PCOS Has A New Name - And It Changes Everything (Episode #47)

🔗 Book your free Hormone Clarity Call HERE

PCOS has a new name! It is now officially PMOS — and Jess is finally doing the episode she's been putting off. In this deeply personal conversation, she shares her own diagnosis story, breaks down what PMOS actually is and why the new name more accurately reflects the condition, and makes the case for why the word "metabolic" changes everything. 

In this episode, Jess discusses:

• Why she hasn't done a PCOS episode until now — and what finally made it feel like the right time
•  Her diagnosis story
• The name change — what PCOS to PMOS actually means, and why the old name was a barrier to proper treatment and diagnosis
• What PMOS actually is: hyperandrogenism, insulin resistance as the root cause, and why the ovaries are downstream of that 
• The hormonal hierarchy — why insulin sits above reproductive hormones, and what that means for how PMOS develops and should be treated
• Cortisol as a primary driver — why chronically stressed thin women are among the most underdiagnosed and undertreated
• Why health is holistic — the brain and body are not separate systems, and PMOS is proof
• Her top frustration with this condition and how it's handled in the traditional medical system 

Part two next week — the HOW TO: nutrition, movement, stress, sleep, supplements, and what Jess's own path to remission actually looked like — coming next week.

 Connect with Jess:

• Instagram: @vitalbalancewithjess 
• Website: jessicatrone.com
• Email: vitalbalancewithjess@gmail.com

DISCLAIMER: The content shared in this podcast is for informational and educational purposes only, is not a substitute for the advice of medical doctors or practitioners and should not be used to prevent, diagnose, or treat any condition. Consult with a physician prior to beginning any fitness, health, or wellness regimen or routine.

Transcript

SPEAKER_01 0:04

Welcome to Vital Balance with Jess, the podcast for women who want real life strategy, no BS conversations about women's health. I'm your host, Jess. While building my career as an attorney, I struggled with hormone imbalances, anxiety, metabolic dysfunction, and a healthcare system that left me with more questions than answers. So I took matters into my own hands. And here's what I discovered. The real magic happens when you get curious, start asking questions, and listening to your body like it actually knows what it's doing. This podcast isn't about weight loss, physical appearance, or rigid wellness routines. It's about agency. I want you to know just how much control you have over your everyday well-being. And I want you to experience stable energy, predictable moods, a sharp yet calm mind, and a body you can trust. Because when women are well, our homes and communities thrive too. Let's get started. Welcome to Vital Balance. I'm Jess. So I want to talk about something today that I probably should have talked about a long time ago. I don't have a single episode dedicated to PCOS on this show. And if you're a regular listener or if you know anything about my coaching work or my health history, that probably seems a little strange. Because female hormones are my thing. And PCOS, or as of a couple weeks ago, PMOS, which I'll explain in a moment, is one of the most common hormonal conditions affecting women. The honest reason I haven't dedicated an episode to it is that it's been a topic I've avoided a little bit, and not for the reason you might think. It's not that I don't want to help women with it. I love doing that. I love answering questions about it, and it is genuinely one of the things I am most equipped to help with. But sitting down alone and talking about it in a solo episode feels different. Part of that is that my own journey with PCOS has been a long one. I was diagnosed at 20 years old while in college. My mom actually pushed me to see an endocrinologist because she suspected I might have it. And I was diagnosed based on symptoms and blood work showing elevated androgens or male dominant hormones. My main symptoms at the time were irregular cycles, unwanted hair growth on my chin, jawline, and neck. I was starting to gain weight really easily. I also had a lot of anxiety, which at the time was not attributed to PCOS. And I had also had pretty severe cystic acne in high school prior to taking Accutane, which helped, but again, at the time nobody connected those dots. The endocrinologist I saw was actually pretty familiar with PCOS, like she had heard of it, which she should have, given that her entire job is hormones in the endocrine system. But back then it wasn't well known like it is now, even really among doctors. Fortunately, she did take me seriously, ran the right labs, and confirmed the diagnosis. But then, and this is where the story gets very familiar for a lot of women, she offered me spironolactane, which is a medication to combat unwanted hair growth, mentioned that I might have trouble getting pregnant someday, and that was essentially the entirety of the conversation. There was no discussion about blood sugar, insulin, or any type of metabolic testing, no explanation of why any of this was happening, just a prescription and a vague warning about fertility. Oh, she did also recommend that I go on birth control to reduce some of my other symptoms. And like I said, I was 20 years old and in college. So what did I do? I basically disregarded what she said for six years. I eventually did end up going on birth control, which masked many of my symptoms. It made the condition easier to ignore, essentially. Fast forward to age 26, I was newly married, and while I didn't want children in the near future, the doctor's warning about fertility issues kept popping into the forefront of my mind. So I went to an OBGYN this time, and I had I told her about my previous diagnosis, and she agreed we needed to run labs again to see where things stood. This time, not only did I come away with a PCOS diagnosis, but two other conditions as well: hypothyroidism and pre-diabetes. I was in shock, mostly at the prediabetes diagnosis. I was very thin at this point in my life and I didn't overeat. How could I be pre-diabetic? I was also in shock because remember, I was never told that PCOS had anything to do with metabolic issues. I'm not sure the OBGYN even knew that. The only reason I was diagnosed with prediabetes is because she ran a complete blood work panel. She never said the two conditions were connected even after giving me the diagnoses. So I thought I had three separate conditions entirely unrelated to each other, and basically thought my health was on a downward spiral. I was in shock, but the doctor didn't even seem shocked at all. She just told me to stay on birth control, prescribed me thyroid medication, and told me to cut back on my sugar intake. She did also conduct an ultrasound of my ovaries and told me they were full of cysts, so I likely wasn't ovulating and that I should come to her if and when I wanted to get pregnant. She said, You will unlikely become pregnant without medical intervention. The results from that doctor's appointment was a complete eye-opener for me. Not just because of the diagnosis, but because I realized that something wasn't right. My gut told me that. And I'll talk more about what that looked like later in this episode and in next week's follow-up episode. But the reason I'm finally doing this episode now is that something significant happened within the past couple weeks. PCOS was officially renamed. The new name is PMOS, and it stands for polyendocrine metabolic ovarian syndrome. And this name change matters. It's not just a linguistic update. It matters because it signals a fundamental shift in how this condition will likely be understood and treated. And I want to talk about why. Today we're gonna cover what PMOS actually is, what the name change means, and why so many women have been failed by the conventional medical system when it comes to this diagnosis. Next week, I'm going to do a full follow-up episode on how to actually address this condition if you have it or think you might have it. I will essentially walk through what I did to drastically mitigate my symptoms. I will discuss not only what helped me, but also what the research supports. There's just too much to cover in one episode, and I don't want to rush through any of this information because it's too important for that. All right, let's get into it. So, for those of you who may not have heard, PCOS, which stands for polycystic ovary syndrome, has been officially renamed PMOS, which stands for polyendocrine metabolic ovarian syndrome. Kind of a mouthful. This name change came after a 14-year global process involving over 50 patient and professional organizations and input from more than 22,000 people, including doctors, researchers, patients, advocates. So this required a lot of time and involvement from a lot of people. And honestly, that's a good thing. More effort, money, and attention are being allocated towards women's health. So, what is the significance with the name change? Because on the surface, it might seem like a small change because it's only one letter. It went from PCOS to P M O S. But as I'm going to explain, that one letter in the change of the first word as well is a pretty big deal. Likely for how it's understood, how it's diagnosed, how it's treated, how patients are taught to about it, how much research funding it receives, how seriously it's taken, all of those things. So the old acronym, PCOS, stood for polycystic ovary syndrome. So let's break that down. Polycystic means mini cis, an ovary, obviously referring to the female organs that are the ovaries. They're actually glands, uh, part of the endocrine system. And syndrome means a collection of symptoms. So that name essentially tells you that this is a condition characterized by cis on the ovaries. And that framing has caused a lot of problems because, first of all, not everyone with this condition has cis on her ovaries. So that right there tells you all you need to know about the name change, that it simply just wasn't an accurate name. And also, cysts are not even a required diagnostic criterion. So when I was diagnosed at age 20, I did not receive an ultrasound on my ovaries, so no one knew whether there were cis on my ovaries. I didn't receive that ultrasound until I went back when I was 26. And perhaps more importantly, the name PCOS suggested that having cis was the main reason or cause of the syndrome, that the cis were causing all the symptoms that resulted from the condition, which obviously they aren't, if not even all women with the syndrome have cis. So the name basically highlighted in an accurate understanding of the condition, which of course had downstream negative impacts on the women trying to get diagnosed, but also receiving care and treatment for it. The new name, polyendocrine, metabolic ovarian syndrome, is much closer to accurately describing the condition. Polyendocrine means multiple endocrine systems are involved, not just the ovaries, right? So the pancreas, the pituitary gland, the thyroid, the entire hormonal architecture of the body can be affected. Metabolic means that metabolism is central to this condition. Blood sugar regulation, insulin sensitivity, how the body processes and stores energy. And ovarian acknowledges the reproductive dimension without making it the entire story. This is a fundamentally more accurate picture of what the condition actually is. And the fact that it took 14 years and 22,000 people to get medicine to acknowledge that, I think says everything about how the condition and frankly women's health in general has historically been treated. But hopefully, that is on the verge of changing. The fact that this condition was called polycystic ovary syndrome for decades, a name that centered around cysts, meant that it was predominantly treated as a gynecological issue. So women were routed to OBGYNs. The metabolic piece was not part of the standard of care. Most physicians were not trained to look for insulin resistance in a woman presenting with irregular cycles and acne. The name itself was a barrier to appropriate treatment. As it was with me, there was no metabolic testing done when I was diagnosed with the condition. Women spending years or decades feeling terrible without understanding why, women being dismissed, under-treated, and sent home with prescriptions that address symptoms, while the underlying dysfunction just continues unchecked. The new name demands a different conversation. It demands that the metabolic dimension be part of the evaluation. It demands that multiple specialists collaborate rather than treating this as a single system condition. It demands that insulin resistance be screened for, that blood sugar be tested, that the condition be understood as the complex multi-system chronic condition that it actually is. So the name change is not cosmetic. It is or should be a directive to change how the condition is managed. That said, change in medicine is slow. The new name was just published. Full implementation in international guidelines isn't expected until 2028. So most physicians you see in the next year or two might still call it PCOS. Many will still offer birth control as first-line treatment without discussing metabolic health. So while I want to celebrate this moment, this change to the name, I also want to be honest that, you know, there's still more work to be done. What this means practically for you is that you may still need to advocate for yourself. You may need to ask your doctor to test your fasting insulin and not just your fasting glucose. You may need to push for a referral to an endocrinologist rather than accepting a gynecological only approach. You may need to seek out practitioners who understand the metabolic dimension of the condition. And you may need to do your own research, which, if you're listening to this show, you're already doing. So now I want to dive a little deeper on the condition itself. What is PMOS? This is really important because I think a lot of women don't fully understand the mechanism behind the condition, and that is not their fault. It's because they were never given an explanation. At its core, PMOS is a condition of hormonal and metabolic dysfunction. The hormonal piece involves an imbalance in androgens, the hormones people typically think of as male hormones, like testosterone. Women produce androgens too, and we need them, but in much smaller amounts. In PMOS, androgen levels are elevated beyond what they should be in a woman, and that excess drives many of the most visible and distressing symptoms of the condition. But here's where the metabolic piece comes in, and this is the part the conventional medicine has consistently underemphasized or missed entirely. For the majority of women with PMOS, insulin resistance is at the root of that androgen excess. Here's how it works. When the body becomes resistant to insulin, meaning our cells don't respond to it efficiently, the pancreas compensates by producing more insulin. Those elevated insulin levels then signal the ovaries to produce more androgens. So high insulin drives high androgens, and high androgens drive the symptoms. The condition is not primarily a problem of the ovaries. It is, for most women, primarily a problem of insulin and metabolic function, and the ovaries are just downstream of that. And that changes everything about how it should be approached. If you treat PMOS as an ovarian problem, you might put someone on birth control to regulate their cycle and call it a day. And the symptoms may improve because you've hormonally overridden them, but you have not touched the insulin resistance. You have not dealt with the metabolic dysfunction. The root cause is still there, still active, still doing damage. The symptoms of PMOS are wide-ranging. And this is also part of why it so often goes undiagnosed or misdiagnosed. Symptoms include irregular or absent menstrual cycles, excess androgen-driven symptoms like unwanted hair growth on the face and body, hair thinning or loss on the scalp, acne, particularly cystic acne, weight gain, especially around the abdomen, difficulty losing weight, fatigue, mood changes, including anxiety and depression, and fertility challenges. Some women have many of these symptoms and some only have a few. So between the variability and wide-ranging symptoms and many physicians not understanding the mechanisms that drive the condition, it's no wonder most women are either not getting a proper diagnosis, or if they are, they aren't being told why they have it and what to do about it. There's also a strong connection between PMOS and other conditions. Hypothyroidism and PMOS frequently co-occur. I had both at the same time. The chronic inflammation and insulin resistance associated with PMOS increases the risk of prediabetes, which can lead to type 2 diabetes, cardiovascular disease, and non-alcoholic fatty liver disease. This is not a benign condition. For women who go undiagnosed and unmanaged, the long-term health consequences are significant. And yet it has historically been treated as primarily a reproductive and fertility challenge. Okay, so we've talked about the what, what PMOS is, and what the name change means for the condition moving forward, as well as the women who have the condition. Now I want to discuss the why. Why do women have it and why does it involve both metabolic and endocrine systems? For most women, the underlying dysfunction behind the condition is rooted in how the body handles insulin. And insulin is not a reproductive hormone, it's a metabolic one. It sits higher in the hormonal hierarchy than estrogen, progesterone, or testosterone. And that hierarchy matters enormously. I've talked about the hormonal hierarchy on the show since the very beginning. In fact, I have an entire episode dedicated to it. Reproductive hormones are at the bottom of the hierarchy. So any issues affecting hormones higher up in that hierarchy are going to have a downstream impact on the reproductive hormones. Insulin sits higher in the hierarchy. So insulin issues will impact reproductive and thyroid hormones. And PMOS is a perfect example of what happens when that hierarchy is ignored or when doctors don't know about it. Women come in with irregular cycles, weight they can't lose, fatigue, and they're given a reproductive solution, typically birth control, which overrides the downstream hormones without ever touching the upstream problem. The insulin resistance is still there. The metabolic dysfunction is still there. The root cause is still there. So now the question becomes why do so many women have problems with insulin and blood sugar? Well, the reality is that men do too. Less than 12% of the American population is metabolically healthy. So is it that we all eat too much sugar and carbohydrates? Well, yeah, that's a big part of it. A large percentage of people eat too much food in general. We're overeating as a society, and it's easy to do given the absolute abundance most of us have. But for many women, there are factors beyond their diet, and often it's chronic stress. Chronic stress impacts a hormone even higher in the hormonal hierarchy than insulin, and that's cortisol. Cortisol is a stress hormone, and if it's dysregulated, you guessed it, the hormones below it will be too. When you are chronically stressed, whether that's emotional stress, which is very common and would be things like work stress, financial stress, familial stress, but it could also be caused by over-exercising, not sleeping enough, or even over-restricting your food. When you have those types of stress, your cortisol stays elevated. And chronically elevated cortisol directly impairs insulin sensitivity. It triggers your liver to release stored glucose for energy to outrun whatever stress it is you're facing. It promotes fat storage, especially around the abdomen, and over time it leads to insulin resistance. So the pathway is chronic stress drives elevated cortisol. Elevated cortisol drives insulin resistance. Elevated androgens drive PMOS symptoms. So that's that's the full chain, so to speak. And if you only address the end of the chain without addressing what's feeding it at the front, you will be managing this condition forever without ever really getting ahead of it. And this is very personal for me. When I look back at the years when my PMOS was at its worst, and when I think about what actually shifted things, it wasn't just changing what I ate. Diet was the first thing I changed, and it helped a lot. That and consistent exercise and muscle building. I started doing a lot of resistance training, but I did eventually hit a ceiling. My symptoms didn't go into remission until I addressed my stress levels. And I mean really addressing it. Not just adding a meditation app to my phone and trying to do a meditation every other day. I actually Quit my job. I started doing yoga five times a week. I took up hobbies that truly felt like me, especially gardening and spending a lot more time outside in nature. I traveled, I learned to cook. I gave myself permission to do things that felt like who I actually was rather than who I thought I was supposed to be, which at that time was an attorney spending long hours sitting in an office inside, essentially being miserable most of the time. And I didn't address my stress initially because I didn't even know that was part of the equation. I had no idea that it had any impact on my PMOS at all. And I share this not because I think everyone needs to quit their job. I realize that's not even possible for most people. That was just the right decision for me at that time in my life. Unfortunately, I had just gotten married and my husband made enough that you know he didn't make a lot, but he made enough that at the time I was able to do that. And I quit not knowing what my next step would be or what kind of job I would get. But I'm just saying all this because stress is not just a soft secondary factor when it comes to this condition. Cortisol dysregulation is a primary driver of the hormonal dysfunction that underlies this condition. And any approach to managing it that doesn't take that seriously is probably gonna get incomplete results. I also want to address something that has bothered me for a long time about how PMOS has been talked about, which is the association with weight and obesity. For years, PCOS, now even, PCOS, or PMOS, I guess now, was framed as a condition that primarily affects overweight women. And weight loss was often presented as the primary solution. Oh, well, once you lose weight, your symptoms will dissipate and you'll be fine. But this framing has done enormous damage because a significant number of women with this condition are not overweight, and they have been severely dismissed. Told they couldn't possibly have PMOS because they didn't look the part. That OBGYN I went to did seem rather perplexed about my blood results and mentioned that she hadn't really seen the condition in someone my size. I was the thinnest I had ever been when I saw her at age 26. I had recently finished the bar exam and started my career as an attorney, and I was I had gotten so stressed and anxious at that point that I lost my appetite and I didn't eat very much, and I was really thin. And here's what I've discovered about this. Many of the thin women I know with PMOS are some of the most chronically stressed women I've ever encountered. High achieving, driven, but also just running on cortisol. And that makes complete physiological sense because you don't need to be overweight to have insulin resistance. You can have normal or even low body weight and still have chronically elevated cortisol that is driving insulin dysregulation, that is then driving androgen excess. The mechanism doesn't require obesity, it just requires a dysregulated stress response, which can happen in any body. This is why I keep coming back to the idea that health is holistic. I have said this since episode number one. The brain and the body are not separate systems. Our organ systems are not working in isolation. Stress is not just a mental health issue. It has a direct, measurable physiological impact on your hormones, your metabolism, your immune system, your gut. That is the holistic framework. That is what the word metabolic in this new name is the beginning of acknowledging that this condition lives at the intersection of hormones, metabolism, stress, lifestyle, and biology. Not just ovaries, not just cyst, the whole system. Lastly, I want to add some important context because I realize that based on everything I've described so far, it might sound like PMOS is simply the result of chronic stress and or poor diet. And if that was true, it would also mean that any woman with chronic stress or metabolic dysfunction would develop it. And that doesn't seem to be the case. So there must be something else going on, right? But the honest answer is that we don't fully know. The evidence we do have points to a combination of genetics and epigenetics, meaning some women are genetically predisposed to developing PMOS, and then environmental and lifestyle factors essentially switch those genes on or amplify the expression of the condition. That's why two women who have nearly identical diets, stress loads, and lifestyles, one might have PMOS and the other doesn't. It's probably because the underlying biological terrain is different. Epigenetics is a topic I really want to do a dedicated episode on at some point because I think it reframes a lot of how we think about chronic conditions and lifestyle and personal responsibility. The short version is that your genes are not your destiny. Your environment and lifestyle choices influence how those genes express themselves, which is both humbling and empowering, depending on how you look at it. I'll also say I went down the research rabbit hole recently and I came across a study looking at the connection between PMOS and circadian rhythm function. And given my recent interest in circadian rhythm biology, that caught my attention immediately. The relationship between disrupted circadian rhythms and hormonal and metabolic dysfunction is a genuinely fascinating area of research. And I'm gonna dig further into that and what the evidence says specifically in the context of PMOS. So that may be a future episode as well. I did see a doctor recently on Instagram who said that PMOS is not genetic and it's like solely a metabolic dysfunction issue. And that might be true. Like I said, the we just don't have enough research and evidence on the causes of PMOS. But I will say from what I've looked into, there does seem to be commonalities uh in families, and there does seem to be some type of genetic condition. But like I said, epigenetics plays a really big role. I mean, think about it. If I can essentially reverse my PMOS, then epigenetics plays a really big role. The bottom line is this PMOS is not simply caused by stress or diet. Those things matter a lot, but they are interacting with a genetic and biological predisposition that we still don't fully understand. And that's not a reason to feel helpless, it's a reason to be curious, to keep asking questions, to stay up to date, and to exercise agency over your choices and lifestyle. So next week's episode is going to be the practical follow-up to everything we've covered today: the how to. If PMOS is fundamentally a condition of metabolic and hormonal dysfunction, driven largely by insulin resistance, cortisol dysregulation, and chronic inflammation, then addressing it requires addressing all three of those factors, not just one. And that is the framework I'm gonna walk through. We'll talk about nutrition, specifically how to eat to support blood sugar regulation and promote insulin sensitivity. We'll talk about movement and why the type and timing of exercise matters, not just the fact that you're doing it. We'll talk about stress and what it actually looks like to address cortisol in a meaningful way. We'll talk about sleep because sleep deprivation is one of the most powerful drivers of insulin resistance, and it is chronically underestimated, in my opinion. And we'll also talk about supplements, what the evidence says behind using certain supplements, what I personally use, what has worked, and what hasn't. I will also share what my own process looked like in more detail, the order in which I made the changes, what moved the needle first, what took longer, and what I wish I had known at the beginning. Because I think there is real value in hearing not just the what, but the how and the timeline from someone who has actually lived it. This is the episode I wish it existed when I was 26, sitting in that doctor's office with three diagnoses and no roadmap. So I'm gonna try to be that roadmap for you. Before I close, I want to say something to anyone listening who has PMOS or suspects that she might, or who has been dismissed or told there's nothing to be done beyond birth control and medication management. Your instinct that there is more to the story is correct because there is. And the fact that it has taken medicine this long to formally acknowledge that is not a reflection of your health or your worth, especially not your worth as a patient. It is a reflection of a system that has consistently underinvested in understanding conditions that primarily affect women. Fortunately, that seems to be changing. Slowly, but it's changing. You deserve a complete picture, you deserve a provider who understands the metabolic dimension of the condition. And in addition to that, I hope this show can be a resource for you. If you want to talk through your specific situation, a free hormone clarity call is a great place to start. The link is in the show notes. I would genuinely love to connect with you. Thank you so much for being here. Until next time.

SPEAKER_00 31:59

If you enjoyed this episode, please leave my mommy a five-star review. And don't forget to hit the subscribe button.

SPEAKER_01 32:07

Thanks so much for tuning in to Vital Balance with Jess. If you loved this episode, it would mean the world if you would leave a review, share it with a friend, or hit subscribe so you never miss a dose of real talk on women's health. Remember, you have more control over your health than you've been told, and sustainable change is possible. Keep listening to your body and showing up for yourself. I'll see you next time.