Factsheet- Polyendocrine Metabolic Syndrome (PMOS): Navigating Preconception, Pregnancy, and Beyond

Abbie Tomson

Midwife MSc, BSc, Yoga Teacher, Project Lead at All4Birth

@enevlorel @All4Birth

Aetiology of PMOS

The exact cause of PMOS remains unclear, but it is believed to result from a combination of genetic and environmental factors. Insulin resistance is a common feature, leading to hyperinsulinemia which, in turn, stimulates ovarian androgen production. Elevated androgen levels disrupt follicular development, resulting in the characteristic polycystic ovaries and anovulation associated with PMOS. Genetic predisposition also plays a role, with familial clustering observed in many cases.

Genetic predisposition also appears to play an important role, with familial clustering observed in many cases. Researchers increasingly recognise that PMOS affects multiple hormonal systems rather than solely reproductive function, supporting the move toward broader terminology.

Signs and Symptoms

PMOS manifests through a spectrum of symptoms, which may include:

• Irregular menstrual cycles or amenorrhoea
• Hirsutism (excessive hair growth on the face, chest, or back)
• Acne and oily skin
• Weight gain or obesity, particularly central adiposity
• Thinning hair or male-pattern hair loss
• Difficulty conceiving due to anovulation
• Fatigue and difficulties with energy regulation
• Insulin resistance and increased metabolic risk

Diagnosis still typically follows established criteria and generally requires the presence of at least two of the following (Rotterdam criteria):

• Oligo- or anovulation
• Clinical and/or biochemical signs of hyperandrogenism
• Polycystic ovaries visible on ultrasound

Impact on Preconception and Fertility

PMOS is a leading cause of infertility due to its association with anovulation. Women with PMOS may require longer to conceive, and some may need fertility treatments. The National Institute for Health and Care Excellence (NICE) guidelines recommend lifestyle modifications, including weight loss and exercise, as first-line interventions to improve ovulatory function. For those requiring medical treatment, options include clomiphene citrate, letrozole, and metformin. In vitro fertilisation (IVF) may be considered for women who do not respond to pharmacological treatments.

Pregnancy and PMOS

Women with PCOS are at an increased risk of pregnancy complications such as gestational diabetes, preeclampsia, and preterm birth. Regular antenatal care is crucial to monitor and manage these risks. NICE guidelines emphasise the importance of preconception counselling and optimising health before pregnancy. This includes achieving a healthy weight, managing blood glucose levels, and addressing any coexisting conditions.

Breastfeeding and PMOS

Breastfeeding has numerous benefits for both mother and child, and its impact on women with PMOS is a topic of ongoing research. While the evidence is still emerging, several studies and expert guidelines provide insights into how breastfeeding can influence PMOS and vice versa.

Benefits of Breastfeeding for Women with PMOS

1. Hormonal Regulation: Breastfeeding has been associated with hormonal changes that may positively influence the symptoms of PMOS. Lactation induces a natural suppression of androgens, the male hormones that are typically elevated in women with PMOS. This can potentially help in reducing androgen-related symptoms such as acne and hirsutism.
2. Weight Management: Women with PMOS often struggle with weight management due to insulin resistance and metabolic issues. Breastfeeding can increase caloric expenditure, which may assist in postpartum weight loss and improve metabolic health, thereby addressing one of the key challenges faced by women with PMOS.
3. Reduced Risk of Type 2 Diabetes: Breastfeeding has been shown to lower the risk of developing type 2 diabetes later in life. Since women with PMOS are at a higher risk for insulin resistance and diabetes, prolonged breastfeeding might offer protective benefits.

Challenges and Considerations

1. Milk Supply Issues: Some women with PMOS may experience difficulties with milk supply. This can be due to hormonal imbalances that affect the production of prolactin, the hormone responsible for milk production. Consulting with a lactation specialist can help address these challenges and provide strategies to enhance milk supply.
2. Delayed Lactation: PMOS is sometimes linked to delayed lactation, meaning that milk production might start later than usual. Awareness and preparation for this potential delay can help mothers manage expectations and seek appropriate support if needed

Evidence-Based Management and Support

NICE guidelines serve as a comprehensive resource for the management of PMOS across all stages of a woman’s reproductive life. Key recommendations include:

Lifestyle Interventions: Emphasis on diet, exercise, and weight management

Medical Treatments: Use of medications like clomiphene, letrozole, and metformin for fertility

Monitoring and Screening: Regular screening for metabolic complications and mental health issues

Conclusion

PMOS is a multifaceted condition with implications that extend from preconception to parenting. Understanding its impact and following evidence-based guidelines can help manage the condition effectively, ensuring better health outcomes for women and their families. By staying informed and proactive, women with PMOS can navigate the challenges and joys of motherhood with confidence.