The symptom profile of PMOS is highly variable, which is one reason it is so frequently missed or misidentified. No two women present identically, and the severity of symptoms does not necessarily correlate with the degree of hormonal imbalance found on testing.
PMOS
Polyendocrine Metabolic Ovarian Syndrome, known as PMOS, is one of the most common endocrine disorders affecting women of reproductive age, estimated to affect between 8 and 13 percent of women globally.
Overview
What Is PMOS?
Polyendocrine Metabolic Ovarian Syndrome, known as PMOS, is one of the most common endocrine disorders affecting women of reproductive age, estimated to affect between 8 and 13 percent of women globally. Despite its prevalence, it remains one of the most underdiagnosed and inadequately managed hormonal conditions in clinical practice, with many women waiting years for an accurate diagnosis and receiving little beyond a prescription for the combined oral contraceptive pill before being left to manage their symptoms without meaningful support.
PMOS is a complex, multi-system condition rooted in hormonal and metabolic dysregulation. At its core, it involves elevated androgen levels, disrupted ovulatory function, and in the majority of cases, underlying insulin resistance that drives much of the hormonal imbalance. It is not simply a gynaecological issue. PMOS affects metabolism, cardiovascular health, psychological wellbeing, fertility, and long-term disease risk, and it demands a clinical approach that reflects that breadth.
At The Schoeman Clinic, we investigate and treat PMOS through a comprehensive hormonal and metabolic lens, addressing the root causes of the condition rather than managing its surface symptoms.
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A Name That Reflects the Condition
In May 2026, following more than a decade of international research and consultation involving nearly 15,000 patients, clinicians, and healthcare organisations from across the world, this condition was formally named Polyendocrine Metabolic Ovarian Syndrome (PMOS). The name change was published in The Lancet and presented at the European Congress of Endocrinology, led by Professor Helena Teede at Monash University and endorsed by over 50 global academic, clinical, and patient organisations, including the Endocrine Society and Verity UK, the leading British patient advocacy charity for the condition.
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Why Was the Name Changed?
The previous name, Polycystic Ovary Syndrome, was widely recognised within the medical community as clinically inaccurate and misleading. Research has confirmed that many women with the condition do not have ovarian cysts at all. What appear on ultrasound as cysts are arrested follicles, a feature that reflects hormonal dysregulation rather than pathological cyst formation. By naming the condition after ovarian cysts, the original terminology led to missed diagnoses, fragmented care, and a persistent failure to recognise the condition's full systemic reach.
The new name, PMOS, was chosen to reflect the clinical reality of what the condition actually involves.
Polyendocrine acknowledges that the condition is driven by multiple interacting hormonal disturbances, including insulin, androgens, and neuroendocrine hormones, rather than being an isolated ovarian disorder. Metabolic recognises the inherent metabolic features of the condition, including insulin resistance and its associated cardiovascular and long-term health risks. Ovarian retains the anatomical reference to the ovary, preserving continuity with existing research literature and patient understanding. Syndrome reflects that the condition presents as a cluster of features rather than a single, uniform disease.
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What Does This Mean for You?
If you were diagnosed under the previous name, your diagnosis, your treatment, and your clinical management remain entirely valid. The name change does not alter the diagnostic criteria, the clinical framework for assessment, or the treatment approaches used in your care. It represents a correction of terminology to better reflect the nature of the condition, not a redefinition of it.
At The Schoeman Clinic, we welcome this change. The root-cause, multi-system approach we have always applied to this condition reflects precisely the understanding that PMOS now names explicitly. Hormonal complexity, metabolic health, and systemic impact have always been central to how we investigate and treat this condition.
Symptoms
Symptoms of PMOS
Menstrual irregularity is among the most commonly reported features, including infrequent periods, prolonged cycles, or the absence of periods altogether. Anovulation, the failure to ovulate regularly, is a central feature of PMOS and has significant implications for fertility.
Androgen excess produces symptoms that include acne, particularly affecting the jaw, chin, and back; hirsutism, meaning unwanted hair growth on the face, chest, or abdomen; and androgenic alopecia, or thinning of the hair at the scalp. These symptoms can be profoundly distressing and are frequently undertreated.
Metabolic symptoms reflect the insulin resistance that underlies PMOS in the majority of affected women. These include unexplained weight gain, particular difficulty losing weight despite dietary effort, cravings for carbohydrates and sugar, energy fluctuations, and, in some women, dark patches of skin around the neck or armpits known as acanthosis nigricans.
Psychological symptoms including low mood, anxiety, and reduced self-esteem are disproportionately common in women with PMOS and are influenced both by the direct neurological effects of hormonal imbalance and by the considerable burden of living with an undertreated chronic condition.
Causes
Causes and Contributing Factors
PMOS does not have a single cause. It arises from the interaction of genetic predisposition with hormonal and metabolic factors, and its severity is significantly influenced by lifestyle, nutritional status, gut health, and environmental factors.
Insulin resistance is present in the majority of women with PMOS, including those who are not overweight, and plays a central role in driving elevated androgen production by the ovaries. High insulin levels stimulate the theca cells of the ovary to produce excess testosterone, suppress SHBG, and impair normal ovulatory signalling.
Inflammation, including chronic low-grade systemic inflammation, has been identified as both a feature and a driver of PMOS. It contributes to insulin resistance, androgen excess, and the metabolic complications associated with the condition.
Adrenal contribution to androgen excess is present in a significant proportion of women with PMOS, with elevated DHEA-S indicating adrenal rather than ovarian androgen production. Distinguishing these sources has important implications for treatment.
Gut microbiome dysbiosis is an emerging area of research in PMOS, with evidence suggesting that microbial imbalance contributes to both insulin resistance and systemic inflammation in affected women.
Diagnosis
How We Diagnose PMOS
PMOS is diagnosed clinically using the Rotterdam criteria, which require at least two of the following three features: irregular or absent ovulation, clinical or biochemical evidence of androgen excess, and polycystic ovarian morphology on ultrasound. A diagnosis of PMOS does not require all three features to be present.
At The Schoeman Clinic, diagnosis is supported by a comprehensive hormonal and metabolic panel. Testing through The Doctors Laboratory (TDL) may include total and free testosterone, SHBG, DHEA-S, LH, FSH, oestradiol, progesterone, prolactin, thyroid function including TSH, free T3, free T4, and thyroid antibodies, fasting insulin, fasting glucose, HbA1c, lipid profile, inflammatory markers including high-sensitivity CRP, and a full nutritional screen. Pelvic ultrasound is arranged where appropriate.
Thyroid dysfunction is assessed in all patients presenting with suspected PMOS, as hypothyroidism can mimic or compound the PMOS symptom profile and must be excluded or identified and treated concurrently.
Treatment
Our Approach to PMOS Treatment
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Hormonal Regulation and Bioidentical Hormone Therapy
Hormonal treatment in PMOS is targeted to the specific hormonal imbalances identified in each patient's testing profile. Your doctor draws on advanced training in bioidentical hormone therapy through WorldLink Medical and the Marion Gluck Training Academy to prescribe the most appropriate hormonal support for each individual, which may include progesterone to support ovulatory cycling, testosterone management strategies, and thyroid support where indicated.
Where a woman is seeking to improve fertility, treatment is planned with that goal explicitly in mind, and referral to gynaecological specialists is arranged where required.
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Metabolic Health Optimisation
Addressing insulin resistance is central to effective PMOS management and is one of the most clinically impactful interventions available. Treatment may include targeted nutritional medicine informed by your metabolic test results, specific supplementation with evidence in insulin sensitisation, and lifestyle intervention focused on blood glucose regulation, sleep quality, and inflammation reduction.
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Nutritional and Lifestyle Medicine
Women with PMOS respond significantly to specific dietary patterns, particular nutritional protocols, and targeted supplementation. Treatment recommendations are based on your individual test results rather than generic dietary advice, and are designed to work with the specific metabolic and hormonal drivers identified in your assessment.
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Gut Health Optimisation
Where gut dysbiosis is identified as a contributing factor through functional stool testing, a targeted microbiome restoration protocol is incorporated into the treatment plan. Further detail about our gut health investigations is available on our Diagnostics and Supportive Services page.
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Ongoing Monitoring
PMOS management requires consistent review. Hormonal and metabolic markers are monitored through repeat testing at follow-up consultations, allowing your doctor to assess treatment response and adjust the plan accordingly.
Why us
Why Choose The Schoeman Clinic for PMOS Care?
The Schoeman Clinic offers a level of PMOS investigation and management that addresses the condition in its full clinical complexity. Rather than prescribing the contraceptive pill and discharging, we investigate the hormonal, metabolic, inflammatory, and nutritional drivers of your PMOS and build a personalised treatment programme designed to address them.
Our clinicians' background across general practice, functional medicine, and specialist hormonal medicine gives them the clinical range to assess PMOS from multiple angles simultaneously, ensuring that no contributing factor is overlooked and that treatment genuinely addresses the root causes of your symptoms.
The Schoeman Clinic is CQC-registered and adheres to NICE guidelines, ESHRE/ASRM Rotterdam criteria, IFM frameworks, WorldLink Medical protocols, and GMC guidance throughout all patient care.
Continue
Where to go next.
Related conditions
Questions
Frequently asked questions
If your question is not answered here, our patient office will take it personally.
Book a consultationPMOS cannot be cured in the conventional sense, but its symptoms and the hormonal and metabolic imbalances that drive them can be very effectively managed. Many women experience significant improvement in their symptom profile, hormonal markers, and metabolic health through a well-designed treatment programme. The goal of care at The Schoeman Clinic is to address the root causes of your PMOS as comprehensively as possible and to restore quality of life to the fullest extent achievable.
Absolutely. Fertility is only one of many concerns in PMOS, and a significant proportion of the women we see are not currently seeking to conceive. The metabolic, hormonal, cardiovascular, and psychological dimensions of PMOS are important regardless of fertility goals, and our treatment programme is tailored to your specific priorities and circumstances.
Not always, but weight management is more challenging for many women with PMOS due to underlying insulin resistance and androgen excess. Importantly, PMOS and insulin resistance are present in women of all body weights, including those who are lean. A low or normal body weight does not exclude PMOS or metabolic dysfunction. Our assessment evaluates insulin sensitivity directly through fasting insulin and glucose testing rather than relying on weight or BMI alone.
The most common experience reported by women with PMOS who come to us is that their previous care consisted of a diagnosis, a prescription for the oral contraceptive pill, and little else. At The Schoeman Clinic, we conduct a comprehensive investigation of your hormonal and metabolic profile, identify the specific drivers of your PMOS, and develop a treatment plan that addresses those drivers directly. We monitor your progress with repeat testing and adjust your treatment as your clinical picture evolves.
This depends on your individual clinical picture and your response to treatment. Many women find that targeted lifestyle, nutritional, and hormonal interventions produce significant and sustainable improvements that reduce or eliminate the need for ongoing pharmaceutical support. Others benefit from longer-term hormonal or metabolic management. This is discussed openly and individually at your consultation and reviewed at every follow-up.
Next step
Book a PMOS
Consultation
If you have been diagnosed with PMOS, suspect you may have it, or have been told your symptoms are not significant enough to investigate further, we are here to provide a thorough, specialist assessment.
Clinics
96 Harley Street
London W1G 7HY
4 St Marks Place
Wimbledon, London SW19 7NP
Patient office
The Schoeman Clinic is a CQC-registered private medical clinic. All clinical content on this page has been written or reviewed by Dr Gina Schoeman MB ChB, MBA, Dip Derm, MRCGP, MBCAM, AFMCP. This page is intended for informational purposes and does not constitute individual medical advice. Please book a consultation to receive advice tailored to your specific circumstances.
