PCOS Has A New Identity: Introducing PMOS

PCOS has had a name change, and it’s about time! Polycystic ovarian syndrome is now polyendocrine metabolic ovarian syndrome - it sounds like a mouthful, but here’s why the name change is really important when it comes to how the condition is managed and diagnosed.

PMOS (formerly known as PCOS) is primarily a metabolic condition, rather than a hormone condition. It affects up to 1 in X women, and is diagnosed by the Rotterdam criteria. Syndromes can cover a range of symptoms, and not everyone will experience all of the symptoms, so a diagnosis is made when you meet 2 out of the 3 key criterion:

The Rotterdam Criteria

1. Polycystic ovaries on ultrasound (we’ll get to what this actually means in a second)

2. Clinical or biochemical hyperandrogenism (essentially, high testosterone on blood tests, OR clinical signs like acne, facial hair, or male pattern hair loss)

3. Oligo / anovulation (irregular or absent periods)
   

Not everyone with PCOS has polycystic ovaries, which is why the new name PMOS is FAR more fitting of the characteristics of this condition.

Myself and I’m sure many other practitioners have sat in consults with women who meet the diagnostic criteria for PCOS/PMOS, but because they didn’t appear to have polycystic ovaries when they had their ultrasound done, they have been told they don’t have PCOS/PMOS. Now, given the nature of how I, and many other Clinical Nutritionists and Naturopaths work, not having a formal diagnosis in no way means we cannot help to manage your acne, hair loss, weight gain, insulin resistance, or periods, but it is invalidating for women to go through the process of seeking support from their health care team and getting so close to having some answers, only to be told they don’t have it because they don’t meet one of the criteria. 

The polycystic ovaries in question refer to high numbers of immature follicles. In a normal cycle, a number of follicles are recruited in preparation for ovulation, but ultimately only one dominant follicle will mature enough to reach oocyte status (the egg), which will be ovulated and has the potential to be fertilised. In PMOS, you can have more follicles than normal get recruited, and yet none of them fully mature, which is what can then delay ovulation, causing the irregular or missing periods.There are a number of things that can contribute to this, but again, not everyone presents with these “cysts” and they are not the defining characteristic, hence the name change. 

PMOS has 4 main subtypes:

1. Insulin resistant PMOS - this makes up 70% of PMOS cases!

2. Post-pill PMOS

3. Inflammatory PMOS

4. Adrenal PMOS
   

The drivers behind these 4 subtypes influence how we can best support you, which is arguably the most important thing. Given insulin resistance is the main driver of the majority of PMOS cases, the rename to polyendocrine metabolic ovarian syndrome starts to make a lot more sense. 

Polyendocrine - affecting multiple endocrine organs e.g the pancreas (insulin resistance) and the ovaries (sex hormones)

Metabolic - metabolism, weight changes, blood sugar regulation etc.

Ovarian - impacts the menstrual cycle and ovarian hormones

Syndrome - covers many different symptoms and is not a one size fits all condition.

In my clinic we take a root cause, and a person centred approach, meaning we will look at your blood tests, take a really thorough case history, listen to your symptoms and your experiences, and come up with a plan to support your hormones, weight, skin, menstrual cycles, fatigue, and whatever else you need help with based on what is driving those symptoms for you. 

The best place to start is by booking an initial consultation.