When I was young, I had elevated levels of testosterone, and I do have a lot of hair on my upper lip and chin/neck. However, I have never had cysts on my ovaries and got pregnant very easily. Because I have the first two symptoms, does it automatically mean I have PMOS?
—Hormonally Hairy
Many women come to me because they are trying to understand if they have polyendocrine metabolic ovarian syndrome, or PMOS. Often they have some symptoms — either body hair growth, scalp hair loss, acne, or irregular periods. Often they have been told by one doctor that they have PMOS and by another that they don’t. By the time they reach my office, they are confused.
The root of all this confusion is twofold: the name of the syndrome is misleading (see below), and a diagnosis of PMOS is made on a clinical basis, meaning there is no one lab test or radiology test that says a woman does or does not have PMOS. Basically, doctors like me are supposed to rule out some other diseases that can cause similar symptoms and consider your overall presentation and come to a conclusion. It isn’t surprising that we disagree sometimes.
Add to that, different medical groups define PMOS slightly differently. The National Institutes of Health defines PMOS as irregular or absent ovulation and signs of high male hormone levels. Many doctors use what’s known as the Rotterdam criteria, which have been updated over the years. Most recently those criteria define PMOS as having two of the following: evidence of high male hormone levels in the blood or in the form of excess body hair growth, scalp hair loss, or acne; infrequent or absent ovulation, which many women will experience as irregular or absent periods; characteristic cysts on the ovaries.
If you have irregular periods and signs of high male hormones, you do not need to have cysts to meet those criteria. In fact, not all women with cysts have PMOS and not all women with PMOS have cysts.
I would argue on some level that whether or not you have PMOS should not impact your treatment. Hear me out. PMOS is a syndrome — just a constellation of symptoms that are often seen together — not a disease. We do not really understand what causes it, and we cannot cure it. We manage PMOS by treating the symptoms that bother you, and we would treat them the same way whether your symptoms are caused by PMOS or not.
Regardless of whether you have PMOS, if your symptoms are bothering you, you should discuss treatment options with your doctor.
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