Your Cycle · 10 min
PMOS (formerly PCOS): the whole picture
Top things to know
PMOS is a whole-body hormonal condition, not mainly about cysts.
Diagnosis needs 2 of 3 features, once other causes have been ruled out.
PMOS is more common in South Asian women than the global average.
It is lifelong but manageable, and many women live full, healthy lives with it.
What is PMOS?
Polycystic ovary syndrome, PMOS, is a common hormonal condition that affects multiple systems in the body. Despite its name, it is not primarily about cysts. The name comes from the appearance of the ovaries on ultrasound: many small follicles that have not fully developed, sitting in the ovary like a string of pearls. But PMOS is much more than what the ovaries look like on a scan.
PMOS affects how the body produces and responds to hormones, how it processes insulin and sugar, how skin and hair behave, how mood and mental health are experienced, and yes, how fertility works. It is a lifelong condition that does not go away, but it is manageable, and many women live full, healthy lives with it.
PMOS is a lifelong condition, not a problem to be defeated. The work is understanding it, not fighting it.
The four PMOS subtypes
Insulin-resistant
The most common pattern. The body's cells respond less to insulin, so the pancreas makes more, which nudges the ovaries to make extra androgens.
Adrenal
Driven by DHEA-S from the adrenal glands rather than the ovaries. Often shows up alongside long-running stress patterns rather than insulin issues.
Post-pill
A temporary PMOS-like picture that can appear after stopping the combined pill, as ovulation re-establishes. Usually settles within a year.
Inflammatory
Associated with chronic low-grade inflammation, sometimes alongside skin conditions, joint pain, or gut symptoms, that overlaps with hormonal patterns.
How common is PMOS?
PMOS is one of the most common hormonal conditions affecting women of reproductive age, but the picture looks different across populations.
Globally, PMOS is estimated to affect between 8 and 13% of women depending on the diagnostic criteria used. In South and East Asian populations, prevalence is significantly higher. A nationwide study of 38,709 Indian women found a PMOS prevalence of 19.6% using Rotterdam diagnostic criteria. A 2026 global systematic review found the Eastern Mediterranean and South-East Asian regions have the highest PMOS prevalence globally, 15.1% and 14.3% respectively.
South Asian adolescents in the United States have been found to have 1.7 times higher PMOS risk compared to Chinese adolescents.
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19.6%
A nationwide study of 38,709 Indian women found a PMOS prevalence of 19.6%, well above the global estimate of 8 to 13%.
Nationwide study of 38,709 Indian women, JAMA Network Open
How is PMOS diagnosed?
A diagnosis of PMOS is made when a person has 2 of the following 3 features, once other causes have been ruled out (2023 International Evidence-Based Guidelines):
1. Irregular or absent periods (cycles longer than 35 days, or fewer than 8 periods per year) 2. Signs of higher male hormones (), excess facial or body hair, acne, or scalp hair thinning; or a blood test showing elevated androgen levels 3. Polycystic-appearing ovaries on ultrasound, or a raised () blood test
Note: testing is not routinely available through all doctor practices in the UK. It is more commonly measured in specialist settings. You may not have this test, a diagnosis can be made without it.
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Putting it into words
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Myth
A common belief is that PMOS only affects women who are overweight.
Evidence
Around 30–40% of people with PMOS have a BMI in the normal range, this is the 'lean PMOS' phenotype. In South Asian bodies, insulin resistance and androgen excess can be present at a normal BMI; the metabolic picture is what matters, not the number on the scale.
2023 International Evidence-Based PCOS Guidelines (Teede et al., Human Reproduction).
What are the symptoms of PMOS?
No single test diagnoses PMOS. A clinical picture built from symptoms, examination, and blood tests is how it is identified. PMOS affects different women differently. You may have all of the following or only a few.
Menstrual symptoms: • Irregular periods, coming far apart, unpredictably, or not at all • Sometimes lighter periods, sometimes heavier • Difficulty predicting when a period will arrive
Skin and hair symptoms: • Excess hair growth (hirsutism) on the face, chin, chest, abdomen, back, or thighs, this is caused by higher androgen levels, not by poor hygiene or diet • Scalp hair thinning or loss, often following a pattern similar to male hair loss • Acne, particularly persistent, hormonal acne • Dark, velvety skin patches (acanthosis nigricans) on the neck, armpits, under the breasts, or in skin folds, this is a sign of , not a skin infection • Small skin tags, often on the neck or armpits
Metabolic symptoms: • Weight gain, particularly around the waist and abdomen • Difficulty losing weight despite diet and exercise changes • Fatigue, often significant
Mood and mental health: • Anxiety and depression are significantly more common in women with PMOS • Body image concerns related to skin and hair symptoms are common • The experience of being undiagnosed or dismissed adds its own psychological burden
Fertility: • Irregular or absent makes it harder to conceive
How does PMOS affect South Asian women differently?
Research shows that South Asian women with PMOS have a distinct clinical picture compared to White European women with PMOS. This matters because much of the clinical guidance for PMOS was developed primarily on non-South Asian populations.
Key differences: • South Asian women with PMOS develop metabolic complications at lower body weight. The standard threshold of 25 for overweight underestimates risk in South Asian populations, where complications can occur at 23 or above. • Higher rate of even at normal weight • Acanthosis nigricans (dark velvety skin patches) is present in 16.8% of South Asian women with PMOS compared to 3.1% of White women with PMOS • Higher androgen levels and lower SHBG compared to White women with PMOS • Strong family history of type 2 diabetes is common and clinically relevant
If you ever decide to raise it
Putting it into words
No words guarantee how an appointment goes. Precise words just make sure what you live with gets described, not rounded down.
Keep it, edit it, or just remember it. Stays on your phone.
Should you self-treat excess hair growth with PMOS?
Many women treat unwanted hair through threading, waxing, shaving, bleaching, or laser treatment. This is normal and very common. It is also clinically significant.
If you remove hair, a clinician examining you may not see the full picture of your symptoms. When describing your experience, think about where hair grows without treatment, not just what is currently visible.
The clinical threshold for defining excess hair (hirsutism) is set at a lower level for Asian populations than for some other ethnic groups. This means that even a modest amount of coarse facial or body hair, combined with other symptoms like irregular periods, can be clinically meaningful.
A global survey of 4,409 ethnic Indian women with PMOS found that 45% had no information about PMOS at all. Only 9.1% received information from a doctor. Women first experienced symptoms at an average age of 19 but were not diagnosed until an average age of 20.8.
What are the long-term health risks of PMOS?
PMOS is a lifelong condition. It does not resolve after a pregnancy, or after , though symptoms change across life stages.
Women with PMOS have a higher risk of: • Type 2 diabetes, particularly South Asian women, given the phenotype • High blood pressure and cardiovascular disease • High cholesterol and lipid abnormalities • Anxiety and depression, significantly higher rates than in women without PMOS • Sleep apnoea (disrupted breathing during sleep) • Endometrial (womb lining) cancer, risk is elevated but absolute risk remains low, particularly in women who have regular periods or treatment to regulate them
These are not inevitable outcomes. They are risks that are actively managed through monitoring, lifestyle, and where appropriate, medication. Knowing about them means they can be watched for.
How do you manage day-to-day life with PMOS?
There is no cure for PMOS, but symptoms can be significantly managed. The 2023 International Evidence-Based Guidelines make clear that lifestyle remains the foundation of management, particularly in terms of and metabolic health.
What the evidence supports: • Modest weight loss of 5 to 10% of body weight can restore more regular in some women who are overweight, but this is not relevant to all women with PMOS, particularly those at a healthy weight • Regular physical activity helps with insulin sensitivity and mental health, independent of weight change • No single "PMOS diet" is proven, but diets that reduce rapid blood sugar spikes, lower refined carbohydrates, higher protein and fibre, may help with
Medical options that exist (a clinician will discuss what is appropriate for your situation): • Hormonal contraceptives to regulate periods and reduce androgen effects on skin and hair • Medications to address • Medications to help with if pregnancy is the goal • Treatments for excess hair and acne
How do culture and emotions shape life with PMOS?
For many women, a PMOS diagnosis brings complicated feelings. In South Asian communities, reproductive health problems can carry significant stigma, the fear that something is "wrong" with you as a woman, that your body is failing a role it is expected to perform. Hair on the face, weight that won't shift, acne that won't clear, these symptoms can be isolating and distressing in ways that go beyond the physical.
A survey of Indian women with PMOS found that 64% were diagnosed with at least one additional condition, anxiety and depression were the most common. This is not coincidence. It reflects the real psychological burden of living with a condition that affects appearance, fertility, and long-term health, often without adequate information or support.
You are not alone in this. And PMOS is not a moral failing or a sign of weakness. It is a hormonal condition with a biological basis.
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Frequently Asked Questions
Is PMOS more common in South Asian women?
Yes. PMOS is more common in South Asian women, tends to start earlier, and is more strongly driven by insulin resistance. That is why symptoms can appear at a lower body weight than many guides assume.
Do you need cysts to have PMOS?
No. Despite the old name, PMOS is not primarily about cysts. It is a hormonal condition diagnosed from a combination of symptoms, blood tests and scans, and many people with PMOS have no cysts at all.
What actually helps with PMOS?
The strongest evidence is for managing insulin: eating pattern, movement, sleep and, where appropriate, medication. What works differs by subtype, so understanding your own picture matters more than any single fix.
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Reviewed by clinicians
Authored and reviewed by clinicians from the founding team. Information only, not personalised medical advice.
From the team behind Her Holistic Health, founded by Dr Divpreet Sacha, NHS-trained GP.