PMOS awareness month: Why is the condition so tough to diagnose?

A few months ago, PCOS, aka Polycystic Ovary Syndrome, which affects more than 170 million women worldwide, was renamed PMOS. PMOS stands for Polyendocrine Metabolic Ovarian Syndrome, and the renaming happened as the old name focused more on ovaries and cysts, rather than its full-body impact. The new name highlights its effects on hormonal pathways, metabolic dysfunction, and systemic risks, and the expectation was that it would improve diagnosis, patient care, and communication. Regardless, it is still an extremely difficult condition to diagnose. Why so? Dr Smitha Joy, Senior Consultant and HOD at the Department of Obstetrics and Gynaecology of VPS Lakeshore Hospital, explains.

The diagnosis challenge
It's extremely tough to diagnose PMOS, as it is not a disease, says Dr Smitha. She explains, "It is a syndrome, which means it is a cluster of disorders. We have three criteria to diagnose patients - irregular ovulation, clinical or biochemical features of hyperandrogenism and the patient's ultrasound features. If the diagnosis satisfies any two of these criteria, the patient has PMOS."

Ovulatory dysfunction refers to irregular periods. "A person can experience it in multiple ways - they can have irregular, frequent or no periods at all! They might also have high or low bleeding. This in itself can be difficult to ascertain," the doctor says. As for the clinical or biochemical features of hyperandrogenism, it refers to the condition in which the male hormones dominate in our body. "Obesity, a male pattern of hair distribution with hairs on the face and body, hair loss like baldness on the head and acanthosis (patches of dark, velvety skin on the neck) are its clinical features," explains Dr Smitha.

Those suffering from PMOS can experience:
a) Obesity
b) Insulin resistance
c) Cholesterol changes
d) Weight gain

"However, the above are not part of PMOS diagnostic criteria. At the same time, even when a patient does not meet any diagnostic criteria, their body can have a PMOS tendency. This is the reason why it is difficult to diagnose PMOS," says the doctor. However, do not self-medicate if a person suspects they have the above symptoms and therefore a PMOS condition. They should follow the right treatment tailored to their specific condition after consulting a gynaecologist. The Cleveland Clinic advises visiting a doctor after thoroughly observing one's symptoms, when they started, and understanding family history of hormone disorders and type 2 diabetes. Also, be prepared for a physical exam, ultrasounds and hormone blood tests.