Navigating PMOS

Polyendocrine metabolic ovarian syndrome (PMOS), previously named polycystic ovary syndrome (PCOS), affects one in eight women.

The new name highlights the fact that PCOS is not just related to ovarian cysts, but rather a lifelong hormonal and metabolic disorder, linked to multiple body systems.

PMOS is linked to various long-term metabolic and mental health and is a leading cause of fertility problems. Despite 6-13% of women around the world being affected

Read on to explore what PMOS is, symptoms to look out for, why a diagnosis is important, and how treatments can help.

What is PMOS?

PMOS is a common medical condition affecting hormone levels in women. It is characterised by an imbalance of reproductive hormones and other metabolic markers like insulin resistance. This leads to symptoms affecting menstrual periods, acne and excess hair.

Additionally, PMOS is the most common cause of infertility whilst increasing the risk of long-term conditions such as type 2 diabetes, obesity and even endometrial cancer.

Whilst the cause is unknown, lifestyle changes and certain medical treatments can help reduce symptoms, increase fertility and improve overall quality of life.

Common Symptoms of PMOS

Symptoms of PMOS vary between individuals and may change over time. Primary symptoms are a result of high androgens (male hormones) and metabolic dysfunction.

• Irregular periods, which may be infrequent or prolonged menstrual cycles

• Weight gain, particularly in the abdomen

• Darkened skin - particularly in skin folds

• Excess facial and body hair (hirsutism)

• Severe acne

• Hair thinning on the scalp

How PMOS Affects Daily Life

PMOS can have a significant impact on day-to-day life. Physically, having PMOS often leads to weight gain, which can trigger health problems like type 2 diabetes (high blood sugar levels), high blood pressure, high cholesterol, and sleep apnoea.

Weight gain can also have an emotional impact and affect self-esteem, with symptoms like increased facial hair and acne also contributing. Emotionally, it can also be hard for women who are struggling to get pregnant.

Women with PMOS can struggle with their mental health, partially due to the hormonal changes, but also the psychological impact of associated symptoms.

Having irregular periods can be frustrating, especially if they’re heavy and painful when they do appear. Women with very irregular periods are also at an increased risk of developing womb lining (endometrial) cancer, although this can be minimised with the right treatments.

Diagnosis of PMOS

Diagnosis of PMOS follows the Rotterdam Criteria.

A patient is diagnosed with PMOS if they meet two of the following:

1. Irregular periods, or absent periods

2. Excess androgens - high levels of “male” hormones leading to increased facial or body hair growth.

3. Polycystic ovaries - visible on an ultrasound.

To confirm diagnosis, a clinician will ask about your symptoms, check your blood pressure, and usually arrange some hormone blood tests. They may also decide to do an ultrasound to check whether your ovaries contain any of the fluid-filled sacs.

Treatment Options for PMOS

It's not known exactly what causes PMOS, and at present there's no cure. Different treatment options however, are available to help manage symptoms.

Lifestyle changes

The first line treatment is lifestyle changes, particularly for overweight women.

Losing just 5% of weight can lead to a significant improvement in symptoms. This can be achieved by diet and exercise modifications:

Diet - focus on low glycemic index (GI) foods, such as fruits and vegetables, lentils, oatmeal, peas and beans. These foods help stabilise insulin levels. Limit high GI foods such as refined carbs, white bread or bakery items.

Exercise - regular aerobic exercise can help improve insulin sensitivity and restore regular ovulation.

Medications

Different medications can be used to treat different PMOS symptoms.

The contraceptive pill can be used to induce regular periods and help regulate hormone levels. In doing so, it can also help with excess facial/body hair whilst reducing the risk of developing endometrial cancer.

Vaniqa cream containing eflornithine, can be used to manage unwanted facial hair, a symptom which psychologically affects many PMOS patients.

A treatment called clomifene, is recommended for PMOS patients who are trying to get pregnant. This treatment encourages ovulation.

Metformin, often used for type-2 diabetes can lower insulin and blood sugar levels in PMOS patients. Importantly, metformin is not licensed for use in PMOS in the UK, following which it is commonly prescribed off-label.

Another off-label medication used is letrozole. Though primarily used for breast cancer, it can also be used to stimulate ovulation.

Alternative treatments include weight loss injections, which can help improve insulin sensitivity and reduce the risk of further health complications later in life.

IVF

If you have tried different medicines that are meant to help with ovulation and have not worked, in-vitro fertilisation (IVF) is an effective option.

During IVF, eggs are removed from the ovaries and fertilised in a laboratory. The resulting embryo is then placed back to the uterus to achieve pregnancy.

Patients with PMOS often respond very well to IVF though chances of success depend on:

• The cause of your infertility

• Your age

• Your body mass index (BMI)

• Whether you drink alcohol or smoke

Surgery

Where medication hasn’t worked surgery is sometimes offered.

A procedure called laparoscopic ovarian drilling (LOD) may help with fertility problems and correct hormonal imbalances. This involves a laser which is used to destroy tissue that is producing androgen hormones and can trigger ovulation.

This procedure is done via keyhole surgery to reduce the risks associated with it.

Long-term considerations

PMOS is a life-long condition which puts you at higher risk of some health conditions, including diabetes, heart disease, and endometrial cancer.

For this reason, regular monitoring is important to pick up any warning signs early. A clinician can offer timely intervention and lifestyle modification to prevent progression.

PMOS key points

PMOS is a common health condition that mainly affects reproductive-age women. It’s a metabolic condition linked to insulin and blood sugar as much as it is about ovaries, suiting its new name.

No two patients with PMOS are the same. Treatment is tailored to a patient's individual symptoms.

Early intervention can slow progression of symptoms, and prevent long term heart and blood sugar levels.