From PCOS to PMOS: Why Experts Are Rethinking One of Women's Most Misunderstood Health Conditions

You may have recently read the news that Polycystic Ovary Syndrome (PCOS) has been renamed Poly-endocrine Metabolic Ovarian Syndrome (PMOS) - a condition that affects more than 170million women globally 

The change reflects the accepted reality: this condition is fundamentally a metabolic, hormonal and systemic disorder that affects the entire body not just ovaries - In fact, many women diagnosed with PCOS don't have ovarian cysts at all, while others experience symptoms that extend well beyond reproduction and fertility.

What Is PMOS?

PMOS is one of the most common endocrine disorders affecting women of reproductive age.

It is estimated to affect between 8-13% of women globally, although many cases remain undiagnosed.

The condition is characterised by a combination of:

• Hormonal imbalance

• Ovulation dysfunction

• Elevated androgen levels

• Insulin resistance

• Metabolic dysfunction

Importantly, not every woman experiences the same symptoms.

PCOS/PMOS exists on a spectrum: two women may carry the same diagnosis while experiencing very different health challenges.

Why Change the Name?

The term "Polycystic Ovary Syndrome" places the focus on the ovaries.

However, research increasingly suggests that ovarian symptoms may be only one manifestation of a broader metabolic disorder and has created several problems: 

It Was Misleading

• Not all women with PCOS have polycystic ovaries.

• Conversely, some women have polycystic ovaries but did not have PCOS.

It Overemphasises Fertility

• Many women are diagnosed only when trying to conceive.

• Yet fertility challenges represent only one aspect of the condition.

It Understates Metabolic Risk

• Perhaps most importantly, the previous name did little to highlight increased risks for:

  • Insulin resistance

  • Pre-diabetes

  • Type 2 diabetes

  • Cardiovascular disease

  • Metabolic syndrome

  • Non-alcoholic fatty liver disease

• The new name attempts to reflect the condition's true systemic nature.

Common Symptoms

PMOS affects multiple body systems. Symptoms may include:

Irregular Periods

Many women experience infrequent or absent periods and unpredictable cycles

These changes typically result from disrupted ovulation.

Difficulty Conceiving

Ovulation irregularities may contribute to fertility challenges.

Weight Gain or Difficulty Losing Weight

Many women describe feeling as though their metabolism works differently from others.

This is because underlying insulin resistance can make weight management significantly more challenging.

Increased Hair Growth

Excess androgen production may cause:

• Facial hair growth

• Chest hair

• Abdominal hair

Acne

Particularly around the jawline and lower face.

Hair Thinning

Some women experience male-pattern hair loss.

Fatigue

Many women report persistent low energy despite adequate sleep.

Mood Changes

Higher rates of anxiety and depression have been observed in women with PMOS.

The Metabolic Piece: Why It Matters

This is where the PMOS concept becomes particularly important.

Research suggests that approximately 50-80% of women with PMOS exhibit some degree of insulin resistance.

Insulin is a hormone responsible for moving glucose from the bloodstream into cells.

When cells become less responsive, the body compensates by producing more insulin.

High insulin levels can:

• Promote fat storage

• Increase hunger

• Drive androgen production

• Disrupt ovulation

• Increase inflammation

This creates a vicious cycle.

Higher insulin levels contribute to hormonal disruption, which further worsens metabolic health.

What We Know

Current evidence strongly supports several conclusions: 

Insulin Resistance Is Common

Even women with PCOS who are not overweight can experience significant insulin resistance.

Weight Is Not the Cause

While excess body fat can worsen symptoms, lean women can also develop PCOS.

The condition is not simply a consequence of body weight.

Strength Training Helps

Resistance training has consistently been shown to improve:

• Insulin sensitivity

• Body composition

• Metabolic health

• Physical function

Exercise Improves Symptoms

Regular physical activity can improve:

• Menstrual regularity

• Insulin sensitivity

• Cardiovascular health

• Psychological wellbeing

Nutrition Matters

Dietary approaches that improve blood sugar regulation often improve symptom management.

What We Still Don't Fully Understand

Despite decades of research, many questions remain. Researchers continue to investigate:

• The exact causes of PCOS

• The role of genetics

• The role of environmental factors

• Why symptoms vary so dramatically

• Why some women develop severe insulin resistance while others do not

• Optimal treatment approaches for different phenotypes

This is one reason management often needs to be highly individualised.

FACT: Exercise is One of the Most Powerful Interventions Available

Exercise is not a cure. But it remains one of the most effective tools available.

1.Strength Training Should Be a Priority

Strength training helps improve:

• Muscle mass

• Glucose uptake

• Insulin sensitivity

• Bone health

• Metabolic rate

Aim for 2-4 sessions per week.

Focus on:

• Squats

• Deadlift variations

• Rows

• Presses

• Lunges

• Carries

2.Walking Is Underrated

Regular walking improves:

• Blood sugar control

• Recovery

• Cardiovascular health

• Energy expenditure

A daily walking habit may be one of the most sustainable interventions available.

3.Cardio Has Value

Moderate aerobic exercise can improve:

• Insulin sensitivity

• Cardiovascular fitness

• Mood

• Metabolic health

The goal is consistency rather than punishment.

When Training Needs Adjusting

Some women with PMOS experience:

• Fatigue

• Blood sugar fluctuations

• Poor recovery

• Sleep disruption

During these periods, adaptation may be necessary.

If Fatigue Is High

Reduce:

• Volume

Before reducing:

• Frequency

Shorter sessions often work better than complete inactivity.

If Recovery Is Poor

Temporarily reduce:

• High-intensity intervals

• Excessive conditioning work

Maintain:

• Strength work

• Walking

• Movement

If Motivation Is Low

Focus on:

• Minimum effective doses

• Habit maintenance

• Small wins

Progress is rarely linear.

Nutrition Considerations

No single "PCOS diet" exists.

However, evidence generally supports:

1.Higher Protein Intake

Protein supports:

• Satiety

• Muscle maintenance

• Blood sugar regulation

2.Fibre-Rich Foods

Fibre helps support:

• Appetite regulation

• Gut health

• Glycaemic control

3.Minimally Processed Foods

Not because foods are inherently "good" or "bad", but because these foods tend to improve overall dietary quality.

4.Consistent Eating Patterns

Large swings in energy intake can make symptom management more difficult for some women.

A Word on Weight Loss

One of the biggest mistakes in PCOS management is assuming that weight loss is the treatment.

Weight loss may improve symptoms for some women.

However, health improvements can occur even when body weight changes very little.

Improved:

• Fitness

• Strength

• Insulin sensitivity

• Blood markers

• Energy levels

are all meaningful outcomes.

The focus should be improving health rather than relentlessly pursuing a number on the scales.