14 December 2023
What is Polyendocrine Metabolic Ovarian Syndrome ?
Polyendocrine Metabolic Ovarian Syndrome (PMOS; previously called PCOS) is a condition that has both hormonal and metabolic causes, with a wide and variable range of symptoms. PMOS can occur at any age after puberty and before menopause.
Are my symptoms caused by PCOS?
Having cysts on the ovaries does not mean you have PMOS. Ovarian cysts are actually fluid- or solid-filled sacs that do not contain eggs. In PMOS, on the other hand, there are small multiple follicles (small round fluid-filled sacs containing an immature egg) which ovulate irregularly.
PMOS can cause symptoms starting from the very first periods, or can appear later on due to weight gain. Symptoms can be very different from one patient to another, and there is no single test that can diagnose PMOS.
Having at least two of the following signs is often enough to confirm PMOS.
A pelvic ultrasound scan shows specific ultrasound features;
Menstrual cycles are irregular (there are over 35 days between each period);
Excess facial and body hair, severe acne and partial/complete loss of hair in the top part of the head (androgenetic alopecia).
All of these symptoms become more severe in overweight or obese women.
What causes PMOS?
The exact cause of PMOS is unknown, although insulin resistance has a key role in causing this condition. Chronic stress and overweightedness can both cause insulin resistance. Insulin resistance then stimulates the ovaries to produce male hormones (androgens) which can block ovulation and cause additional PMOS symptoms such as irregular cycles, acne, excess facial and body hair. Having PMOS and leaving it untreated increases the chances of developing Diabetes.
Are there any tests that can diagnose PCOS?
There is actually no single test that can diagnose PMOS. Your Doctor will accurately collect your history and examine you in order to understand if there are signs of insulin resistance, androgen excess and acne. A pelvic ultrasound scan will assess whether there are typical ultrasound signs that are unique to PMOS. Specific blood tests will rule out other hormonal issues and assess your glucose and lipid metabolism.
Does PCOS cause infertility?
Having PMOS does not mean you cannot get pregnant, as PMOS is a treatable cause of infertility. PMOS can make it difficult to conceive a pregnancy due to ovulatory dysfunction. When there is overweightedness causing PMOS, the resulting hormonal imbalances can block ovulation. Reaching a normal weight in these cases of PMOS is necessary to improve fertility. Hormonal treatments used to induce ovulation only work effectively when the body weight is within normal ranges (with a BMI between 20 and 25).
Which are effective treatments for PMOS?
Treatment for PMOS varies depending on the symptoms involved and may include a combination of the following:
Nutrient intake and Body weight: Reaching your healthy weight is always effective in treating PMOS symptoms such as irregular cycles, acne, unwanted hair and ovulation dysfunction, and will improve the effectiveness of drug treatments used for PMOS. Along with cutting sugars in your diet, it is extremely important to have daily portions of vegetables, wholegrain carbs, berries, pulses, mixed nuts, fish and seafood and lean meats.
Inositol: A specific combination of Myoinositol and Chiroinositol, two vitamin-like substances, is effective in improving PMOS symptoms, ovulation and fertility outcomes. Inositol can be found in fresh citrus fruits, fresh cantaloupe, beans, brown rice and nuts.
Regular and moderate physical exercise: This reduces your sugar levels and prevents insulin resistance.
Mindfulness, Meditation and Counselling: These can support you by reducing stress and improving insulin resistance.
Hormonal contraception: The pill, mini-pill, contraceptive patch or vaginal ring can all reduce androgen production and can therefore improve acne as well as excess facial and body hair.
Hormonal treatments that promote ovulation such as Clomiphene, Gonadotropins and Metformin can be used in some cases, the latter of which is also effective to aid weight reduction.
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Spironolactone: This medication blocks the effects that androgens have on the body, improving acne
and excess hair. It is not recommended for women who are looking to become pregnant.
Eflornitine: This cream slows down hair growth.
Electrolysis and Laser treatments permanently reduce thick and dark facial and body hairs.
Dr Frontino treats women with PMOS struggling with acne, irregular periods and weight gain at the PMOS Clinic at the 25 Harley Street Clinic with Dermatologists specialised in treating acne at all ages and with Prof. Richard Mackenzie who is an expert in Weight management and Metabolic conditions. https://www.phoenixhospitalgroup.com/pcos-clinic-london/
Dr Frontino collaborates with the Centre for Integrated Research in Life and Health Sciences at the University of Roehampton, London on research studies regarding PMOS and insulin resistance.