Gynaecology Polyendocrine Metabolic Ovarian Syndrome (PMOS)

PMOS (PCOS)

Polyendocrine metabolic ovarian syndrome (PMOS, formerly known as polycystic ovarian syndrome or PCOS) is a complex condition that requires a multifaceted approach to management and treatment. By prioritising early diagnosis, personalised treatment plans, and supportive care, women with PMOS can lead healthy, fulfilling lives.

PMOS affects approximately 10% of women worldwide, making it one of the most common hormonal disorders among women of childbearing age. Despite its prevalence, over half of women with PMOS are undiagnosed, partly due to the variability of symptoms

What is PMOS?

PMOS is a common hormonal disorder affecting women of reproductive age, characterised by a combination of symptoms that can impact menstrual function, fertility, skin and hair, and metabolic processes.

It is often associated with enlarged ovaries that contain numerous small cysts, insulin resistance, and elevated levels of male hormones (androgens), leading to a variety of health and cosmetic concerns. Understanding PMOS is the first step towards managing its symptoms and mitigating its impact on your health and quality of life.

Living with PMOS can be challenging, not just physically but emotionally and psychologically. Access to supportive communities, whether online or in-person, can provide valuable resources, encouragement, and advocacy for those affected. Education and awareness are key to improving diagnosis rates and treatment outcomes.

What causes PMOS?

While the exact underlying cause of PMOS is not fully understood, genetic, lifestyle, and environmental factors are known to play a role. These risk factors can include having a first-degree family member with PMOS, living with obesity, or being exposed to certain hormone-disrupting chemicals and pollution in your environment.

PMOS diagnosis

PMOS can increase the risk of several long-term health issues, including type 2 diabetes, cardiovascular disease, and endometrial cancer, underscoring the importance of early diagnosis and management.

PMOS symptoms

The symptoms of PMOS can vary significantly from one individual to another, and many women may not correlate these symptoms to the hormonal disruption from PMOS at first. Symptoms can include:

  • Excessive hair growth on your torso and face (hirsutism), which can typically occur in the male pattern of hair growth
  • Hair loss or thinning on your scalp
  • Acne
  • Weight gain
  • Menstrual disturbances, such as irregular periods or missed periods, leading to infertility

How is PMOS diagnosed?

Diagnosing PMOS typically involves a combination of clinical history review, physical examination, ultrasound imaging to assess your ovaries for fluid-filled sacs (cysts), and blood tests to measure hormone levels. You may approach your GP if you suspect you have PMOS from your symptoms or ask for a referral to a gynaecologist. 

A diagnosis of PMOS can be made with evidence of at least two of the following:

  • Irregular menstrual cycles
  • Signs of high androgen levels (e.g. excessive facial hair or acne)
  • Polycystic ovaries identified with ultrasound

How is PMOS treated?

While there is no cure for PMOS, a range of treatments can help manage your symptoms and reduce your risk of complications. Dr Huang tailors her treatment plan to your symptoms, their severity, and your fertility goals.

Lifestyle modifications

Optimising your weight through a balanced diet and regular exercise can improve your body’s insulin sensitivity, reduce androgen levels, and alleviate many of your PMOS symptoms. For some women with PMOS trying to conceive, even losing a small amount of weight can improve your fertility enough for spontaneous conception.

Medication

Hormonal contraceptives such as the oral contraceptive pill can regulate your menstrual cycles and reduce acne and unwanted hair growth. Metformin, a medication typically used to treat type 2 diabetes, can also help to improve your insulin resistance and regulate ovulation in some women. For others, weight loss medications can help with weight management and metabolic health, while also conferring benefits for fertility. If you are seeking to become pregnant, Dr Huang may prescribe fertility medication to stimulate ovulation and increase your chances of conceiving in that cycle.

Cosmetic treatment

Cosmetic interventions such as laser hair removal, electrolysis, and specialised skincare treatments can be effective at managing symptoms like hirsutism and acne. Though therapies that address the hormone imbalance are still necessary, the positive impact on your self-esteem and confidence from cosmetic treatments should not be understated.

Laparoscopic ovarian drilling

In certain cases, a minimally invasive procedure known as ovarian drilling may be considered. This is performed via laparoscopy through keyhole incisions in your abdomen. Tiny holes created on the surface of your ovaries using heat or laser can help to reduce the amount of androgen hormones produced by these tissues. Ovarian drilling has been utilised to help improve the hormonal environment inside the ovary and may restore normal ovulation and improve fertility in some women.

What can fertility testing identify?

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Testing may help identify ovulation issues, hormone imbalances, ovarian reserve concerns and other factors affecting fertility.

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Frequently Asked Questions

Polyendocrine metabolic ovarian syndrome interferes with your hormone balance and can disrupt ovulation. Without regular, predictable ovulatory cycles, it can be difficult to time intercourse during your fertility window where you have a chance of conceiving. Despite this, it is also possible for some women with PMOS to fall pregnant naturally without problem.

PMOS is a complex gynaecological condition and its causes are not fully understood. As many PMOS risk factors are out of your control – such as your genetics and family history – it is not possible to prevent yourself from developing the condition. However, you can reduce your risk of a PMOS-related complication by maintaining a healthy lifestyle and following up regularly with your doctor.

PMOS is associated with an increased risk of endometrial cancer, which develops in the lining of the uterus (the endometrium). PMOS is only one risk factor for endometrial cancer, and having PMOS does not mean you will definitely get cancer.

You may want to seek assessment if you have irregular periods, acne, unwanted hair growth, scalp hair thinning, weight gain, or difficulty falling pregnant. Diagnosis usually involves a combination of symptom history, blood tests, and ultrasound.

PMOS can be associated with insulin resistance and changes in metabolism, which can make weight gain more likely and weight loss more difficult for some women. Weight changes can also worsen symptoms, which is why treatment often includes a focus on metabolic health as well as hormone symptoms.

Not always. PMOS is diagnosed using a combination of features, and not every woman needs every test. Depending on your age, cycle pattern, symptoms, and hormone results, Dr Huang may use different information to reach a diagnosis.

Need expert gynaecology care? Contact Dr Alice Huang, Melbourne gynaecologist and surgeon, today

Dr Huang has been providing comprehensive gynaecology care for women for over 20 years, with a focus on clear communication and patient-centred, evidence-based care that guides you through the journey step by step. Her expertise includes surgical procedures such as laparoscopy, hysteroscopy, and endometrial ablation, as well as in-office procedures including pelvic ultrasound and colposcopy. Her rooms are conveniently located at Epworth Freemasons Hospital in East Melbourne.

Contact Dr Huang’s rooms today to arrange your appointment.

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