PCOS Has a New Name: What PMOS Means and What Still Hasn’t Changed

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PCOS just got a new name, and I know what some of you are thinking, " Cute. Does that also mean the medical system is gonna rename the part where women wait years for a diagnosis or are asked, ' Have you tried losing weight?'" And honestly, that's totally fair, because the reality is, a new acronym doesn't automatically mean you're gonna get better labs, better providers who stop blaming everything on your weight, your stress, or just the fact that you own ovaries.

But this name change, it does matter. So for decades, PCOS stood for Polycystic Ovary Syndrome, and that name made everyone obsess over cysts in the ovaries, except they were never cysts. They were follicles. Your ovaries were trying very, very hard to ovulate. And we see them in younger patients, but not necessarily older patients.

And some doctors thought because the name is PCOS, you must have cysts, and if you don't, you couldn't have PCOS. So it's [00:01:00] definitely a problem

Because women were walking into their provider and they had irregular cycles, acne, hair loss, facial hair or hair where they don't want it growing, struggling with fertility, having oily skin, uh, the cystic acne, bacne, buttne, and being told your ultrasound's normal, as if your ovaries had the final ruling in all of this, and they don't.

So PCOS is now being reframed to PMOS, polyendocrine metabolic ovarian syndrome. Is it catchy? Absolutely not. Do you wanna embroider it on a sweatshirt? Also no. It sounds like a committee had a meeting and nobody brought snacks, honestly. But it does point us towards something important. This condition is not just about ovaries.

It is about hormones, your metabolic health, ovulation, skin, hair, mood, fertility, and long-term health. Now, I have been saying for years, just because you go through menopause doesn't mean [00:02:00] your PCOS goes away, and doctors are like, "Of course it does. You don't have irregular cycles anymore. You don't have ovaries that are presenting with these string of pearls," which were follicles, but they thought were cysts.

But the reality for women with PCOS, well, PMOS, for- formerly known as PCOS, is that the metabolic issues of PCOS, they persist post-menopause. So you continue to have higher risk of diabetes and cardiovascular disease.

So the name change is important so that we start focusing on the whole person and the whole body experience of PCOS and stop constantly reducing women to just, like, their reproductive capacity and whether or not that uterus is gonna make some babies for us.

But there's also this other problem, is that if clinicians hear metabolic, they're gonna think weight problems, and then lean PCOS patients are about to get shoved into a blind spot yet again. So today, we are gonna talk about what the name change means, what it doesn't mean, why lean PCOS cannot get erased, and then we're also gonna [00:03:00] talk about supplements, like how to think about inositol, spearmint, green tea extract, and saw palmetto.

So stick around to the end 'cause we're gonna talk about some solutions for PCOS. And if you are new here, welcome. I'm Dr. Jolene Brighten. I'm the host of The Dr. Brighten Show. If you can like, comment, subscribe, I would appreciate it so much. I am board-certified in naturopathic endocrinology, a nutrition scientist, and So proud of all of the women, and we're gonna shout them out later in this episode, who have made this change happen for PCOS.

All right, let's get into our episode.

There have been a lot of women on the internet being like, "Why the heck do we need a new name? Like, the old name was fine," and, you know, you do have cysts on your ovaries. So we're gonna talk about why the old name made women and doctors chase the wrong clue. So what does PCOS make us miss? PCOS sounds like it's a condition just of the ovaries.

That was the first problem. The name pointed everyone towards cysts, so that ultrasounds, they became, [00:04:00] like, the main character. A woman could have classic symptoms, but if her ovaries didn't look polycystic, she could get dismissed, and that would... That's what contributes to needing to see, like, two to three specialists and sometimes going, like, three, five, seven years before you get a diagnosis, especially if you're Black or Latina.

And then there's the opposite. That's when someone has polycystic-appearing ovaries on ultrasound, and suddenly they get the label, and it doesn't fully match their symptoms. And that's what happens when a condition gets named after one possible finding. And they were wrong. It was never cysts, and so the name was wrong.

And everyone starts treating the polycystic ovaries as, like, the whole diagnosis. And PCOS has never been that simple. 

Okay, so what do we see in PCOS/PMOS? Usually, there is elevated insulin. There's insulin dysregulation. About 70% of those with PCOS/PMOS, they experience this. That insulin stimulates the ovaries to make higher androgens. Think testosterone, but also [00:05:00] DHT, which is gonna lead to hair loss on the head. So this is where we see hyperandrogen symptoms.

Women with this condition, they will have oily skin, acne, hirsutism, which is hair growth that is thick and coarse and where you do not want it, and hair loss on the head.

So this leads us into the first criteria of the Rotterdam criteria. You need to have two out of three to get the diagnosis of PCOS.

And what we see is with hyperandrogenism, you can have it on the blood test, or you can have it apparent on your skin, oily skin, acne, hirsutism, hair loss on the head.

The second criteria is about ovulation. You're having irregular ovulation, or ovulation is going altogether. But ovulation is a tricky thing to pin down. So what do we ask women? "How are your cycles?" You have irregular cycles. Now, it's not that, like, your cycles became irregular 'cause now you're forty-five.

That's not PCOS or PMOS. It is not from the onset. Maybe you didn't get your period until you were, like, fifteen or sixteen, or from the onset of your experience of getting your [00:06:00] period, menarche, your first period, you had irregular cycles, and they have always been irregular. If you go on the pill, that is not you cycling.

That is not you getting a regular period. And this matters because a lot of women with PCOS, they have irregular cycles. They have acne. The doctor says, "Well, you're young. You don't wanna have a baby, right? Let's put you on the pill." And that can help with some of the symptoms. But this is the great thing about the rename, it's no longer just about the ovaries, so stop just giving her the pill and acting like she's an inconvenience in your office.

So you take the pill. Then you're doing this withdrawal bleed month after month, and you go to the doctor and you're like, "Yeah, my periods are regular." And your doctor's like, "Yeah, you're on the pill. Your periods are regular." Those are not periods. Okay, so that part of your history doesn't matter. What matters is, what was it like when you got your period?

What is it like when you are off the pill? What are your cycles like? And if they're irregular, you just hit number two on the Rotterdam criteria. Now, the slippery slope issue with the Rotterdam criteria, and thankfully you only need two or three, is that the third one is the polycystic ovaries, but we already [00:07:00] established they were never polycystic.

They were follicles, many follicles being recruited. The ovaries are like, "I know the brain is saying work and ovulate, and I just wanna do a good job, but I just can't get there because these freaking androgens are messing with me." And so with that, the younger you are, the more follicles we see. Everybody knows this, right?

Like, younger you are, more eggs in your savings account. The older you are, the less eggs in your savings account. So if you happen to be a woman, thirty-five, forty, you're like, "I've had irregular cycles my whole life. I was just put on the pill, but I, like, actually wanna understand what was going on here 'cause my doctor was not invested in actually working me up."

And y- and your doctor will say to you, "Well, you don't have polycystic ovaries, therefore you cannot have polycystic ovary syndrome." Okay, well, like, that makes sense, but now we've renamed it.

And the rename matters because women with PCOS or PMOS, I'm gonna use them interchangeably 'cause it's just too new, okay? This literally just happened, like, [00:08:00] yesterday. So women with this condition They have increased cardiovascular risk. They have more inflammation. They have high lipids or elevated cholesterol.

They're at higher risk for diabetes. They have blood sugar abnormalities. They also have sleep and mood issues. So it's more than just their fertility and their cycles. And thankfully, it was in 2023 that we got updated criteria. Shout out to Dr. Fiona McCalla, who has PCOS, leader in PCOS. I will link to her episode in this, who was part of putting together these guidelines, and they now say, like, you can also look at an AMH, anti-mullerian hormone, and if it is markedly elevated for your age, 'cause AMH is based on your age, and it's kind of a crude measurement of like how many follicles you can recruit, and it was really developed for IVF, advanced reproductive techniques.

So like I, I just wanna be clear about that. That's where it came from. But when we see that you could d- you could be like recruiting lots and lots of follicles, that's when we start to look at PCOS. [00:09:00] And I do wanna shout out Dr. Fiona McCalla one more time because research just came out showing that PCOS women can get pregnant later in life.

And she has said this for years. I have collaborated with her years in different interviews, different capacities, and she always says her observation is many of her PCOS patients are having babies into their mid-40s, and now we have research showing, yes, like you came with a lot of eggs, my friend, and maybe that anovulatory cycles, like something about that, is making it so that you can reproduce later in life.

But that's a big question mark we don't actually know in the research yet.

So the pattern for PCOS for years has been a woman misses her period for months. She gets told to take the pill. She develops cystic acne. She gets told, "Take the pill, maybe spironolactone." She starts losing hair, spironolactone and the pill. She grows coarse facial hair, spironolactone and the pill. She struggles to conceive, then it's like, "Oh, maybe ovulation actually [00:10:00] matters here."

And if she also has blood sugar issues, then she might be given the pill and metformin. That's not comprehensive care. That is a scavenger hunt, and it's been a big disservice to these women. So PMOS, this is trying to fix them up and trying to fix care. Polyendocrine means more than one hormone system may be involved.

It's more than just estrogen, more than just testosterone, more than just progesterone. Metabolic means you best be checking her insulin, her glucose, her lipids, her blood pressure, and the long-term risk. That actually deserves attention. It deserves more than just the birth control pill. Ovarian keeps ovulation and reproductive health within the frame so that women who are trying to conceive, women with irregular periods, they're not being left behind.

And so PMOS is an attempt to name the pattern of what is happening rather than just centering this about one possible ultrasound finding. Okay, so new name, important, but does it actually change [00:11:00] anything for the woman sitting in the doctor's office? No. No, it doesn't. Your chart's still gonna say PCOS. Your doctor's still gonna operate under old-school PCOS, uh, ideas, and they're still gonna tell you to lose weight. Like, this is still going to happen.

So while the name is helpful, I think it's a step in the right direction, I think it's very problematic that we celebrate this and we don't ask for more. I wanna challenge you. Ask for more. We wouldn't ask for more if we didn't think it was in the capacity for them to give us more. So what does more look like?

More looks like hearing a concrete plan of how medical school education is going to actually change. More is hearing how we're gonna invest more money into PMOS and actually understand it. More is understanding how will you take this information to medical conferences and teach doctors how to do better.

More is how do you teach clinicians to have better conversations with patients and stop reducing them to just their [00:12:00] weight or deciding they can't have PCOS because their weight is fine?

So while we can absolutely celebrate this name, I disagree with every provider out there saying PMOS is this groundbreaking, revolutionary, earth-shattering, pivotal moment of change for women with the condition formerly known as PCOS. It's not. Until doctors step up and do better, until healthcare providers step up and do better, then this name change isn't gonna have that big of an impact.

And what does doing better even look like? It looks like listening to the person sitting in front of you and believing them when they say, "I live in my body. I know my normal, and this is not normal." Doing better means asking why they're having symptoms rather than saying, "Eh, you know what? I can just put you on the pill, and then we'll deal with you if and when you ever decide to have a baby."

Having a baby should not be part of the algorithm of whether or not someone gets [00:13:00] quality care. Having a baby should be part of the algorithm of how do we address this, who are the other specialists that we bring in, and how, how do we think about this case?

Now, a big problem that I see with this name, Dr. Fiona McCalla also pointed this out, is that medicine has a translation problem. It's gonna hear metabolic, and it is gonna translate it to your weight, and that's where lean PCOS is gonna get erased. So you know the patient I mean. They have irregular cycles, acne that laughs at every skincare attempt, hair shedding that turns into shower drain that is a crime scene and completely clogged, facial hair that she can locate with military precision, even bad bathroom lighting.

But her BMI is normal, so someone tells her, "You don't look like you have PCOS." Lovely. We are diagnosing endocrine disorders by silhouette now? Lean PCOS is absolutely real. We have subtypes of PCOS, and this is where too many [00:14:00] providers are not literate enough on this. And it is not just PCOS light because she's, like, on the diet version of PCOS, and it's not mild by default.

It is truly PCOS. And a w- lean woman can have elevated androgens. She can have irregular ovulation. She can have a high AMH. Um, she can have adrenal androgen patterns as well, and she certainly can experience infertility, acne, hair loss, hirsutism, mental health issues. That all goes with PCOS. And yes, she can have normal fasting glucose.

Fasting glucose is one snapshot. It's not a full metabolic, uh, autobiography of your health, and I have a whole episode on what your doctor should be t- testing for insulin resistance. I will link that in the show notes. And we have to acknowledge that women compensate for insulin resistance years before glucose rises.

So some women, they do not have obvious insulin resistance, or they're already doing all the eat right, exercise, you know, methodology that we know does [00:15:00] influence PCOS in a positive way. So the old mistake was no cis, no PCOS. The new mistake cannot become no weight issues, no PMOS.

Absolutely not. We are not updating the label just to keep the bad thinking. So a better approach is to treat metabolic as a prompt, but not a verdict. It should be a prompt. Prompt us to assess metabolic health. It should not become a gatekeeping tool. So why am I worried about this? Because PMOS can widen the lens, but only if clinicians do not turn metabolic into code for body size or you're lazy, and lean PCOS has to stay in the frame.

Now, everybody and their brother in the online health coaching space has stepped out to let us know that all the doctors never knew what they were talking about, and only health coaches have been really solving the problem of PCOS. And I just wanna say that I put this out on social media, and I said, "How long until we see these [00:16:00] fitness influencers who for years gaslit women with PCOS saying it had nothing to do with your metabolism, you just had a willpower issue.

If you just eat right and exercise more, you would have no problems. How long until we saw them step into the light and decide that now they were actually the experts, they never gaslit women, they are the actual experts in PCOS?" And sure enough, it was, like, less than 24 hours that I saw the health coaches, the fitness influencers coming out and saying- Doctors never understood PCOS.

It's been us health coaches who have always understood PCOS, and we're the ones who knew about the metabolic issues, and we're the ones that, like, were treating women appropriately. And I just have to laugh because a health coach cannot treat anybody. It's outside their scope. They cannot order labs, they cannot interpret labs, they cannot diagnose, and they cannot treat.

Anything that's a medical condition is outside their scope. Now, I wanna shout out the women that made this possible, because it really upsets me that especially male health coaches [00:17:00] would claim the work and the efforts and the glory. They step in like they're the hero when they were not boots on the ground actually doing all this work.

Before I shout out those women, though, I do wanna shout out the health coaches who understand their scope, who support women with PCOS and help them actually get to doctors who can help them. Health coaches absolutely have such a pivotal role to play in healthcare, and just like there are awful, awful doctors out there, we have all met them, there are awful, awful health coaches who aren't even actually certified health coaches.

So I wanna shout out the names, I have my list here, of women who were boots on the ground, who actually made this name change happen, who have been advocating for PCOS to be seen more than just some polycystic ovaries.

They deserve all the glory, all the credit for all the efforts that they put in. So first one is Shelby Goodrich Eckard. She has been going off on some of these, uh, bros who decided that they, they are the ones who made this happen. Uh, Renee [00:18:00] Dubose, she's another one, and she's been such an ally to the Black community because they definitely have been left out of the conversation.

Jenny Gutke. I really hope I'm saying people's names rights. I'm kind of butchering them. Dr. Dylan Cutler, she's a PhD. The PCOS Dietitian, which is Martha McKittrick. You can tell I'm not very good at always, uh, reading people's names. PCOS Nutrition Center, which is a whole Instagram account that is dedicated to supporting women with PCOS. The PCOS Challenge organization has been a large part of this as well. Dr. Fiona McCulloch, who I have pointed out before, and The Women's Dietician, which is Corey Ruth.

And there's more. So please, if you know women who have been going to Congress, who have been advocating, who've been working with researchers, who have been doing all of this work to help women with PCOS, please shout them out [00:19:00] in the comments, because I did not intentionally leave anyone out. But I do want to say to the health coaches and fitness influencers that are saying that no doctor actually knew what was going on with PCOS, and it's only been the health coaches, like, which, which doctors?

Because there are doctors that have been part of this name change, that have been part of leading this PCOS community and helping women get access to information. As I said, Dr. Fiona McCulloch helped shape the 2023 guidelines. But also, if you've read any of my books, you know I've been talking about PCOS being a metabolic issue, and even a decade ago, when I was posting on Instagram, the number of gynecologists that came to me and said, "No, birth control pill is just fine.

Stop misleading women and sending them misinformation. PCOS i-is an ovulatory dysfunction disorder." And I'm like, "Okay, where's the ovulatory dysfunction come from?" No, w-we're not, we're not ready for that conversation. So I do want to acknowledge, I'll be the first to [00:20:00] acknowledge there are a lot of doctors that suck out there.

There's a lot of healthcare providers that gaslight women, and it's just plain awful. As a woman with endometriosis, 29 years to get a diagnosis, like, I have walked the path of just awful doctors and feeling like you have to put armor on just to be able to go to a medical appointment because, God, you're going to war with some of these people.

But there are many, many providers out there who are absolutely exceptional. They have PCOS themself, PMOS now, and they're absolutely exceptional at helping women, supporting women, and amplifying the voices of women who are online. And so what I always encourage you to do, and you know this, is when you see a great doctor, shout out that great doctor because believe me, the mediocre colleagues, they're like crabs in a bucket, like b-boiling in a pot.

They want to pull them back down. They don't want exceptionalism out there serving women sometimes because it really amplifies, like, how bad of a job that they're doing. And then I also want to acknowledge that there are a lot of doctors out there who are doing the best they can, who are, [00:21:00] who are like, "Okay, the thing I know that can help with this-" is the pill.

They're not always reaching for the pill because they're lazy. Sometimes they're reaching for the pill because they're like, "I know this can help." Or there's a real concern of endometrial hyperplasia, something that happens in PMOS. You don't ovulate, estrogen stimulates the endometrial lining, you get thickening of the endometrial lining, and that, after years of time, becomes a risk for endometrial cancer.

And so they may pass you the pill and say, "Let's get a withdrawal bleed so that we don't have this risk of cancer." So I'm in no way ever advocating against you having access for the pill, and I'm not saying that all doctors who use the pill are bad. But there are definitely doctors that make you feel like, "Why do you work with women?

'Cause you definitely hate us." And I, I just wanna honor that because, you know, it's such a fine line to wa- to walk, and I was saying to my husband the other day, you know, there are doctors, a- and, like, just profanity warning, I'm gonna use some profanity here 'cause this is, like, literally the [00:22:00] conversation that I had with my husband, is that there are doctors who are complete assholes, and they get mad at me because they're like, "Hey, same team."

At the end of the day, there's this unspoken code that no matter what, healthcare practitioners are supposed to defend them- their own. But I'm sorry, the oath we took was to first do no harm, and if you're an asshole, I was never same-same, okay? I was never in your corner, and I never identified as being on the same team.

Because if you don't care to listen to women, validate women's stories, you're gonna have the audacity to tell, like, thousands upon thousands of women who are having the same experience, "That's just anecdotal," and, like, "I don't really care what you have to say 'cause there's no research study to back that up."

Like, why did you get into medicine? Now, as I say all that, I just wanna be crystal clear, and you've heard me say it before, that every single profession has people that should have never been in that profession. Like, we've all had the bad mechanic, right? Uh, we've all had the bad [00:23:00] waitress, like, who's maybe just having a bad day.

That can happen for providers as well. But every single profession just has the personality that doesn't fit, and medicine is no different. But I digress. We are going off topic here. Welcome to my ADHD side quest.

Okay, so we have PCOS or POLS or I don't even care what you call it, right? Because you are the person living with it, and you're like, "I just want to feel better." And I've seen that a lot online where people are like, "That's great. They changed the name. Now can they actually freaking help us?" So let's talk about what actually helps PCOS.

So it is one of the most modifiable conditions with nutrition and lifestyle, which is not to blame you and say that your nutrition or lifestyle caused it. We know that PCOS is highly genetic. We know there's dysbiosis in the gut. We know there's, like, a lot of things going on with PCOS, but what's the cause?

We don't actually know that. That's why I'm like I don't really... A rose by any other name, right? Like, what do you call it? I don't know that I care as much. Could you just research it and get these women some damn answers? But again, [00:24:00] I do th- I do think the name change is a, is a positive step. So firstly, we've gotta be strength training.

And we tell people, like, strength training twice a week. With a PCOS patient, it might be more like three times a week, maybe four times a week, just depending on your health. Or maybe we're gonna couple it, and we're gonna say, "I need you to do 20 minutes of cardio that you enjoy in, in the zone two, and then I need you to do strength training.

And you're gonna do, like, 30 minutes." "

I would encourage you to work with, not a fitness bro. And not everybody's a fitness bro just 'cause they're a man in personal training. A fitness bro is like what we call a man who thinks he knows more than you about your body.

Don't work with them. Work with a qualified fitness professional or a physical therapist. Even an occupational therapist can be good so that you can get a routine that works best for your body. If you go to drbrighten.com/plan, it's a perimenopause weight loss plan that's in there, but it works well for PCOS as well because what is happening in perimenopause?

Insulin dysregulation, [00:25:00] inflammation, uh, inadequate progesterone. A lot of things that PCOS women have been struggling with their whole life. Now, why I would encourage you to do that is because it has a meal plan and a recipe guide for an anti-inflammatory meal plan that helps you hit your protein goals of at least 30 grams of protein at every meal and 25 grams of fiber for the whole day.

This is the goal with PCOS, the, the minimum. We may need to do more fiber, we may need to do more protein, but this will help you get started on a baseline plan, and it's 100% free, drbrighten.com/plan. Now, the other thing you'll find in that plan is stress strategies and sleep strategies. Those are super important for PCOS as well.

As you don't sleep, as you get stressed, your ovulatory dysfunction becomes more dysfunctional. And again, this is not to blame you, this is to empower you, that you've got things that you can work on that don't require a prescription, that don't require a doctor's visit, and can help you make positive movement towards your health.

That metabolic [00:26:00] component that puts you at high risk for diabetes, cardiovascular disease, we wanna avoid all of that, and the things that you do every single day can help with that. Now, the other component of nutrition, and nobody loves it when I say it, but it needs to be said, is we cannot go above 25 grams of added sugar every day.

I am not talking about your fruit. I'm not talking about you having a banana. A banana was like the least of anyone's problems, okay? I'm talking about added sugar. I'm talking about what's in the yogurt, what's in the protein bar. Oh my God, what is with protein bars being like, "This is 25 grams of protein," but 30 grams of sugar?

Like, just jog on with that. Like, why are you trying to trick me with your marketing? So I'm talking about the added sugar that comes in, and honestly, you guys have heard me say it before, don't waste it on the yogurt. Like, actually have some ice cream or a cookie. If you're gonna have added sugar, like, make it worth it.

Don't make it a Yoplait. That's so lame. That's not even that good. So the added sugar is because when you consume too much sugar, that can contribute to visceral adiposity, the fat that packs around our organs d- [00:27:00] and increases as we age. If you have PCOS or PMOS, I'm, I'm an old dog, man. We gotta change... We gotta learn new tricks here.

I gotta, like, change that name. Waist to hip circumference is one of the most positive things that you can be tracking at home. You measure your waist during, you find the most narrow part, okay? We're not gonna squeeze the tape super tight. We're gonna measure around the waist, and we're gonna measure the hips, and then we are gonna divide the largest number by the smallest number.

That number should be .85 or less. And if it's above that, that's, that's pointing towards visceral adiposity, and that is what makes the PMOS so dangerous, is that your weight gain isn't butt, hips, and thighs, which is, you know, problematic for a pair of jeans, but pretty benign otherwise. Your weight gain is that visceral adiposity, and I'm not talking about a muffin top.

I'm talking about fat around your organs that is metabolically active and that is sabotaging you with inflammation, inflammatory cytokines, the chemical [00:28:00] messengers of your immune system that just like to hate on you sometimes, and insulin resistance increasing But the reality with PCOS is that all this nutrition and lifestyle I talked about, it's foundation.

It's one tool, but it's not enough. That's why women are turning to GLP-1s. I don't have any problem with that as long as that we are making sure that it- we're using it as a tool, and we're not acting like it's the only solution, and that we're monitoring your muscle, and that we're making sure that you still have your muscle mass and that you're still getting enough calories.

I know there's a lot of people out there that like to hate on PCOS women for trying GLP-1s and say things like, "Oh, you should just try harder." And I'm like, " Nobody's trying harder." Nobody is trying harder to manage their weight than that 70% of the PCOS community with insulin resistance. And I dare you to have the metabolic profile, their genetics set up for them, and you to come on with the audacity to be like, "Just try harder."

You're already trying very hard. But let's talk about some [00:29:00] natural approaches as well because not everybody can afford GLP-1s, not everybody wants to go down the route of GLP-1s, and we've had things that the research has shown has helped PCOS, PMOS for a very long time and it doesn't include injecting yourself once a week.

Inositols. One you have got to have heard about, right? And you're probably wondering, is inositol actually helpful, or did the internet turn another supplement into the personality who's basically the superhero of the PMOS story? inositol is very helpful. It is very helpful with your blood sugar.

It is helpful with egg quality. It is helpful with helping regular ovulation get established on top of you doing your nutrition and lifestyle. Myo-inositol paired with D-chiro-inositol at a forty to one ratio is what the research supports. So for women with p- with PMOS that have insulin resistance, cravings, blood sugar swings, irregular ovulation, metabolic changes, sleep issues, inositol is a very reasonable [00:30:00] tool to use, and coupling it with things like chromium, which is a mineral, can help even more with cravings.

Now, for myo-inositol, it's usually two grams once to twice daily. And again, for PCOS, PMOS, we wanna look specifically myo-inositol, D-chiro-inositol, and the forty to one ratio.

And anytime someone starts myo-inositol, I encourage them to track their cycles and see are the cycle lengths getting shorter? Do you have signs of ovulation returning? And that can be really helpful to see those changes, but you have to give it time. You know, for something like myo-inositol, I usually say give it at least three months to start to see improvements.

There are three other supplements I wanna talk to you about, spearmint, green tea, and saw palmetto. So these three supplements can help certain PCOS symptoms.

And you may have heard of women drinking spearmint tea. You need to drink, like, three to four [00:31:00] cups of that a day minimum, and that needs to be day after day after day. Or you can take spearmint in a capsule form. It's one of the few botanicals where the, you know, PCOS conversation doesn't become, like, complete nonsense on the Internet,

like, "Just drink a tea, and that will change your hair." It, it actually does work. It can help with free and total testosterone in those with hirsutism, so hair growth on the chin, chest, abdomen, place where you don't want it, and with hair loss. It may also be helpful for androgen-related acne.

Okay, so but when it comes to spearmint tea, this is also a place where you gotta give it, like, a good three months. You might see improvement in a couple of months, but you wanna track things like acne and the oiliness of your skin. That's the first thing that you're gonna see. When it comes to hair loss, hair loss may stop, but you may not see regrowth for another six months.

You wanna make sure you use spearmint, not peppermint. And if androgen symptoms appear suddenly or severely, like [00:32:00] rapid facial hair growth, deepening voice, major cycle changes, very high testosterone symptoms, I don't want you to go brew more tea. I want you to see your doctor and just make sure nothing else is going on.

Now, another tea is green tea, but you can't drink enough of it to really get the benefits. So green tea extract that's decaffeinated as a capsule is a better way to go when we're talking about PMOS. So drinking the tea in the morning, that's gonna help with metabolic health, polyphenols, oxidative stress, inflammation.

But, like, three cups a day, that is not gonna be reasonable, especially if you don't tolerate caffeine.

Now, green tea extract in a capsule, that's gonna be a concentrated form, so it's gonna be a lot stronger. And if you get decaffeinated version, which a lot of supplements are, um, unless they're for weight loss, then they might be caffeinated. That's gonna have a better effect. And if you have liver issues, you definitely wanna talk to your provider before starting [00:33:00] supplements. I mean, you wanna talk to your provider ideally before starting any supplements. But certainly if you're having liver issues, then we don't wanna be taking gobs of supplements because natural doesn't mean that it's harmless Like, I sometimes think, you know, a raccoon is natural, but I still don't want it loose in my pantry.

You feel me? Now, saw palmetto, that may affect the 5-alpha reductase enzyme. That's the enzyme that converts testosterone to DHT, a very strong, potent androgen that will cause irreversible hair loss. You actually get shrinking of your follicle. And with saw palmetto, the-- a lot of the research is in men, and we don't have a lot of research in women.

It is something that I have used with historically PCOS women, PMOS, w-- I've used, uh, in my practice for a very long time because it has less side effects than some of the medications out there that we would use otherwise. So I think it's a reasonable starting place when your hair is thinning, you have oily skin, you've got that [00:34:00] hirsutism, you've got acne going on.

But if you're not working on the underlying issues that are driving those androgens up, that's only gonna take you so far. That's why I always say, like, it's a tool. It's one tool. It's not gonna be the only tool to get the job done, right? Like, a hammer doesn't build a whole house. Now, if you're pregnant, the only supplement that I've talked about that's considered safe in pregnancy is inositol.

You-- A good prenatal usually, uh, includes inositol because it can help with blood sugar patterns. And, um, actually, before I step away from these supplements, I should also say saw palmetto can take three to six months when it comes to the hair changes, and hirsutism is irreversible. So that means that if you have chin hair, you gotta pluck it, you gotta wax it, you gotta do electrolysis.

But taking something like saw palmetto will not reverse that 'cause it's irreversible. So you gotta get rid of the hair, and then this should hopefully help you not grow more hair. So I hope these tips were helpful for you, so that you have more than just a conversation [00:35:00] about, like, what is this PMOS all about?

Which, by the way, women are saying piss me off syndrome, and I just find that hilarious. I'd love to hear from you. How are you feeling about the new name? Do you think PMOS is a right step? Like, are we going in the right direction here? Do you think it means anything positive for the PCOS community, formerly known as PCOS community?

Or do you think our efforts would be better spent somewhere else? I don't have PMOS, so I always love to hear from people who do have it. What is your per-- experience? What is your perspective around this? If you can take a minute, leave a review, subscribe, share this with someone who could use this information, I would be super grateful to you. It's your support that helps keep this podcast going, and as always, you lead the conversation, so I'd love to hear more about what you wanna learn about on this podcast.

As always, it's such a pleasure to get to spend time with you every week, and I will see you next time.