Polyendocrine Metabolic Ovary Syndrome (PMOS)/Polycystic Ovary Syndrome (PCOS)

Polyendocrine metabolic ovary syndrome (PMOS) and polycystic ovary syndrome (PCOS) are both names for the same endocrine (hormonal) disorder. PMOS is the current name. Experts recently decided to rename the syndrome to PMOS to more accurately describe the disorder.

PMOS affects each person differently. Patients can be affected by:

• Lack of regular ovulation leading to irregular menstrual cycles
• Physical signs or lab results showing excess androgens such as testosterone

They produce excessive quantities of androgens, particularly testosterone.

PMOS is estimated to affect between 5-10% of women of reproductive age. This makes it the most common hormonal disorder among women in this age group. It affects people of all races and nationalities.

Symptoms of PMOS may include:

• Irregular periods
• Hirsutism (excessive hair growth on the face, chest, abdomen, etc.)
• Hair loss (androgenic alopecia, in a classic "male baldness" pattern)
• Acne
• Obesity
• Infertility or reduced fertility
• Diabetes
• Depression

Each person has a unique constellation of symptoms.

Symptoms usually begin in teens or preteens, around the time the menstrual cycle starts. However, some people with PMOS do not develop symptoms until their early to mid-20s. PMOS continues beyond the reproductive years. 

People with PMOS appear to be at increased risk of developing the following health problems:

• Insulin resistance
• Diabetes
• Lipid abnormalities
• Obstructive sleep apnea
• Cardiovascular disease
• Endometrial carcinoma (cancer)

There is no single, quick test to diagnosis PMOS. 

Doctors consider many different factors and each person’s unique medical history when confirming a PMOS diagnosis. Doctors will also try to rule out other possible causes of symptoms like irregular menstruation and excessive hair growth, such as Cushing's syndrome, congenital adrenal hyperplasia or other disorders of the pituitary or adrenal glands.

Sometimes, doctors use tests and tools, such as:

• Ultrasound, to assess whether ovaries are enlarged and cystic
• Blood tests, to detect elevated levels of androgens or LH (luteinizing hormone) or an elevation in the ratio of LH to FSH (follicle stimulating hormone)
• Monitoring the ovary's response to a stimulatory dose of gonadotropin-releasing hormone agonist (e.g., leuprolide), which is a test developed at the University of Chicago and used worldwide
• Checking the ovary's response to a suppressive dose of medications, such as dexamethasone

Symptoms of PMOS may not seem to be related until they become severe or until the person experiences fertility challenges. 

PMOS develops when the ovaries overproduce androgens (e.g., testosterone). Androgen overproduction often results from overproduction of LH (luteinizing hormone), which is produced by the pituitary gland.

Research also suggests that when insulin levels in the blood are high enough, the ovary can be stimulated to produce more testosterone. That is, the combination of having ovaries that are responsive to insulin and high insulin levels in the blood, can result in the overproduction of testosterone.

Obesity alone can cause insulin levels to rise, which may make PMOS worse. But obesity alone does not cause PMOS. There appears to be something unique about PMOS both in the excessively high insulin production and the increased sensitivity of the ovaries to the insulin that is produced.

No. Polycystic ovaries are often, but not always, seen in people with PMOS. Also, about 20% of women with regular periods and normal testosterone levels have cystic ovaries.

Evidence suggests that there is a hereditary basis for PMOS and its associated metabolic abnormalities, such as diabetes. UChicago Medicine researchers found that 1 in 3 women with PMOS will have an abnormal glucose tolerance test and that 1 in 10 will have diabetes by age 40. Women with PCOS who have a family history of diabetes appear to be at highest risk for abnormalities in glucose tolerance.

UChicago Medicine is actively engaged in trying to understand whether the tendency for PMOS and glucose intolerance has a familial, genetic basis. To date, more than 200 families of women with PMOS have participated in testing in our Clinical Research Center.

If you and your immediate family members (parents or siblings) would like to participate in our study of the role of genetics in PMOS, please contact us at 773-702-4295. Most of the study can be done through the mail, so you can still participate even if you don't live close to Chicago.