From Polycystic Ovary Syndrome to Polyendocrine Metabolic Ovarian Syndrome: A Systematic Review of the Rationale, Diagnostic Implications, and Clinical Impact of Reclassifying Polycystic Ovary Syndrome
Wiku Andonotopo, Arief Setiawan, Muhammad Adrianes Bachnas, Mochammad Besari Adi Pramono, Julian Dewantiningrum, Efendi Lukas, I Nyoman Hariyasa Sanjaya, Anak Agung Gede Putra Wiradnyana, Anak Agung Ngurah Jaya Kusuma, Khanisyah Erza Gumilar, Ernawati Darmawan, Dovy Djanas, Dudy Aldiansyah, Aloysius Suryawan, Ridwan Abdullah Putra, Theresia Monica Rahardjo, Rizna Tyrani Rumanti, Roland Frederik Lengkey, Cut Meurah Yeni, Aryani Aziz, Nuswil Bernolian, Donel Suhaimi, Agus Rusdhy Hamid, Laksmana Adi Krista Nugraha, Wibisana Andika Krista Dharma, Waskita Ekamaheswara Kasumba Andanaputra
Abstract
Polycystic ovary syndrome (PCOS) has been known as a complex, heterogeneous disease going far beyond reproductive disorders and involving significant hormonal, metabolic, cardiovascular, and psychological complications developing throughout the whole lifetime of the patient. The term of polyendocrine metabolic ovarian syndrome (PMOS), recently suggested, is intended to reflect the nature of multisystem disease; however, the clinical applicability of the latter has not been proved yet. The goal of this systematic review is to critically assess the justification for changing the PCOS diagnosis to PMOS on the basis of the currently available evidence on the evolution of diagnostics, underlying pathogenesis, multisystem manifestations, and potential implications of this paradigm shift. The systematic literature search was conducted following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement in the main electronic databases. Out of 312 records retrieved during the search, 45 studies met the eligibility criteria and were included into qualitative synthesis. The included evidence covered international guidelines, consensus statements, systematic reviews, meta-analyses, observational studies, and clinical reviews, covering various populations, age groups, and geographical locations. Insulin resistance, endocrine dysfunction, cardiometabolic abnormalities, and psychological comorbidities were consistently mentioned as the core features of the syndrome among all studies, confirming the hypothesis that PCOS is a complex multisystem disease. Still, the high degree of heterogeneity in terms of diagnostic criteria, study methodology, sample characteristics, and outcome measures prevented any direct comparisons between different studies. At present, the PMOS framework looks like a reasonable and biologically plausible approach to comprehending the systemic nature of the disorder. Nonetheless, the current evidence base concerning this topic is mainly theoretical and lacks clinical validation. Therefore, although biologically plausible, PMOS currently lacks prospective clinical validation and should be regarded as an emerging conceptual rather than operational framework pending further clinical evidence.