Midstate Medical Moment: Understanding PMOS

Gretchen Makai, M.D., Ob-gyn, UPMC Magee-Womens Minimally Invasive Gynecologic Surgery

Irregular periods, infertility, acne, weight gain and mental health issues may seem unrelated, but they can all be symptoms of polyendocrine metabolic ovarian syndrome (PMOS).

The condition, formerly known as PCOS, has been renamed PMOS to reflect significant changes in how it is understood and how the diagnosis impacts the entire body. Recognizing the symptoms and having a better understanding of what PMOS is can improve quality of life for many women.

Q: What PMOS symptoms should women be aware of, and when should they talk to their provider?

A: Often, the major symptom that leads women to get checked for PMOS is having trouble getting pregnant. Other symptoms are irregular periods or too few periods and elevated testosterone levels, which can lead to acne that just won’t go away, and hair growth on the face, back or upper chest. To be officially diagnosed with PMOS, you need two of these three symptoms: irregular periods, polycystic ovaries and evidence of too much testosterone in the body.

The number one symptom that should lead women to come see me, as a gynecologist, is irregular periods. Not just because they are incredibly uncomfortable and disrupt daily life, but it can also be dangerous. Women who have irregular or too few periods don’t regulate the lining of the uterus in a normal way and are at risk for developing long-term issues including hyperplasia, a non-cancerous overgrowth of cells causing tissues to become larger than normal and, in rare cases, cancerous.

Q: Why can PMOS be difficult to diagnose?

A: It can be difficult to diagnose because we still really don’t understand what causes PMOS. We know what the symptoms are, but we don’t know how the condition develops, and there isn’t a cure yet.

Also, PMOS symptoms like acne or irregular periods are common in lots of other medical problems, which can make it difficult to pinpoint the real issue. Another factor that contributes to the difficulty of diagnosis is that women aren’t often aware that being overweight is a common symptom of PMOS.

Q: What treatment options are available for women with PMOS?

A: Treatment should really focus on two things: management of the current problems and the long-term metabolic health effects that you want to prevent.

The best overall treatment we currently have is weight loss; even a modest reduction or getting back to a healthy weight can normalize some of those hormones that help the woman ovulate, which is making an egg regularly, and that can relieve many symptoms. This helps with insulin resistance, which is a key problem in PMOS.

When it comes to treating the irregular periods associated with PMOS, we use medication, and the first-line treatment is an estrogen/progesterone medication, typically known as a birth control pill. Women aren’t usually aware that this hormonal medication helps protect the uterine lining from overgrowth and regulate their bleeding pattern. Another benefit it has for PMOS is that it can lower the amount of androgen that your body makes, which helps manage acne and excess hair-growth symptoms. There are other medications to help block the effects of testosterone, different ways to help fertility and other medications and devices that can be used to deliver hormones that prevent long-term gynecologic issues.

Treatment for other problems, such as depression or sleep apnea, may be best delivered by other providers (aside from their gynecologist), so it is important that women with PMOS know they will likely need a multi-disciplinary team to help care for them.

Q: How can PMOS affect mental health and overall emotional well-being?

A: PMOS is associated with depression and anxiety, which makes it important that we identify patients who have these symptoms and create their treatment plan to address those mental health problems. To help combat these mental health symptoms, I first advise my patients to try to incorporate physical movements like walking into their daily routine; we often underappreciate the value of moving our bodies. Personalized therapy and medications may also be needed.

Q: What's your advice to women who may have PMOS?

A: My biggest advice for women is to continue advocating for themselves. It might take some time to get the diagnosis, but the most important thing is to find providers who make you feel heard; because PMOS is a metabolic syndrome, more than one provider is often needed for symptom treatment.

My final advice is to keep trying. It might take four or five appointments and multiple trials of medication, but just because one thing doesn’t work for you doesn’t mean that the next won’t be a success.

Through the Midstate Medical Moment, UPMC wants to raise awareness about the health conditions affecting people living in the communities we serve. For more information about UPMC services in central Pennsylvania, visit UPMC.com/centralpa.