Polycystic ovary syndrome (PCOS), or Polyendocrine Metabolic Ovarian Syndrome (PMOS), is one of the most common hormonal conditions affecting women — yet it remains widely misunderstood. For many women, getting a diagnosis can take years, and even after diagnosis, questions about fertility, weight, nutrition and long-term health can remain unanswered.
In this episode, experts from Stony Brook Medicine take a closer look at PMOS, including diagnosis, symptoms and what PMOS can mean for fertility and long-term health.
Experts in the Studio
- Obstetrics and Gynecology, Stony Brook Medicine
Amy Canterella, MS, RDN, CDN
- Dietician, Stony Brook Medicine
- Endocrinology, Stony Brook Medicine
What You’ll Hear in This Episode
- 00:00 Disclaimer
- 00:17 Opening and Introductions
- 2:49 What is PCOS/PMOS?
- 4:00 What are the warning signs for PMOS?
- 5:02 Why do symptoms vary from person to person?
- 6:10 Why does PMOS often take so long to diagnose?
- 6:33 When should somebody see a provider or specialist?
- 8:05 PMOS and fertility
- 9:18 Nutrition and PMOS
- 11:25 How is PMOS diagnosed?
- 13:03 Is there a “best diet” for those diagnosed with PMOS?
- 14:11 PMOS, insulin and weight loss
- 15:56 Dealing with stress and managing sleep with PMOS
- 17:08 How can PMOS impact our overall health?
- 17:50 Myths about PMOS
- 20:00 What should I do if I suspect I have PMOS?
- 20:32 When should I see a specialist?
- 20:55 The PMOS Center at Stony Brook Medicine
- 21:38 Is PMOS curable/treatable?
- 22:13 Does PMOS go away for women through menopause?
- 22:45 The future of PMOS treatment
- 28:10 Closing remarks
Full Podcast Transcript
Description of Video Studio: News desk with Stony Brook Medicine logo on the front; a big screen is behind experts with HEALTH Yeah! Logo displayed.
00:00 Disclaimer
Disclaimer: The information provided in this podcast is for educational and informational purposes only, and is not intended as a substitute for professional medical advice, diagnosis or treatment. If you think you may be having a medical emergency, call your doctor or emergency services immediately.
00:17 Opening and introductions
Announcer
Welcome to HEALTH Yeah!, where experts from Stony Brook Medicine come together to discuss topics ranging from the complex inner workings of an infectious disease to tips and tricks for staying safe and healthy all year long.
Fatima Daoud Yilmaz, MD
Polycystic ovary syndrome, or PCOS, is one of the most common hormonal conditions affecting women. Yet, it remains widely misunderstood. For many women, getting a diagnosis can take years, and even after diagnosis, questions about fertility, weight gain, nutrition and long-term health can remain unanswered.
You may also be hearing a new name for this condition: polyendocrine metabolic ovarian syndrome (PMOS) and wondering what that means. Today, we’re taking a closer look at PMOS, what’s behind the name change, and why it was needed. How the condition is diagnosed, why symptoms can look so different from woman to woman and what PMOS can mean for fertility and long-term health.
I’m Dr. Fatima Daoud, an OB/GYN who treats PMOS, and I’m joined today by two of my colleagues from Stony Brook Medicine’s PCOS Center, Dr. Deidre Eschler, an endocrinologist, and Amy Cantarella, a registered dietitian. The three of us represent the collaborative approach at the heart of our center. Because PMOS is a complex condition that can affect many different systems in the body, we believe the best care comes from bringing different specialties and perspectives together, including reproductive health, metabolic health, nutrition and lifestyle.
Together, we’ll explore the different aspects of PMOS and how these areas intersect to create a more comprehensive, individualized approach to care. We’ll also talk about the role nutrition and weight management can play in treatment, tackle some of the most common myths about PMOS and answer the questions you may be hesitant to ask. Whether you’ve been recently diagnosed, have been experiencing symptoms without an explanation, are concerned about fertility or simply want to better understand your health. This conversation is for you.
I’m joined today by my colleagues. Do you mind introducing yourselves?
Amy Canterella, MS, RDN, CDN
Yes. Hi, my name is Amy Cantarella. I’m a registered dietitian nutritionist, and I see many patients who are adolescents and young adults with PMOS.
Deirdre Cocks Eschler, MD
And I’m Deirdre Eschler. I’m one of the endocrinologists here at Stony Brook. I see patients across all endocrine disorders, but I’m the endocrine lead of the PCOS Center.
2:49 What is PCOS/PMOS?
Fatima Daoud Yilmaz, MD
Dr. Eschler, can you tell us what exactly is PCOS and why are some experts now calling it PMOS?
Deirdre Cocks Eschler, MD
So PCOS stands for polycystic ovary syndrome, and it’s actually a misnomer because it implies that there’s a problem just with the ovary, and that there are cysts on the ovaries. And actually, it’s not just an ovarian problem, and they’re not really cysts on the ovaries. These are just what look like cysts on ultrasound, or just the follicles which are starting and then stuck in their development.
So recently we changed the name to PMOS, which stands for Polyendocrine Metabolic Ovarian Syndrome. This really reflects that this is a polyendocrine system. This is a metabolic problem. This does not just reflect ovarian and ovulatory dysfunction. It really reflects what’s happening with the disorder.
Fatima Daoud Yilmaz, MD
And do you feel like the new name better reflects what the condition actually is?
Deirdre Cocks Eschler, MD
Absolutely. I think for years people weren’t properly being diagnosed because everybody thought they had to have a problem with the ovary, right? It had to be PCOS. This is going to not just help people get diagnosed appropriately, but also be treated. It’s going to look at the whole picture, not just the GYN component of all this.
4:00 What are the warning signs for PMOS?
Fatima Daoud Yilmaz, MD
Speaking of the GYN component, I’m often asked, “What are the warning signs for PMOS that people should be looking out for?” Certainly, my world as a gynecologist, I think a lot about what’s called ovulatory dysfunction, meaning that your body does not fire off an egg exactly when it’s supposed to every single month, and that can lead to periods that are either very spaced apart, or periods that are way too close together, or bleeding that has no pattern whatsoever, kind of here, there, and everywhere.
But far beyond gynecology, I also tell patients to look out for signs of abnormal hair growth in areas on the body where women do not typically grow dark coarse hair, hair loss at the crown of the head, painful cystic acne along the jawline, as well as, of course, cysts on the ovaries that may have been incidentally found. Really, they’re follicular cysts that are found on ultrasound, but they do vary so much from person to person.
Dr. Eschler, can you explain why it looks so different on each person?
5:02 Why do symptoms vary person to person?
Deirdre Cocks Eschler, MD
I think certainly some ethnic contributions can play a role. Certain ethnic groups will have more hair growth in places where I always say, “Are you getting hair in places where maybe a woman wouldn’t want it right on the face?” But there’s no biomarker. There’s no exact one size fits all. So some women’s menstrual cycles might be just a little irregular, and some women might be getting two menstrual cycles a year. Some might be finding that they’re getting excess hair and having to shave daily, as others might find that they’re plucking from time to time.
Fatima Daoud Yilmaz, MD
And I love that you mentioned how it could be so different across so many people, but it’s still the same condition at the end of the day.
Me, as a gynecologist, I’m asked a lot, “Well, how can I have this condition if my periods are like clockwork? They’re so regular.” And I do want to touch on this in a little bit. But just to kind of emphasize, there is no one size fits all. There is not one picture of what PMOS must look like in order for someone to qualify as having the diagnosis.
It is one of the most common hormonal disorders affecting women. Why do you think, Dr. Escher, it takes so long to diagnose?
6:10 Why does PMOS often take so long to diagnose?
Deirdre Cocks Eschler, MD
Well, I think part of it may have reflected the previous name. Right, we had to think that there was definitely a problem just at the ovarian level, but also, again, that it’s not one size fits all. That a lot of the symptoms can be non-specific. Many women actually go to multiple doctors before they formally come up with a diagnosis.
6:33 When should somebody see a provider or specialist?
Fatima Daoud Yilmaz, MD
Do you think that there’s a certain point where you would encourage your patients to start seeing a specialist?
Deirdre Cocks Eschler, MD
Well, I think if anybody thinks that they have PMOS, it’s a good time to go to your gynecologist, perhaps your endocrinologist, talk with your primary care doctor and certainly advocate for yourself.
Fatima Daoud Yilmaz, MD
You mentioned a lot of different specialties of medicine, primary care, endocrinology, how do those doctors actually diagnose PMOS?
Deirdre Cocks Eschler, MD
Well, again, I think now with the name change, we’re raising more awareness. This is something that decades ago we really weren’t talking enough about, but we’re talking about it now. We’ll talk about it, I think, as well in this session. But this is a problem that will affect anything from cardiology to pulmonary to gastroenterology to endocrinology. So it really does go across all subspecialties in internal medicine and in GYN.
Fatima Daoud Yilmaz, MD
I think that’s also probably, at least in my experience, when I’ve had patients come in for second opinions, having gotten a PMOS diagnosis in the past, or being told that they definitely don’t have it. I think what makes it challenging is that there’s no one single test, the way that there is, for example, for iron deficiency. It’s a combination not only of history-taking about the person’s weight history, fertility history, menstrual history, but we’re also doing sonograms and have very specific sonographic criteria that we look at. And there’s also blood work and physical exam components that go into making a diagnosis to see if a patient has what’s called hyperandrogenism or excess male hormone expression as well.
8:05 PMOS and fertility
Fatima Daoud Yilmaz, MD
One of the biggest fears that people have, at least from what I hear as a gynecologist, is regarding infertility. It’s one of the most common questions that I get, and patients [ask] me, “Well, you know, is it possible for me to get pregnant?” And it’s such an important question, but it’s also a question that’s not very easy to answer.
You know, I kind of talk to my patients about like fertility has no one test, just like PMOS does not have one single test. In fact, myself and the nurse navigator for the PMOS Center, we’re keeping a running list of patients who we send for sonogram to evaluate to see if there are signs of polycystic ovaries on sono, and we find a baby in there, and we say, “Ha ha! Well, that’s why you’re not necessarily getting a period these last three months.”
So it’s perfectly possible for individuals affected by PMOS to not have any issues whatsoever getting pregnant, and it’s also very possible that they will require anything from ovulation induction, intrauterine insemination, IVF to help them build their family. But just like PMOS does not affect all women the same way, or like the same way on all women, it also doesn’t affect fertility across the board to the same degree of severity.
9:18 Nutrition and PMOS
Fatima Daoud Yilmaz, MD
Amy, a question that I have for you: In your experience, what’s the most common misconception regarding nutrition and PMOS?
Amy Canterella, MS, RDN, CDN
I think the most common misconception is that you have to remove things in your diet that you might love, things that bring you joy, foods that you’ve grown up with and that is something that’s just not true.
You know, nutrition with PMOS is really about finding balance, finding a way to include all of the foods that you love, but also focus on adding in other foods that are going to benefit and minimize symptom burden. The individual approach, where we look at a woman as a whole, we look and consider what is her lifestyle. What are her, you know, what are the foods that she loves? What brings her joy? Besides nutrition, can we also focus on behavior change? Can we look at sleep, stress, all inclusive in terms of the approach for the diet.
Fatima Daoud Yilmaz, MD
Does the dietary approach for this always have to include limitation of carbohydrates? I always get that question.
Amy Canterella, MS, RDN, CDN
No, absolutely not. Carbohydrates are actually wonderful, and we’re not happy people when carbohydrates are eliminated from our diet. So I really feel that when we tell someone that they have to restrict their diet, they feel like they’re being punished for a condition that they, you know, did not necessarily cause. There’s so many components that come into PMOS that we don’t want to have anybody feel like this is their fault.
So I don’t believe in restricting carbohydrates. In fact, we want to utilize carbohydrates to enhance one’s diet, but it really depends on the type of carbohydrate, the source of the grain that we’re seeking, because we want to make sure that when someone is having a meal, they’re getting all of the components that come together that will really help their metabolic health overall.
11:25 How is PMOS diagnosed?
Fatima Daoud Yilmaz, MD
Dr. Eschler, how do doctors actually diagnose PMOS?
Deirdre Cocks Eschler, MD
So PMOS is a diagnosis of exclusion, and that means we exclude other reasons why someone’s coming to us. Usually, they’ll come to us with irregular menstrual cycles or with concerns of excess hair growth.
So once we’ve excluded other reasons for those symptoms, you have to meet two out of three criteria. It’s called the Rotterdam criteria. So one would be menstrual cycle irregularity. We usually see cycles either over 35 days on average, or less than 21 days, or less than eight cycles a year. Many women actually will go months without getting a period each year. That would be one criteria.
The other criteria is either physical signs or blood work signs of excess male hormone. So in the blood work, we see elevated male hormone levels, which are called testosterone levels. And physically, some women might complain that they’re getting excess hair growth on their face, for instance.
The third criteria would be that you have either polycystic ovarian morphology on your ultrasound, or in our newest iterations of our guidelines, you can also use a blood test called an AMH. So once we’ve excluded those other reasons, you would have to meet two out of three of those criteria.
Fatima Daoud Yilmaz, MD
So it sounds like this is an approach that requires not just history taking and a physical exam, but an ultrasound and lab work. So there’s no one single test for this condition?
Deirdre Cocks Eschler, MD
No, I always say that’s the most complicated thing. There’s no one biomarker. We can’t say yes, like we say you have diabetes or yes, you have a thyroid problem. We really have to look at the whole picture. And taking a history is actually really important part of our history with the patient and our exam.
13:03 Is there a “best diet” for those diagnosed with PMOS?
Fatima Daoud Yilmaz, MD
Amy, as a registered dietitian, I’m sure you get this question a lot, but is there a “best diet” for people affected by PMOS?
Amy Canterella, MS, RDN, CDN
No, I don’t believe that there is one set best diet. Really, when I’m working with a patient, I like to to get to know them and really take an individualized approach when it comes to nutrition, and not just focusing on nutrition, but also other aspects of their life that include exercise levels, stress, sleep, and addressing all of those in a very small, realistic way.
I do also, when we look at the literature, there is a lot of information on certain diets, especially the Mediterranean style diet, which I love. If you imagine yourself on a Greek island, you know, sandy shores, blue water, unlimited access to fruits and vegetables, as well as fish and and whole grains, and having really more unprocessed foods. That diet has been very effective in helping decrease insulin resistance as well as decreasing inflammation, which will benefit somebody with PMOS.
14:11 PMOS, insulin and weight loss
Fatima Daoud Yilmaz, MD
When you’re talking about balance, I know something that you mentioned a moment ago was insulin resistance. How does that play a role when we’re talking about weight loss? Does everyone with PMOS have to have a weight loss goal?
Amy Canterella, MS, RDN, CDN
No. In fact, I feel like it’s not very fair to place that kind of stress on women that they have to lose weight in order to improve their symptoms. Oftentimes, we can see symptom improvement when we initiate changes again in various aspects of our life, but especially for nutrition.
Insulin is really tricky because it is a cool hormone that gets energy into our cells, but when we become resistant to insulin, it can’t do its job effectively. So our cells are essentially starving, wanting us to eat more and have intense cravings, and that can promote weight gain. But that doesn’t mean that somebody has to only lose weight in order to have improvements. We want to focus on, you know, decreasing their insulin resistance, and we see benefits with that.
Fatima Daoud Yilmaz, MD
So, are you saying that when the body can’t process sugar with insulin properly, is that why people with PMOS have so much difficulty losing weight?
Amy Canterella, MS, RDN, CDN
Yes, absolutely, 100 percent. And so, again, I think that the message has always been eat differently in order to help your PMOS, and in reality, we really need to also address their level of activity, their role with food, their role with their own body image. We need to look at their stress levels. We need to consider their sleep patterns. All of that’s beneficial as well.
Fatima Daoud Yilmaz, MD
So it sounds like this is more of a lifestyle treatment for the condition, in addition to what doctors have to offer with medications.
Amy Canterella, MS, RDN, CDN
Absolutely, 100 percent. 100 percent.
15:56 Dealing with stress and managing sleep with PMOS
Fatima Daoud Yilmaz, MD
Why is something like stress management and sleep, how can that affect our overall well-being with PMOS and nutrition?
Amy Canterella, MS, RDN, CDN
I think when it comes down to it, again, it’s this underlying factor of insulin resistance. When we are stressed, our body releases cortisol, which affects our hormones, increasing insulin resistance, increasing inflammation. When we’re also sleep deprived, as moms we’ve all been, we also crave sweets and look for sugar, which will increase our blood sugar levels and further, you know, increase the insulin resistance that we might be having.
So sleep is imperative. Studies have found that under seven hours of sleep is not enough, and stress levels are higher at that point. So we really recommend seven to nine hours. But any amount of sleep somebody can get is a beautiful thing. But also, we want to focus on decreasing the stress in their life, and again, for women, there’s a lot on their shoulders. So, what can we do realistically to maybe delegate some of the responsibilities that we have, but also find little things in life to help bring down our stress levels in the moment.
17:08 How can PMOS impact our overall health?
Fatima Daoud Yilmaz, MD
So it sounds like we’re talking about nutrition, we’re talking about lifestyle, we’re talking about fertility. Dr. Eschler, how else can PMOS affect our long-term health?
Deirdre Cocks Eschler, MD
Yeah, so the endocrine complications include that you get metabolic syndrome, so that can include insulin resistance, diabetes, pre-diabetes. There’s also an increased risk of having cholesterol abnormalities, and there’s an increased cardiovascular risk overall.
But what people don’t know, there is a higher risk of sleep apnea in women with PMOS. There is a higher risk of what we call fatty liver, which can lead to scarring of the liver or liver fibrosis in women with PMOS. There’s also a higher risk of mood disorders. So anxiety, depression, binge eating disorder. So it’s really the whole patient, the whole person, the whole picture that we want to talk about when we see patients with PMOS.
17:50 Myths about PMOS
Fatima Daoud Yilmaz, MD
Very cool. I mean, I have to ask you. You’ve been doing this for a long time. What is one myth about PMOS that you wish would disappear?
Deirdre Cocks Eschler, MD
Well, I think I’m going to elaborate and give myself two myths. Okay, so I would say first of all, you do not have to be overweight or obese to have PMOS. Twenty percent of women actually are not obese who have PMOS, so that does not exclude the diagnosis. If you think you may have it.
Secondly, I want to say this isn’t your fault. It is not uncommon that a woman with PMOS comes to see me and they end up in tears because they have seen a lot of other doctors, and maybe a doctor told them, “Well, it’s just because you’re overweight or obese and just lose weight, stop eating what you’re eating.” And I want to say it’s not your fault. This is not one single problem here. This is a polygenic condition, meaning lots of genes play a role, as well as environmental and even in utero changes might contribute to PMOS.
So while we do want everybody to see a nutritionist, ideally, and focus on lifestyle, what they’re eating, how they’re exercising and how they’re sleeping, I just want them to know it’s not your fault, and we’re here to support you through whatever challenge it might be.
Fatima Daoud Yilmaz, MD
I want to add on. I want to add a third myth because I completely agree with that. I feel like in my role as a gynecologist, a lot of what I talk to my patients about is the concept of endometrial protection. So protecting the lining of the uterus. People affected by PMOS have higher rates of cancers and precancers, benign overgrowths of the lining of the uterus. And so when I’m talking to them about a short-term and long-term plan, a lot of times we end up talking about hormonal birth control, and I feel like it is a disservice to a lot of my patients who hear that birth control is just a band-aid, birth control is not actually helping. The second you stop it, everything’s going to come back.
When we’re viewing this as a whole-body metabolic hormonal condition, part of that is thinking about yes, your fertility, which you need a healthy uterus for, but even if fertility isn’t a goal for someone, we have to think about what role can hormones play. It is not a band-aid; it is a treatment, hormonal treatment for a hormonal condition.
Deirdre Cocks Eschler, MD
I completely agree. If I can add on to that, I always tell my patients we’re here to talk about a couple different things: one is the metabolic component of PMOS; one is the endometrial protection component; one is possible fertility component; and one is the cosmetic part — the excess hair growth component. And birth control plays a real vital role in a lot of those.
20:00 What should I do if I suspect I may have PMOS?
Fatima Daoud Yilmaz, MD
So, if someone thinks they might have PMLS, what do you think their next steps should be?
Deirdre Cocks Eschler, MD
I would visit either your primary care doctor, your gynecologist or perhaps an endocrinologist to get evaluated.
20:32 When should I see a specialist?
Fatima Daoud Yilmaz, MD
And let’s say someone comes up on a dead end, or maybe is not getting the answers that they need. At what point do you think a patient should really push to see a specialist in this condition?
Deirdre Cocks Eschler, MD
I think you’re always welcome to if you feel like you’re not getting the answers. Again, there was a study that showed that many women will see multiple doctors before they finally come at the answer of PMOS.
20:55 The PMOS Center at Stony Brook Medicine
Fatima Daoud Yilmaz, MD
So you mentioned doctors. Here at the Stony Brook PCOS Center, we have access to lots of different doctors: dermatology, endocrinology, obesity medicine, primary care, mental health.
Beyond seeing a bunch of different doctors. What other resources do we have here at the center for our patients?
Deirdre Cocks Eschler, MD
Yeah, so we are so lucky to have this Center, and I think without having a nurse navigator who can help coordinate all of this care for patients, we really wouldn’t be as successful as we are. And also, really important is our colleague next to us. Having nutritional support is a key role, a real key component in treating PMOS patients.
21:38 Is PMOS curable/treatable?
Fatima Daoud Yilmaz, MD
All right, so I have some rapid fire questions. My first question: is PMOS curable?
Deirdre Cocks Eschler, MD
That’s a loaded question. So it’s treatable at the moment. Again, because we don’t have one single gene, one single reason, one single genetic component that we can target. There is no cure for PMOS, but we treat the different components of PMOS. If it’s causing metabolic syndrome, we treat that. We treat endometrial protection. We treat infertility. So we can’t cure it yet, but we can definitely treat you.
22:13 Does PMOS go away for women going through menopause?
Fatima Daoud Yilmaz, MD
Now I didn’t forget about our menopausal ladies. A question that I get a lot as a gynecologist is: Once menstruation is no longer an aspect of someone’s health, does PCOS / PMOS, does it go away?
And to kind of echo what Dr. Eschler was mentioning, it doesn’t. There are far-reaching effects of this condition well beyond gynecology, including what was mentioned before: sleep apnea, issues with weight, fatty liver, and this is an especially important time in that menopausal chapter of our life to really take those complications seriously to prevent issues down the line.
22:45 The future of PMOS treatment
Fatima Daoud Yilmaz, MD
Dr. Eschler, in your role not just in the PMOS center, but as a full scope endocrinologist, what do you think is the future of PMOS treatment?
Deirdre Cocks Eschler, MD
Yeah, so I have to say, I think that we can’t get on any podcast without probably talking about the GLP-1 analogs right now. So mostly injectable, but now oral agents as well for weight loss. And we talked about lifestyle and nutrition and weight loss really being a cornerstone in the treatment and management of PMOS, and I think the GLP-1s have transformed that.
They’re not formally approved for PMOS; they are studied, looking at how it does improve parameters in PMOS. But I see women who are able to get the GLP-1s ones covered for obesity reasons, based on their BMI, or perhaps based on sleep apnea or fatty liver, and they come back practically in tears about how happy they are, not only do they feel better, but their menstrual cycles have improved, their excess hair growth has improved, perhaps their fertility has improved.
So I think that I hope the future holds approval for a GLP-1 being covered for PMOS, and if not, perhaps advocating if you get it covered for another reason.
Fatima Daoud Yilmaz, MD
Totally, I feel like it’s hitting PMOS from so many different aspects. It’s addressing insulin resistance. It’s addressing the actual amount of body fat that someone carries. It’s definitely affecting the endometrium. I’m a gynecologist. I have to talk about it. But when we decrease the amount of fat tissue on someone’s body, we’re decreasing the amount of estrogen. We’re decreasing the exposure of the lining of the uterus to things that can lead to cancers, precancers. I’m completely on the same boat as you. I’m a huge proponent.
Deirdre Cocks Eschler, MD
Yeah, I really think it’s exciting for what it’s doing in all of medicine, but especially in PMOS.
Amy Canterella, MS, RDN, CDN
I will say one of the most amazing things that I’ve heard from some patients who had started a GLP-1 is how the food noise quieted down. I think people assume that people are making a choice to eat a certain way, and some of us have more hunger hormones in our body. Some of us think about food more often. So the GLP-1 has been really eye-opening in helping patients recognize that I feel in control at this moment. I have more control, and it has given them the first step into starting to initiate changes that they weren’t able to before.
Fatima Daoud Yilmaz, MD
And you were mentioning, this is very cool, before you were mentioning how when the body is insulin resistant, the cells think that they’re starving, and that makes us hungrier.
Amy Canterella, MS, RDN, CDN
Yes.
Fatima Daoud Yilmaz, MD
So it makes sense that GLP ones are utilized for this condition.
Amy Canterella, MS, RDN, CDN
Yes, absolutely. And that has been the most eye opening for me. And I’ve had patients literally say, “I have never felt full. I have always been hungry. I’ve always thought about food, and now I have this tool, along with other things that have allowed me to feel more in control.” And so they are able to make more changes in nutrition. They are able to make changes with activity because their body composition is changing, and all of that comes together and benefits their health.
Fatima Daoud Yilmaz, MD
I like that you mentioned that it is a tool, right? GLP-1s are a tool. Nutrition is a tool. Hormonal treatments are a tool. Something that this reminds me of is I had a patient who happened to carry excess weight, and at the same time we had diagnosed her with a precancer of the lining of the uterus.
And so when I was talking to her about tools in treating her PMOS, we were talking about what are we doing in the short term to take care of you now, and what are we doing in the long term to help you achieve your goals? Because having a baby was one of the most important things to this patient. But, of course, she also cared about herself, so we were treating the gynecologic aspect of the PMOS with a hormonal IUD that releases a hormone called Levonorgestrel to progestin that sprinkles hormone directly on to the uterine lining that has that precancer. It makes the precancer go away.
In the meantime, with excellent contraception on board, she was able to get bariatric surgery. She lost a significant amount of weight. With the combination of the lifestyle change, with the bariatric surgery, with the IUD in place, the precancer completely went away. We were able to remove the IUD, and she spontaneously got pregnant on her own. We’re thinking about PMOS as a long-term condition that has this tool for this particular time of your life and that tool for far beyond.
So I love the idea of having a tool belt to treat PMOS as opposed to like a dogma or a philosophy.
Deirdre Cocks Eschler, MD
That’s a beautiful story. I love that. I do want to say that for women who do go on a GLP-1, and they do want to get pregnant, I always advise using some contraception because they’re not approved for use in pregnancy. And the current recommendations are to stop it two months before trying to get pregnant.
Fatima Daoud Yilmaz, MD
Absolutely, completely agree. While ovulation can naturally come back, not only because of the hormonal effects of the GLP-1, but because of the weight loss effects. Yes, we definitely don’t want people getting pregnant before they’re ready to get pregnant, and while they’re on a medication that is not advised in pregnancy.
So I love that we’ve mentioned PCOS, PMOS needs to have tools that we’re utilizing both short term and long term, and not just relying on philosophy or dogma when it comes to treatment.
28:10 Closing Remarks
Fatima Daoud Yilmaz, MD
Thank you for joining us to explore PMOS, and ladies, thank you so much, Amy, Dr. Eschler, for joining me today. We hope today’s discussion helped you better understand the condition, recognize some of its signs and symptoms and feel more confident talking to your healthcare provider.
To learn more about PMOS and the center available at Stony Brook Medicine, visit our website, womenshealth.stonybrookmedicine.edu/services/pcos. To schedule an appointment, call (631) 444-4686, and be sure to follow us on social media for more health information and updates from Stony Brook Medicine. Until next time, thanks for listening.
Announcer
Stony Brook Medicine is Long Island’s premier academic medical center. We transform lives through scientific discovery, education, and care, and we bring together innovative research, advanced education, and extraordinary healthcare expertise to set the standard for how healthy communities thrive.
For more information, visit StonybrookMedicine.edu or follow us on social media: Stony Brook Medicine on Instagram, Threads, Facebook, YouTube, and LinkedIn, and Stony Brook Med on X.
