How Is PMOS Diagnosed? A Beginner's Guide to Understanding the Diagnosis Process
Polyendocrine Metabolic Ovary Syndrome (PMOS) is a hormonal condition that affects many women around the world. It can cause a wide range of symptoms like irregular periods, acne, excess hair growth, or fertility issues. But figuring out whether you have PMOS can be confusing, especially because symptoms can overlap with other similar conditions.
If you're wondering whether you might have PMOS, or you're just starting to explore what’s going on with your body, this post will walk you through what the diagnosis process looks like.
Where Does a PMOS Diagnosis Start?
Start by talking to your doctor or nurse practitioner.
The first step in diagnosing PMOS is getting a proper medical work-up. Your healthcare provider will look at the whole picture, such as your symptoms, bloodwork, and imaging.
Ask your doctor about:1
- A full physical exam
- Bloodwork (especially checking for hormones and insulin levels)
- A pelvic and transvaginal ultrasound
- A referral to a specialist like an endocrinologist or gynecologist, if needed
What Should You Know Before Getting a PMOS Diagnosis?
Be aware that there’s no single test to diagnose PMOS.1 Your healthcare provider will review your symptoms, medications, medical and family history, menstrual cycle, and weight changes. After that, they might conduct a physical exam to check for physical symptoms, blood tests, and the pelvic and transvaginal ultrasound.
Diagnosing PMOS isn’t always straightforward. It’s what doctors call a diagnosis of exclusion, which means other conditions need to be ruled out first. Your doctor may check for conditions that mimic the PMOS symptoms:
- Hypothyroidism: Happens when your thyroid gland is underactive.2
- Hyperprolactinemia: High prolactin levels in your blood which can cause missed periods, infertility, or unexpected breast discharge.3
- Hypothalamic amenorrhea: Hormonal imbalance when the brain stops sending hormone signals to the ovaries, often due to stress, under-eating, excessive exercise or a combination of all three.
These conditions can cause similar symptoms, like missed periods or hormonal imbalances.
Also important to know that:
- Not all women with polycystic ovaries have PMOS.
- Not all women with PMOS will have polycystic ovaries in their ultrasound results.
This is one of the big reasons why the name was changed from PCOS (polycystic ovarian syndrome) to PMOS.
PMOS can look different for everyone. Some women may have acne and irregular periods, while others struggle mostly with hair growth or fertility. This is why a personalized approach is essential, and it is recommended to reach out to healthcare professionals for an accurate and detailed diagnosis.
What Does a PMOS Physical Examination Look Like?
Physical tests often involve the following:4-6
- General Assessment: Review of your medical & family health history, symptoms, menstrual cycles pattern.
- Pelvic Exam: Checks your reproductive organs for any lumps, growths, or other unusual changes.
- Skin and Hair: Excessive hair growth (hirsutism) on areas such as the face, chest, back, or abdomen areas, as well as thinning hair or hair loss on the scalp, and oily skin or acne.
What Blood Tests Are Usually Done to Investigate PMOS?
Here are some common blood tests your doctor might order, and what they’re looking for:
- HbA1C: This is your average blood sugar level over 3 months which screens for prediabetes or diabetes.
- Fasting insulin: A marker of insulin resistance, a common hallmark of PMOS.
- Fasting glucose: Morning blood sugar levels, also helpful for diagnosing diabetes and prediabetes.
- Prolactin: High prolactin levels in your blood which can cause missed periods or infertility.
- Androstenedione: Checks the function of the adrenal glands and ovaries. Helps find the cause of high testosterone levels in women.
- 17-Hydroxyprogesterone: A key marker for congenital adrenal hyperplasia (CAH), a genetic condition that impacts hormone production in the adrenal glands and can mimic PMOS.
- DHEA-S: Checks how well the adrenal glands are working, looks for certain adrenal tumors, and to helps find the cause of male-like features (such as extra facial and body hair) in females.
- Testosterone: A male hormone that may cause some of the classic features of PMOS like facial hair, acne and missed cycles.
- Estrogen: A female hormone which can be used to assess ovarian function.
- CRP (C-reactive protein): A general marker of inflammation, often elevated in PMOS.
- Full Thyroid panel (TSH, T3, T4): Tests thyroid hormone levels to assess thyroid function and rules out thyroid dysfunction.
- Liver enzymes (ALT, AST, GGT): Monitors liver health, PMOS is often linked to fatty liver disease.
What is a Pelvic Ultrasound?
A pelvic ultrasound is a test that uses imaging to examine the organs and structures in the female pelvis, providing a clear overview of the uterus, cervix, vagina, fallopian tubes, and ovaries.8
What Does the Pelvic Ultrasound Look for in a PMOS Diagnosis?4
- Enlarged ovaries
- Multiple small cysts on the ovaries (often described as a "string of pearls")
- Thickened uterine lining (due to irregular or missed periods)
While the ultrasound alone doesn’t diagnose PMOS, it’s an important part of the overall diagnosis. The ultrasound results will help doctors confirm PMOS, especially when combined with other signs like irregular periods, high testosterone levels, acne, or excess hair growth.
What is Included in "The Rotterdam Criteria"?
After going through different tests, your healthcare provider will use the most widely used diagnostic model for PMOS called the Rotterdam Criteria, which was developed in 2003.4
If you present with at least 2 out of the following 3, you may be diagnosed with PMOS:
1. Irregular or Absent Periods: This usually means that you have fewer than 8 periods per year, or you go more than 35 days between cycles. This happens because the body isn't ovulating (releasing an egg) regularly.
2. Signs of High Androgens (Male Hormones) This can show up in two ways:
Clinical signs (Physical Exam):
- Acne
- Androgenic alopecia (hair thinning)
- Hirsutism (excessive hair growth in other parts of the face/body)
Biochemical signs (Lab/Blood tests):
- High testosterone
- High DHEA-S
- Elevated free androgen index
3. Polycystic Ovaries Seen on Ultrasound. Your doctor may see:
- 20 or more follicles (2–9 mm in size)
- Ovarian volume greater than 10 cm³
How Can I Prepare for a PMOS Diagnosis Process?
If you're feeling overwhelmed, you're not alone. PMOS can be frustrating and confusing, especially when you're just starting out. But getting the right diagnosis is the first step toward understanding your body and taking charge of your health.
Here are some tips to prepare:
- Track and record your symptoms and cycle patterns. This can give your doctor a clearer picture of your condition and support in an accurate diagnosis. Recording this information regularly can make it easier to discuss your health and determine the best treatment options
- Be honest with your doctor about what you're experiencing, let them know your concerns and ask questions about different types of diagnosis examination.
- Don't be afraid to ask for a referral to a specialist as they have the expertise to provide more accurate diagnosis and tailored treatment options for PMOS. Getting a second opinion or more focused care is a proactive step in managing your health.
How July Health Can Help:
Understanding and managing PMOS can be challenging, especially when you’re trying to make sense of new symptoms and information.
At July Health, our goal is to help you get a diagnosis, fast. Whether it’s PMOS or something that looks like it, you deserve to know without having to wait months.
Our nurse practitioners know what signs to look for, what tests to order and can help you figure out your next steps.
Our registered dietitians specialize in hormonal health and are here to provide clear and personalized dietary support.
Our therapists can support you emotionally through the ups and downs of the process and beyond.
Whether you’re dealing with irregular periods, weight changes, acne, or other PMOS-related concerns, we work with you to build a realistic plan that fits your goals and lifestyle.
If you’re looking for guidance from a team who understands what you’re going through, consider booking a session with a registered dietitian.
This article is for informational purposes only and isn't a substitute for individualized medical advice. Talk to your doctor before starting or stopping any medication.
References:
1. Mayo Clinic. (2022, September 8). Polycystic ovary syndrome (PCOS) - Diagnosis and treatment - Mayo Clinic. Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443
2. John Hopkins Medicine. (n.d.). Disorders of the Thyroid. Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/disorders-of-the-thyroid
3. Cleveland Clinic. (2022, January 5). Hyperprolactinemia: What it is, causes, symptoms & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22284-hyperprolactinemia
4. Christ, J. P., & Cedars, M. I. (2023). Current Guidelines for Diagnosing PCOS. Diagnostics, 13(6), 1113. https://doi.org/10.3390/diagnostics13061113
5. Polycystic Ovary Syndrome (PCOS) | HealthLink BC. (2022). Healthlinkbc.ca. https://www.healthlinkbc.ca/healthwise/polycystic-ovary-syndrome-pcos-0
6. NHS. (2022, February 1). Polycystic Ovary Syndrome. NHS. https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/
7. John Hopkins Medicine. (2023). Pelvic Ultrasound. Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/pelvic-ultrasound
