What is PMOS?
Polyendocrine Metabolic Ovarian Syndrome (PMOS), previously known as PCOS, is a whole-body endocrine disorder, affecting 1 in 8 women globally, and involving interactions between the:
- Brain (hypothalamus–pituitary axis)
- Ovaries
- Metabolic system (insulin regulation)
- Adrenal glands
- Immune/inflammatory pathways
It is not primarily an ovarian condition, but a system-wide hormonal and metabolic disorder.
Symptoms of PMOS
Symptoms of PMOS can vary widely depending on the underlying driver, but commonly include:
Reproductive / Hormonal: Irregular or absent periods, deavy or prolonged bleeding, difficulty ovulating (fertility challenges), premenstrual symptoms (PMS)
Androgen (High Testosterone) Symptoms: Acne (often persistent or adult-onset), excess facial or body hair (hirsutism), thinning scalp hair or hair loss, oily skin
Metabolic Symptoms: Weight gain or difficulty losing weight, cravings (especially sugar or carbohydrates), fatigue or energy crashes, blood sugar instability
Adrenal / Stress-Related Symptoms: Anxiety or feeling “wired but tired”, difficulty sleeping, burnout or poor stress tolerance
Inflammatory / Whole-Body Symptoms: Bloating or digestive issues, headaches, joint pain or general inflammation, skin conditions (e.g., eczema)
Not everyone experiences all symptoms. Presentation varies depending on whether PMOS is insulin-driven, inflammatory, adrenal, or post-pill.
Core Features
PMOS is characterised by a combination of Androgen excess, ovulatory and metabolic dysfunction and a central feature of PMOS is disrupted communication between the brain and ovaries:
- Rapid GnRH signalling → increased LH hormone
- Elevated LH → increased testosterone production
- Lack of ovulation → low progesterone
This creates a reinforcing cycle: No ovulation → low progesterone → continued androgen excess → ongoing cycle disruption
Why Progesterone Deficiency Matters:
Progesterone is produced most abundantly after ovulation. In PMOS low progesterone can mean that ovulation may not occur regularly → chronic progesterone deficiency, which in turn can contributes to: Irregular cycles, unopposed estrogen effects, reduced hormonal feedback, persistent androgen excess
Dr Lara Briden suggests the undelying drivers of PMOS are: insulin-resistant PMOS (most common), inflammatory PMOS, adrenal PMOS, post-pill PMOS. Identifying the driver is essential for effective treatment.
Treatment Approach (Root-Cause & Hormone Restoration)
Treatment Approach (Root-Cause & Hormone Restoration) should be based around treating the underlying driver while helping restore ovulation and hormonal balance. Treatments may include:
1. Bioidentical Progesterone Therapy
- Also called oral micronized progesterone, also in a transdermal cream
- Identical to natural human progesterone
- Different from synthetic progestins which may have an androgen-like effect
Progesterone Supports PMOS by helping to regulates brain–hormone signalling, helps normalise LH and reduce androgens (testosterone), promotes menstrual cycle regularity, protects the uterine lining, from unopposed oestrogens, and reduces endometrial hyperplasia.
Progesterone supports hormonal balance but must be combined with metabolic treatment for full effectiveness.
2. Improve Metabolic Health & Reduce Inflammation by stabilising blood sugars, reducing refined carbohydrates, increasing quality, aried protein and healthy fats, consider the use of Inositol and magnesium. Implement a whole-food diet that supports gut health and minimises processed and ultra-processed foods.
3. Support Adrenal & Stress Systems by prioritising sleep, reducing high-intensity overtraining, include gentle movement such as Yoga or Tai Chi, and managing stress.
4.The primary Goal is to Restore Ovulation aiming to produce progesterone naturally and regulating cycles which will help to improve long-term hormonal health.
5. Personalised Care
- PMOS varies between individuals
- Treatment must match the underlying driver
- Combination therapy is often needed
In Summary:
- PMOS is a whole-body endocrine condition
- Symptoms can be reproductive, metabolic, skin-related, or stress-related
- Low progesterone is central due to lack of ovulation
- Bioidentical progesterone can support cycle regulation
- Addressing root causes is essential
References:
Briden, L. (2017). Period repair manual: Natural treatment for better hormones and better periods. GreenPeak Publishing.
Briden, L. (2021). Hormone repair manual: Every woman’s guide to healthy hormones after 40. GreenPeak Publishing.
Briden, L. (2024). Cyclic progesterone therapy for PCOS. Retrieved from https://www.larabriden.com
International PCOS Network. (2023). International evidence-based guideline for the assessment and management of polycystic ovary syndrome. Monash University.
Prior, J. C. (2018). Progesterone for the treatment of polycystic ovary syndrome: A physiological approach. Endocrine Reviews, 39(3), 292–315.
Rosenfield, R. L., & Ehrmann, D. A. (2016). The pathogenesis of polycystic ovary syndrome. Endocrine Reviews, 37(5), 467–520.
Teede, H. J., Misso, M. L., Costello, M. F., et al. (2018). Evidence-based guideline for PCOS. Human Reproduction, 33(9), 1602–1618.
Unfer, V., Facchinetti, F., Orrù, B., Giordani, B., & Nestler, J. E. (2017). Myo-inositol in PCOS. Endocrine Connections, 6(8), 647–658.