From primary care to specialist: Managing PMOS and insulin resistance

Maresca opens by describing periods as a vital sign: irregular cycles paired with hyperandrogenism signs such as hirsutism, severe acne, or androgenic alopecia, or with insulin-resistance markers like acanthosis nigricans, difficulty maintaining a healthy BMI, hypertriglyceridemia, low HDL, or MASLD (formerly NAFLD), should prompt evaluation for PMOS. She says referral decisions ultimately hinge on an individual primary care provider's comfort with diagnosis, treatment, or both. Appelbaum agrees that PCPs are well positioned to lead lifestyle interventions — cardiovascular activity, reduced processed sugar, appropriate caloric intake — and that referral makes sense once a provider reaches the limit of their comfort with diagnosis or management.