What is PMOS?

Polyendocrine metabolic ovarian syndrome (PMOS) is a hormone imbalance that leads to higher-than-normal levels of the male testosterone (male reproductive hormone) in females. PMOS is quite common and affects 6-10% of girls and women worldwide. 

Until recently, PMOS was referred to as polycystic ovarian syndrome (PCOS). It has become more widely understood that this condition is a complex hormonal and metabolic disorder, and that many patients do not experience actual cysts as symptoms.

Hormone abnormalities and higher testosterone levels from PMOS may lead your child to experience irregular periods and skin changes, and have insulin resistance, a risk factor for diabetes. Girls and women with PMOS have a higher risk of diabetes and other metabolic disorders.

Weight gain can be associated with PMOS in some patients, but normal weight or underweight girls can also have PMOS. Adult women with PMOS, may have larger ovaries (with no cysts present) or have more egg follicles. Ovaries in teens with PMOS may appear normal.   

Causes of PMOS

There is no clear cause of PMOS, but there is increased risk in certain conditions:  

• A family history of PMOS 
• A hormonal imbalance while your child was in the womb 
• Early puberty in childhood 
• Excess body weight

Signs and symptoms of PMOS

Reproductive issues

For teens, PMOS results in irregular periods, which is a sign of irregular egg release (ovulation). 

This can show up as:

• Infrequent periods (fewer than eight per year) 
• Periods stopping altogether 
• Never having a period, despite other pubertal development 
• Excess bleeding (this is rare)

In adulthood, PMOS can: 

• Increase the risk of uterine cancer if left untreated 
• Create difficulty getting pregnant (infertility), though this can be treated

Skin issues

Because of higher testosterone levels, your child may experience skin issues, including:  

• Pimples (acne) 
• Excess facial or body hair 
• Scalp hair loss or hair thinning 
• Painful swollen areas (boils), often appearing in the underarms, breast and groin (hidradenitis suppurativa) 

Metabolic issues 

PMOS is strongly associated with metabolic issues, including:   

• Prediabetes or type 2 diabetes 
• High blood pressure 
• High cholesterol 
• Fat deposition in the liver (metabolic dysfunction-associated steatotic liver disease)

Psychological concerns

We are finding that girls with PMOS have increased rates of psychological concerns such as:  

• Depression 
• Anxiety 
• Disordered eating and body image

Testing and diagnosis for PMOS

Our PMOS Clinic offers physical exams, laboratory testing, nutritional and psychological counseling, and other family-centered services to help diagnose and treat PMOS. To diagnose your child with PMOS, we require blood tests showing high testosterone levels, but otherwise normal levels of hormones from the pituitary, thyroid and adrenal glands.  In rare cases, we may perform ultrasounds to look for visible issues in the uterus, ovaries or adrenal glands.