Polycystic Ovary Syndrome

What is Polyendocrine Metabolic Ovarian Syndrome (PMOS)?

Polycystic ovary syndrome (or PMOS) is a common condition that causes an imbalance of reproductive hormones in women. The ovaries of people with PMOS produce high levels of the male sex hormone, testosterone, compared to women without PMOS. Testosterone is usually produced in small quantities in women, and is essential for healthy ovarian function.

In women with PMOS, however, elevated levels of testosterone interfere with the ovaries, ovulation, and a variety of other bodily systems. The hallmark symptom of PMOS is an irregular menstrual cycle. This is because raised testosterone levels can prevent ovulation (i.e., the release of an egg from an ovary), resulting in a delayed or missed period. A lack of ovulation can also lead to the development of ovarian cysts; small, fluid-filled sacs that grow inside the ovaries.

What are the Symptoms of Polyendocrine Metabolic Ovarian Syndrome?

The symptoms of PMOS can vary significantly from person to person, but the three main signs of PMOS are:

• An irregular menstrual cycle (including delayed, missed, or heavy periods)
• High androgen levels
• Ovarian cysts

PMOS is usually diagnosed based on the presence of at least two of these three symptoms. However, PMOS is a complex disorder that can affect multiple organs and bodily systems.

Other symptoms of PMOS include:

• Acne
  High testosterone levels can cause the skin to produce more oil than usual, leading to breakouts. Acne may appear on the face, back, or chest of people with PMOS.
• Weight gain
  Weight problems and PMOS go hand in hand, and as many as 4 out of 5 women with the disorder are obese.
• Hirsutism (excess hair growth)
  Excessive hair growth is a very common symptom of PMOS, and may appear on the face, back, stomach, and chest.
• Dark patches of skin
  PMOS can cause patches of skin in body creases to darken. This often affects areas around the neck, under the arms, and beneath the breasts.
• Male pattern baldness
  High testosterone levels can trigger male pattern baldness in women with PMOS, which causes hair on the scalp to thin or fall out.

Here at the Integra Healthcare Women’s Health Suite in Grand Pavilion, Grand Cayman, we regularly diagnose and treat PMOS. If you are experiencing any of the symptoms listed above, make an appointment with a member of our PMOS team to discuss appropriate investigations and your treatment options.

Complications of Polyendocrine Metabolic Ovarian Syndrome

If left untreated, PMOS can lead to a variety of serious health complications. As PMOS primarily affects the reproductive hormones and system, infertility is a common side effect of the condition. However, PMOS also increases your risk of heart disease, stroke, type II diabetes, and cancer.

• Infertility
  PMOS is a leading cause of infertility in women, as the disorder often prevents ovulation from taking place. Lack of ovulation is the cause of infertility in around 25% of infertile couples, and PMOS accounts for up to 95% of cases where ovulation is the issue.
• Metabolic syndrome
  Up to 80% of women with PMOS are overweight or obese. Both obesity and PMOS can lead to metabolic issues such as high blood pressure, high blood sugar levels, and high cholesterol. Collectively, these conditions are known as metabolic syndrome.
• Cardiovascular diseases
  Metabolic syndrome can increase your risk of cardiovascular diseases, such as heart disease and stroke.
• Diabetes
  Insulin resistance affects 65 – 70% of women with PMOS (though the percentages vary depending on the weight of the patient). Insulin resistance and metabolic syndrome both significantly increase your risk of developing type II diabetes.
• Sleep apnea
  Sleep apnea is a condition in which a person regularly stops breathing as they sleep, which interrupts rest. This is common among women who are overweight, and especially if they also have PMOS.
• Endometrial cancer
  The hormone imbalance caused by PMOS can increase a woman’s risk of endometrial cancer (a cancer of the uterine lining). This is especially true for women who are also overweight, or have type II diabetes.

The Initial Consultation
Your first appointment will involve a discussion of your symptoms and menstrual cycle. You may also be asked about your family medical history, as PMOS may be hereditary.

Pelvic Examination
During your initial appointment, your doctor may also ask to perform a pelvic exam. This is a visual and manual examination of your reproductive organs where the doctor will check for abnormal growths in the vagina, ovaries, and uterus. We are very fortunate to have Dr Madhavi Manoharan on our team, who is formally accredited in Colposcopy by The British Society for Colposcopy and Cervical Pathology.

Blood Tests
Blood tests may be performed to check your hormone levels, as high androgen levels is a key indicator of PMOS. A blood test may also be used to assess your blood glucose and cholesterol levels.

Ultrasound Examination
An ultrasound examination may be carried out to more closely inspect your ovaries and uterine lining. This type of ultrasound is called a transvaginal ultrasound, and involves the insertion of a wand-like device (called a transducer) into the vagina of the patient. Our PMOS team is formally trained and accredited to perform this procedure.