Women's Health

A Guide to Polycystic Ovary Syndrome (PCOS), Now Known as PMOS

What Is Polycystic Ovary Syndrome (PCOS/PMOS)?

Polycystic Ovary Syndrome (PCOS), now officially renamed Polyendocrine Metabolic Ovarian Syndrome (PMOS) following an international consensus of more than 50 medical and patient organisations, including the Endocrine Society, is a common hormonal disorder among women of reproductive age. The new name was introduced to better reflect that the condition is driven by multiple interacting hormonal and metabolic factors, rather than by ovarian cysts alone. It affects around 10% of women of reproductive years and is likely to be increasing in line with the expected increase in obesity seen in the population. PCOS (PMOS) can present as irregular periods or missed periods, excessive hair growth on the face or body, acne, male pattern hair loss and weight gain.

The term polycystic ovary refers to a condition in which the ovaries develop a large number of tiny cysts (fluid-filled sacs). In polycystic ovary syndrome (PCOS), the woman has various other symptoms in addition to the polycystic ovaries seen on ultrasound. The updated name, Polyendocrine Metabolic Ovarian Syndrome (PMOS), was chosen partly because the older term could be misleading, as the condition does not always involve true ovarian cysts.

It is important to know that some women with PCOS do not have polycystic ovaries, while others with cysts in the ovaries do not have the syndrome. This is because in order for a woman to be diagnosed with PCOS (now PMOS), she needs to have other features that define the syndrome.

What Causes Polycystic Ovary Syndrome?

The underlying cause of PCOS (PMOS) is the presence of insulin resistance. When insulin resistance is present, there is a high amount of insulin in the body and this causes the formation of multiple cysts in the ovaries as well as the production of high levels of male hormones, known as androgens. Insulin resistance can run in families, i.e. it can be inherited. Being overweight or obese can also increase the amount of insulin that your body produces.

Early diagnosis and treatment along with weight loss may help reduce the symptoms of PCOS and lower the risk of long-term complications such as type 2 diabetes, high blood pressure, high cholesterol and heart disease.

Risks and Symptoms

If your family member (mother or sister) has PCOS (PMOS), you are more likely to have it as well. This is because the condition has a strong genetic association. Recent studies have found that male first-degree relatives of women with PCOS also have a higher rate of cardiometabolic diseases such as heart disease, type 2 diabetes and obesity.

Signs and symptoms of PCOS often develop during the late teens or early twenties. It can also be brought on by an excessive increase in weight later in life.

Some symptoms of PCOS (PMOS) include:

• irregular periods or no periods at all
• difficulty in getting pregnant as a result of irregular ovulation or failure to ovulate
• excessive hair growth (hirsutism) – usually on the face, chest, back or buttocks
• weight gain
• thinning hair and hair loss from the head
• oily skin or acne

Diagnosis

There is no single test to definitively diagnose PCOS (PMOS). The 3 main features are:

• irregular periods – which means your ovaries do not regularly release eggs (ovulation)
• excess androgen – high levels of “male” hormones in your body, which may cause physical signs such as excess facial or body hair and acne
• polycystic ovaries – your ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs

If you have at least 2 of these features, you may be diagnosed with PCOS (PMOS). Your doctor may also want to exclude other conditions that may present with similar symptoms before confirming the diagnosis.

Your doctor might recommend the following tests before confirming your diagnosis:

Ultrasound

This test creates images of blood vessels, tissues, and organs using sound waves and a computer. This test is performed to determine the appearance and size of the ovaries and whether or not they have cysts. The test can also determine the thickness of the uterine lining (endometrium).

Blood Tests

Your blood may be analysed for elevated androgen levels and other hormones. Your blood glucose levels and cholesterol may also be checked by your doctor.

Complications of Polycystic Ovary Syndrome

Women with PCOS (PMOS) are more likely to develop certain health problems such as:

• Infertility
• Gestational diabetes or pregnancy-induced high blood pressure
• Miscarriage or premature birth
• Non-alcoholic steatohepatitis: A severe liver inflammation caused by fat accumulation in the liver
• Metabolic syndrome: A group of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of heart disease
• Type 2 diabetes or prediabetes
• Sleep apnoea
• Depression, anxiety and eating disorders
• Abnormal uterine bleeding
• Cancer of the uterine lining (endometrial cancer)

The renaming to Polyendocrine Metabolic Ovarian Syndrome (PMOS) was intended in part to highlight these wider metabolic and hormonal risks, which can sometimes be overlooked when the focus is placed on the ovaries alone.

When Should You Seek Medical Attention?

Visit a specialist for an assessment if you have irregular or missed periods, excessive hair growth, acne or weight gain.

Treatment

A variety of factors influence the treatment for PCOS (PMOS); these could include your age, the severity of your symptoms, and your overall health. The type of treatment you receive may also be determined by your desire to become pregnant in the future. In other words, treatment needs to be individualised. Usually, treatment for PCOS will involve diet and lifestyle changes and/or medical therapy.

Diet and lifestyle tips to treat PCOS

Treatment for PCOS (PMOS) usually starts with lifestyle changes like weight loss through diet and exercise.

Losing just 5 to 10 percent of your body weight may help regulate your menstrual cycle and improve symptoms. Studies comparing diets for PCOS have found that low carbohydrate diets can be effective for both weight loss and lowering insulin levels.

Exercise is even more beneficial when combined with a healthy Mediterranean diet. Diet plus exercise may help you lose more weight than either intervention alone, and it can lower your risk of developing diabetes and heart disease.

Common Medical Treatments

Some common medical treatments include birth control pills to help regulate the menstrual cycle. Other medications include metformin, a drug used to treat type 2 diabetes. It treats PCOS (PMOS) by improving insulin resistance. It is important to consult your doctor for an accurate diagnosis and individualised treatment of your condition.

Conclusion

PCOS – now officially known as Polyendocrine Metabolic Ovarian Syndrome (PMOS) – can affect the daily lives of women if left untreated. With appropriate medication and medical intervention, the condition can be better managed, allowing women to lead a fulfilling life. If you are experiencing any of the symptoms described above, do consult a qualified specialist for proper assessment and advice.