PCOS to PMOS: A Guide to Polyendocrine Metabolic Ovarian Syndrome

What is PCOS? Polycystic Ovarian Syndrome (PCOS) is a condition where the ovaries become enlarged and develop many follicles or cysts – around twice as many as in normal ovaries.

PCOS to PMOS: A Guide to Polyendocrine Metabolic Ovarian Syndrome

What is PCOS?

Polycystic Ovarian Syndrome (PCOS) is a condition where the ovaries become enlarged and develop many follicles or cysts – around twice as many as in normal ovaries. Under normal circumstances 15–20 follicles may develop but only one will mature enough to release an egg. However, in cases of PCOS, lots of follicles will develop (sometimes over 30), but none will mature and enlarge sufficiently to release an egg. This can lead to a lack of menstrual cycle or irregular periods, as well as issues with fertility.

PCOS becomes PMOS

The condition was recently renamed to polyendocrine metabolic ovarian syndrome (PMOS) as this describes the wide-ranging symptoms of this syndrome, beyond the effects on the ovaries.1 Many women affected by PMOS experience symptoms well beyond the reproductive system – notably obesity,2 insulin resistance3 and dyslipidemia (abnormal fats in the blood).4

What causes PMOS?

Between 5–26% of women are affected by PMOS, and diagnosis can take up to two years in the UK. Women will need to exhibit two out of three of the following criteria to be diagnosed: irregular or absent periods, high androgens (male hormones) in a blood test or a scan showing high numbers of follicles on the ovaries.5

The exact trigger for the development of PMOS is unknown but is thought to be partially genetic, with a family history of PMOS or blood sugar issues being linked to its development.6 Many women who have PMOS are either overweight (38–88%)7 or accumulate fat around the abdomen and organs8 (abdominal or visceral fat), even when weight is normal.9 This type of fat can have a direct effect on insulin sensitivity and function,10 increasing insulin resistance. High insulin can then increase the production of androgens by the ovaries, which is already high in those with PMOS, and high androgen also worsens insulin resistance.11

Symptoms

Excess androgens are associated with common PMOS symptoms such as excessive body and facial hair, acne, and male-pattern hair loss. Other symptoms include weight gain, which will also affect insulin, heavy menstrual bleeding, headaches and mood swings.

Nutrients for support

As one of the key issues in PMOS is the two-way relationship between insulin and androgens, breaking the cycle where both are overproduced and affect the over-production of the other is important. Myo-inositol has been shown to play a role in insulin signalling12 and studies suggest that supplementation with myo-inositol can improve menstrual regularity, support weight loss, improve follicle maturation, reduce androgen levels and improve insulin sensitivity. Several studies have shown it to be effective in PMOS,13 with the dose varying. However a level of 4g daily seems to be the most effective and commonly used.

Several vitamins, including vitamins D and K have also been shown to be useful for PMOS. 67–85% of women with PMOS are deficient in vitamin D14 and this can exacerbate symptoms such as insulin resistance,15 menstrual and ovulatory irregularities,16 high androgen levels,17 infertility,18 and obesity. Supplementation with vitamins D and K and calcium has been shown to improve insulin parameters and lipid profiles.19 Vitamin E has also been shown to influence PMOS symptoms such as acne, hirsutism, insulin sensitivity and menstrual irregularities.20

Studies have suggested that zinc is often lower in those with PMOS than in women without the condition.21 This mineral plays a role in insulin production and regulation,22 and it has been suggested that it can improve blood glucose control.23

Cinnamon contains active compounds which may help to support insulin action and reduce blood glucose.24 Studies also suggest that cinnamon can positively influence the types of bacteria in the gut, increasing bacteria species which are linked to improving insulin resistance.25

Alpha Lipoic Acid (ALA) is a nutrient which appears to have many benefits for those with PMOS. Its main role is linked to insulin resistance and it appears to improve insulin sensitivity via a number of mechanisms.26 A study has demonstrated the benefits of combining alpha lipoic acid and myo-inositol for symptoms of PMOS. Androgen levels and body mass index (BMI) decreased after 6 months.27 ALA has also been used in combination with myo-inositol, and seems to be particularly useful for normalising both insulin and menstrual cycles.28

Both ALA and myo-inositol have been linked to increases in insulin sensitivity. A meta-analysis of 14 previous investigations has shown that a combination of these two nutrients can be particularly useful for patients with PCOS, especially those with insulin resistance, type 2 diabetes or a higher BMI.

Another group of nutrients which may be useful for symptoms of PMOS are the omega 3 fatty acids. Higher dietary and body levels of the omega 3s are associated with better metabolic controls and body composition (fat vs muscle).29 Studies also suggest that omega 3 fatty acids may reduce inflammation and improve dyslipidemia, which are both often high in those with PMOS and linked to the development of heart disease.30

Lifestyle and diet

There is also evidence to suggest that following certain dietary patterns may be useful for PMOS. A Mediterranean style diet is probably one of the most relevant, as it focuses on polyphenol, potassium and magnesium rich fruits and vegetables, foods such as nuts and seeds which contain both omega 3 and 6 fatty acids, olive oil and lean meats and oily fish, such as herring, mackerel, salmon and sardines which are also rich in omega 3 fats. Processed foods are discouraged, and the emphasis is on the consumption of fresh, unprocessed or minimally processed foods which are naturally much lower in sugar, salt and trans and hydrogenated fats. A high adherence to this diet is associated with lower ovarian volume (an indication of fewer cysts) and a decrease in PMOS symptoms.31

References

  1. Teede HJ, Bahri Khomami M, Morman R, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. Lancet. Published online May 12, 2026.
  2. International Evidence Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Monash University; Melbourne, VIC, Australia: 2018.
  3. Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018;110:364–379.
  4. Berneis K, Rizzo M, Lazzaroni V, Fruzzetti F, Carmina E. Atherogenic lipoprotein phenotype and low-density lipoproteins size and subclasses in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2007;92:186–189.
  5. NHS. Polycystic ovary syndrome (PCOS) – Diagnosis. Available at: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/diagnosis/
  6. Shukla A, Rasquin LI, Anastasopoulou C. Polycystic Ovarian Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026.
  7. Barber TM, McCarthy MI, Wass JA, Franks S. Obesity and polycystic ovary syndrome. Clin Endocrinol (Oxf). 2006;65:137-145.
  8. Lim SS, Davies MJ, Norman RJ, Moran LJ. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2012;18:618–637.
  9. Diamanti-Kandarakis E. Role of obesity and adiposity in polycystic ovary syndrome. Int J Obes (Lond). 2007;31 Suppl 2:S8-13.
  10. Pouliot MC, Després JP, Nadeau A, et al. Visceral obesity in men. Associations with glucose tolerance, plasma insulin, and lipoprotein levels. Diabetes. 1992;41(7):826-34.
  11. Unluhizarci K, Karaca Z, Kelestimur F. Role of insulin and insulin resistance in androgen excess disorders. World J Diabetes. 2021;12:616–629.
  12. Genazzani AD. Inositol as putative integrative treatment for PCOS. Reprod Biomed Online. 2016;33(6):770-780.
  13. Greff D, Juhász AE, Váncsa S, et al. Inositol is an effective and safe treatment in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Reprod Biol Endocrinol. 2023;21(1):10.
  14. Thomson RL, Spedding S, Buckley JD. Vitamin D in the aetiology and management of polycystic ovary syndrome. Clin Endocrinol (Oxf). 2012;77(3):343-50.
  15. Alvarez JA, Ashraf A. Role of vitamin D in insulin secretion and insulin sensitivity for glucose homeostasis. Int J Endocrinol. 2010;2010:351385.
  16. Menichini D, Facchinetti F. Effects of vitamin D supplementation in women with polycystic ovary syndrome: a review. Gynecol Endocrinol. 2020;36(1):1-5.
  17. Gokosmanoglu F, Onmez A, Ergenç H. The relationship between vitamin D deficiency and polycystic ovary syndrome. Afr Health Sci. 2020;20(4):1880-1886.
  18. Kiani AK, Donato K, Dhuli K, Stuppia L, Bertelli M. Dietary supplements for polycystic ovary syndrome. J Prev Med Hyg. 2022;63(2 Suppl 3):E206–E213.
  19. Karamali M, Ashrafi M, Razavi M, et al. The effects of calcium, vitamins D and K co-supplementation on markers of insulin metabolism and lipid profiles in vitamin D-deficient women with polycystic ovary syndrome. Exp Clin Endocrinol Diabetes. 2017;125(5):316-321.
  20. Mukundan A, Jayakumari S. Can vitamin E be a key supplementation in polycystic ovary syndrome. Indian J Pharm Pract. 2019;12(2).
  21. Dhar S, Yadav R, Tomar A. Serum zinc levels in women with polycystic ovarian syndrome are lower as compared to those without polycystic ovarian syndrome: a cohort study. J Hum Reprod Sci. 2024;17(1):25-32.
  22. Jansen J, Karges W, Rink L. Zinc and diabetes – clinical links and molecular mechanisms. J Nutr Biochem. 2009;20(6):399-417.
  23. Wang X, Wu W, Zheng W, et al. Zinc supplementation improves glycemic control for diabetes prevention and management: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2019;110(1):76-90.
  24. Wang JG, Anderson RA, Graham GM 3rd, et al. The effect of cinnamon extract on insulin resistance parameters in polycystic ovary syndrome: a pilot study. Fertil Steril. 2007;88(1):240-3.
  25. Wang R, Yang K, Liu X, et al. The antidiabetic mechanisms of cinnamon extract: insights from network pharmacology, gut microbiota, and metabolites. Curr Issues Mol Biol. 2025;47(7):543.
  26. Di Nicuolo F, Castellani R, Ticconi C, Scambia G, Pontecorvi A, Di Simone N. α-Lipoic acid and its role on female reproduction. Curr Protein Pept Sci. 2021;22:767–774.
  27. De Cicco S, Immediata V, Romualdi D, et al. Myoinositol combined with alpha-lipoic acid may improve the clinical and endocrine features of polycystic ovary syndrome through an insulin-independent action. Gynecol Endocrinol. 2017;33(9):698-701.
  28. Fruzzetti F, Fidecicchi T, Palla G, Gambacciani M. Long-term treatment with α-lipoic acid and myo-inositol positively affects clinical and metabolic features of polycystic ovary syndrome. Gynecol Endocrinol. 2020;36(2):152-155.
  29. Lu L, Li X, Lv L, et al. Associations between omega-3 fatty acids and insulin resistance and body composition in women with polycystic ovary syndrome. Front Nutr. 2022;9:1016943.
  30. Günalan E, Yaba A, Yılmaz B. The effect of nutrient supplementation in the management of polycystic ovary syndrome-associated metabolic dysfunctions: a critical review. J Turk Ger Gynecol Assoc. 2018;19(4):220-232.
  31. Kazemi M, Jarrett BY, Vanden Brink H, et al. Obesity, insulin resistance, and hyperandrogenism mediate the link between poor diet quality and ovarian dysmorphology in reproductive-aged women. Nutrients. 2020;12:1953.
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