Joey Wahler (Host): This is Health Matters: Insights from WCH Medical Experts. Our guest is Dr. Nitisha Mutgi. She's an obstetrician and gynecologist. Thanks so much for joining us. I'm Joey Wahler. Hi there, Doctor. Welcome.

Nitisha Mutgi, MD: Hi, Joey. Thank you. Good to be here.

Host: Thank you. Great to have you aboard. We appreciate the time. So first, in a nutshell, for someone who's never heard of it or isn't real familiar, how common is polymetabolic ovary syndrome, also called PMOS? And of course, what exactly is it?

Nitisha Mutgi, MD: Yeah. So, PMOS, polymetabolic ovarian syndrome, previously known as PCOS, is fairly common. In this country, it happens in about one in 10 individuals. About 7% of women have it. What it is is an androgen-driven metabolic disorder that can affect multiple parts of the body, not just the ovaries. But it can affect the heart. It can affect your blood pressure. It can affect your hair growth. Anything that is related to androgen excess is what drives it.

Host: And the exact cause of this isn't entirely known, is that right?

Nitisha Mutgi, MD: That's correct. And that's part of the challenge we face today in diagnosing and treating it is we still don't know exactly what causes it. We're still learning.

Host: So, you touched on a few of the symptoms. What are the most common ones? What would typically be seen? And are there any here that maybe tend to get overlooked where those experiencing this maybe think it's something else?

Nitisha Mutgi, MD: Sure. So, in order to have the diagnosis, there are some criteria that we need to look for in patients. Most commonly, we look for things called hirsutism or excessive hair growth, particularly on your chin, abdomen, areas where hair doesn't usually grow. Another thing we look for is something called anovulation or missed periods. And the third thing that sometimes can be considered a part of it is large ovaries or multiple follicles inside the ovary. Along with this, most women with PMOS are obese, but there is about a 30% subset of the population that's not. So, just because you're not obese doesn't necessarily mean you won't have the disease or can't have the disease.

Host: Gotcha. Now, you mentioned a moment ago that this can be difficult to diagnose. So, how do you go about doing that?

Nitisha Mutgi, MD: Yeah. So, the challenge comes in the fact that the symptoms are so widely prevalent in women, sometimes outside of the disease itself. For example, women can just skip their periods sometimes, or they can have hair growth in places not necessarily related to the disorder. So, we have to be very careful with looking at the whole clinical picture, figuring out what other risk factors they have, trying to rule out other things that could cause the symptoms they're having other than PCOS, and then trying to really focus on diagnosing them in the proper way.

Host: Gotcha. So, how about the potential impact of this on women going through fertility?

Nitisha Mutgi, MD: Absolutely. So, infertility is a challenge we see sometimes in women with PMOS, mostly related to the anovulation or the lack of the ability for the ovary to ovulate because of the androgen excess that it has and the hormonal imbalance it has. It's very traumatic for some of my patient populations, because they do, you know, everything right and they eat well and they exercise and they're still unable to get pregnant. So, it's a very frustrating process them.

but the news is we do have options for women that are going through infertility with PMOS. Options include anything from diet and exercise to medications that can help them get pregnant and consultation with the multi-specialty group that we also closely work with to help them achieve what they want.

Host: And I'm going to ask you more about some of that in more detail in just a moment or two. But first, if someone suspects they may have this condition, what should their first step be?

Nitisha Mutgi, MD: Yeah. So, I would say the first step should be to talk to your friendly neighborhood board-certified gynecologist. There's a lot of information out there that is easily accessible these days for us women, especially on social and the internet. And it can get quite overwhelming to try to weed out what is accurate and what is misinformation. So, I always recommend starting out with a physician that has dealt with this in the past and is able to provide you with the information you need to navigate the diagnosis.

Host: And be it with a general practitioner, first time out of the box here, or perhaps with a specialist like yourself, what does that evaluation for the condition and then eventual diagnosis, what does that visit typically look like?

Nitisha Mutgi, MD: Sure. So regardless of whether it's our primary care colleagues or us that's doing the evaluation, it should always start with a very thorough history, particularly focused on the cycles the woman's having, how often they're having their periods, when they first started their period, their height and weight, their waist circumference, physical exam, which includes looking for that excessive hair growth pattern. And then, really talking to them to find out what their concerns are and what their goals are and what they want to achieve with their concerns.

Host: Gotcha. So you touched on it a moment ago, to go a little more in depth regarding treatment, first in terms of lifestyle changes. Let's talk diet first. What are some of the basic things that women experiencing this should or should not do when it comes to what they're eating?

Nitisha Mutgi, MD: first of all, I to say it's very important to make sure that we are supporting our women in their lifestyle choices, in their diet choices, and understanding some of the challenges that they may face in eating a healthy diet, for example. So, you know, for me, it's very easy to sit here and say, you know, "You eat from all these food groups. You focus on your proteins. You try to eat whole grain food and not processed food and, you know, less sugar," and the list goes on and on. But, you know, I feel that for us women especially, the pressure so much in the society to eat right and exercise that I usually start by telling them to make realistic goals. And that may look like just small changes in their diet. You know, increase your protein intake by 5 grams a week or 10 grams a day for a week, and start by exercising once a week, and then slowly up from I find when we set more realistic goals and truly understand what their challenges are in meeting those goals, it really helps us succeed in achieving what we want to.

Host: It's a great point because whether it's addressing your diet or upping your exercise or activity, it's most important, especially when you're starting out, isn't it, Doctor, that whatever you do, that it's manageable so that it's realistic, as you said, and so you don't get discouraged and give up easily, right?

Nitisha Mutgi, MD: Exactly. That's exactly right. And the whole goal here is to improve our health well enough to where we have a good effect. So for example, for someone trying to get pregnant and for someone that's obese trying to get pregnant, any weight loss, even as little as 5% of loss in their weight greatly helps with their fertility chances. So, knowing that information, I feel, will really help women get motivated to do what they need to do, to achieve fertility.

Host: And then, how about regarding exercise? Is there, A, something you can suggest, again, to start out and take that first step, something that most anyone is capable of doing regardless of what their physical situation is? And then, along with that, what's the minimum amount? Are we talking about walking, jogging couple days a week? Where can people start?

Nitisha Mutgi, MD: Sure. So ideally, it would be three days a week of moderate activity. And that can look anything like brisk walking for 30 minutes three days a week. It can be swimming or water aerobics if the patient is unable to walk for some reason. And it can be even as intense as resistance training or Pilates or, you know, whatever option that they can achieve easily. But at minimum, we do recommend three times a week, 30 minutes of moderate exercise.

Host: And if all of the above are not working or at least not enough, how about other treatment options for PMOS?

Nitisha Mutgi, MD: Absolutely. So, for diet and exercise or really any options that we want to give them, it's very important to have a multidisciplinary group supporting our women. So, that includes things like dieticians and exercise coaches. It includes things like endocrinologists that can help with certain medications that can decrease their insulin resistance, which is also a very prevalent thing in PMOS. And then, maybe even some bariatric options such as weight loss medications or, in certain cases, bariatric surgery to help support the weight loss.

Host: And so it seems as though what you're talking about there is what's known as a multidisciplinary approach, right, at Wood County Hospital where there may be various cooks in the kitchen, so to speak, attacking this as a team, right?

Nitisha Mutgi, MD: That's exactly right.

Host: And so, in summary here, Doctor, you've done such a great job of breaking down all the details, but what's the main overall message for women in terms of what's most important about what they should understand about this condition? Is there maybe a misconception or something that's just not out there enough in terms of information that you can really address or emphasize right here for them?

Nitisha Mutgi, MD: Sure. I think the main point, I would like to get across right now is the fact that this condition, PMOS or polymetabolic ovarian syndrome, is a multi-system disease. And I think that's one of the reasons we saw a name change in this condition recently from PCOS to PMOS because there was such a misconception that this condition was so attached to women's ovaries or just their gynecological system, when it actually affects multiple systems in the body and can increase your blood pressure, it can make you at risk for diabetes, it can increase your chance of having high lipids in the future and infertility, like we talked about.

So, I would like women to be aware that it's not just your gynecology system that's being affected by this. It's a multi-system disease. And so, it is very important to actively seek out the right information and seek the care that you need for this. And we are here to provide that care at Wood County Hospital with our gynecology team.

Host: Man, great advice indeed. The bottom line is you don't want to let this go for too long, because it can affect more things than just one. Folks, we trust you're now more familiar with the newly named PMOS, Doctor. Valuable information indeed for so many women because it is such a common condition, as you point out. Keep up all your great work, and thanks so much again.

Nitisha Mutgi, MD: Thank you, Joey.

Host: And for more information, we ask that you please visit woodcountyhospital.org/womenshealth. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks so much again for being part of Health Matters, Insights from WCH Medical Experts.