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Oh Be Some Other Name when you
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what's in a name that would you call a rose by any other name would smell as sweet?
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Oh, the famous question, right? What's in the name? Well, apparently a lot. Now, back when Stein and Leventhal first described this syndrome of a special triad of hirsutism, amenorrhea, and these bilaterally enlarged polycystic ovaries. That, by the way, was back in 1935, published in the Gray Journal. That's how long the ajog has been around. That was called Stein Leventhal Syndrome, Small K series. Guess how many women that was? 7. It was seven women with that triad. Hirsutism, amenorrhea, and bilaterally enlarged polycystic ovaries. Of course, at that time the whole focus was on the abnormal pathology of the ovaries. Well, we've come to learn a lot more about pcos, even that it's not primarily an ovarian issue. The ovary is kind of the victim in this thing. Now it's an active player, for sure, but it's not the primary player, because the primary player is the metabolic derangement and the insulin resistance that leads to this condition. This is a big deal. PCOS affects about one in eight women globally. That's about 170 million women of reproductive age worldwide, y'.
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All.
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170 million. Now we know that there are four main manifestations of the condition. We've talked about this because it really is a very diverse phenotype. Now we've moved away from Stein and Levanthal, we've moved away from pcod, which is how I trained and I learned it as polycystic ovarian disease, but it's actually not a disease at all. Then it became PCOS as polycystic ovarian syndrome. But now we are at pmos. That is pmos. This is a big deal. This just came out in the Lancet on May 12, 2026 and it has been a long time coming. We've talked about this many times before when we've covered PCOS that things are changing. It is now really recognized as a polyendocrine metabolic condition with an ovarian manifestation. So that is what PMOS means, Polyendocrine metabolic Ovarian Syndrome. Now, it's not just about the name. Is that what happens when you change name? Is that resources change medications for it change by taking away this thing that is just a gynecology issue and an ovarian problem and making it a metabolic and endocrine problem. Wow, it really is game changing. And by the way guys, this is not like, hey, let's just come up with a new name right now. This has been a multi stage process. Process, believe it or not, this is actually stage seven that we are in right now of eight. What is the final stage eight? Well, stage eight is final integration into nomenclature, into ICD 9, ICD 10 codes and improper health policy recognition. So we are currently in stage seven? Yep, one through six already happened. We're going to touch on those in a minute. But we are in stage seven right now of this new global consensus of changing PCOS to PMOS. Polyandocrine Metabolic Ovarian Syndrome. Stage 8 is going to be the final integration and that's going to happen in 2028. So still two years away, guys. So this is hot off the press of this thing being released. It's made a lot of medical news sites already and as point of reference, we are recording this on the same day that this was released in the Lancet. And it's not like a group of authors, like people who said let's just change the name because we want to. This is A global consortium. It is a global collaboration and I'll tell you who was involved with this. And ACOG has her stamp on this like yep, we're going to have to talk the same language and ABOG is going to have to, you know, change their case list template because PCOS as a term is going away to PMOs. Polyendocrine Metabolic Ovarian Syndrome. Now stage seven is officially underway. It is meant to be a three year implementation strategy that has already gotten started. Now you think why three years, guys? It takes a long time. By the way, this is not something new for this. When, when the palm coin system was first introduced through figo, very similar pathway was done. Data gathering, communication, international consensus, research and planning. Then they met as a consortium and said let's up with palm coin as a causes of heavy menstrual bleeding in reproductive age woman. And then it went out in full integration and now it's a thing. We are seeing this process happen now for pcos. So once again PCOS is going away. So we might as well get our terms familiar with PMOs. Polyendocrine metabolic ovarian Syndrome. And that is on the same day that we're recording this. On May 12, 2026. This did come out in the Lancet. So now I think I've set it up enough. What's in a name? Well, apparently a lot. We'll be right back. We're just trying to fulfill our life calling and our mission. This is Dr. Chapa's OB GYN no Spin podcast. Yes, we have covered PCOS in the past and things that are off label for this like GLP1 medications. When we change our understanding that this is actually a metabolic issue and a polyandocrine endocrine issue, that opens the door to, to that getting officially FDA approved without it being off label. Plus it allows for much more resources to be done to this and we get away from thinking about this just as a hirsutism issue. It is just as an infertility issue, which it is, but it's deeper than that. So before we get into the, the, the new nuances of PMOs, when we do this very quickly, just remember a few things as reminders, okay? Because we covered back in 2023 then update of still PCOS and that introduced the concept of using serum anti mullerian hormone AMH as one of the potential defining criteria for a PCOM polycystic ovarian morphology in adults. Now remember, based on those 2023 guideline, if you don't have a good sonographer or you don't have any sonographer because, hey, not everybody has one. We're very thankful that we have a phenomenal one. But if you don't, you can do anti mullerian hormone in lieu of polycystic ovarian morphology. And that's a substitute or an alternative when ultrasound is not available. However, just to be clear, anti mullerian hormone is not recommended as a standalone single test for the diagnosis of PCOS or pmos. This is just in case you don't have an ultrasound. Then you can use anti mullerian hormone. And remember that AMH is not indicated for use in adolescents. It's only for the adult population. So greater than 18. Okay, now you got to pick one or the other. Don't do both AMH and ultrasound at the same time. It is one or the other. According to the 23 guidance which I'm looking at right now, quote, both tests should not be performed together to limit over diagnosis, end quote. And remember, as another good reminder, that if you're going to do serum anti mullerian hormone, that because of level of distribution, it can be slightly lower in patients who have a higher BMI, especially over the. Over the BMI of 35. Okay? So amh has to be restricted to adult use and there can be some BMI issues, especially with those with larger bmi. If you're going to do an ultrasound for the diagnosis, remember that the full follicle number per ovary, that's called the FNPO. The FNPO has to be at or more than 20 follicles in at least one ovary, which should be the threshold for polycystic ovarian morphology. Remember, most people use the Rotterdam criteria. We're just trying to do quick reminders here, guys. We're not, we're not going to, you know, belabor this thing just to give you, give you. I'm just trying to give you a quick synopsis of what came out on the day of our recording, May 12, 2026. So if a patient asks you tell me about PMOS, you don't have the deer in the headline. Look, you go, ah, yes, polyandocrine metabolic ovarian syndrome. We're kind of getting away from PCOS is just a problem with the ovary, recognizing that this is kind of a whole system malfunction, if you will, in terms of metabolic derangement. And this is why we've, we've kind of changed our perspective on this. But anyway, the follicle number per ovary is a minimum of 20 in at least one ovary. Also remember that in those patients who have PCOS or PMOS as it's soon to be called, those patients do require screening for diabetes. And at the first enrollment into prenatal care, they should have an early oral glucose tolerance test. We talked about this in a previous episode or some kind of evaluation and why you can get a hemoglobin A1C because they already have proven to have some insulin resistance. Those with PCOS should Probably have a 75 gram glucose tolerance test challenge under 16 weeks to try to catch any early quote, unquote early gdm. And I've posted that in our insta, that little algorithm as well previously. Okay, so because of the insulin resistance that can be foundational for PMOs, slash PCOS. Those patients do require evaluation of hyperglycemia, hopefully preconception. But if they don't come in for that until they are early pregnant, then please check for that after the first trimester so they don't puke up their 75 gram and then check that ideally before 16 weeks. Fine. That's just quick reminders from the 2023 ASRM consensus update on PCOS that leads us now, guys, now think about this. That was 2023 in three years. Now we have the Lancet with this global consensus panel. A lot of people went in here, guys, I'm gonna tell you the number here and who actually contributed to this because it's a lot of societies that we've talked about before. 56 leading academic, clinical and even patient organizations went to contribute to this thing in the one through six stage process to get to where we're at now at stage seven. 56 leading academic, clinical and patient organizations. Five, six. That's, that's a lot. That's why I said it's not just, you know, five or six people who said, let's change the name here. And of course, even though this was led by an international consortium, ACOG's leadership was aware. They said, I know it's coming. We're going to play with you all. We're invested in this. Which means that ABOG is going to change the terminology as well at some point so that medical boards, whether it's a written exam or oral boards, we're all going to be talking the same language. Remember, full implement should be done by 2028. And you heard it here first, guys, on May 12, 2026. So there's going to be a, it's a clinical practice guideline or at least a practice advisory is going to be coming out. I am told but, but this is, this is a big deal. This isn't just some, you know, fringe groups think, you know, it's about just, just change the name and you'll be fine. No, this has big policy, this has big medical education implications. This has big patient care implications because it opens up the door to new medications. All right, talking about core leadership, people involved again. And we're going to do this very quickly. I mean, this has the androgen excess society, we've talked about them before, the AES, this has the Endocrine Society, this has the European Society of Endocrinologies. Okay. ASRM is involved, the European Society of Human reproduction and embryology, I.e. eSHRE, they are involved. And a lot of patient organizations, a lot of, of think tanks went into this and said, please get away from pcos and call this P. Moss. So as we said earlier in the intro, yep, six stages did go by that had to do with data and resource gathering, international communications, policy discussions, and now we are at stage seven. This is a three year process and we are in it right now. Now, again, just like palm coin, it takes a while for this thing to change with the deadline being around mid-2028 when this thing should be done. So amazing. I love this. We're seeing medical history and terminology change in real time. So we are one of the kind of hangouts for this because 195 countries have already started using these guidance and these new terms of PMOs. And so now we're kind of coming alongside them so that globally we can speak the same language. Now if your question is what does this have to do with, with treatment? Again, right now we're just doing the name change. We're just trying to shift our focus here to recognize that this is metabolic, endocrine as well as gynecological issues. That that's true. But next things that will follow after we all know the same language here is society toolkits, professional education programs are going to come out. There's going to, there's going to be a whole new patient awareness campaign that's supposed to launch. Also the NIH is working on something as well. But this will actually open the door to new guidelines for care. So if you take a look at the 2023 ASRM update, right, that gives you all of this, these rows by rows and columns by columns of guidance of what to do for, for infertility, for weight management, for preconception care, for pregnancy care. And we've talked about that, we talked about that ASRM guidance, but there's going to be a new one that look just like that. But now more focus on the metabolic component for P. Moss. So again, very quickly, I just want to let you know what's going on. And we wanted to be true to, to our mission here. Tell you what is hot in press. We just did an episode yesterday, guys, and we've been kind of doing them back to back. That's not our mojo. We try to do it, you know, at least two to three days apart to give Michael, our producer, you know, a little break so he doesn't threaten to quit like he always does. But this has been, man, we got a haunted virus going on. And then we had that's a very interesting case yesterday that we did with our PGY1 unindwelling Foley and normal intensive help. And here the new PCOS nomenclature out on 5 12, 20, 26, we could not resist. And so now you have heard it on the same day of release. I'm not sure if it's going to come out today on the 12th or tomorrow on the 13th, but PMOs, the new PCOs, get ready. It's a three year process and you heard it on the no Spin Podcast Podcast family, as always, we're thankful for you. We're glad you're part of our podcast community. And now that we've done all that, Michael, come on, let's take it home.
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Spring just slid into your DMs. Grab that boho, look for that rooftop dinner, those sandals that can keep up with you and hang some string lights to give your patio a glow up. Spring's calling, Ross, work your magic.
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This is Dr. Chapma's ob gyn no spin podcast.