PCOS was formally renamed PMOS, polyendocrine metabolic ovarian syndrome, in 2026, following an international consensus that the old name focused too narrowly on ovarian cysts when the condition is really a whole body hormonal and metabolic picture. As a naturopath in London working across functional medicine and endobiogeny, I still use both names, since most people searching for help are looking for PCOS and the diagnosis on your notes may say either.
My approach starts with working out which pattern of PMOS you actually have, rather than applying the same protocol to everyone who walks through the door.
What the evidence actually points to
PMOS is not one condition
Research grouping over a thousand women with PMOS found three distinct patterns. One driven mainly by weight, insulin resistance and lipids, another driven by androgen excess and reproductive hormone imbalance with little relationship to weight at all, and a mixed group in between. Generic advice aimed at one pattern often does not fit another.
Insulin resistance is not just a weight issue
Insulin resistance is part of PMOS regardless of body size. Women with a lean or normal weight presentation show metabolic and hormonal disruption comparable to those with a higher BMI, which means this driver gets missed in exactly the people least expected to have it.
The real gap is usually what happens after diagnosis
Most people are not wandering for years before being diagnosed. Research on diagnosis experience found the majority were diagnosed within a year and after seeing only one or two practitioners. What is consistently missing is what comes next, most patients report being dissatisfied with the information they were given on lifestyle management, long term health risk, and emotional support once the diagnosis was made.
Where I see people get this wrong
The first mistake is treating PMOS as a single protocol condition, using medication to suppress a cycle, the same supplement stack or generic herbal fomrula, or the same low carb advice regardless of which pattern is actually driving your case. If your picture is androgen led rather than insulin led, or driven by cortisol dysregulation, generic metabolic advice will not touch it.
The second mistake is assuming insulin resistance only matters if you are overweight. I see this missed regularly in lean presentations, where it gets overlooked because the person does not fit the expected picture.
The third mistake is stopping at the diagnosis. A label without a plan for your cycle, your skin, your fertility, your long term cardiovascular and metabolic risk, and the emotional weight of the diagnosis, is not enough. This is usually where naturopathic support actually adds the most, not in finding the diagnosis, but in building what comes after it.
How I work with PMOS
I start with a detailed case history and functional testing, insulin and glucose response, a full androgen panel, lipids, inflammatory markers and thyroid function, to understand which pattern of PMOS is actually present in your case.
From there, I build a plan around your specific drivers using nutrition, herbal medicine and lifestyle strategy, rather than a generic PMOS protocol, whether your main concern is your cycle, your skin, your fertility, or your longer term metabolic and cardiovascular risk.
Where medical management is the right next step, or already part of your care, I work alongside it, not around it. Metformin, one of the most commonly prescribed medications for PMOS, is well documented to deplete vitamin B12 and alter gut bacteria. GLP-1 medications carry a different risk, trial data shows losses of 10% or more of muscle mass over the course of treatment, driven by reduced food intake affecting protein and micronutrient adequacy. I factor gut support, nutrient repletion and muscle preservation into your plan alongside whichever medication you might be prescribed.
