PCOS Is Now PMOS: New Name, Same Problem?

PCOS has officially been renamed PMOS, or Polyendocrine Metabolic Ovarian Syndrome — but does the new name actually change the way patients are diagnosed and treated?

In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols explains why polycystic ovary syndrome was always a misleading name, how PCOS got its name from the historic Stein-Leventhal description, and why the “cysts” in PCOS are usually follicles rather than true ovarian cysts. He breaks down why the new name, PMOS, better reflects the real condition: a lifelong endocrine and metabolic disorder involving insulin resistance, androgen excess, ovulatory dysfunction, diabetes risk, cholesterol, blood pressure, endometrial cancer risk, sleep apnea, fertility, and long-term health.

Dr. Amols also discusses whether this name change is a true medical breakthrough or simply a rebranding of PCOS. While the diagnostic criteria have not dramatically changed, the hope is that the new name will push the medical community to stop treating PCOS as only a fertility problem and start managing it as a full-body metabolic disorder.

If you have PCOS, PMOS, irregular periods, insulin resistance, elevated testosterone, acne, hirsutism, difficulty losing weight, or fertility concerns, this episode explains what the name change means — and what better care should actually look like.

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Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Transcript

>> Dr. Mark Amos: 0:00

Today we talk about PCOS getting a new name, pmos, and whether this is a true medical revolution or just PCOS getting a rebranding. I'm Dr. Mark Amols, and this is Taco about Fertility Tuesday. Well, unless you've been hiding in the hole, you probably saw 4 million reis on Instagram talking about the name change to pcos. The new name, PMOS M stands for Polyendocrine Metabolic Ovarian Syndrome. Now, if you've ever listened to my podcast on pcos, you know that I've talked about polycystic ovaries. It was a misnomer. There has never been cysts on the ovaries. There were always follicles. And so this name change is going to help people understand that there aren't cysts. So from a scientific standpoint, it's a good name. But the problem with polycystic ovarian syndrome was it sounded like it was only this biological problem or fertility problem, and there was a much larger metabolic hormonal disorder that was behind it. But here's the question I want to ask today. Is this name change really going to change the treatment, or is this just a better label on the same poorly managed disease? Anyone who is anyone treating PCOS already knew the disease was a metabolic disorder. So my question is, will we now start treating the disease as a metabolic disorder? We're just going to start using a different name. The name is better. Scientifically, it's better. But does that mean people are going to start treating insulin resistance? Are they going to start screening for diabetes? Are they going to start doing endometrial biopsies? Because the patient may have a higher risk of endometrial cancer since they haven't had a period in a long time. A name change is not going to cause that. That requires real change. To understand why the name change, you have to understand how PCOS got its name in the first place. In the 1930s, Stein and Leventhal described women who had irregular periods, infertility, excess hair growth, and ovaries that appeared enlarged with fluid filled small cysts in them and thought, let's call this polycystic ovarian syndrome. And at that time, we did not have ultrasounds that could show that these were not cysts, but follicles. So at that time, the name made sense. But now we know that cysts are usually follicles. Follicles are not the same as painful ovarian cysts that women may develop. They're not tumors and they're not dangerous cysts because These follicles do not undergo the normal process of ovulation. They accumulate and then they develop multiple of them around the ovary and giving it that cystic appearance. The problem is that old name causes a little bit confusion because it sounds like there's multiple cysts. Polycystic. And so the old name, polycystic ovarian syndrome, pointed everyone towards the ovary when the real issue was much bigger. Now, the new name is not perfect, but it is much better. Polyendocrine means this involves multiple hormone systems. This is not just an estrogen and progesterone hormone that we're talking about. We're now talking about things like insulin, ovarian hormones, and the hypothalamic pituitary ovarian axis. But metabolism is the big one. Metabolic tells the patient and doctors that this is not just periods and fertility. It's about insulin resistance and diabetes risk. It's about cholesterol, blood pressure, sleep apnea, pregnancy, complications, and long term health complications. Now, yeah, the ovarian part is still in the name, but that's because it does still involve the ovary. But the point is, the ovary is not the whole story, which is why now we have added the polyendocrine and metabolic to the name. The reason the word syndrome stays is because it's not one disease. It's symptoms that together become a syndrome that has a spectrum. And when I say spectrum, what I'm saying is that some women can be skinny with some pimples and have polycystic ovaries, and other women can be obese, never get a period, and have type 2 diabetes. It's a very wide spectrum. Now, the question is, did the diagnostic criteria change for pcos? Pmos? No, because the disease, such as the syndrome, did not change. It just has a new name. Now, that doesn't mean it may not change in the future, but at this point, we're still using the Rotterdam criteria. If you want to know more about that, please listen to one of my other podcasts about pcos. But for now, diagnosis looks very similar to it has in the past years. You're looking for two of three criteria, either irregular ovulation, elevated androgens, or clinical signs of elevated androgens and polycystic ovaries. Now, in the newer guidelines, it does add a little bit of nuance by saying AMH can be used in adults as a marker of polycystic ovary morphology, but it's not used to diagnose PMOS by itself. And just like always, you have to Rule out other criteria that can mimic PCOS PMOs, such as Thyroid issues, prolactin issues, tumors, and Cushing's syndrome. This is important because one of the biggest mistakes in PCOS has always been over testing the wrong things and undertesting the right things. A patient does not need a perfect ultrasound label, but they do need the right diagnosis, the right exclusion of things that mimic PCOS, and the right long term care. Now, as someone who has been treating PCOS for a long time, and I welcome the new name pmos, I do worry, will people really start treating it the right way? For years I've been treating it as a metabolic endocrine disorder and really anyone who's a specialist in PCOS has. But now the workup needs to reflect that in everybody else. It is not just a fertility problem. Most of the time when a patient says something to a doctor, the doctor goes, well, we're trying to get pregnant. And they say no, they don't worry about it. But that needs to change. We need to start working up these patients to help prevent the long term medical issues that will develop over time. That means once we define that they have PMOs, we don't just say, well, do you want to be on birth control or try to get pregnant. We should be looking at them from the standpoint of what is their glucose tolerance, do they have insulin resistance, do they have blood pressure issues, do they maybe have hyperlipidemia? Things like sleep apnea and endometrial cancer are going to be higher in this group. We need to stop only looking at this as a fertility problem and start realizing it's a metabolic disease and we need to treat the whole disease. That is the promise of the new name pmos. The hope is that this new name change will lead to people treating the disease more thoroughly and not just as a fertility problem. Now, if you've listened to some of my podcasts in the past, I've mentioned that PCOS is very similar to metabolic disease and metabolic syndrome and PCOS. Now, PMOs are very similar, but they're not exactly the same. There are many things that overlap. Many women with PMOs are going to have insulin resistance, they're going to have increased diabetes risk, abnormal lipids and blood pressure issues, central obesity, fatty liver disease, and even cardiovascular risk, even sometimes androgen excess. But because PMOS also includes things like olfactory dysfunction, follicular arrest, infertility, hirsutism, and, higher endometrial cancer risk, it is a little bit different than metabolic syndrome. But in the end they really should all be treated the same because they all are metabolic diseases. And we see this in families when patients have pcos, pmos, we notice that in the families there's going to be things like more diabetes. Some of the male members in the family are going to have things like beer bellies or increased diabetes, things like hypertension, metabolic syndrome, and early male pattern hair loss. It's one of the things I always do with my patients with pcos. Pmos. I ask them, hey, what's your family like? Does diabetes run in it? Does anyone else have this? Are any of the guys, do they have beer bellies? All this sounds alarms that this is a metabolic issue in their family. So why do I sound so pessimistic about this name change? Why am I not jumping up and down like all the people on Instagram? Because it's just reality. Any doctor who is currently treating PCOS has always been doing it this way. We have always known it was a metabolic disorder. We've already been screening for things like diabetes. We've already been looking for things like acanthosis nigrans and then treating the patient appropriately. We've never looked at it as just a fertility problem. My concern is, is this going to be enough to get the medical community to catch up? A name change is great, but that does not change the treatment. Now, what do I hope? I hope that everyone starts treating PMOS like a metabolic problem. By removing the name pcos, we get rid of the stigma of it being a fertility problem. And then now doctors won't go, oh, they got that fertility problem. They go, oh, they got that metabolic problem. And now they'll start treating it. Now they'll start worrying about the patient getting fatty liver disease, because they realize it's a risk. Now they won't say, oh, we haven't got your period in five months. you should probably see your gynecologist. They're gonna say, hey, wait, this is that PMOS disorder, which is like metabolic syndrome. I really gotta make sure to look at this patient a little bit more carefully. That is what we're all jumping up and down about. It's not the name. It's just that we've always known this. It's now, by changing the name, maybe we can change the way people look at this disorder. Because I can assure you, if you're one of those patients that have PCOS or know people who do, I can tell you they don't feel heard. They feel like their disorder was just fertility only and that all the symptoms they were Dealing with all the problems with things like weight gain and internal inflammation were not being hurt. Most doctors would say things like lose weight, but that wasn't the answer, and that's because they saw it as a fertility problem. So kudos to the people who worked hard to get the name change. I, do think PMOS sounds a little like pms, but still kudos. If we can start getting doctors to stop looking at this as a fertility problem and start looking at it as an actual medical problem, then we have made huge strides. So let's say you have PMOS and you want to be treated correctly. What should you be looking for? How do you know if you're seeing a doctor who really is treating you now for PMOs, not treating you for that old PCOS people used to treat in the past? Well, they should be using those criteria. I told you about the two or three criteria to diagnose it. Number two, they need to rule out the diseases that can look like it. Then they have to see what things you're at risk for. Finding out if you're not ovulating, because that would give you a risk of endometrial cancer. Finding out if you have excess androgen levels. Finding out about your metabolic health by doing an OGTT test or by looking at a hemoglobin A1C to find out where your glucose levels are at. They should be working with you to address things like weight without blame, but helping you give the tools to be able to lose that weight. Because they're treating the metabolic issue, they should be treating things like male pattern balding and addressing hirsutism if you have it. And yes, if you have fertility problems, they should be addressing that by either treating it or having you see an endocrinologist, such as a reproductive endocrinologist. I'm not saying every doctor is going to be able to do this, and that's okay. They can send you to someone who does do this. But what they shouldn't do is treat this the old way and think of it just as a fertility problem. In the past, someone with PCOS would have to see multiple doctors to get the treatment they need. If they saw the gynecologist, they got birth control, they saw a dermatologist, they got acne treatment. If they saw a fertility doctor, they got ovulation induction to have a kid, but that's not the way to do it. You don't see your primary care just to lose weight because you have pcos. Now with pmos, it should be looked at as a Metabolic syndrome and should be treated all the things at once. And all the doctors should be striving to learn how to treat the full syndrome. So is PMOS a better name? Absolutely. And, was PCOS a bad name? Again? Absolutely. The new name's better and reflects the real disease, but the name alone is not going to fix the care. The real test is not whether Doctors start saying PMOs. The real test is whether they start treating PMOS as a lifelong endocrine metabolic disease. That means no more acting like ovarian cysts are the main problem. No more waiting until infertility is what brings the patient in. No more telling the patient, oh, just lose weight. No more just giving birth control to control everything and come back when you're ready to have kids. The new names progress, but patients do not need a better acronym. What they need is better care. The hope is that pmos, that name is finally going to push the medical community to come together and treat this as a metabolic problem. That's why I'm not on Instagram and they're jumping around on the new name. How excited I am. Because yes, it's a great name change, but we have a lot of work to do and that's why it's a three year plan to make this change in the medical community. I sure hope it does. If you're someone who had PCOS now called pmos, hopefully this episode was helpful so you can understand the new name change and understand it didn't change the disease. The goal is, as you probably know, the disease was never being treated correctly. And so the hope is that this name is going to then get the community to change every doctor who is excited about it. We are, because we've been doing it that way. But we're not the ones who need to change, it's all the other doctors. And that's the hope. And so for you, I hope that does happen because it's going to be a lot easier to get treatment versus having to see a bunch of doctors to get what you need. If you know someone who has pcos, let them know about this episode or maybe a family member have it. As always, if you like this show, please tell your friends about it. Give us a five star review on your favorite medium, but most of all, keep coming back. I look forward to talking again next week on Talk about Fertility Tuesday. Sam M.