Nutrition for PMOS (Polyendocrine Metabolic Ovarian Syndrome)
What is PMOS?
Polyendocrine Metabolic Ovarian Syndrome (PMOS) formerly called PCOS, which affects 12-18% of females of reproductive age and up to 21% in some high-risk groups, such as Indigenous Australian women . However, it is estimated that up to 70 % of women with the condition remain undiagnosed.
PMOS is a hormonal disorder that can present as a combination of the following symptoms:
- Irregular or infrequent periods – longer than 35 days
- Lack of ovulation
- Skin changes, specifically acne & darkening of the skin
- Hair changes, specifically excessive hair growth and or hair loss
- Weight gain
- Increased anxiety and depression
- Multiple small follicles on the ovaries seen on ultrasound (not present in all people with PMOS).
- Difficulty becoming pregnant
- Sleep apnoea
How to Diagnose PMOS
Despite the previous name, many people with PMOS don’t actually have ovarian “cysts” – hence why it was renamed in 2026! Instead, they may present with multiple immature follicles on the ovaries. To get a diagnosis of PMOS 2 of 3 of the following symptoms must be present:
- Irregular periods or infrequent periods (lack of ovulation), typically a cycle length of 35 days or more
- High levels of androgens (male hormones e.g. testosterone), can be detected through a blood test or may present with acne, excess hair growth (chin, jaw line, belly, back, legs or arms) or hair loss (head).
- More than 20 follicles on a single ovary have been detected on an ultrasound or an elevated AMH (a blood test measuring ovarian reserve) -neither of these metrics can be used to diagnose an adolesent with PMOS.
People with PMOS may experience difficulty conceiving due to these hormonal imbalances.
Excess androgens can also contribute to excessive hair growth and raised insulin levels. This can affect both menstruation and ovulation, either by completely or by reducing the frequency of regular ovulation.
What is Lean PMOS?
Leam PMOS is a type of PMOS where individuals are within a body weight range that is natural and healthy for them, and weight loss is not considered an appropriate or effective management strategy for this condition.
Despite this, individuals with lean PMOS often experience similar symptoms to other forms of PMOS (including insulin resistance), and the dietary and lifestyle changes outlined below can still be highly beneficial in managing and improving these symptoms.
How Does Diet Affect PMOS?
Diet can significantly influence the management of insulin resistance in PMOS while also providing essential nutrients to help reduce symptoms. However, research emphasises that there is no single “best” dietary pattern for managing PMOS.
Nutrition should be individualised, working alongside health professionals to determine what works best for your body, lifestyle, and needs.
How Effective is Diet for PMOS Symptoms?
Naturally, when we make changes we want to know how effective they can possibly be. We can say having seen hundreds of people with PMOS, how transformative the right diet and lifestyle strategies can be to PMOS symptoms and also fertility potential too.
But, don’t just take our word for it, a 2010 study compared the effectiveness of medical therapy (clomiphene citrate or “clomid”, metformin, or both) versus lifestyle intervention (diet & exercise) in treating those with PMOS.
The results were in favour of the lifestyle intervention, with this group showing higher pregnancy rates and a reduction in waist circumference, total androgen levels and lipid profile.
Considering the low-cost and minimal invasiveness of lifestyle interventions, along with their potential to positively affect other aspects of life including improving their relationship with food and mental health, lifestyle modification could well be used as a first-line therapy in improving fertility outcomes in those with PMOS.
What is Insulin Resistance?
Insulin Resistance (IR) is the term used to describe when some people’s
bodies do not respond to insulin. effectively. Insulin is a hormone produced by the pancreas that helps our bodies
regulate the sugar or glucose levels in our blood.Almost 85% of people
with PMOS also have insulin resistance, and whilst it isn’t a diagnostic
criteria it is a key driver of the underlying hormonal dysfunction
contributing to bothersome symptoms of PMOS. Carbohydrate
containing foods include grains such as bread, rice and pasta, fruits
and starchy vegetables (think potatoes, sweet potatoes, peas and corn),
legumes & beans as well as those treat foods such as lollies,
chocolate, chips and cakes plus so much more! Foods that contain
negligible carbohydrates include plain meat, fish, eggs, chicken or eggs
and plain fats such as oils and non-starchy veggies like leafy greens,
mushrooms, and onions (anything that is not potato, sweet potato, corn,
peas or legumes).After we eat these foods, the levels of glucose in our
blood starts to rise. It is here, where insulin is released to help move
glucose into all of our cells to provide energy and essentially give them
the energy they need to help you get about your life. However, if you
have insulin resistance, your cells resist the actions of the insulin.
Instead of the sugar being in your cells, it sits in your blood. So, your
body has to work harder to produce more insulin. In the end, you just
feel low in energy, sleepy after eating, craving dessert after a main
meal, gaining weight around your mid-section and more.
Why do we want to improve insulin Resistance for PMOS?
Insulin Resistance (IR) can increase your risk of developing type 2 diabetes later in life. IR can also
contribute to weight gain, especially around the mid-section.Research has shown that weight gain can lead
to changes in your ovulation and menstrual cycle meaning longer times to conception and a higher risk of
miscarriage. Weight gain can also lead to a decreased response to fertility
treatments such as IVF.
Carbohydrates and PMOS: Go Low or Low GI?
Don’t worry, we are not telling you to cut out carbohydrates altogether
from your life, because who can live without pasta?! The goal is to help
slow down how much glucose is going into the bloodstream and have
glucose levels rise and fall more smoothly throughout the day so you can
feel your best, and your hard-working pancreas can keep up with what
you’re eating too!To achieve this, it is best to eat moderate amounts of
carbohydrates spread out across the day. For example,porridge made
with oats or quinoa flakes at breakfast, a wholemeal bread sandwich at
lunch and some brown rice at dinner. Rather than skipping breakfast,
having a tuna salad for lunch and then eating a whole pizza and garlic
bread for dinner. You can see that the spread of carbohydrates across
the day are a little different in each of these examples.To manage insulin
resistance for PMOS it is also important to consider the glycaemic
index (GI) of foods and aim to include more low GI sources of
carbohydrates.
Low GI Carbohydrates for PMOS
Low GI carbohydrate foods slowly release glucose (the byproduct of
carbohydrate breakdown in the digestive system) into your blood stream.
This prevents rapid spikes in your blood glucose levels and therefore
your insulin is more likely to keep up with the glucose load entering
your body and getting it to the cells in your brain, muscles and liver to
keep you going.
A few simple low GI swaps include:
- Swapping white Jasmine rice for Brown Basmati Rice or long grain
- Doongara Rice
- Swapping your afternoon cracker snack with nuts & seeds
- Swapping a white potato for sweet potato
- Swapping a chocolate bar for a hot chocolate (the milk will slow
- down the release of glucose into your bloodstream)
- Swapping white bread for a grainy wholemeal, rye or sourdough
- variety
Mediterranean Diet for PMOS
The Mediterranean diet heralded for its heart-healthy, fertility-
promoting and brain-friendly benefits, is also appropriate for people
with PMOS.
- Extra Virgin Olive Oil (EVOO)
- Plenty of colourful vegetables
- Seasonal fruit
- Legumes, pulses, beans & lentils
- Plenty of seafood especially oily fish like salmon
- Wholegrains
- Nuts & seeds
- Moderate amounts of poultry, red meat, eggs
- Moderate amounts of fermented dairy (yoghurt & cheeses)
If you’re trying to fall pregnant and you’re living with PMOS, the Mediterranean diet is a favourable dietary
pattern to follow. The Mediterranean diet promotes lots of essential omega-3 fats and monounsaturated fats, as
well as an overall “anti-inflammatory” style of eating with antioxidants from fruits, veggies and high-quality
EVOO, helping to keep your eggs in tip-top shape and keep the underlying low-grade chronic inflammation
associated with PMOS at bay.
If you’re trying to manage mental health issues alongside PMOS, the
Mediterranean diet can be a great dietary pattern to use alongside any
other treatments you’re receiving from your doctor or mental health
professional. The Mediterranean diet has shown benefits for depression,
as well as anxiety. One size does not fit all, seek professional advice to
tailor your nutrition to your needs.
What about Supplements for PMOS?
Whilst we always recommend diet & lifestyle changes as the first port
of call when it comes to PMOS, we are constantly getting asked about
the best supplements to take for PMOS based on the latest science.
There are so many supplements lining the shelves of supermarkets and
pharmacies today, not to mention the overwhelming amount of advice
online about what to take and what to avoid-it’s all just so confusing!
Inositol for PMOS
Inositol is a chemical compound and B vitamin-like nutrient.Inositol
can help manage PMOS through improving insulin resistance and
many women report less sugar and carbohydrate cravings which are common in women living with
iPMOS. Additionally, a recent study found that inositol may promote
ovulation and menstrual regularity in women experiencing fertility
issues with PMOS.
There is also some evidence around it helping to reduce certain lipids in the blood including triglycerides
as well as blood pressure in women with PMOS . It has also been
shown to help egg and embryo quality too.
Where can I find inositol?
Of course, prioritising food sources if important, so inositol can be found naturally in beans, fruit,
wholegrains and nuts. However, it can be much easier to reach the required dosage of 2-4 grams per day
through supplementation.
Cinnamon for PMOS
Cinnamon can help to reduce insulin levels in women with PMOS.
As well as improved menstrual irregularities. With that in mind,load up
on cinnamon ! We like to put it in my smoothies, on oats, French
toast or on toast with banana and peanut butter, and in baking too!
Zinc for PMOS
Zinc has been shown to be effective in reducing hair growth and hair
loss. It has also been suggested that it may help reduce insulin
resistance in people with PMOS.
Chromium for PMOS
More research is needed in this area, however chromium
supplementation has been seen to be beneficial in regulating insulin,
free testosterone and reducing body weight in those with PMOS.
Omega-3s For PMOS
Omega-3 fatty acids have anti-inflammatory properties in the body
which can assist in reducing the inflammation seen in those with
PMOS. They have also been shown to assist in improving insulin
sensitivity, cholesterol levels and ovulation.
Berberine for PMOS
Berberine is a compound extracted from plants such as Goldenseal,
Oregon Grape. Barberr, Phellodendron and Chinese Goldthread. You
cannot get berberine from your diet. Berberine has been shown to assist
in improving insulin resistance, reducing body fat & improving
cholesterol resulting in improved ovulation.
Are Supplements Really Necessary for PMOS?
If you’re open to supplements and find them helpful, that’s great, it is essential to consult your healthcare
team first. If not, no worries! A balanced diet can provide all the nutrients needed to support PMOS
management.
Bottom line: Always check with your healthcare professional before
starting any supplements to ensure they’re right for you.
PMOS and Gut Health – Is there a link to Irritable Bowel Syndrome
(IBS)?
A 2010 paper highlighted the link between PMOS (formerly PCOS)
and Irritable Bowel Syndrome (IBS). They found that there are greater
rates of IBS in women who suffer from PMOS when compared to those
that did not have PMOS.More research is starting to emerge on gut health, the microbes (or bacteria) that live in our large intestine and the potential links to PMOS.
The Bottom Line: Diet for PMOS
PMOS is a lifelong condition that can be managed using dietary and
lifestyle strategies. There isn’t a one-size-fits-all dietary approach to
managing PMOS. Nutrition should be personalised in collaboration
with health professionals to find what best suits your body, lifestyle,
and unique needs.Whether you’re newly diagnosed, have been
managing PMOS for a while, or have been told to “just lose
weight” by someone in the past, it’s time for a fresh, modern approach
to PMOS nutrition- one that puts you at the centre of the conversation!