In the past year, I have been so low on energy that my family and friends mostly only had the pleasure of phone calls from me. Most weekends, I’d curl up in bed with a book. My skincare routine, making a cup of chai, and sometimes, even making a decision, felt tiresome. After attributing my fatigue to burnout and heavy periods that sometimes lasted up to 20 days a month, I accepted exhaustion as part of my personality. I was inconvenienced but not surprised by my erratic period cycles, since I have what was then known as polycystic ovary syndrome (PCOS). It was only after a consultation and several blood tests that I realised my metabolic function was impaired due to insulin resistance.
What is PMOS?
Women are often taught to look out for signs such as acne, weight gain, hirsutism, and irregular menstrual cycles but few people prepare you for the complete physiological impact you may experience. Which is why the change of terminology to Polyendocrine Metabolic Ovarian Syndrome (PMOS), has been welcomed by many clinicians. Dr Vaishali Joshi, senior obstetrician and gynaecologist at Kokilaben Ambani Hospital believes this was much needed, especially since metabolic health is central to PMOS. The revised term helps explain the metabolic reason behind the cystic ovaries in a way PCOS never did.
Research suggests insulin resistance is present in 60 to 80 per cent of women with the condition. Known to be a major driver of type 2 diabetes, it also increases susceptibility to several other health risks. Dr Joshi points out that it can lead to high cholesterol and triglycerides, which negatively impacts your heart, while also contributing to fatty liver disease. “The new term highlights that it goes beyond ovaries. It involves the complete physiology of our body and different metabolic systems may become dysregulated in PMOS.”
What are the symptoms of PMOS?
Metabolic dysfunction can often show up in various ways before revealing itself in your blood tests. It can make weight management more challenging as your body converts the excess sugar into fat. Steady weight gain can be one of the first signs to watch out for, points out Dr Joshi.
Low endurance and lethargy are also signs of metabolic dysfunction. Dr Paras Agarwal, clinical director and head – diabetes, obesity and metabolic disorders at Marengo Asia Hospitals, Gurugram says fatty liver, thyroid dysfunction, anemia, and vitamin D3 and B12 deficiencies can cause chronic fatigue in PMOS patients. But he warns that not every sign of tiredness can be attributed to PMOS and valid tests need to be conducted for the same. “Sometimes, it may be simpler things like too much on your plate or inadequate hydration and low blood pressure.”
Central abdominal weight gain, colloquially referred to as “cortisol belly” may also be seen in some patients as “PMOS patients with insulin resistance also tend to have high cortisol,” Dr Agarwal adds.
How is PMOS diagnosed?
Earlier, polycystic ovaries were considered to be the defining feature of PMOS until the Rotterdam criteria was introduced in 2003 to diagnose the syndrome.
To understand the long-term impacts of PMOS today, Dr Joshi recommends tests such as fasting insulin, glucose tolerance, and HbA1c as these may reveal hidden prediabetic markers that may not be apparent otherwise. She also suggests a lipid profile blood test to detect cholesterol and for fatty liver, an ultrasound scan of the abdomen and pelvis is the right choice.
The results may surprise some, especially if the baseline hormones are tested to be balanced. “Sometimes the body gives us symptoms that indicate underlying issues, but it takes longer for these changes to be reflected biochemically in hormone levels. There is always a lag,” Dr Joshi explains.
Why PMOS is about more than ovarian cysts
The term PCOS placed the spotlight on ovarian cysts, often overshadowing the metabolic dysfunction believed to drive many of the condition’s symptoms. These cysts are multiple small immature follicles. For ovulation, you need one follicle to grow enough to become dominant but insulin resistance disrupts the hormonal environment needed for it, Dr Joshi says. This leads to several immature follicles and the appearance of cysts in your ovaries. “Since ovulation does not occur, many follicles accumulate within the ovary,” Dr Joshi explains.
How can PMOS be managed?
Women with PMOS are advised to maintain a healthy lifestyle and diet. Richi Agarwal, a nutritionist, recommends addressing the cause first: insulin resistance. She recommends reducing the dietary contributors such as refined carbs, added sugar and ultra-processed foods and consuming meals where protein, fibre and healthy fat sit alongside carbohydrates. She also points out that meal sequencing is crucial in improving insulin resistance. Eating fibre and protein before carbs can significantly blunt the glucose spike.
While nutrition is the first step, a lifestyle change is equally crucial. Luke Coutinho, an integrative lifestyle expert elaborates, “Strength training is especially important because muscle helps the body use glucose better.” Coutinho recommends better sleep for your metabolism to receive the signal of safety and stress management as cortisol directly contributes to insulin resistance.
What does the new terminology change?
The terminology now acknowledges the metabolic impact of PMOS, but what next? The change in terminology, Dr Joshi believes, will drive the narrative beyond reproductive health. It means women who don’t want to conceive or those who have already had children need to continue to maintain a healthy lifestyle, monitor their lipid profile, cardiovascular parameters, and blood sugar levels. “Managing PMOS should not involve only a gynaecologist. It requires a multidisciplinary team because it is an ongoing condition rather than a one-time diagnosis,” Dr Joshi points out. The name change matters because it makes room for the symptoms many women have been living around for years: the missed plans, the unanswered messages, the fatigue mistaken for laziness and the body asking to be understood beyond its ovaries.
Disclaimer : This story is auto aggregated by a computer programme and has not been created or edited by DOWNTHENEWS. Publisher: vogue.in
