PCOS - an often unrecognized health risk in women

Women's Health: PMOS – The Often Unrecognized Health Risk

Approximately one in eight women is affected by it, yet it remains largely unknown: the hormonal disorder PMOS – formerly known as PCOS. A new name and patient guidelines are now intended to enable better care.

Polyendocrine Metabolic Syndrome (PMOS, formerly called PCOS) is the most common hormonal disorder in women of childbearing age. However, the diagnosis often only comes when those affected remain involuntarily childless due to menstrual cycle disorders. Other symptoms, by contrast, are frequently not taken seriously enough – even though it is precisely these symptoms that carry an increased risk of secondary conditions such as diabetes and heart attack.

An international expert panel has therefore agreed on the new name PMOS. It incorporates warning signs relating to metabolism and hormonal balance. In addition, there is now for the first time a German guideline specifically for patients, which already adopts the new name.

Those Affected Are Often Not Taken Seriously

How long it can take for PMOS to be recognized is something Anni, a student from Karlsruhe, has experienced firsthand. For years she struggled with an irregular cycle, excess weight, and acne. Despite many doctor's visits, the now 22-year-old found no explanation for her symptoms. It was only through a hormone test she paid for herself that suspicion first fell on polycystic ovary syndrome, known as PCOS.

Cysts are fluid-filled sacs. In this case, they are immature egg follicles in the ovarian tissue. On ultrasound, they often line up like a string of pearls. However, not all those affected have such cysts – including Anni. The former name PCOS was therefore long considered misleading.

Symptoms Are Not Always Clear-Cut

Maike, another person affected by PMOS, went through a similarly long journey to diagnosis. After becoming aware of the condition through social media, the now 28-year-old from Karlsruhe consulted her gynecologist about her irregular periods. He did find cysts on ultrasound, but ruled out PCOS as a diagnosis, as Maike recalls: "He then said that to have PCOS, you have to be overweight. And I am slim, or rather of normal weight, so I can't have it."

This is precisely what makes the condition so insidious: it is associated with a wide variety of symptoms, which do not, however, occur in all those affected. An irregular cycle, excess weight, acne, hair loss on the scalp, and excessive hair growth on the chin, chest, or abdomen. Fatigue and depression also count among the possible accompanying symptoms. Almost every person affected has their own combination of complaints.

More Than a Menstrual Disorder

The central cause of PMOS is a so-called insulin resistance, explains Cornelia Jaursch-Hancke of DKD Helios Clinic in Wiesbaden. The internist, who specializes in endocrinology and diabetology, initiated the first German guideline for the diagnosis of PMOS.

Insulin signals the body's cells after eating to absorb sugar from the blood. With insulin resistance, however, the cells do not respond sufficiently to this signal. To compensate, the body produces ever greater amounts of insulin.

Insulin in turn stimulates the adrenal glands and ovaries to produce male sex hormones, such as testosterone. While these hormones also occur naturally in women, they do so in significantly smaller quantities. When too many of these hormones are present, it disrupts the menstrual cycle, according to Jaursch-Hancke. In addition to insulin resistance, genetic predisposition and environmental factors also play a role as triggers.

Health risk persists throughout life

To date, estimates suggest that only around one in three affected women is even aware of her diagnosis. Experts see this as a major danger: if PMOS goes undetected, it can have serious consequences — including diabetes, lipid metabolism disorders, and high blood pressure.

Even if women are taking the pill or have no desire to have children, treatment is important, as hormone and metabolism expert Cornelia Jaursch-Hancke emphasizes: "It is also the case that these women already have an increased risk of cardiovascular events before they reach menopause — that is, heart attacks and strokes. (…) That is why it is so important to us that this is a disease which, unfortunately, accompanies women throughout their entire lives."

Treatment through diet and exercise

Together with other experts, Jaursch-Hancke has now authored a guideline for the first time that is directed specifically at patients and already incorporates the new name PMOS. To restore balance to insulin metabolism, regular exercise and a diet that lowers blood sugar levels are beneficial. The diabetes medication metformin is also frequently prescribed.

PMOS is therefore far more than a problem with cysts on the ovaries, as the previous name Polycystic Ovary Syndrome suggested. The letters P and M now stand for polyendocrine, referring to the hormonal system, and metabolic, referring to metabolism. This is intended to help ensure that the focus is not solely on the menstrual cycle — and that affected women receive their diagnosis more quickly in the future.