Endocrine Disorders

PMOS

What is PMOS (PCOS)?

Polyendocrine Metabolic Ovarian Syndrome is what used to be called PCOS.   It is a common endocrine condition whereby an imbalance of hormones (androgens and insulin) is thought to cause metabolic issues and infertility.

What causes PMOS?

Approximately 12-18% of females of reproductive age are affected by PMOS. There is still a lot of research needed to find out the exact cause of PMOS; however, the following are thought to play a role:

• Genetics.
• Hormonal imbalances during our development in the womb before birth.
• Lifestyle and environmental factors.

What are the symptoms of PMOS?

PMOS may cause a range of symptoms, and they can vary among individuals. Not all symptoms are experienced by one individual, but some of the following may be present:

• Irregular periods.
• Heavy menstrual bleeding.
• Acne.
• Weight gain.
• Excess hair growth (especially on the face, stomach, or back).
• Difficulty falling pregnant.
• Emotional challenges – depression, anxiety, and low self-esteem.
• Body image issues.
• Sexual health issues.
• Impact on quality of life.
• Early-onset type 2 diabetes.

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Diagnosing PMOS

Investigating PMOS usually involves a combination of ultrasound scans, blood tests, and a review of your medical history. For a PMOS diagnosis, at least two of the following three criteria need to be met:

1. Irregular Menstrual Cycles (Oligo-anovulation): Irregular or absent ovulation/periods.
2. Hyperandrogenism: High levels of androgens (such as testosterone) and/or related clinical symptoms, including acne, female-pattern baldness (alopecia), or excess facial/body hair (hirsutism).
3. Polycystic Ovarian Morphology (PCOM) or High AMH:
   • Ultrasound findings: An ultrasound showing an excess of antral ovarian follicles or increased ovarian volume
   • Blood test: A blood test confirming high levels of Anti-Müllerian Hormone (AMH) can now replace the ultrasound

Your fertility doctor will exclude other similar diseases before diagnosing PMOS.

PMOS and fertility

A PMOS diagnosis can mean you have trouble having a baby, however once diagnosed and treatment commences, the chance of pregnancy is similar to the rest of the population.

Irregular periods can affect ovulation, not only making it harder to get pregnant but also resulting in fewer opportunities to fall pregnant than if you had a regular menstrual cycle.

The hormones that control appetite and hunger (insulin) are also not regulated effectively in the body, making it harder to maintain a healthy weight (i.e. easily gain weight and have trouble losing weight), which can affect your chances of having a baby. Since PMOS can often be associated with metabolic issues, this can also affect the chances of a healthy pregnancy and can increase the risk of a miscarriage.

Treating PMOS

At Flinders Fertility, we are very mindful of your clinical and emotional needs. We try to maximise the chances of achieving a healthy pregnancy naturally by helping you with lifestyle modifications. We have a multidisciplinary team to identify and address your needs and will work with you toward positive changes (if needed) in your life. Some of the following aspects we might focus on are:

• Metabolic reset: reducing weight can have a significant impact on balancing hormones and restoring regular periods. We offer a metabolic reset program with GLP-1 inhibitor medications and Dr oversight to support this.
• Insulin sensitisers, such as Metformin, can reduce the impact of insulin resistance and can assist in weight loss.
• Ovulation-inducing medication, such as Clomid or Letrozole can be used to stimulate the ovaries.
• IVF treatment may still be necessary if the above treatment options are not suitable or successful.

At your appointment, your fertility doctor will consider your individual situation and can advise on what type of treatment will be best for you.