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PMOS affects 1 in 8 women globally, with many undiagnosed. More than a fertility issue, it’s a lifelong metabolic disorder linked to diabetes, heart disease, and mental health risks. In Malaysia, it impacts healthcare costs and productivity. On Niaga Spotlight, Tehmina Kaoosji speaks with Dr Ashley Chung on why PMOS needs greater attention.
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00:10Hello and welcome to Nyaga Spotlight with me Tamina Khosji. Nyaga Spotlight goes through
00:14the week in economic analysis and future affairs. Now today on analysis we're actually going to dig
00:20deep into women's health issues. In particular we're looking at PMOS and the cost of delayed
00:26diagnosis. So an interesting data fact is that more than 170 million women globally are estimated
00:34to live with what was previously known as PCOS. Very recently this has been renamed to known as
00:41officially polyendocrine metabolic ovarian syndrome or PMOS for short. Now the WHO, the World Health
00:49Organization, also estimates that 70 percent of women with PMOS remain undiagnosed. In addition
00:56to that this conversation matters for Malaysia because we could have anywhere around the number
01:02of an estimated 2.4 million women in Malaysia living diagnosed or undiagnosed together with PMOS.
01:10So there are various cascading impacts including health care costs, delayed fertility treatment
01:17and many more. Joining me live in the studios today for this very timely discussion indeed is Dr. Ashley
01:25Chung-Soo-Bee, consultant obstetrician, gynecologist and fertility specialist at Sunway Medical Center
01:32Velocity, SMCB. A very good morning to you Dr. Ashley. Very good morning Tamina. So fantastic to have you in
01:40the
01:40studio despite your busy schedule and for such a huge global issue. Tell us a little bit about your
01:47reaction as an expert in this field and this has actually been a long awaited for renaming of
01:54PCOS to now PMOS. Let's set the conversation with that. Yeah thank you for having me today. So
02:01PCOS, we have been using this term for many decades. Yes we have. So I think from when I was
02:08young until like
02:09you know schooling time and until now as a consultant we are using this term PCOS for very long right.
02:17I think the public already well known about what is PCOS and why are we changing it to PMOS all
02:23right.
02:24It's something that we need to change for public for even clinician and gynecologist to look into
02:31what is the actual thing about PCOS. Right. The actual root causes. Yes. Okay got it.
02:39So what are the possible implications and what is what are we supposed to look into after this.
02:46I would say changing name is actually the language give us the shape of a diagnosis.
02:53Right. So more clarity and perhaps earlier diagnosis as well. Yes. So PCOS people will think about there's
03:00some problem with the ovary itself. People focus about ovary focus about ovarian cyst but actually
03:08there's nothing to do with cyst for PCOS. Not always. Not always a cyst and it's not about cyst all
03:15right. So it's
03:16more about irregularity of periods, about ovulation timing. So these people will think about it's just
03:25gynecologic problem. Right. So people forget about what is the possible holistic look about a patient
03:32who has PCOS. So hence the name now PMOS. Exactly. And now also I think that helps to explain why
03:40it is
03:41formerly PCOS was always generally viewed from a fertility angle only considering that it was
03:49literally named after anything to do with ovarian syndromes. Right. Yep. So now we know that the
03:56most important things to focus now is actually not only the gynecological problem, not only the
04:02fertility issue, we are now looking into metabolic condition. That means you want to look at a patient as
04:08a whole, a more holistic care. We do not want fragmented care anymore. That means we are also
04:15looking into why are these ladies a bit more obese. They are also having this kind of condition
04:25when we call diabetes mellitus. Higher risk of getting cholesterol issues. We call it dyslipidemia.
04:33And some patients will have also abnormal eutrogen bleeding that might actually have higher risk of
04:38endometrium problem. Right. I mean their uterus condition like hyperplasia or even malignancy in future.
04:45So if not handle it well. And looking into another aspect, we also looking into their
04:52skin condition like acne, overgrowth hair. All this will actually affect the general condition and also
05:01their confidence as a woman in their working life and down hood. Exactly. So really it is about reframing
05:08and looking at PMOS more as a systemic issue, right? Yes. So very commonly, in the past at least,
05:15Dr. Ashley, while women suffering with PCOS or feeling that they may have PCOS, they were often just
05:22by and large told to lose weight, quote unquote. How valuable or perhaps erroneous is this advice? And
05:31would you recommend it as a clinician as sort of like a silver bullet? All right, I would say just
05:38lose weight. The plan of management is just lose weight. Okay, do more exercise and lose weight.
05:42It can be a harmful plan, I would say. I'll put it in that way. Okay, sure. Let's break it
05:49down.
05:50Yeah, people may just think about, okay, lose weight is the only way for me to get better.
05:57But it's not easy to lose weight, to be honest. Especially with women's shifting hormones across
06:03the age cycle. Exactly. So losing weight is not just a sentence for them to start with. Because
06:10I would say that for patients who have metabolic condition, it's not easy for them to lose weight.
06:15Probably they have underlying of other metabolic issues that need to be corrected before they can
06:20really lose weight and balance up the hormones and all. So looking into it,
06:25sometimes we require some endocrine expert to help us to stabilize their metabolic condition. And
06:32that will probably lead to some cardiovascular condition as well. Right, exactly. So there's
06:38actually systemically, there's a lot which is occurring in a woman's body. If you are in a
06:44scenario where you may be at risk for PMOS, I'd like to track back Dr. Ashley, because you did mention
06:49the risk of especially diabetes. So diabetes type 2 in particular is increasing in terms of incidence
06:58and diagnosis in Malaysia. So let's say if an adult woman or even a teenage girl were to get a
07:07diabetes
07:08diagnosis, does that usually also mean we should have concern for PMOS as well?
07:14Yeah, for patients who are in their early age, we found out that you know, they have problems with
07:20weight, they have overweight or obesity, we should have early detection and screening.
07:26All right. So a screening about the risk of them having irregular periods. And from there, we can track
07:33into the, you know, the chances of them having because of your called as PMOS nowadays. So we do work
07:40hand in hand, like for example, in our hospital, we do have hand in hand collaboration with our endocrine
07:45team, where if they screen and they found out that young ladies who have diabetes, sometimes some
07:51uncontrolled diabetes that require a lot of attention, they do refer to us to screen for PCOS or PMOS.
08:00So basically, let's say PMOS indicators could also be used to intelligibly deduce that someone may be at
08:09higher risk for diabetes. So faster diagnosis, earlier treatment and better outcomes, right?
08:15Early detection, then we have better prevention, and it does reduce the cost of medication and the
08:23cost of consultation in future. And it may also reduce the risk of possible fertility and also pregnancy
08:31outcome. Because we know that a better diabetes control will definitely bring a better pregnancy
08:36outcome and a more healthier baby and mother. That's right. So speaking about fertility,
08:42now let's talk about the increasing conversations as well, Dr. Ashley, around IVF and fertility treatments.
08:49However, those usually begin at a much later stage, generally when couples or in particular,
08:56the woman is already deeply concerned that she may not be able to conceive at all. Let's backtrack
09:03a whole lot and talk about how integrating the PMOS narrative earlier can actually be very helpful to
09:13address it before it becomes a rather considerable economic cost for couples and newer families.
09:22All right. So we know that nowadays, ladies, working ladies, and you know that they are also career
09:27focus and they are looking into childbearing in a later life, so in a later period. So that looking into
09:37the readiness of the family to have a child. All right. That also looking into career advancement,
09:45their caregiving pressure, and also financially stability. So at one point when you notice that you
09:53are ready to have a family and you have problem with to conceive. At that point of time, maybe the
09:59lady
09:59just found out that, oh, maybe I have because that I couldn't conceive naturally. So everyone
10:05will looking into the cost of fertility. It may require maybe assisted fertility treatment, like for example,
10:16IUI or IVF. We are looking at the tip of the cost for fertility, for IVF. That's a big cost,
10:22maybe.
10:23But we are also forgetting about how much of money they have spent throughout their
10:31maybe their whole life cycle, maybe for the past 10 years or 15 years, looking into, you know, what
10:36is the cost of irregular periods, what's the cost of this hormonal issue, acne, obesity. So they may
10:43actually spend more than what we expected to GPs, to even psychology because of the impact on their outlook.
10:53impact on their confidence. They may have actually goes into depression.
10:57Exactly. And that is, I think, another dimension that is more recently being recognized about PMOS,
11:03right? Let's talk about some of the psychological impacts that you have also encountered
11:08over your term, looking at a vast demographic of patients who come in with PMOS.
11:15All right. So patients who come to us, they have difficulties in conceiving. So that is another
11:21stress for even the partner, family, in-laws, relative, and sometimes peers. They see everyone get
11:28pregnant and they are not. So that is what we say, the transparent stress, they are facing it every
11:35day. So that actually brings down the women's confidence every time they see their periods,
11:41every month or every two to three months. So that actually gave a lot of invisible stress that we
11:49didn't realize. There's a lot of social pressure as well, particularly as women perhaps have what we
11:56termed as geriatric pregnancies above the age of 35, right? Yeah. So, and a lot of stress from family
12:02as well, even at workplace. So people will think that, okay, you have irregular periods and then with
12:09your metabolic condition, probably you get tired easily, chronic diseases that actually bring you
12:15down and you couldn't focus on your work. And sometimes people cannot perform very well because
12:21of chronic fatigue, okay, hormonal problems. And sometimes you have critics and stigma from your
12:27colleagues and even employers. Sometimes they just think that, why are you not performing? Is it just
12:33because of your, you know, under burn out or things like this? Or under achieving without knowing the
12:42hormonal causes? Exactly. Actually they are actually suffering silently from having this chronic condition.
12:49They are, they themselves are not aware of. So it actually speaks to perhaps a wider opportunity now
12:55for actually mental health support to be also integrated into women's hormonal
13:03profiles as well. Yeah. So eat regardless at home or even workplace. So I think awareness is also
13:09important for us to look into this. So you're getting tired easily doesn't mean it's just equivalent to
13:15the hormone monthly or because of burnt out. So it could be some underlying chronic diseases that
13:21we are not aware of. Yes. Aside from even PMOS, right? Yes. So like employers, they are more focused on
13:28acute diseases. Yes, correct. So they are the big three or top five for each category. Exactly. So they might
13:35actually miss out all this, what we call as human, women's health that is preventive, preventable,
13:42that we can actually realise it earlier and we get help from our consultants and our specialists. Exactly.
13:50And of course, these are also becoming more and more urgent workforce related issues as we have the
13:57pressures of both an aged workforce, but at the same time, we're also trying to ensure that talent is
14:04kept in the workforce. So women who are in early midlife, et cetera, and how that affects them too.
14:11Yeah. All right. Thank you for the conversation so far, Dr. Ashley. Don't go anywhere. We'll be right back
14:15with the rest of this interview, focusing on women's health and PMOS in particular and the cost of delayed diagnosis.
14:43Welcome back to Niagara Spotlight. Still with me, Tamina Kausji and Dr. Ashley Chung-Subi of SMCV also is joining
14:50us today for the conversation
14:51on PMOS and the cost of delayed diagnosis, digging deeper into women's healthcare issues, but
14:57particularly from an economic analysis and also socioeconomic impacts too on the workforce and
15:04broader family structures. Dr. Ashley, so continuing the conversation, right? Now, we very often are also
15:11hearing Malaysia as an ageing society. So we also have these narratives that frame our fertility rates
15:19currently as demographic issues. Let's take a broader lens, but when we look at women's reproductive realities,
15:29in your experience, would you say we are still not paying enough attention to it from a policy angle?
15:37All right. I would say that fertility rates does decrease. I think a lot of factors contribute to it. Like
15:44we mentioned earlier, nowadays, ladies, we are looking into other aspects besides just childbearing.
15:52Okay. Meaning that we have our advanced career advancement, education. Absolutely. Higher education.
16:00Yes. And sometimes family support, caregiving and all that actually do put different boundaries for different
16:07age of ladies. All right. So on top of that, when they are trying to conceive and all that,
16:14there is also a lot of support needed from different, different angle. Okay. Looking into the work-life balance,
16:22looking into support from the employer, colleagues, and also during maternal leave and all that,
16:30you know, sometimes some ladies, they lose their work and all. All right. So we are looking at a broader
16:36aspect of
16:36what is going on. So as a policy holder, I would say that if we are looking into fertility, just
16:47bringing
16:47up the numbers of demographically live birth and all that, but we are actually, we forget about what
16:55caused the fertility rate to drop besides social economy. Yes. So we forget about the other metabolic issues
17:04to actually hinder the ladies from getting pregnant. So as a policy maker to, I mean, such a big change
17:12from PCOS to PMOS, this is to give awareness, not only to the public, I'm sure it's also to the
17:18policy
17:19maker, educational team, because we need to change perspective, not only at a clinician level, we also
17:27need to change at the level of students level when we are studying for, you know, medical school, colleges,
17:35even general practitioner, that we need to aware, they need to aware that what are they detecting as
17:41a first liner. Exactly. Because of course, what quite often occurs is that there's delayed diagnosis.
17:49Now, as a clinician, Dr. Ashley, are you also seeing increasing incidences of women coming in
17:56at later stages in life for fertility-related check-ups or treatments and also discovering
18:03that they have PMOS at the same time? Okay. I do see patients who only know that they have
18:10PCOS or PMOS when they are trying to conceive. Understood. All right. So meaning they can turn in
18:16about maybe 38 years old or even 40 years old, then they say that irregular periods has been a norm
18:21for
18:21them. And that's why they did not think it was irregular, so to speak. Okay. Yeah. So that's also
18:27a lifetime of incurred costs as well as risk, right? Yep. Yep. So that means they are not even aware
18:35that
18:35this is abnormalities that need to take into consideration. So they would be thinking that I
18:41was trying, but I don't think I have a problem until I think that, you know, the clock is ticking
18:48and I
18:49think that I'm a bit running out of time. So when they turn to us, then only they found out,
18:55oh, actually I have this issue. By then, the metabolic condition is already set in. Probably
19:01they already have early stage of diabetes. They already have deranged cholesterol. They already have
19:06some problems with obesity and so on and so forth. Even cardiovascular issue, the heart issue that we
19:13need to take care of. Exactly. And of course, cardiovascular issues, particularly for women,
19:18are highly underdiagnosed too. Yep. Yep. Yeah. So another issue when it comes to the idea about
19:26information, I think we can't go without talking about the huge role these days that social media
19:33plays in greater awareness, but also greater misinformation that is out there. Some perspectives on
19:41that, Dr. Ashi. All right. Social media, I believe that now everyone is on social media. Sure.
19:48It plays an important and a huge role in awareness. I would say that it's not a too bad thing.
19:56All right.
19:56But we must know that social media, sometimes it doesn't give correct information with evidence base.
20:04All right. So yes, they can provide a general idea or general awareness for everyone. So what is
20:11what is the trend? Like because to PMOS, I'm sure everyone actually found out from social media what it is.
20:19Sure. Yes. Viral videos. Viral videos.
20:22Made by either sometimes doctors, but very often from health influencers. Yes.
20:26Yes. So it's important to have social media, but not to forget that social media is not a platform for
20:33you to
20:34seek for treatment. Evidence based medical care is very different. It's very different. Yes. You can
20:40have a rough idea about that. But the most important thing is do not diagnose yourself just through a
20:45social media information. All right. So seek a proper consultation and examination scans and all that.
20:53It's also very important to dig into a correct diagnosis. Because one thing which comes to my mind,
21:00at least Dr. Ashley, also being a woman in my 40s, what I've come across repeatedly, because I do have
21:05an interest in women's health and other issues, you often are bombarded by content, which is talking
21:11about hormone balancing, et cetera. And generally those focus highly on dietary related supplementing
21:20or incorporating various foods into your daily diet. Some thoughts around that and whether it is
21:29helpful, harmful, pretty neutral when it comes to PMOS and diagnosis of more deeper healthcare issues.
21:38All right. I would say that we need to individualize every patient. All right. So every patient,
21:45every lady, they have different social economic status. Definitely. All right. I would say digging
21:51into, you know, more supplements, healthy lifestyle, exercises, personal trainers to help you to lose
21:59weight and not forgetting, you know, like healthy diet, which actually, you know, they cater a special
22:06menu for you every day. That all need a lot of costs. Sure. Extra costs.
22:11Completely out of reach for most of us. Yes. So you can't imagine how much it costs you for a
22:17session
22:18of personal trainers or even a very so-called a healthy menu for you for a week. All right.
22:24That actually depends on your, uh, uh, uh, ability to cater. That's my earning capacity. Yeah. Your earning
22:31capacity as well. It's good that you can cater all this into your, uh, what you call it, your individual
22:39needs,
22:39I will say. Uh, first of all, get yourself diagnosed, whether do you really suffering,
22:46or having PMOS. All right. Get yourself a proper channel of treatment, a plan of treatment that can
22:53help you better. All right. Some patient who goes for everyday, you know, gym and all that, but they
22:59did come back to us, they tell us that I'm not seeing any results. Ah, all right. That could also
23:04be
23:05early indicators. Exactly. That could be something that's hidden that we are not aware of. So maybe
23:11there are some metabolic issues that need to be corrected before you have, you can see a better
23:16outcome. Exactly. Now, another thing about, um, healthcare systems, not just Malaysia, but globally,
23:22we are generally rather treatment oriented rather than prevention oriented. Exactly. Um, given both our
23:29were incidences for NCDs as well as PMOS as well, uh, would you recommend, uh, more earlier diagnosis
23:38and also for that earlier screening and intervention for adolescent girls in particular?
23:44That's why we always say prevention is better than cure. All right. So I think the purpose of
23:49rename this PCOS to PMOS, the aim is to help us to detect things earlier, detect metabolic disorder
23:57earlier so that we can have better prevention when they are still young. All right. So if the
24:02adolescents or young ladies who come to us with irregular period, have a click in their mind,
24:06in our mind that, you know, we need to screen, we need to screen whether they have risk of PMOS,
24:12whether they have higher risk of getting, you know, diabetes, hypertension, cardiovascular issues,
24:17that we can intervene early to reduce a personal cost and generally national cost.
24:23Because we know that when, if we not, if we are not detecting it earlier and sooner or later,
24:29maybe 10 years or 15 years down the line, maybe we have more chronic diseases that actually drain
24:34more finance, more cost of the government hospital, the whole government financial status.
24:40Hmm. So looking at the fertility rate is coming down, meaning that probably we have more elderly
24:47population compared to younger population. So that is actually in long run, it affects the economy
24:53status of the whole country. Okay. Looking at a broader aspect of it. So prevention at this moment
25:01probably will give us a better holistic care, less fragmented care in the next maybe 10 years, 15 years.
25:09Exactly. But it's never too late to start and we can actually start earlier, right?
25:15I'm sure there actually has been thinking of changing names from Picos to PMOS for a long time.
25:22Yes, it's been almost a decade actually.
25:24A decade. So a lot of researchers, a lot of association, non-government or government
25:31bodies actually working very hard to look into all these conditions. And finally, they made a decision to
25:37change name from Picos to PMOS. There is a big intention behind it. So this is the aim. Prevention
25:45is better than cure. Yes, naturally. And if there would be some one major misconception that you would
25:53hope to correct about PMOS for the general public and also for women and girls, what would that be,
25:59Dr. Ashley? I would say Picos is not only focusing on the ovary anymore.
26:05Now that it's PMOS. Yes. It's not only at irregular periods. It's not about infertility anymore. We are
26:13looking at a broader conceptions where we involve chronic diseases, metabolic condition. We are
26:22looking into their skin condition, their general outlook about obesity and not forgetting about mental
26:29health as well. So you know that this outlook of, you know, obesity, acne, hair growth will bring down a
26:37lot of their self-esteem and finally may actually contribute to a lot of mental health that leads
26:43to depression. So we are looking into a holistic condition instead of just the ovaries itself.
26:50Exactly. So that, in a nutshell, is exactly why it's now PMOS instead. Dr. Ashley, thank you very much for
26:57the valuable insights. We very much appreciate the reframing and also the analysis on how this affects
27:04women's economic status too, as well as, of course, future ability to form a family and plan family life.
27:12Thank you for having me today. Absolutely. Well, there you go. In a nutshell, that's our conversation
27:18on Niagara Spotlight, focusing on PMOS and also the cost of delayed diagnosis for women around Malaysia
27:24with Dr. Ashley Chung-Soo Bee, consultant obstetrician, gynecologist and fertility specialist with Sunway
27:31Medical, Sunway Velocity Medical Centre, SMCB, for the discussion today. That's all we have time for.
27:37Here's to a productive week ahead. I'm Tamina Kousji signing off for now. We'll see you again next week
27:43with more economic analysis and insights.
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