What Is PMOS?
As you’ve probably heard or seen, PCOS, polycystic ovarian syndrome, was recently changed to PMOS (polyendocrine metabolic ovarian syndrome) this week. This is exciting news because this name is much more representative of the diagnosis than polycystic ovarian syndrome, as this is not just an ovarian issue in most patients.
So let’s talk about what exactly PMOS is and what this change actually means.
PMOS can impact much more than just the ovaries, including:
Ovulation
Insulin resistance
Blood sugar regulation
Hormones
Fertility
Common Signs and Symptoms
The most common signs and symptoms of PMOS include:
Difficulty losing weight
Unwanted hair growth
Acne
Hair loss, including male pattern baldness
As far as the menstrual cycle goes, cycles are often:
Irregular
Unpredictable
Longer than 35 days
Patients with PMOS will also commonly have disrupted ovulation.
How Is PMOS Diagnosed and Treated?
PMOS is diagnosed by the Rotterdam criteria. To be diagnosed with PMOS, you need two out of the three Rotterdam criteria present.
The Rotterdam criteria include:
Irregular cycles or absent ovulation
Signs of elevated androgens, including unwanted hair growth, acne, and hair loss, including male pattern baldness
Polycystic appearing ovaries on ultrasound
This is where the name change is the most fitting, in my opinion, because you can have PMOS without having cysts on the ovaries. This is where a lot of my patients were not receiving a diagnosis - because they did not have cysts on the ovaries, even though they had the other two symptoms present but providers stopped evaluating for PCOS when cysts weren’t present on ultrasound.
Treatment and Management for PMOS
The treatment and management for PMOS is basically a lot of lifestyle treatment at this point. Things that should be addressed with PMOS include:
Insulin resistance
Weight management
Ovulation induction if trying to conceive
Insulin Resistance
Insulin is what helps your tissues store and use glucose, and it does not work appropriately with insulin resistance. Addressing that is a game changer for many patients with PMOS.
Sometimes patients are prescribed metformin, and now GLP-1s are also being recommended to help address insulin resistance.
Strength training is also huge with PMOS because skeletal muscle is the biggest organ in the body that uptakes glucose. Building skeletal muscle can significantly help with insulin resistance.
Weight Management
For all of the lifestyle things, I recommend changing how you eat your food instead of what you eat. I hate the blanket recommendation of “just lose weight” because it is significantly harder to lose weight with PMOS, so I like to give specific recommendations instead.
Completely overhauling your entire diet can feel incredibly overwhelming, so I typically recommend starting with changing the order you eat your food:
Fiber first
Then protein and fat
Then carbohydrates last
This helps blunt the blood sugar spike when you eat.
Supplements like:
Berberine
Inositol
can also be incredibly beneficial for PMOS.
As mentioned previously, strength training is also very beneficial, and starting with as little as 10-20 minutes per session, 3-4x/week will be beneficial to get you in a routine.
Ovulation Induction
If trying to conceive, ovulation induction is commonly recommended for patients with PMOS who are not ovulating regularly.
The ovulation induction medications most commonly used are:
Clomid
Letrozole
Though Letrozole has been shown to be more beneficial in patients with PMOS.
Fertility and Reproductive Health
I’m a huge advocate for cycle tracking, even if you’re not trying to conceive. But, cycle tracking is especially important with PMOS because you can have a period and still not ovulate, and if not tracking you might not know this information until you’re TTC.
Other benefits of true cycle tracking include knowing how long your follicular and luteal phase is, documenting bleeding patterns, and tracking other symptoms like headaches, GI symptoms, and spotting.
A huge benefit to charting and tracking everything related to your menstrual health is that if and when you do see a provider, you have relevant data to present to them and they should be able to give you better recommendations.
I typically do not recommend using LH strips (ovulation predictor kits) to track ovulation with PMOS because they can give false positives. The main ways that I recommend cycle tracking with PMOS include:
Basal body temperature tracking
Cervical mucus tracking
We created a free cycle tracker that you can download to help make cycle tracking with PMOS feel much less overwhelming. It uses basal body temperature and automatically graphs everything for you, similar to a popular wearable device but free.
We included a full guide on how to use it so you can:
Better understand your cycle
Identify ovulation patterns
Have organized data to bring to your provider if needed
When to See a Provider
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.
If you have been diagnosed with PMOS and you're trying to conceive but have not conceived within six months, it's recommended that you see a fertility specialist.
The good news is that some of the things discussed in this blog can be easily implemented while waiting to see your provider and then they can give you more specific recommendations for your symptoms and goals.
Ready for More Support?
If you’re struggling with:
Irregular cycles
Ovulation issues
Symptoms of PMOS
Difficulty understanding your cycle
and feel like you’re not getting answers as to why you’re experiencing the symptoms you’re experiencing or what you should do to treat those symptoms, 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 regarding next steps and what could be being missed in your case based on your symptoms, goals, and tracking data.
You do not have to wait around wondering if what you’re experiencing is normal or just keep trying without a plan. We would love to work with you!
