How PMOS and Metabolic Health Are Connected
Health ConditionsWeight ManagementMetabolic Health

PMOS and Metabolic Health: What’s the Connection?

PMOS and Metabolic Health: What’s the Connection?
Everyday Health
When polycystic ovary syndrome was officially renamed polyendocrine metabolic ovarian syndrome (PMOS) in May 2026, the change was considered a true win.

 Recognizing this as an endocrine, metabolic, and ovarian dysfunction disorder more accurately captures the true nature of the condition, hopefully allowing for quicker diagnoses and improvements in care.
This change was also appropriate because PMOS commonly has features of metabolic disease, including obesity, abnormal blood sugars, type 2 diabetes, hypertension, unhealthy lipid levels, metabolic dysfunction-associated steatotic liver disease (“fatty liver”), cardiovascular disease, and sleep apnea.

While the name change puts more emphasis on the metabolic health component of PMOS, treatment and management of the disorder may also look somewhat different going forward.

The Metabolic Feedback Loop of PMOS

“The way I explain to patients is that PMOS is inherently a metabolic disease,” says obesity medicine–certified physician Samantha Schon, MD, a reproductive endocrinologist and an associate professor in the department of obstetrics and gynecology at the University of Michigan in Ann Arbor. “The fundamental drivers of PMOS are insulin resistance and hyperandrogenism.”

Insulin resistance is when your body’s cells don’t respond to insulin, a hormone that moves glucose from your blood into your cells.

 Hyperandrogenism means that you have higher levels of androgens, such as testosterone, than women typically have. This can lead to symptoms like acne, excess body hair, male-pattern baldness, and irregular periods.

Insulin resistance can increase insulin levels in the blood, says Dr. Schon. This condition, called hyperinsulinemia, stimulates an increased production of androgens and suppresses the production of proteins, like sex hormone–binding globulin, that normally bind to and deactivate circulating androgens.

This dynamic leaves even higher levels of active androgens circulating in the body, exacerbating PMOS symptoms and driving further metabolic consequences. As Schon explains, “The relationship is complicated, but it’s important to know that insulin resistance and hyperandrogenism work synergistically to increase the risk of metabolic disorders.”

According to research, about 70 percent of women with PMOS have insulin resistance.

 Prevalence may change depending on weight, with data suggesting that, in PMOS, both hyperinsulinemia and insulin resistance affect up to 90 percent of women with obesity and 60 percent of women who are lean.

 Chronically high blood sugar from insulin resistance can lead to prediabetes and type 2 diabetes.

The long-term risks to health are significant. More than half of women who have PMOS develop type 2 diabetes by age 40, according to the Centers for Disease Control and Prevention.

 Women with PMOS also have more than a twofold risk of developing hypertension (high blood pressure), and more than a threefold risk of developing dyslipidemia (abnormal lipid levels), compared with women without PMOS.

Because people with PMOS are inconsistently screened for metabolic dysfunction, the name change is even more critical, as it reframes patients as having a “lifelong endocrine-metabolic condition” that should set the stage for early blood sugar testing and closer blood pressure and cardiometabolic risk factor monitoring, research suggests.

 That’s where talking to your healthcare provider about regular testing comes in.

How Metabolic Tests Can Help People With PMOS

Despite the change in how we view PMOS, the recommended screenings remain the same, says Schon. She says that physicians will continue to follow the recommendations from the 2023 International Evidence-Based Guideline, which cover needed testing.

 According to these recommendations, all women with PMOS, regardless of age or body mass index (BMI), should have:
  • Lipid profile testing (total, low-density lipoprotein, and high-density lipoprotein cholesterol) at diagnosis, with repeat testing based on results and additional risk factors
  • Blood pressure measurement annually and when planning pregnancy or seeking fertility treatment
  • Blood sugar testing at diagnosis and retesting every one to three years, based on personal diabetes risk factors
  • Obstructive sleep apnea symptom assessment, advancing to screening or testing if needed
“Women with PMOS are at an increased risk of metabolic disease independent of their weight,” says Schon. Research suggests that fasting glucose and triglycerides are higher, and HDL (“good”) cholesterol is lower, in women with PMOS, regardless of their BMI.

Treatment Options for Metabolic Issues in PMOS

Treatment for metabolic dysfunction in PMOS includes metformin, a medication that lowers blood sugar by reducing its absorption during digestion. It also reduces the release of sugar from the liver and improves how your body uses blood sugar.

 Other treatments may be used for high blood pressure or cholesterol if you’re diagnosed with those conditions.
Glucagon-like peptide-1 agonists (GLP-1s), used for weight loss and to treat diabetes, are not specifically approved by the U.S. Food and Drug Administration to treat PMOS. However, they may be part of a woman’s treatment plan if she is overweight or has obesity.

 In addition, bariatric or metabolic surgery may be considered, and reproductive symptom management may be treated with hormonal birth control and anti-androgen medication.

For anyone with PMOS, following a healthy lifestyle is an important part of managing the disorder, says Christa Brown, RDN, a dietitian in private practice in Woodbridge, New Jersey, who specializes in PMOS care. “Sleep and stress management are absolute cornerstones in the PMOS population. If the body is not able to restore itself, that creates even more metabolic problems,” she says.

In addition, Brown highly recommends that her patients follow a strength-training regimen. “Active muscle tissue growth helps reduce insulin resistance because it utilizes the excess sugar in your blood more efficiently and effectively,” says Brown.

One gap in PMOS care that often exists is personalized guidance on diet, exercise, and other lifestyle factors, including the ways that they come together alongside medical treatment of PMOS. “Registered dietitians can really help bridge recommendations from primary care providers, endocrinologists, and fertility clinics to help make sense of all of their information and recommendations,” says Brown.

EDITORIAL SOURCES
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Resources
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  3. Hyperandrogenism. Cleveland Clinic. August 11, 2025.
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