From the Editor's Desk

We have two review articles dealing with totally varied subjects in this issue. One article is regarding lean women with polycystic ovaries (PCOS) and the other is regarding oral health and erectile dysfunction (ED). Women with PCOS demonstrate different phenotypes based on their body mass index (BMI), which may vary considerably by geography. We also know that most women with PCOS are obese, and this obesity has a significant impact on the metabolic and reproductive consequences of PCOS. However, one must remember that lean women with PCOS also carry a huge metabolic risk. It has been reported that 5–10% of lean women have PCOS, and 30–50% of women with PCOS are lean. The numbers among the Indian population may be much more, because thin Indian women with PCOS have more fat, less muscle and are sarcopenic with abdominal obesity. Lean Indian women with PCOS are often misdiagnosed and not managed in time. We diagnosed PCOS in lean women when the women had BMI <23 kg/mwith waist circumference (WC) <80 cm. Though obesity has a higher incidence of insulin resistance, 75% of lean women were insulin resistant. luteneizing hormone (LH)/follicle stimulating hormone (FSH) ratios and dehydroepiandrosterone (DHEAS) levels were also higher in lean women with PCOS. Moreover, β-endorphin levels were found to be higher in lean women with PCOS, which correlated with other hormonal parameters. These higher β-endorphins, which stimulate the release of LH, are linked to mood disorders. Lean women with PCOS have a genetic predisposition with insulin resistance and hypersensitivity, as well as higher postprandial insulin levels. These women also have reactive hypoglycemia to carbs, excess hunger and body fat storage. Lean women with PCOS did not report a history of type-2 diabetes among their first-degree relatives. Therefore, the management of lean women with PCOS should deal with handling sarcopenia, building muscle, modifying diet by reducing the intake of carbohydrates and fats and adding proteins. Apart from modifying the diet, one must advise these women to eat less and eat slowly. It is also important to curb stress by various means such as yoga and meditation.