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The Rejuvenating Health Podcast
Join Women's Health Nurse Practitioner, Lindsey VanSchoyck for a weekly dose of Precision Medicine as she addresses the hot-button topics specific to Women's Health, Fitness and Nutrition, interviews expert guests and hosts round table discussions with the team of dedicated functional health care specialists.
The Rejuvenating Health Podcast
E166 | PMOS Explained
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PCOS gets talked about like it’s an ovarian problem, but that framing keeps a lot of women stuck. We’re breaking down the newer term PMOS, polyendocrine metabolic ovarian syndrome, and why it’s a better fit for what’s happening in the body: a metabolic and endocrine pattern that can affect cycles, skin, hair, weight, mood, energy, and long-term health. If you’ve ever been told your labs are “normal,” to just eat less and move more, or that birth control is the only answer, this conversation gives you a clearer map.
We dig into what the “string of pearls” ultrasound finding actually represents, why insulin resistance is often the main driver, and how elevated insulin can push the ovaries to make more testosterone and disrupt ovulation. We also talk about the domino effect that follows: low progesterone, shifting estrogen, worsening insulin sensitivity, and inflammation that can keep the cycle going. Along the way, we call out common myths like “only overweight women have it,” “you’ll grow out of it,” and “you can’t get pregnant with PMOS.”
You’ll hear how PMOS can show up differently depending on root cause, including lean PMOS, stress or adrenal-driven patterns, inflammation-driven cases, and symptoms that appear after stopping birth control. We also cover how PMOS can intensify during perimenopause and why it doesn’t automatically disappear after menopause, plus the key labs that help you and your clinician confirm what’s going on. Then we get practical: protein and fiber targets, strength training and walking, sleep support, stress recovery, targeted supplements like inositol and vitamin D, and when medications like metformin or GLP-1s may be appropriate.
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Medical Disclaimer And Intro
SPEAKER_00Any views, thoughts, and opinions expressed on the Rejuvenating Health podcast are solely those of the speakers and are intended as such. Please consult your trusted healthcare practitioner for medical advice. Let's go, girls.
PCOS Becomes PMOS
SPEAKER_01All righty, welcome back to the Rejuvenating Health Podcast. I am your mindset coach, Lakin, and as always, I am joined by women's health nurse practitioner, Lindsay. What are we chatting about today, Lindsay?
SPEAKER_00Yeah, so today we're gonna talk about one of the most common hormone conditions that affect women. But I feel like this this one is like crazy misunderstood. Crazy. And you probably know it as PCOS, which is polycystic ovarian syndrome. So when people hear that, they think I have cysts on my ovaries. And I'm like, you could really you could, but it's not actually a cyst, it's a string of pearls, anyways. You you actually have an ovarian cyst every single month when you ovulate, and people don't realize that either. But, anyways, PCOS. But it's not called PCOS anymore. If you're up to date on the medical professional world, you're gonna start hearing it by a different name, and it's called PMOS, which is polymetabolic ovarian syndrome.
SPEAKER_01I love this change, and I love that I, you know, we talk about this all the time that changes in the medical industry are slow and it takes a long time for something to shift. But I love that this change is happening, especially as there's a lot of noise around things that are relevant to women's health. And I think that helps with it. But you know, PCOS didn't really describe what was happening for most women that were experiencing this issue or this syndrome. So can we talk more about that?
SPEAKER_00Yeah, because I mean, PCOS, you polycystic ovarian, like cystic. You you think that you have cis, but it's not that. Most women, like in order to be diagnosed with PCOS, you have to have like two out of three symptoms. And it is like amenorrhea, Hertuism, acne, amenorrhea or irregular cycles, just not regular bleeding, acne, hair growth, high androgen levels, so high testosterone, high DHEA, low sex hormone bonding globulin, or on a vaginal ultrasound, you have this like string of pearls. And that string of pearls aren't aren't true cis, they're actually very, very small. They're immature follicles that never completed ovulation. Okay. And what's the most important thing about this and why the name has changed is because it's not an ovarian issue. It the your ovaries are responding to signaling from the rest of your body. That's why the name PMOS is such more accurate because this is a metabolic condition. It's a metabolic condition that affects your hormones, not an ovarian disorder. Like I always tell people that PCOS is diabetes of the ovaries.
SPEAKER_02Yeah.
SPEAKER_00Like that is exactly what it is. It's metabolic disease or diabetes of your ovaries.
Insulin Resistance Drives The Cycle
SPEAKER_01Okay. So let's get more into now that we understand why this name is more appropriate, let's get into like what actually is PMOS when we look at it. Like take on a look under the hood.
SPEAKER_00Yeah, so it's a very complex endocrine and metabolic disorder. It's not just a hormone imbalance. And I think that's what women think it is. They think this is truly just my hormones not being right.
SPEAKER_01And well, it's probably the most simplest way that they're being having it explained to them by their physician, you know.
SPEAKER_00Yeah, it's so common too. Like an estimated somewhere between like eight to thirteen percent of women in their reproductive age. So if you look at that, one in ten women have PMOS. And that's like diagnosed PMOS. Like it's probably even way higher because a lot of women are never diagnosed. And you can flip in and out of it. Just a 10% reduction in weight loss can flip you out of PMOS. So there's been studies showing that like up to 70% of women with PMOS have don't know that they have it.
SPEAKER_01Yeah. That's like that's a lot. That's a lot of people just walking around, you know. Well, the thing is, is because we have such we have such a prevalence of negative symptoms associated with our cycles as women, you know, we talked about that before, that these things are common. It doesn't mean that they're normal, but so many women just walk around thinking, well, this is just a this is just part of being a woman, this is just how it feels. It this sucks to suck kind of thing. And that's not the case. And people are surprised to think that this is it's not just about fertility.
SPEAKER_00Yeah, I think when you think PCOS, you think about fertility and your periods. Like those are the two things that come to your mind is that, and it's really an interaction between your insulin, your genetics, inflammation, stress, the brain, the ovaries, fat tissue, lifestyle, environmental factors, like all of these things communicate with each other, just like we talked about in the past. Like one every system affects another system. So when one of those things becomes dysregulated, it affects pretty much everything else. And I'll say the biggest drivers of PMOS is insulin resistance. And when insulin stays elevated, your ovaries begin to produce excess testosterone. That excess testosterone interferes with ovulation. That lack of ovulation means you don't have progesterone, which then affects estrogen, which then makes your metabolism even worse because the decline in estrogen makes you insulin resistant. So it's one big giant domino effect that goes around and around and around in a circle.
SPEAKER_01Yeah, all the while most women are thinking like this is just something that's located, you know, in my reproductive organs, and there's nothing I can do about it to change it. And that's not the case at all. We touched a little bit about like on the stats, but how common exactly is PMOS when we're looking at this these studies that you mentioned?
SPEAKER_00Yeah, so I mean, one in 10 women, maybe even closer to 15%. So one in eight women, you know, 70% aren't diagnosed. Most women are like, most doctors don't know how to diagnose it. And most doctors only diagnose it by an ultrasound. You know, it's kind of one of those things where we hear this with everything. Your labs are normal, you're just getting older, eat less, move more, like, and really like you can't a lot of times people with PMOS have a really hard time losing weight, and they get really frustrated because they can't lose weight. And then their doctor's like, eat less, move more, like right.
SPEAKER_01And then we're just driving up inflammation, which is causing more issues because it's it's inflammatory essentially at its root.
unknownYeah.
SPEAKER_01Yeah. Okay, so there's different types of PMOS, though.
Types Of PMOS And Root Causes
SPEAKER_01And I don't think I don't think people I mean, we don't know a lot about it historically, but I guarantee you most people don't know that there's different types.
SPEAKER_00Well, because I think when you say PMOS is a metabolic disorder, you think you have to be overweight to have PMOS. And that's not the case either. There's like skinny phenotype PMOS, which is not a good way to put it, but you know, not everyone develops PMOS for the same reason. Some women have it because they're insulin resistant. Some women have it because of their adrenal glands, where like chronic stress is driving into that. Some get it after stopping birth control. And then others, inflammation is that primary driver. So you can have you can be super lean and have PMOS. You can have excess abdominal fat and have PMOS. And this is why like treatment for treatment looks this different for every person. You have to figure out the root driver, what's causing PMOS and then fix that issue, where most of the time you're just slapped on birth control to fix it.
SPEAKER_01Why would it come up after stopping birth control? What causes that?
SPEAKER_00Yeah, because when you stop birth control, birth control makes you so nutrient depleted. And it takes, I don't know, if you've been on birth control for a year, it could take up to 12 months for your hormones in your adrenal system to get back online. So in that time are not on it for only a year. Yeah. Like that's why your cycles don't come back when you come off birth control.
SPEAKER_01So how does this how does this affect different women differently in different seasons of their life or in different age groups?
How PMOS Changes With Age
SPEAKER_00I think the biggest thing here is people think, well, I'm menopausal, so it doesn't affect me anymore. Yeah. So I mean, okay, it can happen in your teens and your twenties. And classic classic signals are gonna be acne, missing periods, difficulty losing weight, facial hair, thinning hair, infertility. In your 30s, because you can develop it in your 30s, like you can develop it at any point in your life, you're gonna have that weight loss resistant, you're gonna have infertility issues, miscarriages, pre-diabetes, fatigue, mood changes. Then in your 40s, when you're flipping into perimenopause, that just makes the PMOS even worse. Like if you have any estrogen, it begins declining even further, your progesterone's declining even further, and that makes your insulin resistance go up even more. So that's where that 20 to 30 pounds happens despite changing nothing. And this is this is really where we're seeing women with infertility and recurrent miscarriages and elevated cholesterol and fatty liver disease and pre-diabetes and sleep problems, and it's perimenopause mixed with PMOS, and it can just be a recipe for disaster. Yeah. And then what happens in postmenopause? Yeah, I mean, most people just think it goes away, but it doesn't. Like, even if you stop having menstrual cycles, that metabolic dysfunction is still there. Like you're still if if metabolic diabetes doesn't discriminate by age, you know. And it makes you so much more at risk for type 2 diabetes and heart disease and high blood pressure and high cholesterol and fatty liver disease and sleep apnea. So this is it really is not just a fertility issue and an issue that you have when you're having menstrual cycles. It's a lifelong metabolic condition. And not having a menstrual cycle is not okay. Like PMOS can be very dangerous if you do not do something to protect your endometrial lining. Like, I get it, we bash birth control all the time, but you have to do something to protect that endometrial lining if you have PMOS, or you're gonna get endometrial cancer.
Symptoms To Watch For
SPEAKER_01So if someone was worried about it or thought that they may have PMOS, what are some of the signs, signs and symptoms? Like, what are the things that they're gonna be looking out for?
SPEAKER_00So irregular periods. I don't mean that you have a period 20 every 28 days, that's actually like very not normal. A regular period is every 21 to 35 days. Some months it might be 23 days, some months it might be 32 days, but like you're having irregular periods, you're having no periods. Your periods are like crazy heavy, like you're like hemorrhaging, like you're like, I'm changing pads and tampons like crazy for seven days straight. You're having a lot of trouble getting pregnant, you're having miscarriages, and then those signs of androgen dominance or testosterone dominance, like a lot of acne in your jawline, chin hair, hair thinning, and you're like hair thinning and receding, weight gain, a lot of times it'll be like you can like spot PCOS, like it's that apple shape or pear shape, where you have like the little legs, but like you're full in your abdomen. If you have trouble losing weight, if you're like I'm doing all of the right things and I cannot lose weight, if you're having sugar cravings and brain fog and fatigue and mood swings, anxiety, depression, like one thing is darkening around the neck, and people don't realize that skin tags. Skin tags are huge. If you have skin tags, you have metabolic disease. High cholesterol, high triglycerides, high blood pressure, like nighttime awakening, low energy, low libido. There you go.
SPEAKER_01Now, these, like we've talked about before, are symptoms that can show up with other issues as well. So it's not to say that this equals PMOS, but these are things that you should be on the lookout for. And if you have multiple symptoms that we've listed, it would be worth inquiring about and getting checked.
Labs And Diagnosis Criteria
SPEAKER_00Yeah, and labs can help. So Yeah, so how do we test for it? Yeah, so you're looking at hormones. So you're looking at your free testosterone and total testosterone, and those are often elevated. You're looking at your DHEA, and it's often elevated. You're looking at your sex hormone binding globulin, it's often really low. And you're looking at your estrogen and progesterone, and they're often low. And your LH and FSH are often low. So those are all hormones that you're looking at. Common, really high DHEA and testosterone levels, really low sex hormone binding globulin, and like estrogen and progesterone. When you're looking at metabolic markers, you're gonna see an elevated insulin, an elevated fasting glucose, an elevated hemoglobin A1C, and probably some elevated liver enzymes. When you're looking at inflammation, to make sure it's not the driver of it, you're looking at HSCRP above three, ferritin above 100, homocysteine above nine. And then you're looking at nutrient depletion, which you should be looking at with everyone, like your vitamin D and B and stuff like that. And anything that affects your metabolism is gonna affect your thyroid, but thyroid disease can mimic PMOS. Like, like there's a lot of things that can mimic PMOS. So you definitely want to look at cortisol and hormones and metabolic, and you know, you want to do all of those things to because everything's connected. And then again, yeah, if everyone's some gut health, because gut dysfunction can really make PMOS worse.
SPEAKER_01Let's say you get your blood work done and all of the markers point towards it. Is it like definitive based on those blood tests? Yes, you have PMOS, or is there something else that you need to do to confirm that you have it?
SPEAKER_00If you have two of three, so it's either it's either vaginal ultrasound with string of pearls, lab markers, the the hormone lab markers, and then irregular or missed cycles. So if you have two of the three of those, you're diagnosed, essentially.
SPEAKER_01And then how do we treat
Treatment Basics: Food And Training
SPEAKER_01it? What have if you do have it? How do we treat it?
SPEAKER_00What do you think some of my answer is gonna be?
SPEAKER_01Probably a lot of the same things that we use to treat everything. Like we're talking about the lifestyle improvements, because as you were saying before, it's it is essentially it's a metabolic disease. And so we have to we treat metabolic diseases with the same form of treatment. We have to improve metabolic health.
SPEAKER_00Yeah, so I think first figuring out why. Is it adrenal driven? Okay, well, then you need to do the mindset stuff and the stress relief stuff. Is it inflammatory driven? Okay, well, then you need to take an omega, you need to be eating an anti-inflammatory diet, you need to be focusing on inflammation. Most of the time, it's metabolic driven, and then we're focusing on nutrition. It's not about eating less, it's about eating your 100 to 130 grams of protein a day, your 30 to 25 to 35 grams of fiber, your whole like your natural carbohydrates paired with protein, your healthy fats, your antioxidant-rich foods, like color for vegetables. And honestly, under eating will make this so much worse.
SPEAKER_01Yeah. So much worse. Just driving the stress out, yeah.
SPEAKER_00Because you need your met you need your muscle to help with your metabolism. So you have to be eating consistently.
SPEAKER_01Yeah. So cutting carbs is the opposite of what you would want to do if you have this issue.
SPEAKER_00Yeah, it's putting it's eating smart carbohydrates and putting them with the foods and the right timing.
SPEAKER_01Or like any like uh any fad, like restrictive diet is like not the direction that we want to go, basically.
SPEAKER_00And I love CGMs for PC for PMOS people. Like they're great. One of the most powerful things you can do is strength train. Must like lifting pulls sugar into the muscle, and muscle is metabolically active. So the more muscle you build, the more insulin sensitive you're gonna become. So three to five strength sessions a day, walking daily.
SPEAKER_01A week, a week, not a day.
SPEAKER_00Yeah, not a day. Yeah. That would break down your body, and the goal is to build it up, not break it
Sleep And Stress Recovery Tools
SPEAKER_00down. So ignore that. Sleep. Sleep's often really overlooked. Like one poor night of sleep can really reduce your insulin sensitivity for the next day. So a lot of women with PMLS are more likely to have obstructive sleep apnea, especially if like you have excess weight. So if you're someone that snores, wake up exhausted, needs a nap every day, like go get a sleep study and get a CPAP. Like it will help you lose weight. And then your favorite.
SPEAKER_01Yes, stress management. Because like we were talking about all those things that are going to elevate cortisol, that's all going to affect affect your blood sugar, your inflammation markers, your appetite, like also your ovulation. So it is going to affect you at the reproductive level. And this doesn't mean that we expect that you're just going to eliminate all stress. Like that's not possible. Life is going to be lifing. There are going to be stressors every single day. But it does mean that we want to facilitate how the nervous system recovers from the stressors that are coming into our environment and also auditing those and looking at what is necessary, how am I processing this? Can I process it differently? But also, are there things that I can remove from my environment or remove myself from if that's possible? And so when we look at nervous system recovery, it's simple things. It's taking a walk outside, it's using meditation, guided or otherwise. And that you could do a walking meditation. I love those. You could do breath work or any just deep breathing or box breathing at its simplest form. Taking time to prioritize connection with loved ones, like people being around people that make your nervous system feel safe, that that you leave those interactions feeling filled up instead of drained. That's really important. Having boundaries around your work is super important. If you're one of those ladies that find yourself like on the laptop until you know 11 p.m. Because you've got to get as much done as possible and maximize all the hours that you have, that's not doing you any favors. We have to have some boundaries around our time. And making sure that you're recovering from your exercise routine as well. Recovery is just as important as how much intense training that we're putting in.
SPEAKER_00Yeah, and
Supplements And Medications
SPEAKER_00lifestyle's great here. Supplements are also really good here, but every supplement that you take should have a reason. So my favorite supplements for PMLS are myelinositol and D-chronoenositol. So inazitol is great. It has some of the strongest evidence for improving insulin sensitivity and supporting ovulation. Vitamin D. Like literally, just if you're listening, go get vitamin D, probably.
SPEAKER_01Just get on it.
SPEAKER_00I mean, most like pretty much everyone with PMOS is deficient in vitamin D, and correcting that deficiency is going to support your metabolic health.
SPEAKER_01Also, almost everyone that's not that doesn't have PMOS is also deficient in vitamin D. So just take it.
SPEAKER_005,000 I use daily with vitamin K. There you go. Omega-3 fatty acids. You're like everyone should be on this as well. It's helpful for triglycerides, inflammation, cardiovascular health. Magnesium, especially magnesium glycinine at bedtime. It's gonna help support your sleep, insulin sensitivity, muscle function, stress regulation, NAC, N acetylcholine, or NAD plus has evidence against, or not against, supporting insulin sensitivity and ovulary ovulatory function. And then berberine. Berberine's really good. Um, it's kind of like a natural metformin. It's not appropriate for everyone. So talk to your physician or clinician before you take it because it does act like a natural metformin. But it can be really good for this. And so don't just go buy all these supplements. You have to figure out if it's insulin resistant driven. Like what do your labs say? Yeah. I've talked to women that are like on 20 supplements. I'm like, why are you taking all those? Like, I don't even know. I just keep like adding them on. Like you, you're just because I saw an ad and I clicked on I clicked on the ad. Yeah. Like your supplement should have a reason, and though like you should be having targeted interventions based on symptoms, laps, and goals. Yeah. And you know, sometimes medications are appropriate. Like metformin can be great for PMLS, it improves insulin sensitivity, and it is like it is well studied, super safe drug, can be super beneficial for longevity. GLP1s, like if you're doing the right lifestyle stuff, GLP1s can really help, but you have to be doing the lifestyle stuff with them. They're not a standalone solution. You have to be eating your protein, resistance training, and focusing on that muscle preservation. And like I talked earlier, you have to protect your endometrial lining. So I don't love birth control for this. It is a treatment option, it doesn't fix the underlying issue. I more think like get a progested IUD to protect your endometrial. Lining or do progesterone withdrawals every month. It's like a more natural way to make sure you're protecting your endometrio. And some women need anti-androgens. Like, listen, no one wants their hair falling out, and no one wants cyclic acne all over the place. So some women need like Spronolactone if they're really struggling with acne and excessive hair growth. Again, I don't want anyone to be on these things long term because it's like putting a band-aid on it. You need to fix the underlying issue. But these things are okay to use as bridges. Yeah.
SPEAKER_01Now, what about HRT? Like, can women with PMOS still receive hormone replacement therapy during their perimenopause or postmenopause season?
SPEAKER_00Yes, like they should. They probably don't need testosterone therapy, but like we should be treating your declining estrogen and progesterone because that can make symptoms worse. Again, it's individualized and you're kind of looking at the whole picture, not just what's happening.
SPEAKER_02Yeah. All
Myths And Final Takeaways
SPEAKER_02right. So let's bust a few myths.
SPEAKER_01Yeah. There is, and we've touched on this briefly, but there is a myth that like only overweight women have PMOS.
SPEAKER_00Yeah. False. No. Lean PMOS absolutely exists. Absolutely.
SPEAKER_02Okay.
SPEAKER_01Myth number two, you'll grow out of it.
SPEAKER_00That's a stupid myth. No. Yeah, wow.
SPEAKER_01You don't grow out of the way. Right. But people would think that because it was something that was related to like when a woman was getting her period and like there was a big hormonal shift that like that would just change and regulate over time. You know what I mean? It's like, no, that's not what's happening. Yeah. Again, it's not just localized in the reproductive organ. All right. You you just need to lose weight and that will fix it.
SPEAKER_00Myth. Unfortunately, like losing weight does fix it, but most of these women can't lose weight. Like they have to improve their metabolic, like they have they have to improve their endocrine system to be able to lose weight. Right. It's not as simple as the weight loss.
SPEAKER_01Like the weight loss is an effect of improving the metabolic system as a whole.
SPEAKER_02Why did your audio just go away? Can you hear me? Yeah, I can hear you. Can you hear me? Can you hear me now? Can you hear me? I can hear you. You still can't hear me? Talk now. Can you hear me now? Yeah, that was weird. What'd you say last?
SPEAKER_01I said, yeah, most people will think that the weight loss on its own is a solution, but actually the weight loss is a side effect of correcting the metabolic system. It's like you get the weight loss as a byproduct or as a result of that, but that's not what's actually driving the improvement of the PMOS.
SPEAKER_00Yeah, I mean it's that saying that I always say like a healthy body on the inside is healthy on the outside. So if you fix the underlying metabolic disease, then the weight loss will come.
SPEAKER_01Yeah, a lot of people think that we we may mention this briefly, but that birth control just cures PMOS.
SPEAKER_00Yeah, it doesn't. It just manages certain symptoms. Like it's a band-aid. Like sometimes it's needed, but it's a band-aid.
SPEAKER_01Yeah. Uh a lot of women think that they cannot get pregnant if they have PMOS.
SPEAKER_00Yeah, false. Definitely false. You can absolutely get pregnant. So do not think that you have PMOS, you're on birth control. Like that you that like you can definitely get pregnant. You can still ovulate in there. And many women with PMOS still can conceive naturally. You just might have to use like ovulation strips and stuff like that. Or you support like clomid and or something that helps make you ovulate, but you can absolutely get get pregnant for sure.
SPEAKER_01Now that being said, it depends, you know, and everyone's timeline is different and you know what their what their family planning looks like is different. But if you are able to focus on improving your metabolic health prior to getting pregnant, that is going to be more beneficial for you.
SPEAKER_00Always. Yeah. You're just gonna have a healthier pregnancy, be less at risk for um gestational diabetes, all of those things.
SPEAKER_01So what's our takeaways for today?
SPEAKER_00Yeah, if there's one thing that you take away from, whether you know this as PCOS, PMLS, whatever, it's more than just irregular periods and ovarian cysts, because you really don't have ovarian cysts. It is literally a whole metabolic, whole body metabolic condition. And the good news is that because it's that, we can fix it with the right nutrition, resistance training, sleep, stress management, targeted supplementation, maybe medications as needed. Like you can see really great improvements with hormones and energy and body comp and long-term health. And so this isn't like your body working against you. It's again your body giving you signals, and it's your job to listen to those signals and address the root cause of what's happening.
SPEAKER_01Yes. So thank you, ladies, so much for tuning in today. If you are having some of the symptoms that we listed and you want to run labs or want more insight into that, feel free to reach out to us. We'd be happy to help you with that and help you with implementing some of those lifestyle changes to improve the overall metabolic health, which can make a huge difference in how you're feeling. Or if you know somebody that struggles with this but feels like they're at a dead end or haven't gotten good results trying to work with, you know, maybe some of the physicians that they've been working with or haven't gotten the answers that they're looking for or the help that they need, please share this with them. That would that would be really helpful. And as always, it costs you nothing, it means everything to us. So please, please, please subscribe in all the locations that we are available. Apple Podcasts, Spotify, and YouTube, and please leave us a review. We read all of them, and it's really, really special to us to hear what you have to say. See you there.
SPEAKER_00Yeah, bye.
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