PCOS is now PMOS: what’s changed and why it matters for mood
- Nicola Shubrook
- 6h
- 6 min read
PCOS is being renamed PMOS, something that as a functional medicine clinic we support. It is a much better descriptor for what is actually happening in the body. In this article we explore more about what PMOS is, how it can affect your mental health, but also what you can do support your wellbeing
PCOS stands for Polycystic Ovary Syndrome, a condition historically defined by irregular cycles, higher androgens and “polycystic” ovaries on scan. But the name has always been problematic as you don’t need to have cysts to have PCOS, something that can often be overlooked and lead to a missed diagnosis. For the real driver of symptoms is hormonal and metabolic disruption, not just what your ovaries look like.
PCOS has recently been renamed Polyendocrine Metabolic Ovarian Syndrome (PMOS), which may seem like semantics but for millions of women globally, this could mean an earlier diagnosis, broader screening, and the right support that addresses the whole body.
In short, PMOS better reflects what’s really going on and shots the condition away from just being a ‘reproductive condition’. The focus shifts from “cysts” to a metabolic, hormonal and systemic condition that can begins in your teens but carryon through to menopause, and shows up through symptoms like cycle changes, excess hair, acne, fertility issues, weight gain (although this isn’t the case for everyone) and insulin resistance or blood sugar challenges.
Key takeaway: PMOS is not just a “gynaecology” issue, it’s a whole-body metabolic condition that profoundly affects mood, energy and brain health
PMOS and perimenopause
PCOS/PMOS is typically diagnosed in women in their 20s and 30s, but it doesn’t then simply go away when you reach menopause. In fact PMOS can significantly impact perimenopause, often delaying its onset by 2-4 years, and causing irregular menstrual cycles to become more regular as androgen levels naturally decline.
For some, symptoms such as acne and hirsutism may improve in perimenopause but others may face worsening metabolic issues including weight gain and insulin resistance[1].
Possible impact of PMOS on Perimenopause
Delayed Transition: Women with PCOS often reach menopause later, sometimes in their early-to-mid 50s.
Cycle Regularization: As ovarian testosterone production falls, many women find their long, irregular cycles become more regular.
Persistent Metabolic Risks: Despite improved cycles, the high risk of metabolic syndrome, cardiovascular disease, and type 2 diabetes often continues, requiring monitoring of blood sugar and blood pressure.
Symptom Overlap: Symptoms like weight gain, hair loss, and mood changes can be tricky to attribute to either PCOS or perimenopause, as they often overlap.
Lower Risk of Hot Flashes: Studies show people with PCOS may be less likely to experience severe hot flashes and night sweats, but may face increased issues with vaginal dryness[2]
How PMOS affects the brain and mood
Many women with PMOS report anxiety, low mood, brain fog, irritability and even panic, yet are often told “your bloods are normal” or “just lose some weight”. Research consistently shows higher rates of depression and anxiety in women with PCOS compared with those without the condition, even when weight is taken out of the equation.
The reasons are multifactorial, but four big drivers keep showing up:
Hormonal imbalances (oestrogen, progesterone, androgens)
Insulin resistance and blood sugar swings
High cortisol and chronic stress load
Systemic, low‑grade inflammation
These factors don’t work in isolation; they constantly interact, and the brain sits at the centre of that cross‑talk. That’s why mood can feel so volatile and so out of proportion to “what’s actually happening” in your life. Let’s look at these in more detail:
Hormones: oestrogen, progesterone and androgens
Oestrogen and mood
Oestrogen is not just a reproductive hormone; it also modulates serotonin, dopamine and noradrenaline - the key neurotransmitters involved in mood, motivation and stress resilience. In PMOS, oestrogen levels and receptor sensitivity can be altered, and cycles are often irregular or anovulatory, which changes the normal rise and fall of oestrogen across the month.
This dysregulation can show up as:
Mood swings at certain times ins your (often unpredictable) cycle
Low mood or “flatness” when oestrogen drops
Heightened anxiety or irritability when levels are fluctuating
Progesterone and GABA (your “calming” system)
Ovulation is commonly disrupted in PMOS, which means progesterone can be low or inconsistent. Progesterone is a key precursor for allopregnanolone, a neurosteroid that supports GABA, the brain’s main calming neurotransmitter.
When progesterone is low or erratic, you may notice:
Feeling “on edge” or wired at night
Poor sleep and early waking
Heightened premenstrual anxiety or tearfulness
Androgens and emotional regulation
Higher androgens such as testosterone and androstenedione are a hallmark of PCOS/PMOS for many women.
Androgen excess is linked with:
Acne, hirsutism (excess hair growth) and hair thinning
Possible effects on impulsivity, irritability and aggression in some women
Some of the side effects from high androgens can also affect self-esteem and body image, can for some lead to a disordered eating. These physical and neurochemical effects can reinforce each other, for example, visible acne or facial hair may drive increased self-consciousness and social withdrawal layered on top of an already fragile mood.
How many people with PCOS have an ED?
Individuals with PCOS are 3–6 times more likely to experience an eating disorder than those without, and research indicates that 8% to 58% of people with PCOS experience disordered eating behaviors, with Binge Eating Disorder (BED) being particularly common, affecting up to 42%[3]
2. Insulin resistance, blood sugar and mood swings
Around 50–70% of women with PCOS have some degree of insulin resistance, even if they are not living in a larger body. Insulin resistance means your cells are less responsive to insulin, so your body must release more to keep blood glucose normal.
This has several knock‑on effects for mood:
Blood sugar rollercoaster: High insulin can drive reactive drops in blood glucose, leading to shakiness, irritability, feeling “hangry”, brain fog and fatigue.
Cravings and binge‑like eating: Fluctuating blood sugar and dopamine signalling can increase cravings for refined carbohydrates and sugar, which can then trigger guilt and shame.
Impact on neurotransmitters: Glucose is a key fuel for the brain; big swings can affect the availability of tryptophan (for serotonin) and other amino acids needed for neurotransmitter synthesis.
On top of this, insulin resistance itself can worsen androgen excess and ovarian dysfunction, creating a vicious cycle where metabolic changes and mood symptoms constantly feed each other.
3. Cortisol, stress and the HPA axis
Living with PMOS is inherently stressful: navigating symptoms, weight stigma, fertility concerns, unpredictable cycles and often feeling dismissed by healthcare professionals. Chronic psychological stress activates the HPA axis (hypothalamic‑pituitary‑adrenal), think fight-and-flight, which increases cortisol (stress hormone) output.
In PMOS, there may already be alterations in HPA axis activity and cortisol patterns. Elevated or dysregulated cortisol can:
Disrupt sleep, especially early‑morning waking or difficulty winding down at night
Increase anxiety, racing thoughts and feelings of being “wired but tired”
Promote central fat gain and worsen insulin resistance, feeding back into metabolic dysfunction
Cortisol also interacts with sex hormones: high stress can further disrupt ovulation and progesterone production, amplifying the mood effects mentioned earlier.
Chronic inflammation and the inflamed brain
Many women with PMOS can show signs of low‑grade, systemic inflammation, for example, elevated CRP. Even if standard bloods look “fine”, there can still be a subtle inflammatory load happening.
Inflammation is now recognised as a key player in depression and anxiety for a subset of people. Pro‑inflammatory cytokines can:
Alter serotonin metabolism via the kynurenine pathway, which is neuroinflammatory
Affect neuroplasticity and BDNF (brain‑derived neurotrophic factor)
Contribute to fatigue, lack of motivation or emotional numbness, and “sickness behaviour” – wanting to withdraw and do less
In PMOS, inflammation is often linked to insulin resistance, gut dysbiosis, adipose tissue activity and oxidative stress. All of these can be modulated, which is where nutrition and lifestyle can play a powerful role.
Where nutrition and lifestyle fit in
The new PMOS framing highlights that supporting mood means supporting the whole metabolic‑hormonal system, not just “treating depression” in isolation. For whilst there is no cure for PMOS, symptoms can often be improved through lifestyle changes such as eating a healthy diet, taking regular exercise and taking steps to improve your sleep.
From a functional medicine perspective, here at Urban Wellness we consider:
Stabilising blood sugar to support both insulin and mood
Supporting ovulation and hormone balance where possible
Calming an over‑fired stress response and improving sleep
Reducing chronic inflammation and supporting gut health
Looking at genetics and the impact on hormones, the nervous system and metabolism
Each woman’s root‑cause picture is different, despite the same PMOS diagnosis, so a personalised plan, including nutrition, supplements where appropriate, and lifestyle, is key.
There is also strong evidence[4] that eating a Mediterranean-style diet can help PMOS, but it may also help improve general symptoms or perimenopause and menopause too. The basic principles of a Mediterranean Diet are:
Lots of non-starchy vegetables, fruit, beans, lentils and nuts
Using whole grains like wholewheat bread and brown rice
Healthy fats such as extra virgin olive oil, and oily fish such as salmon, mackerel, sardines and anchovies
Moderate amounts of natural cheese and yoghurts
Protein mainly from poultry, fish or beans and keeping red meat to occasional
Little or no refined sugars such as sweets, baked goods or sugary drinks
These types of dietary and lifestyle changes may also improve more general symptoms of perimenopause and menopause.
If you are struggling with perimenopause, your mood and PMOS then get in touch and book a Clarity Call with one of the team to find out how we can support you
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