Complaints & connections · borters.ch
PMOS since 2026, PCOS before that — the same condition, the same criteria, and both names stay side by side.
Also known as: Polyendocrine metabolic ovarian syndrome · PMOS since 2026 · previously PCOS, polycystic ovary syndrome
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
This condition has carried a new name since May 2026. Internationally it is now called polyendocrine metabolic ovarian syndrome, PMOS for short; previously it was called polycystic ovary syndrome, PCOS for short. The same clinical picture is meant in both cases, and the diagnostic criteria were not changed with the renaming. Both terms stand side by side here, because older results, reports, books and search results still carry PCOS and the changeover takes several years. In substance it is a common disorder that involves several hormone systems and the metabolism. Three features form the framework: infrequent, very long or absent cycles; signs of raised male hormones such as increased body hair, acne or thinning hair on the head; and on ultrasound many small follicles — they are follicles and not cysts, and exactly this misunderstanding was one reason for the new name. Two of the three features suffice when other causes have been ruled out. A reduced action of insulin often comes with it, at a normal weight too. So sugar, blood pressure and blood fats belong in the picture from the start.
Results and reports from before 2026 carry PCOS, newer ones PMOS. Giving both terms means finding one’s own documents again and being understood in practices that do not yet use the new name. The changeover runs over several years.
Thyroid, prolactin and a late-onset form of adrenal disorder make a very similar picture and are treated differently. Only once they are settled does the diagnosis stand.
Regardless of weight, and in pregnancy earlier than usual. If a disturbance is found early, most can be changed about it.
In a large share of those affected insulin works less well — including at normal weight. The pancreas then releases more of it, and that surplus acts in two places at once: it makes the ovary produce more male hormones, and it lowers SHBG in the liver, the protein that binds testosterone. Less SHBG means more free testosterone. That is the route by which sugar is connected to the cycles and to skin and hair.
The three criteria are the cycle, the signs of raised male hormones and the ultrasound — no metabolic value is among them. A normal insulin or HOMA therefore does not rule PMOS out, and an abnormal value alone does not make the diagnosis. Sugar is measured because of what can follow from it: gestational diabetes, type 2 diabetes and fatty liver are more common.
If the bleeding stays away for months, the lining keeps building up without a counterweight. There are different ways to balance that — which one fits depends on the wish for children and on one’s own views, and belongs discussed.
The commonest reason it does not happen is the missing ovulation — and there are medicines that bring it on. Most women with this picture do become pregnant. It helps to write down the cycle for some months beforehand and to look at the sugar metabolism, because both improve the outlook.
Regular movement improves the action of insulin regardless of weight and thereby acts back on cycle and androgens. Sleep belongs to it too, because it affects the same metabolism.
Body hair, acne and thinning scalp hair need patience: visible changes appear after six months at the earliest, because that is how long the hair takes for one cycle.
Pauses in breathing at night are commoner in this picture and further worsen the sugar metabolism. Anyone who snores and is tired during the day should be asked about it.
Metformin improves insulin action, the pill takes over cycle control and lowers androgen effects, inositol is being studied as an alternative. None of them cures PMOS — they act on whichever wheel matters most right now: cycle, skin or fertility. What moves the metabolic part itself is muscle work.
About eight to thirteen in a hundred women of childbearing age are affected — making it the most common hormonal disorder of that stage of life. Years and several changes of doctor often pass before the diagnosis, because each of the three features looks unremarkable on its own.
Metformin puts a load on stomach and bowel in the first weeks; dosed up slowly and taken with food this is usually manageable. Over years vitamin B12 can fall under it — a value that then belongs in regular checks. Inositol needs three to six months and causes loose stools at higher doses. Anti-androgens such as spironolactone lower the androgen effect at the skin; potassium is monitored alongside, and they must not be used in pregnancy.
The path leads further than it first appears. More insulin lowers SHBG in the liver, less SHBG means more free testosterone — and more free testosterone means more sebum in the gland. That is why acne in this picture often sits along the jawline and fluctuates with the cycle, and why it is not a second, separate matter but the same wheel seen from the other side. What moves on the sugar side moves the skin as well — only more slowly than one would like.
Alongside acne and increased hair growth there are two skin signs that are rarely named and both hang on insulin: many soft skin tags on the neck, armpits and under the breasts, and velvety, thickened, darker skin in the same folds — acanthosis nigricans. They are not a separate problem and not a question of hygiene; they are what HOMA-IR and long-term sugar show as numbers, made visible. Noticing them is a reason to measure — and when sugar metabolism improves, the darker skin often lightens with it.
With insulin resistance the pancreas has to release more insulin to move the same amount of sugar out of the blood. That surplus keeps working after the sugar has been taken up — blood sugar then falls lower and faster than it should. That fall is the signal that arrives as craving, usually one to three hours after a carbohydrate-rich meal, often with shakiness, irritability and tiredness. It is a message from metabolism, not a matter of character — and knowing that sends you looking at the meal rather than at yourself.
Honestly first: no study has measured “sugar craving” as an outcome. What is measured are the values underneath — in PCOS/PMOS reviews lower fasting insulin and HOMA-IR, in type 2 diabetes HbA1c by about one percentage point, with 500 mg two to three times daily with meals over eight to twelve weeks. The route from one to the other is plausible and simple: if the curve after eating flattens, the fall afterwards disappears — and with it the trigger. The same is why some people have less appetite on metformin. But it remains an inferred link, not a study result.
The phrase is right in direction and wrong in magnitude. Less than one per cent of berberine reaches the blood; much stays in the gut and changes the bacteria there and the signals the gut sends onward — including GLP-1, exactly the messenger the new weight drugs copy. So the route is the same. But those drugs generate many times the signal and their effect is measured over years in controlled trials, while berberine only nudges it. Equating the two does not make berberine bigger, it makes the expectation wrong.
The same meal makes a different curve depending on what you start with. Vegetables and protein first, carbohydrates last: the stomach empties more slowly, the sugar arrives spread out instead of all at once, the peak stays lower — and so does the fall afterwards. It costs nothing, demands no going without, and in insulin resistance it is one of the few levers that works immediately rather than after weeks. To test it, do not watch the scales but whether the tiredness two hours later fails to arrive.
Working muscle takes sugar from the blood without insulin having to unlock it — through a second route that opens with movement. That is why a short walk after the meal is, in insulin resistance, more effective than the same movement at some other time: it acts exactly when the peak forms. Ten to fifteen minutes is enough, it need not be exercise. In a body that hears insulin poorly, this is the route that still hears.
Three things act on the same meal; modest singly, noticeable together. Gel-forming fibre — psyllium husks or oat beta-glucan — thickens the food mass and slows uptake; for the lipid effect 7 to 10 g of psyllium or 3 g of beta-glucan a day is studied, for the sugar curve what counts is mainly that they are in the same meal. Protein at breakfast carries the morning; a breakfast of carbohydrate alone produces the first fall before noon. And sleep: too short a night raises the hunger hormone and lowers the fullness signal — in PCOS/PMOS there is the added point that night-time breathing pauses are commoner than generally assumed.
Fewer than about eight periods a year or gaps of more than five weeks are the commonest first sign. A cycle calendar over six months says more about it than any single examination.
Increased hair on chin, upper lip, belly or chest, stubborn acne beyond the teenage years and thinning hair at the crown and hairline. These signs count even when the blood values come back normal.
On ultrasound one sees numerous small, immature follicles at the edge of the ovary. They are neither diseased nor do they have to be removed — the old name misled here for decades.
A reduced action of insulin, a raised blood pressure or altered blood fats often come with it — in slim women as in heavier ones. That is why the word metabolic is in the name today.
Irregular cycles and many follicles are normal at this time. So the diagnosis is made cautiously in young girls and reviewed later, rather than fixed early.
Cycles longer than five weeks or absent bleeding are one of the three criteria — not a side finding but part of the definition.
Raised male hormones are one of the three features. Measurement is in the morning and not under hormonal contraception, which lowers the value and hides the picture.
This transport protein binds testosterone. If it is low, more free testosterone is active even when the total value looks normal — so it always belongs alongside.
Comes from the adrenal gland. A markedly raised value points to a different cause of the male hormones and therefore belongs in the first round.
A reduced action of insulin is often present, at a normal weight too. It explains part of the raised androgens and is the point where most can be moved.
It finds a disturbance of sugar metabolism earlier than the fasting value alone. Before and during a pregnancy it is done earlier than is otherwise usual.
Reflects the number of small follicles and is often high in this picture. It can replace the ultrasound in the workup, but on its own it is no proof — many healthy women also have high values.
Belongs to ruling out other causes of irregular or absent cycles. An underactive thyroid makes a very similar picture and is simple to treat.
The second value of the exclusion. A raised prolactin stops the periods and has causes of its own, among them several commonly used medicines.
Reviews show reductions in fasting insulin, HOMA-IR and testosterone — 500 mg two to three times daily with meals. Inconsistent for ovulation and pregnancy. Strong CYP3A4 interactions.
Never tested as a powder in PMOS. Only galactose in the blood was measured: in a case-control study it went along with fasting insulin — an indicator, not a cause, and not the galactose that was eaten. It stays a sugar: it raises blood glucose less than glucose does, but it raises it.
Works via insulin resistance on the whole loop — the most effective single lever.