PCOS is now PMOS: What does it imply?

Renaming polycystic ovary syndrome to polyendocrine metabolic ovarian syndrome reflects a broader reality that includes hormonal and metabolic disorders, and not just reproductive health, writes Dr Aviva Pinto Rodrigues.

A recent paper published in The Lancet has announced the renaming of polycystic ovary syndrome (PCOS) to polyendocrine metabolic ovarian syndrome, or PMOS, in what experts are calling a major shift in women’s health research and awareness. The change comes after years of debate among scientists, clinicians, and patient advocacy groups who argued that the term PCOS has failed to capture the true nature of the disorder. A global survey of over 14,000 responses was taken into account before arriving at the name change.

The term polycystic ovary syndrome, widely known as PCOS thus far, has impacted how millions of women understand their medical condition. Doctors and researchers believe that the name of the condition has in itself posed difficulties for people to understand the medical problem. This name is a simplistic understanding of a medical condition that primarily affects people with ovarian cysts. However, many women who receive a PCOS diagnosis actually show no signs of ovarian cysts. Also, women may have ovarian cysts but they may not exactly suffer from the syndrome. The condition affects a wide range of health areas that extend beyond its reproductive health impacts. The condition is, in reality, a complex hormonal and metabolic disorder which affects all aspects of female health according to research. The term PMOS attempts to reflect this broader reality.

Hormonal and metabolic

The word ‘polyendocrine’ acknowledges that multiple hormonal systems are involved. The term ‘metabolic’ demonstrates a strong relationship between insulin resistance and type 2 diabetes, and cardiovascular disease. The name contains the word ‘ovarian’ because reproductive symptoms remain essential for diagnosis although they no longer serve as the primary identifying factor. The new terminology offers a complete comprehension of the disorder which will lead to better diagnostic methods and treatment solutions.

The most common misunderstanding about PCOS states that the condition only affects women who have excessive body weight. The public image of PCOS has been established through social media platforms and popular cultural references as a condition that exclusively affects people with obesity. The assumption causes doctors to warn that multiple women will remain undiagnosed due to this single factor.

Impact of syndrome

The condition, hitherto known as lean PCOS, affects women who show normal body weight but face severe hormonal disorders. Women with this condition experience facial hair growth and scalp hair thinning and they also suffer from fertility difficulties and mood fluctuations and insulin resistance while their body mass index remains within normal limits. Medical professionals dismiss many lean women because they do not match traditional physical characteristics associated with their medical condition. Some patients are told they weigh “too little” to develop PCOS while others spend years searching for answers about symptoms that persistently affect their everyday activities. Research increasingly shows that insulin resistance can occur even in women who are not overweight. This is one of the reasons why experts believe the term PMOS is more accurate. It helps to concentrate on internal problems rather than external factors such as weight.

The World Health Organisation says that what was thus far known as polycystic ovary syndrome affects close to 8-13 per cent of women of reproductive age all over the world. The disease is considered to be the most common endocrinological disorder among women. Nevertheless, experts believe that up to 70 per cent of all patients do not have any diagnosis because of social taboos related to reproductive issues.

The condition starts during adolescence with symptoms that include irregular menstrual cycles and constant acne breakouts and sudden weight increases and excessive body hair growth. The untreated condition develops into infertility, diabetes, fatty liver disease, sleep apnea, anxiety, depression and heart disease risk escalation over time.

Weight loss not the only focus

Doctors say management should never focus only on weight loss. Individualised treatment should be the focus.

Patients need medical treatment which includes hormonal therapy and insulin-sensitising medications, fertility support and psychological counselling that matches their specific symptoms and needs.

Attitudinal shift

The shift from PCOS to PMOS will not create immediate changes in how doctors diagnose patients. Experts believe that this development represents a significant transformation in the cultural and medical aspects of society. The condition extends beyond ovarian cysts because it involves more than body weight.

The condition requires healthcare providers to identify it as a lifelong multisystem disorder that needs immediate recognition and additional scientific investigation and professional treatment.

The name change provides validation to millions of women who have spent years feeling misunderstood.

(The author is senior consultant and clinical director at a fertility clinic in Bengaluru.)