Once understood mainly as a condition affecting the ovaries and fertility, PCOS is now known as Polyendocrine Metabolic Ovarian Syndrome, or PMOS, reflecting the wider hormonal and metabolic changes it can cause.
For years, 27-year-old Sarah Nakanwagi felt that something was seriously wrong with her body. Her menstrual periods would sometimes disappear for months, and she struggled with stubborn acne well into adulthood. Despite trying to eat healthily, she noticed increasing weight around her abdomen. When she eventually got married and faced difficulties conceiving, relatives made hurtful comments, suggesting she was cursed and infertile.
‘I kept moving from clinic to clinic looking for answers,’ she recalls. ‘Some doctors told me it was just stress, while others advised me to lose weight. But nobody explained why my body was functioning this way.’
Sarah’s experience reflects that of many women living with a condition that has long been misunderstood. For decades, it was commonly referred to as Polycystic Ovary Syndrome, or PCOS. It is now known as Polyendocrine Metabolic Ovarian Syndrome, or PMOS, a change intended to better describe its wider effects on the body.
While the new name may sound technical, specialists say it represents a broader understanding of the condition. PMOS is not simply about the ovaries; it involves complex interactions between hormones, metabolism and reproductive health.
Beyond the ‘cysts’
Dr Stephen Sematimba, a gynaecologist at Crystal Medical Centre in Kampala, says the previous name could be misleading because many people assumed ovarian cysts were the defining feature.
‘Many women came with symptoms such as irregular periods, excessive weight gain, infertility or abnormal hair growth. However, when the ultrasound scan showed normal results, they were told they did not have the condition,’ he says. ‘Yet, PMOS is much broader than just what appears on the ovaries.’
Dr Joel Lwasa, a gynaecologist at Kawempe Regional Referral Hospital, says the renaming reinforces the fact that the condition affects several aspects of a woman’s health.
‘This is not just a fertility issue,’ he says. ‘It is a metabolic and hormonal condition that affects many systems in the body. A woman can have normal ovaries on an ultrasound but still suffer from PMOS.’
This broader perspective is important because some women spend years focusing on fertility while overlooking symptoms that may have appeared much earlier.
Some experience menstrual cycles only a few times a year, while others develop persistent acne, unwanted facial hair, thinning scalp hair or unexplained weight gain, particularly around the abdomen. For some, the problem only becomes apparent when they start trying to conceive.
Dr Sematimba says irregular menstruation should not be dismissed.
‘A regular menstrual cycle typically occurs monthly. When someone consistently misses periods or goes several months without menstruation, it should not be ignored,’ he explains.
For adolescents, however, discussing menstrual changes can be difficult. In many Ugandan households, menstruation remains a private topic, leaving girls to struggle with irregular cycles without telling their parents.
For married women, infertility may be the point at which the problem finally receives attention.
‘In our culture, there is immense pressure on women to have children,’ Dr Lwasa says. ‘When conception is delayed, the blame is often placed on the woman, yet there is frequently an underlying medical explanation, such as PMOS.’
What happens inside the body?
PMOS involves hormonal and metabolic changes that can interfere with normal ovulation.
Insulin resistance is an important feature for many women. This occurs when the body does not respond effectively to insulin, the hormone that helps regulate blood sugar.
Dr Sematimba explains that when the body becomes less sensitive to insulin, it may produce more insulin to compensate.
‘The body produces insulin but cannot use it efficiently. As a result, insulin levels rise and this can contribute to hormonal imbalance, including increased male hormones,’ he says.
Higher levels of these hormones can contribute to acne, excessive facial hair, irregular ovulation and difficulties conceiving.
The metabolic effects are one reason women should not view PMOS purely as a fertility condition. Women can face an increased risk of Type 2 diabetes, high blood pressure and other long-term metabolic complications. Prolonged irregular ovulation can also increase the risk of abnormal changes to the lining of the womb. ‘This is why the new name emphasises metabolism,’ Dr Lwasa says. ‘We want women to understand that this condition goes far beyond the reproductive organs.’
Why diagnosis can take years
For many women, getting an explanation is not straightforward. Limited awareness means some assume their symptoms are simply part of being a woman. Others first seek help from herbalists or unqualified clinics, delaying proper assessment.
Cost can also be a barrier. In private facilities around Kampala, consultation fees with a gynaecologist can range between Shs50,000 and Shs150,000. Hormonal blood tests may cost more than Shs200,000, while additional investigations can increase the expense.
Public hospitals such as Mulago and Kawempe offer gynaecological services, although long queues and delayed appointments can discourage patients.
Diagnosis generally involves a combination of a woman’s symptoms, menstrual history, physical examination and, where necessary, laboratory tests and ultrasound findings.
‘There is no single test that explains everything,’ Dr Lwasa says. ‘We look at the whole picture.’
Management is also a long-term process.
‘PMOS is not something managed in one week or one month. It requires long-term follow-up and lifestyle adjustment,’ he says.
Holistic treatment
The broader understanding of PMOS is also changing the approach to treatment. Instead of focusing only on restoring periods or helping a woman conceive, doctors consider her overall hormonal and metabolic health. Lifestyle changes are also an important part of management.
Dr Lwasa says physical activity can improve metabolic health and, where appropriate, modest weight loss may improve hormonal balance and ovulation.
‘We encourage women to become physically active through walking, jogging, home exercises or regular activities such as gardening,’ he explains.
Nutrition is equally important. Specialists encourage balanced meals built around minimally processed foods, vegetables, adequate fibre and appropriate portions, while reducing excessive sugar and highly refined foods.
Dr Sematimba says women should not resort to starvation in an attempt to lose weight.
‘We do not tell patients to stop eating,’ he says. ‘We teach them how to eat better and more sustainably.’
Medication may also be prescribed according to an individual woman’s symptoms and needs. Metformin, for example, may be used in some patients to improve insulin sensitivity and regulate blood sugar. For women trying to conceive, fertility treatment can be considered when appropriate.
‘The good news is that many women with PMOS can still become pregnant with proper treatment and lifestyle adjustment,’ Dr Lwasa says.
Young girls should not be overlooked
The condition does not begin when a woman gets married. Teenage girls experiencing extremely irregular periods, severe acne, excessive hair growth or rapid, unexplained weight changes should not automatically dismiss these symptoms as normal puberty.
Dr Sematimba says parents should create safe environments where girls can discuss menstrual health.
He also cautions against body-shaming girls who gain weight because some may already be struggling with hormonal and metabolic changes.
Early attention can help girls understand their bodies and seek appropriate care instead of growing up believing something is wrong with them.
Beware of miracle cures
As awareness of hormonal disorders grows, social media has also become a marketplace for herbal mixtures and unverified ‘fertility boosters’ promising instant hormonal balance.
Doctors warn that women desperate for answers can spend large amounts of money on products with no proven benefit.
‘We have patients who come after taking multiple herbal products that worsen their condition or delay proper treatment,’ Dr Sematimba says.
He advises women to seek care from qualified health professionals rather than relying entirely on online advice.
‘There is no miracle drink that cures PMOS overnight,’ he says. ‘Management requires proper medical evaluation.’