Polyendocrine Metabolic Ovarian Sydrome (PMOS) Symptoms
What Is Polyendocrine Metabolic Ovarian Syndrome (PMOS)?
Polyendocrine Metabolic Ovarian Syndrome, or PMOS, is an endocrine disorder that is common among women of reproductive age. PMOS was formerly referred to as PCOS, but the name was recently changed to PMOS. This is VERY exciting news because the updated name is more representative of the actual pathology and helps better describe what is happening throughout the whole body, not just ovaries.
Keep reading to learn about the most common PMOS symptoms.
Common PMOS Symptoms
Some of the most common symptoms associated with PMOS include:
Irregular menstrual cycles, most often long cycles
Weight gain
Difficulty losing weight
Hormonal acne
Unwanted hair growth
Hair loss, especially male pattern hair loss
Fatigue
Insulin resistance
Fertility struggles
Not everyone with PMOS will experience all of these symptoms, and symptoms can (and do) vary significantly from person to person.
How PMOS Is Diagnosed
PMOS is diagnosed using the Rotterdam criteria. In order to receive a diagnosis, two out of the following three criteria must be present:
Irregular menstrual cycles
High androgen labs or symptoms associated with elevated androgens, such as unwanted hair growth or acne
A “string of pearls” appearance (cysts) on ultrasound of the ovaries
This is one of the reasons the name change from PCOS to PMOS is so exciting. I have seen so many women go undiagnosed because they did not have the “string of pearls” appearance present on ultrasound. However, they did have the other two criteria and still should have received a diagnosis. Because the cysts were not visible on ultrasound, the other symptoms were often not fully evaluated, and this led to delayed diagnosis and delayed treatment.
Weight Changes and Metabolic Symptoms
Insulin resistance is very, very common among women with PMOS. Insulin is what helps your body utilize and store glucose, which is the fuel your body needs to do basically anything. Without insulin, your body cannot properly use glucose.
When there is elevated glucose in the body, the pancreas makes more insulin. Over time, the cells can become resistant to that insulin, which creates a cycle that can be really difficult to break. High insulin levels contribute to inflammation and impact the entire body, but especially the reproductive organs.
Insulin resistance can:
Increase ovarian androgen production
Impair egg maturation
Change endometrial receptivity
Increase fat accumulation
Increase inflammation throughout the body
You can probably see the vicious cycle here.
Signs of elevated androgens (also common with PMOS) can include:
Acne
Increased unwanted face and body hair
Male pattern baldness or hair thinning
Because of the inflammation and insulin resistance associated with PMOS, many women also experience weight gain and difficulty losing weight, even when they feel like they are doing “everything right.”
Menstrual Cycle Irregularities
Menstrual cycle irregularities are among the most common symptoms of PMOS. Most often, I see patients who have really, really long cycles because they are not ovulating.
When you ovulate, your body produces a corpus luteum, and then within about 12 to 14 days, you will typically start your period. But when you are not ovulating, your body does not get that signal to go ahead and start your period, which can lead to very long or irregular cycles.
Some patients can also have a regular cycle length but still have anovulatory cycles, meaning they are bleeding regularly but not actually ovulating. Because of this, it is SO important to know whether or not you are ovulating, not just track your cycle length.
Fertility and Reproductive Concerns
A lot of patients with PMOS require medications to help with conception. Most commonly, we see women prescribed:
Metformin for blood sugar management
GLP-1 medications for inflammation and/or blood sugar management
Clomid or letrozole to help induce ovulation
Typically, letrozole tends to be more beneficial for patients with PMOS.
GLP-1 medications are being used more commonly now in women with PMOS, and I am personally seeing and hearing about a lot of benefit from them, especially related to inflammation and metabolic symptoms. But, like most things in women’s health, we need more research.
Lifestyle Changes That May Help
Outside of the medications listed above, treatment for PMOS is very much so lifestyle based.
I strongly recommend strength training, as skeletal muscle is the biggest uptake site of glucose in the body. Because insulin resistance is such a major component of PMOS, building skeletal muscle can help improve insulin resistance and blood sugar management.
Nutrition is also key. I typically do not recommend starting with a complete overhaul of your diet, that’s never sustainable. Instead, I often recommend first changing how you eat your food, specifically the order in which you eat it:
Fiber first
Protein and fat second
Carbohydrates last
This can help minimize glucose spikes, which also helps with insulin resistance.
Other strategies, like going on a walk after meals, can also be really helpful.
Supplements like berberine and ovasitol can also be game changers for supporting ovulation and helping manage blood sugar.
When to See a Provider
If you are trying to conceive and have not conceived within six months, it is recommended to see a fertility specialist if you have been diagnosed with PMOS.
If you have not been diagnosed with PMOS but are wondering if you have it, I recommend seeing a doctor as soon as you can, especially if you have not already established care.
The good news is that some of the things discussed in this blog can be easily implemented while waiting to see a specialist.
Ready for More Support?
If you are struggling with:
Irregular cycles
Ovulation issues
Symptoms of PMOS
Difficulty understanding your cycle
and feel like you are not getting answers, this is exactly why we created The Cycle Script Analysis + Action Plan.
The Cycle Script Analysis + Action plan is designed to help you better understand your cycle, identify patterns, and receive individualized recommendations based on your symptoms, goals, and tracking data. We would love to work with you!
