Cervical Cancer Is Preventable: Cervical Cancer Screening

SWARAJ HOSPITAL & RESEARCH INSTITUTE

BOLANGIR, ODISHA  •  OBSTETRICS & GYNAECOLOGY CLINICAL PATHWAY SERIES

Clinician Reference Infographic

Cervical Cancer Screening — HPV, VIA & the Pathway to Treatment

Cervical cancer can be prevented by finding and treating pre-cancer. This sheet gives who to screen and with which test, how the tests work, what to do with a positive result, treatment, and follow-up.

🎯 AT A GLANCE — CERVICAL CANCER SCREENING

Cervical cancer is almost entirely caused by persistent infection with high-risk human papillomavirus (HPV); it develops slowly through pre-cancer stages, so screening can find and treat it before it becomes cancer

Worldwide in 2020, more than 500,000 women were diagnosed and about 342,000 died, mostly in poorer countries (WHO)

WHO now recommends an HPV DNA test as the preferred screening test, from age 30, repeated every 5 to 10 years; women living with HIV start at 25 and are screened every 3 to 5 years

India’s national framework screens all women aged 30 to 65 with VIA (visual inspection with acetic acid) once every 5 years, done by the ANM or staff nurse

Screening works only with follow-up: every positive woman must reach treatment

HPV vaccination of girls, with screening, is the route to eliminating cervical cancer

Screen every eligible woman, tell her the result in plain words, and make sure that a positive result leads to treatment.

🚨 DO NOT JUST SCREEN — INVESTIGATE OR REFER IF…

She has bleeding after sex, between periods or after menopause — examine the cervix and refer for colposcopy and biopsy; this is not screening (from memory)

The cervix looks irregular, hard, ulcerated or bleeds on touch — suspect cancer; biopsy and refer at once (from memory)

Offensive or blood-stained discharge, or pelvic or back pain — examine and refer (from memory)

A screening result is positive — do not let her go home without a plan: arrange triage or treatment and record the follow-up date

She is living with HIV or immunosuppressed — screen earlier and more often, and treat lesions with extra care

STEP 1 · WHO TO SCREEN — and with which test

📋 AGES, TESTS AND INTERVALS

Group	Test	Start and repeat
General population (WHO 2021)	HPV DNA test, with screen-and-treat or screen-triage-treat	From 30 years; every 5 to 10 years
Women living with HIV (WHO 2021)	HPV DNA test with a triage test if positive	From 25 years; every 3 to 5 years; retest sooner after a positive result or treatment
India, national framework	VIA (visual inspection with acetic acid)	All women 30–65 years; once every 5 years
Self-sampling (WHO)	Self-collected sample for HPV DNA testing	May help more women to be screened; she needs clear instructions and support

Other tests such as the Pap smear (cytology) are used in many settings; they are not covered by the sources checked here. Stopping age, pregnancy and other details are from memory below.

🧪 HOW THE TESTS WORK

HPV DNA test: detects high-risk HPV in a cervical or vaginal sample; objective, so it needs less interpretation than VIA or cytology, and is more effective and cost-effective, according to WHO

VIA: the cervix is washed with 3–5% acetic acid; a well-defined white patch near the squamocolumnar junction is a positive result (from memory)

Pap smear (cytology): cells are collected, stained and read by a cytologist, using the Bethesda system (from memory)

Triage after a positive HPV test: HPV 16/18 genotyping, VIA, cytology or colposcopy, according to what is available (from memory)

Colposcopy with biopsy confirms the grade of any lesion; histology gives the final diagnosis

STEP 2 · THE SCREENING PATHWAY — from the result to treatment

🧭 WHAT TO DO AFTER THE FIRST TEST

STEP 3 · TREAT AND FOLLOW UP — never lose a positive woman

🛠️ TREATMENT OF PRE-CANCER (CIN)

Ablative treatment (cryotherapy or thermal ablation) when the whole lesion is visible and does not extend into the cervical canal, and there is no suspicion of cancer (criteria from memory)

LEEP or cold-knife conisation when the lesion is larger, reaches into the canal, or ablation is not suitable (from memory)

Suspected invasive cancer: biopsy and refer to a cancer centre

In India, the medical officer at the PHC, CHC or district hospital manages VIA-positive women, with cryotherapy or colposcopy and biopsy, and the ANM and sub-centre staff arrange follow-up

Treat on the same visit where possible, so she is not lost (from memory)

📅 FOLLOW-UP AFTER TREATMENT

Test again after treatment to check that it worked; women living with HIV are retested sooner

Check healing, give written advice, and tell her to avoid sex and tampons for a few weeks (from memory)

Warning signs after treatment: heavy bleeding, fever, foul discharge, or severe pain; she should return at once (from memory)

Record every positive woman in a register and trace those who miss follow-up; a screening programme is effective only with an organised system of follow-up and management

🏘️ MAKING SCREENING REACH EVERY WOMAN

Register families and list every woman over 30; the national framework plans population-based screening, with the ANM and ASHA on a fixed weekly screening day

Counsel her before the test: what it is, that it is quick and safe, that the result is private

Remove barriers: cost, distance, shyness, fear of the result, and the need for a woman provider (from memory)

Link screening with HPV vaccination of girls, and with family planning, antenatal and immunisation visits (from memory)

Use self-sampling where available to reach women who will not attend

🛡️ PREVENTION: BEYOND SCREENING

HPV vaccination of girls before they become sexually active is part of the global strategy to eliminate cervical cancer; the 2030 targets are 90% vaccinated, 70% of women screened with a high-performance test, and 90% of women with cervical disease treated (vaccination target from memory)

Condom use, delaying the first sex, avoiding tobacco, and treating HIV all lower the risk (from memory)

⚠️ COMMON PITFALLS

Treating screening and diagnosis as the same thing: bleeding after sex needs a work-up

Letting a positive woman go home without a treatment or follow-up date

Screening too early, or too often, in low-risk women when resources are short (from memory)

Forgetting that women living with HIV need earlier and more frequent screening

Telling a woman that a negative HPV test means she will never need screening again

Breaking her privacy about the result

Memory Aid

SCREEN

Six steps for cervical cancer screening.

S

Start at 30 — at 25 if living with HIV

C

Choose the test — HPV DNA preferred; VIA in the national programme

R

Repeat on schedule — every 5–10 years (3–5 with HIV); every 5 years in India

E

Evaluate the positive — triage, colposcopy and biopsy

E

Eradicate the lesion — ablation or LEEP, same visit if possible

N

Note and follow up — register, recall, record

Remember: screening finds the pre-cancer; treatment and follow-up prevent the cancer.

Swaraj Hospital & Research Institute · Department of Obstetrics & Gynaecology, Bolangir, Odisha

Clinician-facing summary. Checked against: the WHO news release on the 2021 cervical cancer screening and treatment recommendations (HPV DNA test preferred, starting age, intervals, women living with HIV, self-sampling, burden, 2030 targets); WHO 2021 guideline annex (screen-and-treat and screen-triage-treat, ages and intervals); and the National Operational Framework on cancer screening (target age 30–65, VIA every 5 years, ANM and staff nurse roles, referral, cryotherapy and colposcopy, follow-up). Items marked “from memory” (how VIA and cytology are read, triage options, ablation eligibility, LEEP indications, red-flag symptoms, post-treatment advice, vaccination target, barriers) were not checked. Guidelines are updated and differ between countries and states: follow your national programme and local protocol.

ABORTION CARE

SWARAJ HOSPITAL & RESEARCH INSTITUTE

BOLANGIR, ODISHA  •  OBSTETRICS & GYNAECOLOGY CLINICAL PATHWAY SERIES

Clinician Reference Infographic

Abortion Care — Safe, Legal & Respectful (MTP Act, India)

Abortion care is a routine part of women’s health. This sheet gives the legal framework in India, counselling and assessment, medical and surgical methods, aftercare, and the management of complications.

🎯 AT A GLANCE — ABORTION CARE

Abortion is a common, safe procedure when it is done by trained providers with the right method for the gestational age; unsafe abortion is a major cause of maternal death and illness

Comprehensive abortion care includes counselling, the abortion itself (medical or surgical), pain control, treatment of complications, and contraception afterwards

Medical abortion with mifepristone followed by misoprostol is the preferred medicine regimen; vacuum aspiration is the preferred surgical method in the first trimester

In India the MTP Act (as amended in 2021) sets who may terminate a pregnancy, up to what gestation, and protects the woman’s privacy

Care should be respectful, non-judgemental and confidential, and the woman’s informed choice comes first

Before any abortion: confirm the pregnancy is intrauterine, assess gestation, and check for conditions that change the method.

🚨 STOP, ESCALATE OR ADMIT IF…

Ectopic pregnancy is possible — pain, bleeding, an adnexal mass or no pregnancy seen in the uterus: do not give abortion medicines; investigate first (from memory)

Heavy bleeding (soaking more than two pads an hour for two hours) or signs of shock — resuscitate, give uterotonics, empty the uterus, and arrange transfusion

Fever with foul discharge, lower abdominal pain, or a woman who looks ill after an abortion — think of sepsis: start antibiotics, clear any retained tissue, and refer (from memory)

A previous caesarean or uterine scar, anaemia, a bleeding disorder, an IUD in place, or adrenal disease or long-term steroids — review the method and the setting; refer where needed

Gestation over 20 weeks, a minor, or a woman who cannot consent — follow the legal requirements for opinions, boards and consent before proceeding

STEP 1 · KNOW THE LAW — MTP (Amendment) Act 2021, India

⚖️ WHO CAN BE TERMINATED, AND UP TO WHEN

Up to 20 weeks: one registered medical practitioner (RMP) gives an opinion; this includes failure of a contraceptive method, for married and unmarried women

20 to 24 weeks: two RMPs give an opinion, for special categories of women (such as survivors of rape or incest, minors, and differently abled women; the full list is in the MTP Rules, from memory)

After 24 weeks: only for substantial fetal abnormalities, with the opinion of a state-level medical board (gynaecologist, paediatrician, radiologist or sonologist, and other members notified by the state)

Confidentiality: the woman’s name and particulars must not be revealed except to persons authorised by law; breach is punishable

Only authorised providers, in approved facilities, should perform the termination; check the current Rules, because training and facility requirements change

STEP 2 · ASSESS AND COUNSEL — before choosing a method

🗣️ COUNSELLING

Offer information, not pressure: explain the options, how each works, what she will feel, and what to expect afterwards

Respect her decision, keep privacy, and obtain informed consent in a language she understands

Ask about her health, her pregnancy history, and her safety at home (from memory)

Discuss contraception before the procedure so that she can leave with the method she wants

Give her written advice on warning signs and a number to call

🩺 ASSESSMENT

History: last period, symptoms, previous pregnancies and caesarean, bleeding disorders, allergies, medicines, and any IUD in place

Examine: general condition, blood pressure, pulse, and a pelvic examination for uterine size and position (from memory)

Ultrasound is not essential before a first-trimester medical abortion, but is useful when dates are uncertain, an ectopic pregnancy is suspected, or the gestation is near the limit of the method (WHO says it is not required for routine care; the second part is from memory)

Check haemoglobin when anaemia is likely, and blood group and Rh status as per your protocol (from memory)

Medical abortion is not for her if she has: suspected ectopic pregnancy, inherited porphyria, chronic adrenal failure, or an allergy to mifepristone or misoprostol; take care with bleeding disorders, severe anaemia and long-term steroids

STEP 3 · PERFORM — choose the method by gestation and her wishes

💊 MEDICAL ABORTION: REGIMENS

Gestation	Regimen (WHO 2022)	Notes
Under 12 weeks	Mifepristone 200 mg by mouth, then misoprostol 800 µg (vaginal, sublingual or buccal) 1–2 days later	At least 24 hours between the two drugs; the combination works better than misoprostol alone
Under 12 weeks, no mifepristone	Misoprostol 800 µg (vaginal, sublingual or buccal)	Less effective; may need a repeat dose or surgery
12 weeks or more	Mifepristone 200 mg by mouth, then misoprostol 400 µg every 3 hours (vaginal, sublingual or buccal) 1–2 days later	Repeat doses as needed (WHO sets no maximum); use caution with a previous uterine scar; provide medical supervision
12 weeks or more, no mifepristone	Misoprostol 400 µg every 3 hours	Same routes; mean time to expulsion is several hours

The WHO regimen is shown. India’s national technical guidelines give their own doses and gestation limits for each setting (for example, misoprostol 400 µg in the early kit): follow the current national guideline and the product label. Success is about 97% up to 10 weeks.

🔧 SURGICAL ABORTION

Vacuum aspiration (manual or electric) is the preferred surgical method in the first trimester, and is safer than sharp curettage (from memory)

Dilatation and evacuation (D&E) is the surgical method for the second trimester and needs a trained provider; cervical preparation with misoprostol or mifepristone is advised (from memory)

Pain control: paracervical block, NSAIDs, and kind verbal support; sedation as needed (from memory)

Check the tissue to be sure the evacuation is complete (from memory)

Antibiotic prophylaxis is advised for surgical abortion as per your protocol (from memory)

😣 WHAT TO EXPECT AND PAIN CONTROL

Cramping pain and heavier bleeding than a period are expected after misoprostol; expulsion usually occurs within a few hours to a day

NSAIDs such as ibuprofen reduce the pain; offer them before or with the misoprostol

Nausea, vomiting, diarrhoea, fever and chills can occur; vaginal misoprostol causes fewer gut side effects

Bleeding usually tapers over about two weeks, but can last longer

Advise her to stay near a toilet and to have a companion with her (from memory)

STEP 4 · AFTERCARE — follow-up, complications and contraception

📅 FOLLOW-UP AND WARNING SIGNS

Confirm that the abortion is complete, by history and examination, a pregnancy test or an ultrasound where needed (from memory)

Warning signs to give in writing: soaking more than two pads an hour for two hours, fever of 38 °C or more for more than 4 hours, severe or lasting pain, foul discharge, or feeling very unwell

Prolonged bleeding or retained tissue does not need surgery if she is well; consider it for heavy or prolonged bleeding, anaemia, infection or her wish

Antibiotics are not routinely needed after a medical abortion

Avoid tampons and intercourse for 2–3 weeks to reduce the risk of infection

Serious complications are rare: in medical abortion under 10 weeks, transfusion-needing bleeding occurs in about 0.03–0.6% and serious infection in about 0.01–0.5%.

🛡️ CONTRACEPTION AFTER ABORTION

Fertility returns quickly, within about two weeks, so offer contraception on the same visit (timing from memory)

Any method can be started: pills, injectables, implants, condoms; an IUD or implant can be placed right after the procedure or once the abortion is complete (from memory)

Counsel her without pressure; a method she wants is a method she will use

Emergency contraception is available if she has unprotected sex before starting a method (from memory)

🚑 TREATING COMPLICATIONS

Incomplete abortion or retained tissue: complete the evacuation with misoprostol or vacuum aspiration (from memory)

Haemorrhage: resuscitate, massage the uterus, give uterotonics, empty the uterus, and arrange transfusion and referral

Infection and sepsis: antibiotics, remove retained tissue, and give intravenous fluids; refer early for severe sepsis, and think of toxic shock after medical abortion (from memory)

Uterine perforation or injury during surgery: stop, call for help, observe, and refer for laparoscopy or laparotomy when needed (from memory)

⚠️ COMMON PITFALLS

Giving abortion medicines without excluding an ectopic pregnancy

Giving misoprostol before 24 hours after mifepristone

Using the wrong dose for the gestation, or forgetting extra caution with a uterine scar

Not offering contraception or pain relief

Missing infection or retained tissue because there was no follow-up plan

Judgemental counselling, or breaking confidentiality

Forgetting the legal requirements for gestation, opinions and boards

Memory Aid

CARE

Four reminders for abortion care.

C

Counsel and consent — respectful, private, informed

A

Assess gestation — and exclude an ectopic pregnancy

R

Right method, right dose — mifepristone then misoprostol, or vacuum aspiration

E

Ensure follow-up and contraception — warning signs in writing

Remember: safe, timely, respectful abortion care saves lives; the law sets the limits, and good care protects the woman.

Swaraj Hospital & Research Institute · Department of Obstetrics & Gynaecology, Bolangir, Odisha

Clinician-facing summary. Checked against: news summaries of the Medical Termination of Pregnancy (Amendment) Act 2021 (gestational limits, opinions, special categories, medical boards, confidentiality); a summary of the WHO 2022 Abortion care guideline regimens for medical abortion (mifepristone and misoprostol doses and intervals by gestation, misoprostol alone, uterine scar caution); and a clinical review of medical abortion (success rates, contraindications, side effects, warning signs, follow-up, safety figures). Items marked “from memory” (full list of special categories, details of surgical methods, post-abortion contraception timing, management of complications, red-flag situations, Rh and haemoglobin checks) were not checked. The Act and Rules, and India’s national technical guidelines, are updated: check the current official text and follow your protocol, with a senior gynaecologist where needed.

SWARAJ HOSPITAL & RESEARCH INSTITUTE

BOLANGIR, ODISHA  •  COMMUNITY HEALTH & PREVENTION SERIES

Clinician & Community Health Worker Reference

Sickle Cell Disease — Prevention

Sickle cell disease is common in Odisha and many tribal areas of India, and it can be prevented by screening and counselling. This sheet gives how it is inherited, who to screen, genetic counselling, prenatal diagnosis, newborn screening, and early care.

🎯 AT A GLANCE — SICKLE CELL DISEASE PREVENTION

Sickle cell disease (SCD) is an inherited blood disease; it is not infectious and cannot be caught from another person

A child gets SCD only when both parents pass on the sickle gene: when both parents are carriers (sickle cell trait, HbAS), each pregnancy has a 25% chance of an affected child (HbSS)

Carriers are healthy and need no treatment, but must know their status

Prevention works at four points: screening, counselling before marriage or pregnancy, prenatal diagnosis, and newborn screening with early care

India launched the National Sickle Cell Anaemia Elimination Mission in July 2023, aiming to eliminate SCD as a public health problem by 2047; it targets everyone under 40 years, and Odisha is among the states with the most cases

Every woman planning pregnancy, every pregnant woman, and every newborn in an at-risk area should be screened.

🚨 ACT NOW IF…

Both partners are carriers, or one has SCD and the other is a carrier — offer genetic counselling and options before pregnancy, or prenatal diagnosis as early as possible in pregnancy

A pregnant woman is a carrier or has SCD — test the father by HPLC, and refer early if he is positive

A newborn tests positive for sickle cell disease — start penicillin prophylaxis, complete vaccination, and enrol the child in the care programme

A child or adult with SCD has fever above 38°C, severe pain, breathlessness, a swollen belly, weakness on one side, or marked pallor — refer to hospital at once

A screening report is shared with others — results are confidential; share them only with the person tested

STEP 1 · KNOW THE RISK — how the gene is inherited

🧬 INHERITANCE IN A NUTSHELL

HbAA: normal. HbAS: carrier (trait), usually no symptoms. HbSS: sickle cell disease, usually symptomatic

Other symptomatic forms: HbS-beta thalassaemia, HbSD Punjab and HbSE disease

A carrier does not become ill with SCD; the risk is only for the children

The four couples to recognise: one carrier, two carriers, carrier with a person who has SCD, and both with SCD

STEP 2 · PREVENT — screen, counsel, test, and protect

🔍 WHO TO SCREEN AND HOW

Who	Why	Test
Everyone under 40 in high-prevalence areas	Population screening under the national mission	Point-of-care or solubility test first
Young people before marriage	To avoid a carrier-by-carrier marriage, or to prepare	Screening, then confirmation, then counselling
Women planning pregnancy, and all antenatal women (first trimester)	To find at-risk couples in time	Screening, with a full blood count
Partners of carriers, and extended family	The father must be tested when the mother is a carrier; test relatives (cascade screening)	HPLC (ideal) or electrophoresis
Newborns in at-risk areas	To start penicillin and vaccines before symptoms	Point-of-care test, then confirm

A positive solubility or point-of-care test does not separate carrier from disease: confirm with HPLC or electrophoresis, and counsel by the confirmed result.

💬 GENETIC COUNSELLING

Offer it: after diagnosis, before pregnancy or early in pregnancy, when both partners are carriers, and before and after prenatal diagnosis

Be non-directive: explain the facts and options; the couple decides, and culture, religion and elders will influence them

Tell carriers they are healthy, but explain the risk of marrying another carrier

Explain how variable and severe SCD can be, how it is inherited, and what trait means, and give emotional and social support

Do not discourage a wanted pregnancy, or pressure her towards termination, without offering prenatal testing

Get informed consent before any test, and keep results confidential

Explain the risk afresh for each pregnancy: a healthy first child does not change the chance for the next.

🤰 IN PREGNANCY: PRENATAL SCREENING AND DIAGNOSIS

Test every pregnant woman in the first trimester; if she is a carrier or has SCD, test the father

If both carry the gene, offer prenatal diagnosis at a suitable centre, with counselling before and after the result

Prenatal diagnosis tests the baby’s DNA, by chorionic villus sampling at about 10–13 weeks or amniocentesis later (timings from memory)

Pregnancy with SCD is high risk: more pain crises, infection, thrombosis and pre-eclampsia, and a risk of maternal death; the baby may have poor growth, preterm birth or stillbirth, so extra monitoring is needed

Plan care with a team that includes an obstetrician and a haematologist

👶 NEWBORN SCREENING AND EARLY CARE

A point-of-care test on the newborn lets treatment start before symptoms

Counsel clearly whether the baby has SCD or only trait

Penicillin prophylaxis from the first months of life until about 5 years, and lifelong after splenectomy; doses follow the national protocol (age and duration partly from memory)

Folic acid daily: 2.5 mg under 1 year, then 5 mg

Vaccines: pneumococcal, meningococcal, Haemophilus influenzae type b, typhoid, influenza and COVID-19, as well as the routine schedule

Hydroxyurea for children above 2 years (may be offered from 9 months), at 10–15 mg/kg a day, with blood count checks; started and monitored by a doctor

🛡️ PREVENTING CRISES AND COMPLICATIONS

Triggers: fever, infection, dehydration, strenuous exercise, cold or rain exposure, and surgery

Drink plenty of fluids, avoid extremes of temperature and heavy exertion, eat well, and wash hands

Treat fever and pain early and aggressively; pain relief with paracetamol, diclofenac or tramadol, and refer when severe

Regular review, a health card for long-term care, and yearly check-ups

Stem cell transplant is the only cure, and is for a small group who do not respond to other treatment

🏘️ COMMUNITY ACTIONS

Use ASHA workers, anganwadi staff, schools and tribal welfare departments to mobilise screening

Give every person screened a card with the result, explained in the local language

Link carriers and affected people to counselling and to the nearest centre for treatment

Fight stigma: SCD is inherited, not infectious, and carriers are healthy

Keep results private; never announce them in public

⚠️ COMMON PITFALLS

Telling a carrier that she has a disease

Counselling from a screening test alone, without confirmation by HPLC

Testing the mother only and not the father

Pressing the couple to decide, instead of giving non-directive counselling

Forgetting that every pregnancy carries the same risk

Starting penicillin or vaccines late because the child “looks well”

Sharing results with family members or the community without consent

Memory Aid

SICKLE

Six steps to prevent sickle cell disease.

S

Screen — everyone under 40, couples, antenatal women, newborns

I

Identify the type — confirm by HPLC or electrophoresis

C

Counsel — non-directive, confidential, every pregnancy

K

Know the father’s status — test both partners

L

Look at prenatal diagnosis — when both are carriers

E

Early care — penicillin, folic acid, vaccines, fluids, hydroxyurea

Remember: carriers are healthy; the risk is to the children, and it can be known, discussed, and acted on before it matters.

Swaraj Hospital & Research Institute · Bolangir, Odisha

Clinician-facing summary. Checked against: the National Health Mission sickle cell portal genetic counselling page (inheritance, counselling principles, confidentiality, prenatal diagnosis); an ICMR sickle cell disease summary (genotypes, screening tests, prevention strategies, folic acid, hydroxyurea, vaccines, crisis management, red flags); and a summary of the National Sickle Cell Anaemia Elimination Mission (launched July 2023, goal 2047, under-40 target). The NHM page gives the risk for a carrier and a normal partner as 25%; the standard Mendelian figure of 50% carrier children is used here. Items marked “from memory” (prenatal diagnosis timings, penicillin schedule details) were not checked. Penicillin and other doses follow the national protocol: follow your local guidance.

Polyendocrine Metabolic Ovarian Syndrome

SWARAJ HOSPITAL & RESEARCH INSTITUTE

BOLANGIR, ODISHA  •  OBSTETRICS & GYNAECOLOGY CLINICAL PATHWAY SERIES

Clinician Reference Infographic

PMOS — Polyendocrine Metabolic Ovarian Syndrome (formerly PCOS)

PMOS, the new name for PCOS since May 2026, is a common hormonal and metabolic condition. This sheet gives why it was renamed, how to diagnose it, what to screen for, and how to treat the periods, hair, metabolic effects and fertility.

🎯 AT A GLANCE — PMOS (FORMERLY PCOS)

Polyendocrine Metabolic Ovarian Syndrome (PMOS) is the new name for polycystic ovary syndrome (PCOS), announced in May 2026 after a global consensus process published in The Lancet

Why the change: the old name suggested an ovarian cyst problem; the condition is really hormonal and metabolic, with no excess of abnormal ovarian cysts, and the narrow name contributed to missed diagnoses

About 1 in 8 women (over 170 million worldwide) are affected, and up to 70% are undiagnosed

Insulin resistance is present in up to 85%, including about 75% of women with a BMI of 25 or less

The diagnostic criteria have not changed; the name will be fully adopted in the 2028 international guideline update, after a three-year transition

PMOS affects periods, fertility, skin and hair, weight, blood sugar, mood and long-term health: assess and treat all of these.

🚨 THINK OF ANOTHER DIAGNOSIS OR ACT IF…

Rapid onset of virilisation (deep voice, clitoromegaly, rapid hair growth) or a very high testosterone — look for an androgen-secreting tumour of the ovary or adrenal and refer (from memory)

Amenorrhoea with milk discharge, headache or visual change — check prolactin and image the pituitary (from memory)

Bleeding after a gap of months, or heavy irregular bleeding, especially with obesity or over 45 — sample the endometrium; the risk of hyperplasia and cancer is higher in PMOS

Pregnancy with PMOS — treat as higher risk: screen for gestational diabetes at 24–28 weeks, and watch for hypertensive disorders

Low mood, anxiety, an eating disorder, or thoughts of self-harm — screen at diagnosis and refer for psychological support

STEP 1 · DIAGNOSE — two of three criteria

🧩 THE DIAGNOSTIC CRITERIA

First exclude other causes: pregnancy, thyroid disease, high prolactin, non-classic congenital adrenal hyperplasia, Cushing syndrome and androgen-secreting tumours (list from memory)

Hyperandrogenism: clinical (acne, excess hair growth, scalp hair loss) or biochemical (raised free testosterone or free androgen index)

Ultrasound: use a transvaginal scan when possible; the follicle and ovarian volume thresholds are from memory (at least 20 follicles in an ovary, or volume of 10 mL or more)

Adolescents: irregular cycles are normal in the first years after the first period; scans and AMH are poorly specific, so do not use them

🩺 HISTORY AND EXAMINATION

Ask about: cycle pattern, hair growth and acne, weight change, fertility plans, mood and sleep, snoring, and family history of diabetes (from memory)

Examine: BMI and waist, blood pressure, hirsutism score (Ferriman-Gallwey), acne, scalp hair loss, and dark velvety skin (acanthosis nigricans) (from memory)

Ask permission before weighing, and avoid weight stigma

Blood tests: testosterone or free androgen index, plus tests to exclude other causes; 75 g oral glucose tolerance test, lipids

STEP 2 · SCREEN — metabolic, mental and endometrial health

🩸 METABOLIC, MENTAL AND ENDOMETRIAL HEALTH

Area	What to do	How often
Glucose	75 g oral glucose tolerance test (the most accurate test)	At diagnosis, then every 1–3 years
Lipids and blood pressure	Lipid profile and blood pressure at diagnosis	Blood pressure every year
Sleep apnoea	Assess when symptoms are present, such as snoring and daytime sleepiness	When symptoms occur
Depression and anxiety	Screen every woman; offer psychological therapy such as CBT when needed; be aware of eating disorders and body image concerns	At diagnosis and as needed
Endometrium	Higher risk of hyperplasia and cancer (absolute risk is low); no routine screening; prevent with weight management, cycle regulation, and regular progestogen	Do not let her go months without a bleed

STEP 3 · TREAT — target the problem she brings

🥗 LIFESTYLE FIRST

Healthy eating and physical activity are central at every life stage; aim to prevent weight gain, and to lose weight when needed

No single diet or exercise plan has been shown to be better than another; choose one she can keep up

Even a modest weight loss can improve cycles, androgen levels and fertility (from memory)

Anti-obesity drugs or bariatric surgery may be considered by general population guidelines

Offer support, not blame

💊 DRUG TREATMENT BY PROBLEM

Problem	First choice	Points to remember
Irregular periods and hyperandrogenism	Combined oral contraceptive pill; lower-dose preparations preferred	Also protects the endometrium; check the contraindications (last point from memory)
Metabolic features	Metformin	More effective than inositol; inositol has limited benefit
Unwanted hair	Cosmetic measures and laser; the combined pill	Antiandrogens only when other treatments fail or cannot be used; they need reliable contraception (last point from memory)
Needs a regular bleed but not the pill	Cyclical progestogen	Prevents endometrial overgrowth (from memory)

👶 FERTILITY

Line	Option
First	Letrozole for ovulation induction
Second	Clomiphene (alone or with metformin), gonadotrophins, or laparoscopic ovarian surgery
Third	IVF, possibly with in vitro maturation, when the other treatments have failed

Before conception: optimise weight, glucose and blood pressure; offer an OGTT before pregnancy where possible

In pregnancy: PMOS raises the risk of gestational diabetes, hypertension and pre-eclampsia, miscarriage, preterm birth and caesarean birth; repeat the OGTT at 24–28 weeks

Metformin does not prevent gestational diabetes or pre-eclampsia; it may reduce preterm birth

⚠️ COMMON PITFALLS

Telling a woman she “does not have PCOS” because her ultrasound shows no cysts

Diagnosing it in a teenager by ultrasound or AMH

Treating only the periods or the hair and missing glucose, mood and sleep

Using a glucose-only fasting test when an OGTT would find the problem

Leaving a woman with months of amenorrhoea and no endometrial protection

Giving clomiphene first when letrozole is the first-line drug

Blaming her weight

Memory Aid

PMOS

Four reminders for a woman with PMOS.

P

Periods, hair and scan: two of three — adults; teenagers need hyperandrogenism and irregular cycles

M

Metabolic check — OGTT, lipids, blood pressure, sleep

O

Offer help for her goal — cycles, hair, fertility (letrozole first) or weight

S

Support the mind — screen for depression and anxiety; protect the endometrium

Remember: PMOS is a lifelong hormonal and metabolic condition, not an ovarian cyst problem; screen, treat the whole woman, and follow up.

Swaraj Hospital & Research Institute · Department of Obstetrics & Gynaecology, Bolangir, Odisha

Clinician-facing summary. Checked against: the Endocrine Society and AAFP reports on the May 2026 renaming of PCOS to PMOS (name, reasons, prevalence, transition to the 2028 guideline update, diagnostic approach), and a summary of the 2023 International evidence-based guideline on PCOS (diagnostic criteria, adolescents, lifestyle, combined pill, metformin, inositol, letrozole and later fertility lines, metabolic screening, psychological health, endometrial protection, pregnancy risks). Items marked “from memory” (ultrasound thresholds, conditions to exclude, history and examination details, anti-androgen and progestogen notes, red-flag situations) were not checked. Guidance is updated: follow your local protocol and the current international guideline.