What is the cause of PMOS?

According to the 2019 study on PCOS: Environmental/Occupational, Lifestyle Factors, environmental factors may play a role in the expression of PMOS in later life.

There is significant variability in the severity and mix of PMOS symptoms across individuals with PMOS and across their lifetime.  Environmental factors are therefore believed to have a significant effect on how the condition manifests.  This article explores PMOS and Environmental Factors.

The underlying cause of PMOS is a result of a complex interaction of genetic, epigenetic and environmental factors.[1]  Genetic factors relate to how individual or groups of genes are implicated in health and disease.[2]  Epigenetic factors relate to how genes are expressed or function, in response to the environmental factors within the womb or later in life.[3]  Environmental factors include lifestyle, diet, stress/trauma and exposure to endocrine-disrupting chemicals (EDCs),[4] natural or man-made chemicals that may mimic, block or interfere with the body’s hormones.[5]

Many clinicians recommend lifestyle modifications, including high-impact exercise and a low-carbohydrate diet, for individuals with PMOS to reduce BMI and manage symptoms.[6][7]  Having a high body mass index (BMI) is believed to exacerbate the symptoms of PMOS as it contributes to increased insulin resistance. 

The evidence on the effectiveness of diet and exercise on managing symptoms is relatively weak overall.[8][9][10]  Preliminary evidence suggests that lifestyle modifications can benefit individuals with PMOS through improved reproductive function.[11][12]  This research indicates that the combination of a calorie-restricted/high protein diet with resistance exercise to increase muscle mass is likely to offer the greatest benefit.[13]

The relationship between PMOS and BMI is not straightforward.  For individuals with metabolic type PMOS, insulin resistance can lead to weight gain.  However, dysfunction in adipose tissue (AT), the connective tissue or fat that extends throughout your body,[14] is implicated in PMOS even in individuals who do not have an excess of body fat.[15]

The expression of PMOS symptoms is likely exacerbated by stress due to the release of cortisol, the body’s main stress hormone.[16]  An elevated cortisol level has a number of effects on the metabolism including contributing to insulin resistance.[17]

PMOS has been linked with a variety of forms of stress/trauma beyond the scope of managing a chronic condition and its associated symptoms and health complications:

• Experience of childhood emotional abuse is >5x more common in individuals with PMOS;[18]

• Experience of childhood physical abuse is >4x more common in individuals with PMOS;[19]

• Individuals with PMOS are 3-8x more likely to experience depression,[20] with particularly high rates amongst young women;[21]

• Individuals with PMOS are almost 5x more likely to experience anxiety;[22]

• Individuals with PMOS are 4x more likely to have an eating disorder;[23] and

• Individuals with PMOS are 2x more likely to develop post-traumatic stress disorder (PTSD).[24]

Endocrine Disrupting Chemicals (EDCs) are chemicals that interfere with the endocrine system, the network of glands that produce all of our hormones, the chemical messengers that help cells talk to each other.[25][26]  These hormones control all our cellular processes including reproduction, metabolism and stress response.

EDCs span a huge number of different chemicals that we are exposed to through a range of sources including the foods we consume, medications, cosmetics, household chemicals, plastic packaging and air-borne industrial pollutants.[27]

Sources 

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883751/

[2] https://www.cdc.gov/genomics/about/basics.htm

[3] https://www.cdc.gov/genomics/disease/epigenetics.htm

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9864804/      

[5] https://www.niehs.nih.gov/health/topics/agents/endocrine

[6] https://www.hopkinsmedicine.org/health/wellness-and-prevention/pcos-diet

[7] https://nyulangone.org/conditions/polycystic-ovary-syndrome/treatments/lifestyle-changes-for-polycystic-ovary-syndrome

[8] https://www.elsevier.es/es-revista-medicina-familia-semergen-40-articulo-lifestyle-interventions-in-women-with-S1138359321003488

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6438659/

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876590/

[11] https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.808898/full

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876590/

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876590/

[14] https://my.clevelandclinic.org/health/body/24052-adipose-tissue-body-fat

[15] https://academic.oup.com/jcem/article-abstract/109/1/10/7199845?redirectedFrom=fulltext

[16] https://carespace.health/post/is-pcos-triggered-by-trauma/

[17] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9331414/

[18] https://pubmed.ncbi.nlm.nih.gov/35985071/

[19] https://pubmed.ncbi.nlm.nih.gov/35985071/

[20] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9470949/

[21] https://pubmed.ncbi.nlm.nih.gov/29962792/

[22] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9319705/

[23] https://pubmed.ncbi.nlm.nih.gov/28104244/

[24] https://www.imrpress.com/journal/CEOG/50/9/10.31083/j.ceog5009193/htm

[25] https://www.webmd.com/children/what-are-endocrine-disruptors

[26] https://www.webmd.com/diabetes/endocrine-system-facts

[27] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9864804/