Polycystic ovarian syndrome has a new name, and is still the most common cause of infertility

Polycystic ovarian syndrome is now known as polyendocrine metabolic ovarian syndrome, or PMOS. More than 50 patient and professional organizations took part in the process to develop a new name, which was announced publicly last week.

The hormonal condition is the most common cause of infertility in women, according to the Endocrine Society. It is estimated that five to six million women in the United States suffer from the condition.

“It is basically a disease with excess androgens (male hormone),” said Tara Chute, MD, an obstetrician/gynecologist with Women's Health Associates of Cape Cod. “Your ovaries make extra follicles which produce the androgen, causing imbalance in the reproductive hormones, estrogen and progesterone.”

The following symptoms or risks can be an indication of PMOS, according to Dr. Chute:

• Irregular periods or no period for a long time.
• Excess hair growth in the chin area of your face, chest area, lower abdomen, back, and thighs. The hair is very thick and coarse.
• Obesity, weight gain or trouble losing weight.
• Age group is usually women in their 20s, although older women can be diagnosed with PMOS.
• PMOS in a parent or aunt
• Infertility

“There has been some misinformation on social media that goes a little too far in having women diagnose themselves with diseases they don’t actually have,” said Dr. Chute. “I have a lot of patients who come to the office complaining of painful periods and other random symptoms believing they have PMOS.”

To be diagnosed with PMOS, patients need to meet two out of three of the following criteria, Dr. Chute said.

• Oligomenorrhea: occurs when women don’t have regular cycles or skip having a period altogether for three to six months.
• Hirsutism: excessive hair growth
• Polycystic ovaries: Enlarged ovaries, multiple small follicles and other changes.

Diagnostic Testing

In addition to a pelvic ultrasound of the ovaries, diagnostic testing includes bloodwork to check various hormonal levels, including testosterone levels and adrenal hormones (especially with excess hair growth).

Dr. Chute will check hormonal levels, testosterone levels, screen for adrenal issues (especially with excess hair growth), diabetes and cholesterol levels.

Once she has a complete picture of medical history, pelvic exam, test results and has ruled out other possibilities, she will decide on a plan of treatment for PMOS.

Treatment

“One of the first things we need to do when a woman is diagnosed with PMOS is to regulate their menstrual cycles,” said Dr. Chute. “While most women are very happy to not have a period for months at a time, it is not a good thing in this specific scenario. They could be building up an abnormal lining in their uterus, which puts them at a higher risk for precancer of the uterus. I always say that unless I am medically causing you not to have a period for several months, it is not necessarily a good thing.”

PMOS is typically treated with birth control and there is a variety of options, Dr. Chute said.

One of the most difficult challenges for women is the excessive hair growth. Spironolactone is a medication that blocks the effects of androgen that causes excessive hair growth. However, it can also cause birth defects and women need to have a birth control plan in place. It can also affect electrolyte balance which needs to be monitored.

Laser treatments are available and work the best, but it is costly and is not covered by insurance.

Risks

Insulin resistance can occur with PMOS, due to excess androgens, and puts patients at risk for diabetes and high cholesterol, said Dr. Chute. Annual testing for diabetes and cholesterol levels are part of the management of this syndrome.

While obesity isn’t one of the criteria women need to meet to be diagnosed with PMOS, weight management is extremely important. Any excess fat tissue makes more estrogen and, in turn, makes the condition more challenging, with the potential for diabetes and management of menstrual cycles.

Infertility can be a trial for women when they are trying to get pregnant. It can be harder to get pregnant because they are not having regular menstrual cycles.

“We try to work with them or refer to an infertility specialist,” said Dr. Chute.

Treatment for PMOS is not one size fits all, she said. “It involves targeting the symptoms or risk factors for the patient and treating that appropriately and preventively.”