Polyendocrine Metabolic Ovarian Syndrome (PMOS)

Symptoms

Symptoms of PMOS tend to start gradually. You may have only a few symptoms or a lot of them. Symptoms may include:

• Acne and oily skin.
• Weight gain and trouble losing weight.
• Extra hair on the face and body. You may get thicker, darker facial hair and more hair on your chest, belly, and back.
• Thinning hair on the scalp.
• Irregular periods. Often those with PMOS have fewer than nine periods a year. Some have no periods. Others have heavy bleeding.
• Fertility problems. You may have trouble getting pregnant.
• Depression.
• Insulin resistance and too much insulin. They can cause things like upper body obesity and skin tags.
• Breathing problems while sleeping (obstructive sleep apnea). This is linked to both obesity and insulin resistance.

Hormone changes that lead to PMOS often start in the early teens, after the first menstrual period. Symptoms may be more noticeable after a weight gain.

What Happens

When you have PMOS, your hormones are imbalanced. That can trigger other changes. You may stop ovulating. You may get acne and grow extra facial and body hair, and your chance of getting diabetes may increase. But there are treatments. Treatment can improve symptoms and help prevent serious health problems.

Complications of PMOS

PMOS can affect your reproductive system and how your body handles blood sugar. It can also affect your heart.

Reproductive problems may include:

• Infertility. This happens when the ovaries aren't releasing an egg every month.
• Repeat miscarriages.
• Gestational diabetes during pregnancy.
• Increased blood pressure during pregnancy or delivery, having a larger than normal or smaller than normal baby, or having a premature baby.
• Precancer of the uterine lining (endometrial hyperplasia).
• Uterine (endometrial) cancer.

PMOS can also cause problems with blood sugar. Insulin is a hormone that helps your body's cells get the sugar they need for energy. Sometimes these cells don't fully respond to insulin, which can lead to diabetes.

High insulin levels from PMOS can lead to heart and blood vessel problems. These problems may include:

• Hardening of the arteries (atherosclerosis).
• Coronary artery disease and heart attack.
• High blood pressure.
• High cholesterol.
• Stroke.

When to Call a Doctor

PMOS causes a wide range of symptoms, so it may be hard to know when to see your doctor. But early diagnosis and treatment will help prevent serious health problems, such as diabetes and heart disease. See your doctor if you have symptoms that suggest PMOS.

Contact your doctor now or seek immediate medical care if:

• You have heavy vaginal bleeding. This means that you are soaking through one or more pads in an hour.

Contact your doctor if you have:

• Skipped your period for 3 months or more.
• More vaginal bleeding than usual, or bleeding is more irregular.
• Regular menstrual cycles but you have been trying unsuccessfully to become pregnant for more than 12 months.
• Any symptoms of diabetes, such as increased thirst and frequent urination (especially at night), unexplained increase in appetite, unexplained weight loss, fatigue, blurred vision, or tingling or numbness in your hands or feet.
• Depression or mood swings.

Watchful waiting

Taking a wait-and-see approach (called watchful waiting) is not a good choice if you may have PMOS. Early diagnosis and treatment may help prevent future problems.

Exams and Tests

No single test can show that you have PMOS. To diagnose PMOS, the doctor will:

• Ask questions about your past health, symptoms, and menstrual cycles.
• Do a physical exam to look for signs of PMOS, such as extra body hair and high blood pressure. This may include a pelvic exam. The doctor will also check your height and weight to see if you have a healthy body mass index (BMI).
• Do a number of lab tests to check your blood sugar, insulin, and other hormone levels. Hormone tests can help rule out thyroid or other gland problems that could cause similar symptoms.

You may also have a pelvic ultrasound to look for cysts on your ovaries. Your doctor may be able to tell that you have PMOS without an ultrasound, but this test will help rule out other problems. Your doctor may do other tests to check for problems caused by PMOS.

Treatment Overview

Treatment for PMOS can help reduce symptoms and help prevent long-term health problems. Treatment can include lifestyle changes and medicines.

Lifestyle changes

Medicines

Medicines used to treat PMOS include:

It's important to see your doctor for follow-up to make sure that treatment is working.

Self-Care

Home treatment can help you manage the symptoms of PMOS and live a healthy life.

• Choose healthy foods. Try to eat a variety of healthy foods every day. This can include whole grains, vegetables, fruits, dairy products, and lean protein foods. It may help to work with a registered dietitian.
• Make physical activity a regular and essential part of your life. Choose fitness activities that are right for you to help boost your motivation. For many, walking is a good choice. Or you may want to swim, bike, or do other activities.
• Stay at a weight that is healthy for you. If you are overweight or have obesity, try to lose weight. Losing even a small amount of weight can improve symptoms and health risks. Talk to your doctor if you need help losing weight.
• If you smoke, try to quit. If you need help quitting, talk to your doctor about quit programs and medicines. These can increase your chances of quitting for good. Also avoid secondhand smoke if possible.
• Care for your skin. Acne treatment may include nonprescription or prescription medicines that you put on your skin (topical) or take by mouth (oral). You may notice an improvement in your acne after using estrogen-progestin hormone pills.
• Remove or treat unwanted hair. Excess hair growth (hirsutism) slows when high androgen levels decrease. In the meantime, you can remove or treat unwanted hair with:
  • Laser hair removal, in which the hair follicle is destroyed by a laser beam.
  • Electrolysis, in which your hair is permanently removed by electric current applied to the hair root.
  • Depilatories. These are chemical hair removal products applied to the skin.
  • Waxing. This pulls the hair out by the root.
  • Shaving.
  • Tweezing.
  • Bleaching.

Hair removal methods differ in cost and long-term effectiveness. Before trying one, ask your doctor about risks of infection and scarring.

Medicines

As part of treatment for PMOS, medicines can be used to help control reproductive hormone or insulin levels. These medicines can include:

• Combination estrogen and progestin hormones. These are in birth control pills, vaginal rings, and skin patches. These hormones correct irregular or absent menstrual cycles. They may also improve acne problems and reduce unwanted hair growth or loss.
• Progestin. This can help regulate your menstrual period and may help protect against endometrial cancer.
• Androgen-lowering spironolactone. This is often used with estrogen-progestin therapy to reduce acne and unwanted hair growth or loss.
• Metformin. This diabetes medicine is used for controlling insulin, blood sugar levels, and androgen levels.
• Fertility medicines. These include clomiphene and letrozole, and gonadotropin injections (LH and FSH).

Infertility Treatments

People who have PMOS and are overweight can try to lose weight. Even a modest weight loss may help improve ovulation. If weight loss doesn't help, then medicines may help.

The medicines letrozole, clomiphene, and metformin may be used to help with ovulation in people who have PMOS. If these medicines don't work, gonadotropins may be tried.

If weight loss and medicines don't work, surgery or IVF may sometimes be an option. A surgery that may be done is ovarian drilling. This is a surgery that can help with ovulation.