Dr Sherene Kalloo

Most women are fa­mil­iar with the term Poly­cys­tic Ovar­i­an Syn­drome (PCOS), a con­di­tion I have treat­ed fre­quent­ly at my gy­nae­co­log­i­cal prac­tice and I am see­ing an in­crease in in­ci­dence over the years. It is one of the most com­mon hor­mon­al dis­or­ders af­fect­ing women of re­pro­duc­tive age, im­pact­ing ap­prox­i­mate­ly one in eight women world­wide.

Tra­di­tion­al­ly, PCOS has been char­ac­terised by ir­reg­u­lar men­stru­al pe­ri­ods, el­e­vat­ed lev­els of an­dro­gens (male hor­mones), and ovaries that may con­tain mul­ti­ple small fol­li­cles of­ten re­ferred to as “cysts.” Com­mon symp­toms in­clude missed or in­fre­quent pe­ri­ods, weight gain, ac­ne, ex­cess fa­cial or body hair growth, thin­ning scalp hair, and dif­fi­cul­ty be­com­ing preg­nant (in­fer­til­i­ty). How­ev­er, symp­toms can vary con­sid­er­ably from one woman to an­oth­er.

Re­cent­ly, many pa­tients have be­come aware that PCOS is now be­ing re­ferred to as Poly­en­docrine Meta­bol­ic Ovar­i­an Syn­drome (PMOS) and have un­der­stand­ably ques­tioned whether this rep­re­sents a new con­di­tion. The an­swer is no. PMOS is the new name for the same dis­or­der, but one that more ac­cu­rate­ly re­flects our cur­rent un­der­stand­ing of the con­di­tion.

For many years, gy­nae­col­o­gists, en­docri­nol­o­gists, der­ma­tol­o­gists and re­searchers recog­nised that PCOS was nev­er sim­ply a dis­or­der of the ovaries. It is a com­plex con­di­tion that af­fects mul­ti­ple sys­tems through­out the body, in­clud­ing re­pro­duc­tive, hor­mon­al, and meta­bol­ic health. We have long known that in­sulin re­sis­tance af­fects ap­prox­i­mate­ly 85% of women with the con­di­tion, sig­nif­i­cant­ly in­creas­ing the risk of de­vel­op­ing type 2 di­a­betes, obe­si­ty, car­dio­vas­cu­lar dis­ease, and oth­er meta­bol­ic com­pli­ca­tions. As a re­sult, treat­ment has of­ten in­clud­ed not on­ly hor­mon­al ther­a­pies but al­so med­ica­tions com­mon­ly used to im­prove in­sulin sen­si­tiv­i­ty and meta­bol­ic health.

An­oth­er chal­lenge with the term PCOS was that many women ex­hib­it­ed clas­sic symp­toms of the con­di­tion with­out hav­ing “poly­cys­tic” ovaries on ul­tra­sound. It was not un­com­mon to see pa­tients with ir­reg­u­lar pe­ri­ods, ac­ne, ex­cess hair growth, weight gain, and hor­mon­al ab­nor­mal­i­ties, yet their ul­tra­sound find­ings ap­peared nor­mal. In such cas­es, the name PCOS could be mis­lead­ing and some­times con­tribute to con­fu­sion for both pa­tients and health­care providers. The term “hor­mon­al im­bal­ance” was of­ten used in­stead.

The orig­i­nal name, PCOS, dates back to 1935 and re­flects the med­ical un­der­stand­ing of the con­di­tion at that time, when the fo­cus was pri­mar­i­ly on the ovaries and re­pro­duc­tive symp­toms. Over the decades, re­search has re­vealed that the con­di­tion ex­tends far be­yond ovar­i­an func­tion.

The new name, Poly­en­docrine Meta­bol­ic Ovar­i­an Syn­drome (PMOS), recog­nis­es that this is a whole-body dis­or­der in­volv­ing mul­ti­ple hor­mone-pro­duc­ing sys­tems and sig­nif­i­cant meta­bol­ic ef­fects. It al­so ac­knowl­edges the con­di­tion’s im­pact on men­tal health, skin health, fer­til­i­ty, and long-term risks such as di­a­betes and heart dis­ease.

The move to re­name PCOS was not made light­ly. In 2012, a fo­rum or­gan­ised by the US Na­tion­al In­sti­tutes of Health rec­om­mend­ed re­con­sid­er­ing the name. This led to a glob­al ef­fort in­volv­ing ex­perts, pa­tient ad­vo­ca­cy groups, and med­ical or­gan­i­sa­tions world­wide. Af­ter 14 years of col­lab­o­ra­tion, more than 22,000 sur­vey re­spons­es, par­tic­i­pa­tion from 56 or­gan­i­sa­tions, and an over­whelm­ing 97% con­sen­sus, the name PMOS was adopt­ed.

While the name has changed, the im­por­tance of ear­ly di­ag­no­sis and man­age­ment re­mains the same. Treat­ment is in­di­vid­u­alised and de­pends on how the con­di­tion af­fects each per­son. Some women seek help for in­fer­til­i­ty, oth­ers for ir­reg­u­lar pe­ri­ods, ac­ne, ex­cess hair growth, or weight man­age­ment con­cerns.

With this new name change, hope­ful­ly the stig­ma is re­moved that it’s not just a “re­pro­duc­tive” prob­lem, but it’s a med­ical con­di­tion that re­quires a mul­ti­dis­ci­pli­nary ap­proach to man­age­ment, look­ing at the “whole body” and in­ves­ti­gat­ing oth­er or­gans.

Most im­por­tant­ly, lifestyle mea­sures such as a healthy di­et, reg­u­lar ex­er­cise, weight man­age­ment, and on­go­ing med­ical fol­low-up re­main the foun­da­tion of treat­ment and can sig­nif­i­cant­ly im­prove both symp­toms and long-term health out­comes.

PMOS is com­mon, but with ap­pro­pri­ate care and sup­port, it is a man­age­able con­di­tion that al­lows women to lead healthy and ful­fill­ing lives.

Dr Sherene Kalloo

MDW, MBBS, DGO, DM, FACOG

Spe­cial­ist Ob­ste­tri­cian & Gy­nae­col­o­gist