GPs should offer annual review for PMOS, NICE advises
Patients with polyendocrine metabolic ovarian syndrome (PMOS) should be offered an annual review to monitor symptoms, medication and general health, NICE has recommended in new draft guidance.
The yearly check-up for people diagnosed with PMOS should cover signs such as menstrual irregularities and excess hair growth, medicines use, and risk of long-term conditions such as diabetes and cardiovascular disease at a stage when lifestyle changes could help to prevent more serious illness, NICE said.
It is the first UK-only guideline for the condition building on recommendations set out in Monash University’s International Evidence Based Guideline from 2023.
The draft document now out for consultation, also includes detailed recommendations on when to suspect PMOS, how to assess patients, ruling out other conditions and how to diagnose it.
Under the recommendations GPs should suspect PMOS in people aged 10 or over who have a menstrual cycle length shorter than 21 days or longer than 45 days, or any single cycle lasting more than 90 days, as long as it is least a year since their first period.
The condition should also be considered in anyone with a menstrual cycle shorter than 21 days or longer than 35 days, or fewer than eight menstrual cycles per year, if it has been more than three years since their first period and they are not yet in perimenopause, it states.
PMOS is also a possibility in patients who have not had their first period by the age of 15, or three years after the start of breast development, the guidance notes.
But the condition should also be suspected in individuals over the age of 10 who have symptoms or signs of hyperandrogenism even if they have regular menstrual cycles.
And clinicians should not exclude the possibility of PMOS in women, trans men and non-binary people who have experienced menopause, it adds.
Early assessment and investigation, including blood tests and ultrasound, should mean a quicker diagnosis for the condition, which is frequently under-diagnosed and inconsistently managed, NICE said.
The draft guidance follows a renaming of PMOS from polycystic ovary syndrome (PCOS) in May this year after international consensus.
PMOS is thought to affect around one in eight women – around 4 million individuals – in the UK.
NICE also stresses that PMOS may be more prevalent in women of Black, Asian and mixed ethnicity, and healthcare professionals should consider this when assessing symptoms.
And it notes that depression and anxiety are common across all ages in people with the condition.
Eating disorders also disproportionately affect people with PMOS and the draft guideline reiterates that this possibility should not be dismissed solely on the basis of a person’s weight.
The guidance also includes detailed advice on treatments including oral contraceptives and spironolactone for hirsutism in patients over the age of 18 and when to refer to endocrinology.
Marie Anne Ledingham, consultant clinical advisor for women’s and reproductive health at NICE, said: ‘PMOS is a common but often overlooked condition that can have a major impact on health and wellbeing.
‘Recommending a simple annual review is an important step towards ensuring people get the ongoing care and monitoring they need.
‘This new guideline will help improve consistency of care, increase awareness of the condition, and support earlier diagnosis and management.’
Guidance at a glance: NICE draft guideline on PMOS
- Annual review: Offer all patients with diagnosed polyendocrine metabolic ovarian syndrome (PMOS) a yearly review covering:
- Symptoms (including menstrual irregularities and hirsutism)
- Medication
- Risk of long-term conditions such as diabetes and cardiovascular disease
- Lifestyle measures to reduce future health risks
- When to suspect PMOS:
- Age 10+ with menstrual cycles:
- <21 days or >45 days, or
- Any cycle >90 days, at least one year after menarche.
- More than three years after menarche:
- Cycles <21 days or >35 days, or
- Fewer than eight periods a year (before perimenopause).
- No first period by age 15 or three years after breast development.
- Signs or symptoms of hyperandrogenism, even with regular periods.
- If polycystic ovarian morphology has been clearly identified as an incidental finding, e.g. in a scan carried out for another reason
- Age 10+ with menstrual cycles:
- Assessment:
- Do not exclude PMOS in postmenopausal women, trans men or non-binary people.
- Assess promptly using appropriate investigations, including blood tests and ultrasound, while excluding alternative diagnoses.
- Associated health issues:
- Consider increased risks of diabetes, cardiovascular disease, depression, anxiety and eating disorders.
- Do not rule out eating disorders based solely on a patient’s weight.
- Treatment:
- Guidance covers use of oral contraceptives and spironolactone (for hirsutism in adults), and when to refer to endocrinology.
- Other key points:
- PMOS (formerly PCOS) is estimated to affect around one in eight women in the UK.
- NICE notes it may be more prevalent in women of Black, Asian and mixed ethnicity, which should be considered during assessment.
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