The Journal

PCOS & PMOS

PCOS (now PMOS): the cardiometabolic chameleon

Dr Amy Shacaluga·17 March 20265 min read

Polycystic ovary syndrome (PCOS), now often discussed as PMOS, polyendocrine metabolic ovarian syndrome, is one of the most common endocrine disorders affecting women of reproductive age. Global prevalence estimates range from about 6-13%, depending on diagnostic criteria and the population studied.[1] Despite that frequency, PCOS remains under-recognised and often misunderstood beyond its overt reproductive signs.

Women with PMOS commonly have menstrual challenges: absent periods (amenorrhoea) or infrequent periods (oligomenorrhoea). Other signs include hirsutism, acne, androgenetic alopecia and difficulty with weight management. The condition extends far beyond ovarian dysfunction. At its core sits a metabolic and hormonal imbalance, with insulin resistance present in 35-80% of cases, independent of BMI in many instances.[2] That drives hyperinsulinaemia, which stimulates ovarian androgen production, perpetuating symptoms and raising long-term cardiometabolic risk, including type 2 diabetes and cardiovascular disease.

Conventional management frequently focuses on symptom control: combined oral contraceptives for cycle regulation, or metformin for insulin sensitisation. Those approaches can be useful. They often leave the underlying contributors untouched.

Lifestyle medicine adopts an integrative, root-cause-oriented framework. PMOS is viewed as a systemic condition influenced by insulin resistance, chronic low-grade inflammation, gut microbiome disruption and nutrient insufficiencies, including vitamin D, magnesium, zinc and B vitamins. Chronic stress-mediated cortisol elevation, and exposure to endocrine-disrupting chemicals, also feature in the PMOS picture.

Through personalised, evidence-informed lifestyle interventions, many women can improve ovulatory function, fertility potential and downstream metabolic risk, often with less reliance on medicines alone.[3] That is not a promise that everyone can come off treatment. It is a reason to write a plan that includes more than a prescription.

The four core lifestyle pillars for PMOS

Nourish: an anti-inflammatory, blood-sugar-stabilising pattern

Dietary change is one of the most useful interventions in PMOS care.[4] Nutrient-dense, anti-inflammatory foods help steady post-meal glucose, improve insulin sensitivity and support gut integrity, all of which help hormone regulation.

Useful building blocks include non-starchy vegetables, lower-glycaemic berries, legumes, nuts, seeds, and high-quality proteins (for example fish, eggs, poultry, or plant-based options). Anti-inflammatory fats (extra-virgin olive oil, avocado, oily fish, nuts and seeds) and fibre-rich foods that nourish the microbiome sit alongside spices such as turmeric (with black pepper), ginger and cinnamon.

Refined carbohydrates and added sugars, ultra-processed foods, and, for some women, dairy (possible IGF-1 and insulinotropic effects) are often worth a time-limited reduction or pause. They are candidates to limit or pause, not foods I am recommending. Reduce or pause them for four to six weeks, then assess your own response. That is a trial, not a lifetime ban.

An illustrative day (not a prescription) might look like chia pudding with berries, almond butter and cinnamon; a salmon or tempeh salad with olive oil and seeds; a stir-fry of protein or legumes with cruciferous vegetables; and simple snacks such as apple with nut butter.

Move: consistent, enjoyable activity

Regular movement improves insulin sensitivity and can reduce circulating androgens, while supporting lean mass and mental health. Consistency outweighs intensity. Excessive high-intensity training may raise cortisol and worsen symptoms in some people.[5]

Evidence-supported starting points include resistance or strength work two to three times a week; moderate aerobic activity such as brisk walking, cycling or swimming, aiming for at least 150 minutes a week; and mind-body practices such as yoga, pilates or tai chi. Any movement available to you is better than none.

Restore: stress and sleep

Chronic stress and disrupted sleep unsettle hormonal equilibrium and aggravate insulin resistance and androgen excess. Practical starting points include daily breath work or mindfulness; a calmer evening (tea, reading, a screen curfew of two hours); and a consistent 7-9 hours in a cool, dark, quiet room.

Support: targeted nutraceuticals when there is a reason

There is no one-size-fits-all supplement stack. I prefer a test-and-treat approach. Diet first. Use supplements judiciously, based on biomarkers, history and response, and not as a substitute for the other three pillars.

What change can look like

With sustained work, many women notice meaningful change within three to six months: more regular cycles, fewer androgenic symptoms, better energy and mood, and more favourable metabolic markers. Tracking symptoms makes the next consultation more precise.

Start modestly (a steadier breakfast and daily gentle movement) and build. Collaboration with a clinician who can interpret tests and rewrite the plan is what turns a list of ideas into care.[6]

You hold considerable influence over the trajectory of PCOS. Hormonal “harmony” is marketing language. Better cycles, lower risk and a plan you can actually keep are realistic aims.

References

1. World Health Organization. Polycystic ovary syndrome. Geneva: WHO; 2023. who.int
2. Sanchez-Garrido MA, Tena-Sempere M. Metabolic dysfunction in polycystic ovary syndrome. Mol Metab. 2020;35:100937.
3. Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. J Clin Endocrinol Metab. 2023;108(9):2447-2469.
4. Cowan S, Lim S, Alycia C, et al. Lifestyle management in polycystic ovary syndrome: beyond diet and physical activity. BMC Endocr Disord. 2023;23(1):14.
5. Kite C, Parkes E, Taylor SR, et al. Exercise in the management of polycystic ovary syndrome: a position statement from Exercise and Sports Science Australia. J Sci Med Sport. 2024;27(9):589-599.
6. NICE Clinical Knowledge Summaries. Polycystic ovary syndrome. cks.nice.org.uk