Polyendocrine metabolic ovarian syndrome, previously called PCOS (polycystic ovarian syndrome), affects an estimated 1 out of 8 women worldwide
By Eva Briggs, MD
When I was a medical student, the professors used to say, “Fifty percent of what we are teaching you is wrong. We just don’t know which 50%.”
Forty-five years later, I can vouch that the medical knowledge has evolved, grown, changed and refined with time. A name change for a common condition, announced in May, is an example of this change.
Polyendocrine metabolic syndrome (PMOS) is the new name for the condition previously called polycystic ovarian syndrome (PCOS). The new name better reflects the pathology underlying this disease. PMOS affects an estimated 1 out of 8 women worldwide.
We used to think that this condition was an ovarian disorder due to its association with irregular periods and infertility. The “cysts” for which PCOS is named weren’t cysts at all. They were ovarian follicles, a normal structure containing young eggs, and not cysts at all.
PMOS is much more complex than a disorder of the ovaries. It involves multiple organs throughout the body and many endocrine systems.
The diagnosis requires two of the following three findings.
1. Irregular periods. Menstrual periods may be infrequent, coming more than 35 days apart. They can be too close together. Bleeding could be heavy and last for days. Sometimes periods cease altogether. Many women with PMOS struggle with fertility problems.
2. Too much androgen effect. Women with PMOS may develop signs that they are reacting to excessive male hormones. This could manifest as unwanted excess hair on the face or body(hirsutism), male pattern baldness, or severe acne.
3. Abnormal appearance of ovaries on ultrasound. The ovaries may appear large with what appears to be cysts, although we now know they are follicles – tiny harmless sacs containing immature eggs.
The new name reflects how medical providers will think about and treat patients. Because of the emphasis on metabolic changes, patients may be diagnosed sooner. Earlier recognition could lead to earlier treatment. There will also be more focus on metabolic screening, such as blood sugar, blood pressure, and cardiovascular risk factors.
Abnormal insulin metabolism leads to many of the manifestations of PMOS. The body’s cells are resistant to circulating insulin. Insulin resistance can lead to Type 2 diabetes. Over half of women with PMOS aged over 40 develop diabetes. Patients with PMOS face increased rates of heart disease and metabolic syndrome. Metabolic syndrome is a combination of diabetes, high blood pressure, and elevated cholesterol.
Elevated insulin levels stimulate the ovaries to produce increased androgens, which are male hormones. High circulating androgens lead to irregular periods, fertility problems, and excess body and facial hair.
Insulin promotes fat storage. This can cause obesity, often with excess abdominal fat.
Standard blood tests for diabetes, such as fasting blood sugar and hemoglobin A1c, are often normal especially early in the disease. A fasting insulin test can help pinpoint the diagnosis earlier,
Lifestyle changes can help. Limiting simple carbohydrates and sugars helps reduce blood sugar and insulin levels.
Metformin is a medicine that improves the body’s sensitivity to insulin. GLP-1 receptor agonists, best known for weight loss, help improve insulin sensitivity and reduce cravings.
Excess hair growth and acne can be treated with oral contraceptive pills. These decrease androgen levels and can also lead to regular menstrual cycles. Certain androgen-blocking medicines such as spironolactone also treat hirsutism.
Eva Briggs is a retired medical doctor who practiced in Central New York for several decades. She lives in Marcellus.