Your periods are unpredictable. Maybe you’re dealing with acne that won’t budge, facial hair that seems to be getting worse, unexplained weight gain (or weight that just won’t come off), intense cravings, or difficulty getting pregnant. Maybe your doctor has told you that everything looks “normal,” but you know something isn’t quite right.

These symptoms may seem unrelated, but sometimes they’re different clues pointing toward the same underlying condition: PMOS, formerly known as PCOS.

PMOS affects an estimated 1 in 8 women, and despite how common it is, it remains surprisingly misunderstood. Some women go years without a diagnosis. Others are diagnosed and simply told to lose weight, take birth control, or come back when they’re ready to get pregnant. And still others assume they couldn’t possibly have it because they’re lean, they don’t have ovarian cysts, or their blood sugar is “normal.”

There’s much more to the story.

What we’ve historically called Polycystic Ovary Syndrome (PCOS) was officially renamed Polyendocrine Metabolic Ovarian Syndrome (PMOS) in 2026, and I think the new name gives us an important clue about how we should be thinking about this condition. PMOS involves much more than the ovaries. Metabolism, insulin signaling, androgen production, ovulation, genetics, and several other systems can all be involved.

So let’s talk about what PMOS actually is, how to recognize it, why insulin resistance matters SO much, and (most importantly!) what you can do to start improving the underlying physiology and feeling better.

What Is PMOS and Why Did PCOS Get a New Name?

First, if you’ve been diagnosed with PCOS, you don’t suddenly have a different condition! The name has simply changed.

In 2026, an international consensus process involving 56 professional and patient organizations officially renamed Polycystic Ovary Syndrome Polyendocrine Metabolic Ovarian Syndrome (PMOS).

And I think this is a fantastic change.

One of the biggest problems with “Polycystic Ovary Syndrome” was the word cystic. The follicles that can be seen on the ovaries in PMOS aren’t actually pathological ovarian cysts. Even more importantly, you don’t need to have polycystic-appearing ovaries to have PMOS.

That has caused a LOT of confusion over the years.

Someone might have irregular periods, elevated testosterone, acne, insulin resistance, and difficulty ovulating, but assume she couldn’t have PCOS because her ultrasound didn’t show “cysts.” Conversely, someone can have polycystic ovarian morphology on an ultrasound without actually having the syndrome.

The new terminology recognizes that we’re dealing with multiple endocrine systems (polyendocrine), metabolic dysfunction (metabolic), and reproductive/ovarian manifestations (ovarian). That’s a much better representation of what we see clinically.

How Is PMOS Diagnosed?

One important clarification: the name changed, but the diagnostic criteria did not.

In adults, current international guidelines generally diagnose PMOS when at least two of the following three criteria are present, after excluding other potential causes:

1. Ovulatory dysfunction, which often appears as irregular, infrequent, or absent menstrual cycles.
2. Clinical or biochemical hyperandrogenism, meaning symptoms or lab evidence of elevated androgen activity. This might show up as elevated testosterone, facial hair growth, acne, or androgen-pattern hair loss.
3. Polycystic ovarian morphology, assessed through ultrasound or, in appropriate adults, anti-Müllerian hormone (AMH).

If someone already has irregular cycles plus hyperandrogenism, an ultrasound or AMH isn’t necessarily required to make the diagnosis. Adolescents are handled differently because irregular cycles and polycystic-appearing ovaries can both occur as part of normal reproductive maturation.

And here’s something that may surprise you given everything I’m about to say:

Elevated fasting insulin is NOT one of the formal diagnostic criteria. Neither are insulin resistance, elevated glucose, HbA1c, or body weight.

But insulin resistance not being diagnostic does not mean it isn’t central to the pathophysiology of PMOS. (We’re about to come back to this!)

What Are the Symptoms of PMOS?

PMOS is a syndrome, which means it’s a collection of signs and symptoms, and it can look very different from one woman to another.

Common signs and symptoms include:

• Irregular, long, or absent menstrual cycles
• Difficulty ovulating
• Difficulty conceiving
• Acne, especially hormonal acne
• Excess facial or body hair
• Thinning scalp hair
• Weight gain or difficulty losing weight, particularly around the abdomen
• Blood sugar instability or cravings
• Insulin resistance
• Fatigue
• Anxiety or depression
• Sleep issues, including an increased risk of sleep apnea

Some women have nearly all of these. Others have only a few.

One of the misconceptions I most want to clear up is that having a larger body is not a diagnostic criterion for PMOS, and insulin resistance isn’t exclusive to people who are overweight. A woman can be lean and active and still have hyperinsulinemia, elevated androgens, irregular ovulation, or other manifestations of PMOS.

So, How Does PMOS Develop?

There isn’t one single pathway that explains every case of PMOS. Genetics, insulin signaling, androgen production, ovarian function, inflammation, environmental influences, sleep, stress, and other factors can all contribute.

But if there’s one metabolic piece of PMOS that I want you to understand, it’s insulin resistance.

Insulin Resistance and Hyperinsulinemia

Depending on the population and how it’s measured, research suggests that somewhere around 50–70% of women with PMOS have insulin resistance, and some estimates are even higher. Importantly, this isn’t limited to women who are overweight. Lean women with PMOS can be insulin resistant, too.

When your cells become less responsive to insulin, your pancreas compensates by producing more of it. And here’s where this gets particularly relevant to PMOS: insulin does much more than regulate blood sugar.

Higher insulin levels can stimulate the ovaries to produce more androgens and can decrease production of sex hormone-binding globulin (SHBG) in the liver. Lower SHBG means more biologically active testosterone is available. That combination can contribute to acne, facial hair growth, disrupted follicular development, irregular ovulation, and difficulty conceiving.

And then we can get into a vicious cycle: insulin resistance contributes to hyperinsulinemia and androgen excess, while androgen excess can further impair insulin sensitivity.

This is one of the reasons I get frustrated when someone with obvious PMOS symptoms tells me, “My glucose was normal, so my doctor said my blood sugar is fine.”

Glucose can remain beautifully normal for years because your pancreas is pumping out more insulin to keep it there! By the time glucose or HbA1c rises, metabolic dysfunction may have been developing for quite some time.

Interestingly, as I mentioned above, elevated fasting insulin is still not part of the formal diagnostic criteria for PMOS. That’s partly because insulin resistance is difficult to measure reliably in routine clinical practice. The gold-standard testing isn’t practical for everyday clinical care, and fasting insulin and calculations like HOMA-IR have limitations and lack universally accepted cutoffs.

But diagnostically required and physiologically important are two different questions, and insulin resistance is one of the first things I want to investigate in someone with PMOS.

This is why we often look beyond fasting glucose and HbA1c and assess fasting insulin and other metabolic markers when appropriate. We want to know how hard your body is working to keep that glucose “normal.”

Androgen Excess

Androgens like testosterone and DHEA aren’t “male hormones” that women shouldn’t have. Women absolutely need them! The problem occurs when androgen production or activity becomes excessive.

High androgen activity contributes to some of the most recognizable PMOS symptoms, including acne, facial hair growth, scalp hair loss, and disrupted ovulation. As you can see from the insulin discussion above, these systems also aren’t operating independently.

This is why simply trying to “lower testosterone” without investigating what may be driving androgen production can miss an important part of the picture.

Genetics and Environment

PMOS tends to run in families, so we know there is a significant genetic component. But, as with most chronic health conditions, genetics don’t operate in isolation.

Nutrition, physical activity, sleep, stress, body composition, environmental exposures, and metabolic health can all influence physiology.

I also think it’s important to distinguish between what we know contributes to PMOS and what we’re still investigating. Environmental endocrine-disrupting chemicals, for example, are an interesting and growing area of research, but I wouldn’t tell someone that toxins “caused” her PMOS based on the evidence we currently have.

What About the Gut?

This is another area I’m watching closely.

Research has found differences in the gut microbiomes of women with PMOS compared with women without it, including altered microbial composition and, in some studies, reduced microbial diversity. Researchers are investigating how these differences may interact with intestinal permeability, inflammation, insulin resistance, and sex hormones.

I think this is exciting, but we don’t yet know that gut dysbiosis causes PMOS. But someone who has PMOS plus bloating, constipation, diarrhea, significant food reactions, a history of frequent antibiotics, or other GI symptoms? Now I’m very interested in what is happening in her gut.

Don’t Forget About the Thyroid

Thyroid health deserves consideration, too.

Research suggests that thyroid dysfunction, including Hashimoto’s and subclinical hypothyroidism, occurs more frequently in women with PMOS. Thyroid dysfunction can independently contribute to irregular cycles, difficulty ovulating, fatigue, metabolic changes, and weight changes.

Thyroid disorders can also mimic some features of PMOS and therefore need to be considered during the diagnostic process.

This is one reason we don’t want to see a symptom like an irregular period and automatically label it PMOS. We need to look at the entire person.

Why Is PMOS So Often Misdiagnosed or Misunderstood?

Despite how common PMOS is, diagnosis can take years.

In one large international study, nearly half of women with PCOS saw three or more healthcare professionals before receiving their diagnosis, and about one-third waited more than two years. Only 35% were satisfied with their diagnostic experience.

There are several reasons this happens.

The old name itself certainly didn’t help. Again, you do not need ovarian “cysts” to have PMOS.

Symptoms also look dramatically different among women. One woman might be struggling primarily with infertility. Another has fairly regular periods but severe acne and elevated testosterone. Another has 60-day cycles, weight gain, and insulin resistance. Another is lean, active, and has never been told to consider a metabolic issue.

And sometimes each symptom gets treated separately without anyone connecting the dots. Acne gets a dermatology treatment. Irregular periods get birth control. Difficulty conceiving gets a fertility referral. Weight gain gets advice to eat less and exercise more.

Any of those interventions may have a place. But when several of these symptoms occur together, I want someone asking what could be connecting them.

How Do We Treat PMOS From a Functional Medicine Perspective?

This is the good news: there is a LOT we can do. The exact plan depends on the individual’s symptoms, labs, health history, goals, medications, lifestyle, and which aspects of PMOS appear to be driving her particular presentation.

1. Improve Insulin Sensitivity and Blood Sugar Regulation

Given everything we just discussed, this is foundational for many of the women we work with.

We may focus on:

• Eating adequate protein throughout the day
• Increasing fiber and plant diversity gradually
• Choosing primarily whole-food carbohydrates and pairing carbohydrates with protein, fat, and/or fiber
• Minimizing ultra-processed foods and excess added sugars
• Walking after meals
• Building muscle through resistance training
• Getting adequate sleep
• Managing chronic stress
• Eating enough overall rather than chronically under-fueling

The international guidelines specifically note that there isn’t evidence supporting one particular diet composition over another. I want someone eating in a way that improves her metabolic health, provides adequate nutrients, supports her goals, and is actually sustainable.

2. Build Muscle and Move Consistently

Muscle is one of our greatest metabolic tools.

Skeletal muscle is a major site of glucose disposal, which is one reason resistance training can be so helpful for improving insulin sensitivity. Cardiovascular exercise is beneficial, too, and there isn’t one magical “PMOS workout.”

For many clients, I love combining regular walking (especially after meals!) with 2–4 strength-training sessions per week, depending on fitness level, recovery capacity, and goals.

But if you love running, cycling, Pilates, swimming, tennis, pickleball, or something else, fantastic. Consistency matters.

3. Address Stress and Sleep

This sometimes gets treated as the fluffy part of a hormone protocol, but I think it is one of the most important pieces.

Chronic stress can influence blood sugar regulation, appetite, sleep, inflammation, and reproductive hormone signaling. Poor sleep can impair insulin sensitivity, which isn’t particularly helpful when insulin resistance may already be part of the picture.

Women with PMOS also have an increased prevalence of obstructive sleep apnea, even after accounting for BMI. If someone snores, wakes up exhausted despite spending plenty of time in bed, or struggles with significant daytime sleepiness, I don’t want to automatically chalk that up to “hormones.”

Sometimes the next step isn’t another supplement. It might be getting someone to sleep more than six hours, actually eating enough, or finding ways to bring her nervous system out of fight-or-flight more often.

4. Check for Nutrient Insufficiencies

Depending on the individual, we may evaluate nutrients including vitamin D, magnesium, B vitamins, iron, zinc, omega-3 fatty acids, and others.

That does not mean everyone with PMOS should automatically supplement all of these.

We look at diet, symptoms, medications, labs, and individual needs and fill in what’s actually missing.

5. Consider Targeted Supplements

There are several supplements with research in PMOS, although supplements work best as part of a broader strategy rather than as the entire strategy.

Inositol is probably the best-known PMOS supplement. Research suggests potential benefits for insulin signaling and some reproductive outcomes, although the international guideline points out that clinical benefits may be relatively modest. We use a blend of d-chiro and myo-inositol in practice.

Berberine also has interesting research for glucose and lipid metabolism and insulin sensitivity, but it’s not something I’d recommend indiscriminately. Medications, GI tolerance, dosing, and whether someone is pregnant or trying to conceive all matter.

Vitamin D, omega-3 fatty acids, and magnesium may also be appropriate depending on someone’s diet, labs, metabolic picture, and individual needs.

As always, more isn’t always better, and targeted supplementation is very different from throwing every “PCOS supplement” you see on social media into your cart.

6. Look at the Whole Picture

This is probably my favorite thing about the new PMOS name.

Depending on the person, we may evaluate:

• Fasting glucose, fasting insulin, and HbA1c
• Lipids and other cardiovascular markers
• Thyroid function
• Androgens and SHBG
• Menstrual cycles and ovulatory patterns
• Nutrient status
• Inflammatory markers
• Sleep and stress
• Digestive health
• Body composition
• Family and personal metabolic history

And sometimes we go further.

If there are significant digestive symptoms, comprehensive stool testing may give us useful information about digestive function, inflammation, microbial patterns, and other GI markers. If there are reasons to suspect significant environmental exposures, we may investigate those as well.

Not everyone needs advanced testing. But when someone’s symptoms aren’t improving despite doing the basics well, additional data can sometimes help us figure out where to look next.

What About Birth Control, Metformin, and GLP-1 Medications?

I don’t think we can have a complete conversation about PMOS treatment without discussing medication. Conventional treatments invoice birth control pills and metformin, both of which I have mixed feelings about in general and need to be considered very individually.

And then there are GLP-1 receptor agonists, which are becoming increasingly relevant in PMOS, particularly for women with overweight, obesity, or significant metabolic dysfunction.

Research in this area is growing quickly. Recent randomized trials and meta-analyses suggest GLP-1 medications can improve body weight and insulin resistance in women with PMOS. Some data, particularly with liraglutide, also suggest potential improvements in menstrual frequency and androgen-related markers. We still need better long-term data and more information about reproductive outcomes, but these medications are a legitimate tool to discuss when clinically appropriate.

I don’t think GLP-1s are necessary or appropriate for every woman with PMOS. I also don’t think taking metformin somehow means you’ve “failed” to address your health naturally.

If someone is using metformin or a GLP1 while we work on nutrition, strength training, sleep, stress, and metabolic health, great. But no medication will do “all the work” without some lifestyle and diet changes.

PMOS Is About Much More Than Fertility

Historically, PMOS has often received the most attention when a woman is trying to get pregnant.

But even if you have absolutely no interest in fertility, this condition matters.

PMOS is associated with increased risks of impaired glucose tolerance, type 2 diabetes, dyslipidemia, cardiovascular risk factors, sleep apnea, anxiety and depression, and endometrial hyperplasia and cancer. The absolute risk of endometrial cancer remains low, but chronically absent periods shouldn’t simply be ignored.

The Bottom Line

If you’ve been diagnosed with PCOS in the past, your diagnosis didn’t suddenly change. We simply have a new (and I think much better!) name for it: Polyendocrine Metabolic Ovarian Syndrome, or PMOS.

The biggest things I want you to remember are:

• You do not need ovarian cysts to have PMOS.
• PMOS can occur at any body size.
• Insulin resistance is extremely common in PMOS and can play a central role in its underlying physiology, even though it isn’t part of the formal diagnostic criteria.
• A normal fasting glucose doesn’t necessarily tell us that insulin regulation is optimal.
• Nutrition, movement, muscle mass, sleep, stress, and metabolic health can make a significant difference.
• Gut health, thyroid health, nutrients, and environmental factors may also be worth investigating depending on the individual.
• There is no single “PMOS diet” or supplement protocol that works for everyone.
• Conventional medications and functional medicine strategies can absolutely be used together.
• You deserve more than being told to lose weight or take birth control without understanding what’s happening in your body.

Need Help Figuring Out Your Hormones?

At The Lyons’ Share Wellness, we work with women with hormonal and metabolic concerns every day. Our functional nutrition programs can include comprehensive bloodwork, hormone assessment, metabolic markers, stool testing, nutrient testing, and other advanced testing when appropriate. From there, we create an individualized nutrition, supplement, movement, and lifestyle plan based on what your body actually needs.

If you’ve been diagnosed with PCOS/PMOS, or you’ve wondered for years whether your irregular cycles, acne, blood sugar issues, difficulty losing weight, or other symptoms might fit the picture, schedule a free initial consultation with our team. We’ll help you determine which of our programs and practitioners is the best fit and whether additional testing would actually be useful.