Tag: how is PMOS diagnosed

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 […]