PMOS (Formerly PCOS)
Individualized evaluation and treatment for polyendocrine metabolic ovarian syndrome (PMOS) — from hormonal and metabolic testing to fertility, weight, and long-term health.
Medically reviewed by Dr. Chhaya Makhija, MD, Triple Board-Certified Endocrinologist, Sept. 2026
Understanding PMOS
PMOS — polyendocrine metabolic ovarian syndrome, previously known as PCOS — is the most common endocrine disorder in women of reproductive age, and both its prevalence and its presentation differ among racial and ethnic groups. Females can present with symptoms of irregular menstrual cycles, difficulty in conception (that is, anovulation), a clinical finding of hyperandrogenism, or a biochemical presence of hyperandrogenism.
What Hyperandrogenism Means
Hyperandrogenism, in simple terms, means an excess amount of androgens, or the male-producing hormone, which leads to symptoms of acne, hair loss, and hirsutism. Biochemically, this could be seen as elevated levels of testosterone, androstenedione, or DHEA-S (dehydroepiandrosterone sulfate).
The Metabolic Component
PMOS also has a metabolic component—insulin resistance, compensatory hyperinsulinemia, and inflammation.
Evaluation: A Step-by-Step Approach
Evaluation should be step-by-step and differs between adolescent females and adult female patients. Patients may present with symptoms of infrequent or irregular menstrual cycles, or difficulty in conception, along with facial hair or metabolic symptoms of pre-diabetes, obesity, and dyslipidemia. Depending on the clinical presentation, evaluation includes appropriate hormonal testing and metabolic testing.
Below is a list, which is not a complete list:
General and Metabolic Testing
A complete blood count
Iron panel
Metabolic panel
Vitamin D and B12 in case of fatigue
A hemoglobin A1c
A fasting glucose
A fasting lipid panel, along with apolipoprotein B and lipoprotein A in young adult females
Hormonal Testing
Hormonal testing includes a testosterone panel. Appropriate immunoassays are used, like liquid chromatography and mass spectrometry assays, to check for:
Total and pre-testosterone levels
LH (luteinizing hormone)
Follicle-stimulating hormone
Only in certain cases, estradiol as well as progesterone, including AMH
In all my patients, I will also look for:
Thyroid dysfunction
Prolactin level
Any concerns for Cushing syndrome or hypercortisolemia
A 17-hydroxy progesterone, if there is concern for non-classic congenital adrenal hyperplasia
Imaging
Ultrasound pelvis is individualized because, as per the new guideline criteria, ultrasound or the finding of multiple follicular cysts is not specific for diagnosis in many of these patients, especially not in the adolescent age group.
Treatment Options and Approach
PMOS care is highly individualized, depending on the clinical presentation, the patient's age, and their health goals — whether they are seeking fertility, symptom relief, or correction of abnormal metabolic or ovulatory dysfunction.
Medication and Supplement Options
Oral contraceptive pills, including the use of less androgenic progesterone, are options in individuals with menstrual cycle dysfunction as well as hirsutism.
Spironolactone can help with acne and hirsutism.
Metformin has been used off-label for PMOS for a long time, but its use is very dependent on younger patients, as it might help to restore menstrual regularity in certain individuals. It could also be considered in patients with prediabetes or overt diabetes.
Inositol is a supplement and could be considered in women with PMOS. Again, it is case-by-case and the studies have limited data to reflect clinical benefits in ovulation, hirsutism, or weight.
Weight and Metabolic Health
Weight loss intervention is a personalized approach for each individual, and it includes lifestyle interventions, correction of any deficiencies, and pharmacological options. Emerging evidence of GLP-1 receptor agonists in patients with PMOS is promising, and as of mid-2026, we are learning more about their benefits in this realm. A GLP-1 receptor agonist as an option is commonly reviewed at my patient visits if there is a clinical indication like overweight, obesity, prediabetes, insulin resistance, or type 2 diabetes.
Ongoing Care and Monitoring
After a thorough lab and imaging evaluation and a discussion of the treatment plan, patients can be monitored by their endocrinologist every 4–6 months while continuing care with their gynecologist and primary care physician.
Alternatively, patients who have multiple endocrine conditions alongside PMOS — and who need endocrine expertise periodically to improve their metabolic and hormone health prior to conception, to reduce their risk of pregnancy complications, and to improve their glucose, lipid control, and weight — can enroll in the medical membership care program.
A Collaborative, Whole-Person Approach
Female patients with PMOS need multifaceted care, given their higher risk for metabolic disturbances, obstructive sleep apnea, and psychological conditions. For that reason, I believe in collaborating on your care with the right specialists, as well as helping patients approach it holistically with both lifestyle interventions and cutting-edge science.
With the right medical expertise and interventions, females with a diagnosis of PMOS can achieve alleviation or improvement in their symptoms, experience an uneventful pregnancy, and have options that help reduce their risk for metabolic diseases and complications.
How to Begin Care
You can seek care via telemedicine or at one of our in-person office locations. Member patients have access to Dr. Makhija through the patient portal to share meal logs, symptom logs, and progress, and to ask questions, so that there is ongoing communication to optimize their treatment and achieve their health goals.
Frequently Asked Questions
Is pregnancy always difficult if I have PMOS?
No, it is not always difficult to conceive, but in many cases it is complex and needs close medical monitoring and treatment. Outcomes depend on the patient's history, age at diagnosis, and timely intervention — that is, addressing and treating weight and metabolic conditions such as prediabetes and type 2 diabetes, establishing care with a reproductive endocrinologist, evaluating for ovulatory dysfunction, and taking a proactive approach in the preconception period. It is also very important to have emotional and psychological support during the preconception period of this journey.
Can I be eligible for a GLP-1 receptor agonist if I have PMOS?
In general, currently (Aug 2026), there is no FDA approval of GLP-1 for PMOS management. Clinically, however, in real-world medicine, we have seen improvement in inflammation, insulin resistance, and other parameters with GLP-1 receptor agonists. We have patients with PMOS who meet the criteria for GLP-1 based on an overweight or obesity diagnosis, and since many of these patients also have prediabetes, insulin resistance, diabetes-2, obstructive sleep apnea, or fatty liver disease (MAFLD), they meet the criteria for the use of GLP-1. This is why it is important to see the right endocrinologist and other medical specialists to help navigate this journey. Emerging data in science looks promising for PMOS and GLP-1, and more data needs to be published.
Additional Resources
A Note on Insurance
Unified Endocrine Care is an out-of-network practice. Practicing outside of insurance networks allows us to give each patient the time and attention their care deserves and to build treatment plans around clinical need and personal health goals rather than the limitations insurance coverage imposes.
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Complex Hormones Require Specialist-Level Care
Conditions We Treat:
Where We Provide PMOS Treatment:
In person at our Fresno office (serving Clovis, Visalia, Madera, Hanford, and Tulare) and our Lafayette office (serving Walnut Creek, Orinda, Danville, Berkeley, Oakland, and San Francisco) — plus telehealth for patients anywhere in California.