Quick Answer
Polyendocrine Metabolic Ovarian Syndrome (PMOS), formerly called PCOS, includes important metabolic as well as reproductive features. Insulin resistance can lead to higher insulin levels, which may influence ovarian androgen activity and occur alongside irregular ovulation, acne, or unwanted hair growth. PMOS is also associated with increased risks involving glucose regulation and type 2 diabetes. Research on PCOS and insulin resistance remains relevant as healthcare providers transition to the updated PMOS terminology.
PMOS and Insulin Resistance: Why Metabolic Health Matters
Earlier in our PMOS series, we explained why PCOS was renamed PMOS and why PMOS can be present without ovarian ‘cysts.’
Here, we’re taking a closer look at insulin resistance and what the metabolic side of PMOS can mean for blood sugar and longer-term health.
What Is Metabolic Health in PMOS?
In PMOS, the “M” means metabolic, but what does that really mean? A big part of the answer starts with insulin.
Insulin is a hormone that helps the body use sugar from food for energy. After we eat, glucose enters the bloodstream, and insulin helps move it into cells where it can be used.
But in many women with PMOS, cells do not respond as efficiently to insulin. This is called insulin resistance. To keep glucose under control, the pancreas compensates by producing more insulin.
In PMOS, metabolic health includes insulin response, glucose regulation, cholesterol and triglycerides, blood pressure, and longer-term cardiometabolic risk.
How Are PMOS and Insulin Resistance Connected?
Higher insulin levels can signal the ovaries to produce more androgens, a group of hormones that includes testosterone.
Higher androgen activity may contribute to familiar PMOS signs such as unwanted hair growth, acne, irregular menstrual cycles, and irregular or absent ovulation.
The metabolic and reproductive features of PMOS are interconnected. Insulin resistance, higher insulin levels, androgen activity, the ovaries, liver, and other hormonal signals can interact in feedback loops rather than acting as isolated problems.
How Can PMOS Affect Blood Sugar and Diabetes Risk?
Insulin resistance does not mean someone has diabetes. It does, however, mean the body is working harder to keep glucose within a healthy range.
For a time, the pancreas may compensate by producing additional insulin. If that is no longer enough, glucose levels can begin to rise. This can progress from impaired glucose tolerance to prediabetes or type 2 diabetes. Women with PMOS have an increased risk of these glucose problems regardless of age or BMI.
Other cardiometabolic concerns associated with PMOS can include dyslipidemia, high blood pressure, cardiovascular risk, and sleep apnea.
Provider Note: PMOS carries an increased risk of impaired glucose tolerance and type 2 diabetes regardless of age or BMI. Current guidance recommends assessing glycemic status at diagnosis and reassessing every one to three years based on individual diabetes risk.
Current guidance identifies the 75-g oral glucose tolerance test as the most accurate test for assessing glycemic status. It does not recommend routinely available insulin assays for routine evaluation.
When Hormone Needs Call for Customized Options
If a prescriber determines that a patient needs a strength, dosage form, or ingredient profile that a commercially available medication does not provide, they may consider a compounded option. Central Ohio Compounding Pharmacy works with patients and providers in Worthington, Columbus, and across Central Ohio. We prepare customized medications according to prescriber directions.
We also offer hormone testing kits that may help patients prepare questions for their healthcare providers. These tests do not diagnose PMOS.
Patients can visit us at our Worthington or Arena District locations, and prescription shipping is available throughout Ohio.
Have questions about hormone-related changes, testing, or compounded medication options? Schedule a private consultation with Lucy, our hormone pharmacist.
Next in the PMOS Series
How Your Compounding Pharmacy May Help
The next article will look at how a compounding pharmacy can support patients as part of a personalized PMOS care plan, from hormone-related needs to practical guidance along the way.
Frequently Asked Questions About PMOS and Insulin Resistance
What Are the Symptoms of Insulin Resistance in PMOS?
Insulin resistance often has no obvious symptoms. Some people may notice darkened or thickened skin in certain areas or skin tags. PMOS-related changes such as irregular cycles, acne, unwanted hair growth, or ovulation concerns may occur separately.
How Often Should Blood Sugar Be Checked With PMOS?
Current guidance recommends checking glucose status when PMOS is diagnosed and reassessing it every one to three years based on individual diabetes risk factors. A healthcare provider can determine the appropriate testing schedule for each patient.
Should Insulin Levels Be Tested in PMOS?
Insulin resistance is an important feature of PMOS, but routinely available insulin assays are not recommended for routine evaluation. Healthcare providers instead consider glucose status and other metabolic risk factors when deciding what testing is appropriate.
References
- Chan, J. L., Masini, I., & Pisarska, M. D. (2026). Polyendocrine metabolic ovarian syndrome (PMOS)/polycystic ovary syndrome (PCOS): current and future trends. Journal of Clinical Investigation, 136(12). Link
- Teede, H. J., Khomami, M. B., 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., & Piltonen, T. (2026). Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. The Lancet, 407(10545), 2329–2339. Link
- Teede, H. J., Tay, C. T., Laven, J. J. E., Dokras, A., Moran, L. J., Piltonen, T. T., Costello, M. F., Boivin, J., Redman, L. M., Boyle, J. A., Norman, R. J., Mousa, A., & Joham, A. E. (2023). Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology & Metabolism, 108(10), 2447–2469. Link