Polyendocrine Metabolic Ovarian Syndrome (PMOS) (previously PCOS)

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Update May 2026: Polycystic Ovary Syndrome (PCOS) has officially been renamed Polyendocrine Metabolic Ovarian Syndrome (PMOS).

This change is intended to better reflect the full body impacts of the condition beyond the ovaries; including endocrine, metabolic and reproductive impacts of the condition. We welcome this change and hope it contributes to improved awareness, more accurate diagnosis and better health outcomes for people affected by PMOS. The new, fully updated international guidelines for PMOS are scheduled to be published in 2028 and we will review any new content and update our information with best practice guidelines as this develops. You can read more about this name change in the Lancet here.

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Polyendocrine Metabolic Ovarian Syndrome (PMOS) (previously known as PCOS) is an underdiagnosed and under-researched women’s health condition that affects up to 12 per cent of women/people. It is often misclassified as a reproductive disorder, despite its far-reaching implications for metabolic, psychological, and pregnancy health.1

PMOS is a multi-faceted condition, affecting the body in several different ways including infertility, hair growth or loss, irregular or absent menstrual cycles, weight gain and resistance to insulin. It has impacts on people’s reproductive, metabolic and cardiovascular health.

Symptoms

PMOS symptoms can be broad. Women/people with PMOS might have some or all of these symptoms – it is highly variable from one patient to the next.

Common symptoms include:

➜ Hormonal disruption: women/people with PMOS can have higher levels of male hormones (androgens) which leads to acne, excess hair growth on the body, or areas like the chin or upper lip, and male-pattern hair loss or hair thinning.2

➜ Menstrual cycle: a disrupted menstrual cycle is common. Symptoms range from normal menstruation being delayed or fewer than normal periods, to not having a period at all for more than three months. For some women with PMOS, their menstrual cycle may not be associated with ovulation and they could have heavy bleeding.3

➜ Weight: People with PMOS often have higher body weight, with fat disposition on areas of the body such as lower abdomen and upper thighs. PMOS can cause insulin resistance, making it easier for people to gain weight, and difficult to lose weight. A small but significant portion of patients with PMOS have a normal body mass index (BMI), which can lead to delays in diagnosis.

➜ Insulin: levels can be elevated in women with PMOS. Often they can be insulin resistant, which can increase the risk of heart disease and diabetes.2

➜ Infertility: many people with PMOS experience difficulty getting pregnant. Some medications that are commonly prescribed (see below) can help, and speaking to a doctor or fertility specialist is recommended.

Diagnosis

You don’t have to have all of the PMOS symptoms to be diagnosed with PMOS. Symptoms can vary from person to person.

To be diagnosed with PMOS, 2 out of 3 of the following are required:

  1. Irregular periods or no period
  2. Higher levels of testosterone (hyperandrogenism), as shown by a blood test, or visible symptoms like acne, hair loss at the crown, excess facial or body hair.
  3. Many partly formed eggs (also called cysts or follicles) in your ovaries as shown by a transvaginal ultrasound, or blood test (for raised levels of anti-mullerian hormone or AMH).

If the first two criteria are present, an ultrasound may not be required for diagnosis.

If you suspect you have PMOS or have any of the symptoms, it’s important to talk to your GP or doctor about it. Your GP should be able to refer you for an ultrasound via our public health system, though there may be wait times. Private ultrasounds, which can usually be booked in faster, can cost anywhere between $200-$450 depending on where in the country you are.

PMOS and fertility

Some people who may not experience severe symptoms are not aware that they have PMOS until they try to get pregnant. Whilst it’s important to seek your own medical advice from a GP or doctor, there are several ways to improve fertility, including natural and medical methods.

In positive news, new research from the University of Queensland looked at 1,109 women who were undergoing fertility treatment. Interestingly, it didn’t find any difference in births between the women with and without PMOS, nor any difference between those on different treatment paths. Dr Katrina Moss from the University of Queensland School of Public Health noted that while more people with PMOS were receiving fertility treatment (almost 40% compared to 13% of people without PMOS), the birth rate was the same. 

The researchers also noted that those with PMOS are more likely to start fertility treatments earlier than those without PMOS – around three years earlier, at 31 years of age.5 

Treatments

There are a range of commonly prescribed medications to improve PMOS symptoms. Women’s Health Action recommends you speak to a doctor about the best available options for your needs, as treatment may vary over time and from person to person.

Metformin

This drug is commonly prescribed to people with Type 2 Diabetes, but can also can help to reduce some symptoms of PMOS. It can help to regulate periods, enhance ovulation and reduce the effect of elevated male hormones.2 Common side effects are nausea, digestive upset and vomiting. Women with PMOS have a high likelihood of developing Type 2 Diabetes due to insulin resistance, but taking Metformin can help delay or prevent this. Metformin should be used together with increased exercise and a nutritious diet7, not as a replacement for lifestyle changes.

Spironolactone

This drug is known to reduce male-pattern hair growth and acne. It can reduce androgen levels. It is a diuretic so it will rid the body of excess salt and water. Common side effects are nausea, vomiting, headaches and rarely, rashes. Up to 80% of women with PMOS see a reduction in excess hair growth when using spironolactone. It can take up to six months of daily use for it to become effective.8

Clomiphene or clomid

The ovulation stimulating drug clomiphene, also known as clomid, is often prescribed to women/people with PMOS who are seeking to get pregnant, because it can help periods to regulate by indirectly causing eggs to mature and be released. It can assist women with PMOS to achieve pregnancy, but can increase the likelihood of twins.9

Diet and exercise

Women with PMOS are recommended to choose foods with a low glycaemic index (such as wholegrain bread, chickpeas, kidney beans, lentils, milk, yogurt, apples, pears, grapes, kiwifruit, pasta, noodles, oats, and bran) and moderate their intake of carbohydrates by spacing them out over the day and combining them with protein and fats. Speaking to a registered dietitian or registered nutritionist is recommended.

Regular exercise is important for people with PMOS. It helps to counteract insulin resistance, and can lead to weight loss which can help with regulating the menstrual cycle. This can also improve the chance of achieving pregnancy. A study undertaken in 2011-2012 found that after six months of regular exercise, women with PMOS saw significant improvement in their menstrual frequency and reduced problems with menstrual cycle. Their hormonal profile improved, and many found they lost weight around their waist and hips.3 Consistent and varied types of exercise are positive for women with PMOS – cardio can help with weight loss, lower blood pressure and potentially decrease insulin resistance, while weight training builds lean muscle mass and improves strength.11

Useful Links

Healthify NZ – more information about PMOS

Jean Hailes – including diagnosis, living with PMOS, and information/fact sheets in different languages

Understanding Polycystic Ovary Syndrome » Best Practice Advocacy Centre NZ information page on PMOS

Soul Cysters » women with PMOS speak about their experiences.

References

  1. https://www.wgtn.ac.nz/health/about/news/new-international-guideline-to-improve-the-health-of-women-with-polycystic-ovary-syndrome ↩︎
  2. Lord, J., Balen, A., Norman, R., Tang, T. (2003). Insulin-sensitising drugs (metformin, troglita-zone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome, The Cochrane Collaboration, The Cochrane Library, Issue 2. ↩︎
  3. Sayed, M. Salem, M. Sweed (2012). Effect of Lifestyle Modifications on Polycystic Ovarian Syndrome Symptoms, Journal of American Science 8(8), 535. ↩︎
  4. Lord, J., Balen, A., Norman, R., Tang, T. (2003). Insulin-sensitising drugs (metformin, troglita-zone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome, The Cochrane Collaboration, The Cochrane Library, Issue 2. ↩︎
  5. https://www.repromed.co.nz/news-and-stories/pcos-and-your-fertility-positive-new-research/ ↩︎
  6. Lord, J., Balen, A., Norman, R., Tang, T. (2003). Insulin-sensitising drugs (metformin, troglita-zone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome, The Cochrane Collaboration, The Cochrane Library, Issue 2. ↩︎
  7. Lifchez, A., Jasulaitis, S. (2009). Polycystic Ovarian Syndrome, Medical and Reproductive Implications, The OB/GYN & Infertility Nurse – NP/PA, October 2009, Vol 1, No 1. ↩︎
  8. Huang I, et al. (2007). Endocrine disorders. In JS Berek, ed., Berek and Novak’s Gynecology, 14th ed., pp. 1069–1135. Philadelphia: Lippincott Williams and Wilkins. ↩︎
  9. Legro, R. S., Barnhart, H. X., Schlaff, W. D., Carr, B. R., Diamond, M. P., Carson, S. A., … & Gosman, G. G. (2007). Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. New England Journal of Medicine, 356(6), 551-566. ↩︎
  10. Sayed, M. Salem, M. Sweed (2012). Effect of Lifestyle Modifications on Polycystic Ovarian Syndrome Symptoms, Journal of American Science 8(8), 535. ↩︎
  11. Lifchez, A., Jasulaitis, S. (2009). Polycystic Ovarian Syndrome, Medical and Reproductive Implications, The OB/GYN & Infertility Nurse – NP/PA, October 2009, Vol 1, No 1. ↩︎