Symptoms and Diagnosis of Polyendocrine Metabolic Ovarian Syndrome (PMOS)
Women's HealthReproductive System Disorders

Symptoms and Diagnosis of Polyendocrine Metabolic Ovarian Syndrome (PMOS)

Symptoms and Diagnosis of Polyendocrine Metabolic Ovarian Syndrome (PMOS)
Everyday Health
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Updated on July 7, 2026
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Editor’s Note: In May 2026, the Endocrine Society and other international experts officially renamed polycystic ovary syndrome (PCOS) polyendocrine metabolic ovarian syndrome (PMOS). This change better reflects the condition’s nature as a systemic metabolic disorder. This article has been updated to reflect the new terminology.

As a woman, dealing with acne, stray hairs, weight gain, and period problems seems like par for the course — and in some people’s minds, these are health woes that women just need to deal with. But a condition called polyendocrine metabolic ovarian syndrome (PMOS) may really be behind these problems. And if you have PMOS, it’s important to get the right diagnosis for your current comfort and long-term health. Unfortunately, the reality is that several hurdles can make getting that diagnosis especially difficult.

PMOS is a hormonal problem that affects 10 million women in the world.

 Women with PMOS can produce high levels of androgens, which are male sex hormones. (Women typically have low amounts of these).

Nonetheless, rather than referring to the condition as PCOS, experts now see it as a reproductive metabolic syndrome, says David A. Ehrmann, MD, an endocrinologist and clinical professor specializing in PMOS at the University of Chicago in Illinois. That’s because not everyone who has the condition has polycystic ovaries (the development of cysts, or fluid-filled sacs, in the ovaries).

The first step in understanding PMOS is learning about the signs and symptoms. Take a look at some of the most common ones, so you know if PMOS may be at the root of your health concerns.

Symptoms of PMOS

PMOS affects everyone a little differently. These are some of the most common symptoms to look for.

Irregular Periods

You may have irregular, unpredictable periods (called oligomenorrhea). This isn’t just two or three days late here or there; it means that your cycle length is greater than 35 days.

 A normal cycle can range between 22 and 35 days. “[PMOS] patients have unpredictable cycles and have about eight or fewer cycles per year,” says Dr. Ehrmann. Periods may also be especially heavy or really light.

Difficulty Conceiving

People with PMOS often have trouble getting pregnant. In fact, PMOS is one of the most common causes of female infertility.

 Fertility problems arise from a lack of ovulation. Even if you are getting your period (albeit very late), that’s not an assurance that you’re ovulating. You can get your period without ovulating. That’s why you may not notice anything is wrong until you’ve been trying to get pregnant for some time.

Excess Hair Growth

Because PMOS is a hormonal condition in part marked by higher levels of androgens (male hormones), women experience excess hair growth in unwanted places — a condition also known as hirsutism.

 With PMOS, you may often notice this unusual hair growth on your face, arms, back, chest, thumbs, toes, and abdomen.

But this symptom can vary depending on your ethnicity, which may predispose you to having excess hair, says Loren Wissner Greene, MD, professor of endocrinology and ob-gyn at NYU Langone Health in New York City. She explains that this is one symptom to pay close attention to. In people with PMOS, hirsutism was strongly linked to metabolic problems, research found.

Hair Loss

While you may grow hair in places you don’t want, you may also lose hair that you’d otherwise want to keep. Because of those excess androgens, women may experience male-pattern hair loss, which is thinning hair on the top of the head or hair recession. This may be more severe in middle-aged women.

Acne

Elevated androgens come into play again, this time delivering skin concerns like acne in people with PMOS. This increase in androgens makes your skin produce more oil, which makes it easier for your pores to get clogged and lead to acne. However, this type of acne isn’t like the hormonal acne that people often experience before and during their periods. PMOS-related acne tends to be deeper in your skin, more inflamed, and located on the lower part of your face, like the chin and jawline.

Unintended Weight Gain

While half of women with PMOS experience weight gain or live with obesity, the condition can also affect people who are thin.

 The view that all women with PMOS are overweight or have obesity is a misnomer that can stand in the way of receiving the right diagnosis, says Amy Medling, a certified health coach, the founder of PMOS Diva, and the author of Healing PCOS: A 21-Day Plan for Reclaiming Your Health and Life With Polycystic Ovary Syndrome. “Some doctors are only looking for the stereotypical overweight woman, meaning there are lots of thin women who are missed [during diagnosis],” she says.

Increased Risk of Mood Disorders

People who live with PMOS have a heightened risk of developing mental health conditions like depression and anxiety. Research explains that this may be due to dysfunction with important body systems like gut health, hormones, and the immune system.

Insulin Resistance

People with PMOS are typically not as responsive to the hormone insulin, which helps ferry glucose to our cells for energy. This lack of response to insulin is known as insulin resistance, which can often lead to the development of diabetes if untreated. This is when the metabolic problems associated with PMOS tend to arise.

According to Mayo Clinic, insulin resistance can also cause secondary symptoms like skin tags and a darkening of the skin, called acanthosis nigricans, which appears as dark, velvety patches around the armpits, groin, and neck.

Trouble Sleeping and Fatigue

Tiredness and low energy are extremely common if you live with PMOS.

 Research explains that people with PMOS are more likely to have sleep apnea, a condition that causes brief pauses in breathing, which can contribute to daytime sleepiness.

 Issues with sleep and insomnia can also worsen mood swings.

How Is PMOS Diagnosed?

Usually, PMOS appears around early puberty, but it can develop in your teens or twenties, says Ehrmann. More unlikely is when the condition emerges later in life, such as in your thirties and forties, he notes. That said, significant hurdles stand in the way of getting a proper diagnosis.

First, there’s embarrassment. “Many women don’t want to talk about their symptoms, and they don’t tell their doctors specifically what’s going on,” says Medling. Or if a woman is seeking help, she may be seeing different doctors to treat the varying symptoms. For example, a dermatologist for acne, an ob-gyn for period problems, and a psychologist for a mood disorder, for instance. “The pieces aren’t put together,” she says. That’s why, as Medling notes, as many as 50 percent of women with PMOS are undiagnosed.

If you have PMOS symptoms or feel like you may be at an increased risk of developing the condition, it’s important to make an appointment with your healthcare provider. They can conduct a physical exam, order imaging scans, discuss your symptoms, and help you understand your options for treatment.

Healthcare providers use the Rotterdam criteria for diagnosis. For a PMOS diagnosis, you must have two of three markers: androgen excess (marked by hirsutism, acne, hair loss, or laboratory evidence of androgen excess), ovulatory dysfunction (irregular menstruation), or polycystic ovaries (found on an ultrasound).

What to Do Next

The first step that many people take if they suspect they have PMOS is meeting with an ob-gyn (for the menstrual irregularities). But Ehrmann also recommends getting an endocrinologist involved. You can do this by asking your primary care provider for a referral. While there are no tests to directly diagnose PMOS, it’s often a matter of elimination. “We have to exclude other causes that can give the same picture,” says Ehrmann. That includes hypothyroidism, high prolactin levels, and rare conditions like Cushing syndrome and acromegaly. Providers will often figure this out via blood and urine tests.

If you suspect that you may have PMOS, talk to your healthcare provider. “It’s best to get diagnosed as young as possible,” says Dr. Wissner Greene. For one, there’s comfort. Young women may say their periods are “crazy,” they are worried about bleeding to death, and they just knew something was wrong all along. Second, because PMOS can increase the risk of type 2 diabetes (due to insulin resistance), heart disease, high blood pressure (hypertension), sleep apnea, and stroke, it’s important to find it as early as possible to help prevent these conditions from occurring in the future.

 Plus, getting diagnosed and treated can help support your reproductive life and overall health, she adds.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. PCOS Overview. PCOS Awareness Association.
  2. Polycystic Ovary Syndrome (PCOS). Johns Hopkins Medicine.
  3. Abnormal Menstruation (Periods). Cleveland Clinic. January 18, 2023.
  4. Diabetes and Polycystic Ovary Syndrome (PCOS). Centers for Disease Control and Prevention. May 15, 2024.
  5. Hirsutism. Mayo Clinic. September 17, 2025.
  6. PCOS Symptoms. PCOS Awareness Association.
  7. Atakul N et al. Levels of a novel metabolic marker, spexin in patients with hirsutism: metabolic syndrome risk in idiopathic and polycystic ovarian syndrome (PCOS) hirsutism. Ginekologia Polska (Polish Gynecology). August 14, 2024.
  8. Have PCOS? Here’s Everything You Need To Know About Acne and Other Skin Symptoms. Cleveland Clinic. September 12, 2024.
  9. Dubé-Zinatelli E et al. The overlooked mental health burden of polycystic ovary syndrome: neurobiological insights into PCOS-related depression. Frontiers in Neuroendocrinology. July 1, 2025.
  10. Acanthosis Nigricans. Mayo Clinic. April 30, 2025.
  11. PCOS and Fatigue. PCOS Awareness Association.
  12. What Is PCOS? PCOS Challenge.
  13. Diagnosing Polycystic Ovary Syndrome. NYU Langone Health.
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Anna L. Goldman, MD

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Anna L. Goldman, MD, is a board-certified endocrinologist. She teaches first year medical students at Harvard Medical School and practices general endocrinology in Boston.

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