PMOS (Previously PCOS): Understanding Symptoms, Testing, and Naturopathic Treatment
In 2026, an international panel of experts announced that Polycystic Ovary Syndrome (PCOS) would be renamed Polyendocrine Metabolic Ovarian Syndrome (PMOS)(1). While the condition itself has not changed, the new name better reflects what we have known for years: this is not simply an ovarian condition. PMOS is a complex hormonal and metabolic disorder that affects multiple systems throughout the body.
Why Was PCOS Renamed to PMOS?
The term "polycystic ovary syndrome" has been criticized for decades because it does not accurately describe the condition.
Many individuals diagnosed with PCOS do not actually have ovarian cysts, while others may have polycystic-appearing ovaries without having the syndrome. The name also places a heavy emphasis on the ovaries, despite the fact that metabolic and hormonal dysfunction are often central to the condition.
The new name: Polyendocrine Metabolic Ovarian Syndrome (PMOS), better reflects the systems involved:
Polyendocrine: Multiple hormone systems are affected.
Metabolic: Insulin resistance and metabolic dysfunction are common underlying drivers.
Ovarian: Ovarian function and ovulation remain important aspects of the condition.
Syndrome: Symptoms can vary significantly between individuals.
The name change represents an important shift toward recognizing PMOS as a whole-body condition rather than solely a reproductive disorder.
What Are the Symptoms of PMOS?
PMOS can present differently from person to person, but common symptoms include:
Irregular or absent menstrual cycles
Difficulty conceiving
Acne, particularly along the jawline and chin
Excess facial or body hair growth (hirsutism)
Hair thinning or hair loss
Weight gain or difficulty losing weight
Insulin resistance
Fatigue
Cravings and blood sugar fluctuations
Anxiety or mood changes
Darkened skin folds (acanthosis nigricans)
Not every individual will experience all of these symptoms, which is one reason PMOS is frequently underdiagnosed or misdiagnosed.
What Causes PMOS?
There is no single cause of PMOS. Instead, several interconnected factors may contribute to its development.
Insulin Resistance
Insulin resistance is one of the most common underlying drivers of PMOS (2).
When cells become less responsive to insulin, the body compensates by producing more. Elevated insulin levels can stimulate the ovaries to produce excess androgens (such as testosterone), contributing to irregular ovulation, acne, unwanted hair growth, and fertility challenges.
Importantly, fasting glucose and HbA1C can remain normal for years while insulin levels are already elevated. This is why assessing insulin resistance directly can be so valuable.
Hormonal Imbalances
Individuals with PMOS often have alterations in:
Testosterone
DHEA
LH and FSH
Estrogen
Progesterone
SHBG (Sex Hormone Binding Globulin)
These hormonal shifts can contribute to irregular cycles, anovulation, acne, and androgen-related symptoms.
Inflammation
Low-grade chronic inflammation appears to play a role in many cases of PMOS and may contribute to insulin resistance and metabolic dysfunction (3).
Genetics
PMOS, gestational diabetes and type II diabetes often run in families, suggesting a significant genetic component.
Stress and Cortisol Dysregulation
Chronic stress and altered cortisol patterns may worsen insulin resistance, inflammation, appetite regulation, and reproductive hormone balance.
How Is PMOS Diagnosed?
The name has changed, but the diagnostic criteria remain the same.
PMOS is currently diagnosed using the Rotterdam Criteria, which require two of the following three findings (4):
Oligomenorrhea (menstrual cycles that are longer than 35 days) or anovulation (absence of ovulation)
Hyperandrogenism: high levels of the hormones DHEA, Testosterone and DHT. Clinically, this can lead to acne, irregular hair growth, and menstrual irregularities.
Polycystic Ovaries: ≥ 12 follicles measuring 2‐9 mm in diameter and/or an ovarian volume > 10 mL in at least one ovary viewed on transvaginal ultrasound.
A comprehensive assessment should also investigate the metabolic and hormonal factors contributing to symptoms.
What Testing Is Helpful for PMOS?
Blood Sugar and Insulin Testing
Because insulin resistance is so common in PMOS, evaluating metabolic health is often one of the most important parts of the workup.
Recommended testing may include:
Fasting insulin
Fasting glucose
Hemoglobin A1C (HbA1C)
2-hour oral glucose insulin challenge test
One of the most valuable markers is often fasting insulin, which can become elevated years before blood sugar markers become abnormal. Fasting insulin and glucose can be used to calculate a HOMA-IR score, a marker for insulin resistance.
Inflammatory Markers
Metabolic conditions are inflammatory in nature and inflammation may contribute to both symptoms and long-term health risks.
Testing may include:
Highly sensitive C-reactive protein (hs-CRP)
Erythrocyte sedimentation rate (ESR)
Thyroid Testing
Thyroid dysfunction can contribute to fatigue, weight changes, menstrual irregularities, infertility, and hair loss.
A comprehensive thyroid assessment may include:
Thyroid Stimulating Hormone (TSH)
Free T3
Free T4
Thyroid antibodies
Cortisol Testing
Assessing cortisol may provide insight into stress physiology and its impact on metabolic and reproductive health.
Nutrient Testing
Vitamin D deficiency is common in PMOS and may contribute to metabolic and reproductive dysfunction (5, 6).
Testing may include:
Vitamin D (25-OH Vitamin D)
Hormone Testing for PMOS
Hormone testing can provide valuable information about ovulation, androgen excess, and reproductive hormone balance.
Common markers include:
Follicle Stimulating Hormone (FSH)
Luteinizing Hormone (LH)
Total Testosterone
Dehydroepiandrosterone (DHEA)
Estrogen
Progesterone
Sex Hormone Binding Globulin (SHBG)
These markers can help identify patterns commonly seen in PMOS and guide individualized treatment recommendations.
Naturopathic Management of PMOS
Successful PMOS treatment focuses on addressing the underlying factors driving symptoms rather than simply masking them.
Nutrition for PMOS
Nutrition is one of the most effective tools for improving insulin sensitivity and supporting hormone balance.
Rather than focusing on restrictive dieting, focus on building meals that support blood sugar regulation, satiety, and metabolic health.
Key dietary strategies include:
Following a Mediterranean-style dietary pattern
Prioritizing protein at every meal
Choosing lower glycemic load carbohydrates
Incorporating lower glycemic index foods
Increasing fibre intake
Including resistant starches such as legumes, cooked and cooled potatoes/rice, and green bananas
Applying food insulin demand principles to meals
The goal is to improve insulin sensitivity while providing the nutrients necessary for healthy hormone production and ovulation.
Exercise and Strength Training
Exercise is one of the most effective interventions for improving insulin sensitivity.
While all movement is beneficial, resistance and strength training appear particularly helpful for individuals with PMOS.
Benefits may include:
Improved insulin sensitivity (7)
Increased lean muscle mass and basal metabolic rate
Better body composition
Improved metabolic health
Enhanced ovulatory function
Improved energy and mood
Even without significant weight loss, improvements in muscle mass and insulin sensitivity can have profound effects on symptoms.
Evidence-Based Supplements for PMOS
Depending on laboratory findings and clinical presentation, targeted supplementation may be beneficial.
Myo-Inositol
Myo-inositol is one of the most extensively studied supplements for PMOS (8).
Research suggests it may help:
Improve insulin sensitivity
Support ovulation
Improve menstrual regularity
Enhance fertility outcomes
Fish Oil
Omega-3 fatty acids may help:
Reduce inflammation
Improve metabolic health and lipid parameters (increase HDL and lower triglycerides/LDL)(9)
Support cardiovascular health
Vitamin D
Vitamin D deficiency is common in PMOS and may contribute to:
Insulin resistance
Menstrual irregularities
Fertility challenges
Magnesium
Magnesium supports:
Blood sugar regulation (10)
Insulin signaling
Sleep quality
Stress resilience
CoQ10
Coenzyme Q10 may support:
Mitochondrial function
Energy production
Metabolic health and lipid parameters (increase HDL and lower triglycerides/LDL)(11)
Reproductive health (increase FSH, lower testosterone)(11)
Berberine
Berberine has demonstrated benefits for (12, 13):
Insulin sensitivity
Blood sugar regulation
Metabolic health
Influence on gut microflora
Chromium
Chromium plays a role in insulin signalling and may support blood sugar regulation (14).
Botanical Medicine for PMOS
Herbal medicine may be incorporated depending on an individual's presentation and treatment goals.
Examples include:
Vitex (Vitex agnus-castus)
Vitex may help support:
Ovulation
Menstrual regularity
Hormonal communication between the brain and ovaries
Black Cohosh (Actaea racemosa)
Black cohosh may be considered in certain cases to support reproductive hormone balance.
Spearmint
Spearmint may help reduce androgen-related symptoms (e.g., acne) and has been studied for its potential anti-androgenic effects (15).
Cinnamon
Cinnamon may support healthy glucose metabolism and insulin sensitivity (16).
The Long-Term Health Implications of PMOS
PMOS is not simply a fertility condition.
When left unaddressed, it may increase the risk of (17):
Type 2 diabetes
Prediabetes
Metabolic syndrome
Non-alcoholic fatty liver disease
Cardiovascular disease
Infertility
Endometrial hyperplasia
Endometrial cancer
This is one reason why early identification and treatment are so important.
Medications in PMOS: Metformin & GLP-1 Receptor Agonists
While nutrition, lifestyle, and supplementation form the foundation of PMOS care, some individuals may also benefit from medications that target insulin resistance and metabolic dysfunction.
Metformin
Metformin is one of the most well-studied medications for PMOS. It works primarily by improving insulin sensitivity and reducing liver glucose production, which can help lower insulin levels—a key driver of hormonal imbalance in many individuals (18).
Potential benefits include:
Improved insulin sensitivity and lower fasting insulin
Menstrual cycle regularity and improved ovulation
Support for fertility outcomes
Improved blood sugar control
Reduced risk of progression to type 2 diabetes
It is often considered when there is clear insulin resistance, prediabetes, or impaired glucose tolerance. Common side effects include digestive upset, especially early on, and long-term use may reduce vitamin B12 levels (19).
GLP-1 Receptor Agonists
GLP-1 medications such as Ozempic, Wegovy, Mounjaro, and Zepbound work by increasing satiety, slowing gastric emptying, and enhancing insulin sensitivity (20).
In PMOS, they may help:
Improve insulin resistance and glucose control
Support weight loss and reduce visceral fat
Improve metabolic markers and fatty liver
Potentially improve ovulation and cycle regularity in some individuals
The Bottom Line
PMOS, previously known as PCOS, is a complex endocrine and metabolic condition that extends far beyond the ovaries.
A comprehensive approach involves assessing insulin resistance, metabolic health, inflammation, thyroid function, nutrient status, and reproductive hormones while implementing targeted nutrition, lifestyle, supplement, and botanical medicine strategies.
By addressing the root causes of symptoms, many individuals experience improvements in menstrual regularity, ovulation, fertility, energy, metabolic and skin health, and overall quality of life.
Disclaimer: This information is for educational purposes only and is not intended to provide or replace medical advice, diagnosis, or treatment. Always consult your qualified healthcare provider for individualized recommendations.