Polyendocrine metabolic ovarian syndrome (PMOS) is a hormone disorder that affects up to 1 in 10 people with ovaries. Most symptoms start in the teen years, but some people do not notice them until their early to mid-20s.
There is no cure for PMOS, but we can treat the symptoms and their causes. Each person with PMOS is unique. Some may have only a couple of symptoms while others may have more.
Many people with PMOS have a metabolic syndrome that must be treated. Symptoms include:
High blood pressure
High cholesterol
Glucose intolerance or diabetes
How PMOS Is Diagnosed
In people under age 21, PMOS is diagnosed when there are:
Increased levels of androgen hormones, and
Missing or irregular periods.
The exact cause of PMOS is not known.
Doctors diagnose PMOS based on:
Your symptoms
A physical exam
Blood tests to rule out other conditions
In most cases, a pelvic exam is not needed at the first visit. An ultrasound of the ovaries is only done in rare cases.
Symptoms
Common symptoms include:
Extra hair on the face or body
Acne
Irregular periods
Insulin resistance
Obesity
Possible Effects of PMOS
Cystic Ovaries
The parts of the ovary that normally contain an egg that is released with each menstrual cycle can turn into cysts and no egg is released. Only some people with PMOS have cystic ovaries. Most people with PMOS have normal ovaries. The cysts in PMOS look like a string of pearls on ultrasound and contain many, many small cysts, not just one big single cyst. A single cyst can commonly occur and is not PMOS.
No Periods or Infrequent Periods
The time between menstrual bleeding can be greater than six weeks, with eight or fewer periods per year. Irregular bleeding may occur. Periods may be lengthy, light, or heavy. Frequent spotting may also occur. Absence of a period for more than 3 months at a time should be treated.
Infertility
Infertility is not being able to get pregnant within six to twelve months of unprotected sex (depending on your age). In the case of PMOS, this is often due to no eggs or few eggs being released from the ovary. Teenagers with PMOS may still get pregnant, so they should not have unprotected sex.
Increased Androgen Hormone Levels
Androgens are certain types of hormones produced by the ovaries and adrenal glands. Making too much of these hormones can cause excess body and facial hair, as well as oily skin.
Excessive Hair Growth
The hair growth mostly occurs on the face, chest, abdomen, back, or toes. This can be a response to the body making too many androgens.
Oily Skin, Acne and Dry Flaky Scalp
All of these are a result of the skin making too much oil which can be caused by the body making too many androgens.
Obesity or Weight Gain
Weight gain tends to occur around the middle, causing an “apple” shaped figure. Weight gain can worsen insulin resistance and heart disease risk factors, such as high cholesterol and high blood pressure.
Insulin Resistance and Hyperinsulinemia Insulin resistance occurs when the body does not use insulin very well to change sugar from food into energy. The body then must produce higher than normal levels of insulin (hyperinsulinemia) to try to keep the blood sugars under control.
Abnormal Lipids
Lipids are fats in the blood. In PMOS, the bad lipids or cholesterols (LDL and triglycerides) become high and the good one (HDL) becomes low.
High Blood Pressure (Hypertension)
Blood pressure for a young adult should be around 120/80 or less. High blood pressure is a reading of 130/80 or greater. High blood pressure is a risk factor for heart disease.
Dark Patches on the Skin
This most often occurs around the neck but can also occur in the skin creases under the arms, breasts, knuckles, and between the thighs. The patch can feel smooth and ranges in color from tan to dark brown. These skin changes reflect high insulin levels.
Treatment
Birth Control Pills
Birth control pills contain hormones to make periods regular. Some can also decrease the androgens produced by the ovaries and help control symptoms such as increased hair growth and acne. People with a history of blood clots, migraines with aura, clotting disorder, or liver disease should not use birth control pills.
Anti-Androgen Medicine
These medicines block the effect of the androgen hormones that cause unwanted hair growth and acne. Spironolactone (Aldactone®) is one of the drugs we often prescribe to decrease acne and facial and body hair growth. It may take up to 24 weeks for full results to be seen. You cannot take this medicine during pregnancy.
Insulin Sensitizers
These medicines make the body more sensitive to insulin. They lower the amount of insulin produced by the pancreas. Metformin (Glucophage) is the medicine most often used for PMOS. It can also help you to lose a small amount of weight, regulate periods, and help improve cholesterol levels.
Weight Loss
Losing weight can be hard at first because of the insulin resistance. A healthy diet and exercise will be important for weight loss. Our dietician can help you create a food plan and set goals. Weight loss can also decrease the risks of heart disease and type 2 diabetes.
Excessive Hair Growth
Along with medicine, electrolysis or laser treatments can work well to achieve more permanent hair removal. These techniques are performed by a licensed dermatologist or plastic surgeon and can be costly.
Long Term Health Risks
Endometrial (Uterine Lining) Cancer
Each month, a lining builds up in the uterus. If pregnancy does not occur, the lining is shed through a menstrual period. PMOS does cause a buildup of the lining, but the lining is not fully shed due to rare or absent periods. This buildup of the lining over time can increase the chance of endometrial cancer if it is not treated.
Type 2 Diabetes
Insulin resistance and obesity both increase the risk of having type 2 diabetes. People with PMOS who have family members with diabetes appear to be at the highest risk for also getting diabetes. By the age of 40, four out of ten people with PMOS have either diabetes or cannot process glucose the right way (glucose intolerance or pre-diabetes).
Heart Disease
PMOS can lead to an increased risk of heart disease. Symptoms such as high blood pressure, high cholesterol, obesity, and hyperinsulinemia increase risk of heart disease.
Resources
Polycystic Ovarian Syndrome Association, website: http://www.pcosupport.org
Center for Young Women’s Health, website: www.youngwomenshealth.org