The PCOS Name Change: Why PMOS Better Reflects the Whole-Body Condition

Polycystic ovary syndrome has long been associated mainly with irregular periods, ovarian cysts and fertility concerns. But the condition can also affect insulin resistance, weight, heart health, diabetes risk and other systems throughout the body—one reason the new name PMOS, or polyendocrine metabolic ovarian syndrome, is gaining attention.

Host Sandra Peebles talks with Baptist Health endocrinologist Dr. Priscilla Escalona Villasmil and obstetrician-gynecologist Dr. Ingrid Paredes about what the name change means, how PMOS is diagnosed and why symptoms can look very different from one woman to another.

In this episode:

•  Why the condition is about much more than ovarian cysts 
•  Common signs, including irregular periods, acne, excess hair growth and hair loss 
•  How doctors diagnose PMOS and rule out other hormonal conditions 
•  What PMOS means for ovulation, fertility and unplanned pregnancy 
•  The connection to insulin resistance, diabetes and cardiovascular risk 
•  Treatment options, including lifestyle changes, birth control pills, metformin, spironolactone and GLP-1 medications 
•  Why early diagnosis and coordinated care can improve long-term health 

PMOS is manageable, and a diagnosis does not mean pregnancy is impossible. Early evaluation by an OB-GYN and an endocrinologist can help patients address both reproductive and metabolic health.

Host:
Sandra Peebles
Award-Winning Journalist

Guests:
Ingrid Paredes, M.D. 
Obstetrician/Gynecologist

Priscilla Escalona Villasmil, M.D.
Endocrinologist 
Baptist Health

Transcript

SPEAKER_03 0:00

And it's very important to address that yes, they can get pregnant because I think it's more common that I see patients getting pregnant unplanned because they have PCOS than the alternative.

SPEAKER_00 0:16

Welcome to Baptist Health Talk, a podcast on all things healthcare, powered by Baptist Health South Florida, your trusted source for healthcare prevention and wellness.

SPEAKER_01 0:26

I'm your host, Sandra Peebles. Welcome back to another episode of Baptist Health Talk, where we answer your most searched questions on trending health topics. Today we're diving into a topic that made headlines and was celebrated on social media by women everywhere: the name change from polycystic ovary syndrome, PICOS, to PMOS or polyendocrine metabolic ovarian syndrome. This condition goes beyond reproductive health. It touches hormones, metabolism, insulin resistance, fertility, heart health, and even the risk for diabetes. Today we're talking to two specialists who work with patients navigating this every single day. We are joined by Dr. Priscilla Escalona Biasmil, endocrinologist with Baptist Health, and Dr. Ingrid Paredes, obstetrician and gynecologist. Thank you, ladies, for being here. Thank you for having us. So it's wonderful to have both specialties dealing with this condition that really affects so many areas, so many symptoms of our body. So this question is for both of you, and let's start with the name change. Um, why the name change?

SPEAKER_03 1:31

Okay, I guess I will start. I think the name change was necessary because the prior one, the polycystic ovarian syndrome, will be too focused on the ovaries. Like the name says, polycystic ovarian syndrome. Many patients will say, okay, I got an ultrasound. I don't have any cyst, so I don't have the syndrome. So it was very focused on the ovary. When in reality, the syndrome is a condition that is polyendocrine. It's a metabolic problem that affects the other organ system that you said. So it was needed to be changed because even in the criteria that you get the diagnosis, you don't necessarily have the multiple cysts in the ovaries.

SPEAKER_01 2:10

Dr. Ascolono, from your perspective, the what's the reason for the name change or how does it help patients understand it better?

SPEAKER_02 2:16

Well, of course, definitely actually the change of the nomenclature is actually leading us, even from endocrine perspective, to go beyond what she explained. It's not only about the menses irregularities or the things about the acne or the hair. It's just beyond that. It's actually that this population has increased risk of metabolic conditions long-term, actually, like hypertension, type 2 diabetes, obesity with sleep apnea. So definitely the recognition of this beyond just cycle of fertility will let actually like offer a more like multidisciplinary approach for these patients for early diagnosis as well. So now we have different phenotypes. Like she said, not everybody is feeding the classic profile from this condition before. So we are targeting therapies and offering actually treatment options in a better way.

SPEAKER_01 3:08

And I imagine this is a lot has to do with the fact that there are so many different symptoms and so many different signs that might point to this condition. Why is it that, what are the symptoms and why do they differ so much from woman to woman?

SPEAKER_03 3:22

Yeah, I'll tell you it's the most common one that they present with is menstrual irregularity, hersotism, or just a fancy term to hair in this area on the shin, acne, and um they all relate to the elevated um levels of androgens. So by thinking like that, then you know the physical features. Most of them, or in general, they are obese, overweight, but not necessarily. Some of them are actually normal weight and they may have the syndrome.

SPEAKER_01 3:52

Dr. Escalona, why is PMOS considered a whole body condition and not just a reproductive one?

SPEAKER_02 4:01

Well, just going back to the basics, so it actually is a dysregulation from all, actually, even from neuroendocrine perspective. So hormones from your uh hypothalamus are actually dysregulated that actually create the increased androgen production. And even just by itself, even patients without obesity that have this condition, they can have increased insulin resistance with hyperinsulinism. So the body needs to create more insulin to overcome all the challenges with the sugar or glucose metabolism. So from the even they have actually recognized changes in the skeletal tissue on the muscle, skeletal muscle tissue, changes in the adipocite or the fat tissue, and it intervenes actually from skin. Even one of the symptoms as well is hair loss. So beyond actually just the menses and the fertility-related issues. And how do you diagnose it?

SPEAKER_03 4:56

Well, I think it's like a clinical diagnosis, what I tell my patients, especially based on the Rotterdam criteria, which is this terminology that there's a criteria that you follow. And if you have two out of the three, you have the syndrome. But it's so broad because the three characteristics is hyperandroionism, right? Um, the next one is the irregular period, and the third is the polycystic ovaries. So you don't have to have the ultrasound, like we said now, to diagnose it. So if you have the two of them, the first two, you could diagnose it. However, it's very broad, right? So what I tend to do is obviously at first take a physical history, uh, a history and a physical exam, because there's other features in the physical exam that can point towards it like changes in the skin, like a chanthosis nigricans, which is that darkening in the neck, which is usually associated with that insulin resistance, too, that we mentioned. Um, laboratory-wise, I do like a panel of hormones because you could see an elevated or double in the LH and the FSH. And therefore, that LH increases the testosterone. And then, because of the elevated uh testosterone, that's why the hair, the acne. Um, and then obviously you could do an ultrasound and do a C look at the ovaries, but if you don't have the cyst, it doesn't mean that you don't have it. So that's how I diagnose.

SPEAKER_01 6:17

So when a patient comes to you, how do you, how do you, how does this even begin? They come with complaints about something and then you begin to do the research, or do you just see the person and realize there's something going on?

SPEAKER_03 6:27

That's a wonderful question. Because today's days with social media and all the information that is out there, they already come with the diagnosis themselves. They tell me, Doctor, I have PCOS, okay? I'm like, okay, well, how can I help you? And then some of them are like, Well, I need this, this, and this and that, because it all depends what they're looking for. And that's a great question because if at first they just come in with the irregular periods, you want to then do a screening for the PCOS, right? Like you take it for their history. When did it start? Were you ever regular your age? It depends because you could be in the adolescent area or pre-reproductive years, and in that case, we don't even look at the ultrasound. We go mainly on the hormonal aspect. If you're in the reproductive age, we look at the ultrasound, but also you want to know what they are looking for? Because usually, depending on the symptoms, it's a treatment. Let's say just to diagnosis, a history, and blood work. If they just come with the regular periods, you want to ask further about the physical features. If they don't, then I usually see them for yearly. I ask them about their period. I don't know what's going to it.

SPEAKER_01 7:35

Sure.

SPEAKER_03 7:35

Either the patient already knows that they have it and they are looking for help, or they don't know, they've heard or they want the pill, birth control pills, which I guess we'll get into later as to how we treat it. But it it's very different how they present for minodiagnosis.

SPEAKER_01 7:53

Sure, as different as patients are, right? From human to human. Yes. Uh, Dr. Escalona, from um an endocrine, I always find your field of medicine so fascinating because I think it's so mysterious hormones. Uh, who is most likely to get this condition? Is it hereditary? Is it just the look of the draw?

SPEAKER_02 8:13

Well, it has a polygenic, actually, a polygenetic background, but definitely environmental factors or factors that are poorly understood. So sometimes actually we see in in the same family several actually relatives with the condition. Um, but even going back to the diagnosis, importantly, as she mentioned, in our case, we do an extensive extensive hormonal evaluation. There are other hormone conditions that can mimic exactly the same symptoms. So we rule out thyroid conditions, prolactin, or which is the breastfeeding hormone, um in cases with periods of irregularities. And even sometimes we, depending on how the patient is looking at their symptoms, we even go beyond and sometimes rule out cortisol excess, like pathological cortisol excess, as a part of actually the workup and the diagnosis for these patients.

SPEAKER_01 9:04

One of the issues, of course, that comes out once there's a diagnosis of PMOS is fertility. So once they get a diagnosis, the patient gets a diagnosis, what is their prospect of ovulation and pregnancy?

SPEAKER_03 9:17

I know that's the popular one. That's usually when they come to see me. Sure. Because they're concerned because they have given you the diagnosis. Sometimes they give it themselves, not a doctor gave them the diagnosis, and they're very concerned that they cannot get pregnant. And it's very important to address that yes, they can get pregnant because I think it's more common that I see patients getting pregnant unplanned because they have PCOS than the alternative. Okay. I hope you follow me. So many times the ones that thought that because they have PCOS, they cannot get pregnant and they have an unwanted pregnancy versus the other ones that they don't know why they're not getting pregnant and have more common of getting pregnant. So, what's the idea behind it? I always explain it that it's not that they cannot get pregnant, it's that their ovaries with those multiple cysts or that uh abnormality that is happening in the ovary doesn't allow the regular ovulation to happen. For you to get pregnant, you need to be able to release an egg. In these patients, they don't have that regular cycle where they release the egg. So in those patients that have already done a diagnosis that I agree with them, you have PCOS, we've confirmed it, you don't have a regular period. I get them to, I can give them a pill that will get them to ovulate. And it's called letrozol. It's very important because many patients they say reading social media, what about clomifin? But or clomyd, there's different ovulation induction medication and PCOS. Actually, there were studies done that patients that have PCOS do better to be able to get pregnant with the letrozol compared to clomyd. Um, so the infertility is a risk factor just because of that potential competition of the ovaries, competing with each other, the cysts in the ovaries, not allowing one fully mature cyst to release the egg. So I usually tell them it's not that you cannot get pregnant, it's you have a high potential to get pregnant. It's just that you don't have that maturation, which is why I warn them that when you induce ovulation, you can get pregnant with twins. I mean, at that point they're excited to get multiples, but that's the idea behind it.

SPEAKER_01 11:30

And so you have had women deliver babies, healthy babies, despite the fact of having a PM.

SPEAKER_03 11:36

Yes, I have more patients that have delivered babies with PCOS than patients with PCOS going through infertility.

SPEAKER_01 11:42

Wow, that's wonderful. But beyond this being um a reproductive issue, it's really a systemic issue. It involves so many things in the body. So what are the risks, um, health risks, long-term and short term? What should they know?

SPEAKER_02 11:57

Well, definitely actually going back because we see patients at any age, you know, all ages groups. So, for example, we have the reproductive age, but we also have we have our perimenopausal, menopausal patients, that this is a population that is, you know, is facing all the risk of having because of normal aging. So you're saying that some people are diagnosed that late? Well, I have had a few patients that uh that's what I'm saying. The change the changes of nomenclature and more awareness about this condition is gonna let actually us to diagnose earlier in early on in somebody's life. So definitely um there are patients that they were not diagnosed or they don't didn't seek, or the menstrual irregularities were not as severe as other patients, and they were actually, you know, not diagnosed or misdiagnosed. So this is a population that also we take care of, and definitely there is increased risk of diabetes, any kind of glucose uh metabolism abnormality, hypertension, there is increased uh risk of cardiovascular disease. Even in this population, there is an uh increased risk of heart attacks and even a stroke compared to general population or women without PCO, PC PMOS. Yeah.

SPEAKER_01 13:15

I know we have to get used to that. I know the answer. It was just changed in June. Yes. You were you're telling us. Just last month. Yeah, so just last month, we had we're still still getting used to the terminology PMOS. Yes. Dr. Escalona, if um a person, uh obviously a woman who is suffering from PMOS has uh a lot of issues going on, but one of the main things to be concerned about is metabolic resistance. What is it? How do you deal with that?

SPEAKER_02 13:38

Yes, so definitely we see insulin resistance associated with this condition. And even on lean patients with normal body max index. Before we thought, okay, yeah, these patients have tendency to gain weight or they could be overweight or obese, and that was what's leading actually to the metabolic complications. But no. So even up to 75% of patients with PMOS in a normal weight or a healthy weight, they have actually underlying insulin resistance. So in one thing actually leads to the other. So you continue to gain weight, insulin resistant is one of worse. And even the insulin resistant is gonna be actually indirectly a mechanism to increase androgens or testosterone production as well by the ovary. So it's like a like a shin of event. Exactly. So definitely that is something that we can actually help to say that way, keeping patients actually or helping them to keep a healthy weight, healthy lifestyle, lifestyle interventions of these patients are critical, important, especially when they're looking to get pregnant. I always state my patients, my young patients, if you keep a healthy weight, we work on weight loss. Definitely the odds, the insulin resistant will improve, the androgen secretion will improve, and even we have patients that they can have normal menses without the support of birth control pills, just actually working on lifestyle, losing weight, and even 10% of the weight can actually trigger ovulation. So it's very important to this multidisciplinary approach for patients, yes.

SPEAKER_01 15:16

And you know, it's so interesting is that really that lifestyle changes are important across the board for everything. It's so important that we love ourselves and take care of our health for every condition that I have sat here and interviewed uh specialists on. Um, this question is for both of you, and I'm very interested in knowing your approach from your different uh specialties. So let's start with you, Dr. Paredes. Uh what are the treatment options? And I know you kind of mentioned it earlier. I'm interested to know what are the differences from each of your approaches.

SPEAKER_03 15:46

Yeah, because my first, obviously, lifestyle first. That's what I always address because I have many patients reluctant to do hormones, and then by losing the weight, they can regulate the period and get better. But it's easier said than done, especially today's day with the GOP ones and all this stuff. I think it's a great uh added tool. But my typical treatment options are birth control pills. Birth control pills, the way they would potentially help is that they increase um the sex hormone binding globalin in the liver, which would then bind to this free testosterone that is in the blood, therefore decreasing the physiologic appearance of the VCOS, right? So if you decrease the testosterone, there's less hair surism. Many of the time the patients, they just want, just I just want this hair out. And the breast control pills will help with that, will help to regulate the periods. There's also, let's say that their periods are regular and they don't want the hormones, we can give um spiralactone, we can give metformin to help them with the insulin resistance, even though they don't have the diabetes. If they have this diagnosis of the PCOS, I can give them metformin, which would help them with the weight control. And uh it would help them to lose the weight, actually. I mean, now with the GOP ones, I'm curious to see what you're gonna say because I feel like the GOP ones help so much in so many aspects that I feel like my forming is kind of like the old, the old dream, the old school.

SPEAKER_01 17:11

Yeah. What about you, Dr.

SPEAKER_02 17:12

Scalona? How do you treat patients? Yes, well, so definitely pretty much the same as Dr. Parents is stating. I always tell my patients when you have this condition, there are actually four or three actually may, you know, advice. One is actually that we make we need to make your periods regular. So to avoid all long-term complications, endometriperplasia. So that we achieve it with birth control pills or an intense lifestyle style modification program. Um, so that can happen. Second, we treat actually the symptoms of hyperandrogenism or elevation of testosterone, which is acne, the hair loss, uh, skin changes in earsutism or the abnormal hair growth, um, that we can achieve it with a spironolacton. This medication works as an antiandrogen or testosterone receptor blocker. So definitely, because I see the patients potentially in conjunction with uh GYN, this medication, we need to use it along with birth control pills and contraception because we cannot, women should not get pregnant on this medication because of the babies and the teratogenicity related to it. So I'm always actually making that distinction, and that's very important for patients to know exactly. And then all the metabolic aspects actually of this condition, which is weight management. Unfortunately, we have a few patients in early 20s or mid-20s even with diagnosed with type 2 diabetes, even at early, you know, age. So definitely weight management is very important. So we have uh metformin. Metformin several years ago was used actually for fertility support, which we know it's not longer for that, you know. Um, but it will improve. It's a important and powerful insulin sensitizer in some patient population. Even it can help even up to 50% of women without birth control pills, they can achieve regularization of the menses with metformin in the background. And definitely, if somebody is pre-diabetic and is actually planning potential pregnancy in the future, we tend to give metformin to improve the glucose, you know, metabolism. And it's a medication that has been proven to be safe when people I keep them when they're pregnant, I keep them. Definitely. So that for weight loss definitely leading GLP1 receptor acids. It is helping, yeah. Definitely. We have semaglutide, thirsepatide. Uh, these agents actually will help, definitely, too. And it's a very important tool that we have nowadays when patients actually are obese. And as even there is a lot of research ongoing in clinical trials about the use not only for weight loss, just for management of MOS. So it's a lot of things coming and a lot of things under research at this point. Yes.

SPEAKER_01 19:57

Very interesting. So the next question, and Dr. Petta is for you is there a cure or is this really about managing symptoms?

SPEAKER_03 20:04

I think it's managing symptoms. I don't think, especially because it's a polygenic effect that, you know, if you know one thing.

SPEAKER_01 20:09

So there's never a time where you're going to be diagnosed and one day you won't have it. I mean, that it's gone forever. No, it's about managing.

SPEAKER_03 20:16

So I think it's managing, and then you can, it's kind of like type two diabetes and obesity. When you have the weight loss surgery, you're only at the many of my patients. Oh, I was diabetic, but I lost the weight, I'm not diabetic anymore. Exactly. I think it's one of those that if you control the hormones, you control the weight, you can say that you're controlled. And in pregnancy, too, I don't know if we're gonna get there, but pregnancy itself becomes a high risk pregnancy because they are at increased risk of developing gestational diabetes, hypertension, just to go back to the polymer, you know, it's a polyendocrine metabolic condition.

SPEAKER_01 20:48

So it's important. Well, a lot of the reason we're doing this is because of the name change, something that was so celebrated. And the question is for both of you um this opens the possibility of more funding. And one would ask, what does a name have to do with funding? But why is it that changing the name could lead to better uh financial funding for research?

SPEAKER_02 21:08

Well, definitely understanding that, as I said, this is all the metabolic and the this condition is risk to develop uh uh obesity, obesity-related comorbidity, and other and chronic medical conditions. So clearly, if we treat actually and we diagnose early on and we treat these patients at young age, and early screening, if you think about it, uh somebody at 20 or 25 doesn't need necessarily to be screened for type 2 diabetes, but the fact that they have three COS, we do so. So we test for cholesterol, for triglyceride levels. So we do differently in this patient population than we would do for women without the condition. So definitely that also will open the ways for more research, clinical trials. More information now. There is a lot of actually potential, you know, studies on animal models about other things coming from in that neuroendocrine pathway that regulates all these hormones with the hypothalamus and pituitary gland to find new therapeutic actually and new emerging therapies to treat these patients actually and treat them from the basics the neuroendocrine disruption, the insulin resistance, and so forth.

SPEAKER_01 22:29

Yes. And your thoughts on this, Dr. Perez, on the funding aspect?

SPEAKER_03 22:32

Yeah, I think it's that that too, you know, it's like before when Monjaro came out, it was only for diabetic patients. Yeah. But then, you know, once it was covered for obesity, then it changed the name. So I think it's just changing the name, what it addresses, then hopefully it will be covered. That's the way I look at it.

SPEAKER_01 22:52

What is the one thing every woman should know about PMOS?

SPEAKER_03 22:57

I think they should know that is to not be afraid of the condition, to not rely on that to not get pregnant, because you can't get pregnant.

SPEAKER_01 23:07

Oh. So some people might think the other way. I haven't someone.

SPEAKER_03 23:09

I'm telling you, I have a number of patients that they have come up pregnant and wanted because they were told they have PCOS and they were falsely told, well, PCOS patients cannot get pregnant. Then that's a strong statement. So I would say it's difficult to get pregnant, but you can definitely get pregnant. So don't be afraid of the diagnosis. Definitely go see at your OBGYN. And obviously an endocrinologist, because, like the name change says, it is not just the ovaries, so it's not just me. So definitely an endocrinologist to see. That would be my advice.

SPEAKER_01 23:39

If someone didn't really know they have it, they might first come to the OBGYN and then uh they would come to the specialist. What do you think every woman should know about this?

SPEAKER_02 23:46

Well, agreeing with her actually, early diagnosis, early treatment, I think it will improve outcomes long term. So we will help these patients or as good as we can. And the responsibility that the patient actually follows a healthy lifestyle and knows that this is a manageable condition and that we what we're doing, managing everything from metabolic perspective, is just to decrease the chances of these patients becoming or having chronic medical conditions as well in the future. At the beginning, in young patients, the concern honestly is fertility in periods that they don't see, you know, regular periods. But beyond that, long term, I still have patients. And one of the main things that I ask with I see my patients with type 2 diabetes is, oh yeah, I had history of PCOS or PMS, PMOS, right? PMOS, so we call it. It'll be difficult for everyone to get used to it. Exactly. So definitely that is actually what we can help patients, and that definitely their options, there are more awareness as well. And they they are there's solutions actually. There's a condition that can be manageable, definitely.

SPEAKER_01 24:56

Thank you both for sharing your expertise. I can feel how you truly want to help your patients. I can feel how this research uh would help you better help uh your patients. And it's, I guess it's a daily fight that you go through in your in your respective fields. So thank you so much for sharing uh your knowledge with our audience. It's really very valuable. And remember, viewers, be sure to hit the subscribe button on our channel here to keep up with the latest health and wellness information and tips from our experts. You can also find Baptist Health Talk on Apple Podcasts, Spotify, or wherever you listen to podcasts. So you can tune in anytime, anywhere.

SPEAKER_00 25:32

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