Living with PCOS can feel like a collection of unrelated problems. Irregular periods lead to one appointment. Acne and unwanted facial hair lead to another. Weight becomes its own frustrating conversation, while anxiety or depression may be treated in a completely different setting.
For many women living with polycystic ovary syndrome, or PCOS, now renamed polyendocrine metabolic ovarian syndrome (PMOS), these symptoms may reflect different expressions of a broader whole-body disorder. As the most common hormonal disorder among women of reproductive age and a leading cause of infertility, PCOS affects 1 in 8 women, more than 170 million worldwide[*], and its global burden has increased significantly over the past three decades. That rise makes the question of what drives the condition more pressing[*][*].
Increasingly, researchers and clinicians are looking beyond the ovaries. Insulin resistance may play a central role in PCOS, affecting reproductive hormones, fertility, metabolic health, and mood at the same time. That broader view could help shift care away from treating each symptom in isolation and toward addressing the dysfunction that may connect them.
In this article, reproductive endocrinologist Dr. Steven Palter, Dr. Madison Kackley of the SHE IS Lab at The Ohio State University, and registered dietitian and medical student Temple Stewart explore what this metabolic view may mean for women living with PCOS.
From PCOS to PMOS: A Name That Reflects the Whole Body
In May 2026, an international consensus published in The Lancet renamed polycystic ovary syndrome, or PCOS, as polyendocrine metabolic ovarian syndrome, or PMOS. Led by Professor Helena Teede at Monash University, the global process engaged 56 academic, clinical, and patient organizations and drew on 14,360 survey responses from people living with PCOS and multidisciplinary health professionals worldwide[*]. The American Society for Reproductive Medicine announced the change on 27 May 2026[*].
Why the Name Change?
As research into the condition has evolved, experts in the field have recognized that the term “polycystic ovary syndrome” placed too much emphasis on the ovaries and suggested that abnormal ovarian cysts define the condition. In reality, many women living with PMOS do not have ovarian cysts, and cysts are not required for diagnosis. Researchers involved in the renaming process concluded that this narrow framing obscured the condition’s broader hormonal and metabolic effects, contributing to delayed diagnosis, fragmented care, and stigma.
What PMOS Recognizes
The new name describes the condition more accurately:
- Polyendocrine reflects disruptions across multiple hormone systems.
- Metabolic recognizes insulin resistance and the increased risks of type 2 diabetes and cardiovascular disease.
- Ovarian preserves the important reproductive and ovulatory features of the condition.
The official rationale also recognizes mental and psychological health as central parts of PMOS, alongside its effects on metabolism, skin, weight, and reproductive health. This broader language encourages clinicians to see the full condition rather than focusing only on periods, fertility, or ovarian appearance.
What the Name Change Means Right Now
For women who already have a PCOS diagnosis, the diagnosis itself has not changed. Current diagnostic criteria, treatment plans, and eligibility for care remain in place.
The terminology will take time to reach every clinic, pharmacy, insurer, and medical record system. A three-year transition is underway, with full implementation planned for the 2028 International Guideline update. In the meantime, patients should expect to see PCOS and PMOS used interchangeably on medical records, prescriptions, insurance documents, and educational materials.
But the significance of the change goes beyond terminology. PMOS gives clinicians and patients a more accurate starting point for understanding a condition that affects the whole body.
What PCOS Looks Like, and What It Actually Is
At first glance, PCOS can look like a reproductive or cosmetic condition. A woman may notice that her periods are irregular or unusually heavy. She may struggle with acne, unwanted facial hair, or difficulty becoming pregnant. Bloodwork may show elevated androgens, sometimes called male hormones.
Those are the visible signs. Underneath them, a much broader metabolic problem may be unfolding. Research indicates that insulin resistance, and the high insulin levels that follow, are present in about 85% of people living with PCOS, including about 75% of those at a lower body weight[*].
Dr. Steven Palter describes PCOS as “diabetes of the ovary” because insulin resistance often helps drive the hormonal disruption. When the body becomes less responsive to insulin, insulin levels can remain elevated, influencing the ovaries to produce more androgens and interfering with normal ovulation[*].
This helps explain why the condition reaches far beyond periods and fertility. Women living with PCOS face higher risks of type 2 diabetes, gestational diabetes, sleep apnea, and cardiovascular disease[*]. The Lancet consensus paper puts numbers to the cardiovascular picture, reporting increased odds of cardiovascular disease overall (1.68), alongside higher odds of myocardial infarction (2.50) and stroke (1.71)[*].
Seen through this lens, irregular cycles, acne, fertility challenges, and metabolic disease are connected parts of the same condition. The ovaries may reveal the problem, but the effects can extend throughout the body.
The PCOS and Mental Health Connection
Women living with PCOS have nearly three times the odds of a clinical diagnosis of depression or anxiety compared with women without the condition, while meta-analyses have reported depressive symptoms in about 42% and anxiety symptoms in about 37%[*][*].
For years, those symptoms were often explained as a reaction to infertility, weight gain, acne, or unwanted facial hair. While those experiences can take a real psychological toll, Dr. Steven Palter believes the connection runs deeper:
“The same insulin resistance and metabolic effect is affecting their mood,” he says, adding that elevated androgens may also play a role. This clinical perspective raises the possibility that some of the biological factors associated with disrupted ovulation may also contribute to mental-health symptoms.
Eating disorders are another important part of the psychological picture in PCOS. A 2024 meta-analysis found a significantly higher risk of binge eating disorder, along with increased odds of bulimia nervosa and disordered eating more broadly. Given that overlap, the international PCOS guideline not only recommends screening adults with PCOS for depression and anxiety, but also advises clinicians to consider screening for eating disorders as part of routine care[*][*].
A metabolic psychiatry lens offers a plausible explanation for why these symptoms cluster together. The same insulin resistance and hormonal disruption that can affect ovulation and androgen levels may also influence psychological states. PCOS is often understood as a hormonal disorder, but its metabolic features appear to reach further than the reproductive system.
Why Current Treatment May Miss a Metabolic Driver
PCOS care often starts by targeting the symptom causing the most immediate concern. Birth control pills may help regulate cycles and reduce androgen-related symptoms. For women trying to conceive, oral fertility medications may come next, followed by IVF when needed. Other concerns, such as depression, sleep apnea, diabetes risk, or cardiovascular disease, are often treated in their own separate lanes.
While that approach can bring real relief, when each symptom is managed on its own, symptom-focused treatment may not directly address insulin resistance when it is part of the clinical picture.
Overlooking the role of insulin resistance is also why the familiar advice to “lose weight” can feel so frustrating. Weight loss may improve PCOS symptoms, but insulin resistance itself can make appetite regulation harder and fat loss slower. Without that context, women can end up feeling blamed for a biological problem they were never taught to understand.
Some treatments already work on that metabolic layer. Metformin has been used in PCOS care for decades to improve insulin sensitivity, GLP-1 receptor agonists are increasingly prescribed for the metabolic features of the condition, and broader changes across nutrition quality, activity, sleep, and stress act on the same system. Nutritional approaches like ketogenic therapy belong in that group too, though they are the least likely to come up in a short appointment.
Addressing metabolic factors can complement conventional treatment. It can work alongside it by addressing key metabolic drivers that may contribute to hormonal disruption. For many women, improving metabolic health may help address that deeper layer while symptom-focused care continues to provide support where it’s needed.
What the Research on Ketogenic Therapy and PCOS Suggests
Research on ketogenic therapy for PCOS is still developing. Small studies suggest possible changes in menstrual, reproductive, hormonal, and metabolic outcomes, while reports of mood changes remain largely clinical observations.
Changes May Begin Before the Scale Moves
In Dr. Steven Palter’s clinical practice, some women report feeling better within weeks of starting a ketogenic intervention. “Within one month, they’ll say that their mood has changed,” he explains. Some also begin ovulating within one to two months, including women who had not ovulated regularly in years.
These are clinical observations rather than results from a controlled trial, but the timing matters. When mood or ovulation improves before substantial weight loss, it raises the possibility that lowering insulin and improving metabolic function may be contributing directly.
A 2024 Study Found Improvements in Cycles and Fertility
A 2024 retrospective study looked back at the outcomes of 30 women living with PCOS who had followed a ketogenic diet for at least three months. All 30 regained regular menstrual cycles. Furthermore, of the 18 who wanted to conceive, 10 became pregnant.
Of note, the women who became pregnant didn’t lose significantly more weight than those who did not become pregnant, suggesting that weight loss alone may not explain the reproductive improvements. The authors proposed that improvements in insulin resistance could occur earlier and help restore ovulatory function[*].
The SHE IS Lab Found a Similar Pattern
Dr. Madison Kackley’s research at The Ohio State University adds another piece to the picture. In a six-week diet intervention study comparing ketogenic and low-fat diets, women in both groups lost similar amounts of weight and improved several metabolic markers. Yet menstrual changes were reported only in the ketogenic groups.
Some women noticed changes in menstrual frequency or intensity within two weeks, while others regained a period after more than a year without one. Meanwhile, none of the women in the low-fat group reported menstrual changes. The study included only 19 participants and relied on self-reported outcomes, but the difference between groups once again suggests that nutritional ketosis may influence menstrual physiology in ways that extend beyond weight loss[*].
What The Broader Research Shows
Early research suggests ketogenic and lower-carbohydrate diets may improve some of the hormonal, metabolic, and reproductive features of PCOS.
A 2023 review of seven small studies involving 170 participants found that ketogenic diets followed for six to 24 weeks were associated with several hormonal changes. These included a lower ratio of LH to FSH, two hormones that help regulate ovulation and the menstrual cycle, along with lower free testosterone and higher sex hormone-binding globulin (SHBG). Progesterone did not significantly change. The researchers rated the studies as fair quality and emphasized the need for larger studies.[*]
Randomized trials have found similar results. In one 16-week study, participants following a ketogenic diet had greater reductions in total and visceral fat and greater improvements in excess androgen activity and ovulatory function than those following a Mediterranean low-carbohydrate diet. Read the study Another 12-week trial found that a Mediterranean-style lower-carbohydrate diet helped significantly more participants regain regular menstrual cycles, while total testosterone decreased only in the lower-carbohydrate group.[*] Smaller studies have reported findings in the same general direction.[*]
So far, the research suggests carbohydrate reduction may improve several metabolic, hormonal, and reproductive features of PCOS. The evidence is still based on relatively small, short-term studies, so larger and longer trials are needed to better understand these effects.
The Details of the Diet Matter
Ketogenic therapy for PCOS may look different from protocols used for epilepsy or serious mental illness. Dr. Palter often emphasizes a higher protein intake, targeting roughly 100 grams per day to support reproductive health and preserve lean mass. Temple Stewart typically aims for mild nutritional ketosis, often around 0.6 to 1.5 mmol/L, because many of her clients see cycle regulation without needing very high ketone levels.
Both clinicians also look beyond ketones. Continuous glucose monitors can help reveal whether meals, stress, or poor sleep are driving glucose instability. Body composition matters as well, since preserving muscle supports insulin sensitivity and long-term metabolic health.
This is also why a well-formulated ketogenic diet involves more than reducing carbohydrates. Adequate calories, sufficient protein, micronutrients, minerals, sleep, stress management, and individualized support can all shape hormonal outcomes. As Dr. Kackley explains, conflicting reports about ketogenic diets and women’s hormones may sometimes reflect differences in diet quality, nutrient intake, timing, or the person’s broader health context rather than ketosis itself.
Important Considerations Before Making Changes
A metabolic approach to PCOS can open new treatment possibilities, but it should still begin with a complete view of the person’s health. Anyone taking glucose-lowering medications or other prescriptions should work with a qualified clinician before making a major dietary change. Ketogenic therapy can alter blood glucose and medication needs, so doses should never be adjusted without medical supervision.
That broader care plan matters even more when pregnancy is the goal. Improving insulin resistance may support ovulation, but PCOS is only one possible factor in infertility. Dr. Steven Palter emphasizes that a standard evaluation should still consider age, semen analysis in a partner, and whether the fallopian tubes are open.
Medication planning needs to be part of that conversation too. GLP-1 drugs require particular caution before conception. Current semaglutide prescribing information advises discontinuing treatment at least two months before a planned pregnancy. Patients should discuss timing, risks, and alternatives with their prescribing clinician.
Over time, the nutrition strategy may also change. Temple Stewart explains that some women who regain regular cycles and improve their metabolic health may eventually transition to a whole-food, lower-carbohydrate pattern. Even then, it remains important to watch for changes in cycles, glucose regulation, body composition, and other signs that insulin markers may be changing, especially through perimenopause and menopause.
The Takeaway
PMOS, formerly PCOS, can look like a long list of unrelated problems: irregular periods, acne, fertility struggles, weight gain, depression, anxiety. But when insulin resistance is part of the picture, those symptoms start to make more sense together.
That broader view can change how women and their clinicians approach care. Symptom relief still has an important place, but it can be paired with a closer look at the metabolic dysfunction that may be driving hormonal and reproductive changes, along with the psychological symptoms that travel with them.
Research on PCOS and metabolic therapies is still growing, but the conversation has already expanded. Women living with PCOS now have more evidence to work from than they did a few years ago, and better grounds for asking whether their care is addressing the condition as a whole.
To go deeper on the metabolic view of PCOS, watch our full interview with Dr. Steven Palter, The Metabolic Fix for PCOS and Infertility, where he explains why he calls the condition “diabetes of the ovary” and what he sees when patients address insulin resistance directly. Dr. Madison Kackley also joined us to discuss keto, hormones, PCOS, and menopause from the SHE IS Lab, and our Is Keto Safe? topic page covers the safety questions that often come up first.
You can also explore THINK+SMART, our free, evidence-informed metabolic program for mental health, designed to help you and your care team build a personalized approach.
Frequently Asked Questions
Is PCOS/PMOS a metabolic disorder?
PCOS is increasingly understood as a whole-body metabolic and hormonal condition rather than a disorder limited to the ovaries. Insulin resistance is common in women living with PCOS and can influence ovulation, androgen levels, fertility, weight regulation, mood, and long-term health risks.
Can PCOS cause depression and anxiety?
PCOS is associated with a substantially higher risk of depression and anxiety. The emotional strain of symptoms such as infertility, acne, unwanted facial hair, and weight changes can contribute, but research also points to biological factors as possible links between PCOS and mental health, including insulin resistance and inflammation, along with elevated androgens.
Can ketogenic therapy help with PCOS?
Early research suggests that a well-formulated ketogenic diet may improve insulin resistance, menstrual regularity, ovulation, androgen levels, and other metabolic markers in some women living with PCOS. Small studies have also reported restored cycles and pregnancies, though larger controlled trials are still needed. Ketogenic therapy should be personalized and discussed with a qualified clinician, especially for anyone taking medication or trying to conceive.
Does PCOS improvement require weight loss?
Not always. Weight loss can improve PCOS symptoms for some women, but several studies and clinical observations suggest that menstrual cycles, ovulation, mood, and insulin sensitivity may begin improving before substantial weight loss occurs. This may be because lowering insulin levels can affect reproductive hormones and ovulatory function relatively quickly.
How is PCOS related to insulin resistance?
Insulin resistance means the body does not respond to insulin as effectively, so the pancreas releases more of it to keep blood glucose under control. Higher insulin levels can stimulate the ovaries to produce more androgens and interfere with normal ovulation. This helps connect many common features of PCOS, including irregular cycles, acne, unwanted facial hair, fertility challenges, and a higher risk of type 2 diabetes.
Disclaimer: Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice or establishing a provider-patient relationship. Many of the interventions we discuss can have potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications. In addition, it is important to note that people may respond differently to ketosis, and there isn’t one recognized universal response.
