Polyendocrine metabolic ovarian syndrome
Polyendocrine metabolic ovarian syndrome (PMOS), previously known as PCOS, is a complex medical condition affecting around 10% of women of reproductive age. If you’re a woman living with PMOS, you know that the symptoms can be more than an inconvenience, negatively impacting your mental health and causing anxiety, depression, and low body image.
In addition to the association between PMOS and infertility, this condition is linked with several health concerns in the long-term, including cardiovascular disease, sleep apnoea, endometrial cancer, and type 2 diabetes.
Though there is no cure for this chronic condition, Dr Simon Nothman is an experienced PMOS doctor who can help you manage its symptoms and navigate the impacts of PMOS on fertility.
What is PMOS?
PMOS is one of the leading causes of infertility and is a relatively common condition found in women of reproductive age. Women with PMOS produce abnormally high levels of certain hormones, such as insulin and androgens (normally found in higher levels in men). These elevated hormones cause the typical PMOS symptoms, including:
- Excessive hair growth on the face and torso
- Baldness and hair loss from the scalp
- Irregular or absent periods
- Acne
- Weight gain
- Infertility
The exact cause of PMOS is not fully understood, but is thought to result from a combination of genetics, lifestyle, and environmental factors. There is also a strong link between insulin resistance and PMOS, meaning the cells of your body have difficulty taking up glucose from the bloodstream.
Treatment for PMOS and infertility
Around 70% of women with PMOS have fertility problems. Irregular or absent ovulation, high levels of androgens and insulin resistance can all contribute to difficulties in falling pregnant and maintaining a healthy pregnancy.
Managing PMOS effectively can take a team of healthcare professionals, including a general practitioner, gynaecologist, fertility specialist, dietitian, and psychologist.
Medical management of PCOS
Your specialist may recommend one or more medical treatments to help you manage your PMOS symptoms. These can include:
- Oral contraceptives (the pill) or hormone-secreting IUD for women who are not looking to fall pregnant at this time
- Metformin to manage insulin resistance
- Hormone therapy, such as medications to stimulate ovulation when trying to conceive
- Lifestyle interventions for improved insulin sensitivity, weight loss, and reduced pregnancy risks
- Antidepressants or other interventions to support your mental health
Lifestyle management of PMOS
Maintaining a healthy lifestyle is the first step towards successfully managing PMOS and its symptoms. Doing this can potentially be enough to enable you to fall pregnant. Managing PMOS with lifestyle choices includes:
- Eating a well-balanced diet low in processed foods
- Engaging in regular physical activity
- Quitting smoking
- Avoiding excessive alcohol consumption
- Maintaining a healthy weight
In addition to improving your chances of conceiving, these lifestyle modifications can also help to regulate your periods, reduce your risk of future disease such as cardiovascular problems, and boost your mental health. You can read more about a PMOS-friendly diet here.
If you have been unable to conceive despite trying other options to manage PMOS and improve your fertility, IVF can often be a highly efficacious option.
Frequently Asked Questions
What is PMOS?
PMOS is a hormonal disorder involving enlarged ovaries with multiple small follicles, leading to irregular periods, excess androgen (“male hormone”) levels, and potential fertility issues. In many cases it involves a degree of insulin resistance, which worsens the androgen-related symptoms, as well as resulting in a tendency to weight gain, diabetes and high blood pressure.
How is PMOS diagnosed?
Diagnosis involves evaluating symptoms, blood tests to check hormone levels, and ultrasound imaging of the ovaries. It is not based on any one characteristic alone, and the finding of “polycystic ovaries” on ultrasound does not automatically identify the presence of PMOS.
Can women with PMOS conceive naturally?
Many women with PMOS can conceive naturally, though some may require lifestyle changes or medical treatments to improve ovulation. In some cases, whether as a result of other infertility factors (blocked tubes, poor semen parameters) or other individual considerations, IVF may be the preferred method for achieving pregnancy.
What treatments are available for PMOS-related infertility?
Treatments include lifestyle modifications, medications to induce ovulation, and assisted reproductive technologies if necessary. Medications to improve insulin sensitivity can also be helpful, but are usually best used in combination with ovulation induction medications. My approach to fertility in general, and PMOS in particular, involves a holistic approach including aspects of lifestyle intervention alongside conventional medical therapies to try achieve optimal outcomes for each patient.
Does PMOS increase the risk of other health issues?
Yes, PMOS is associated with increased risks of type 2 diabetes, cardiovascular disease, and endometrial cancer. It is also associated with increased risk for some pregnancy complications, including miscarriage, gestational diabetes and preeclampsia.
Is PMOS and PCOS the same condition?
Yes, PMOS was previously named PCOS (polycystic ovarian syndrome), but in 2026 the name was changed to better reflect the metabolic and endocrine dimensions of the condition. A three-year transition period is underway, during which both names are in use and refer to the same condition.