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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: The new name, PMOS, does not fully encapsulate the condition\u2019s complexities, some experts say. Others said that, while not perfect, the new name is a huge step forward in education and clinical care. Many experts agree that polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome, better reflects the hormonal and metabolic aspects of the condition. But some argue that PMOS still falls short in becoming a comprehensive moniker for the complex syndrome.
Anuja Dokras, MD, MHCI, PhD, director of the Penn Polyendocrine Metabolic Syndrome Center and Founder\u2019s Professor of Women\u2019s Health at the University of Pennsylvania, was one of the senior authors of the initial paper that announced the name change in The Lancet. She told Healio that PCOS \u201cwas problematic\u201d for two main reasons. The first issue with the PCOS name was that \u201cthe ovarian findings are follicles, not pathologic cysts,\u201d and, while ovarian cysts can be large and cause pain, \u201cthis does not occur with the small follicles.\u201d Plus, the original name \u201cframed the condition primarily as a reproductive or gynecologic disorder, even though my research and others have shown endocrine, metabolic, psychological and dermatologic manifestations\u201d throughout a patient\u2019s life. \u201cClinically, the consequences of narrow framing were delayed or missed diagnosis, fragmented care, and an emphasis on menstrual cycles or fertility without adequate attention to long-term risks such as diabetes, cardiovascular disease and mental health conditions,\u201d Dokras said. \u201cMy research has shown that women take from 6 months to 2 years to be diagnosed and typically see two to four providers before diagnosis is established.\u201d The debate The old name \u201ccreated uncertainty about whether care belonged solely in gynecology rather than being shared across primary care, endocrinology, adolescent medicine, cardiology, mental health and other specialties as needed,\u201d Dokras said. But in the new name, \u201cthe word \u2018ovarian\u2019 appropriately reflects a central component of the condition, while \u2018polyendocrine\u2019 and \u2018metabolic\u2019 deliberately broaden the frame beyond gynecology.\u201d Andrea Dunaif, MD, the Lillian and Henry M. Stratton Professor of Molecular Medicine and chief of the Hilda and J. Lester Gabrilove division of endocrinology, diabetes and bone disease at the Icahn School of Medicine and the Mount Sinai Health System in New York, represented the Endocrine Society during the PCOS\/PMOS renaming process. She told Healio that the need for a new name is not in dispute, but PMOS is not the right term. \u201cIn 2012, the NIH Evidence-Based Methodology Workshop formally concluded that \u2018PCOS\u2019 was \u2018a distraction and an impediment to progress\u2019 and recommended renaming the disorder to reflect its endocrine and metabolic biology,\u201d Dunaif, who is also an Healio | Endocrine Today co-editor, said. \u201cA successful replacement should move the disorder\u2019s conceptual center beyond the ovary. Retaining \u2018ovarian\u2019 leaves PCOS anchored to the gynecologic framework the renaming was intended to correct.\u201d Dokras said that when looking at \u201ca complex condition such as PMOS, no name can capture every manifestation or determine exactly which specialist should manage each patient,\u201d and the new name \u201cshould not be interpreted as assigning\u201d one specialty ownership. \u201cMost patients can be managed through coordinated primary care and women\u2019s health care, with referral to endocrinology, cardiology, dermatology, reproductive medicine, mental health or other specialists according to phenotype and risk. The goal is multidisciplinary accountability, not transferring the condition from one silo to another,\u201d she said. Addressing multidisciplinary care The metabolic complications of PCOS\/PMOS extend to other specialties, such as cardiology. Dunaif said that OB\/GYNs can screen for cardiometabolic risk, but the \u201cspecialists responsible for PCOS\u2019s nonreproductive comorbidities often fail to diagnose the disorder or appreciate its implications for the conditions they manage.\u201d \u201cPCOS has been recognized as a major metabolic disorder for decades. Our research in the 1980s and 1990s identified intrinsic insulin resistance and demonstrated a markedly increased risk for type 2 diabetes with substantially earlier onset. Metabolic syndrome and other cardiometabolic risk factors are also well established,\u201d Dunaif said. \u201cYet the long-term cardiovascular consequences remain inadequately defined because few cohorts have followed women into the ages when events become prevalent.\u201d It is also important for gastroenterologists and psychiatrists to be aware of PCOS\/PMOS, Dunaif said, because these patients see increased risks for liver issues, anxiety and depression. In one study that she presented at ENDO 2022, Dunaif and colleagues analyzed a health insurance database to examine which specialists women with PCOS\/PMOS see. They found that women with PCOS\/PMOS were more likely to see providers across multiple medical and surgical fields, including cardiology, gastroenterology, neurology and pulmonology. \u201cWe could not determine whether those clinicians recognized PCOS or whether individual visits were related to it. What is clear is that these physicians are already caring for affected women,\u201d she said. \u201cPCOS education therefore needs to extend beyond gynecology, endocrinology and dermatology to the broader medical workforce.\u201d As Healio previously reported, Dokras recently released a paper showing that PCOS\/PMOS may be an independent predictor of atherosclerotic CVD (ASCVD) events, including coronary artery disease, cerebrovascular disease and peripheral artery disease. The study, published in The Lancet Obstetrics, Gynaecology, & Women\u2019s Health, revealed that participants with PCOS\/PMOS had a greater prevalence of comorbidities, including obesity, diabetes, hypertension, hyperlipidemia, obstructive sleep apnea, metabolic dysfunction-associated steatotic liver disease, infertility and depression. However, the association between PCOS\/PMOS and ASCVD was only partially mediated by these comorbidities. \u201cThis means CVD risk factors do not fully explain our findings,\u201d Dokras said. \u201cHyperandrogenism, chronic low-grade inflammation, vascular dysfunction and adverse lipoprotein patterns observed in PMOS may also contribute to ASCVD risk.\u201d For OB\/GYNs, Dokras said \u201cthe key is not to wait\u201d for CVD symptoms. \u201cStarting<\/p>\n","protected":false},"author":1,"featured_media":3513,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3512","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3512","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3512"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3512\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/3513"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3512"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3512"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3512"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}