PCOS/PMOS: Are You Missing the Signs?
(PART I: the Hormonal/Physical Picture)
I’m often thought of as a perimenopause and menopause doctor—that work will always remain at the heart of my practice.
But hormones need support at every stage of life, not just midlife.
One of the most common—and frequently missed—examples of this is PCOS.
Polycystic ovary syndrome affects roughly one in ten women of reproductive age.
Many don’t know they have it.
They’ve been told their acne is just acne.
That irregular periods are “normal for them.”
That the extra hair on their chin is genetic.
That the moodiness is stress.
Sometimes those things are true.
But sometimes they’re signals worth paying attention to.
A New Name Finally Catches Up To the Science
PCOS is a hormonal and metabolic condition—not just an ovarian one.
For years, the name polycystic ovary syndrome has caused confusion. Many women with PCOS don’t have ovarian cysts, while others have ovarian cysts but don’t have PCOS.
Recently, an international consensus panel announced a new name: PMOS (Polyendocrine Metabolic Ovarian Syndrome).
The new name better reflects what we now understand about the condition. PMOS involves multiple hormone systems, metabolism, insulin regulation, and ovarian function—often without any ovarian cysts.
While the name is changing, the condition itself—and the concerns discussed here—remain the same. From here on out, I’ll refer to the condition as PCOS/PMOS.
SIGNS of PCOS/PMOS
Signs that may point toward PCOS/PMOS:
-Irregular, infrequent, or unpredictable periods
-Cycles longer than 35 days—or cycles that come and go without pattern
-Acne along the jawline, chin, or lower face (especially if it persists past your teens or flares around your cycle)
-Excess hair growth on the face, chest, or abdomen
-Thinning hair on the scalp
-Difficulty losing weight, or weight that tends to accumulate around the midsection
-Skin tags or darkened patches of skin (often at the neck or underarms)
-Ovarian cysts found incidentally on ultrasound
If at least three are familiar to you, it’s worth a conversation with your provider.
THE BLOOD SUGAR CONNECTION
One of the most important—and often overlooked—pieces of PCOS/PMOS is insulin.
Most women with PCOS/PMOS have some degree of insulin resistance, meaning their cells don’t respond to insulin efficiently.
The body compensates by producing more.
Elevated insulin signals the ovaries to produce more androgens (like testosterone).
That androgen excess is what drives many of the most visible symptoms:
-acne
-facial hair
-irregular ovulation
Blood sugar dysregulation in PCOS/PMOS can show up as:
-Energy crashes after meals
-Strong cravings for sugar or carbs (especially in the afternoon)
-Feeling shaky or irritable when meals are delayed
-Difficulty feeling satisfied after eating
-Weight that doesn’t respond as expected to diet or exercise
This is why blood sugar support is often central to PCOS/PMOS care.
Not just for weight—but for hormone balance at the root level.
WHY IT GETS MISSED
PCOS/PMOS exists on a spectrum.
Some women have clear, textbook presentations.
Others have subtler patterns that don’t raise concern—until they’re trying to conceive, or until the right labs are finally ordered.
And because symptoms like acne and irregular cycles are so common in adolescence, they’re often normalized rather than investigated.
If you’ve always had unpredictable cycles, skin that won’t cooperate, or a sense that your hormones have been “off” in ways that are hard to articulate—trust your inklings. You are the expert of your body.
My practice supports women at every stage of hormonal health—from the first signs that something feels off in adolescence through the reproductive years, and into perimenopause and menopause.
Hormonal imbalance doesn’t have an age requirement. And neither does getting support.
Next week we’ll look at the component of PCOS/PMOS that doesn’t get enough attention: the stress response, emotional and mood-related symptoms, and why women with PCOS/PMOS are often more sensitive to hormonal shifts across the entire cycle.
Warmly,
Dr. Krista
Olive Says
I may not know what an ovary is…
…but I do know when I need a belly rub!