Many women have been diagnosed with PCOS or Polycystic Ovary Syndrome but the common hormonal and metabolic disorder has been renamed*.
Polyendocrine Metabolic Ovarian Syndrome or PMOS was recently adopted by the medical world in an effort to better diagnose the disorder and improve health outcomes for women living with it.
The new name offers a more accurate understanding of the condition and answers for women living with it who are trying to conceive.
Genea fertility specialist Dr Rebecca Taylor is a RANZCOG certified Gynaecologist.
She says for a long time the misleading name meant the disorder was incorrectly linked to ovarian cysts when in actual fact, it is a complex hormonal and metabolic disorder which can affect the reproductive system, weight, skin and mental health.
Dr Taylor says the old terminology caused a lot of confusion and misdiagnosis.
“There were patients being wrongly diagnosed with polycystic ovarian syndrome,” Dr Taylor tells Women’s Agenda.
“They may have had a cyst on their ovary at one point that was picked up on a scan or presented to the emergency department with acute severe pain suggestive of a ‘cyst accident’ and were then being told they had PCOS when actually they didn’t have any of the symptoms or signs of the condition.
“What you see in PMOS is not the formation of cysts but actually multiple small, fluid-filled sacs called follicles.”
The new name PMOS presents the medical world with a clearer understanding of what the disorder actually is and can offer some important insights for people planning to grow or start a family.
“Around 10 to 15 per cent of women of reproductive age meet the criteria for PMOS so it is very common but the manifestations can be varied,” says Dr Taylor.
The shift from PCOS to PMOS was led by Australian advocates and researchers at the Monash Centre for Health Research and Implementation (MCHRI).
Monash Health endocrinologist Professor Helena Teede AM says the name change was a critical step to recognising and improving the long-term impacts of the condition.
“The diverse features of the condition were often unappreciated,” Professor Teede tells the MCHRI.
“It was heartbreaking to see the delayed diagnosis, limited awareness and inadequate care afforded those affected by this neglected condition.”
What is PMOS?
PMOS (previously known as PCOS) is a complex hormonal or endocrine disorder.
According to the MCHRI, it affects more than 170 million women around the world.
Women who have it experience hormonal imbalances rather than ovarian cysts.
“If you’re over 20 years of age, you need to have two out of three issues in order to pin the diagnosis – but I always say to patients that it’s a spectrum,” Dr Taylor says.
| For a PMOS diagnosis, a patient must present with at least two of the below: – Oligoanovulation: infrequent or absent ovulation presenting as menstrual cycles typically lasting 35 days or longer – Evidence of high androgens (excess of male hormones) such as acne, excess hair growth or on blood testing – Polycystic Ovarian Morphology (20 or more follicles per ovary on ultrasound) or high level of Anti-Müllerian Hormone |
When diagnosing PMOS, one of the common features a doctor will look for is ‘oligoanovulation’ which refers to infrequent or absent ovulation meaning the ovaries are not releasing eggs or do so irregularly.
“Sometimes I’ll see patients with PMOS that don’t have a period for three or four months at a time because of this,” Dr Taylor says.
“Some patients may not have a period at all with the condition.”
However, some patients with regular cycles can still have PMOS so doctors also look for other markers such as clinical or biochemical evidence of high androgens.
This occurs when a biological female has an excess of male hormones.
“Biochemical evidence of that on bloods may be a slightly elevated testosterone level or something called the free androgen index,” she says.
“Clinically, it can manifest as acne, hair loss like male pattern balding and also hirsutism so that may be excess hair growth on the face or other parts of the body.”
The third criterion is Polycystic Ovarian Morphology (PCOM) or high level of Anti-Müllerian Hormone (AMH).
PCOM is picked up with an ultrasound.
“As a fertility doctor, I’m always very interested in what someone’s antral follicle count is,” says Dr Taylor.
“When we see more than 20 follicles on each ovary and someone is having issues conceiving, then PMOS may be at play.”
Dr Taylor says people with PMOS commonly have a very high AMH.
“AMH is a blood marker of your ovarian reserve,” says Dr Taylor.
“It measures a glycoprotein produced by the granulosa cells of the ovary.”
In addition to fertility challenges, Dr Taylor says PMOS can be associated with a number of metabolic conditions like insulin resistance, Type 2 diabetes, high cholesterol, obesity, hypertension and cardiovascular disease.
“That’s why it’s important to try and accurately diagnose as many people as possible,” she says.
“I see a lot of patients with PMOS who are really struggling with things like weight management or mental health wellbeing.”
As PMOS can be linked to so many underlying issues, accurate diagnosis is critical so the right treatment is identified and patients can get better healthcare outcomes.
“Many patients with PMOS will have no issue conceiving,” she says.
“Generally, they will have good ovarian reserves.
“So we have eggs there.
“But one of the problems we’ll see is that those eggs are not being released in a timely fashion each month that allows for intercourse at the right time of the cycle or adequate development of the lining of the womb.
“Now, if you’ve got a diagnosis of PMOS but you have regular cycles – somewhere in the sort of 28 to 35 day cycle, you’re tracking your cycle, you’re getting evidence of good ovulation on the urine test, you may not need any help at all.
“And there’s every chance you’ll fall pregnant without any issues.
“But if you have no idea when you’re ovulating and your cycles are very irregular, I would go and see your GP and then get a referral to a fertility specialist sooner rather than later because it’s very hard to fall pregnant unless you’re ovulating and having intercourse at the right time.
“The good news is these things are often easy to sort with treatment such as ‘ovulation induction’ which involves taking medication to help a person ovulate.”
*As the medical world adopts the new term PMOS, a transition period is in place until 2028 so the term PCOS can be phased out.