‘PCOS to PMOS’: Landmark change of name makes this condition every doctor’s business, not just fertility clinics

In a historic change of name, the condition PCOS (Polycystic ovarian syndrome) has been renamed to PMOS (Polyendocrine metabolic ovarian syndrome), after being called a misnomer, causing delay in diagnosis and leading to fragmented treatments in women. 

The notorious condition which affects one in eight women and almost 170 million women worldwide, has left many in the dark for years before it represents itself with dangerous underlying metabolic symptoms.

After 14 years of collaborative efforts between the experts, the Endocrine Society, a global network of physicians treating hormonal disorders, pushed this change for the better.

The disease, initially thought to be a problem with the ovaries, was found to be a much bigger challenge, affecting multiple systems in the body.

Professor Helena Teede, Director of Monash University’s Monash Center for Health Research and Implementation and an endocrinologist at Monash Health, has been attributed to have led the change after witnessing the challenges of the patients who failed to receive adequate diagnosis and care.

The name change journey has been detailed in an article published in the journal Lancet.

Speaking to DH, Dr Nirmala M, a consultant obstetrician, gynaecologist & fertility specialist at Motherhood Hospitals (Whitefield, Bengaluru) said: “The renaming of PCOS to PMOS can be considered as one of the most significant changes in the management of this condition. Bringing the word ‘metabolic’ at the center will ensure that the underlying causes are taken seriously by the medical community. This can validate the suffering of so many women who have been struggling with no answers and no comprehensive treatment that could help them.”

Until now what was just a fertility concern has suddenly placed general physicians in the center of disease management, authorising their role in making a diagnosis.

There was never a cyst

Ironically, there are no cysts in the ovaries of the women diagnosed with PCOS. Even if a woman has ovarian cysts, it is not directly connected to the disorder. 

The researchers, who for the first time, came across the fluid-filled sacs in the ovaries thought of it as cysts. In reality, those were just immature follicular tissue holding the egg.

Since then, the erroneous name continued to be used by the medical community who sidelined it as a fertility issue.

For the longest, the fertility experts made ovarian cyst and their size as the hallmark criterion of diagnosis.

Other symptoms like irregular periods, receding hairline, skin breakouts and disrupted male sex hormones (steroid hormones like testosterone) were thought to be consequential of the fertility condition.

A lot kept happening in their bodies behind the obvious fertility symptoms and no one took a notice. 

A multi-system disorder

In recent years, many scientists started to understand PMOS in a better way. Though the exact cause is still uncertain, they came to be sure of it being a multi-system disorder and not just limited to the ovaries.

The newer research on PMOS calls it an attack on the endocrine machinery of the body.

A characteristic associated with the condition is an increase in the male sex hormone, called testosterone which explains some symptoms like excessive body hair and irregular ovulation in the affected women.

Ongoing research has figured out a mismatch in the levels of two other hormones which may have a role to play in this – follicle stimulating hormone (FSH) and luteinising hormone (LH). This has an effect on the levels of testosterone which is found to be more than permissible levels in these females.

This has a connection to another problem – people with PMOS are found to have poor insulin sensitivity. 

The scientists have also discovered a vicious cycle that goes between insulin resistance and androgens (male sex hormone) with each of them making the other increase. 

People having PMOS have an increased tendency to become resistant to action of insulin whose primary function is to initiate fat storage in the blood. When body cells don’t respond to insulin, the pancreas increases its production. Elevation in levels of insulin can push the body to increase fat storage, sometimes in places where it is not needed. It can also lead to more fatty acids reaching the liver to and the organ itself starts to store excessive fat, causing chronic liver disease and in rare cases, scarring of tissue. 

So, naturally people with PMOS become highly susceptible to MASLD (Metabolic Dysfunction Associated Steatotic Liver Disease), earlier called the non-alcoholic fatty liver disease.

The person affected by PMOS finds it hard to shed weight and sometimes might gain weight due to this, ending up in a vicious loop.

When the body handles fat and sugar poorly, people have an increased risk for all types of problems – diabetes type 2, fatty liver disease, heart disease and even some cancers.

No organised treatment

For a medical condition that affects a hormonal cascade and also various systems, a fertility expert cannot manage the symptoms alone.

Women having irregular periods may find themselves knocking at a fertility clinic who might put them on combination hormonal pills to regularise ovulation. 

However, they might not look into the metabolic side of the symptoms which tend to grow with time.

In fact, in some female patients with PMOS, there may be no irregularities with ovulation or ovaries at all.

Many women who are seeking active treatment for the condition tend to consume Metformin, a drug meant to treat insulin resistance and diabetes type 2.

As per an article in the Time Magazine, the recognition of PMOS can allow treatments like GLP-1 medications to be prescribed for these patients which can help them manage their symptoms.

Till date, PMOS is a chronic metabolic condition and the symptoms can only be managed, not cured. 

With this name change, for the first time, the complex condition shall be looked into as a whole.