What Type of PMOS Do I Have?
You may have heard about the recent name change from PCOS to PMOS in either clinical or wellness spaces. The constellation of symptoms might be floating around in your head, leaving you wondering why your experience doesn’t quite look like what you’ve read about. After spending hours scrolling other women’s stories, something still feels off... The picture of PMOS online and in clinical settings may not match your own experience, and this may leave you wondering if you are the only one who is feeling this way. But you’re not alone!
Research has shown that there are different PMOS presentations. Meaning that this condition looks and clinically presents differently in different people. There are four known subtypes (or phenotypes) of PMOS. Each subtype looks slightly different, and breaking down what type of PMOS you have is the first step in better managing this hormonal (and metabolic) condition.
What Is PMOS and How Is It Diagnosed?
PMOS (Polyendocrine Metabolic Ovarian Syndrome) is a hormonal condition that affects roughly 1 in 10 women.1 It occurs due to a combination of different factors including genetics, insulin resistance, and hormonal imbalances.
Currently a PMOS diagnosis requires any two of the following symptoms after other causes have been excluded:2
1) Hyperandrogenism: when the body produces higher than normal levels of androgens. Androgens are a group of sex hormones that influence reproductive health. While they are found in much higher concentrations in male bodies, female bodies also produce androgens. Hyperandrogenism can present clinically and/or show up on blood work
Clinical presentation: the classic triad of excess facial and/or body hair (hirsutism), acne, and female-pattern hair loss (androgenic alopecia).
Blood work results: elevated total testosterone, elevated free testosterone, or other androgen hormone elevation (such as androstenedione, and dehydroepiandrosterone sulfate [DHEAS])
2) Ovulatory dysfunction: irregular, infrequent, or absent ovulation. This could look like menstrual cycles of >35 days or fewer than 8 menstrual cycles per year (oligomenorrhea).
3) Polycystic ovary morphology (PCOM): > 20 follicles per ovary (most accurately identified using a transvaginal ultrasound or assessing anti-mullerian hormone levels in blood work)3
We’ve written about what PMOS is and why the name changed from PCOS before if you want to learn more.
What Are the Different Subtypes of PMOS and What Do They Look Like?
There are four identified subtypes of PMOS. Each subtype presents with slightly different symptoms.4,5
Phenotype A: Classic PMOS, The most common presentation
● High androgens
● Irregular ovulation
● Polycystic ovaries
Phenotype B: Non-polycystic
● High androgens
● Irregular ovulation
● No polycystic ovaries
Phenotype C: Ovulatory PMOS, Characterized by Hyperandrogenism + Polycystic Ovaries
● High androgens
● Regular menstrual cycles
● Polycystic ovaries
Phenotype D: Non-hyperadrenergic PMOS
● Normal androgen levels
● Irregular ovulation
● Polycystic ovaries
Although the subtypes have slight variations in their clinical presentation, each of them may still show up with “classic” PMOS symptoms including: hirsutism, acne, missed or irregular periods and mood symptoms (including depression and anxiety).
What Are the Root Causes of Each PMOS Subtype?
Although the exact root cause of PMOS and its subtypes is not yet known, researchers have uncovered genetic and environmental drivers that can lead to the development of this condition.
Experts believe that PMOS may be caused by a combination of multiple factors such as:6
● Insulin resistance: insulin is a hormone made in the pancreas that helps your body use sugar (the main source of energy) effectively. If cells no longer respond properly to insulin, this can cause levels of insulin to remain high in the blood which can lead to insulin resistance.
● Genetics: certain genes may make you more or less susceptible to developing PMOS. PMOS is a multigenetic condition, which means that multiple genes can influence the development of the condition.7
● Hyperandrogenism: when your body makes an abnormal amount of androgens, this can lead to hirsutism, acne, and irregular ovulation.
What Are the Risks Associated With PMOS?
PMOS is considered to be both an endocrine and metabolic disorder which affects both the reproductive system and metabolism. If left unmanaged, it may manifest in a host of complications including:3
- Insulin resistance
- Prediabetes and Type 2 diabetes
- High cholesterol
- Metabolic syndrome
- Cardiovascular disease risk
- Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
- Obesity
- Thickened uterine lining (endometrial hyperplasia)
- Reproductive sub-fertility due to irregular menstrual cycles
Understanding the different complications that can occur if PMOS is not addressed is important for maintaining your overall metabolic health regardless of your subtype.
Are There Psychological Conditions Associated with PMOS?
Not only does PMOS alter your body composition and appearance which influences your mood and the relationship you have with your body, but PMOS itself is known to be a factor in the development of mental health conditions such as anxiety and depression.
Women with PMOS frequently report feelings of distress surrounding the delay in obtaining a diagnosis. Due to the different subtypes of PMOS, symptoms can present differently in patients. If they’re stuck dealing with an untrained clinician, this can heavily impact time to diagnosis.8
It’s no surprise that there is a psychological component to PMOS. Many women report that healthcare providers seem to minimize their experience, often attributing the symptoms to other causes. If you’ve been told to “just eat less and move more”, you get it. This can lead to feelings of helplessness or uncertainty about the condition, which naturally, influence mental health.9
Healthcare providers are increasingly becoming aware that addressing the psychological burden of PMOS is equally as important as addressing concerns about fertility.8 If clinicians are to improve access to care for women with all varieties of PMOS, advocating for improved education and training is non-negotiable.9
Can PMOS Get Better?
The PMOS subtype you have may change as you age. Research has shown that with increasing age, the proportion of women who fit the criteria for the phenotype A subtype decreased. Androgen levels were shown to significantly decrease with age, menstrual cycles became more regular, and polycystic ovarian presentation also decreased.4
While the reproductive symptoms declined with age, this was not true with metabolic symptoms. In fact, as women age, both body mass index (BMI) and waist circumference increase.4This indicates that while PMOS is a dynamic condition, it is important to manage both the reproductive and metabolic symptoms early to improve quality of life.
Why Does Knowing Your PMOS Subtype Matter?
This knowledge can help medical professionals tailor treatment plans that are right for you. This can include:
● Lifestyle changes: a high-fiber, low-glycemic index diet, rich in lean proteins and healthy fats, less refined carbohydrates, and regular physical activity
● Diabetes screening
● Mental health support
● Medications
● Hormone management
● Fertility support
Where Can You Get Help for PMOS?
While there is no cure for PMOS, with the right support it can be managed well. At July Health we have taken the time to understand PMOS and the different subtypes. We have a multi-disciplinary team of healthcare professionals that focus on different aspects of clinical care.
A nurse practitioner can help with diagnosis of your condition and discuss treatment options including medication.
A dietitian can help optimize your diet to address your specific health concerns and metabolic goals, while taking into consideration your preferences and barriers.
A therapist is available for mental health support, because PMOS goes beyond physical manifestations and symptoms, impacting all aspects of health.
We understand how complicated this condition can be, and we are ready to tackle it by your side whenever you are ready for support or advice. Book a session with our team to get started today.
This article is for informational purposes only and is not a substitute for professional medical advice. Talk to your healthcare provider about testing and treatment options tailored to you.
References:
- Salari N, Nankali A, Ghanbari A, et al. Global prevalence of polycystic ovary syndrome in women worldwide: a comprehensive systematic review and meta-analysis. Arch Gynecol Obstet. 2024;310(3):1303-1314. doi:10.1007/s00404-024-07607-x
- Christ JP, Cedars MI. Current guidelines for diagnosing PCOS. Diagnost
- ics (Basel). 2023;13(6):1113. doi:10.3390/diagnostics13061113
- Teede HJ, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2023. doi:10.1016/j.fertnstert.2023.07.025
- van Keizerswaard J, Dietz de Loos ALP, Louwers YV, Laven JSE. Changes in individual polycystic ovary syndrome phenotypical characteristics over time: a long-term follow-up study. Fertil Steril. 2022;117(5):1059-1066. doi:10.1016/j.fertnstert.2022.01.025
- Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25. doi:10.1016/j.fertnstert.2003.10.004
- Polycystic ovary syndrome. Office on Women's Health. https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome. Accessed May 17, 2025.
- Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 2018 May;14(5):270-284.
- Sydora BC, Wilke MS, McPherson M, Chambers S, Ghosh M, Vine DF. Challenges in diagnosis and health care in polycystic ovary syndrome in Canada: a patient view to improve health care. BMC Womens Health. 2023;23:100. doi:10.1186/s12905-023-02252-1.
- Ismayilova M, Yaya S. What can be done to improve polycystic ovary syndrome (PCOS) healthcare? Insights from semi-structured interviews with women in Canada. BMC Womens Health. 2022;22(1):220. doi:10.1186/s12905-022-01755-3.
