extra important to head to your doctor and work closely with a dietitian to get this checked out!

5 hacks to help tackle lean PCOS!

So how can we fix this if weight loss is not the answer…? For starters, it is really important to maintain your healthy weight. Or if your body fat percentage is too low, you won’t ovulate! So actually healthy weight gain is really important to help ensure regular and healthy ovulation and menstrual cycles.

5 tips that you can action today that can help:

1. Don’t make carbohydrates your enemy!

Lots of people tend to think if you need to maintain a healthy weight it’s time to cut the carbs!

But this is not true.

Carbohydrates are still necessary to maintain your blood sugar levels and stop them from dropping too low. Not only are low blood sugar levels dangerous and can cause issues like, dizziness, fainting, blurred vision, shakiness and a fast heart rate, but they can also contribute to intense hunger!

Choosing carbohydrates that serve your body and blood sugars well, is still important whether you are insulin resistant or not, as we know these carbohydrates contain more fibre, B vitamins and wholegrain content, and therefore a better source of inositol – hailed as the “new metformin” for women with PCOS.

If you’re very active, carbohydrates of all kinds become a lot more important to help fuel endurance exercise activities such as runs and marathons.

Touch base with an Accredited Sports Dietitian to work on a plan that is right for you.

2. The lower GI the better!

In my previous blog post eating for PCOS I spoke about low GI carbohydrates. This means the carbohydrates you are choosing release sugar into your blood slowly and gradually to allow for your body’s insulin stores to keep up. These foods include:

  • Basmati and brown rice instead of jasmine rice
  • Multigrain, wholemeal or sourdough bread instead of white bread
  • Fresh fruit and veggies
  • Low fat milk, unsweetened yoghurt and low fat cheese

Try spreading your carbohydrates across the whole day. Include a source of carbohydrate at each meal, but keep it to the recommended portion sizes (head here to check them out).

3. Eat your veggies!

Choosing fresh, whole foods like fruit and veggies are a great way to boost your antioxidants, fibre and vitamins and minerals – all important when managing PCOS.

4. Pack a punch with protein!

Try to organise your meals around a lean protein source. Protein will fill you up, whilst controlling your blood sugar levels at each meal. Reach for cuts of meat that are lower in fat like, chicken breasts instead of thighs, pork medallions or loins instead of ham or bacon and heart smart (or 5 star/extra lean) beef mince instead of the full fat option. This will keep your heart healthy whilst getting the iron, zinc and protein from these lean meats.

It is also a great idea to have 1-2 days that are #meatfree! Try a tofu stir-fry (like my Satay Tofu Soba), kidney bean nachos or lentil dhal for a vegetarian option that is high protein and very low fat.

We know that loading up on legumes is a great way to improve the management of your PCOS (Kazemi et al., 2018). Another reason to try my popular lentil lasagne recipe.

5. Do resistance exercise, don’t resist exercise!

Research has shown that women with lean PCOS who add resistance exercise to their day-to-day regime had lower abdominal fat, higher lean muscle mass and lower circulating testosterone levels than those who did not (Miranda-Furtado, et al., 2016). Resistance exercise includes:

  • Lifting weights, this can simply be using dumbbells while you go for your morning walk
  • Using resistance bands when doing a floor workout
  • Doing squats, push ups and planks

Speak to an Accredited Exercise Physiologist for a tailored exercise plan for you!


Have you been diagnosed with PCOS? Take control of your PCOS rather than letting it take control of you!

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This self-paced online course has been developed to highlight the role of diet and nutrition in managing your PCOS symptoms and taking control of the rollercoaster that is PCOS with 10 comprehensive PCOS-specific nutrition lessons. We also include BONUS PCOS-friendly 7-day meal plans and recipes! Check it out ?

What you’ll get inside The PCOS Project:

  • Over 10 comprehensive PCOS-specific nutrition lessons designed & delivered by expert reproductive health dietitian & nutritionist
  • Learn exactly what bloodwork you need to monitor your PCOS today and in the long-term too!
  • Take control of insulin resistance and stubborn weight using the insulin resistance lesson & comprehensive workbook
  • Our strategies to lower androgens driving those pesky pimples & chin hairs!
  • Understand your menstrual cycle, the ways you can track it, what the “red flags” are for more help and how to nourish yourself for more regular periods!
  • PLUS: supplementation considerations for PCOS (note: does not include personalised supplementary advice), mood & food for mental health, anti-inflammatory eating for PCOSoptimising gut health & how to build a PCOS-friendly meal

BONUS: PCOS-friendly done-for-you 7-day meal plans with recipes AND additional recipe resources!
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Co-written by Maddison Breen, Masters of Nutrition and Dietetics student from the University of Sydney. Connect with Maddi on LinkedIn.

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