Polyendocrine Metabolic Ovarian Syndrome (PMOS)

Polyendocrine Metabolic Ovarian Syndrome (PMOS) (previously known as Polycystic Ovarian Syndrome (PCOS) is a common hormonal condition that can cause irregular periods, excess hair growth, acne, and fertility problems. It affects multiple body systems, including metabolic health, not just the ovaries.
PMOS is associated with obesity and increased insulin resistance and therefore increases the risk of developing diabetes, heart disease and other conditions later in life.
Women with PMOS can reduce the risk of long-term health problems by having a healthy lifestyle and maintaining normal body weight.

It’s difficult to know exactly how many women have PMOS, but it’s thought to be very common, affecting about 1 in every 10 women in the UK.

More than half of these women do not have any symptoms.

Polycystic ovaries

Polycystic ovaries are slightly larger than normal ovaries and have twice the number of follicles (fluid-filled spaces within the ovary that release the eggs when you ovulate).

Symptoms

If you have signs and symptoms of PMOS, they’ll usually become apparent during your late teens or early 20s.

Not all women with PMOS will have all the symptoms, and each symptom can vary from mild to severe. Some women only experience menstrual problems or are unable to conceive, or both.

Common symptoms of PMOS include:

irregular periods or no periods at all
an increase in facial or body hair (hirsutism)
loss of hair on your head
being overweight, experiencing a rapid increase in weight or having difficulty losing weight
oily skin, acne
difficulty becoming pregnant (reduced fertility)

You may still become pregnant even if you do not have periods. If you do not want to become pregnant, you should seek advice from your GP about contraception.

Depression and psychological problems can also result from having PMOS.

PMOS is also associated with an increased risk of developing health problems in later life, such as type 2 diabetes and high cholesterol levels.

Cause

The cause of PMOS, is not yet known but it often runs in families. If any of your relatives (mother, aunts, sisters) are affected with PMOS, your risk of developing PMOS, may be increased.

The symptoms are related to abnormal hormone levels:

Testosterone is a hormone that is produced in small amounts by the ovaries in all women. Women with PMOS, have slightly higher than normal levels of testosterone and this is associated with many of the symptoms of the condition.
Insulin is a hormone that controls the level of glucose (a type of sugar) in the blood. If you have PMOS, your body may not respond to insulin (this is known as insulin resistance), so the level of glucose is higher. To try to prevent the glucose levels becoming higher, your body produces even more insulin. High levels of insulin can lead to weight gain, irregular periods, fertility problems and higher levels of testosterone.

Diagnosis

Having polycystic ovaries does not necessarily mean you have PMOS.

Women with PMOS often have symptoms that come and go, particularly if their weight goes up and down. This can make it a difficult condition to diagnose, which means it may take a while to get a diagnosis.

A diagnosis is made when you have any two of the following:

irregular, infrequent periods or no periods at all
an increase in facial or body hair and/or blood tests that show higher testosterone levels than normal
an ultrasound scan that shows polyendocrine metabolic ovaries

What could having PMOS mean for my long-term health?

If you have PMOS, you are at greater risk of developing the long-term health problems discussed below:

Insulin resistance and diabetes

If your blood glucose does not stay normal, this can lead to diabetes. One or two in every ten women with PMOS go on to develop diabetes at some point. If the diabetes is untreated, this can cause damage to organs in the body. If you have PMOS, your risk of developing diabetes is increased further if you:

are over 40 years of age
have relatives with diabetes
developed diabetes during a pregnancy (known as gestational diabetes)
are obese (a body mass index (BMI) of over 30).

If you are diagnosed with diabetes, you will be given advice about your diet and may be prescribed tablets or insulin injections.

High blood pressure

Women with PMOS tend to have high blood pressure, which is likely to be related to insulin resistance and to being overweight rather than to the PMOS itself. High blood pressure can lead to heart problems and should be treated.

Cancer

If you have fewer than three periods a year, the lining of the womb (endometrium) can thicken, and this may lead to endometrial cancer in a small number of women.

There are various ways to protect the lining of the womb using the hormone progestogen. Your doctor will discuss the options with you. This may include a five-day course of progestogen tablets used every three or four months, taking a contraceptive pill or using the intrauterine contraceptive system (Mirena®). The options will depend on whether you are trying for a baby.

PMOS does not increase your chance of breast or ovarian cancer.

Depression and mood swings

The symptoms of PMOS may affect how you see yourself and how you think others see you. It can lower your self-esteem.

Snoring and daytime drowsiness

PMOS can lead to fatigue or sleepiness during the day. It is also associated with snoring.

Treatment and self-care

There is no cure for PMOS. Medical treatments aim to manage and reduce the symptoms or consequences of having PMOS. Medication alone has not been shown to be any better than healthy lifestyle changes (weight loss and exercise).

Many women with PMOS successfully manage their symptoms and long-term health risks without medical intervention. They do this by eating a healthy diet, exercising regularly and maintaining a healthy lifestyle.

The main ways to reduce your overall risk of long-term health problems are to:

eat a healthy balanced diet. This should include fruit and vegetables and whole foods (such as wholemeal bread, whole-grain cereals, brown rice and whole-wheat pasta), lean meat, fish and chicken. You should cut down the amount of sugar, salt and caffeine that you eat and drink. You should not drink more alcohol than is recommended (14 units a week for women).
eat meals regularly, especially breakfast
take exercise regularly (30 minutes at least three times a week).

You should aim to keep your weight to a level that is normal. BMI is the measurement of weight in relation to height and you should aim to keep your BMI between 19 and 25. Calculate your BMI. If you are overweight, it would be helpful to lose weight and maintain your weight at this new level.

The benefits of losing weight include:

a lower risk of insulin resistance and developing diabetes
a lower risk of heart problems
a lower risk of cancer of the womb
more regular periods
an increased chance of becoming pregnant
a reduction in acne and a decrease in excess hair growth over time
improved mood and self-esteem

You only have to lose a small amount of weight to make a difference to your symptoms and your health. There is no strong evidence that PMOS by itself can cause you to gain weight or makes losing weight difficult. Many women find great benefit from support groups such as Verity

Once you have a diagnosis of PMOS, you will be monitored to check for any early signs of health problems:

Diabetes: Women with PMOS over the age of 40 should be offered a blood sugar test once a year to check for signs of diabetes. If your BMI is 30 or over or you have a family history of diabetes, you may be offered testing for diabetes earlier than age 40.
Cancer of the womb: If you have not had a period for a long time (over 4 months) or have irregular bleeding, it is advisable to see your doctor. You may be offered a referral for further tests that may include an ultrasound scan of your womb (uterus) or treatment to make you have a period if they are very irregular.
High blood pressure: Discuss with your doctor how often you should have your blood pressure checked and whether you should have blood tests to check your cholesterol levels.
Depression and psychological problems: You can be referred to a counsellor or trained specialist if necessary.

When to contact your GP

You should talk to your GP if you have any of the typical symptoms mentioned above and think you may have PMOS.

You should talk to your GP if you have PMOS and have not had a period in the last 4 months (unless of course you are on the pill or have an intra-uterine system like Mirena fitted)

You should have an annual blood test to check for diabetes if you have PMOS and are over the age of 40.

Your GP may consider referring you to a gynaecological specialist if they remain uncertain about your diagnosis, or if you develop irregular or very heavy bleeding.

Useful information about PCOS

Waiting for a specialist opinion

If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.

What support is available?

Support for managing your weight

If you live in Torbay, you can visit Torbay and South Devon NHS Foundation Trust’s website for information on Eating well and managing your weight
If you live in Plymouth, One you Plymouth has a Eat Well programme which helps you to manage your weight more effectively and live a healthier lifestyle