What are the types of PMOS, and can they be cured?

Polyendocrine Metabolic Ovarian Syndrome (PMOS), previously called polycystic ovary syndrome (PCOS), is a common problem in women. In fact, it’s the most common hormonal issue facing women between about 12 and 51 years old.

Annevay Conlee, MD, a family medicine obstetrics physician at OSF HealthCare, treats women with PMOS. Dr. Conlee aims to get to the root of the problem and address the issue at the source.

What is PMOS?

PMOS often causes your body to produce higher levels of androgens, which are hormones that are typically present only in small amounts in women. These hormones can increase skin and hair changes, menstrual changes and fertility issues.

This hormone and metabolic imbalance can:

• Prevent ovulation from happening regularly, which can cause irregular, painful, heavy, missing, or extended periods
• Affect how your body uses insulin, which can lead to diabetes
• Cause acne, excessive hair growth on the face and neck, or thinning hair on the scalp

Understanding what’s causing your symptoms can help you take the next step toward feeling better.

PMOS Symptoms

PMOS can look different from person to person. Some women have only a few symptoms, while others experience several that affect their daily life.

Many of the symptoms are linked to a hormone imbalance that affects ovulation, your menstrual cycle and how your body processes insulin.

Common symptoms of PMOS may include

• Irregular or missed periods
• Acne or oily skin that doesn’t improve with typical treatments
• Alopecia or thinning hair on the scalp that can mimic male-pattern baldness
• Excess hair growth on the face, chest or back
• Weight gain or difficulty losing weight
• Insulin resistance or Type 2 diabetes
• Trouble getting pregnant
• High blood pressure, high blood sugars
• Liver disease, which can increase your risk of cardiovascular disease
• Sleep apnea
• Uterine or ovarian cancer, caused by the uterine lining being too thick
• Cysts on the ovaries

These symptoms can develop slowly over time, which can make PCOS difficult to diagnose.

Types of PMOS

PMOS is a condition that can involve higher androgen levels, ovulatory dysfunction and polycystic ovaries. Because symptoms can vary, PMOS is not officially divided into separate “types.” Instead, providers look at which features are present and how they affect your periods, skin and hair changes, metabolism and fertility goals.

Rather than diagnosing a specific subtype, your provider may describe PMOS by the main features you have.

Ovulatory or Menstrual Cycle Changes

One common presentation involves irregular, missed or unpredictable periods. This happens when ovulation does not occur regularly. Irregular ovulation can also make it harder to become pregnant.

Higher Androgen Levels

Another common presentation includes higher-than-expected androgen levels. This may cause acne, oily skin, excess hair growth on the face or body, or thinning hair on the scalp. Androgen levels may be identified by symptoms, blood tests or both.

These signs may show up differently from person to person, so your provider will consider your full health history and test results before recommending treatment.

Polycystic Ovarian Appearance

Some people with PMOS have many small follicles seen on an ultrasound. These are not always true cysts, and not everyone with PMOS has this finding. This is why the condition can still be diagnosed based on other features.

Your provider may use ultrasound along with your symptoms, menstrual history and lab testing to better understand how PMOS is affecting you.

PMOS Diagnosis

To diagnose PMOS, your provider will review your symptoms, menstrual history, physical exam and test results. PMOS is generally diagnosed when at least two of the following features are present, after other possible causes have been ruled out:

• Irregular ovulation or irregular menstrual cycles
• Clinical signs or blood test evidence of higher androgen levels, such as excess facial or body hair growth, acne or thinning hair on the scalp
• Polycystic ovarian appearance on ultrasound

Your provider may also order tests to look for other conditions that can cause similar symptoms, such as thyroid disease, high prolactin levels, adrenal conditions or other hormone disorders. This helps make sure the diagnosis is accurate and that your treatment plan fits your needs.

• Physical exam: Your provider may check for signs of higher androgen levels, such as acne, excess hair growth or thinning hair, and may also review weight, blood pressure and other health factors.
• Blood tests: Blood work may be used to check androgen levels and to screen for other conditions that can look like PMOS.
• Menstrual history: Your provider will ask about how often your periods occur, whether they are predictable and whether you may be ovulating regularly.
• Ultrasound: An ultrasound may be used to look at the ovaries. Not everyone with PMOS has polycystic-appearing ovaries, and this finding is not required if other diagnostic features are present.

PMOS Treatment

PMOS does not have a single cure, but symptoms and underlying contributors can often be managed with a root-cause approach. A NaProTECHNOLOGY™ approach focuses on understanding what is disrupting the menstrual and fertility cycle, then using medical, lifestyle or surgical treatments.

Because PMOS affects hormones, ovulation and metabolism, treatment is usually individualized. The goal is not only to reduce symptoms, but also to identify and treat issues such as irregular ovulation, insulin resistance, abnormal hormone patterns, inflammation, thyroid concerns, vitamin deficiencies or other conditions that may be affecting reproductive health.

“It’s best to find a provider who works in cooperation with your body and your cycle,” Dr. Conlee said.

Finding and Treating the Root Cause

PMOS is often linked to hormone imbalances that can affect how your ovaries function.

Your provider will check to see which method is best to help you reduce your hormonal or metabolic imbalances, which will lead to your ovaries decreasing in size.

Enlarged ovaries can happen due to undeveloped egg follicles. They can lead to cysts, and can cause pelvic discomfort, menstrual and fertility issues, or urinary and bowel discomfort.

“Once we know the root cause, we can try to decrease the size of that ovary by addressing that problem. Because when your ovary gets larger, it just doesn’t function well,” Dr. Conlee said.

Depending on your needs, this could include:

• Weight management strategies
• Nutrition changes
• Medications to support hormone balance
• Surgery in select cases

Treatment Options

The Creighton Model FertilityCare™ System can be an important first step. By charting your cycle signs, you and your provider can gather information about ovulation, bleeding patterns, mucus changes and other biomarkers that may point to what needs treatment.

Depending on your symptoms and goals, other root-cause treatment can include:

• Nutrition, movement, sleep and stress-management support
• Testing and treatment for insulin resistance, thyroid concerns, vitamin deficiencies or inflammation
• Cycle-timed medications to support ovulation or hormone balance
• Treatment for other gynecologic conditions, such as abnormal bleeding, chronic endometritis or endometriosis, when present
• Surgery in select cases when an anatomic or ovarian issue is contributing to symptoms or infertility

NaProTECHNOLOGY™

NaProTECHNOLOGY™ is a women’s health science that uses cycle charting, targeted evaluation and cooperative medical or surgical treatments to address gynecologic abnormalities and underlying causes of infertility. For PMOS, NaPro will help guide a personalized treatment plan that supports ovulation, hormone balance and reproductive health rather than simply masking symptoms.

Medical Treatments

Medical treatment may include medications or supplements chosen for your specific findings. Some treatments are timed to your cycle, especially when the goal is to support ovulation, improve the post-ovulation phase or balance estrogen and progesterone levels.

Depending on your evaluation, your provider may discuss options such as medication for insulin resistance, ovulation support, progesterone support, treatment for thyroid or vitamin deficiencies, antibiotics for chronic endometritis or other targeted therapies.

The goal is to improve how your cycle functions over time. Treatment may be adjusted from cycle to cycle based on your charting, symptoms, lab results and fertility goals.

Surgical Treatments

Surgery is not needed for everyone with PMOS. In select cases, a NaPro-trained surgeon may consider minimally invasive surgery when evaluation suggests that an anatomic issue, ovarian enlargement, endometriosis, scar tissue or another gynecologic condition is contributing to symptoms or infertility. Surgical treatment is individualized and aims to preserve or restore healthy reproductive function whenever possible.

Diet for PMOS

What you eat and how you care for your body can play a big role in managing PMOS symptoms. A Mediterranean-style, anti-inflammatory diet can help support blood sugar balance, reduce inflammation and improve long-term heart and metabolic health.

PMOS is often linked with insulin resistance and low-grade inflammation. Diet, movement, sleep and stress management cannot cure PMOS, but they can help reduce symptoms and lower the risk of long-term health conditions such as Type 2 diabetes, high blood pressure, fatty liver disease and cardiovascular disease.

What to eat with PMOS

A Mediterranean-style approach focuses on colorful plants, fiber-rich carbohydrates, lean proteins and healthy fats. This pattern can support hormone balance, insulin sensitivity and inflammation control without being overly restrictive.

Dr. Conlee recommends building meals around:

• Vegetables and fruits in a variety of colors
• Lean proteins, such as fish, chicken, eggs, beans, lentils or Greek yogurt
• High-fiber carbohydrates, such as oats, quinoa, brown rice, beans, lentils and sweet potatoes
• Healthy fats, especially olive oil, avocado, nuts, seeds and fatty fish
• Whole, minimally processed foods most of the time

Focus on Reducing Inflammation (H3)

Inflammation may play a role in PMOS symptoms. Choosing anti-inflammatory foods can help support your body.

You can support an anti-inflammatory pattern by choosing:

• Extra-virgin olive oil as a main added fat
• Fatty fish, such as salmon, sardines or trout, or plant-based omega-3 sources such as chia seeds, flaxseed and walnuts
• Herbs and spices with natural anti-inflammatory benefits, such as turmeric [link to .], ginger, garlic and cinnamon
• Beans, lentils, vegetables, berries and whole grains for fiber
• Water or unsweetened drinks instead of sugary beverages
• Fewer ultra-processed foods, fried foods, refined carbohydrates and foods high in added sugar

Weight Management and PMOS

Weight management with PMOS can be challenging because insulin resistance can make it easier to gain weight and harder to lose it. The goal is not a quick diet or strict food rules. The goal is a sustainable plan that supports insulin sensitivity, lowers inflammation and works with your body over time.

A Mediterranean-style plate can be a helpful starting point: fill half your plate with non-starchy vegetables, one quarter with protein and one quarter with a high-fiber carbohydrate, then add a small amount of healthy fat such as olive oil, nuts, seeds or avocado.

Even modest weight loss, when appropriate, may help:

• Improve insulin resistance and blood sugar levels
• Support more regular ovulation and menstrual cycles
• Lower androgen-related symptoms in some people
• Reduce the risk of Type 2 diabetes, fatty liver disease and cardiovascular disease

PMOS and Pregnancy

Many women with PMOS can become pregnant and have healthy pregnancies, but it may take extra support. PMOS can affect ovulation, hormone balance and insulin resistance, which can make it harder to predict fertile days or achieve pregnancy without treatment.

Current recommendations focus first on improving overall health before pregnancy and identifying factors that may interfere with ovulation. This may include optimizing nutrition, movement, sleep, weight management when appropriate, blood sugar control, blood pressure, thyroid health and other hormone concerns.

A NaPro approach can help by using cycle charting and targeted testing to look for the root causes of irregular ovulation or infertility. Instead of bypassing the cycle, NaPro works to identify what is disrupting normal fertility and then treats those issues in cooperation with your body.

Treatment may include cycle-timed lab testing, medications to support ovulation, progesterone support after ovulation when indicated, treatment for insulin resistance or thyroid concerns, and evaluation for other conditions such as endometriosis or chronic endometritis. Medication choices depend on your diagnosis, goals and medical history.

For women with PMOS who do not ovulate regularly, ovulation induction medicine may be considered. Current evidence-based guidelines commonly recommend letrozole as a first-line option to kickstart ovulation in anovulatory infertility related to PMOS. Your provider will determine which option is safest and most appropriate for you.

Once pregnancy occurs, women with PMOS may need closer monitoring because PMOS is associated with higher risks of gestational diabetes, high blood pressure disorders of pregnancy, preterm birth and pregnancy loss. Your care team may recommend early blood sugar screening, ongoing blood pressure monitoring and individualized prenatal care.

“We want you to have the healthiest pregnancy possible. Women who achieve pregnancy and have a history of PMOS are often put in a ‘high-risk’ category,” Dr. Conlee said.

If you’re trying to achieve pregnancy while living with PMOS, find a provider who can help you address the root cause of those issues.

What is the difference between PMOS and endometriosis?

PMOS and endometriosis are both reproductive issues in women.

Like PMOS, endometriosis can cause symptoms like imbalanced hormones and irregular, painful periods. However, these are two different disorders that can occasionally occur at the same time in some women.

Endometriosis is a condition that causes endometrial tissue to grow in areas where it shouldn’t – for example, on the ovaries or fallopian tubes. It often causes severe pain.

Dr. Conlee encourages her patients to get to know their cycles. Every woman’s cycle is different. So, knowing what’s normal and not for your health is best. Knowing your cycle can also play a role in diagnosing what condition you might have.