Signs and Symptoms of Polyendocrine Metabolic Ovarian Syndrome (PMOS)

Polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS), is a systemic metabolic disorder affecting up to 13% of women ages 15 to 49 worldwide. According to the Endocrine Society, the condition occurs when the ovaries produce elevated levels of androgens, which are male sex hormones such as testosterone, leading to fertility issues, irregular periods, and weight gain.

In May 2026, the Endocrine Society and other international experts officially renamed the condition to PMOS. The organization stated the name change better reflects the nature of the condition as a systemic metabolic disorder rather than one limited to the ovaries.

How is PMOS diagnosed?

A physician diagnoses PMOS when a patient meets at least two of three specific criteria: irregular menstrual cycles, high androgen levels, or the presence of polycystic ovaries. High androgen levels can interfere with the creation of follicles in the ovaries and lead to acne and unwanted hair growth.

There is no single test for the condition. Doctors use a combination of physical exams to check for acne and weight gain, pelvic exams to check the ovaries, blood tests to measure hormone levels, and pelvic ultrasounds to look for cysts on the ovaries or examine the uterine lining.

The World Health Organization reports that up to 70% of PMOS cases worldwide go undiagnosed. Many women are not identified as having the condition until their 20s or 30s, often when they encounter difficulty conceiving a child.

What are the symptoms and complications of PMOS?

Symptoms vary by individual and may appear at the time of a woman’s first period or later in life. Common signs include unpredictable periods, infertility, and weight gain, particularly around the stomach. Physical manifestations include oily skin, acne, thinning scalp hair, and hirsutism, which is excess hair growth on the face, chest, and lower abdomen.

Insulin resistance is another common symptom, which may manifest as skin tags or acanthosis nigricans, a darkening of the skin. Some women also experience sleep problems, including snoring, frequent waking, and daytime fatigue, as well as mood disorders such as depression and anxiety.

The condition increases the risk of several long-term health complications. These include:

• Type 2 diabetes and gestational diabetes
• Heart disease and high blood pressure
• Endometrial cancer
• Obstructive sleep apnea
• High cholesterol

What causes PMOS and who is at risk?

The exact cause of PMOS is unknown, but insulin resistance is a primary factor. When cells do not respond well to insulin, blood sugar rises, prompting the body to produce more insulin, which in turn triggers the production of androgens.

Obesity and low-grade inflammation also play roles. Research indicates that between 33% and 88% of women with PMOS are overweight or have obesity. Genetics and family history further increase the risk of development.

Environmental factors contribute to the condition’s onset. Exposure to endocrine-disrupting chemicals, such as bisphenol A (BPA) found in some housewares and medical devices, can increase inflammation. Air pollutants, including nitrogen dioxide and polycyclic aromatic hydrocarbons found in cigarette smoke and burnt coal, are also linked to the disorder.

How is PMOS treated and managed?

There is currently no cure for PMOS, but medications and lifestyle changes can manage the symptoms. Weight loss is a primary recommendation; losing as little as 10% of body weight can help regulate periods, improve insulin levels, and ease fertility issues.

Dietary strategies focus on lowering inflammation and stabilizing blood sugar. Recommended approaches include eating omega-3 fatty fish, anti-inflammatory foods like berries, broccoli, and spinach, and low-glycemic index foods such as lean meats, tofu, and eggs. Patients are advised to limit processed foods, simple carbohydrates, and added sugars.

Physical activity is also critical. The Physical Activity Guidelines for Americans suggest 150 to 300 minutes of moderate-intensity exercise—such as walking or gardening—or 75 to 150 minutes of vigorous exercise—such as running or cycling—each week. Strength training on two nonconsecutive days is recommended to build muscle and prevent weight gain.

Medical interventions depend on the patient’s goals regarding pregnancy:

• For those not seeking pregnancy: Combined hormonal birth control pills containing estrogen and progestin help regulate periods and reduce acne and excess hair.
• For insulin and weight management: Metformin, a diabetes medication, may be prescribed off-label to improve ovulation and decrease the risk of type 2 diabetes.
• For hair and skin: Anti-androgens block the effects of excess hormones, while retinoids and antibiotics treat acne.
• For infertility: Doctors may prescribe clomiphene, letrozole, metformin, or gonadotropins to induce ovulation. In vitro fertilization (IVF) is an option if medications fail.

In rare cases, doctors may perform ovarian drilling, an outpatient surgical procedure that destroys androgen-producing ovarian tissue to help improve ovulation.

How does PMOS affect different ethnic populations?

Research shows that PMOS presents differently across racial and ethnic backgrounds. Middle Eastern, Indian, Mediterranean, and South Asian women tend to experience higher rates of excess hair growth compared to white and East Asian populations.

Metabolic effects also vary. Hispanic women with PMOS are more likely to have high fasting insulin levels and a higher risk of postpartum depression than non-Hispanic white women. Black women with PMOS also show higher fasting insulin levels and higher systolic blood pressure compared to white women.

Asian women with PMOS typically have lower rates of obesity than other racial groups but are more likely to develop diabetes than white women.