PCOS: Why Misconceptions About Weight Can Delay Diagnosis in Women for Years


Female patient reviewing a document with her doctor

Women are at higher risk of developing PCOS (polycystic ovarian syndrome)-one of the most common hormonal issues for girls and women all over the world-if they're overweight.

Problems with weight (whether you're gaining weight unintentionally or having trouble losing it) are among the main factors associated with PCOS, a disorder that can occur when you're of childbearing age and cause hormonal imbalance and metabolism issues that affect your overall health and cosmetic appearance.

But a big misconception is that you're only at risk if you're overweight, when in fact PCOS can be an underlying condition even if you're at a normal weight, says Shivani J. Narasimhan, M.D., a LifeBridge Health board-certified endocrinologist. 

"Normal weight women can certainly have PCOS, and that's actually what I find very interesting to treat because those patients are not the classic, textbook-style, fit-the-mold PCOS patients, but they nevertheless may have PCOS, which is best evaluated by clinical judgment, blood work, listening to the patient's medical history and examination," she says. 

In many cases, Narasimhan says, this misconception about weight causes a delay in PCOS diagnosis "by up to five to ten years."

For instance, if you are at a healthy weight but having irregular periods (a possible symptom of PCOS, though it can be unrelated), you may not discover until down the road, perhaps amid difficulties starting a family, that the issue was something more serious.

"You may have had undiagnosed PCOS that was treated or masked by birth control pills, which probably is the right treatment if you aren't seeking fertility, but then when you're ready to come off birth control pill and start seeking fertility, those symptoms come back because PCOS is usually something that stays from menarche (the first occurrence of menstruation) to menopause. 

"When we diagnose a woman who may be at a normal weight, or just a few pounds overweight, she can often be surprised."

In addition to weight problems and irregular periods, symptoms of PCOS can include:

  • Acne on the face, chest and upper back
  • Hirsutism (too much hair on the face, chin, or parts of the body where men usually have hair)
  • Thinning hair or hair loss on the scalp (male-pattern baldness)


Studies have found links between PCOS and:

  • Type 2 diabetes
  • High blood pressure
  • Unhealthy cholesterol levels
  • Sleep apnea
  • Depression and anxiety
  • Cancer of the endometrium (lining of the uterus or womb) if PCOS remains untreated


When doing a full checkup for PCOS, doctors will typically evaluate your pituitary hormone and testosterone levels and check for metabolic syndrome, a cluster of conditions (including high blood pressure, high blood sugar and abnormal cholesterol levels) occurring together that increase your risk of heart disease, stroke and Type 2 diabetes.

"That's why PCOS is called a syndrome, because there's many different aspects," Narasimhan says.

The goal of treatment, Narasimhan says, is not only to address needs such as cosmetic improvements and normal periods, but to do what's medically necessary for your overall health.

The exact cause of PCOS is not known and there is no cure, but your symptoms can be managed. Your doctor will determine a treatment plan based on your symptoms, risk of long-term health problems and plans for having children. "When PCOS is mild, you can have natural pregnancy. When PCOS is severe, you may need fertility help," Narasimhan says.

Depending on the issues that a patient would like to have addressed, several treatment options can be offered, including: prescription acne treatments, laser hair removal, facial hair removal creams, weight loss measures, hormonal birth control, anti-androgen medicines and metformin.

Call 410-601-WELL to learn more about endocrinology services offered at LifeBridge Health or to schedule an appointment with a physician. You can also visit our website.