How renaming PCOS to PMOS will improve care for millions of women

Jeff Bennett:

New understanding has been gained about a health condition that affects millions of women.

An estimated 1 in 10 women around the world live with the hormonal disorder long known as PCOS. That is polycystic ovary syndrome. But this condition has a new name.

And, as Stephanie Sy reports, this change goes far beyond terminology. Supporters say it could lead to better diagnosis, treatment and care.

Stephanie See:

That’s correct. PMOS is the new name for a hormonal condition with symptoms ranging from irregular periods to excessive hair growth and acne to pelvic pain and even anxiety and depression.

The changes were announced in The Lancet by an international collaboration of doctors, experts and women living with the disorder. Researchers say the new name is expected to be more accurate and lead to better diagnosis and medical care.

Dr. Melanie Cree, a professor of medicine at the University of Colorado Anschutz and a physician at Children’s Hospital Colorado, is the person behind the name change and joins me now.

Dr. Cree, thank you very much for joining us on “NewsHour.”

That’s interesting. The new name doesn’t even include the word cyst. Does this change reflect a new understanding of the disease, or has polycystic ovary syndrome always been a misnomer?

Dr. Melanie Cree, Children’s Hospital Colorado:

That name was always a misnomer.

There are young eggs that are incorrectly called cysts. This condition has never included cysts.

Stephanie See:

As we know, women with PCOS often face a maze of healthcare providers before receiving a proper diagnosis. How does changing the name account for the fact that this is a disease that can affect multiple body systems, endocrine and metabolic systems? How does that lead to better care?

Dr. Melanie Cree:

Our hope is that it doesn’t matter what kind of doctor a patient sees.

So if you’re giving a presentation to endocrinologists who live in the polyendocrine-metabolic world, they’re going to think about the ovaries. If they consult a gynecologist who usually sits in the ovarian world, the gynecologist will think about metabolic effects.

And primary care physicians will hopefully think about all of that and hope that name will help remind them of all the parts of this disease. The diagnostic criteria have not changed. What we would like to see change is that those caring for these women look at their entire body and condition, not just their ovaries.

Stephanie See:

Well, because PCOS is often associated with childbirth. And I understand that advocates complain that it ignores the many women suffering from conditions who may not want to get pregnant.

How has the focus on female fertility affected patients over the years?

Dr. Melanie Cree:

Patients have not been given accurate information about associated illnesses, leading them to believe that their difficulty gaining or losing weight is their fault, such as type 2 diabetes, excess fat in the liver, or high cholesterol.

And they absolutely aren’t. What causes all these problems has to do with the PMOS hormone and the insulin hormone. So in some cases, if a woman is being tested for type 2 diabetes, obstructive sleep apnea, or excess fat in the liver, she may be able to get our weight loss medications for these conditions right now.

These are FDA approved and most are covered by insurance. That means we can transform care for millions of women right now.

Stephanie See:

There’s another thing about PCOS that I think is worth recognizing. That means women with PCOS are often at higher risk for heart disease. Heart disease is, of course, the leading cause of death for women in the United States.

Could you briefly explain why that is and how this change can actually better address these types of concerns?

Dr. Melanie Cree:

absolutely.

So what happens with insulin? Insulin is released to store the sugar we consume and also helps us store fat. And when people with testosterone have high insulin levels, fat accumulates in their blood vessels.

One of our research studies over 10 years ago showed that 15-year-old girls with PMOS had thicker plaques in their neck arteries than girls with normal periods. You can measure this at the age of 15.

Stephanie See:

I would also like to return to the issue of body fat. Because women with PCOS are often told by their health care providers that they simply need to lose weight. That’s obviously a daunting thing for many American women to say. And I know a lot of women with PCOS who have toned bodies.

So, could you please clarify what a woman can and cannot do with lifestyle changes, diet, exercise, etc., and how should she take such advice?

Dr. Melanie Cree:

Therefore, the main point for changing your lifestyle is to lower your insulin levels. And, as I mentioned earlier, insulin is secreted when you eat especially sweet foods.

When you are active, insulin works better. And that’s where these recommendations come from. And everyone with PMOS has insulin resistance, regardless of body size. And again, a study from the University of Colorado showed this.

So everyone needs to make those changes. There are other parts of the lifestyle that are really difficult for women. What that means is that if you’re feeling really stressed and depressed, your stress hormone cortisol will be a little bit higher. Yes, cortisol makes you crave sweet and fatty foods and makes you feel too tired to exercise.

So if we’re really trying to change our diet or exercise, but we’re not doing anything to manage our daily stress, we’re working against our bodies. The same goes for sleep. Going to bed after midnight, getting less than 7 hours of sleep, or having obstructive sleep apnea can all increase cortisol at night.

So your 24-hour cortisol is only slightly high, but it’s high enough that you can’t make any lifestyle changes. And I think that’s really important for people to understand, that it’s not just food and activity, but every aspect of lifestyle.

Stephanie See:

That’s Dr. Melanie Cree.

thank you.

Dr. Melanie Cree:

good bye.