Polyendocrine Metabolic Ovarian Syndrome (PMOS)

Formerly called Polycystic Ovarian Syndrome (PCOS)

Overview

What Is Polyendocrine Metabolic Ovarian Syndrome (PMOS)?

Polyendocrine metabolic ovarian syndrome (PMOS) is a common health problem that can affect teen girls and young women. It can cause irregular menstrual periods or even make periods stop. It can also cause them to have excess hair and acne. PMOS used to be called polycystic ovarian syndrome or PCOS.

Doctors can't say for sure what causes it, but PMOS seems to be related to imbalanced hormones.

Both males and females produce sex hormones, but in different amounts. In females, the ovaries make the hormones estrogen and progesterone, and also androgens, such as testosterone. The adrenal glands also make androgens. These small glands sit on top of each kidney. These hormones regulate a female's menstrual cycle and ovulation (when the egg is released).

Androgens are sometimes called "male hormones," but the female body also makes them. In females with PMOS, the body makes a higher than normal amount of androgens.

Research also suggests that the body might make too much insulin, a hormone that regulates blood sugar levels. This important relationship between the ovaries and metabolism is the reason the name was changed.

PMOS seems to run in families too, so if someone in your family has it, your child might be more likely to develop it.

What Happens in Polyendocrine Metabolic Ovarian Syndrome (PMOS)?

The higher amounts of androgens that happen in PMOS can interfere with egg development and release. Instead of the eggs maturing, sometimes cysts (little sacs filled with liquid) develop. Then, instead of an egg being released during ovulation as in a normal period, the cysts build up in the ovaries and ovaries can become enlarged. Teens with PMOS might not be ovulating or releasing an egg each month, so many have irregular or missed periods.

Signs & Symptoms

What Are the Signs & Symptoms of Polyendocrine Metabolic Ovarian Syndrome (PMOS)?

A key sign of PMOS is irregular periods or missed periods. The effects of PMOS on the ovaries can make a female stop ovulating. PMOS cannot be diagnosed until 2–3 years after the first menstrual cycle because it can take up to two years after a first period for any female's cycle to become regular.

Still, many females with PMOS can get pregnant if they have sex. So, if your child is sexually active, they should use condoms every time they have sex to avoid becoming pregnant or getting a sexually transmitted disease (STD). (Of course, this is important whether they have PMOS or not.)

Imbalanced hormone levels can cause changes in a female's entire body, not just the ovaries. So, doctors also look for these other signs of PMOS:

• weight gain, obesity, or difficulty maintaining a normal weight, especially when the extra weight is concentrated around the waist
• a condition called hirsutism (HER-suh-tiz-um), where a female grows extra hair on the face, chest, abdomen, nipple area, or back (a little of this is normal for most females, though)
• thinning hair on the head (alopecia)
• acne
• darkened, thickened skin around the neck, armpits, or breasts (this is called acanthosis nigricans), which is a sign of insulin resistance
• high blood pressure, high cholesterol, or diabetes mellitus (high blood sugar levels)

Females who show signs of puberty early — such as developing underarm or pubic hair before age 8 — may be at greater risk for PMOS later on.

What Problems Can Polyendocrine Metabolic Ovarian Syndrome (PMOS) Cause?

Someone with PMOS is more likely to:

• have trouble getting pregnant, but this is treatable if and when a female decides she wants to become pregnant (It's also important to remember that not everyone with PMOS has difficulty getting pregnant, and if your child is sexually active it's important to discuss this with the doctor.)
• have excessive hair growth on places such as the face, chest, or belly
• get acne or have the acne get worse
• be obese
• develop diabetes, heart disease, or high blood pressure
• have obstructive sleep apnea

Diagnosis

How Is Polyendocrine Metabolic Ovarian Syndrome (PMOS) Diagnosed?

If the doctor thinks your child might have PMOS, they might want them to see a gynecologist or an endocrinologist for a diagnosis.

The gynecologist or endocrinologist will ask about concerns and symptoms, past health, the family's health, any medicines your child is taking, any allergies, and other issues. They'll also ask about your child's period and its regularity.

The doctor also will do an exam, which includes checking your child's weight, and looking for physical signs such as acne, hair growth, and darkened skin. The doctor might do a gynecologic exam to rule out other possible causes of their symptoms, but this is not always necessary for diagnosis.

Doctors sometimes order blood tests to diagnose PMOS and to make sure the symptoms are not caused by other conditions, such as thyroid or other ovarian or gland problems.

The doctor might order a pelvic ultrasound (a safe, painless test that uses sound waves to make images of the pelvis) to check your child's ovaries for cysts or other problems. Because there is a lot of variation in normal teen ovaries, this test isn't always done.

Treatment & Care

How Is Polyendocrine Metabolic Ovarian Syndrome (PMOS) Treated?

There's no cure for PMOS, but there are several ways to treat and manage it.

Diet and Exercise

If your child is overweight or obese, the doctor will recommend lifestyle changes. Healthy habits can be very effective in decreasing many of the metabolic conditions associated with PMOS, such as high blood pressure and diabetes. Sometimes, these simple changes can even help regulate their cycle. The doctor or a registered dietitian can look at your child's food intake and exercise and activity to create a program for them. It's usually focused on decreasing simple carbohydrate intake. Exercise is also very important to improve the body’s sensitivity to insulin and prevent progression to diabetes.

Medicines

If irregular periods or excess hair or acne are bothersome, the doctor may prescribe medicines to help with these symptoms. The doctor might first have your child try birth control pills to help control androgen levels in their body and regulate their menstrual cycle. Birth control pills may help control acne and excessive hair growth, but they don't work for everyone. It may take up to six months to see whether treatment with birth control is effective, especially for excess hair.

Antiandrogens also are sometimes used to treat PMOS. These medicines counter the effects of excess androgens, and can help clear up skin and hair growth problems. They are often used with the birth control pill if it’s effect alone is not adequate.

A diabetes medicine, metformin, can lower insulin levels. In some teens with PMOS, it can help ovulation as well. This can make menstrual cycles more regular.

Medicines should always be combined with the recommended lifestyle changes.

How Can Your Child Cope With Polyendocrine Metabolic Ovarian Syndrome (PMOS)?

Having PMOS can be hard on a teen's self-esteem. Fortunately, there are things they can do to reduce the physical symptoms and take care of the emotional side of living with PMOS.

Medicines used to treat PMOS will slow down or stop excessive hair growth for many teens. Also, different types of products can help get rid of hair where it's not wanted. Shaving is not recommended as it can increase the hair growth over time. Instead, depilatory creams can gently remove facial hair on the upper lip or chin. Make sure your teen follows the instructions carefully so they don't develop a rash or allergic reaction.

Tweezing and waxing done at home or at a salon can manage excess hair growth. A dermatologist (a doctor who specializes in skin problems) or qualified hair removal specialist can use electrolysis and laser surgery treatments for long-term removal of unwanted hair, but it's more expensive.

Treatment with birth control pills or antiandrogens might make severe acne better. If it doesn't, the doctor may refer your child to a dermatologist for treatment. A dermatologist can also recommend medicines to reduce skin darkening or discoloration, and to prevent hair growth.

Some teens with PMOS may become depressed, in which case it may help to talk to a therapist or other mental health professional. Talking with other teens and women with PMOS is a great way to share information about treatment and get support. Ask the doctor or search online for a local support group.