From PCOS to PMOS: What You Need to Know

Last month saw a significant change in the landscape of women’s healthcare: PCOS (Polycystic Ovary Syndrome) has officially been renamed PMOS (Polyendocrine Metabolic Ovarian Syndrome).

This announcement followed decades of international collaboration between specialists and patients.  It was felt that PCOS was an inaccurate and misleading term and that PMOS better reflects the complexity of this common condition, which is thought to affect around 1 in 8 women in the UK.

What is PMOS?

PMOS is a complex, hormone-driven and metabolic condition which can impact on multiple systems in the body rather than solely affecting the ovaries as its previous name suggested.

Insulin is a hormone that controls sugar levels; in PMOS, there is resistance to the action of insulin.   As a result, the body responds to this by producing more insulin.  The raised insulin levels then cause increased production of testosterone, leading to menstrual period irregularity and skin changes.  It is thought that PMOS develops due to a combination of factors and there is a tendency for this to run in families.

PMOS can have a significant impact on not only on a woman’s current physical health but also have long-term implications as it is associated with an increased risk of developing type 2 diabetes, obstructive sleep apnoea and high cholesterol.  Self-esteem and mental health can also be significantly impacted.

What are the symptoms of PMOS?

It is important to note that PMOS can affect each woman differently both in terms of the symptoms experienced and the severity of these, and these can vary and change over time.

Common symptoms include:

• Changes to periods – they can be irregular or absent and as a result affect fertility due to dysregulated ovulation.
• Skin changes – commonly acne
• Excess hair growth on face, abdomen and chest (hirsutism) and conversely, thinning of scalp hair
• Weight gain

How is PMOS diagnosed?

Diagnosis is based on a combination of clinical features, blood tests and imaging.

Assessment may include:

• History and examination – irregular or absent periods, family history and clinical signs of elevated testosterone levels such as acne or hirsutism
• Blood tests – to check hormone levels; not only looking for elevated testosterone levels but also ruling out other causes of irregular or absent periods, for example thyroid problems
• Ultrasound scan – to assess for the presence of multiple cysts in the ovaries

Diagnosis criteria (2 out of 3 required)

• Infrequent or absent ovulation (presents as irregular or absent periods)
• Clinical features or signs of raised testosterone on blood tests – e.g. acne, hirsutism or elevated free testosterone
• Polycystic appearances of ovaries on ultrasound scan – however, it is important to know that polycystic ovaries on a scan alone do not necessarily mean PMOS is the cause and conversely, the absence of polycystic ovaries do not rule out PMOS as the diagnosis

Treatment and management of PMOS

PMOS is a lifelong condition.  Management options include –

• Ensuring a healthy lifestyle and managing weight – this can improve the symptoms of PMOS but also reduce the risk of developing complications later in life, such as type 2 diabetes
• Considering hormone medication to regulate periods and protect the endometrium (lining of the womb)
• Metformin is a diabetes medication which has been used off-label to treat PMOS, however it is unclear how this compares with combined contraceptive pills in terms of benefits
• Use of topical treatments with or without oral antibiotics to manage acne
• Options for management of hirsutism can include a topical cream (eflornithine) or consideration of specialist treatments such as electrolysis or laser hair removal
• Regular checks of BMI, blood pressure, cholesterol and blood sugar levels are also key to ensure that any risk factors to future cardiovascular health are identified and addressed early

Final thoughts

While it will take time for the name change transition of PCOS to PMOS to take place and resources to be updated, it is hoped that this move will improve understanding, recognition and management of this complex, multisystemic condition that affects approximately 170 million women worldwide.

Useful links

Verity – The UK PCOS Charity 

PCOS Challenge

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