PCOS renamed PMOS to improve diagnosis and treatment

Why polycystic ovary syndrome (PCOS), a common metabolic condition, is now known as polyendocrine metabolic ovarian syndrome (PMOS).

Polyendocrine metabolic ovarian syndrome (PMOS) is the new name for polycystic ovary syndrome (PCOS). Doctors say the reason is that PMOS describes the condition more accurately and may help reduce misdiagnosis. This could also ensure more women receive the right treatment for what is now considered the world’s most common female endocrine condition, says Dr Caitlin Hegter, an obstetrician and gynaecologist at Mediclinic Kloof.

Why PCOS has been misunderstood

For years, gynaecologists have called for PCOS to be renamed because it suggests the condition is mainly about cysts and ovaries. In fact, it is a complex, long-term hormonal and metabolic disorder that affects the whole body.

“The concern with PCOS was that the ovaries or cysts on the ovaries were looked at as the primary problem,” says Dr Hegter. But the condition’s underlying pathophysiology has nothing to do with cysts on the ovaries, she explains. This has caused two seemingly contradictory problems – both under- and overdiagnosis:

1. Overdiagnosis – In clinical practice, this misunderstanding has led to many patients being incorrectly diagnosed. Sometimes doctors were not seeing cysts at all, says Dr Hegter, but physiological follicles on the ovaries. These are egg cells developing in preparation for ovulation – a normal process.
   “So, we were seeing an overdiagnosis, with patients often being told very young that they have PCOS, which is a lifelong diagnosis. This was creating unnecessary anxiety in patients.”
2. Underdiagnosis – Conversely, some patients who do have the condition were being missed because they did not have polycystic or enlarged ovaries on ultrasound.

“The ovaries are a byproduct of the bigger underlying physiological problem, which is metabolic in nature,” Dr Hegter explains. “These patients therefore have metabolic risks, for example, the development of type two diabetes, high blood pressure or high cholesterol as well as a high cardiovascular risk later in life.”

Patients who needed early help for insulin resistance or high blood pressure, for example, were not getting the regular monitoring needed to prevent diabetes or cardiovascular complications, she adds.

“These are the patients who we need to identify early, so that we can put the appropriate endocrine monitoring in place to detect the problems early.”

Understanding PMOS symptoms

The latest available data suggests that PMOS affects around 1 in 10 women globally – more than 170 million. “If we extrapolate this statistic to the South African population, around a million women in South Africa are likely affected,” Dr Hegter says.

Given how common the condition is, PMOS is an important name change because it improves awareness of key symptoms, explains Dr Hegter. One of the most common signs gynaecologists identify is irregular periods. This includes cycles that are shorter than 21 days or longer than 45 days, measured from the first day of each period. Having fewer than eight periods a year, or any cycle lasting longer than 90 days, is also a concern.

Other symptoms include severe acne that doesn’t respond to normal skincare management, as well as male pattern hair growth in women – either on their face or lower abdomen. “Some patients gain weight excessively or struggle to lose weight, despite dieting and exercising well.” The condition may also be picked up through a routine metabolic screening.

“Patients often come in with low self-esteem, with symptoms similar to depression and anxiety, very strongly linked to their self-image and all the problems they’re experiencing without any answers,” Dr Hegter adds.

Women with a family history of PMOS or type 2 diabetes are at higher risk, she explains. Other risk factors include insulin resistance, being obese, or having diabetes. Children who start puberty early – before age eight – should also be monitored. However, PMOS can only be diagnosed eight years after menstruation begins.

Treating PMOS

Despite the name change, the underlying treatment of the condition remains the same. “It’s not a new disease, it’s just a more accurate name,” Dr Hegter says. “We're hoping that with the name change, the emphasis will be in the right place in terms of detection and management.”

PMOS is a lifelong condition managed through each stage of a woman’s life, she adds. Treatment includes lifestyle changes such as a healthy diet, regular exercise, weight management, stress management, and good sleep habits.

Medication depends on the patient’s symptoms, Dr Hegter says. “For example, for irregular periods, an oral contraceptive pill or hormone therapies is used regulate cycles. This can also help manage male-pattern hair growth, along with anti-androgen medications. For metabolic issues like weight gain or insulin resistance, diabetic medication, metformin may be used. For clinically obese patients, we often combine an oral contraceptive with metformin.”

More recently, for PMOS patients battling with insulin resistance and obesity, GLP-1 agonists, like Ozempic and Mounjaro, are making a big difference. Since PMOS patients often don’t ovulate, ovulation induction options are explored when they want to start a family, Dr Hegter says.

Ultimately, PMOS is a very manageable condition, she adds, but it must be controlled throughout a patient’s life. “Hopefully with the name change, we can get earlier and better diagnoses helping patients manage their condition.”