The Hormone Cafe

In this episode of The Hormone Café, Dr. Sarah Pederson explains why polycystic ovary syndrome, or PCOS, is now called polyendocrine metabolic ovarian syndrome, or PMOS.

She discusses why the original name was misleading, how PMOS affects much more than the ovaries, and why testing and treatment should be personalized to each woman’s hormones, metabolism, symptoms, and health goals.

In This Episode, You’ll Learn

🧬 Why PCOS Was Renamed PMOS

The name polycystic ovary syndrome caused many people to believe the condition involved harmful ovarian cysts.

However, what appears on an ultrasound is typically a collection of small follicles that have not fully matured. PMOS more accurately reflects the condition’s effects on the endocrine, metabolic, ovarian, and reproductive systems.

The diagnostic criteria have not changed. The updated name provides a more complete understanding of the condition.

🧠 How PMOS Affects the Brain and Ovaries

PMOS can disrupt communication between the brain and ovaries.

Changes in LH and FSH may affect follicle development, ovulation, and androgen production. This can contribute to long or unpredictable cycles, difficulty ovulating, elevated testosterone, and multiple small follicles on the ovaries.

⚠️ Common Signs of PMOS

Possible signs and symptoms include:

• Irregular or absent periods
• Long or unpredictable cycles
• Difficulty ovulating
• Elevated testosterone or other androgens
• Acne
• Unwanted facial or body hair
• Scalp hair thinning
• Weight or metabolic changes
• Insulin resistance
• Elevated cholesterol
• Difficulty conceiving

Not every woman with PMOS experiences the same symptoms. Some women do not have insulin resistance, elevated testosterone, or weight gain.

🧪 How PMOS Is Diagnosed

A PMOS diagnosis generally requires two of the following three findings:

• Irregular cycles or ovulatory dysfunction
• Clinical or laboratory signs of elevated androgens
• Multiple small ovarian follicles seen on ultrasound

A comprehensive evaluation may also include:

• LH and FSH
• Total and free testosterone
• DHEA-S
• Sex hormone-binding globulin
• AMH
• Fasting glucose and insulin
• Hemoglobin A1c
• Cholesterol and triglycerides
• Thyroid testing
• Pelvic ultrasound
• Continuous glucose monitoring when appropriate

🍽️ Why a Low-Carbohydrate Diet Is Not Always the Answer

Women with PMOS are often told to eliminate carbohydrates and sugar, but this advice does not work for everyone.

Some women have insulin resistance, while others may already be eating too little, skipping meals, or restricting carbohydrates excessively. Dr. Pederson explains why nutrition should be based on each person’s blood sugar response, hormone levels, lifestyle, and individual needs.

The goal is to determine the right balance of protein, fiber, carbohydrates, and healthy fats rather than following a highly restrictive diet.

🩺 Personalized Treatment for PMOS

There is no single treatment plan for PMOS.

Depending on the patient, treatment may include:

• Personalized nutrition changes
• Blood sugar monitoring
• Consistent sleep and exercise
• Stress management
• Supplements
• Medication
• Ovulation support
• Hormone monitoring
• Surgery in select cases

Dr. Pederson shares patient examples that demonstrate how different PMOS patterns require different approaches.

🤰 PMOS and Pregnancy

Managing PMOS before conception and during pregnancy is important because it may be associated with an increased risk of:

• Miscarriage
• Gestational diabetes
• High blood pressure
• Preeclampsia
• Cesarean delivery
• Preterm birth
• Fetal growth concerns

A comprehensive preconception evaluation can help identify hormonal, metabolic, nutritional, and ovulatory concerns.

Weekly Challenge

Determine whether you know when you ovulate and whether your cycles are predictable.

If you have irregular cycles, signs of elevated testosterone, insulin resistance, or a previous PCOS or PMOS diagnosis, ask your healthcare provider whether additional testing may be appropriate.

Consider discussing:

• AMH
• LH and FSH
• Testosterone
• Fasting glucose and insulin
• Hemoglobin A1c
• Pelvic ultrasound
• Continuous glucose monitoring

Key Takeaways

• PCOS is now called polyendocrine metabolic ovarian syndrome, or PMOS.
• PMOS is a lifelong hormonal and metabolic condition, not only an ovarian or fertility concern.
• The “cysts” associated with the previous name are typically small ovarian follicles.
• PMOS can affect ovulation, fertility, blood sugar, skin, hair, mood, and long-term health.
• A diagnosis generally requires two of three findings: ovulatory dysfunction, elevated androgens, or polyfollicular ovarian morphology.
• Not everyone with PMOS has insulin resistance, elevated testosterone, or weight gain.
• A low-carbohydrate diet is not appropriate for every patient.
• Testing and treatment should be personalized to each woman’s symptoms, hormones, metabolism, and goals.
• Long-term management can help support more predictable cycles, ovulation, energy, and overall health.

Resources & Next Steps

If you are experiencing irregular cycles, difficulty ovulating, elevated testosterone, insulin resistance, or other possible signs of PMOS, Vera Health & Fertility can provide a comprehensive evaluation and personalized treatment plan.