No cyst, hence PMOS: Docs back name change

(Dr Varini N, Sr Consultant – Obstetrics and Gynaecology, Milann Fertility and Birthing Hospital)

The term PCOS is mostly focused on ovarian conditions. It is a misnomer as there are no ovarian cysts. The polycystic appearance are actually multiple follicles produced by ovaries in response to hormonal imbalance.

Even though PCOS has effect on multiple organ systems by derranging hormones and metabolism, the term was focussing only on the changes in the ovaries. This also created confusion among women delaying the diagnosis and treatment. Therefore, renaming of Polyendocrine Metabolic Ovarian Syndrome defines both complex endocrine and metabolic disorders that affect multiple systems in the body, including hormones, metabolism, skin health, mental wellbeing, fertility, and cardiovascular risk. The term also highlights insulin resistance and metabolic dysfunction, which are central to the condition but were not emphasized earlier.

The word “polycystic” dominated the diagnosis because many women whose ultrasounds appeared normal were told they did not have the condition, despite experiencing irregular periods, acne, weight gain, hair fall, or insulin resistance. These symptoms are dismissed as lifestyle-related issues rather than signs of an endocrine disorder. Surprisingly, up to 50% of individuals with the condition do not have these visible ovary features. The old name reduced a systemic, metabolic disorder to a reproductive/gynecological issue. This led to fragmented care, focusing solely on birth control for periods or acne, while ignoring insulin resistance, high cardiovascular risks, obesity, fatty liver, and mental health issues (anxiety/depression).

Case Study:

A young woman aged 22 years, had excessive facial hair and acne. She also had excessive weight gain and irregularly irregular cycles.

She visited a dermatologist for treatment of acne and hirsutism. She was advised to have an ultrasound scan. USG showed normal ovaries. Hence, she was told she did not have PCOS (older term) and was given local creams and treatment for hirsutism and acne. Irregular cycles and weight gain was neglected for 2-3 years and when she later visited Gynaecologist, she was told even though ovaries appeared normal on USG, she has the syndrome (PCOS) because of clinical features. She had delayed treatment for 2-3 years.

We now increasingly look at the overall hormonal and metabolic profile of the patient before making a diagnosis. Key parameters include irregular menstrual cycles, signs of androgen excess such as acne or excessive facial hair, unexplained weight gain, insulin resistance, and metabolic abnormalities. Psychological symptoms including anxiety, body image concerns, and mood disturbances are also receiving greater attention.

The diagnostic workup may include hormone tests such as testosterone, LH, FSH, thyroid profile, prolactin levels, and insulin assessment. Blood sugar levels, HbA1c, lipid profile, and ultrasound evaluation of ovaries are also commonly advised. Importantly, ultrasound findings alone are no longer considered sufficient or mandatory for diagnosis in every patient. This broader approach helps identify women earlier and allows treatment to focus not only on fertility but also on long-term metabolic and cardiovascular health.

PMOS is increasingly being seen among urban Indian women, where sedentary lifestyles, stress, sleep disturbances, and dietary changes are contributing factors. Various Indian studies estimate that nearly 1 in 5 women in urban settings may show features associated with PMOS, although many cases remain undiagnosed. The condition is most commonly identified in adolescents and women between 15 and 35 years of age. What is more concerning is that women generally ignore symptoms such as irregular periods, acne, or weight fluctuations and avoid consulting doctors; they seek medical help only when fertility issues arise later. Therefore, women must prioritize and stay informed about their own health.

Women should not ignore persistent menstrual irregularities, especially cycles that are consistently delayed, absent, or unpredictable. Other common symptoms include acne that does not respond easily to treatment, excessive facial or body hair growth, scalp hair thinning, unexplained weight gain, and difficulty losing weight despite lifestyle modifications.

Many women also experience fatigue, mood fluctuations, darkening of skin around the neck or underarms due to insulin resistance, and sleep disturbances. Some may struggle with infertility or difficulty conceiving later in life.

An important point is that symptoms can vary significantly from person to person. Not every woman with PMOS will have visible ovarian cysts or obesity. Even lean women can develop the condition due to hormonal and metabolic imbalances. Remember, untreated PMOS may increase the long-term risk of type 2 diabetes, cardiovascular disease, and endometrial complications in addition to reproductive concerns, therefore, consulting on time becomes crucial.

PMOS can often be identified during adolescence, particularly within a few years after the onset of menstruation, if symptoms such as irregular periods, severe acne, excessive hair growth, or rapid weight gain are persistent. However, diagnosis in teenagers requires careful evaluation because some hormonal fluctuations are common during puberty.

Early diagnosis plays a crucial role in preventing long-term complications. Timely lifestyle interventions, nutritional guidance, weight management, and hormonal or metabolic treatment can help regulate menstrual cycles, improve insulin sensitivity, reduce future fertility complications, and lower the risk of diabetes and cardiovascular disease.

Equally important is the psychological impact. Many young women silently struggle with body image issues, anxiety, or low self-esteem linked to PMOS symptoms. Early counselling and supportive care can significantly improve quality of life.

The shift from PCOS to PMOS states that those symptoms may not be only fertility condition but a lifelong metabolic and endocrine disorder that benefits greatly from early, multidisciplinary management