PMOS: What's In A Name?

PCOS is now PMOS and we are here to tell you why this name change is important!

Polyendocrine Metabolic Ovarian Syndrome (PMOS) is one of the most common multi-system conditions affecting AFABs and yet is still very misunderstood, undersdiagnosed often reduced to "just an ovary thing." Spoiler: it's not just an ovary thing.

Join as we give you a run down of the condition, why the name change is important and why having an understanding of PMOS will help you understand the mind and body changes, and what you can do about it. 

Find us here!

Instagram: @fgsx_pod
Email: fgsx.pod@gmail.com

Resources here!

PMOS Resources https://mchri.org.au/guidelines-resources/community/pmos-resources/

AskPMOS app https://www.askpmos.org/

Articles here!

Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary sundrome: a multi-step global consensus process https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00717-8/fulltext

PCOS officially names polyendocrine metabolic ovarian syndrome https://www1.racgp.org.au/newsgp/clinical/pcos-officially-renamed-polyendocrine-metabolic-ov

Guidelines here!

PMOS Guidelines and Resources (Monash) https://www.monash.edu/medicine/mchri/pcos

We are your co-hosts, Dr Shyamini and Nurse Ellie, and this, is For Goodness Sex xx

Transcript

SPEAKER_01 0:00

Hello, my name is Shamani and I am a co-host of the podcast for Goodness Sex. I'm a Fijian Indian woman of immigrant parents and am proud to live, work, and play on Wajakyunga Country. This podcast acknowledges the past, present, and future traditional custodians of stolen country and the impact this has had on the health and well-being of our Aboriginal and Torres Strait Islander brothers and sisters. Sovereignty was never ceded.

SPEAKER_00 0:26

Hi team. Now, whilst we are healthcare professionals, this episode is for informational purposes only, and it does not replace personalized healthcare advice. Your health is unique to you. If you have healthcare concerns, please seek out your local health professional. Nailed it. Nailed it. Nailed it. Nailed it. Absolutely nailed it. Thank you, babe. Thank you.

SPEAKER_01 0:49

You are the best.

SPEAKER_00 0:50

Also, I'm a power bottom. Okay? Let it be known out there. I'm at your power bottom. So you should be hi hello and welcome. We are your co-hosts, Dr. Charmanie and Nurse Ellie.

SPEAKER_01 1:12

And this is for goodness sakes. Okay, so before we begin, as I said, we are gonna do true or false.

SPEAKER_00 1:28

So rude.

SPEAKER_01 1:29

You're gonna you're gonna be fine. You're gonna be fine. Okay. Ready? Yes. Louisa's probably gonna help you in the corner there. She's I'll take all the help I can get. She knows, she knows. Okay, so POS was changed to PMOS because the diagnostic name was misleading to think that polycystic ovaries were required for diagnosis. That's true. That is true. Yeah, well done. Question number two An estimated 5% of AFABs of reproductive age are affected.

SPEAKER_00 1:57

God.

SPEAKER_01 1:59

I don't know, true? Actually false. Yeah. It's more prevalent. Yeah, okay, okay. Yeah, yeah, yeah. Okay. Good try though. Thank you. I'm doing so well. Okay. PMOS is a chronic metabolic condition that persists beyond reproductive years. True. Yes, that is true. You need to have a high BMI to be diagnosed with PMOS.

SPEAKER_00 2:23

I think that that is not true. Yeah, that's false.

SPEAKER_01 2:27

Yeah, absolutely. Although a high BMI does affect the majority of people with PMOS, but it's not required for diagnosis. Okay. Yeah. So you're doing so well. Thank you. Final question. Your genetic predisposition to having PMOS may be affected by your ethnicity.

SPEAKER_00 2:44

Okay.

SPEAKER_01 2:45

So it's more likely to happen in other ethnicities versus others. Okay. Is true? Yeah, it is true. Okay. Yeah, and we'll certainly get into that. Amazing. Okay, can't wait. Okay, you did so well. Thank you. Okay, thank you. Right. So, the as I said, polycystic ovarian syndrome has now been renamed as polyendocrine metabolic ovarian syndrome.

SPEAKER_00 3:05

Polyendocrine metabolic ovarian syndrome. Gorgeous.

SPEAKER_01 3:09

Stunning 10 out of 10. Thank you. This is to better reflect the condition. So this is a good thing because you don't actually need to have polycystic ovaries. So polymany cystic cis ovaries. So multiple cysts on your ovaries to have a diagnosis. So you can actually meet the diagnostic criteria without. Okay, well thank God.

SPEAKER_00 3:26

Yeah. Which begs the question, why has it been called that for so long? Why I know, I know.

SPEAKER_01 3:30

Um and so the previous name also focused more on the ovaries and not on the major kind of endocrine and metabolic features of the condition.

SPEAKER_00 3:38

And I'm gonna be honest, that's what I linked PCOS to when I first heard about, you know, it's like, okay, clearly that means cyst on your ovaries, you know?

SPEAKER_01 3:44

Like it's in the name. It's in the name, absolutely. What's in a name? What's in a name? What's in a name? A lot, apparently, it would seem. Um So it's important because I guess it can delay diagnosis. So if somebody has an ultrasound and they don't have cis but they have the other diagnostic criteria, it's like it delays the diagnosis.

SPEAKER_00 4:00

Okay, so like is that the was that the first thing that would be ordered, like an ultrasound to check if someone had symptoms, is that was that part of the diagnostic diagram?

SPEAKER_01 4:10

Yeah, so yeah. So like it it is part of the diagnostic criteria, but it's not necessarily required as part of it. And we are gonna talk about the diagnostic criteria later. But it's not unreasonable to have if someone has uh one of the features of irregular cycles to then do an ultrasound, and if they're oh we don't you don't have cysts, it's probably not. It's actually not true. I see. So just to be clear, the underlying condition hasn't changed, just the name. Okay. So I'm gonna just give you the best explanation I can of PMOS. Good. I was just gonna say that.

SPEAKER_02 4:39

I was gonna say okay, yeah.

SPEAKER_01 4:40

So PMOS is a lifelong hormonal and metabolic condition that affects how the ovaries, hormones, metabolism, and often how mental health work together. It can cause irregular periods, excess hair growth, acne, fertility problems, weight gain, and insulin resistance. Okay. The new name replaces PCOS because the old name incorrectly suggested that ovarian cysts were the main problem when actually the condition affects the whole body. Does that make sense? It does make sense, yeah, yeah.

SPEAKER_00 5:11

So it's taking the focus away from the ovaries as such when it is something that actually quite complex. Yeah, yeah. Okay, beautiful. Thank you.

SPEAKER_01 5:18

Yeah, so it's quite complex. There's problems with ovulatory function. So when the egg comes out and the cycle, our menstrual cycle.

SPEAKER_00 5:27

And by problems do you mean like irregular ovulation or none?

SPEAKER_01 5:31

Irregular or none. Uh okay. Yep. So amenorrhea or oligomenorrhea, they're the fancy medical terms. Um other features, something called hyperandrogenism, which basically means that if there's an excess of and androgen hormones, then you can get x excess hair, oily skin, acne, those features that I mentioned. Herotis. No. Herosis. No. Her suit. Thank you, so close. So cut that out. We will not be cutting that. Horose. Hursuit. Um and then the the ovarian features are still possible. Um and then the metabolic dysfunction. Um and then there's lot there's just so many flow-ons, I suppose. So the polyendocrine bit, I guess, is really important because it just it means that there's lots of hormonal abnormalities, lots of things going on. And this can also increase your risk of getting things like type 2 diabetes, abnormal cholesterol, heart disease. Um and then the ovarian bit of the diagnosis is that because the ovaries are commonly affected. Okay. So it's not the primary part of the problem. I see. But it's the polyendocrine metabolic ovarian syndrome, is that it's lots of hormones involved.

SPEAKER_00 6:44

The ovaries are also involved, but not the sole focus. Okay, okay. It's not so the ovaries aren't the primary focus, they are involved. Not everyone has cysts on their ovaries. Correct. Correct. Yep. Um there's many, many functions, many things involved, and Okay, I'm sure you're gonna get into this, but yeah, okay. I'll let you continue.

SPEAKER_01 7:03

Oh no, that's fine, that's fine. So the the diagnostic criteria, I suppose, a little bit boring but relevant. No. It's called the Rotterdam criteria. Okay, you said it was boring. Rotterdam. Rotterdam. Rotterdam. Rotterdam, I hardly never. Yeah, but Mrs. Rotterdam? I have no idea. Anyway. So the Rotterdam criteria, you need two of the following three criteria. Okay. So one, irregular or absent periods. Okay. So just to clarify what irregular means, okay, so that's less than 21 days or over 35 days between periods.

SPEAKER_00 7:39

Less than 21 days or over 35 days. Okay. Yeah, because everyone's cycle is different. Yeah. Um, and some people have a shorter and longer cycle, and that's normal for them. But the you're saying if it's your cycle is less than 21 days and over 35, that's considered irregular. Correct. Yeah.

SPEAKER_01 7:56

So if you hand it up here for three months, irregular. Versus like, yeah. So that's the yeah. So that's the first criteria. Second criteria, hyperandrogenism that I mentioned. So clinical things, excessive facial or body hair, acne, or female patterned hair loss. Okay. Um, or biochemical things like measuring testosterone and androgen levels.

SPEAKER_00 8:17

Two. Okay, so you're saying like um hair growth maybe on the face, but then hair loss, like hair thinning on the on the head.

SPEAKER_01 8:24

Yeah. Is that right? Yeah, correct. Yeah, like a yeah, absolutely right. And you can still have those and have normal testing on the blood. So it's clinical or biochemical.

SPEAKER_00 8:34

Okay.

SPEAKER_01 8:35

As part of that one criteria. I see. So sometimes people will not have those features and you've got the irregular cycles and then you've gone on to test the hormones, and the hormones are abnormal. Okay. That's meeting two of the criteria. I see what you're saying. I see what you're saying. Or you might have the irregular cycles and then you have your Hursute. Thank you. And you've got the acne problems. That's clinical, you don't need the blood test. Okay. Two out of three. Two out of three already. Beautiful. Yeah. The third one is the polycystic ovaries. So it's part of it, but as I said, you only need two of three. And recently they have introduced AMH to the diagnosis criteria. So ovarian features, either polycystic ovaries or elevated AMH. Do you know what AMH is? I don't. Yeah. So AMH is known as anti-malarian hormone. Okay. Okay. So it's tested through a blood test. Some people listening might be aware that AMH is used in fertility testing as a mark of a marker of egg reserve. Okay. But in this context, it actually means something different. So if there is if the AMH is high, it tells us there's a high number of small follicles, i.e., high numbers of cysts. Um but b just because it's high doesn't mean your egg reserve is high. Okay. This is where it complicates things. Um So I guess just a reminder that while in the context of fertility, AMH might indicate egg reserve, in this context it it will not, but it helps us determine if there's a high number of follicles and as part of the diagnosis. Like if you can't get an ultrasound, for example. Okay.

SPEAKER_00 10:03

So in this context, like in the context of um seeking diagnosis for PMOS, it's different to fertility and the high AMH. Yeah, yeah. Correct. Equals high number of follicles. Correct. Not necessarily a high number of eggs.

SPEAKER_01 10:16

Correct, correct. Yep, yep, yeah. Um so this test is not taken in isolation. That's a really important thing to think about. Um and we do obviously also tests for other hormones. It may support the diagnosis, but it doesn't necessarily equal the diagnosis. Okay. So the clinical picture is important. Absolutely. Yep. Any questions so far?

SPEAKER_00 10:41

I don't think so. Again, I'm already seeing that it is it is complex and obviously all these things work together as one. Yeah. And I'm already thinking like, I've had friends that have queried PM like PCOS in the past and had, you know, maybe had the ultrasound and had it ruled out, and I'm thinking had other symptoms that you're mentioning now. And I'm like, I wonder if we should go back for a second appearance.

SPEAKER_01 11:00

Yeah, and I guess like I've I've thought about why I suppose it may have been dismissed. Like, what is it about P COS that was relevant? You know, uh it's not and I'll talk about the treatment shortly, but you know, it's like okay, you've got irregular cycles, your ovaries are normal. No, you probably need contraception, let's just whack you on that. And and and that is part of the treatment, I suppose, but it doesn't address the metabolic and cardiovascular things that we've just established. And so you actually need quite a bit of follow-up and and good management for people who have PMOS because yeah, like it's it's I think it's just frustrating because a lot of people will have regular cycles. We know how to treat them maybe with the commander or contraceptive pill. You put them on it, you might have done the tests, but then you don't kind of follow up the other consequences as a result.

SPEAKER_00 11:43

Yeah, yeah. And I guess that was going to be one question which why was it I mean, obviously it could just be like now development in medicine and all those things, which makes sense. But like why was it originally coined PCOS? Was that originally just a channel? I'm not sure.

SPEAKER_01 12:00

I think maybe just the knowledge around it has has changed. Um but I think you know, some people might say what's in a name, but like I think this just helps um particularly clinicians anyway, to recognise that it's not required to have the Well I did like I had I asked a few clinicians about this as well, and I had one of my favourite clinicians said something which I feel like you love.

SPEAKER_00 12:22

Um I'll just read it out and then let you get back to it. No, you're fine, yeah.

unknown 12:28

Don't mind me.

SPEAKER_01 12:29

I also love how you brought paper notes. I need to do that more often.

SPEAKER_00 12:31

Well, it's because my laptop's broken forever. Um, yeah, one of the clinicians said, I think the renaming of PCOS is excellent. We have to spend so much time backpedaling in consults, especially with younger women who don't have multiple cysts on their ovaries yet. Um, PCOS cons concentrates patient thoughts on the picture of cysts on their ovaries, which as we know is so not what this condition is about. My other clinician said, I can no longer use my favourite opening line when discussing PCOS. The first thing, which is the first thing to know about PCOS is that it's got a stupid name. So, yes, I am a big fan of the change.

SPEAKER_01 13:09

Yeah, cool. Oh, that's nice. Yeah, and I I I totally agree. Totally agree. Um, and it just I think it just helps guide management as well and understanding for the patients, because they probably felt dismissed or gas lit even. If they just don't emphasize on their ovaries, then that's just not the be all and angel. Yeah, I guess.

SPEAKER_00 13:41

Yes. Um, okay, okay, starting. Okay, so now I feel like I have a good understanding. What is the treatment, if any, for PM? Yes, there are there are plenty of treatments.

SPEAKER_01 13:49

Good question. So, as always, should be holistic, okay, given the fact that it involves multiple hormonal abnormalities. So we do need to think of it broadly. I usually like to think of it as treating each symptom that you experience while simul simultaneously improving metabolic risk and fertility. So you're you're treating the sympt symptoms, but at the same time you're trying to imp you know improve those risks and the chances of fertility as mentioned. I've just said the same thing twice.

SPEAKER_00 14:16

No, I think it was uh worth remote reading. Yeah.

SPEAKER_01 14:19

Yeah. So obviously there's lifestyle stuff. Lifestyle stuff. Yeah. Yeah. Always. Yeah. Yeah. Basics. Lifestyles. Exercise, good nutrition, good relationship. No, that's not evidence-based to it. We always have good relationships. No, but like, you know, there's obviously lifestyle things. So stress management, um, you know, good sleep, good nutrition, exercise, stripping it back to basics as always. We we talk about the details of those in a minute. So, in terms of medications, um, there's a medication called metformin. Yes. Do you know what that is? I do. Yes, yeah. So metformin is um you m listeners may be familiar that it's used to treat um people living with type 2 diabetes, um, but it what it does is it improves sugar control. And it can also suppress the hormones that produce facial hair. Okay. So the androgens, as we mentioned, yeah, and acne, things like that. So by doing that, it can actually improve the frequency of ovulation, right? Right. Which may actually improve the menstrual irregularities. It's like a flow-on effect.

SPEAKER_00 15:20

Okay. So people will get put on metformin for multiple things, maybe one sugar control, but also for management of the antigen. So like facial hair, things like that. Yep. And then ipso facto period ovulation control and then the periods return. The periods return.

SPEAKER_01 15:40

Yep. Yeah. But the the metformin's not used uh indication for specific treatment of menstrual irregularities. So it's like a flow-on effect. So we don't go if the main issue is the menstrual irregularities, we don't say, oh, we'll give you metformin. Of course not. Um but we we often use it in the treatment of subfertility. Okay. So if people aren't ovulating regularly, we will use metformin to try and induce ovulation regularly. Okay. Okay. So to improve menstrual disturbances, we will often prescribe. Menstrual disturbance. Dysterbia. Disturbia's left. Disterbia. Yeah, great song. Great song. Menstrual dysturbia. Um, we will often prescribe the combined oral contraceptive pill. Okay. That can often suppress the same hormones that metformin does. Yep. And also just induces that regular regular cycle. Yeah, yeah, yeah. Um not necessarily ovulation though, because the combined oral contraceptive pill can suppress ovulation, so it's not used for fertility. So this is what I mean by treating symptoms. So if you want if if someone's like, I've got PMOS and I am subfertile, then we would look at metformin. But if someone's not looking at fertility, we want to get their menstrual regularities back, menstrual, sorry, irregularities back on track, then we would look at the combined oral contraceptive pill, which also manages those excess hormones as well. Cool. Okay, it's almost like you need like a flow chart. Yeah. This is why it's complex, right? Right? Absolutely. Then the next thing is weight. Okay. Okay. So a five percent weight reduction can improve all symptoms, and sometimes metformin can be used to help this. Okay. Okay. And obviously lifestyle stuff, regular exercise, good nutrition, sleep, etc. Now I did just want to make a point about weight. Please. So weight loss Wow. Were you sitting on that one for a while?

SPEAKER_02 17:26

Yes.

SPEAKER_00 17:29

Don't do it, don't do it. Don't do it. We've only got six minutes, but then go go.

SPEAKER_01 17:32

So weight loss inherently does not solve all health problems. Okay. I think, you know, historically people with high BMIs have been unfairly vilified even in health. Be like, if you lose weight, everything will be fixed. So I just want to make that clear that it doesn't. Okay. Um and you know, we could talk about weight from a sociological point of view for a long time. I'm holding my tongue. Yeah. But in this case, in PMOS, it does help. Okay. Okay. So I just want to be clear that I'm not saying here everyone needs to lose weight to to to fix their metabolic risk. But in in this instance, it does help. Okay. Nuance everyone is a good thing. Yeah. And not only will it help, you know, PMOS overall, it will help reduce your risk of the complications or consequences that we've previously mentioned. So cardiovascular disease, insulin resistance, type 2 diabetes, that sort of stuff. Okay? So that is important. Yeah, it is important. Now in terms of supplements, you might be wondering. Always. Always. So there is a supplement called inositol. I don't know how to pronounce it. I nocy. Do you nocetol? Inositol. Yeah, we are no citol. Because she's easy. Yeah, yeah, yeah. Anyway. So it is a supplement that affects insulin. Some studies of women with PMOS suggest it could be helpful for regular menstrual cycle, insulin resistance, and androgen hormones. But the evidence is low. Okay. So it's not something we would necessarily recommend because it's low quality evidence. Okay. But it is a supplement that is out there. Any questions? Not yet. No, yep. Yeah. We're actually only done. Yay. Yeah.

SPEAKER_00 19:16

Well that's good, I think.

SPEAKER_01 19:17

I think so. I mean, there's a couple of extra notes. So the the ethnicity, just going back to the few extra notes. So um POS is more oh sorry, Picos. I literally're talking about the whole name change, like PECOS. Yeah, PECOS. We've just been saying it. We've been saying it for the is um more like well the the metabolic and cardiovascular complications are more likely to affect women of Southeast Asian origin and also African descent. Yeah. So it doesn't necessarily change management, I think, but sometimes it's worth just noting that. And you know, we know that people um from different ethnicities are susceptible to different conditions. So and in Australia, obviously, we're very multicultural and diverse, but sometimes we do miss those things. So it's just important to just recognise that some people might need extra surveillance or monitoring. Yeah. Um The other thing I wanted to mention is you know the irregular cycles thing. So when you first get your period, you can actually experience irregular periods for the first year. This does not mean you have females because in your first year they're probably going to be irregular. Yes. But if the irregularity continues, it's worth a check-up.

SPEAKER_00 20:24

So important. Yeah. So important. Yeah. Yeah. No, that's what it's good to know. Yeah.

SPEAKER_01 20:27

Yeah.

SPEAKER_00 20:28

So yeah, they're the main that's the slightly. I'm glad. I'm glad that it shifted in such a way that it's exciting. You know, we've you know, but it's exciting.

SPEAKER_01 20:37

Yeah, I think it's exciting. It's you know, what's in a name, I guess, for clinicians or doctors, nurses, researchers. It just means that we look at this condition more holistically and we certainly don't have delays in diagnosis. Well, we hop hopefully don't have delays in diagnosis as much. And some people might be wondering what's the significance, right, if we just get their, you know, cycles back on track and they ovulate whatever. There's obviously flow on effects of metabolic conditions. And I think that's the common step that's missed. It's like, oh, you've got to regular cycles, we'll just put you on the pill to regulate them. And I think it just gets missed because then the unfortunate thing is once you're on the pill, testing hormones m is challenging. Yeah. So I think it just will allow us to look at things more broadly. Yeah. Um, and I think, you know, the fact that the name change has been so widely publicised in the media, it's actually really helpful for patient autonomy. It is. To be like, hey, listen, I've got these symptoms. Even if we do the ultrasound, I might not have cis. Like, what do you think? Yeah, absolutely.

SPEAKER_00 21:32

To educate your doctors, further understanding, yeah, absolutely. I think that's awesome.

SPEAKER_01 21:37

Yeah, yeah. So that's the that's the that's the gist of it. That's the crux of it. I guess maybe the other things to think about is the um Louisa just said metformin makes you fuck.

SPEAKER_00 21:51

Um stayed.

SPEAKER_01 21:54

She's not wrong. Um I guess the other thing just to think about is like maybe the Mental health impacts. Um I do certainly think a lot of AFABs will struggle with a lot of the like I I I find they don't really mind too much about the menstrual irregularities. Like I think it's a concern, so they should get it looked at, but it's not sort of hugely bothers them. But what does bother them is the acne and the hair and the weight, and you know, um that can really have a significant impact on people's mental health, also the risk of you know, cardiovascular disease fertility impacts. It's not really fair that they have it. Um, and I think that that can certainly weigh people down. So I think it's also just important to really screen for mental health, and and that's a reason enough for you to feel impacted having a diagnosis like this, but it's certainly manageable. Um get yourself a good GP to manage and um find a good therapeutic fit and you'll you'll be okay.

SPEAKER_00 22:47

That's so good. That's so good. Yeah, yeah. Actually, I did have a thought is that um I've had a few clients come through, I guess not on contraception with PMOS, and I guess sort of been like, oh, I'm probably infertile anyway, or like my fertility topping shit. Anyway, I've got PCOS, I've got PMOS, you know. What would you say to them, I guess? You know, because like yes, as you say, it can affect fertility, but also do we want to be relying on that?

SPEAKER_01 23:14

Yeah, no, I it's not it's not black and white. Um so if you have POS, you're um you may it may impact your fertility, but it doesn't mean you're infertile. Yeah, if you're still having cycles, you're ovulating at some point, right? We just don't know when. Yeah. Um, so if an egg is released, there's a chance. There's always a chance. It's just that I think if um you know we can predict uh regular cycles and plan pregnancy more appropriately in that way. So using metformin and weight management, things like that to help induce that is helpful. Yeah, but it certainly doesn't mean you're in fertile. Yeah, yeah, yeah. I think that's really important because I I certainly have had a lot of patients like, I was told I could never fall pregnant. Suddenly they, you know, he with an unplanned pregnancy and that is a misconception. Yeah, okay, thank you. Yeah, yeah, yeah. Oh thank you for that. So that was brilliant. I hope you learned something. I did. I also learned something. Oh that learned something at you. Okay, love you. We've had a whole bottle of wine now. Yeah, I'm right in and send us my mail if you want. Um yeah, so if you go to our show notes, you'll see a little link at the top that says send us mail. And then you click the mail, the link, the mail, you click the link, and then you can send us a voice note or a message.

SPEAKER_00 24:33

Everyone already has. Yeah, um, we're gonna keep doing this until we don't talk.

SPEAKER_01 24:38

Yeah, no one has. Maybe in the heads I have. If you want us to talk about anything in particular, um, until it's a breakway. We couldn't do it without our management team, Louisa and Sarah, the henhouse recording studio for hosting our recording sessions at Harry Sound Safari for our music. Don't forget to check out our show notes for all our recommendations and to send us a text with your questions, queries, stories, or feedback. We love hearing from you. Thanks for listening.