Polyendocrine Metabolic Ovarian Syndrome (PMOS) - My Approach

What Is This Issue?

Polyendocrine Metabolic Ovarian Syndrome (PMOS): A Functional Nutrition Approach

What Is This Issue?

Polyendocrine Metabolic Ovarian Syndrome (PMOS), which you might know as PCOS, is a complex hormonal issue that affects multiple systems in your body, not just your ovaries. The name changed in 2026 to better reflect what this condition really is – a polyendocrine metabolic disorder with ovarian manifestations.

PMOS is characterised by hormonal imbalances, which can lead to irregular periods, acne, excess hair growth, or difficulty with weight management. The specific symptoms you experience often depend on the underlying drivers of your condition, which is why a one-size-fits-all approach rarely works.

What Is Underlying This Issue?

The old name "polycystic ovary syndrome" was misleading because it suggested that having cysts on your ovaries was the main problem, when actually that's not even a defining feature of the condition. In reality, PMOS is a complex metabolic and endocrine disorder with several underlying causes.

In my practice, I see PMOS presenting in different ways, with the following root causes accounting for most cases:

1. Insulin resistant PMOS (about 70% of cases) – when your body doesn't respond properly to insulin, it produces more, which stimulates your ovaries to make excess male hormones

2. Post-pill PMOS – an androgen surge that can occur after stopping hormonal contraception, especially if the pill contained progestin

3. Adrenal PMOS – characterised by elevated DHEA and cortisol with normal testosterone levels, indicating stress as the primary driver

4. Chronic inflammatory PMOS – often linked to gut issues and leaky gut, which can be diagnosed through markers like C-reactive protein and white blood cell levels

My Functional Nutrition Perspective

In my practice, I've found that PMOS requires a whole-body approach rather than focusing solely on reproductive symptoms. The new name "polyendocrine metabolic ovarian syndrome" better reflects what I see in clinical practice – that this is fundamentally a metabolic condition with hormonal consequences rather than just a gynaecological issue.

What I often observe is that the conventional approach focuses primarily on managing symptoms like irregular periods or excess hair growth with medications that don't address the underlying metabolic dysfunction. While these treatments may provide temporary relief, they don't resolve the insulin resistance and hormonal imbalances driving the condition.

The gut-hormone connection is particularly relevant in PMOS, as digestive health directly impacts insulin sensitivity and hormone metabolism. Additionally, the nervous system plays a crucial role, as stress can exacerbate insulin resistance and further disrupt hormonal balance.

What I Will Look At

When working with PMOS, I focus on several key areas to understand your unique situation:

Hormonal Balance

• I'll assess your androgen levels and how they relate to insulin production

• I'll examine the relationship between your reproductive hormones and metabolic markers

• I'll evaluate how your stress hormones (cortisol) might be affecting your insulin sensitivity and reproductive hormones

Metabolic Function

• I'll investigate your insulin sensitivity, ketones and glucose metabolism

• I'll evaluate how your body is processing and utilising carbohydrates and fats

• I'll consider the potential benefits of ketogenic approaches and intermittent fasting as tools to improve insulin sensitivity and hormone balance

Gut Health

• I'll assess your microbiome balance to identify any dysbiosis that might be contributing to inflammation

• I'll evaluate your digestive function and nutrient absorption capabilities

• I'll investigate potential gut permeability that might be driving inflammation

Nervous System Impact

• I'll evaluate your stress response and how it might be affecting your insulin sensitivity and hormonal health

• I'll assess how your nervous system might be contributing to symptom severity

Recommended Lab Testing

For comprehensive assessment of PMOS, I recommend the DUTCH Plus test, which provides:

• Complete hormone panel including oestrogen, progesterone, testosterone, and DHEA metabolites

• Cortisol awakening response and daily rhythm to assess stress impact on insulin sensitivity

• Organic acid markers that reveal insulin resistance and metabolic dysfunction

• Melatonin production to assess sleep quality and hormonal recovery

Additionally, I may recommend the Elite Thyroid test if thyroid function needs to be evaluated, as thyroid disorders can mimic or exacerbate PMOS symptoms.

Hormone Considerations

Many women with PMOS have elevated androgens and relative progesterone deficiency, which is worth investigating as progesterone helps balance the effects of excess androgens and can help regulate menstrual cycles. Research has shown that progesterone therapy can help restore regular menstrual cycles in women with PMOS by counteracting the effects of excess androgens and supporting proper ovulation.

The hormonal imbalances in PMOS are complex and multifactorial, involving not just reproductive hormones but also insulin, cortisol, and other hormones that interact in a network of dysregulation. This is why the new name "polyendocrine metabolic ovarian syndrome" is more accurate – it reflects the multiple hormonal systems involved rather than focusing solely on the ovaries.

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