How to manage your symptoms of this lifelong condition
- Symptoms of PMOS (PCOS) can be similar to those experienced during perimenopause
- How a testosterone deficiency can affect you
- Why HRT can be beneficial
Polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS), affects the way the ovaries work. There are three main diagnostic features of PMOS:
- Irregular or absent periods
- Excess androgen (characteristically ‘male’ hormones that women also produce), which can lead to excess facial hair, thinning of hair, receding hairline and acne
- Polycystic ovaries – a scan may show that your ovaries are enlarged, and may contain fluid-filled sacs (cysts) that surround the eggs.
At least two of these three criteria are required to diagnose PMOS [1]. However, more than half of those affected by PMOS don’t have any symptoms.
Around 1 in 10 women are thought to have PMOS [2]. It is often associated with women of reproductive age, because those who do have symptoms are most likely to become aware of them during their late teens and early 20s.
However, PMOS doesn’t automatically resolve when your periods stop and you reach menopause. In fact, it is a lifelong condition and some of its symptoms are similar to those experienced during perimenopause. This overlap of symptoms can make PMOS harder to diagnose and manage during perimenopause and menopause.
What happens to PMOS during menopause?
During perimenopause, levels of the hormones estrogen, testosterone and progesterone begin to fluctuate and then decline and stay low forever. If you have PMOS, you may already have lower levels of estrogen and progesterone (which helps to regulate periods and maintain a pregnancy) so these changes can make your existing symptoms worse.
Women with PMOS also tend to have higher levels of testosterone but levels of testosterone reduce during perimenopause and menopause. Women with PMOS often have symptoms of testosterone deficiency more than those without PMOS – these include memory problems, brain fog, reduced stamina, fatigue and low libido.
Both PMOS and perimenopause or menopause can cause the following symptoms or changes. If you are over the age of 40, these changes are most likely associated with perimenopause rather than PMOS:
- irregular or missed periods
- fertility problems
- mood swings
- difficulty sleeping
- hair loss (general thinning in menopause, male pattern hair loss in PMOS)
- unwanted hair growth (e.g. facial hair)
- weight gain.
Some studies show that people with PMOS are less likely to experience hot flushes and sweating during perimenopause and menopause, however they are more likely to report problems with vaginal dryness [3].
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Women with PMOS tend to reach menopause an average of two years later than those who are not affected [4].
How can I manage my PMOS?
There’s no cure for PMOS, but symptoms can sometimes be managed through lifestyle changes such as eating a healthy diet, taking regular exercise and taking steps to improve your sleep.
Eating a Mediterranean-style diet is one of the best ways to help PMOS [5]. This type of diet involves eating plenty of vegetables, legumes/pulses/beans, whole grains, extra virgin olive oil, nuts and seeds, fermented dairy foods, fish and seafood, fresh fruit and eating little meat. Eating 30g of milled flaxseed each day, perhaps stirred into breakfast, may also help reduce the inflammatory and glycaemic effects of PMOS [6].
RELATED: Can the Mediterranean diet help menopause symptoms?
These types of dietary and lifestyle changes may also improve more general symptoms of perimenopause and menopause.
Your doctor may also be able to prescribe medication to help with PMOS symptoms such as excessive hair growth, irregular periods and fertility problems.
Can I take HRT?
Most people with PMOS can safely take HRT. As well as managing symptoms of perimenopause and menopause, HRT can help reduce your risk of type 2 diabetes and cardiovascular disease, which is particularly beneficial as PMOS increases your risk of developing these conditions.
Replacement estrogen can be given through your skin as a patch, a spray or a gel, or as a tablet that you swallow. If you still have a uterus (womb), you’ll also need a progesterone alongside this. The safest type of replacement progesterone is called micronised progesterone, which is branded as Utrogestan in the UK, and comes in the form of a capsule that you swallow and can sometimes be used vaginally. Alternatively, you can have a Mirena coil inserted into your uterus that will last for five years.
If you have PMOS, you’re likely to be used to having higher levels of testosterone, so you’re more likely to experience symptoms when levels begin to decline sharply during perimenopause and menopause and stay low thereafter. As a result, you may benefit from taking testosterone as part of your HRT. Although it’s not currently licensed for women in the UK, testosterone is prescribed by many menopause experts and some GPs as it has many benefits including:
- increased energy and stamina
- improved muscle mass and strength
- better concentration, clarity of thought and memory
- improved sleep
- increased libido and sexual arousal.
Testosterone is usually given as a cream or gel, which you rub into your outer thigh or buttocks. It can also sometimes be given as an implant that is inserted under the surface of your skin.
You don’t usually need to have a blood test before treatment is started, but your doctor is likely to want to measure the testosterone levels in your blood after a few months, to ensure your levels are within the normal ‘female’ range.
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