When I started my practice almost 10 years ago, I had no intention of specializing in PCOS. I had never even heard of it, despite going to graduate school for nutrition. (Sigh.) A couple years into working with people on their relationships with food and their bodies, it had become clear folks with PCOS needed support and that they were frustrated. I got frustrated with them. These women had spent years trying to get diagnosed and weren’t treated great along the way.
Some of them were never able to get a proper diagnosis for PCOS, but they knew they had it. They were usually given one or both of these suggestions: lose weight and go on birth control. Or a shrug, and “there’s nothing else to do, come back when you’re ready to get pregnant.”
They came to me because they had tried everything to lose weight and couldn’t. Or because they knew that PCOS causes insulin resistance and they were struggling to lose weight and with food because of that. They wanted to accept their bodies and take good care of them. And I was so honored to help.
This month, after over a decade of work, 22,000 voices, and one landmark paper published in The Lancet, the medical community officially acknowledged it. PCOS (polycystic ovary syndrome) needed a new name. Now PCOS is PMOS: polyendocrine metabolic ovarian syndrome.
This is great news!
Why the Name Was Changed
“Polycystic ovary syndrome” implied this condition was about cysts on the ovaries. But those aren’t actually abnormal cysts. They’re follicles, the things that normally develop into eggs each cycle. In PMOS, elevated androgens (male-type hormones like testosterone) prevent them from maturing and releasing, so they accumulate instead.
This name has been confusing and causing lots of folks without those follicles to not get a diagnosis. In fact, up to 70% of people with this condition have gone undiagnosed. 70%!
Changing the name to PMOS changes the focus from cysts on the ovaries to acknowledge what this condition actually is: a complex hormonal and metabolic condition. It affects periods, yes. But it also affects so many other things including skin, mental health, metabolism, sleep, fertility, and cardiovascular health. It is not really a gynecology issue. It is a full-body condition that has historically been cared for in the gynecologist’s office.
Insulin resistance, elevated androgens, and low-grade inflammation are now understood to be core drivers of this condition, not side effects of it. The irregular cycles and ovarian changes that gave the old name its “polycystic” label are a downstream result of those metabolic and hormonal processes, not the cause..
The Endocrine Society describes PMOS as a “multisystem condition involving endocrine, metabolic, reproductive, dermatological, and psychological health.” Basically, it’s complicated. That bit hasn’t changed.
It has been systematically underfunded and underdiagnosed because medicine tends to do that with conditions that primarily affect women. PMOS affects more than 170 million people worldwide – not at all rare.
How the Name Change May Affect You
According to coverage of the consensus, this name change comes with many practical changes that are in the works. Under the old criteria, a normal ovarian ultrasound could be used to rule the condition out, even when everything else pointed to it.
Under PMOS, irregular cycles plus metabolic or hormonal signs of excess androgens are enough for a diagnosis.
The hope is that all of this means that providers will be trained differently and research dollars will follow a more accurate picture of the condition so people get diagnosed sooner and more effectively.
Earlier diagnosis means earlier treatment, earlier understanding of what’s actually going on in your body, and earlier access to quality support instead of years of being told to come back when things get worse. Women don’t really love being brushed off because we’re so used to it.
Research has found that roughly half of people who meet diagnostic criteria for this condition are still undiagnosed by age 35, with symptom-to-diagnosis timelines ranging from a few months to well over a decade. Going that long without a diagnosis is infuriating. But it’s also damaging. The support that you could have gotten during that time could make a difference for your long-term health.
How Diet Culture Will Inevitably Co-Opt This
Many people with PMOS have spent years fighting to get good care. Being told to lose weight instead of being offered a diagnosis, which, if you have PMOS, you know is its own special kind of exhausting.
Centering the metabolic aspects of this condition, as it should be, will of course get misused. “Insulin resistance” and “metabolic condition” are phrases that diet culture is very, very good at turning into “See!! You should eliminate sugar.”
If your provider or a wellness influencer uses PMOS as the reason you need to go on a strict diet or cut your carbs super low, let’s push back. The science is not saying that will help. And just in general, it’s worth being skeptical of nutrition claims that use clinical language to dress up rigid diets and restriction because they get clicks and sound a little intense.
The science is saying that this condition has been misunderstood, mismanaged, and routinely dismissed. The answer to that is better care, not more diets.
What You Can Do With This New PMOS Name Information
From where I sit as a HAES-aligned dietitian, the day-to-day treatment doesn’t really change much. But I do hope that the care we suggest is more compassionate and nuanced going forward.
Rates of eating disorders and disordered eating are significantly higher among people with PCOS/PMOS than in the general population. For decades, the standard advice for PCOS has been some version of “lose weight, cut carbs”, which is just a chronic dieting prescription. And chronic dieting is one of the strongest known predictors of binge eating disorder.
Insulin resistance and blood sugar swings drive intense carb cravings, which is often misunderstood as some kind of willpower problem. But if your body is biologically pushing back against restriction and being told you just ‘try harder’, you are being set up for exactly the restrict-binge cycle.
You can absolutely practice intuitive eating with PMOS and it’s actually a really well-supported method of eating for this type of condition. Research on sustainable eating patterns for insulin sensitivity supports a non-restrictive approach.
So what does actual metabolic care look like, if not another meal plan? In practice, it tends to come down to the same few things.
blood sugar balance
Insulin resistance is central to PMOS, so the goal is to balance blood sugar throughout the day and reduce any big swings too high or too low. That usually means eating regularly (every 2-4 hours) and pairing carbs with protein, fat, and fiber, rather than skipping meals and “making up for it” later. Skipping breakfast because you’re “not hungry yet” and then white-knuckling until 3pm is one of the most common patterns that keeps both blood sugar and hormones unstable.
Less inflammation: added in, not cut out.
PMOS has an inflammatory component. And while you don’t need an “anti-inflammatory protocol”; you can just add in foods that support your body’s inflammatory response. Fatty fish, walnuts, chia and flax, beans and lentils, colorful produce. Adding tends to work better than cutting, both nutritionally and for your sanity.
Sleep and stress (for real though)
Chronic stress raises cortisol, which interacts with the same hormonal pathways involved in PMOS. Chronic dieting is a stressor. Your body doesn’t know the difference between “I’m trying to be in a calorie deficit on purpose” and “food is scarce.” so it feels threatened when you don’t feed it enough food, especially carbs and fat. This can feel counter-intuitive if you’re really stuck in the belief you need to lose weight. I suggest working with an Intuitive Eating Counselor (find a full list of Certified Intuitive Eating Counselors here) to find a way to improve your diet without triggering any disordered eating or worsening your relationship with food.
Getting 7-9 hours of sleep a night (and not brushing this aside if you have trouble sleeping) and finding ways to truly rest from overwork ( and over-doing other things in life) are also very important to look at. You should not be “doing everything” all of the time. Let productivity culture die a lonely death.
None of this requires eating less. And in fact, it’ll all work better when you’re eating enough. This is also, not coincidentally, where fertility comes in.
Fertility and PMOS
If your fertility is part of why you’re paying attention to all this, I see you. PMOS is one of the most common reasons for irregular ovulation, and a lot of the conventional advice (cut calories, cut carbs, just lose weight) can actually work against you trying to conceive. I wrote a separate post on what actually supports fertility with PMOS — and spoiler: it starts with making sure you’re eating enough.
If you want to understand more about the new name for PCOS and how PMOS works in the body, particularly the hormonal and insulin dynamics, I really like how Dr. Jordan Emont breaks it down.
And if you’re looking for nutrition and body image support on your PMOS/PCOS journey, I’d love to support you. You could be a great fit for The Love Food Again Program or for working with me 1-1 inside the Heal & Nourish program.
About Emily
Emily Van Eck, MS, RDN specializes in Intuitive Eating, eating disorders, body image, women’s reproductive health, and healing from years of weight-bias and disordered eating. She helps people find balance, consistency, and peace with their eating habits so they can feel confident to get outta their heads and into their bodies. Emily is a registered dietitian and certified Intuitive Eating counselor with a master’s degree in nutrition science. Read more about her practice, values, and experience here.
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