Polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS), affects an estimated 170 million women* of childbearing age worldwide — meaning anyone who has started menstruating but hasn’t reached menopause.

The updated name — from PCOS to PMOS — reflects that the condition involves multiple hormone systems and metabolic processes, not just the ovaries, and is not associated with the presence of ovarian cysts. The “cysts” seen on the ovaries are actually small, immature follicles.

Signs and Symptoms of PMOS

• Irregular periods (menstrual cycles): This includes infrequent periods, which means fewer than eight per year. People who have regular periods typically get 12 per year.
• Excess facial and body hair growth: Higher levels of androgens (hormones like testosterone) may cause extra facial hair, including on the sideburn area or chin.
• Acne: Pimples may occur on the face.
• Alopecia: This type of hair loss results in thinning of the hair, including a widening part.
• Weight gain: Your hormones play a role in your metabolism. Because PMOS impacts your hormones, it also can impact your metabolism. Many people with PMOS have insulin resistance, where the body’s cells can’t take up glucose (blood sugar) from the bloodstream, making weight management harder. This can increase your risk of Type 2 diabetes, high blood pressure and heart disease.
• Infertility: Because people with PMOS may not ovulate regularly, it is the leading cause of hormone-related infertility. “If there’s no egg released, there’s no chance of getting pregnant,” explains Dr. Boots. “It’s hard to get the timing just right for egg fertilization.”

How PMOS Is Diagnosed

Your ovaries store your eggs in follicles, which are small fluid-filled sacs. Each menstrual cycle, the brain sends hormonal signals from your hypothalamus and pituitary gland to stimulate one follicle to ovulate. Typically, a follicle releases an egg that travels through the fallopian tubes to the uterus for possible fertilization.

With PMOS, this process can be disrupted. The signal from the brain to the ovaries becomes dysregulated, and the follicles do not progress through development or ovulation. This creates a buildup that can prevent an egg from being released and moving through the fallopian tubes. Dr. Boots describes this as a “traffic jam” in the ovaries.

To help diagnose PMOS, your doctor may use hormonal blood tests and an ultrasound to look for an increased number of follicles in the ovaries.

Although the exact cause of PMOS is unknown, it has been linked to genetics, insulin levels and hormones called androgens. While androgens are often thought of as “male” hormones, they play an important role in people of all sexes. Higher-than-normal levels, called hyperandrogenism, can contribute to PMOS and its symptoms.

Managing PMOS

PMOS can be a challenging diagnosis. There is no cure for it, but help is available to manage your symptoms and support fertility goals.

“Lifestyle is far and away the most important way to manage PMOS,” says Dr. Boots.

Dr. Boots encourages people with PMOS to:

• Exercise regularly (150 minutes of moderate activity every week).
• Eat a healthy diet that is rich in vegetables and lean protein, such as chicken.
• Maintain a healthy weight, which can improve fertility.

Medication may also be used to manage symptoms in some people, including:

• Hormonal birth control
• Metformin, which can help reduce insulin resistance
• Spironolactone, which is an anti-androgen medication that can help with unwanted hair growth

Managing PMOS is important, as the effects can increase the risk for complications and long-term health problems. These can include:

• Diabetes: People with PMOS are often resistant to insulin, which can lead to Type 2 diabetes. While healthy lifestyle changes can help you manage Type 2 diabetes, PMOS may complicate diabetes management. Your care team can develop a personalized care plan if you have both conditions.
• Heart disease: PMOS is associated with a higher risk for cardiovascular disease, likely due to its links with diabetes, sleep apnea and excess weight.
• Depression or anxiety: Hormonal imbalances can affect mental health, including a higher risk of mood disorders. “There is a whole interplay with self-confidence and body image, and some of that has to do with hormone dysfunction,” adds Dr. Boots.
• Cancer of the uterine lining: Unmanaged symptoms can increase the risk of endometrial cancer.
• Infertility: Your doctor can talk with you about options to raise your chance of getting pregnant.

What the Future Holds

If you have PMOS, work with your doctor to manage your symptoms. If fertility is a concern, ovulation medications, intrauterine insemination (IUI) and in vitro fertilization (IVF) may be options to pursue.

Learn more about the Northwestern Medicine Fertility and Reproductive Medicine team.