Introducing PMOS: A Shift in Understanding Women’s Health
The condition formerly known as Polycystic Ovary Syndrome (PCOS) is among the most prevalent endocrine disorders in women of reproductive age. Current estimates suggest that over 170 million women worldwide are affected, with prevalence rates in Germany reaching up to 15%. Alarmingly, nearly 70% of cases go undiagnosed, based on reports from medical societies.
The Need for a New Terminology
The traditional name placed emphasis largely on ovarian changes. However, recent research emphasizes that metabolic alterations significantly influence the disease’s trajectory. To reflect this understanding, the syndrome will now be referred to internationally as Polyendocrine Metabolic Ovary Syndrome (PMOS). Both the German Diabetes Society (DDG) and the German Society for Endocrinology (DGE) advocate for this terminology change as a means to enhance understanding and promote earlier diagnosis of the condition.
Clarifying Pathophysiology with PMOS
The new term more accurately reflects the underlying disease mechanisms that were inadequately described by the previous nomenclature. PMOS describes a condition where hormonal and metabolic disturbances are tightly interconnected. A critical factor in this condition is insulin resistance. When the body’s cells become less sensitive to insulin, there is a compensatory increase in insulin secretion. This hyperinsulinemia stimulates the ovaries to produce androgens, which leads to ovulation disturbances and irregular menstrual cycles.
Moreover, the new name aims to address misconceptions surrounding the previous terminology. The changes visible through ultrasound examinations are not true ovarian cysts but rather follicles. The term PCOS implied that cysts were central to the condition, obscuring the true pathophysiological core.
The Interconnectedness of Diabetes and Menstrual Disorders
According to Professor Susanne Reger-Tan, metabolism and the female menstrual cycle are intricately linked. Conditions like diabetes, obesity, and insulin resistance can influence the menstrual cycle. Conversely, diabetic management should consider hormonal rhythms more closely moving forward. PMOS is not exclusively a reproductive or gynecological concern; it represents a frequently overlooked cardiometabolic risk.
Support from Medical Societies
A range of medical societies, including DGE, DDG, the German Obesity Society (DAG), and others, have welcomed the name change in a joint statement. They assert that the new terminology underscores that PMOS carries increased risks not just for menstrual irregularities and fertility challenges, but also elevates the risk for type 2 diabetes and cardiovascular diseases. Furthermore, this change could expedite the identification of previously undiagnosed patients.
Interdisciplinary Approach to Diagnosis and Care
The new Patient Guidelines for PMOS have already adopted this terminology. This indicates a shift towards multidisciplinary care that encompasses gynecology, endocrinology, and diabetes management.
It is recommended that women diagnosed with PMOS undergo glucose metabolism assessments. Conversely, premenopausal women with type 1 or type 2 diabetes presenting symptoms like menstrual irregularities, acne, or excessive hair growth should also be evaluated for PMOS. Nonetheless, it is crucial to exclude other potential causes of menstrual disorders as part of differential diagnosis.
Aiming for Improved Diagnostics and Prevention
The rebranding of PCOS to PMOS aims to bring metabolic aspects of the condition into sharp clinical focus. Specifically, recognizing the close connection between insulin resistance, diabetes, and reproductive issues is essential in everyday clinical practice.
While it remains to be seen whether this new terminology will conclusively lead to improved diagnosis and consistent interdisciplinary care, it has the potential to raise awareness about the cardiometabolic risks associated with the condition. Ultimately, this could pave the way for earlier diagnosis and prevention strategies for diabetes-related complications among affected women.
