Polycystic Ovary Syndrome (PCOS) is changing its name and becoming Polyendocrine Metabolic Ovarian Syndrome (PMOS)! In this article, we explain the name change and review the latest scientific evidence on nutrition, plant-based products, and supplements that have been studied for the management of the syndrome.

Why did the name change, and what symptoms are associated with Polyendocrine Metabolic Ovarian Syndrome (PMOS)?

Polyendocrine Metabolic Ovarian Syndrome is the most common disorder affecting women of reproductive age, impacting one in eight women.

The term “Polycystic Ovary Syndrome” (PCOS) was recently replaced by the term “Polyendocrine Metabolic Ovarian Syndrome” (PMOS), as the previous name did not accurately reflect the multisystem nature of the disorder. More specifically, the former term was misleading: patients do not actually develop cysts in the ovaries, and the name focused solely on the reproductive system, overlooking the significant endocrine and metabolic imbalances associated with the condition, such as insulin resistance and hyperandrogenism. This often resulted in delayed diagnosis and the stigmatization of patients. For this reason, the new term “Polyendocrine Metabolic Ovarian Syndrome” was proposed, as it more comprehensively reflects the syndrome’s pathophysiology.

The syndrome is characterized by a variety of signs and symptoms that differ from patient to patient. Women with Polyendocrine Metabolic Ovarian Syndrome often experience prolonged menstrual cycles or amenorrhea, along with elevated levels of male hormones. As a result of the disrupted hormonal balance, multiple small immature follicles may accumulate in the ovaries, which until recently were incorrectly referred to as cysts. In addition, the syndrome may be associated with insulin resistance, obesity, infertility, abdominal pain, acne, excessive hair growth, and mood swings. The syndrome also increases the risk of chronic conditions such as dyslipidemia, cardiovascular disease, hypertension, type II diabetes mellitus, and various forms of cancer.

What causes Polyendocrine Metabolic Ovarian Syndrome?

Polyendocrine Metabolic Ovarian Syndrome has multiple underlying causes, with hyperandrogenism being the most predominant. This means that various male hormones, including testosterone, proandrogens, androstenedione, and dehydroepiandrosterone sulfate, are found at elevated levels in women. Increased androgen levels in the ovaries lead to impaired follicular maturation, progressively resulting in atresia, a condition in which ovarian follicles rapidly degenerate, causing infertility.

How is nutrition related to Polyendocrine Metabolic Ovarian Syndrome?

At the carbohydrate level

According to studies, Polyendocrine Metabolic Ovarian Syndrome is associated with the consumption of refined carbohydrates. In fact, women who consume higher amounts of starchy foods with a high glycemic index, such as cakes and biscuits, appear to be at greater risk of developing the syndrome. The consumption of refined carbohydrates increases blood glucose levels and promotes an inflammatory state in the body. Therefore, women with Polyendocrine Metabolic Ovarian Syndrome are advised to consume more unprocessed carbohydrates and dietary fiber found in whole grains, fruits, and vegetables, rather than simple carbohydrates found in refined starchy foods such as white rice, white bread, sweets, and salty snacks. It has also been suggested that carbohydrates should account for no more than 45% of total daily energy intake. For example, if a woman consumes 1,800 calories per day, no more than 810 calories should come from carbohydrates.

At the lipid level

Insulin resistance is one of the key factors contributing to the development of hyperandrogenism, which subsequently progresses to Polyendocrine Metabolic Ovarian Syndrome. A diet rich in saturated fats promotes insulin resistance and leads to dyslipidemia, characterized by increased LDL and total cholesterol levels, along with reduced levels of cardioprotective HDL cholesterol. Consuming high amounts of saturated fat increases the likelihood of hormonal imbalance, whereas consuming unsaturated fatty acids improves ovulation. Unsaturated fats include monounsaturated and polyunsaturated fats. Sources of monounsaturated fats include olive oil, avocado, and nuts. Sources of polyunsaturated fats include oily fish such as salmon and sardines, as well as seeds such as flaxseed and chia seeds.

At the protein level

Protein is one of the most important nutrients, as it serves regulatory, structural, and functional roles in the body. Unlike carbohydrates and fats, a high-protein diet has been found to be beneficial for hormonal activity. When referring to a high-protein diet, this means that daily protein intake ranges from 1.2–1.5 grams per kilogram of body weight. Of course, consulting a registered Dietitian-Nutritionist would be beneficial in order to receive a high-protein meal plan tailored to your preferences.

Have plant-based products and supplements been studied for improving Polyendocrine Metabolic Ovarian Syndrome?

Positive effects on the symptoms of Polyendocrine Metabolic Ovarian Syndrome have been observed with plant-based products such as aloe vera gel, curcumin extract, flaxseed, fenugreek extract, licorice extract, and green tea.

Supplementation with micronutrients including folic acid, vitamin E, omega-3 fatty acids, and selenium has been shown to be effective in reducing testosterone levels and generally improving hormonal balance in women with Polyendocrine Metabolic Ovarian Syndrome. In addition, some studies suggest that vitamin D may have a beneficial effect on improving glucose metabolism in women with vitamin D deficiency. Several studies have highlighted that inositol- a sugar belonging to the vitamin B family-is a useful molecule capable of counteracting the clinical and metabolic symptoms of Polyendocrine Metabolic Ovarian Syndrome. Specifically, inositol appears to play a key role in androgen synthesis, insulin regulation, and glucose metabolism.

Nevertheless, further research is required to determine the effectiveness of these treatments and their interactions with the biological processes underlying Polyendocrine Metabolic Ovarian Syndrome.

Nutrition for Polyendocrine Metabolic Ovarian Syndrome in practice

1. Consume a protein-rich breakfast: A balanced breakfast with an adequate amount of protein may contribute to better glycemic regulation throughout the day. Good options include an omelet with eggs and wholegrain bread, yogurt with fruit, cottage cheese with wholegrain rusks and tomato, or kefir accompanied by fruit and nuts.
2. Choose unprocessed carbohydrates in your meals: Foods containing unprocessed carbohydrates gradually increase blood sugar levels, helping regulate appetite. Good choices include wholegrain products, oats, brown rice, and legumes.
3. Do not skip fruits and vegetables: These foods increase the intake of fiber, vitamins, and antioxidants. Therefore, choose fruits of your preference as snacks between meals instead of processed snacks, and include a salad with both lunch and dinner.
4. Pay attention to the sources of fat you consume: Minimize sources of trans fats (found in processed snacks such as biscuits, donuts, crisps, and croissants) and moderate the intake of saturated fats- excluding those naturally present in dairy products and cheese. Emphasize healthy fats found in olive oil, olives, avocado, and nuts, while paying attention to portion sizes, as these foods are energy-dense.
5. In cases of increased body weight, follow a calorie-deficit diet for gradual weight loss. Even moderate weight loss improves insulin sensitivity and hormone levels. This approach should be based on a personalized and balanced nutritional plan.

If you would like personalized support for the management of Polyendocrine Metabolic Ovarian Syndrome (formerly known as Polycystic Ovary Syndrome), you can contact us to schedule a session with the dietitian!

REFERENCES

1. Shahid, R., Iahtisham-Ul-Haq, Mahnoor, Awan, K.A., Iqbal, M.J., Munir, H. and Saeed, I. (2022) ‘Diet and lifestyle modifications for effective management of polycystic ovarian syndrome (PCOS)’, Journal of Food Biochemistry, 46(7), e14117. Available at: https://doi.org/10.1111/jfbc.14117.
2. Di Lorenzo, M., Cacciapuoti, N., Lonardo, M.S., Nasti, G., Gautiero, C., Belfiore, A., Guida, B. and Chiurazzi, M. (2023) ‘Pathophysiology and Nutritional Approaches in Polycystic Ovary Syndrome (PCOS): A Comprehensive Review’, Archives of Gynecology and Obstetrics, published online 22 May 2023.
3. Teede, H.J., Bahri Khomami, M., Morman, R., Laven, J.S.E., Joham, A.E., Costello, M.F., Patil, M., Rees, D.A., Berry, L., Cree, M.G., Zhao, H., Norman, R.J., Dokras, A. and Piltonen, T. (2026) ‘Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovarian syndrome: a multistep global consensus process’, The Lancet, published online 12 May. Available at: https://doi.org/10.1016/S0140-6736(26)00717-8.