Beyond the Ovaries: Understanding PMOS with OB-GYN Dr. Anoosha Ghodsi

Conversations with Clinicians | Health As a WholeInterviewed by Dina Shirazi

What was long known as polycystic ovary syndrome (PCOS) is now being renamed polyendocrine metabolic ovarian syndrome (PMOS). In this conversation, OB-GYN Dr. Anoosha Ghodsi explains why the new name matters, the symptoms that deserve attention, how the condition may change across a person's life, and how patients can advocate for a more complete evaluation and individualized care.

Terminology note: PMOS is the new name for the condition previously called PCOS. Because the transition is still underway, this article uses PMOS (formerly PCOS) so readers can recognize both terms.

Meet the clinician

Dr. Anoosha Ghodsi is an obstetrician-gynecologist practicing in San Diego, California. After completing her medical training in Chicago, she moved to San Diego, where she has cared for patients across different ages and backgrounds for nearly two decades. She was drawn to obstetrics and gynecology by a longstanding interest in women's health and the opportunity to support well-being throughout the course of a patient's life.

Why PCOS is becoming PMOS

The familiar name polycystic ovary syndrome placed most of the attention on the ovaries and on the presence of “cysts.” But the condition is much broader than the appearance of the ovaries alone. It can involve reproductive hormones, ovulation, insulin regulation, cardiovascular risk factors, skin and hair changes, fertility, and long-term metabolic health.

The new name—polyendocrine metabolic ovarian syndrome—is intended to reflect that whole-body picture. “Polyendocrine” signals that multiple hormonal pathways may be involved, while “metabolic” highlights associations with insulin resistance, type 2 diabetes, cholesterol changes, higher blood pressure, and weight-related concerns. “Ovarian” remains in the name because ovulation and reproductive health are still important parts of the condition.

This shift is more than a change in vocabulary. It encourages clinicians and patients to look beyond the ovaries and consider the person's overall health. It also helps correct a common misconception: a person does not need to have ovarian cysts to have PMOS.

PMOS does not look the same in everyone

PMOS is a syndrome, which means that it can appear as different combinations of signs, symptoms, and laboratory findings. One person may have irregular periods without acne or noticeable hair growth. Another may experience several symptoms at once. PMOS can also occur in people across the weight spectrum.

Common signs discussed in the interview include:

• Irregular, infrequent, or absent menstrual periods

• Acne that persists into or begins in adulthood

• Increased coarse hair growth, particularly on the chin, chest, around the nipples, or lower abdomen

• Thinning hair or hair loss from the scalp

• Difficulty ovulating or becoming pregnant

• Weight gain or difficulty managing weight in some patients

• Abnormal glucose, cholesterol, or blood-pressure measurements

For many patients, irregular periods are the first clue that leads to an evaluation. Acne, facial or body hair growth, and scalp hair loss can be easy to dismiss or feel uncomfortable to discuss, but they may provide clinically useful information.

Family and personal history matter as well. A family history of type 2 diabetes or a personal history of gestational diabetes can help a clinician understand a patient's metabolic risk.

Why irregular periods deserve attention

An irregular cycle is not only an inconvenience; it can also signal that ovulation is not occurring regularly.

During a typical ovulatory cycle, estrogen helps build the uterine lining. After ovulation, progesterone changes and stabilizes that lining. If pregnancy does not occur, hormone levels fall and the lining is shed as a period.

When ovulation does not occur regularly, the uterine lining may continue to be exposed to estrogen without the usual progesterone phase. Over time, infrequent shedding of the lining can increase the risk of endometrial hyperplasia, an abnormal thickening of the uterine lining, and may increase the risk of endometrial cancer. This does not mean that most people with PMOS will develop cancer, but it is one reason prolonged gaps between periods should be discussed with a healthcare professional.

Depending on the individual, a clinician may recommend combined hormonal birth control, periodic progesterone, or a progestin-releasing intrauterine device to regulate bleeding or protect the uterine lining. Treatment decisions should reflect the patient's symptoms, medical history, pregnancy goals, and preferences.

PMOS and endometriosis are different conditions

Although PMOS and endometriosis can both affect menstruation, pain, fertility, and quality of life, they are separate conditions.

PMOS is an endocrine, metabolic, and reproductive syndrome commonly associated with irregular ovulation and signs of higher androgen activity. Endometriosis involves tissue similar to the uterine lining growing outside the uterus and is often associated with pelvic pain, especially around menstruation. A person can have both conditions, but one does not cause the other.

How PMOS can change across life stages

Dr. Ghodsi emphasizes that PMOS is a chronic condition, but chronic does not mean unmanageable. The most important symptoms and treatment goals may change over time.

Adolescence

Irregular periods can be common soon after menstruation begins, which can make diagnosis during adolescence more complex. Persistent cycle irregularity accompanied by signs of excess androgen activity—such as significant acne or coarse hair growth—may warrant a closer evaluation.

When pregnancy is not a current goal, treatment may focus on regulating cycles, protecting the uterine lining, and addressing acne or unwanted hair growth. Hormonal birth control is one option. In selected patients, clinicians may also prescribe an anti-androgen medication such as spironolactone for acne or excess hair growth. These medications require individualized medical guidance and monitoring.

Reproductive years and fertility

When a patient wants to become pregnant, the focus often shifts toward supporting regular ovulation. Irregular ovulation can make conception less predictable, but PMOS does not mean that pregnancy is impossible. Many people conceive either spontaneously or with treatment.

Care may include attention to metabolic health, medications that support ovulation, and—in some patients—metformin to improve glucose regulation and potentially support more regular ovulation. The appropriate approach depends on the patient's laboratory results, health history, and fertility goals.

Pregnancy and postpartum

People with PMOS may have a higher risk of gestational diabetes, although not everyone with the condition will develop it. Routine prenatal screening remains important, and a clinician may recommend earlier or additional monitoring based on individual risk factors.

Some patients may also encounter breastfeeding challenges postpartum. Because experiences vary widely, concerns about milk supply or feeding should be raised early with an obstetric clinician, pediatric clinician, or lactation specialist.

Later adulthood and after menopause

Even when menstrual cycles and fertility are no longer the central concern, the metabolic component of PMOS remains relevant. Ongoing care may focus on blood glucose, cholesterol, blood pressure, weight trends, sleep, mental health, and cardiovascular risk. Regular preventive visits can help identify changes early rather than waiting for a condition such as type 2 diabetes or hypertension to become established.

How PMOS is evaluated

There is no single test that, by itself, confirms PMOS. An evaluation typically combines several forms of information:

1. A detailed history. A clinician may ask about menstrual patterns, acne, facial or body hair growth, scalp hair loss, weight changes, pregnancy history, medications, and family history of PMOS or type 2 diabetes.

2. A physical examination. When appropriate, this may include blood pressure, signs of androgen activity, and other findings relevant to the patient's symptoms.

3. Laboratory testing. Bloodwork may assess androgen levels and metabolic health, including glucose and cholesterol. Testing may also help exclude other explanations for irregular periods or similar symptoms, such as thyroid or prolactin abnormalities.

4. Additional assessment when indicated. Depending on age and circumstances, a clinician may consider imaging or other measures of ovarian function and appearance. Not every patient needs every test.

The diagnosis is based on a pattern of findings and the exclusion of other conditions that can look similar. It should not be made—or dismissed—based only on body size, a single symptom, or whether an ultrasound shows ovarian changes.

Treatment should match the patient, not just the label

There is no one-size-fits-all PMOS treatment plan. Care is usually built around the concerns that matter most to the individual while also protecting long-term health.

Possible components include:

• Nutrition and physical-activity support that is realistic and sustainable

• Screening and treatment for abnormal glucose, cholesterol, or blood pressure

• Hormonal birth control or progesterone to regulate bleeding and protect the uterine lining

• Treatment for acne, excess facial or body hair, or scalp hair loss

• Metformin when clinically appropriate, particularly for metabolic concerns

• Ovulation-supporting medication or fertility care when pregnancy is a goal

• Support for mental health and quality-of-life concerns

Lifestyle care should not be reduced to a generic instruction to “lose weight.” Effective care considers access to food, movement, sleep, stress, medications, medical conditions, and the patient's own priorities. Medication and lifestyle strategies can also be used together rather than treated as competing approaches.

Preparing to advocate for yourself

Dr. Ghodsi's most practical advice is simple: write down your concerns before the appointment. Medical visits can feel rushed, and it is easy to forget a symptom or question once the conversation begins.

Consider bringing the following information:

• The dates and length of recent menstrual cycles

• How long you typically go between periods

• Changes in acne, facial or body hair, or scalp hair density

• Weight changes that feel unexplained or difficult to manage

• Current medications and supplements

• A personal history of gestational diabetes, high blood pressure, or abnormal cholesterol or blood sugar

• A family history of PMOS, type 2 diabetes, or related metabolic conditions

• Whether pregnancy is a current or future goal

• The symptoms that affect your daily life most

You do not need to decide in advance whether every concern is connected to PMOS. Your role is to describe what you are experiencing; your clinician's role is to help evaluate the possible causes.

Questions you may want to ask include:

• Could my menstrual pattern or symptoms be consistent with PMOS?

• What other conditions should be ruled out?

• Which laboratory tests or other evaluations are appropriate for me?

• Do I need treatment to protect my uterine lining if I rarely have a period?

• How often should my blood pressure, glucose, and cholesterol be checked?

• How would the treatment plan change if I want to become pregnant?

• What options are available for the symptom that bothers me most?

The central takeaway

The move from PCOS to PMOS reflects a more accurate understanding of the condition: it is not simply about ovarian cysts, and it is not solely a fertility issue. It can affect hormones, metabolism, menstrual health, skin and hair, pregnancy, and long-term well-being.

As Dr. Ghodsi explains, PMOS is a lifelong condition, but it can be managed. Recognizing symptoms, protecting menstrual and metabolic health, and finding a clinician who listens can help patients make informed decisions at every stage of life.

About Conversations with Clinicians

Conversations with Clinicians is a Health As a Whole series that makes expert health information easier to understand and use. Through conversations with physicians and other health professionals, the series explores prevention, diagnosis, treatment, lifestyle, and the questions patients can bring into their own healthcare visits.

Medical disclaimer

This article is for educational purposes only and does not provide medical advice, diagnosis, or treatment. It summarizes an interview and includes limited editorial context for clarity. Individual needs vary; consult a qualified healthcare professional about symptoms, testing, medication, or treatment decisions. Seek prompt medical care for severe or rapidly worsening symptoms.

Sources and further reading

• The Lancet: https://www.thelancet.com/journals/lancet/article/PIIS0140-67362600717-8/fulltext

• Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439

• World Health Organization: https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome

• American College of Obstetricians and Gynecologists: https://www.acog.org/womens-health/faqs/polycystic-ovary-syndrome-pcos