Polyendocrine Metabolic Ovarian Syndrome: What Is PMOS (PCOS) And How Do I Manage It?

It's Polyendocrine Metabolic Ovarian Syndrome (PMOS) Awareness Month and at Lena, we believe the dissemination of evidence-based and current literature supports women in making the best decisions about their health, so we wanted to share our latest findings, from our medical expert Dr Rachel Denham. PMOS is a complex condition which has recently been renamed from PCOS to more fully encapsulate the wide range of lived experiences that can be felt by patients. To find out exactly what PMOS is and what it looks like, check out our latest blog post here.

What is PMOS?

If you've seen the acronym PMOS online recently and thought "isn't that PCOS?" - you're right, it used to be. PMOS was renamed from Polycystic Ovarian Syndrome to better reflect what the condition actually is: a complex, whole-body condition, not something that only affects the ovaries. The word "cyst" was also dropped, because what shows up on an ultrasound isn't cysts at all, it's a cluster of arrested follicles, eggs that started developing and then stalled.

PMOS affects around 1 in 8 women around the world and it looks different in everyone. It's diagnosed when someone has at least two of three things: signs of hyperandrogenism (raised testosterone on a blood test, or an increase in facial or body hair), oligomenorrhoea or anovulation (cycles longer than 35 days, or fewer than 9 periods a year), or specific features on an ultrasound scan.

Because PMOS touches hormones, metabolism, skin, mood and the reproductive system, symptoms vary hugely. Some people experience excessive hair growth, weight changes, low sex drive, irregular or missed periods, fatigue, mood changes, acne, or trouble conceiving. Others have almost no visible symptoms at all.

What Causes PMOS In Women?

Normally, hormonal signals travel from the brain to the ovaries, telling them to mature and release an egg each month. In PMOS, that signalling is slightly off, so eggs either mature and release irregularly or not at all, leaving arrested follicles behind in the ovaries. Without a released egg, pregnancy can't occur, which is why fertility struggles are so common in this condition.

What Role Does Insulin Have In PMOS?

It isn't only the reproductive hormone signalling that's disrupted, insulin signalling is disrupted too, meaning the body stops responding properly to insulin. This is known as insulin resistance and it's central to PMOS.

Insulin resistance does double damage in women with PMOS as it directly disrupts the maturation and release of eggs, compounding the fertility issues already caused by the hormonal signalling problem. It also drives the ovaries to produce more testosterone, which then disrupts egg maturation even further. That creates a negative feedback loop, cycling between insulin resistance and rising androgens, and it's this loop that underlies so many of the problems seen in PMOS across metabolism, skin, mood and fertility.

Because insulin resistance sits at the centre of that loop, it's also one of the most effective places to intervene. This is exactly why leaning on nutrition matters so much in PMOS: the right approach to diet can genuinely improve how the body responds to insulin, which in turn eases the downstream effects on testosterone, ovulation and fertility. 

How Do You Treat PMOS?

There's no known cure for PMOS, but diet and lifestyle changes, alongside medications and certain herbal options (compounds like berberine, used in traditional medicine for metabolic conditions, are being explored here too) could reduce symptoms and support fertility, though more widespread and rigorous research is needed. Given how central insulin resistance is to the condition, tackling it through nutrition is one of the most powerful places to start.

The general treatment direction is to try and reduce symptoms such as acne, excess facial hair or excess weight, reduce insulin resistance and hope to balance the patient's hormones in the hope this will support their fertility, too. Your doctor may suggest any of the following:

• The pill (either combined or progesterone-only) or an IUD, to give you more regularity of hormones rising and falling each month. However, taking these contraceptions means that you don't ovulate, so any bleeding is not a true period, but a breakthrough bleed. Many patients find that their symptoms of acne can reduce on the pill, however finding the right contraceptive is all about what works for you and your body.
• Other medications such as: Clomifene (this can improve fertility), Spironolactone or Eflornithine (to help reduce hair growth on the face and body), Metformin (to help with losing weight)
  
• Creams or medications for skin to help acne

As well as these, your doctor is likely to recommend eating a more balanced diet, exercising regularly (and not in excess, as this can worsen PMOS symptoms in some cases) as well as directing you towards counselling or psychological support if you are struggling with anxiety or low mood relating to your PMOS.

As well as this, there are several supplements and herbal remedies that are becoming popular amongst the PMOS population (check below!).

If you want to learn more about PMOS, check out our other blog articles:

• What Is Berberine? 
• What Is Myo-Inositol?
• Explaining Insulin Resistance

Written and edited by Dr Rachel Denham, a trained medic and Women's Health Practitioner, who has worked across the charity and humanitarian sector and now specialises in women's health. Rachel is the creator of Bloody Nora, a women's health and wellbeing zine that fuses storytelling, art and science.