Women's Health

PMOS (Polycystic Metabolic Ovarian Syndrome), previously known as PCOS, is a common hormonal condition affecting 1 in 10 women of reproductive age. It involves insulin resistance, androgen excess, and ovulatory dysfunction, but it looks different in every body.

Many advocates and clinicians now prefer PMOS to shift focus from "cysts" (which aren't required for diagnosis) to the metabolic and hormonal root causes. Not everyone with PMOS has visible cysts on their ovaries, and the metabolic component, insulin resistance, inflammation, weight changes, is often the most impactful part.

A diagnosis of PMOS requires at least 2 of 3 criteria:

• Irregular or absent ovulation, long cycles, skipped periods, or anovulation.
• Clinical or biochemical signs of high androgens, acne, excess facial/body hair, hair loss at the crown.
• Polycystic ovaries on ultrasound, 12+ follicles per ovary or volume >10 mL.

Other conditions (thyroid, prolactin, NCAH) must be ruled out first. Diagnosis should involve a knowledgeable provider, not self-diagnosis alone.

• Cycle-related: Very long cycles (35+ days), missed periods, unpredictable ovulation, heavy or scanty bleeding.
• Skin & hair: Hormonal acne (especially jawline), hirsutism, hair thinning, oily skin.
• Metabolic: Weight gain or difficulty losing weight, intense sugar cravings, fatigue after meals.
• Fertility: Irregular ovulation making timing hard; higher risk of miscarriage in some cases.
• Mental health: Anxiety, depression, mood swings, often overlooked but very common.
• Long-term risks: Type 2 diabetes, cardiovascular disease, endometrial hyperplasia (from unopposed estrogen).

• Type A (Classic): Irregular cycles + high androgens + polycystic ovaries.
• Type B: Irregular cycles + high androgens (no cysts visible).
• Type C: High androgens + cysts (cycles may be somewhat regular).
• Type D: Irregular cycles + cysts (androgens in normal range, "mild" PMOS).

• Lifestyle: Regular movement (strength training helps insulin sensitivity), sleep hygiene, stress reduction.
• Nutrition: Lower glycemic load, adequate protein, anti-inflammatory foods. Some find benefit reducing dairy/gluten; it's individual.
• Supplements (talk to a provider): Inositol (myo- or d-chiro), omega-3s, vitamin D, NAC, berberine.
• Medications: Metformin (insulin sensitivity), hormonal birth control (cycle regulation), spironolactone (androgens), letrozole (ovulation induction for TTC).

• Track ovulation with BBT, OPKs, and cervical mucus, cycles may vary widely.
• Letrozole is often the first-line ovulation induction medication (more effective than clomiphene for PMOS).
• Maintaining a healthy weight (if applicable) and managing insulin resistance can improve ovulation naturally.
• Work with a reproductive endocrinologist if cycles remain irregular after 6 months of trying.