What is PMOS, or as it was recently known, PCOS? Its Symptoms and Treatment

Polyendocrine Metabolic Ovary Syndrome (PMOS)

Polyendocrine metabolic ovary syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS), is a multi-systemic condition that can affect women and girls of reproductive age and has reproductive, hormonal, metabolic, and psychological dimensions. The name PMOS more accurately reflects that the problem is not limited to ovarian cysts and that its metabolic effects are also significant.

PMOS can cause changes in the menstrual cycle, skin changes such as increased facial and body hair and acne, ovulation problems, and fertility difficulties. Insulin resistance and other metabolic problems can also be observed in women with PMOS.

Women with PMOS typically present with at least two of the following three conditions:

• Anovulation, irregular menstrual periods, or absence of menstruation
• Elevated androgen hormone levels or clinical signs of high androgens, such as excess body or facial hair
• Detection of polycystic ovary morphology on ultrasound, or the use of anti-müllerian hormone (AMH) levels under appropriate conditions in adults as a substitute. The structures seen here are not true cysts, but ovarian follicles at different stages of development.

PMOS is the most common cause of anovulatory infertility. This means it is caused by the absence of ovulation, the process by which a mature egg is released from the ovary each month. Many women do not know they have PMOS until they have trouble getting pregnant.

PMOS can also cause other problems, such as unwanted hair growth, dark skin patches, acne, weight gain, and irregular bleeding.

Women with PMOS are also at higher risk for:

• Obstructive sleep apnea (a disorder that causes pauses in breathing during sleep)
• Insulin resistance
• Metabolic syndrome, heart disease, and type 2 diabetes
• Obesity
• Heart disease and high blood pressure (cardiovascular disease)
• Mood disorders
• Endometrial hyperplasia (a condition where the uterine lining becomes too thick, leading to endometrial cancer).

What are the symptoms of PMOS?

In addition to the three main features used to evaluate polyendocrine metabolic ovary syndrome (PMOS)—ovulatory dysfunction, clinical or biochemical hyperandrogenism, and polycystic ovary morphology—there may be many signs and symptoms, some of which may not seem related to one another:

• Menstrual irregularities
• Absence of menstruation (amenorrhea)
• Frequently irregular menstrual periods (oligomenorrhea)
• Prolonged menstrual periods
• Bleeding without ovulation (anovulation)
• Infertility
• Excessive hair growth on the face, chest, abdomen, or upper thighs (hirsutism)
• Severe, late-onset, and persistent acne that does not respond well to conventional treatments
• Weight gain, difficulty losing weight, or obesity, particularly around the waist
• Oily skin
• Thickened, dark, velvety skin patches (Acanthosis Nigricans)

What causes PMOS?

Researchers and healthcare professionals know that genetic and environmental factors contribute to the development of polyendocrine metabolic ovary syndrome, but they do not know exactly what causes PMOS.

Because PMOS symptoms are linked to genetic predisposition, the syndrome is likely caused by changes or mutations in one or more genes. Recent research in animal models suggests that in some cases, PMOS may be caused by genetic or chemical changes that occur in the womb.

What causes PMOS symptoms?

Most PMOS symptoms are caused by higher-than-normal levels of certain hormones called androgens.

Ovaries produce hormones, which are chemicals that control certain functions in the body. One of the hormones produced by the ovaries is estrogen; it is also called the "female hormone" because women’s bodies produce more estrogen than men’s. Ovaries also produce androgens; these are also called "male hormones" because men’s bodies produce more androgens than women’s bodies. Men and women need certain levels of both hormones for normal health.

In women with PMOS, hormones are imbalanced. These women may have higher-than-normal androgen levels and lower-than-normal estrogen levels. High levels of androgens can:

• Interfere with brain signals that normally result in ovulation, causing ovulation not to occur regularly,
• Stop the development of follicles—small, fluid-filled sacs within the ovaries where eggs grow and mature—causing them to stop growing,
• Cause other symptoms of PMOS, including excess hair growth and acne.

Other symptoms of PMOS are caused by problems with insulin, another hormone in the body. Insulin helps move sugar (also known as glucose) from the bloodstream into cells to be used as energy. When cells do not respond normally to insulin, the level of sugar in the blood rises. Also, insulin levels rise as the body produces more and more insulin to get glucose into the cells. Too much insulin increases androgen production, which causes PMOS symptoms. High insulin levels can also increase appetite and cause weight gain. High insulin levels are also linked to a skin condition called acanthosis nigricans, which causes dark, velvety patches of thickened skin.

Who is at risk for PMOS?

Women are at higher risk for PMOS if:

• You have a mother or sister with PMOS,
• You are obese.

How do healthcare professionals diagnose PMOS?

Healthcare professionals look for three main features in the assessment of PMOS: ovulatory dysfunction, clinical or biochemical hyperandrogenism, and polycystic ovary morphology. In adults, the presence of at least two of these three features supports the diagnosis after other conditions that could cause similar symptoms have been excluded. If irregular menstrual cycles and hyperandrogenism are both present, an ultrasound or AMH test may not always be necessary for diagnosis.

Some of these conditions include:

• Excessive hormone production by the adrenal glands called adrenal hyperplasia,
• Problems with thyroid gland function,
• Excessive production of the hormone prolactin by the pituitary gland, called hyperprolactinemia.

Before ruling out other conditions and diagnosing PMOS, your healthcare provider may:

• Take a complete family history. Your healthcare provider will ask you questions about your menstrual cycle and any history of infertility. They will also ask if you have a mother or sister with PMOS or symptoms like yours, as PMOS tends to run in families.
• Perform a complete physical examination. Your healthcare provider will perform a physical exam and look for extra hair growth, acne, and other signs of high androgen levels. They will also check your blood pressure, measure your waist, and calculate your body mass index, which is a measure of your body fat based on your height and weight.
• Take blood samples. Your healthcare provider will check your blood for androgen, cholesterol, and sugar levels.
• Perform a pelvic exam or ultrasound. If necessary, your healthcare provider may recommend a pelvic ultrasound to evaluate the appearance of the ovaries and the thickness of the uterine lining. During irregular menstrual periods, the uterine lining may be thicker than normal. Ultrasound findings alone do not diagnose PMOS and are not necessary for every patient.

Is there a cure for PMOS?

Currently, there is no cure for polyendocrine metabolic ovary syndrome (PMOS), and it does not go away on its own.

What are the treatments for PMOS?

Because polyendocrine metabolic ovary syndrome (PMOS) has a wide range of symptoms, healthcare professionals may use a variety of treatments for this condition and its symptoms.

The treatment(s) recommended by healthcare professionals will depend on:

• Your symptoms
• Your other health problems
• Whether you want to become pregnant

Because some common treatments for PMOS symptoms can prevent pregnancy or harm a fetus during pregnancy, it is important to discuss your fertility goals with your healthcare provider when discussing treatment options. Make sure you fully understand your treatment options and their effects on pregnancy before deciding on a treatment method.

Treatments for Infertility Caused by PMOS

In most cases, fertility problems in women with polyendocrine metabolic ovary syndrome (PMOS) are caused by the absence or irregularity of ovulation; however, this may not be the only reason. Other possible causes are also evaluated before starting treatment for PMOS-related infertility.

Lifestyle changes, such as losing weight, can trigger body changes that make it easier for women with PMOS to conceive. Your healthcare provider may recommend that you try losing weight and making other lifestyle changes before trying any medication to see if fertility returns and if pregnancy occurs naturally. Research shows that lifestyle changes can help restore ovulation and improve pregnancy rates among women with PMOS. Research shows that even a small amount of weight loss among obese women with PMOS who have menstrual disorders improves menstrual function and fertility.

Treatments to Relieve PMOS Symptoms

In most cases, one of the first steps healthcare professionals recommend to women with polyendocrine metabolic ovary syndrome (PMOS) is personalized lifestyle modifications.

Lifestyle Modifications

In most cases, the first action healthcare professionals recommend to women with PMOS is specific lifestyle changes, such as following a lower-calorie diet, losing weight, and getting more physical activity.

Losing weight and being more physically active can minimize many PMOS symptoms and related conditions. Even a 5% weight loss can improve many symptoms of PMOS.

• Weight loss can restore ovulation and make your menstrual cycles more regular, which can increase your chances of getting pregnant.
• Losing weight reduces the risk of diabetes and lowers cholesterol levels.
• For many women, weight loss reduces symptoms such as excessive hair growth and acne.
• Physical activity can reduce depression associated with PMOS.

Oral Contraceptives

Hormonal contraceptives, also called birth control pills, can be used for the long-term management of women with PMOS who do not wish to become pregnant, and they are actually the primary treatment for these women. Oral contraceptive pills contain a combination of the hormones estrogen and progestin. In women with PMOS, these hormones are used to:

• Make menstrual periods more regular,
• Reduce androgen activity by lowering the level of androgens produced by the ovaries,
• Clear acne and reduce excessive hair growth.

Oral contraceptives can help reduce the risk of certain types of cancer, but they may also increase the risk of other types of cancer. There is no single oral contraceptive that works best for women with PMOS, but those that are less androgenic are more effective in treating PMOS symptoms. It should be remembered that like all medications, oral contraceptives have a certain level of risk of side effects, some of which are serious.

Insulin-Sensitizing Agents

These types of medications make the body more sensitive to insulin and help keep glucose levels more stable. In women with PMOS, these medications can help with:

• Clearing acne and reducing hair growth
• Achieving weight loss,
• Lowering cholesterol levels,
• Making menstrual periods more regular,
• Reducing PMOS-related infertility.
  

Are there disorders or conditions associated with PMOS?

Women with polyendocrine metabolic ovary syndrome (PMOS) may be at higher risk for other health problems, some of which are serious.

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