Management of Polyendocrine Metabolic Ovary Syndrome and it’s Link to Insulin Resistance

Polyendocrine metabolic ovary syndrome (PMOS) is a prevalent hormonal disorder affecting individuals of reproductive age, primarily women. It presents with a collection of symptoms and metabolic abnormalities that can significantly impact physical and emotional well-being. In this article, we will delve into the complexities of PMOS, exploring its symptoms, diagnostic criteria, causes, and potential management options. Additionally, we will examine the association between PMOS and insulin resistance, shedding light on their relationship and implications for overall health.

What is Polyendocrine Metabolic Ovary Syndrome (PMOS)?

Polyendocrine metabolic ovary syndrome, or PMOS, is a multifaceted endocrine disorder characterised by hormonal imbalances and reproductive irregularities. While the exact cause of PMOS remains a mystery, it is believed to involve genetic, hormonal, and lifestyle factors. Women with PMOS may experience a range of symptoms, including irregular menstrual cycles, excessive hair growth, acne, and infertility. Diagnosis is based on a combination of clinical presentation, hormonal testing, and imaging studies.

Diagnostic Criteria for PMOS:

Diagnosis of PMOS involves an individual presenting with 2 or more of the 3 key criteria below (1):

1. Menstrual Irregularities: Women with PMOS often exhibit irregular menstrual cycles, characterised by infrequent periods, prolonged menstrual intervals, or absent menstruation (amenorrhea) (1).

2. Clinical or Biochemical Hyperandrogenism: Hyperandrogenism, or elevated levels of male hormones, may manifest as hirsutism (excessive hair growth), acne, and male-pattern baldness. Blood tests may reveal elevated levels of testosterone or other androgens (1).

3. Polycystic Ovaries on Ultrasound: Ultrasound imaging may reveal the presence of polycystic ovaries, characterised by the presence of multiple small follicles arranged around the outside of the ovary (1).

What is the management for individuals with PMOS?

Nutrition management plays a pivotal role in the comprehensive treatment approach for PMOS, aiming to improve symptoms, regulate hormonal levels, and enhance metabolic health.

Key strategies for nutrition management:

1. Balanced Diet: Emphasise the consumption of a balanced diet rich in whole foods, including fruits, vegetables, lean proteins, whole grains, and healthy fats. Avoid processed and sugary foods to stabilise blood sugar levels and reduce insulin resistance (2).

2. Low-Glycaemic Index Foods: Prioritise low-glycaemic index (GI) foods, such as non-starchy vegetables, legumes (such as lentils, chickpeas and beans), whole grains, and nuts, to promote a slow release of sugar into the blood stream and improve insulin sensitivity (2).

3. Portion Control: Practice portion control to prevent overeating and support weight management, essential for individuals with PMOS who may be predisposed to obesity and insulin resistance (2).

4. Regular Meals and Snacks: Consume regular meals and snacks throughout the day to maintain stable blood sugar levels and prevent energy fluctuations. Opt for protein-rich snacks (such as boiled eggs, cottage cheese with veggie sticks, natural yoghurt, nuts and seeds) to promote satiety and control cravings (2).

5. Nutrient-Rich Foods: Include nutrient-dense foods high in vitamins, minerals, and antioxidants to support hormonal balance and overall health. Incorporate omega-3 fatty acids from sources like oily fish (such as salmon and sardines), flaxseeds, and walnuts for their anti-inflammatory properties (2).

6. Limit Added Sugars and Refined Carbohydrates: Minimise the intake of added sugars, sugary beverages, and refined carbohydrates, as these can exacerbate insulin resistance and contribute to weight gain (2).

7. Hydration: Stay hydrated by drinking an adequate amount of water throughout the day to support metabolism, digestion, and overall health (2).

Professional Guidance: Seek guidance from a registered dietitian specialised in PMOS management to develop personalised nutrition plans tailored to individual needs and goals (2).

Additional Management Considerations:

1. Regular Exercise: to help improve insulin sensitivity and manage weight (2).

2. Medications: such as hormonal contraceptives, anti-androgen medications, and insulin-sensitising agents may be prescribed to manage symptoms and regulate hormonal levels (2).

3. Surgical Interventions: In some cases, surgical procedures such as ovarian drilling or bariatric surgery may be considered as a last resort for managing symptoms of PMOS (2).

What is the link between PMOS and Insulin Resistance?

Insulin resistance is a common metabolic abnormality observed in individuals with PMOS. Insulin is a hormone produced by the pancreas that helps regulate blood sugar levels and facilitates the uptake of glucose into cells for energy production. In insulin resistance, cells become less responsive to the action of insulin, leading to elevated blood sugar levels and compensatory increases in insulin secretion (2).

The relationship between PMOS and insulin resistance is bidirectional, with each condition exacerbating the other. Elevated insulin levels stimulate the ovaries to produce excess androgens, contributing to the hormonal imbalances characteristic of PMOS (2). Conversely, hyperandrogenism and obesity, both common features of PMOS, can further impair insulin sensitivity and exacerbate insulin resistance (2).

Insulin resistance can be managed through lifestyle changes as discussed above. Alternatively, supplements such as myo-inositol can be recommended to help support management of insulin levels (3).

Conclusion:

Polyendocrine metabolic ovary syndrome is a complex and multifaceted condition that requires a comprehensive approach to diagnosis and management. By addressing symptoms, optimising hormonal balance, and managing metabolic health, individuals with PMOS can achieve better symptom control and improve their overall quality of life. Through nutrition management, lifestyle modifications, and appropriate medical interventions, individuals can take proactive steps towards managing PMOS and its associated complications.

References:

1. Legro RS, Arslanian SA, Ehrmann DA, et al. (2013). Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013 Dec;98(12):4565-92. doi: 10.1210/jc.2013-2350.

2. Healthline (19/4/21). Polycystic Ovary Syndrome (PCOS). https://www.healthline.com/health/polycystic-ovary-disease

3. Aidan Muir (7/9/22). Supplements for Insulin Resistance. Ideal Nutrition. https://www.idealnutrition.com.au/supplements-for-insulin-resistance/

Copyright: Lyndal Schnabel Dietitian 2024