New research shows that PCOS (polycystic ovary syndrome) obscured the broader aspects at play, affecting insulin resistance, type 2 diabetes & cardiovascular disease
After 14 years of global collaboration about polycystic ovary syndrome (PCOS), a broad consensus of medical organizations, including the Endocrine Society, has determined that polycystic ovary syndrome is an inaccurate name. This has led to misunderstanding among patients and healthcare providers, resulting in missed diagnoses.
PCOS is being renamed as polyendocrine metabolic ovarian syndrome (PMOS). This decision was recently announced in The Lancet medical journal.
The condition itself has not changed, but the medical community’s understanding of it and the way we discuss it is changing. The steps to diagnose the syndrome have not changed, and the treatments for it have not changed either. The name change itself will take 3-5 years to be fully implemented. In three years, the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome (PCOS) will update the new term. It will probably take a couple more years for all medical systems and insurance organizations to switch to PMOS, with both terms being used together for a while.
Why polycystic ovary syndrome is misleading
This better understanding based on much research led to the determination that polycystic ovary syndrome is a misleading name. That name puts the focus on the ovarian cysts, indicating that PCOS is more of a fertility issue. In fact, the “cysts” are not actually cysts but arrested follicles (ovarian follicles that stop growing and maturing prematurely), nor are said cysts always present.
Related Reading: Fertility and PMOS (Polyendocrine Metabolic Ovarian Syndrome), Formerly PCOS (Polycystic Ovary Syndrome)
Differences in the implications of the names PCOS and PMOS
| Implication | Polycystic ovary syndrome | Polyendocrine metabolic ovarian syndrome |
|---|---|---|
| What the name indicates | Cysts (fluid-filled sacs) exist on the ovaries | Multiple hormone and metabolic systems can affect ovarian function |
| Primary effect of the syndrome | Only involves the ovaries | Involving multiple endocrine hormonal systems (polyendocrine) and disruptions in the metabolic system that converts food to energy |
| Health implications | Ovarian cysts cause infertility and other symptoms | Problems exist in hormonal and metabolic systems that can result in serious conditions (insulin resistance, type 2 diabetes, cardiovascular disease) and ovarian dysfunction |
| Treatment scope | Treated primarily as an infertility and gynecologic issue | Monitored and treated as a lifelong endocrine and metabolic condition |
| Patient interpretation | May cause patients to expect infertility and be concerned about cysts only | Communicates that non-reproductive symptoms (including insulin resistance, fatigue and weight) are central aspects beyond infertility |
What the name PMOS emphasizes
PMOS provides a much broader, more accurate concept of the condition than PCOS does. PCOS tended to obscure the important endocrine and metabolic issues such as insulin resistance (studies suggest this affects 50%-80% of PCOS/PMOS patients), type 2 diabetes, cardiovascular disease, unhealthy lipid levels and accompanying mental health conditions.
Elements of the new name polyendocrine metabolic ovarian syndrome
- Polyendocrine indicates this is a hormonal condition that involves multiple endocrine gland systems that produce various hormones and not just reproductive hormones; these other hormones include androgens (male hormones) and insulin.
- The condition involves the metabolism, directly affecting insulin resistance and risks for type 2 diabetes, cardiovascular issues and fatty liver.
- There are ovarian effects related to fertility such as ovulation problems and structural changes to the follicles.
- It is still a syndrome, meaning it is a collection of issues and not just one disease.
How will the change from PCOS to PMOS help women?
This is at the heart of the decision to change the name. The polycystic ovary syndrome name helped lead to missed or delayed diagnosis, with an estimated 70% of women with the syndrome undiagnosed, according to the World Health Organization.
We predict that the name change will have several direct, positive benefits.
- Improve early recognition and treatment.
- Clear up confusion about the condition among patients and healthcare providers.
- Viewing the condition as a life-long endocrine and metabolic issue expands the healthcare providers who can diagnose and address the condition beyond fertility specialists and gynecologists.
- Improve long-term management of the condition by involving a broader range of healthcare providers.
- Remove the stigma that the syndrome was primarily related to infertility.
- Promote important metabolic related screenings of blood sugar, blood pressure and cardiovascular risks.
- Lead to more holistic treatment plans. These include promoting good sleep for metabolic health and different ways to manage weight that don’t involve diets and exercise routines that increase cortisol stress hormones.
How the name shift will affect PMOS treatment/PCOS treatment
Since it is still the same collection of issues, our diagnosis of PMOS and treatments to address infertility caused by it will not change directly. Note that PMOS treatments do not have to be related to infertility, and those cases can be treated by healthcare providers who are not fertility specialists. Treatments for those not concerned with fertility will shift from symptom management with oral contraceptives or cosmetic treatments to include lifelong monitoring for associated risks.
PMOS diagnosis
Diagnosis criteria remain unchanged. Testing and evaluation must indicate that at least two of three conditions exist:
- Ovulation problems.
- Hyperandrogenism (excess of male androgen hormones in a female, often showing as acne and hirsutism).
- Ovarian changes (previously identified as cysts) noted on ultrasound.
The broader understanding of the syndrome will lead to earlier diagnosis and the beginning of treatment.
PMOS treatment for infertility
Our treatments for infertility caused by PMOS/PCOS will remain the same. Primary PMOS treatments for infertility are:
- Lifestyle changes.
- Oral medications for ovulation induction.
- Injectable gonadotropins, which are protein hormones that stimulate the ovaries and testicles, are sometimes used with intrauterine insemination (IUI).
- Laparoscopic surgery.
- In vitro fertilization (IVF) in some cases.
How PMOS treatment may evolve
Our fertility treatments will likely evolve over time due to the new understanding. Fertility treatments may begin to move toward metabolic optimization being added to existing ovulation-induction therapy with medications.
According to the American Journal of Managed Care, the new understanding will open up PMOS infertility treatment to target metabolic causes of ovulation disruption, such as managing insulin resistance. This can increase treatment success for ovulation as well as pregnancy outcomes.
As noted previously, the care team for women with PMOS experiencing infertility can expand. This can bring together early in PMOS treatment plans fertility specialists, OB/GYNs, endocrinologists and metabolic specialists.
Treatments may evolve to sometimes include GLP-1 receptor agonists to address metabolic health and insulin resistance before conception. However, these drugs take some time to completely leave the body (washout), so their use would be restricted before resuming attempts to conceive.
FAQ on PCOS name change to PMOS
In conclusion on the PCOS name change to PMOS
This is an improvement in the understanding of the syndrome based on research and clinical knowledge that advances the application of medicine. Both clinicians and patients will benefit, with substantial increases in the diagnosis and early treatment of PMOS, formerly known as PCOS. These advances in our understanding will help us better treat women with PMOS, both those experiencing infertility and those with other negative effects from the syndrome.