PMOS and anti-Müllerian hormone

PMOS affects up to 12% of women globally, impacting millions with infertility and metabolic health challenges, signifying that as many as 1 in 8 women may be affected by PMOS. PMOS is a hormonal imbalance affecting women of reproductive age. It’s characterized by a combination of symptoms such as irregular menstrual cycles, excess androgen levels, leading to hair growth and acne, and polycystic ovaries detected by ultrasound.

Diagnosing PMOS is a complex puzzle, there has been no single test, and symptoms can be confused with other conditions, often leading to a diagnostic odyssey that can span several years. When you think about diagnostic algorithms, it can involve multiple visits, multiple blood tests, and transabdominal or transvaginal scans, all to exclude the range of alternative diagnoses that can range from thyroid dysfunction to hyperprolactinemia, to nonclassical congenital adrenal hyperplasia. And of course some of these conditions like thyroid dysfunction, can coexist with polycystic ovarian syndrome.

The Rotterdam criteria established in 2003 has been a cornerstone of diagnosis, which necessitates two out of three indicators: irregular ovulation, excess androgens, and polycystic ovaries. The big change in the 2023 guideline was the introduction of AMH or anti-Muellerian hormone, and this makes a significant advancement in the diagnostic pathway. The key biological rationale is that AMH is made from the exact same follicles that we see on ultrasound. So women with lots of follicles that would meet the criteria for polycystic ovarian morphology would also have much higher AMH levels.

The Rotterdam criteria has now been updated to include AMH measurements is poised to refine your diagnostic process, making it significantly more streamlined and less invasive as we can use AMH to define polycystic ovarian morphology in adults and replace the need for a transvaginal scan. And given that you are already going to do some blood tests to exclude other diagnoses, it makes sense to incorporate AMH into that initial screen and get to that diagnosis faster.

With the updated criteria, all doctors can now diagnose PMOS with greater confidence, potentially reducing the time it takes to identify the syndrome and allowing for earlier intervention and management. General practitioners, endocrinologists, and gynecologists can all access it through their routine clinical chemistry service. It runs on the same platform that analyses your thyroid function and for the diagnosis of PMOS using the AMH PLUS Assay from Roche the critical number to remember is 3.2 ng/ml or 23 pmol/L. Together we can make a difference in the lives of millions of women worldwide.

This transcript was generated using an AI-based transcription tool and may contain errors. It reflects the spoken content of a live webinar and has been lightly edited for clarity.

It is well over time that we should have tests like this for conditions like PMOS, which has been so poorly recognised and supported over the years.

Traditionally, we have sent women for an ultrasound scan if we are not quite sure that we have got the clinical picture right. At the moment, wait times are phenomenal for ultrasound scans, and women often have to travel to a busy hospital or try to find another clinic. Consequently, the DNA rate, the"do not attend" rate goes up, particularly the longer the wait. It is an invasive test that they choose not to have, and being able to do a blood test—I truly believe this gives us a great option for many women.

Firstly, we are going to be taking blood anyway, so adding in another test to what we are already taking is actually no extra time or pressure for the woman. Beyond that, for the whole system, it is likely this blood test is going to be more cost-effective. We will be able to reduce the pressure on system costs, as well as the burden on overloaded diagnostic services.

Women’s health generally has been under-resourced, under-investigated, and under-researched. Many women who have long-term conditions have not been able to get the support or information early enough to manage their health going forward. Having better education will allow GPs and other healthcare professionals to think PMOS earlier. Following that up with a confirmatory blood test—the sort of evidence we use day in and day out in primary care—will really benefit women. Ultimately, this allows us to give the right support to the right woman at the right time and in the right way.

This transcript was generated using an AI-based transcription tool and may contain errors. It reflects the spoken content of a live webinar and has been lightly edited for clarity.

It answered questions about myself, my health, and my life, to the point that I didn’t even realise I had. The GP started asking about my weight, which I didn’t want to talk about, and whether I had excess hair, which I had never told anybody. I was rather embarrassed that he’d asked me, so I answered “no” to that question, whilst going like this to make sure he couldn’t see it. He sent me off for some blood tests and an ultrasound. We came back a couple of months later, and he said that I had a diagnosis of PMOS.

I had never heard about PMOS in my life. He said that I might not be able to have children, and I didn’t hear anything else from that point. The bottom fell out of my world. I left devastated, confused, overwhelmed, and just at a complete loss as to what to do next.

Then I came across Verity, which is the UK patient organisation for PMOS, and I realised that I wasn’t as alone as I had thought my entire life. I realised I’m the same as one in eight women in the country. Despite feeling that kind of overwhelming sadness and grief, I started to learn that there might be things I could do—that I might be able to have children one day. Clearly, I was able to, but not until the ripe age of 37. I hope that no one else has to go through that kind of process, but sadly, too many people still do. 

A simple blood test to help diagnose PMOS might make that path to diagnosis a lot shorter. Evidence shows that early management, support, and partnership with healthcare providers can really change the trajectory of your life. I hope that no one else has to wait 11 years like I had to. It potentially can help join those dots up a little bit sooner.