Polyendocrine metabolic ovarian syndrome

Polyendocrine metabolic Ovarian Syndrome, also known as PMOS and previously called Polycystic Ovary Syndrome (PCOS), is the most common hormonal disorder in women who can have children. It is diagnosed when a woman has at least two of three main signs: irregular menstrual periods, high levels of testosterone or related symptoms such as extra facial hair, or many small follicles in the ovaries seen on ultrasound. Other symptoms can include heavy periods, acne, difficulty getting pregnant, and patches of darker skin.

The exact cause of PMOS is not fully known, but genes and environment both seem to play a role. It affects between 5% and 18% of women. PMOS is often linked to insulin resistance, which can be worse in women who are obese. This can increase the risk of health problems such as type 2 diabetes, liver disease, and endometrial cancer.

Treatment focuses on helping with symptoms and lowering long-term health risks. A healthy lifestyle and keeping a balanced weight are important. Hormonal contraception can help make periods more regular and reduce acne and extra hair growth. Metformin, a medicine used for diabetes, can help the body use insulin better. For women who want to become pregnant, doctors may use letrozole to help start ovulation. Women with PMOS should also be checked for heart and metabolic health risks, especially during pregnancy.

Signs and symptoms

PMOS can cause many different signs and symptoms. These include problems with ovulation, like irregular periods, and changes in hormones that can lead to hair growth in places usually seen only in males, such as the face or chest. It can also affect metabolism, leading to weight gain. These symptoms often begin during puberty.

Common signs of PMOS are irregular periods, difficulty getting pregnant, hair growth in a male pattern, severe acne, and hair loss on the scalp. The skin might also have dark, thick patches. The ovaries may be larger than normal and have many small fluid-filled sacs. Levels of certain hormones, like testosterone, are often higher in women with PMOS.

Women with PMOS have a higher risk of several health issues, including obesity, problems with fats in the blood, high blood pressure, and type 2 diabetes if they are overweight. PMOS can also increase the risk of heart disease and strokes. During pregnancy, complications like high blood pressure and low blood sugar are more common. Mental health issues such as depression and anxiety can also occur. PMOS may also affect body image and increase the risk of certain cancers and sleep problems.

Cause

The exact cause of PMOS is not known. It often runs in families, suggesting that genes may play a role. It can also appear in people who developed pubic hair and sweat glands early or who are overweight. Being born small, exposure to certain hormones before birth, and contact with substances that change hormone levels may also increase the chances of having PMOS.

PMOS seems to have a strong genetic link. Studies with families and twins show that genetics are important. Men related to women with PMOS can also show similar health issues, like higher chances of being overweight or having type-2 diabetes. While genes are important, the environment may also affect PMOS. For example, certain chemicals in plastics might increase the risk. Being overweight can also make PMOS more likely, and PMOS can sometimes make it harder to lose weight.

Mechanism

PMOS involves changes in hormones and how the body uses food. Women with PMOS often have higher levels of certain hormones made by the ovaries. This happens because of changes in the brain that affect how the body controls hormones.

These hormone changes can stop the ovaries from working normally. This leads to many small structures in the ovaries and less regular periods. The hormones also affect how the body uses sugar, which can cause problems even in women who are not overweight.

PMOS can also be linked to issues with the heart and liver. For example, women with PMOS may have changes in their blood vessels. Being overweight, having trouble processing sugar, and having too much of certain hormones can all affect the liver.

Diagnosis

To diagnose PMOS, doctors use specific guidelines called the Rotterdam criteria. A woman is diagnosed with PMOS if she has two out of three things: signs of extra hormones called androgens (like facial hair or acne), irregular or missing menstrual periods, or many small structures in the ovaries seen on an ultrasound or high levels of a certain hormone in the blood.

For teenagers, only having extra androgen signs and irregular periods is needed for diagnosis, since many small ovarian structures are normal at that age. Older guidelines exist but are stricter, needing both irregular periods and androgen signs.

Management

PMOS has no cure, and managing it focuses on helping with symptoms. This often includes changes in daily habits like eating better and getting regular exercise. For some women, medicines such as metformin or GLP-1 receptor agonists can help with certain health issues. If a woman’s weight is high, bariatric surgery might be an option. Doctors often use special pills called combined oral contraceptives to help with skin changes and keep monthly cycles regular. Other treatments can help with hair growth or acne, and some medicines can support women who want to have a baby.

Making healthy choices is important for managing PMOS. Keeping a healthy weight through diet and exercise is a key part of treatment. Even small amounts of weight loss can help both general health and reproductive health. Exercise guidelines for everyone suggest about 150 minutes a week of moderate activity to keep weight stable, and more for weight loss. Women with PMOS might find it harder to manage weight because of feeling full quickly, trouble sleeping, or body image concerns. Setting clear goals, tracking progress, and learning to stick with plans can help. Support strategies like SMART goals and behavioural programmes can also be useful.

Medicines like metformin and combined oral contraceptives are commonly used. Metformin, often used for diabetes, can help with insulin resistance and might help with irregular periods. It can cause side effects like stomach pain or upset stomach. Combined oral contraceptives help with hair growth and keeping cycles regular. They work by changing hormone levels and can lower the risk of certain cancers. Other medicines might be used if these aren’t suitable. GLP-1 receptor agonists like liraglutide and semaglutide can also help with metabolism and might improve menstrual regularity.

Having a baby can be challenging with PMOS because of irregular ovulation. The first step is improving overall health through lifestyle changes. As of 2025, there isn’t enough information to know if certain weight-loss medicines are safe during pregnancy. The most common medicine to help with ovulation is letrozole. Other options include combinations of medicines or, in some cases, a minor surgery. For women who still have trouble conceiving, assisted reproductive technologies like in vitro fertilisation might be considered, though they come with some risks.

Managing hair growth and acne often involves lowering hormone levels and removing unwanted hair. Standard contraceptive pills can be effective, and sometimes combined with other medicines. Additional treatments might be needed for severe cases.

Women with PMOS are more likely to experience low mood, and it’s important to check for this. Standard treatments like talking therapies and other medicines are recommended. Regular check-ups for heart health and blood sugar levels are also important to catch any problems early. This includes testing for glucose tolerance and checking blood pressure yearly.

Epidemiology

PMOS is the most common hormonal disorder among women who can have children. When women have trouble getting pregnant because they don't release eggs regularly, PMOS is often the reason.

According to the World Health Organization, PMOS affects over 6 to 13% of women who can have children. Different studies show numbers between 5% and 18%. The number depends on the rules doctors use to diagnose PMOS. No matter which rules are used, the number of women with PMOS is growing. This is likely because people are living longer, more people know about it, and more people are overweight.

PMOS seems to affect people from different backgrounds fairly equally. However, it might be more common in people from Southeast Asia and the Eastern Mediterranean. People from Africa and Hispanic America with PMOS often have more trouble with insulin, and people from South Asia often have more symptoms related to metabolism and higher body weights. Women from East Asia usually have fewer hair growth symptoms and lower body weights compared to other groups.

History

People have noticed signs of what we now call PMOS for a very long time. Ancient Greek doctors wrote about women who had thick, oily skin and missed their periods. In 1721, doctors in Italy described women who were a bit overweight, had trouble having babies, and had bigger-than-normal ovaries that looked bumpy and shiny.

In 1935, two American doctors, Irving F. Stein and Michael L. Leventhal, wrote about women with ovaries that looked like many small cysts. They noticed these women also had extra hair on their faces and bodies, trouble getting pregnant, and missed periods. Their work helped scientists understand that PMOS might be linked to problems with hormones in the body. Later, scientists began studying how metabolism and genes might also play a role in PMOS.

Terminology

Until 2026, this condition was called polycystic ovary syndrome. The old name came from what doctors saw in medical images, where the ovaries looked like they had many small cysts. However, these weren't really cysts but many developing follicles.

In 2026, doctors changed the name to polyendocrine metabolic ovarian syndrome, or PMOS, after talking with many people. They decided the old name was not accurate and made it hard to understand the full effects of the condition. The new name better shows that it affects many parts of the body and is not just about the ovaries.

Research directions

Researchers are looking for the best ways to help manage PMOS, including using new medicines for weight loss. They also want to find better ways to tell if someone has PMOS, especially by looking at certain levels in the blood.

Scientists are studying new methods to understand health problems related to PMOS. They are using advanced tools to find patterns in health data and to group patients in helpful ways. These tools might help doctors give better care to people with PMOS.

Since 2024, scientists have made models in labs to study PMOS using special cells from people with the condition. These cells can change into many types of cells, helping researchers learn more about how PMOS affects the body.

Society and culture

PMOS affects many people and costs a lot to manage. In the United States, it costs over $15 billion each year to handle PMOS and its effects, like strokes and mental health issues. Even though PMOS is common, it did not get as much research money as other diseases like arthritis and lupus. This might be because of differences in how health care treats conditions that mostly affect women.

There is also a lot of incorrect information about PMOS on social media. Some people online, even those without medical training, share advice that is not proven to help. This can make it harder for people with PMOS to get the right care. Doctors sometimes don’t know enough about PMOS, which can delay diagnosis and treatment. Many people with PMOS are not happy with the care they receive.