Review of Updates in Risk Factors and the Family Physician Role in Management of Polyendocrine Metabolic Ovarian Syndrome

Abstract

Polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS), is a complex, lifelong syndrome with a variety of combinations of hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology. The new name reflects the fact that insulin resistance, cardiometabolic risk, mental health and reproductive health go beyond a fertility consultation. This is a critical review of the recent literature regarding susceptibility, diagnosis, complications, and the part played by family physicians in this field. Evidence for the polygenicity of susceptibility, and for a causal role of excess adiposity in some patients is strongest, and prenatal programming and endocrine disruptors are possible prevention targets that have biological plausibility but have not been established in clinical practice. Diagnosis in adults is based on 2 of 3 features after excluding mimicking disorders, anti-Müllerian hormone can be used for the definition of morphology in selected adults in lieu of ultrasound, and both tests are not suitable for diagnosing adolescents. Risk assessment involves glycaemia, blood pressure, lipid profile, symptoms of sleep disturbance, psychological assessment, and endometrial protection in the presence of amenorrhoea. Family doctors have good opportunities to coordinate the longitudinal, preference-sensitive care: explanation of the diagnosis, addressing weight without stigma, prescribing cycle and androgen treatment, identifying metabolic disease, providing preconception counselling and making a timely referral to fertility or specialist services. If the sole cause of infertility is anovulatory, then letrozole is the preferred first-line pharmacological ovulation-induction agent. The metabolic role of metformin is known, while that for inositol is less clear and needs to be discussed openly, and for glucagon-like peptide-1 receptor agonists is still less, and therefore warrants further discussion. The renaming does not change the diagnostic criteria or indiscriminate testing for licensure. A standardized primary-care pathway can help limit the diagnostic delay and the potential for a "too narrow" focus on ovarian imaging to overlook the syndrome's underlying clinical burden.