PMOS is Not Just About Weight

If there’s one thing that will forever and ever make me rage - it’s weight stigma in reproductive medicine.

For a large population of people, visiting the doctor for concerns of irregular periods, stubborn acne, or thinning hair is met with a frustratingly singular piece of advice: "Just lose some weight, and your symptoms will go away."

When it comes to Polyendocrine Metabolic Ovary Syndrome (previously called Polycystic Ovary Syndrome), this "weight-first" approach is not just oversimplified… it’s scientifically incomplete. Framing PMOS solely as a "weight issue" ignores the complex hormonal, metabolic, and genetic machinery driving the condition. PMOS is an endocrine disorder, not a character flaw or a math problem of calories in versus calories out.

Approximately 70–80% of people with PMOS have some level of insulin resistance, regardless of their body size. You might have heard the term before, but what does it mean? Insulin is the hormone that allows your cells to use sugar for energy, pulling glucose out of the bloodstream and sending it to the organs and tissues where they will convert it into ATP, the body’s energy currency. In PMOS, the cells can become "numb" to insulin’s signal or require significantly more insulin to get the job done. To compensate for this poor response, the pancreas pumps out EVEN MORE insulin. 

When this happens, the ovaries are signaled to produce more androgens, which include hormones like testosterone and can cause ovulation to become delayed, along with a myriad of other symptoms such as facial hair growth, hair loss on the head and an increase in acne. These high insulin levels can also trigger the body to store energy as adipose tissue, and reduce how well it can be used for fueling energy processes. The body stops ovulating regularly, which causes delayed or absent cycles, and can be a possible cause of infertility.

You can’t “willpower” or “discipline” or “calorie deficit” your way out of this hormonal mess - and telling someone to just eat less and exercise for weight loss is not the answer. Not to mention many of the symptoms of PMOS can impact body image and deeply affect mental health. Experiencing weight stigma in care environments leads to people not seeking care soon enough, and reducing their self-efficacy to make changes that suit their life and values.

It’s also a big myth that PMOS only affects people in larger bodies - small bodies can have metabolic and endocrine challenges too. Fun fact: there isn’t a single condition that only affects larger bodied people (which is one of many reasons why calling fatness a disease isn’t accurate). Individuals who live in a smaller body, or who fit within the old “normal BMI” range, are often diagnosed years later than they should be, due to being dismissed by their care providers and incorrect assumptions about other reasons for hormone dysfunction.

Interesting new research suggests that PMOS has an element of chronic low-grade inflammation. If you’ve read my content before, you know what the real deal is when it comes to inflammation (and if you’re new, inflammation isn’t as much of a bad guy as you’ve heard online!). Systemic immune responses and inflammatory compounds can further stimulate the ovaries to produce androgens, delay ovulation and contribute to other symptoms that affect well-being, like energy levels, sleep quality, muscle function and more. This gives hope to nutrition and lifestyle education, where focusing on the addition of anti-inflammatory principles to eating practices and focusing on health-promoting behaviours is the key instead of outdated and unfounded claims that restriction and dieting are the only option.

And PMOS also needs mental health care. It’s exhausting to navigate a health system that does not prioritize care of the female reproductive system, actively tries to change body size at every turn and also puts blame and shame on these individuals. Individuals with PMOS have been found to have a significantly higher risk for anxiety, depression, eating disorders, and are more likely to also experience forms of neurodivergence such as ADHD. Not only do the insulin and androgen alterations impact menstrual cycles and metabolic health, but they can affect neurotransmitters like serotonin and dopamine too.

PMOS needs to be focused on holistic management through education and empowerment. It cannot be reversed or cured, despite what you may read online, but its symptoms and its associated health risks can be managed well. Using tools like resistance training, fiber-rich carbohydrates, and sometimes medications like metformin or supplements like inositol can help to sensitize insulin so people can fuel their bodies, strengthen them and improve their energy levels. We also can’t forget that sleep and stress management need to be a priority, as high levels of cortisol can worsen ovulation dysfunction and make androgen production more significant. And when it’s indicated (especially after review by a specialized dietitian in reproductive medicine), boosting vitamin D, omega-3 and magnesium intake can help to support effective and efficient inflammation processes (instead of namby-pamby low-grade nonsense that never stops).

PMOS is a multifaceted, systemic condition that requires a multifaceted approach, and it is high time that we retire the idea of weight loss as the “cure” or the “treatment”. When we teach people that their weight isn’t the best marker of health, heal our society’s relationship with focusing on smallness at all costs, and stop obsessing over the scale and start focusing on hormonal harmony, insulin stability, and mental well-being, we finally give people with PMOS the care they deserve.

You are not a weight loss project. You are a person with a complex endocrine system that needs support, not shame. Ask me how you can change your PMOS journey, without dieting or weight stigma!