PMOS—Expanding Diagnosis and Care Beyond Cysts and Cycles - Frankly Speaking Ep 505

Frank Domino (0:06)

Welcome to Frankly Speaking About Family Medicine, a CME podcast series where each week we translate today's late breaking clinical research and news into tomorrow's practice. I'm Dr. Frank Domino, professor in the Department of Family Medicine and Community Health at the University of Massachusetts Chan Medical School, and editor in chief of the Five Minute Clinical Consult. This podcast is brought to you by Primed.

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Register now, and I can't wait to see you there. Samantha is a 26-year-old woman who presents to her primary care provider for a visit with concerns of irregular periods. She reports she's been only having four to five periods per year since she first got her period. Samantha is also stressed about her progressive facial hair and acne that's worsened over the last two years despite topical treatments. She's discouraged about how she looks and her weight. Overall, she just doesn't feel great. While she isn't trying to get pregnant at this time, she asks, will I still be able to get pregnant when I want to have children? Hi, this is Frank Domino, and joining me this morning is Dr. Mariyan Montague, Associate Visiting Professor at Fitchburg State University and Turn Lecturer at the Mass General Hospital Institute of Health Professionals. Good morning, Mariyan.

Mariyan L. Montaque (2:22)

Good morning, Frank. How are you?

Frank Domino (2:23)

Doing all right. Well, we've got quite the topic to discuss today.

Samantha, sounds like what we used to call Polycystic Ovarian Syndrome. I understand there's a new name and lots of misconceptions. Can you talk about that, please?

Mariyan L. Montaque (2:39)

Yes. I think it's an exciting new change. It is called PMOS, Polyendocrine Metabolic Ovarian Syndrome now.

It was previously known as PCOS. The name change helps us better understand this condition, as it's more than ovarian disorder that we have had misconceptions previously. It is a complex endocrine and metabolic condition that affects multiple body systems.

PMOS affects approximately one in eight women globally, making it one of the most common endocrine disorders among women of reproductive age like our patient Samantha. In adult patients, typically, they are diagnosed if they meet at least two of the following criteria. Irregular or absent ovulation, clinical or laboratory evidence of elevated androgens, polycystic ovarian morphology on ultrasound or elevated AMH. This is interesting because ovarian cysts are not required for diagnosis, which highlights one of the most important reasons why the previous name could have been misleading.

Frank Domino (3:58)

Well, Samantha certainly has irregular periods and clinical evidence of elevated androgens. What led them to finally decide to change the name from polycystic ovarian syndrome to PMOS and how does this new terminology better reflect the condition and its prevalence?

Mariyan L. Montaque (4:18)

Well, recently there was a global consensus process involving more than 14,000 patients and healthcare professionals that led to the adoption of the new name. If we break it down, polyendocrine, meaning multiple hormone systems are involved, metabolic, insulin resistance and metabolic dysfunction are central features, and then ovarian, reproductive and ovarian manifestations. Through changing this name, the goal is to improve awareness, reduce stigma, facilitate earlier diagnosis and encourage a more comprehensive approach.

This impacts an estimate of 6-20 percent of women of reproductive age, which is over 170 million of the world's wide population. Yet, it's estimated that 70 percent of affected women remain undiagnosed. With delay in diagnosis, it can lead to multiple comorbidities, including type 2 diabetes, hypertension, dyslipidemia, fatty liver disease, infertility like Samantha's concern, depression, anxiety, and cardiovascular disease.

Frank Domino (5:33)

Wow.

So, PMOS better reflects that there's more things that we have to be concerned about besides just reproductive health. What are the major health risks and long-term consequences for patients and things that we as clinicians need to be aware of?

Mariyan L. Montaque (5:51)

Well, exactly as you said, before we had a more focused, targeted way that we looked for individuals or we might, you know, flag an individual as potentially having PCOS. And now with PMOS, it helps broaden our understanding. So with changing the name and bringing more awareness, one of the most important shifts is understanding of PMOS, is recognizing it is not simply a fertility disorder. And when we look at this form from a metabolic perspective, we're looking at it a more comprehensive approach. So we look at insulin-resistant, it's considered a central driver of this condition. Many patients will develop type 2 diabetes, pre-diabetes, have obesity, especially central obesity, dyslipidemia, metabolic syndrome, and non-alcoholic fatty liver disease. So in practice, we'll see how patients present in different forms and we'll be more astute to listen to patients and understand that this could be more of a bigger diagnosis.