PCOS Has a New Name: What PMOS Means and What Still Hasn’t Changed

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0:42Gemini and Chrome is here for it. Ready to make anything online make sense? There's no place like Chrome. Check responses set up required, compatibility and availability varies 18+. PCOS just got a new name and I know what some of you are thinking. Cute. Does that also mean the medical system is going to rename the part where women wait years for a diagnosis or are asked, have you tried losing weight? And honestly, that's totally fair because the reality is a new acronym doesn't automatically mean you're going to get better labs, better providers who stop blaming everything on your weight, your stress, or just the fact that you own ovaries.

1:21But this name change, it does matter. So for decades, PCOS stood for polycystic ovary syndrome. And that name made everyone obsess over cysts in the ovaries, except they were never cysts. They were follicles. Your ovaries were trying very, very hard to ovulate. And we see them in younger patients, but not necessarily older patients. And some doctors thought because the name is PCOS, you must have cysts. And if you don't, you couldn't have PCOS. So it was definitely a problem because women were walking into their provider and they had irregular cycles, acne, hair loss, facial hair or hair where they don't want it growing, struggling with fertility, having oily skin, the cystic acne, back knee, butt knee, and being told your ultrasound's normal as if your ovaries had the final ruling in all of this.

2:13And they don't. So PCOS is now being reframed to PMOS, polyendocrine metabolic ovarian syndrome. Is it catchy? Absolutely not. Do you want to embroider it on a sweatshirt? Also, no. It sounds like a committee had a meeting and nobody brought snacks, honestly. But it does point us towards something important. This condition is not just about ovaries. It is about hormones, your metabolic health, ovulation, skin, hair, mood, fertility, and long-term health. Now, I have been saying for years, just because you go through menopause doesn't mean your PCOS goes away. And doctors are like, of course it does.

2:55You don't have irregular cycles anymore. You don't have ovaries that are presenting with these string of pearls, which were follicles, but they thought were cis. But the reality for women with PCOS, well, PMOS, formerly known as PCOS, is that the medical issues of PCOS, they persist post-menopause. So you continue to have higher risk of diabetes and cardiovascular disease. So the name change is important so that we start focusing on the whole person and the whole body experience of PCOS and stop constantly reducing women to just like their reproductive capacity and whether or not that uterus is going to make some babies for us.

3:33But there's also this other problem is that if clinicians hear metabolic, they're going to think weight problems. And then lean PCOS patients are about to get shoved into a blind spot yet again. So today we are going to talk about what the name change means, what it doesn't mean, why lean PCOS cannot get erased. And then we're also going to talk about supplements like how to think about inositol, spearmint, green tea extract, and saw palmetto. So stick around to the end because we're going to talk about some solutions for PCOS. And if you are new here, welcome. I'm Dr. Jolene Brighton. I'm the host of the Dr.

4:06Brighton Show. If you can like, comment, subscribe, I would appreciate it so much. I am board certified in naturopathic endocrinology, a nutrition scientist, and so proud of all of the women, and we're going to shout them out later in this episode, who have made this change happen for PCOS. All right, let's get into our episode. There have been a lot of women on the internet being like, why the heck do we need a new name? Like the old name was fine. And you know, you do have cysts on your ovaries. So we're going to talk about why the old name made women and doctors chase the wrong clue. So what does PCOS make us miss?

4:44PCOS sounds like it's a condition just of the ovaries. That was the first problem. The name pointed everyone towards cysts so that ultrasounds, they became like the main character. A woman could have classic symptoms, but if her ovaries didn't look polycystic, she could get dismissed. And that's what contributes to needing to see like two to three specialists and sometimes going like three, five, seven years before you get a diagnosis, especially if you're Black or Latina. And then there's the opposite. That's when someone has polycystic appearing ovaries on ultrasound and suddenly they get the label and it doesn't fully match their symptoms.

5:20And that's what happens when a condition gets named after one possible finding and they were wrong. It was never cysts. And so the name was wrong. And everyone starts treating the polycystic ovaries as like the whole diagnosis. And PCOS has never been that simple. Okay, so what do we see in PCOS, PMOS? Usually there is elevated insulin. There's insulin dysregulation. About 70 % of those with PCOS, PMOS, they experience this. That insulin stimulates the ovaries to make higher androgens. Think testosterone, but also DHT, which is going to lead to hair loss on the head. So this is where we see hyperandrogen symptoms.

5:58Women with this condition, they will have oily skin, acne, hirsutism, which is hair growth that is thick and coarse and where you do not want it, and hair loss on the head. So this leads us into the first criteria of the Rotterdam criteria. You need to have two out of three to get the diagnosis of PCOS. And what we see is with hyperandrogenism, you can have it on the blood test or you can have it apparent on your skin, oily skin, acne, hirsutism, hair loss on the head. The second criteria is about ovulation. You are having irregular ovulation. Ovulation is going all together. But ovulation is a tricky thing to pin down.

6:35So what do we ask women? How are your cycles? You have irregular cycles. Now, it's not that like your cycles became irregular because now you're 45. That's not PCOS or PMOS. it is that from the onset, maybe you didn't get your period until you were like 15 or 16, or from the onset of your experience of getting your period, menarche, your first period, you had irregular cycles and they have always been irregular. If you go on the pill, that is not you cycling. That is not you getting a regular period. And this matters because a lot of women with PCOS, they have irregular cycles. They have acne.

7:08The doctor says, well, you're young. You don't want to have a baby, right? Let's put you on the pill. And that can help with some of the symptoms. But this is the great thing about the rename. It's no longer just about the ovaries. So stop just giving her the pill and acting like she's an inconvenience in your office. So you take the pill. Then you're doing this withdrawal bleed month after month. And you go to the doctor and you're like, yeah, my periods are regular. And your doctor's like, yeah, you're on the pill. Your periods are regular. Those are not periods. Okay, so that part of your history doesn't matter.

7:35What matters is what was it like when you got your period? What is it like when you are off the pill? What are your cycles like? And if they're irregular, you just hit number two on the Rotterdam criteria. Now, the slippery slope issue with the Rotterdam criteria, and thankfully you only need two or three, is that the third one is the polycystic ovaries, but we already established they were never polycystic. They were follicles, many follicles being recruited. The ovaries are like, I know the brain is saying work and ovulate, and I just want to do a good job, but I just can't get there because these freaking androgens are messing with me.

8:10And so with that, the younger you are, the more follicles we see. Everybody knows this, right? Like younger you are, more eggs in your savings account. The older you are, the less eggs in your savings account. So if you happen to be a woman, 35, 40, you're like, I've had irregular cycles my whole life. I was just put on the pill, but I like actually want to understand what was going on here because my doctor was not invested in actually working me up. And your doctor will say to you, well, you don't have polycystic ovaries. Therefore, you cannot have polycystic ovary syndrome. Okay, well, like that makes sense.

8:41But now we've renamed it. And the rename matters because women with PCOS or PMOS, I'm going to use them interchangeably because it's just too new. Okay, this literally just happened like yesterday. So women with this condition, they have increased cardiovascular risk, they have more inflammation, they have high lipids or elevated cholesterol, they're higher risk for diabetes, they have blood sugar abnormalities. They also have sleep and mood issues. So it's more than just their fertility and their cycles. And thankfully, it was in 2023 that we got updated criteria. Shout out to Dr. Fiona McCullough, who has PCOS, leader in PCOS.

9:20I will link to her episode in this, who was part of putting together these guidelines. And they now say, like, you can also look at an AMH, anti-malarian hormone. And if it is markedly elevated for your age, because AMH is based on your age. And it's kind of a crude measurement of like how many follicles you can recruit. And it was really developed for IVF, advanced reproductive techniques. So like, I just want to be clear about that. That's where it came from. But when we see that you could be like recruiting lots and lots of follicles, that's when we start to look at DCOS. And I do want to shout out Dr.

9:54Fiona McCullough one more time, because research just came out showing that PCOS women can get pregnant later in life. And she has said this for years. I have collaborated with her years in different interviews, different capacities. And she always says her observation is many of her PCOS patients are having babies into their mid-40s. And now we have research showing, yes, like you came with a lot of eggs, my friend. And maybe that and ovulatory cycles, like something about that is making it so that you can reproduce later in life. But that's a big question mark. We don't actually know in the research yet.

10:31So the pattern for PCOS for years has been a woman misses her period for months. She gets told to take the pill. She develops cystic acne. She gets told, take the pill, maybe spironolactone. She starts losing hair, spironolactone in the pill. She grows coarse facial hair, spironolactone in the pill. She struggles to conceive. Then it's like, oh, maybe ovulation actually matters here. And if she also has blood sugar issues, then she might be given the pill and metformin. That's not comprehensive care. That is a scavenger hunt, and it's been a big disservice to these women. So PMOS, this is trying to fix the map and trying to fix care.

11:12Polyendocrine means more than one hormone system may be involved. It's more than just estrogen, more than just testosterone, more than just progesterone. Metabolic means you best be checking her insulin, her glucose, her lipids, her blood pressure, and the long-term risk, that actually deserves attention. It deserves more than just the birth control pill. Ovarian keeps ovulation and reproductive health within the frame so that women who are trying to conceive, women with irregular periods, they're not being left behind. And so PMOS is an attempt to name the pattern of what is happening rather than just centering this about one possible ultrasound finding.

11:49Okay, so new name. Important, but does it actually change anything for the woman sitting in the doctor's office? No. No, it doesn't. Your chart's still going to say PCOS. Your doctor's still going to operate under old school PCOS ideas, and they're still going to tell you to lose weight. Like, this is still going to happen. So while the name is helpful, I think it's a step in the right direction, I think it's very problematic that we celebrate this and we don't ask for more. I want to challenge you. Ask for more. We wouldn't ask for more if we didn't think it was in the capacity for them to give us more.

12:23So what does more look like? More looks like hearing a concrete plan of how medical school education is going to actually change. More is hearing how we're going to invest more money into PMOS and actually understand it. More is understanding how will you take this information to medical conferences and teach doctors how to do better. More is how do you teach clinicians to have better conversations with patients and stop reducing them to just their weight or deciding they can't have PCOS because their weight is fine. So while we can absolutely celebrate this name, I disagree with every provider out there saying PMOS is this groundbreaking, revolutionary, earth-shattering, pivotal moment of change for women with a condition formerly known as PCOS.

13:14It's not. until doctors step up and do better, until healthcare providers step up and do better, then this name change isn't gonna have that big of an impact. And what does doing better even look like? It looks like listening to the person sitting in front of you and believing them when they say, I live in my body, I know my normal, and this is not normal. Doing better means asking why they're having symptoms rather than saying, you know what? I can just put you on the pill and then we'll deal with you if and when you ever decide to have a baby. Having a baby should not be part of the algorithm of whether or not someone gets quality care.

13:53Having a baby should be part of the algorithm of how do we address this? Who are the other specialists that we bring in and how do we think about this case? Now, a big problem that I see with this name, Dr. Fiona McCullough also pointed this out, is that medicine has a translation problem. It's going to hear metabolic and it is going to translate it to your weight. And that's where lean PCOS is going to get erased. So you know the patient. I mean, they have irregular cycles, acne that laughs at every skincare attempt, hair shedding that turns into shower drain that is a crime scene and completely clogged, facial hair that she can locate with military precision, even bad bathroom lighting.

14:35But her BMI is normal. So someone tells her, you don't look like you have PCOS. Lovely. We are diagnosing endocrine disorders by silhouette now. Lean PCOS is absolutely real. We have subtypes of PCOS. And this is where too many providers are not literate enough on this. And it is not just PCOS light because she's like on the diet version of PCOS. And it's not mild by default. It is truly PCOS. And a lean woman can have elevated androgens. She can have irregular ovulation. She can have a high AMH. she can have adrenal androgen patterns as well. And she certainly can experience infertility, acne, hair loss, hirsutism, mental health issues.

15:19That all goes with PCOS. And yes, she can have normal fasting glucose. Fasting glucose is one snapshot. It's not a full metabolic autobiography of your health. And I have a whole episode on what your doctor should be testing for insulin resistance. I will link that in the show notes. And we have to acknowledge that women compensate for insulin resistance years before glucose rises. So some women, they do not have obvious insulin resistance, or they're already doing all the eat right exercise methodology that we know does influence PCOS in a positive way. So the old mistake was no cysts, no PCOS.

15:57The new mistake cannot become no weight issues, no PMOS. Absolutely not. We are not updating the label just to keep the bad thinking. One thing I hear from women all the time is that they're struggling with symptoms like hot flashes, sleep disruptions, and brain fog, but aren't sure where to turn to for help. Menopause is inevitable, but suffering through it isn't. That's why I want to tell you about Alloy. Alloy is a digital health platform that connects you with a menopause-specialized doctor who can create a personalized treatment plan tailored to your needs, all from the comfort of your home.

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17:33And most of those people maintain skin that's still more clear at one year with monthly dosing. EBCLIS, LibriKizumab, LBKZ, a 250 milligram per two milliliter injection is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema. Also called atopic dermatitis that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies. EBCLIS can be used with or without topical corticosteroids. Don't use if you're allergic to EpGliss. Allergic reactions can occur that can be severe.

18:02Eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine when treated with EpGliss. Before starting EpGliss, tell your doctor if you have a parasitic infection. Ask your doctor about EpGliss and visit epgliss.lily.com or call 1-800-LILY-RX or 1-800-545-5979. So a better approach is to treat metabolic as a prompt, but not a verdict. It should be a prompt. Prompt us to assess metabolic health. It should not become a gatekeeping tool. So why am I worried about this? Because PMOS can widen the lens, but only if clinicians do not turn metabolic into code for body size or you're lazy, and lean PCOS has to stay in the frame.

18:45Now, everybody and their brother in the online health coaching space has stepped out to let us know that all the doctors never knew what they were talking about, and only health coaches have been really solving the problem of PCOS. And I just want to say that I put this out on social media and I said, how long until we see these fitness influencers who for years gaslit women with PCOS saying it had nothing to do with your metabolism, you just had a willpower issue, if you just eat right and exercise more, you would have no problems. How long until we saw them step into the light and decide that now they were actually the experts, they never gaslit women, they are the actual experts in PCOS.

19:24And sure enough, it was like less than 24 hours that I saw the health coaches, the fitness influencers coming out and saying, doctors never understood PCOS. It's been us health coaches who have always understood PCOS. And we're the ones who knew about the metabolic issues. And we're the ones that like we're treating women appropriately. And I just have to laugh because a health coach cannot treat anybody. It's outside their scope. They They cannot order labs. They cannot interpret labs. They cannot diagnose and they cannot treat anything that's a medical condition is outside their scope. Now, I want to shout out the women that made this possible because it really upsets me that especially male health coaches would claim the work and the efforts and the glory.

20:07They step in like they're the hero when they were not boots on the ground actually doing all this work. Before I shout out those women, though, I do want to shout out the health coaches who understand their scope, who support women with PCOS, and help them actually get to doctors who can help them. Health coaches absolutely have such a pivotal role to play in healthcare. And just like there are awful, awful doctors out there, we have all met them. There are awful, awful health coaches who aren't even actually certified health coaches. So I want to shout out the names, I have my list here, of women who are boots on the ground, who actually made this name change happen, who've been advocating for PCOS to be seen more than just some polycystic ovaries.

20:47They deserve all the glory, all the credit for all the efforts that they put in. So first one is Shelby Goodrich Eckhard. She has been going off on some of these bros who decided that they are the ones who made this happen. Renette Dubose, she's another one, and she's been such an ally to the Black community because they definitely have been left out of the conversation. Jenny Gutke. I really hope I'm saying people's names right. I'm kind of butchering them. Dr. Dylan Cutler. She's a PhD. The PCOS dietician, which is Martha McKittrick. You can tell I'm not very good at always reading people's names.

21:29PCOS Nutrition Center, which is a whole Instagram account that is dedicated to supporting women with PCOS. The PCOS Challenge Organization has been a large part of this as well. Dr. Fiona McCullough, who I have pointed out before, and the women's dietician, which is Corey Ruth. And there's more. So please, if you know women who have been going to Congress, who have been advocating, who've been working with researchers, who have been doing all of this work to help women with PCOS, please shout them out in the comments because I did not intentionally leave anyone out. But I do want to say to the health coaches and fitness influencers that are saying that no doctor actually knew what was going on with PCOS and it's only been the health coaches.

22:19Like, which doctors? Because there are doctors that have been part of this name change, that have been part of leading this PCOS community and helping women get access to information. As I said, Dr. Fiona McCullough helped shape the 2023 guidelines. But also, if you've read any of my books, you know I've been talking about PCOS being a metabolic issue. And even a decade ago, when I was posting on Instagram, the number of gynecologists that came to me and said, no, birth control pill is just fine. Stop misleading women and sending them misinformation. PCOS is an ovulatory dysfunction disorder. And I'm like, okay, where's the ovulatory dysfunction come from?

22:58No, we're not ready for that conversation. So I do want to acknowledge, I'll be the first to acknowledge, there are a lot of doctors that suck out there. There's a lot of healthcare providers that gaslight women, and it's just plain awful. As a woman with endometriosis, 29 years to get a diagnosis, like I have walked the path of just awful doctors and feeling like you have to put armor on just to be able to go to a medical appointment because, God, you're going to war with some of these people. There are many, many providers out there who are absolutely exceptional. They have PCOS themselves, PMOS now.

23:28And they're absolutely exceptional at helping women, supporting women, and amplifying the voices of women who are online. And so what I always encourage you to do, and you know this, is when you see a great doctor, shout out that great doctor. Because believe me, the mediocre colleagues, they're like crabs in a bucket, like boiling in a pot. They want to pull them back down. They don't want exceptionalism out there serving women sometimes because it really amplifies like how bad of a job that they're doing. And then I also want to acknowledge that there are a lot of doctors out there who are doing the best they can, who are like, okay, the thing I know that can help with this is the pill.

24:08They're not always reaching for the pill because they're lazy. Sometimes they're reaching for the pill because they're like, I know this can help. Or there's a real concern of endometrial hyperplasia, something that happens in PMOS. You don't ovulate. Estrogen stimulates the endometrial lining, you get thickening of the endometrial lining. And that, after years of time, becomes a risk for endometrial cancer. And so they may pass you the pill and say, let's get a withdrawal bleed so that we don't have this risk of cancer. So I'm in no way ever advocating against you having access for the pill. And I'm not saying that all doctors who use the pill are bad.

24:42But there are definitely doctors that make you feel like, why do you work with women because you definitely hate us. And I just want to honor that because, you know, it's such a fine line to walk. And I was saying to my husband the other day, you know, there are doctors and like just profanity warning. I'm going to use some profanity here because this is like literally the conversation that I had with my husband is that there are doctors who are complete assholes and they get mad at me because they're like, hey, same team. At the end of the day, there's this unspoken code that no matter what, healthcare practitioners are supposed to defend them their own.

25:19But I'm sorry. The oath we took was to first do no harm. And if you're an asshole, I was never same, same. Okay. I was never in your corner and I never identified as being on the same team because if you don't care to listen to women, validate women's stories, you're going to have the audacity to tell like thousands upon thousands of women who are having the same experience. that's just anecdotal. And like, I don't really care what you have to say because there's no research study to back that up. Like, why did you get into medicine? Now, as I say all of that, I just want to be crystal clear. And you've heard me say it before that every single profession has people that should have never been in that profession.