PMOS: Past, present, and future

One of the common most disorders which affected 1 in 8 women was polycystic ovary syndrome (PCOS). Recently the name of this condition has been updated from PCOS to polyendocrine metabolic ovarian syndrome (PMOS). As usual, the internet was divided. One group celebrated the name change and anticipated better diagnosis and treatment. Whereas, some keyboard warriors were sceptical and questioned if the name change is going to have any impact. Several social media influencers who have no medical knowledge spoke on this "trending topic" and provided misleading information. 

The correct information comes from the research article published by The Lancet. I read the article and I made my informed opinion. I belong to the first group and these are my thoughts on this matter.

PCOS vs PMOS

Diagnosis:

Old approach: PCOS was diagnosed based on presence of at least 2 markers: 

• oligo-anovulation (infrequent or absence of ovulation/periods), 
• hyperandrogenism (excess amount of male hormones such as testosterone), or 
• polycystic ovaries (presence of multiple cysts in the ovaries). 

If the patient did not experience 2 of the 3 conditions, then the diagnosis of PCOS was ruled out. A lot of the patients received delayed diagnosis since their symptoms did not into fit this narrow and strict criteria. As a result, up to 70% of affected population remained undiagnosed. Furthermore, PCOS diagnosis did not recognise the presence of metabolic, cardiovascular, reproductive, psychological, and dermatological conditions. Hence, their treatment was vastly ignored.

New approach: PMOS eases the restrictions and proceeds with a broader approach for diagnosis. It recognizes the multisystem involvement including reproductive, endocrinal, and metabolic systems, rather than considering it to be an ovarian disorder. New term understands and reflects the complexity of the condition.

Clinical features:

Old approach: If the ovarian cysts were not present (one of the chief clinical features), the patients often did not receive the diagnosis of PCOS. 

New approach: PMOS will consider wide range of clinical features which were not taken into account for PCOS. These include:

• Hyperandrogenism (excess amount of male hormones such as testosterone) resulting in hirsutism (male pattern facial hair growth in women), acne, alopecia (loss of hair, increased hair fall, hair thinning), and metabolic features.
• Hormonal imbalance
• Insulin resistance
• Obesity, unexplained weight gain, inability to lose weight even with diet and excercise 
• Complications including cardiac and metabolic dysfunction or dysregulation resulting in impaired glucose tolerance, gestational diabetes, type 2 diabetes, blood pressure elevation, and overall increased risk of cardiac conditions.
• Various mental health disorders which occur due to hormonal imbalance
• Skin conditions arising due to hormonal imbalance

Management:

Old approach: Traditionally, only OB-GYN was in charge of the treatment of PCOS. Most treatment regimens included high dose synthetic or semi synthetic forms of oestrogen and progesterone. These medications had their own demerits. There were no specific management regimens for obesity, skin conditions, and hormonal imbalance.

New approach: With the broader consideration towards the disorder, the involvement of multiple specialists is anticipated. The treatment regimen may get finalized in collaboration with OB-GYN, endocrinologists, dermatologists, cardiologists, diabetologists, and other specialists as per the patient's symptoms. The patients would receive targeted treatments as per their symptoms. 

The biggest question is whether a name change can benefit the patients. The answer is not simple, but it could be the first step towards a better patient outcome

• The new name accurately reflects the complexity of the condition which earlier was considered restricted to only ovarian function.
• New name specifies dysregulation of hormones and metabolic functions which was completely ignored in the previous name.
• There will be better clarity, awareness, understanding, and management due to the new name. 
• The new name recognizes the condition as a long-term, complex, and multisystem disorder rather than minimizing it to a fertility disorder. 

Women's health and disorders still face challenges such as stigma, avoidance, lack of clarity, and minimal discussions. A mere name change required 14+ years of research and will require 3+ years for the implementation. The name change will not result in immediate revolution in the healthcare domain. However, the name change brings the patients a step closer to better diagnosis, clarity, and treatment. As a woman, I wholeheartedly welcome this change, so that the next generation of girls and women will have a better chance at faster diagnosis, clear understanding, and better results.

[Note: The information posted in this blog has been taken from the research article published in The Lancet. If the reader wishes to read more, they are encouraged to read the article.]