Category: Uncategorized

Getting diagnosed with PMOS (PCOS), should not take years. Yet many people are dismissed, told their symptoms are normal, or given the pill without being told what is driving their irregular periods, acne, excess hair growth or fertility concerns. PMOS is diagnosed using the Rotterdam criteria. This means you need to meet at least 2 out of 3 criteria: irregular or absent periods, signs of high androgens, and/or polycystic ovarian morphology on ultrasound or AMH testing. Other conditions, such as thyroid disorders and raised prolactin, should also be ruled out. This guide explains the tests used to diagnose PMOS, what the criteria mean, whether you need an ultrasound, and what to do if you are not getting clear answers. Quick facts: What tests are used to diagnose PMOS (PCOS)? There is no single test that can diagnose polyendocrine metabolic ovarian syndrome, or PMOS. Instead, diagnosis is usually based on a combination of your symptoms, menstrual cycle pattern, hormone levels, metabolic health markers and, in some cases, an ultrasound scan. Your doctor may recommend a combination of the following assessments. Medical history and symptom assessment The first step is usually a detailed conversation about your symptoms and health history. This may include questions about: This helps build a clearer picture of whether your symptoms fit with PMOS and whether other conditions need to be ruled out. Physical examination A clinician may also look for physical signs that can be associated with PMOS. These may include acne, excess facial or body hair, scalp hair thinning, skin tags or darker velvety patches of skin, which can sometimes be linked to insulin resistance. This helps identify patterns that may guide further testing. Blood tests for PMOS (PCOS) Blood tests are often used to check hormone levels, assess metabolic health and rule out other conditions that can cause similar symptoms. These may include: These tests help identify whether PMOS is likely, how it may be affecting your body, and what kind of support may be most appropriate. Pelvic ultrasound scan for PMOS (PCOS) A pelvic ultrasound may be recommended to look at the ovaries and uterus. This can help assess whether the ovaries have a polycystic appearance, meaning they contain a higher number of small follicles. A transvaginal ultrasound is often used because it provides a clearer view of the ovaries. This involves placing a slim ultrasound probe into the vagina, which uses sound waves to create images on a screen. However, having polycystic-looking ovaries alone is not enough to diagnose PMOS. Some people have polycystic ovaries without symptoms, and some people with PMOS may not have obvious changes on ultrasound. Pelvic examination In some cases, a pelvic examination may be offered to check for abnormalities or signs of other reproductive health conditions. This is not always needed for a PMOS diagnosis, but it may be useful if you have symptoms such as pelvic pain, abnormal bleeding or pain during sex. Testing does more than confirm a diagnosis. It can help rule out other causes of irregular periods, acne, excess hair growth or difficulty conceiving, and it can identify whether PMOS is affecting ovulation, hormone balance or metabolic health. That means your care can be tailored to what is actually happening in your body, whether that involves cycle support, fertility planning, skin and hair treatment, metabolic health support or longer-term monitoring. How is PMOS/PCOS diagnosed? PMOS is diagnosed using the Rotterdam criteria, the internationally recognised diagnostic framework, most recently updated in the 2023 International Evidence-Based PCOS Guidelines. To receive a diagnosis, you must meet at least 2 of the following 3 criteria. You do not need all three. Criterion 1: Irregular or absent menstrual cycles This criterion reflects the disruption to ovulation that is central to PMOS. When elevated androgens interfere with follicle development, ovulation doesn’t happen reliably, and without ovulation, the regular hormonal cycle that produces a period is disrupted. What counts as irregular?  A single late or missing period doesn’t meet this criterion, it needs to be a consistent pattern, not an occasional variation. Criterion 2: Clinical or biochemical hyperandrogenism (elevated androgens) This criterion reflects the androgen excess that is the hormonal driver of many PMOS symptoms. It can be met in two ways, through physical symptoms, or through blood test results, either is sufficient. Clinical hyperandrogenism means physical signs of elevated androgen activity: Biochemical hyperandrogenism means elevated androgens on a blood test including high testosterone and DHEAS. SHBG is a protein that binds to testosterone and reduces its biological activity. In PMOS, SHBG is often low, meaning more testosterone is free and active. This is why a PMOS-focused blood panel should always include SHBG alongside testosterone, not testosterone in isolation. Hormonal contraception can raise SHBG significantly, which suppresses testosterone and can mask androgen excess entirely. If you’re on or have recently stopped the pill, your androgen levels may not reflect your true baseline for several months. Ideally, androgens should be tested at least 3 full cycles after stopping hormonal contraception for the most accurate picture. Criterion 3: Polycystic ovarian morphology (PCOM) This criterion refers to evidence of the characteristic ovarian appearance associated with PMOS, a high number of follicles that haven’t been able to progress to ovulation. It can now be assessed in two ways: Transvaginal ultrasound (TVUS) A pelvic ultrasound scan counts the number of follicles visible in each ovary. The scan should ideally be performed in the early follicular phase, days 1-7 of the menstrual cycle, when follicles are at their most clearly countable.  AMH blood test This is the significant change introduced in the updated 2023 guidelines. AMH (anti-Müllerian hormone) is a hormone made by the follicles themselves. In PMOS, AMH is typically elevated, reflecting the high number of small arrested follicles. AMH is now formally accepted as an alternative to ultrasound for assessing polycystic ovarian morphology. This means that for many people, a blood test alone can support this third criterion, without the need for an internal transvaginal scan. Can AMH diagnose PMOS (PCOS)? AMH can help […]

If you’ve recently heard the term PMOS and wondered what it means, or if you’ve had a PCOS diagnosis for years and want to understand what’s changed, this is your complete guide. PMOS stands for polyendocrine metabolic ovarian syndrome. It’s the new name for what was previously called polycystic ovary syndrome (PCOS). The name has changed, but the condition hasn’t, and understanding it properly has never mattered more. PMOS affects an estimated 1 in 8 women and people with ovaries worldwide, more than 3.1 million in the UK alone. Despite being one of the most common hormonal conditions, it remains widely misdiagnosed, misunderstood, and undertreated. On average, it takes two years and multiple doctor visits to get a diagnosis. You deserve better than that. This guide covers everything: what PMOS actually is, what causes it, what it feels like, how it’s diagnosed, and what you can do about it. Quick facts: What is PMOS? P – PolyendocrineM – MetabolicO – OvarianS – Syndrome Let’s break that down: Polyendocrine means more than one hormone system may be involved. PMOS can affect reproductive hormones such as testosterone, LH and FSH, but it may also affect insulin, thyroid hormones, cortisol and other metabolic pathways. Metabolic refers to the way your body processes energy, sugar and insulin. Many people with PCOS/PMOS have some degree of insulin resistance, where the body has to produce more insulin to keep blood sugar stable. Ovarian reflects the fact that the ovaries may be affected, particularly ovulation. However, despite the old name “polycystic ovary syndrome”, you do not need to have cysts on your ovaries to have the condition. Syndrome means it is a collection of features that can look different from person to person. PMOS is the most common cause of irregular periods and ovulatory infertility in people with ovaries. It is also linked to an increased risk of developing insulin resistance and longer-term health risks including type 2 diabetes, cardiovascular disease, endometrial cancer, anxiety and depression. Is PMOS the same as PCOS? PMOS is just the newer name being used for PCOS. For years, the condition was called polycystic ovary syndrome (PCOS), but that name has always been a bit misleading. Not everyone with PCOS has polycystic-looking ovaries, and not everyone with polycystic-looking ovaries has PCOS. The condition also affects far more than the ovaries. The shift towards PMOS aims to better reflect the full-body nature of the condition, including its links with insulin resistance, androgen excess, metabolic health, cardiovascular risk, mental health and fertility. That said, PCOS is still the most widely recognised search term, and most NHS, NICE and clinical guidance currently still uses PCOS. So, for now, you may see both terms used: PCOS = the older, widely used namePMOS = the newer, more accurate name You can read more about why PCOS was renamed PMOS here. What causes PMOS? The exact cause of PMOS isn’t fully understood, but research points to a combination of genetic, hormonal and metabolic factors. It tends to run in families, and if your mother, sister or aunt has PMOS, you might be at a higher risk. At its core, PMOS involves a dysfunction in the way the body produces and responds to hormones, particularly androgens and insulin. Androgen excess – the ovaries (and in some cases the adrenal glands) produce higher levels of androgens than normal. Androgens are often called “male hormones,” but they play important roles in everyone’s body. In PMOS, elevated androgens disrupt the normal development of follicles in the ovaries, preventing regular ovulation. Insulin resistance – the majority of people with PMOS have some degree of insulin resistance, meaning their cells don’t respond efficiently to insulin. This causes the pancreas to produce more insulin to compensate, and elevated insulin in turn stimulates the ovaries to produce more androgens, creating a self-reinforcing cycle. Disrupted pituitary signalling – the hormonal signals from the brain to the ovaries are altered in PMOS. LH (luteinising hormone) is often disproportionately elevated relative to FSH (follicle-stimulating hormone), which further disrupts follicle development and ovulation. Genetic factors – PMOS can run in families, suggesting genes play an important role. Researchers are trying to identify which genes are involved, but because it’s a complex condition, it’s not surprising that it’s not a single gene, but that many genes are involved. What are the symptoms of PMOS? PMOS presents differently  from person to person. Some people have many symptoms; others have very few. Some symptoms are visible; others are internal. This variability is one of the reasons it takes so long to diagnose. Irregular or absent periods Irregular menstrual cycles are one of the hallmark features of PMOS. Because elevated androgens interfere with regular ovulation, periods can arrive unpredictably, sometimes weeks late, sometimes skipped altogether. Some people experience very long cycles (35 days or more); others may go several months without a period. What counts as irregular? Cycles shorter than 21 days or longer than 35 days, fewer than 8 periods per year, or periods that have no predictable pattern. If your periods have always been irregular  or if they became irregular after stopping the pill, PMOS is one of the first things worth looking into. Hormonal acne Hormonal acne is one of the most common and most distressing symptoms of PMOS. PMOS-related acne typically appears along the jawline, chin and lower cheeks. It may flare around the time of a period, or it may be persistent and seemingly random. It tends to involve deeper, more inflamed spots rather than surface-level break out, and it often doesn’t respond well to standard skincare. If you’ve tried everything on your skin and still can’t get it under control, your hormones are worth investigating. Unwanted hair growth (hirsutism) Elevated testosterone stimulates hair growth in areas where most women don’t typically grow coarse hair, the upper lip, chin, jaw, chest, stomach and inner thighs. This is called hirsutism, and it affects a significant proportion of people with PMOS. It can range from fine, barely noticeable hair to […]

As a consultant dermatologist, I’ve seen many women come through my clinic doors frustrated by stubborn acne that doesn’t seem to respond to any treatment. If this sounds familiar, you’re not alone. Acne can be a visible and sometimes painful marker of an underlying condition called polycystic ovary syndrome (PCOS). Understanding the connection between acne and PCOS is crucial, not just for the health of your skin but for your overall well being Why Should You Consider PCOS if You Have Acne? Acne is often thought of as a teenage problem, something that magically disappears with age. But for many people, particularly those with PCOS, acne can persist into adulthood and become a significant concern. PCOS is a hormonal condition that affects up to 10% of women and people assigned female at birth and is often characterised by elevated levels of androgens like testosterone– hormones that can lead to increased oil production in the skin, causing clogged pores and, subsequently, acne. But it’s not just any acne we’re talking about. Women with PCOS often experience more persistent and inflammatory acne that tends to appear along the lower third of the face, jawline, and upper neck. This is because of the hormonal imbalance that’s driving excess oil production. So, if you find yourself struggling with acne in these areas and have tried countless treatments without success, it might be time to think beyond the skincare aisle and look a little deeper. What Are the Signs That PCOS Could Be Affecting Your Skin? When we talk about PCOS and acne, it’s essential to consider the bigger picture. PCOS is not just about your skin; it can impact various aspects of your health. So, when should you start thinking about getting screened for PCOS? Here are a few signs that might suggest PCOS could be contributing to your acne: If you’re noticing any of these symptoms alongside your acne, it’s worth discussing them with your doctor. Why Early Diagnosis and Treatment is Key If you’ve been diagnosed with PCOS, it can feel like a lot to take in. But remember, getting an early diagnosis is a positive step. Why? Because it allows you to take control of your health and manage the condition effectively. PCOS doesn’t just affect your skin; it’s a systemic condition that can have long-term health implications, including an increased risk of developing type 2 diabetes, high blood pressure, mental health issues and other metabolic issues. It can also impact fertility and increase the risk of complications during pregnancy. By diagnosing PCOS early, you can work with your healthcare provider to develop a management plan tailored to your needs. This might include lifestyle changes, like a balanced diet and regular exercise, which are crucial in managing weight and improving insulin sensitivity – both key factors in PCOS. Medications may also be prescribed to help regulate your menstrual cycle, manage acne, or reduce excess hair growth. Treating Acne in PCOS: What Works? When it comes to managing acne in the context of PCOS, it’s not just about what you put on your skin – it’s also about addressing the hormonal imbalance driving it. Here are some treatment options that might be recommended: Lifestyle Changes: Small Steps, Big Impact Don’t underestimate the power of lifestyle changes when managing PCOS and its symptoms. Maintaining a healthy weight through a balanced diet and regular physical activity can significantly impact hormone levels and insulin sensitivity, improving both your skin and overall health. Focus on whole foods, such as fruits, vegetables, lean proteins, and whole grains, and try to reduce your intake of sugar and processed foods. Staying hydrated and getting plenty of sleep can also make a difference. In addition to lifestyle changes, a consistent and gentle skincare routine can help manage acne. Opt for non-comedogenic (non-pore-clogging) products and avoid harsh scrubs or overly drying treatments that can irritate the skin further. Take Charge of Your Health Remember, PCOS is a manageable condition. With the right care and support, you can control its impact on your life. Getting screened is the first step towards understanding your body better and finding a treatment plan that works for you.PCOS and acne don’t have to define you. With early screening and proper management, you can take control of your skin and health and feel more confident in your body. The journey might seem daunting, but with the right information and a proactive approach, you can find a way forward that brings clarity and comfort to both your skin and your overall well being Inspiring skin confidence with Hertility and Self London Hertility and Self London are collaborating to give you absolute clarity into what’s going on inside your body and inspire skin confidence. We’re working with patients to uncover how hormones impact not only our reproductive health but also our skin’s natural glow.Discover the partnership

This January as part of Cervical Cancer Awareness Month, we explore how to improve your cervical health to prevent cervical cancer, enhance your fertility and improve your overall reproductive health. Quick facts: Understanding cervical health Cervical health refers to the health and functioning of the cervix, the lower part of the uterus that connects to the vagina. To check your cervical health, you need to attend regular cervical screenings, (known as the smear test), and ensure you have your HPV vaccination. Your cervical fluid changes throughout your menstrual cycle and understanding these changes can give you insight into your fertility. Knowing what your cervical fluid looks and feels like throughout your menstrual cycle can help you identify your optimal fertile window (when you’re most likely to get pregnant). Usually, it becomes more slippery, slimy like egg white around ovulation, to help the sperm swim up towards the cervix. Cervical cancer Every year, more than 3,200 people are affected by cervical cancer in the UK. Two women lose their lives to cervical cancer every week and nine more receive a life-changing diagnosis. Despite this, 1 in 3 people don’t attend their smear test. Yet, if it’s caught early, cervical cancer can be treated. Some countries, like Sweden, predict that they will have eliminated cervical cancer by 2030, while the UK aims to eliminate it by 2040. Ensuring that you have your HPV vaccination and also attending your Cervical Screening when you’re invited is the best way to protect against cervical cancer. With the NHS, you should be invited to a smear test every 3 years between the age of 25-49, and every 5 years after that until to turn 64. The frequency may increase depending on if you have any abnormal results. These cervical screenings check the health of your cervix. It’s not a test for cancer, but it’s a test to help prevent cancer. They are crucial in spotting any changes in the cervical cell which could be signs of an infection or cervical cancer.  Cervical cancer often remains undetected because not everyone will always experience symptoms so ensuring your cervical screening is up to date is an important preventative measure.Symptoms like a change in your vaginal discharge, bleeding between periods, or during or after sex, unexplained pain in your lower back or pelvis, or pain and discomfort during sex can all indicate cervical infection or cervical cancer. Cervical cancer awareness month Cervical Cancer Awareness Month aims to encourage more people to attend their cervical screening appointment and take their HPV vaccinations, (in case they haven’t already got it) to prevent cervical cancer as well as raise awareness about common signs and symptoms. You know your body better than anyone. Becoming attuned to it will empower you and help you spot anything out of the ordinary.If you notice anything that doesn’t feel normal (symptoms like bleeding between periods, or unusual vaginal discharge, for example) when it comes to your reproductive health, especially if you’re trying to conceive or plan to have a baby in the future, speaking to a healthcare professional and getting the necessary tests early in the process is key. The connection between cervical health and fertility First, let’s talk about the cervix and how it’s related to your fertility.  Your cervix is a narrow, cylinder-shaped passage, this is where all the uterine lining will pass through during your period. It is the mouth of the uterus and connects it to your vagina. When in labour, the cervix is also the part that dilates, so the baby can be delivered, but it’s more than just a passageway. The cervix plays a key role in conception. When you ovulate, your cervical fluid (sometimes called cervical mucus) becomes watery to help transport the sperm from the vagina towards the cervix and to the egg to become fertilised (the first step of conception). Your cervical health can affect your fertility in various ways. Infections, cervical cancer and structural abnormalities can lead to your cervix not functioning properly. Without the cervical fluid that helps to transport the sperm, and the protective barrier your cervical fluid creates during pregnancy, a poorly functioning cervix could have led to complications. After ovulation, your cervical fluid becomes sticky and thick, acting like a barrier to the sperm. If this happens around the time of ovulation, it could inhibit sperm from reaching the egg, preventing fertilisation and conception. If you do become pregnant, poor cervical health can cause miscarriage or preterm labour. Infections of the cervix, such as sexually transmitted infections (STIs) can negatively impact fertility. Infections cause inflammation and scarring of the cervix, which can affect its normal function and increase the risk of infertility. Common cervical health issues affecting fertility Cervical infections can affect fertility Infections of the cervix, such as sexually transmitted infections (STIs) can negatively impact fertility. Infections cause inflammation and scarring of the cervix, which can affect its normal function and increase the risk of infertility. Cervical polyps can affect fertility Cervical polyps are growths that can develop on the cervix. Polyps are usually (benign) harmless and do not often cause any symptoms, but they can sometimes cause fertility issues, or increase the risk of miscarriage.  Once found, the treatment is usually to remove them. The process of removal depends on the size, type, location, visibility and number of polyps. Cervical dysplasia can affect fertility Cervical dysplasia is a cervical condition in which abnormal cells grow on the surface of your cervix. Cervical dysplasia (also known as cervical intraepithelial neoplasia or CIN) is not cancer but if left untreated, it can develop into cervical cancer and affect fertility. Early detection and treatment is key. Cervical dysplasia is often termed “precancerous”, which can sound scary, but if you get timely treatment, most people who get it do not get cancer. If you have abnormal cells from your screening test, you may be invited to have a colposcopy test to look closer at your cervix. The treatment you need for abnormal cervical cell changes […]