PMOS or Polycystic Ovary Syndrome

PCOS (polycystic ovary syndrome) will henceforth be known as PMOS (polyendocrine metabolic ovarian syndrome).

The new name better describes the syndrome's widespread effects on the body. The previous name has been misleading, as it strongly refers to ovarian cysts, but these do not actually occur in those suffering from the syndrome. The health effects of the syndrome extend to the entire body – metabolism, mental health, skin, and reproductive health.

PCOS is a hormonal and metabolic disorder in which ovulations are rare or absent and the effect of male sex hormones is accentuated. An estimated 8–13 percent of women of reproductive age meet the criteria for the syndrome.

PMOS manifests comprehensively, and its symptoms widely reflect on metabolism, skin, and even mood, in addition to reproductive health. The symptoms are always individual, and their intensity can vary throughout life, often alleviating in middle age.

The symptoms are caused by insulin resistance and the overactivity of male sex hormones; genetic factors also play a role. Insulin resistance means the body's weakened response to insulin, which can promote weight gain and maintain hormonal imbalance.

Typical PMOS symptoms include:

• Irregular menstrual cycles, infrequent bleeding, or amenorrhea
• Prolonged bleeding or spotting
• Skin symptoms, such as acne and oily skin
• Hirsutism on the face and body
• Weight gain, especially around the waist
• Fatigue and sugar cravings, related to insulin resistance
• Thinning hairline or scalp hair loss

Associated health risks

If left untreated, continuous ovulation disorders can make it difficult to conceive. In addition, prolonged cycle disturbance can increase the risk of endometrial hyperplasia.

The syndrome is also associated with an increased risk of metabolic disorders. These include, for example, type 2 diabetes, hypertension, abnormal lipid values, and fatty liver. For this reason, a physician always ascertains that there are no other underlying diseases causing the symptoms.

The majority of those with PMOS can have children. However, it may take longer than usual to conceive and may require support. Lifestyle changes, such as weight management and a healthy diet, can regulate ovulation and improve fertility. If necessary, ovulation-supporting medication or other infertility treatments can be used.

The most important thing is to seek an expert's practice so that we can plan a treatment path that is right for you. At Felicitas Mehiläinen, we help you individually towards a desired pregnancy. Learn more about the first infertility appointment and the free fertility check-up.

Seek a physician's assessment if you suspect PMOS syndrome or recognize the following symptoms in yourself. You can easily start an assessment at the Digital Clinic 24/7 or book an appointment directly with a gynaecologist.

Seek an appointment in these situations:

• Menstrual cycles become significantly less frequent or cease for several months
• You have been trying to conceive for 12 months, or 6 months if you are over 35 years old
• Increased hirsutism, acne, or hair loss
• Rapid weight gain, significant fatigue, or sugar cravings are concerning
• You have elevated blood sugar or lipid levels, elevated liver enzyme levels, or a family history of type 2 diabetes

The PCOS diagnosis is always based on a physician's overall assessment and requires the exclusion of other diseases causing symptoms. The diagnosis can be made when at least two of the following three so-called Rotterdam criteria are met:

• Menstrual cycle disorders: Infrequent or absent menstruation, indicating an ovulation disorder.
• Signs of hyperandrogenism, i.e., excessive secretion of male hormones: Excessive hair growth, acne, or elevated male hormone levels detected in blood tests.
• Polycystic ovaries: A typical finding in a gynaecological ultrasound scan.

Blood tests are used to support the diagnosis, excluding other causes such as thyroid dysfunction or high prolactin (milk hormone). However, a single blood test or ultrasound finding alone is not sufficient for diagnosis.

Especially in young people, the diagnosis is made carefully and based on follow-up, as normal changes during puberty can resemble PCOS symptoms. For example, an ultrasound finding may appear polycystic without an actual syndrome for up to 8 years after the onset of menstruation.

PMOS treatment is always tailored individually according to symptoms and your personal goals. Treatment can focus on alleviating daily symptoms, regularizing the menstrual cycle, or supporting conception. The symptoms of PMOS and the risk of associated diseases can be reduced particularly through lifestyle choices.

PMOS self-care – exercise, weight management, and lifestyle

Regular exercise and weight management are key in PMOS treatment, as they improve insulin sensitivity and can significantly alleviate symptoms.

• Regular endurance and strength training improves insulin sensitivity. Aim for 150–300 minutes of brisk exercise per week. Additionally, do 2–3 strength training sessions.
• Even a 5–10 percent weight loss can regularize the menstrual cycle. It can also improve fertility and alleviate skin symptoms.
• Quitting smoking is also important, as it reduces the risk of cardiovascular diseases.

PMOS treatment with diet

The symptoms of PMOS and the risk of associated diseases can be reduced by changing eating habits. A balanced diet supports insulin sensitivity and aids in weight management.

• A regular meal rhythm helps balance blood sugar.
• Favoring quality carbohydrates, such as vegetables, legumes, and whole grains, supports well-being.
• Include soft fats in your diet, which can be found in vegetable oils, nuts, and fish, for example.
• Avoid added sugar and highly processed foods.

If necessary, a dietitian can help you plan an individualized diet.

Medication as needed

If lifestyle treatment is not sufficient, treatment can be supplemented with medication according to symptoms and goals. PMOS medication is always planned individually.

• For skin and hair growth symptoms, combined contraception is often recommended. It balances hormones and protects the uterine lining. If pregnancy is not desired, this is a primary treatment for many.
• If necessary, antiandrogen medication, such as spironolactone, can be added. In this case, reliable contraception is essential. These preparations are not suitable during pregnancy.
• For insulin resistance, metformin may be considered, especially if the BMI is over 25 kg/m2. It improves insulin sensitivity and can support ovulations.
• To support the desire for pregnancy , ovulation-inducing drugs, such as letrozole, and, if necessary, gonadotropin treatments can be used.

Surgical treatment for PMOS is very rarely needed.

• Keep a diary or use an app to track your menstrual cycle – it facilitates diagnosis and treatment follow-up.
• Start with small steps: a regular meal rhythm and 2–3 walks a week support insulin sensitivity.
• If skin or hair growth symptoms interfere with daily life, bravely seek help. Combination therapy, i.e., contraception and topical treatment, often quickly alleviates symptoms.