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Why is PCOS Getting a Name Change?
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The condition long known as polycystic ovary syndrome (PCOS) has been renamed polyendocrine metabolic ovarian syndrome (PMOS) to better reflect its complex endocrine, metabolic, reproductive, and mental health effects. The name change highlights a growing recognition that this condition extends far beyond ovarian findings and requires a more comprehensive approach to diagnosis, treatment, and long-term risk management. You will be better prepared to understand the rationale behind the new terminology and support patients through evidence-based management of this multifaceted condition.
HOST
Rachel Maynard, PharmD
GameChangers Podcast Host and Lead, Clinical & Partnership Education, CEimpact
GUEST
Erin Raney, PharmD, BCPS
Professor
Midwestern University College of Pharmacy
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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe the rationale for the transition from polycystic ovary syndrome (PCOS) to polyendocrine metabolic ovarian syndrome (PMOS).
2. Explain the endocrine, metabolic, and reproductive features that influence the management of PMOS.
Rachel Maynard and [Speaker] have no relevant financial relationships to disclose.
0.075 CEU/0.75 Hr
UAN: 0107-0000-26-314-H01-P
Initial release date: 8/24/2026
Expiration date: 8/24/2029
Additional CPE details can be found here.
PCOS Becomes PMOS
SPEAKER_01Hi HealthMart Pharmacists, from your education partner CE Impact, this is Game Changers. I'm your host, Jen Moulton, and each week we have a conversation on a hot clinical topic that will keep you current in practice and position you as a resource for prescribers and patients. Thanks for listening in.
SPEAKER_02Hi everyone. Welcome to the Game Changers Clinical Update Podcast. I'm your host, Rachel Maynard. Today we'll be talking about a situation that doesn't come up too often, and that's a name change for a very common condition, polycystic ovaries syndrome, or PCOS. That name is going away, and the new name for this condition is polyendocrine metabolic ovarian syndrome, or PMOS. One of the goals with this name change is to reflect a growing recognition that the condition extends well beyond the ovaries. And I'm sure that's already raising lots of questions for you, so I want to jump right into our discussion and clarify why the name is changing, what it tells us about the condition itself, and what the change will mean for us and our patients in practice. And I am so pleased to welcome back our expert guest for this topic, Dr. Erin Rainey. So welcome back, Erin.
SPEAKER_00Thank you. I'm glad to be here.
SPEAKER_02We're very excited to have your expertise here again. And Erin, for our listeners who may not have heard your voice in the past, would you mind sharing a little bit about your background, your current role, and why you're interested in this topic?
SPEAKER_00Great. Well, I am a professor of pharmacy practice at Midwestern University College of Pharmacy in Glendale, Arizona. And my clinical practice in the past, over 20 years in family medicine, and really an interest and an emphasis on women's health and cardiometabolic disease. I now am in a campus-based role where I'm teaching in those areas and my scholarly work is still in women's health. But I also have taken on the role of some professional development programming for our students. So I have had this interest in my whole career in terms of the women's health across a lifespan. And as you mentioned with the name change, what we're really going to emphasize is this is a long-term chronic condition, not just about the ovaries. So I'm excited to get into this more.
SPEAKER_02Yeah, and I love that you highlighted your interest in women's health, but also cardiometabolic conditions. And that also ties in with exactly what we're going to be talking about. So thank you for highlighting that. And thank you again for taking time to add a Rizzy schedule to chat with us about this. But I did leave our listeners in a little bit of suspense by just sharing that name and how it's going, moving from PCOS to this polyendocrine metabolic ovarian syndrome. I'll say it again, PMOS. And I do want to wait a little bit longer before we get to the punchline of why that's changing, because I think if we get a little bit of a fresher on the condition itself, it might tie in better to the thought process behind that name change.
Defining PMOS And Diagnosis Basics
SPEAKER_02So can you just remind us about what this condition is, how it's sort of categorized, characterized, and how common it is?
SPEAKER_00Right. Well, we can start with how common it is. This is internationally recognized as a medical condition in 10% of women in their reproductive years. So this is this is common and something that crosses over beyond reproductive years into menopausal years as well. And so what we look at with PCOS or PMOS now is it's a condition that's impacting our endocrine system as well as reproductive function. So what we see with the diagnostic criteria really have not changed with the name change. And the individual would either have signs of ovulatory dysfunction, so usually that would be affecting their menstrual cycle, fewer menstrual cycles per year, longer menstrual cycles, that can impact fertility as well. Then we have kind of this aspect of hyperandrogenism, so elevated testosterone levels, and that can manifest clinically with her certism, hair thinning, acne, oily skin. And then there's the aspect of the polycystic ovaries, which is a function that's indicating really that there is an anovulatory cycle, these clustering of immature follicles on ultrasound within the ovary that indicates that ovulation is not occurring. So that's kind of some of the multifactorial aspects of PCOS, and then we can get into what that means clinically for the patient.
SPEAKER_02Okay, sure. Yeah, and so um I think that's a good sort of foundation, and then it translates into this name change. So let's let's talk about why that happened. Why is this name change happening? Who who decided this should happen? Just a little bit of background about why this push away from PCOS to PMOS now.
How The Name Change Happened
SPEAKER_00Yeah, so really, and this is a first for me in terms of watching this process unfold over many years, actually, then an international initiative. So, really, when looking at the the clinical guidelines and this name of PCOS, it was recognized by clinicians and researchers that this emphasis on polycystic ovaries really didn't give value to this lifelong metabolic condition that is really affecting a patient over her lifespan. So the name change involved a consensus process that involved stakeholders in patient arenas, clinicians, researchers across the globe, and many, many years and loops of feedback on name propositions and then voting and all of this. So now coming up with this name of PMOS. So really an exciting initiative. That's now just starting really with the unfolding of the name, and then really now getting this into diagnostic criteria and textbooks and educational systems that will take several years. Um, so that's kind of where we're at with that process.
SPEAKER_02And you highlighted uh, I think one thing you highlighted that was important is the fact that uh it is something that can happen throughout the lifespan. So, not many people may think of um the condition being associated with fertility problems, as you said, and that that is still a component, but maybe more focus on the metabolic side of things too is really where this name change is coming from, the endocrine and metabolic side. Maybe you can speak a little bit more about that. Is is that part of this this change to put more focus on those non-ovarian sort of considerations?
SPEAKER_00Yes, it's it's leaving the ovarians ovarian ovaries, seems as part of it, but really emphasizing so the polyendocrine part. Um we think about the androgen side, but also the insulin side of the endocrine disorder here. And that hyperinsulinemia and insulin resistance is what brings these long-term metabolic factors. And really thinking it, I think of this as a condition that would be like prediabetes, where we are wanting to prevent development of type 2 diabetes and the cardiovascular conditions that go with that. So it's just in line with that long-term metabolic risk, and that is such a key player in the clinical landscape now, is thinking about metabolic disease. So it links right into that and gives it that weight and value that it deserves. Now they retained the ovulatory name in the in the name so that it is recognizing that ovulatory dysfunction is what brings that the risk for infertility. But also something that goes under-recognized is that you know, when an individual is not having ovulatory cycles, that puts them at risk for endometrial cancer in their life, a higher risk. And so part of when we get to pharmacotherapy is protecting that endometrium, regardless of whether fertility is um in the plan for the patient.
SPEAKER_02Great clarification. And I think the other thing you highlighted in that in that background is the the name change is partly intended to increase awareness around some of these other complications and and and just recognition of this condition more broadly, too, in general. So helping to prevent misdiagnoses, helping to raise awareness among patients and providers. Would you say that's fair, that that was part of the the change as well to increase awareness?
SPEAKER_00Absolutely. It's it's estimated that maybe 70% of individuals affected by this are not diagnosed. So what happens over time typically is that the patient might notice um fewer cycles in the year or changes in their menstrual regularity. Um they might notice some of the clinical aspects of high androgen levels, but what brings them maybe to the diagnosis in many cases is infertility. And that could be years and years after the patient is already dealing with some of the ramifications of the neuroendocrine side and the metabolic side of this condition. So having an awareness on the clinician side as well as the patient side that we need to have a diagnosis as early as possible to really minimize this lifelong risk from the metabolic disease. So that is important to bring to light and have the conversation about it and recognize that this isn't about the cysts on the ovaries. I would say also something that is unique about that terminology that was part of the name change is that polycystic ovaries, as I mentioned, is that visualization of immature follicles in an anovulatory cycle. But we also, in the public eye, know of ovarian cysts, which are fluid-filled sacs from an ovulatory cycle that might cause pain. Many patients have heard of ruptured ovarian cysts. These are not the same thing. So just the aspect of having polycysts in the name, um, pulling back from that kind of helped with the confusion factor that was going on as well.
SPEAKER_02So that's a great clarification and not something I realized. It's it is the the new name is more precise and accurate, actually, to what is happening, not only better representing that sort of interconnected set of uh considerations for these patients, but also more precise. Because one one quote I saw from the press release for this guideline, or sorry, for this uh name change was that there we know now that there is actually no increase in abnormal cysts on the ovary. And so to that point, what you're saying is in in PMOS, that maybe you could respond to that quote a little bit.
SPEAKER_00Yeah, I think that's um kind of leaning towards that misunderstanding that the cysts or the pathology there, and that's that's not true. It's a it's a finding indicating that there's ovulatory dysfunction, but there isn't uh a danger from that um finding. Right. Um so disconnecting it and and really leaning into the correct um kind of understanding
Metabolic Risk Beyond The Ovaries
SPEAKER_00and diagnosis, and maybe just from the patient's side, having some advocacy towards understanding their how their body's working and what is manifesting and some of the things they're noticing, and validating that in a way that is welcoming, and the clinicians can really take a big picture look, holistic look at that that person's lifespan and and what we can do. We can't cure PMOS, but we can reduce the risks that are associated with it. The earlier we're addressing it, the better outcomes that individual have all across reproductive years and beyond. So it's absolutely an exciting awareness campaign.
SPEAKER_02Yeah, yeah. Thank you so much for that clarification. And I guess when you think about this condition and patients with this condition, what would you say are some of these components of PMOS that have been under recognized in the past and that we want to have more awareness of, especially given this name change?
SPEAKER_00Yeah, I think that um in as I mentioned, what might bring a patient to diagnosis would maybe be infertility or maybe some of the bothersome androgenic effects like herstitism. And with that being a singular complaint, then it can allow for the patient to have just that narrowed treatment as well, and making sure that we are looking broadly at the whole picture so that we can address infertility, but also at the same time look at the long-term health of that patient from a metabolic side as well. We can address the hercitism, but also making sure. So, from the standpoint of the patient, what they're noticing about their complaints is is valid, allowing them to advocate for that, but also recognizing this is a whole body condition that that's a lifelong process and really opening up that dialogue and having the patient have confidence to advocate for herself and say, hey, I'm noticing things. We need to figure this out.
SPEAKER_02And and that it's it is not just one aspect to they may be having multiple sort of symptoms. Maybe one symptom was driving them to have that conversation, but then making that connection with other things that might be going on too. So what would you say is how how should we be thinking differently about managing this condition?
Treatment Priorities And Cancer Prevention
SPEAKER_02And or if not, what are sort of those principles of management and and what might we not have been thinking about before that we do want to ensure is part of that approach?
SPEAKER_00Yeah, I think that the treatment and management also hasn't really changed. The guidelines are emerging with new data, of course, but what is, I think, about kind of a three-pronged approach to managing P PMOS. And and one part would be addressing those uh the irregular cycles. And from the pharmacist perspective, oh, this is uh an amazing condition to be involved with because there's so much pharmacotherapy and patient um education involved with all of this. But if we are having those irregular cycles and ovitory cycles, I mentioned that endometrial cancer risk. So we need to regulate the menstrual cycle, most commonly through combined oral contraceptives. And if that is an option for a patient, that helps not only protect the endometrial lining, but it also can reduce androgen levels. So it has that dual benefit. Now, the selection of the oral contraceptive, we want a low androgenicity progestin, so there's some nuance to that, and also making sure a patient's a good candidate. So the whole choice of contraceptive, that is one angle that's important. Now, another aspect of that is if the patient desires pregnancy at part as part of her journey, then the combined oral contraceptive obviously is not going to be a part of that. And so switching into treatment of ovulatory dysfunction and using ovulation inducers as part of that treatment plan. So when we look at the fertility management side, that opens up a whole other aspect of pharmacotherapy. The oral ovulation inducers like clomophene, but most importantly, really off-label use of letrozole is well supported for patients that may have ovulatory dysfunction. This can lead to other needs like in vitro fertilization and things as well, but we really have that side of it. So, what I've spoken about so far is just one of the three angles that I'm going to talk about, but that would be that we want to protect the endometrial lining lifelong and prevent endometrial cancer. And we also want to have ovulation occur if the patient desires pregnancy. That's one angle of it.
SPEAKER_02Right. So okay, so that's that's one component. And I like really like how that's great. That's great. Let's set us up for the three discussions, three-point discussion. Um, but thinking about that, I like how you just, you know, sort of divide it into whether the patient wants to be thinking about pregnancy or not, and how that's going to tie into management and choice there. If you if they are, as you said, combined oral contraceptives are a first-line option for many patients who do want contraception. And you alluded to the choice of combined oral contraceptive, I think that's a common question. So maybe you could expand a little bit about that and if if it matters which one patients might lean towards or not.
SPEAKER_00Yeah, I think the the key is um what is highly recommended per the guidelines and clinician experiences, the monophasic products, um, a low estrogen dose, whatever is tolerated by the patient, but there's no need to have a higher estrogen level in the product. And then it's really the the progestins that have that low androgenicity profile, like drospirinone would be an example. Um, that will greatly help. Now, the the oral administration also, we get the dual benefit of having elevation and sex hormone binding globulin with those products, and that can eat up that free testosterone and and hold that out so that we can lower androgen levels too. So the oral um administration route is also something that's preferential, although it's it's not required, but that's usually where the starting point would be.
SPEAKER_02Got it. Okay, good clarification. And what about a progestin-only drosperone product, for example? Where would that fit in, pros, cons of that versus a combined oral contraceptive with estrogen?
SPEAKER_00Yeah, I think that um when we're looking at the data with PCOS in the past and and most of that for that uh regulating the cycle and things, it's with those combined oral contraceptives. There's emerging data with progestin-only products, even the leavon or gestral IUD. So looking big picture what the patient's needs are, it is possible to go those routes. Also, there's a way to protect that lining through uh cyclical progesterone or progesterone products that doesn't provide contraception, but does allow for a monthly withdrawal bleed. And that's the key here. It's not the contraceptive side so much as it is about making sure that we have that balanced um, we need to check that or keep that estrogen in check and allow for that bleed to occur for that endometral protection. So there's there's processes that can be used that don't only require the COC or the combined role.
SPEAKER_02Okay.
Fertility Meds And Safer Counseling
SPEAKER_02Okay, got it. And then uh on the other side for patients who may be thinking about pregnancy, then you mentioned clomophene and letrazole as sort of the core considerations there. Any any key counseling points or considerations with those that we should be thinking about, keeping the top of mind?
SPEAKER_00You know, I I think in terms of counseling for patients who are receiving, these are these would be five-day regimens started in the early um follicular phase of the cycle. Just I think more so than just the information provided, but the empathy surrounding this. Um, when we have a patient experiencing infertility and understanding that even a five-day regimen can cause side effects and can be uncomfortable and understanding the timing, but also the context of its use, you know, this is a big deal to that patient and having that empathetic approach to what does the patient want to know? What is she is she having questions about, etc. But also when we have an off-label use of a product like an aromatase inhibitor, the most common use, approved use is for cancer. And so, really, as a pharmacist paying attention, what is this regimen? A five-day regimen is not a breast cancer regimen. Uh, coming from a fertility physician is not a breast cancer prescription. So, what materials are we handing out with this information or the prescription and how are we counseling the patient? Take a step back as a pharmacist and say, I need to understand the context, and the information I provide can can be put within the context that's appropriate for the patient. We don't need to add fear and concern by what I would call sloppy counseling, which would be just saying the same thing about the medication, regardless of who's receiving it or what they're receiving it for.
SPEAKER_02Right, right. Sort of backing up and doing that question of what did your doctor tell you this was for? Starting with that as a way to open the conversation and have them share the information versus just assuming it's for a specific use. Great clarification there and call out. Okay, so that was uh bucket one. What are the other two buckets? Or maybe we take the next one next.
Androgens Insulin Resistance And Med Options
SPEAKER_00So we'll kind of link onto that with the hyperandrogenism. So as a patient may have the clinical signs of high androgen levels, this can be bothersome to the patient, um, facial hair growth, hair thinning, acne, et cetera. And that might be the primary complaint that they're having. So, as I mentioned, actually the combined oral contraceptives can help with the lowering of the androgen levels. Sometimes an anti-androgen is utilized, and in that case, that would be like sporonolactone, is often the choice there. It does have the anti-androgen effect and it doesn't provide contraceptive benefit, but not everyone needs contraception. And in that case, though, we do want to make sure that if a patient on sporonolactone is sexually active, that there is adequate contraception in some form, because it it would be teratogenic if the patient is having is pregnant. So there's a big um focus in all of our choices here on where the patient is at in her reproductive plan, but also in sexual activity and plans surrounding that as well. So that's where that androgen side is. Now, there's also pretty good evidence that with her cutism specifically, there's better response with things like laser hair removal and some procedures that are beyond pharmacotherapy. And so supporting the patient in choices. There may be some initial benefit with a COC or a contraceptive, but they may need some other procedures for the androgenic effects.
SPEAKER_02Got it. Okay. And that might be outside of our sc our scope potentially. But good to be aware of and to support in support patients and understanding that these other options are also available too.
SPEAKER_00I think you know one of our biggest superpowers as pharmacists is understanding the big picture of what the patient's experiencing. We have our lens, but when we know our limits, we can also refer the patients to some hope for other options and take that seriously. So that's the androgen side. And then we have the insulin, hyperinsulinemia, and insulin resistance side. And that opens up another whole window of opportunity for pharmacotherapy, lifelong. We know that there's this really complex interplay between insulin resistance and high high insulin levels, then trigger androgen production. Androgen production triggers high insulin production as well. So it's a vicious cycle occurring there. And so drug therapy targeting insulin resistance is important. For the most part, for a long period of time, metformin has been the foundational drug therapy there. By impacting insulin resistance, then that actually can help with lowering androgen levels. And then we think, as in prediabetes, for instance, we want to prevent progression to type 2 diabetes. We want to have good cardiometabolic health long term. So that's where that fits in. Now we haven't really talked about lifestyle factors quite yet, but a big part of insulin resistance that is part of PMOS as well is obesity. So in those individuals with obesity, weight loss can obviously impact insulin resistance as well, just like we see with diabetes care. So having having those play into each other. There's some recent evidence emerging with the GLP1 agonist now, with insulin resistance, weight loss specifically, and in the population with PMOS. The GLP1 agonist like lyriclutide has been studied more the most so far in this population, primarily because it's been on the market longer. And even in combination with metformin and having some really good outcomes with metabolic parameters. And but even the summer uh trasepatide study in this population looking at um the more you know benefit in weight loss, um, more extensive weight loss with those drugs. Gosh, we have a whole whole open um opportunity here to see what's going to happen with the GLP1 agonist. So these are not um the this would is off label use, but the the studies are occurring and we're gonna hear more and more in the next few years about that. So insulin resistance is the the long-term key problem here for the patient, and using drug therapy and lifestyle together is gonna be a lifelong process.
SPEAKER_02Okay, I have a few questions for you. That that was a great overview of the antrogenic focus. No, no, no, that was great. Um, the antrogenic focus and the insulin resistance focus. So, how commonly in your experience is uh overweight sort of interconnected with PMOS? Is that is that pretty common? And therefore, you know, you mentioned GLP ones being off-labeled, but if you're using it for a weight management perspective, then it might not be for you know that angle. So maybe you can clarify is that something that we are seeing intertwined most often in in these patients?
SPEAKER_00Yeah, it's it's very much intertwined in into many disease states, including this one. And the statistic I've seen is about maybe about 50% or more individuals with West will have an obese BMI and would benefit from a weight loss in the big picture management of their PMS. And so we have uh, as I mentioned, some of the more recent commentary about what the role could be with these drugs is really in those patients who have would would benefit from weight loss in the big picture. Sure. But uh when we're ever talking about a syndrome, we have patients that will have aspects of the condition, everyone's different, and not everyone with PMOS is an overweight or obese BMI.
SPEAKER_02Okay, okay, great call out. And uh for that first bucket, we talked about this the contraception fertility bucket. If we're thinking about the androgen and insulin resistance buckets, so would a patient ever be on, say, just spironalctone or just metformin or combining these, what uh to target specific concerns the patient has. How does that how what are you considering when you're thinking about the whole patient approach and those buckets? Are are they sort of again combined often, or what what do you think about when approaching a patient and caring for them, optimizing their medications?
SPEAKER_00Yeah, it has to be very individualized. And I guess I would emphasize that um an assessment of the ovulatory pattern and menstrual cycle pattern of the patient is is key because if there is any risk for that um anovulatory pattern and infrequent menstrual cycles, regardless of what's happening with the insulin resistance and other things, we we do need to address that in some form or fashion to have that long-term risk reduction for endometrial cancer. But that may not be the highest priority for that patient. And um I think as we look at the the treatment, it does have to be the big picture of everything that the patient is not just complaining of, but also what we clinically can see as that long-term risk. So addressing uh weight and insulin resistance, the androgen side, there may be no clinical manifestation of her certism in the patient, but by managing the ovulatory cycles and also the the um hype the hyperinsulinemia, that will help reduce the androgen levels as well. So there'll be some some things that are treated that are visible to the patient or part of their high priority list, and other things that are managed, cross-managed because we're looking at the big picture long term.
SPEAKER_02Got it. Okay, and that goes ties again back into the name change, this polyendocrine metabolic ovary. And the the metabolic to me is is one of those key words that's we we are hearing about metabolic risk factors more and more, I think. And so again, putting more attention on that and having that be part of that whole lifespan uh focus, I as you say, is is a really good um way to draw attention to that. So one other thing to call out in thinking about weight management and metformin use, even is if patients are seeing improvement, say in insulin resistance and weight management with some of those options, can fertility also improve? Like I think that's some a can or a consideration, right? Maybe you can speak to that a little bit.
SPEAKER_00Yeah. So this all these are these buckets are all related to each other, right? And as I mentioned, this interesting interplay between insulin affecting ovarian function and ovarian secretion of testosterone affecting insulin secretion. So when we can address one of those, there'll be benefit across there. And so actually, way back when troglitosone was marketed and we looked at that for in improving insulin sensitivity, and one of our first insulin sensitivity drugs, really, at the time, there were cases of, and if you looked in the package labeling of spontaneous ovulation and improved pregnancy rates and things that were happening. And so it's been well recognized that when we have insulin resistance, there is that impact on ovulation, and when we can address it, improve it, that may help with that. Now, um, that is why metformin and clomophene together have been many times partnered together for managing the fertility side of this condition for for years now. What you'll see in the guidelines is there's a real nuanced approach to who might be a candidate for a letrozole approach versus a clomophene approach versus a clomophene plus metformin approach. So all of that is something that is kind of beyond the scope of our discussion, but there's there's consideration there.
SPEAKER_02Okay. And for those, I I keep saying buckets, but as you said, we are really focusing on the fact that this is so interconnected and really all intertwined. But for those other buckets that we talked about, um, key counseling considerations and points to be thinking about with those, I think you really highlighted an important point with the clomophene and letrazole and asking what the patient is using them for. What other sort of pearls do you have for those other meds that might be used for PMOS?
SPEAKER_00Yeah, I think that whenever we're looking at the use of a combined hormonal contraceptive, that the tolerability of these varies, right? It might take a few tries to find something that the patient's going to tolerate. So having an awareness not just of who is safe to use those drugs, but also the tolerability profile. So side effects of the contraceptives themselves. When we look at the use of sporolactone, while there may be benefit, kind of thinking about that risk if the patient was to become pregnant and surrounding that conversation. Metformin comes with its own side effects in terms of GI tolerability and getting the patient to a tolerable dose. The GLP1 agonist, my goodness, we could go on for many, many shows on the tolerability there. But also I would bring in kind of the interplay there as well with a patient on a GLP1 agonist. We we don't have safety data in pregnancy on those. And in fact, there's a recommended washout prior to pregnancy of those drugs. And there can be a drug interaction with trazepatite and oral contraceptives in terms of wanting to have backup reception and the initiation and phases and drug uh dose escalation. So take a deep breath. Can you imagine patients not only the singular counseling points on all of these drugs that they may be taking, but the counseling on their understanding of the length of use, what role it's playing in their long-term health? When we have some medications maybe used for a short-term process like ovulation induction, but the understanding of something like metformin may be a long-term use because we're looking at protecting this 25-year-old when she's 60, right? And so really having it's complex and can't be addressed by any one clinician in any one visit. So all of us partnering together as from our clinical lenses to make sure the patient can see see the short term and the long term and what place in therapy these drugs um these drugs play is. I think I think this could be one of the most complex counseling situations we can come up with from a drug therapy side.
SPEAKER_02Yeah, yeah. And like you say, not forgetting about specific the patients with this specific condition, which again, a lot of these drugs are used for other sort of situations too. And so not necessarily translating those counseling points into what you might be talking about with a patient with PC PMOS. And what about for we've been talking about all about drug therapy, but you did highlight the importance of lifestyle modifications too and non-pharmacologic therapy. So let's talk about that a little bit more too, because as you said, this is going to be maybe a complex counseling situation, but that that needs to be part of it too,
Lifestyle Risk Screening And Patient Tools
SPEAKER_02right? So what would you focus on in those discussions?
SPEAKER_00Yeah. So lifestyle uh is foundational for PMOS. And really, we want to think about maintaining healthy weight. We want to think about uh maintaining healthy blood pressure, lipids, uh, not smoking, all the things we think about long term with cardiometabolic disease. So physical activity can help with weight management as well as all of those cardiovascular factors like blood pressure and lipids. There's not a specific diet that is recommended in terms of PMOS specifically, but having a healthy diet that supports healthy weight, but also the blood pressure and lipid factors as well. So I think those if we have take what we foundationally do for conditions like preventing diabetes, preventing heart disease, and really add MOS into that situation, that will give us a lot of the same language that we can use. And that might be what is so surprising to the patient who was needing therapy maybe to get pregnant, and now we're talking about lifestyle management to prevent heart attacks later in life. Um so we have the tools already for the lifestyle counseling. It's using them in this context.
SPEAKER_02Sure. And just to be crystal clear, for patients with PMLS, are they at increased risk of cardiovascular events, diabetes? Is that is PMOS sort of itself a risk factor for some of those types of outcomes?
SPEAKER_00Yes. Yes. Okay. It's right on there. Um PCOS has been labeled on the diabetes screening guidelines for for decades.
SPEAKER_02Okay. Okay. And so again, thinking about that, polyendocrine metabolic ovarian syndrome is the new name. I'm just going to keep saying it so it sticks a little bit for me and hopefully for listeners. Um and I think that helps the point about this reducing long-term risk. It it makes it make sense because we are, we are, we are not just focusing on the ovarians, we are focusing on long-term cardiovascular health and metabolic health broadly. And so, as you say, that really is it's a really nice reminder, I think, to have those conversations, even if, say, a patient with PDM MOS is just getting a combined oral contraceptive and that is all they need to manage um, you know, that component of it, still having those conversations because they're at risk, by definition, of having PMOS. Is that fair? Am I assessing that correctly? Okay.
SPEAKER_00Absolutely. We want that patient to be aware that in the moment, if if regulating the menstrual cycle is the key priority at that time, but in a parallel process along her life, we want to make sure that there is a look at in any of those metabolic risks, like what is her weight? Um, what about physical activity, all of this? Because we're going to be testing for diabetes and insulin resistance at some point that might manifest, and it might not be when the patient is 25 years old. And in a way, we don't, this is not to put fear in the mind of the patient, but to help with self-advocacy that at any point in that lifespan of that patient, there's going to be different priorities. And so we want to place value on that and respect that. But there are some great resources for patient advocacy that are that are published out of the international guidelines. Um, an entire patient-facing website and an app on how to ask questions, what are you noticing about your body, what is happening lifelong for you, what about in the moment, what are you scared of? It's really some really important part of the rollout of this um name. So I I highly recommend utilizing resources like that to help with this big picture. It can be overwhelming to the patient.
SPEAKER_02Absolutely. Yeah, yeah. And what I found important too when looking at the the sort of background behind this name change is that the patient voice was considered very strongly in the development of this name change. As you say, this this required multiple associations, international groups, but also patients and patients with lived experience and those who can can speak to a part of this too is about limiting stigma and uh improving cultural awareness and all of these sorts of things too. So I think it's a really good call out to to you know have people refer to some of these additional resources and supporting patients in advocating for themselves too. One additional clarification I'm just thinking about. So if a patient, if you have a patient with prediabetes, for example, or diabetes, should you also be thinking about PCOS? Should you be thinking about in the reverse too? Or is that um would you only be thinking about it if they are reporting some of those other factors that you talked about?
SPEAKER_00Well, I think that um certainly we'd look at a whole hopefully we can look at each patient holistically and evaluate um from the standpoint of if she's of reproductive age, what's the gynecologic history, menstrual cycle history? Having that um gyne history should be part of an assessment of any any human. So, yes, absolutely backtracking and thinking back about anyone who has a um insulin resistance pattern that's showing up to really broaden that view and step back and look at what are some other factors here that might be at play that maybe the patient um didn't really notice. Um, there aren't too many people that complain about not having a lot of menstrual cycles, right? There may be something the patient would say, Oh, I I didn't really realize that that was dangerous, that I was only cycling five times a year. I thought that was great. So having that conversation wherever they enter your care, right? If it is because they have pre-diabetes, but taking that step back to make sure we have a good history from the gyneclogic perspective.
SPEAKER_02And again, just thinking about the patient holistically and uh where as you said before, wherever they are in their care process and who they're speaking with in terms of any one clinician, this is something to be on the radar because that it all is so interconnected. So I think maybe last question is if if you have a patient who has historically referred to their condition as PCOS and you're trying to help them become aware of this change and maybe sharing some of those resources, how would you go about having that conversation? How would you explain why this is happening to a patient?
SPEAKER_00Yeah, well, I would I would say for sure that it would be from not a correctional angle, like, oh, don't you know this is now called PMOS? Um, but from a very positive and um kind of patient advocate standpoint to be able to say there's actually a movement to change the name of this to really recognize that this is a big picture long-term condition that you are going to be dealing with, and we want to partner with you on. And so there's it's embracing the many factors that this affects in your body, and then having the literature to be able to back up and say, let's let's talk about those things. Are you are you aware that this also can affect your insulin levels or also put you at risk for diabetes or these types of things? The the patient site facing site that I mentioned earlier, uh, that actually they have handouts on why is this name changing that are meant for patients to understand. So I when I think about counseling patients, I like reading patient literature. I use some of that same language because I could work with the experts. How can I explain this so I don't don't bumble it up? Um, but that ask askpmos.org is the patient site. That's part of the international guidelines. And those guidelines are then out of Australia, actually, um, but endorsed in the US by Endocrine Society as well as the American Society for Reproductive Medicine or ASRM. So they're all embedded within those guidelines as well. And uh we'll watch for new guidelines. 2028 is when we'll have a fresh set of guidelines um published as the anticipation.
SPEAKER_02So okay, great. And I appreciate calling at the website and also why would we reinvent the wheel when those materials were obviously very thought through? I'm sure they were developed very carefully and with, you know, an intent and consistent messaging. So great, great point to leverage those in our conversations. Erin, is there anything we haven't really talked about that you wanted to be sure we touch on in terms of an awareness? This is such a big change. And even things like documenting inpatient profiles or EHRs, I feel like it's gonna take some time to have this shift happen. So, what else would you want people to know about or what's what have we talked about that you wanted to be sure we cover?
SPEAKER_00I would say um the one thing we haven't covered quite yet, which actually was discussed as part of the name but was left out of the PMOS, is the mental health side of this condition. And patients with um PMOS have a higher rate of anxiety and depression diagnoses, whether this is from kind of the neuroendocrine side or if it's also from just the stigma of um hyperandrogenic effects clinically outward, like herstetism, infertility, and the weight of infertility on a patient's anxiety and and you know, just lifelong perspective. So addressing that is part of the guidelines as well, to make sure that this holistic approach, we've already talked about buckets, adding another one that is making sure to give give value and um respect to the mental health challenges that come with a lifelong chronic condition.
SPEAKER_02That is a great call out, and I think something that is overlooked, especially when you're thinking about cardiometabolic uh considerations. That's not the first thing that comes to mind, at least for me. And so I do appreciate you calling that out and recognizing that not only the chronic condition itself, but all of those sort of specific factors can come into play when with the patient's mental health and and supporting them in that process too. Great call out. So I think in summary, what I've learned is that uh this name change is important not only for increasing increasing awareness, recognition of this condition, that it is more than just ovaries. It's about metabolic health more broadly. And there is a lot of long-term support and interventions we can help optimize with these patients, both pharmacologic and non-pharmacologic. And we are in the great position to support that lifelong care as pharmacists. So I think you really highlighted a really a lot of really important points, and I appreciate you you calling attention to those. If we had to summarize and choose just one key takeaway, since this is our game changers podcast, what would you say is the game changer that you'd want our listeners to walk away with?
SPEAKER_00I would say the game changer is that this name change actually doesn't reflect diagnostic criteria change or treatment recommendation changes. It's really uh a game changer in awareness. And
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SPEAKER_00as pharmacists, we need to jump right into this because we have a really obvious place in the care of patients because of the pharmacologic side of managing the condition.
SPEAKER_02Yeah, great call out. And uh I appreciate your highlighting no change. That that part is keeps it quote simple that there's no change in the management at this point. But get wrapping our head around the name change is going to take time. So uh I've really had we ch I'm really glad we had a chance to talk about this and really appreciate your expertise and the time you took to share your insights with us. Thank you so much, Erin.
SPEAKER_00Oh, well, thank you for the opportunity.
SPEAKER_01And that's it for this week. Be sure to log in to Healthmart University to claim your CE credit for this episode. As always, have a great week and keep learning. We'll talk to you next week.