PMOS can mean years of weight gain, acne and hair loss. Menopause isn't the end of it

Jaritsa Dominguez was just 15 years old when a doctor bluntly delivered some heartbreaking news.

“ ‘You’re probably never going to have kids,’ ” the Brentwood resident recalled being told. “I started crying right away. Then he said, ‘I wouldn't worry too much, you aren’t at the age of thinking about those things anyway.’ “

Dominguez had just been diagnosed with polycystic ovary syndrome (PCOS), now called polyendocrine metabolic ovarian syndrome (PMOS). It is the most common endocrinologic condition for women, impacting their hormones and metabolism.

The symptoms can be merciless — irregular periods, weight gain, insulin resistance and cystic acne. A woman may grow excessive hair on her face and body while losing the hair on her head. Women with PMOS can experience fertility issues and long-term cardiovascular risks as well as depression, anxiety and eating disorders as a result of dealing with these changes to their bodies.

And the symptoms don't go away during perimenopause or menopause.

"Because both conditions are marked by menstrual irregularity, it can take some work to figure out whether the irregular periods are signs of PMOS versus she is going through the menopausal transition," said Dr. Fatima Daoud Yilmaz, an obstetrician and gynecologist at Stony Brook Medicine and one of the specialists at its PMOS Center.

"PMOS is not simply a condition of the reproductive years," she said. "It has implications across the life span, and women with a history of PMOS should continue to receive appropriate metabolic and cardiovascular risk assessment as they transition through menopause."

Dominguez struggled with many of those symptoms as she tried for years to manage the condition and fulfill her dream of becoming a mother.

“I was becoming pre-diabetic,” Dominguez said. “When I tried to be on a diet, eat healthier or exercise, I wouldn't lose the same amount of weight compared to someone else."

Some researchers say between 5% and 20% of women have PMOS, depending on the criteria used. Many women suffering with undiagnosed symptoms don't know they have it.

“The tricky part is that there's no one test that says you have it or not,” said Dr. Emilia Liao, an endocrinologist at Northwell Health based at Lenox Hill Hospital in Manhattan.

“It’s not like diabetes or thyroid, where you can just run and test and determine you have hyperthyroidism,” Liao said. “It’s really a clinical picture. They do have some criteria, but not everyone is going to fit in those boxes.”

A difficult journey

After losing weight and exploring different treatments that eventually regulated her period and allowed her to become pregnant, Dominguez, now 33, is the proud mother of a healthy 2-year-old daughter named Mikaela.

But her journey has been a difficult one, navigating a sea of physicians and treatments for an ailment that still has no known origin or cure.

Because some people with PMOS have cysts on their ovaries, the condition was viewed as a gynecologic one, instead of a complex hormonal and metabolic one that affects a woman’s entire body, said Daoud, who is also one of Dominguez's doctors. 

Changing the name from polycystic ovary syndrome to polyendocrine metabolic ovarian syndrome is an important recognition of the spectrum of symptoms that extend beyond cysts on ovaries, experts said.

“Some of my patients have told me they brought it up with their doctor or previous gynecologists and were told their issues were due to their weight, which is ironic since it’s PMOS that leads to the issues with weight,” said Daoud, who has been treating Dominguez for several years.

Some women with the condition, but not all, may have elevated levels of the male hormone testosterone, which women naturally produce. One patient was told she couldn’t possibly have PMOS because her testosterone levels were normal and not elevated, a narrow view that has led to many misdiagnoses, Daoud said.

"The ovarian androgen (male hormone) production generally declines with age, women with PMOS may continue to have higher androgen levels relative to women without PMOS," she said. "Some metabolic features, including insulin resistance and an increased risk of type 2 diabetes and cardiovascular disease, may also persist beyond the reproductive years."

Some patients ended up getting a delayed diagnosis of diabetes that could have possibly prevented sleep apnea, heart disease and high blood pressure because this was viewed as a strictly gynecologic condition,” Daoud said. “Part of that reason was lack of awareness, both in the medical community and the broader community.”

'An ancient disease'

While the name polyendocrine metabolic ovarian syndrome is new, the medical condition appears to have been documented for centuries.

Hippocrates, a physician in ancient Greece known as the “Father of Medicine” wrote about "robust" women who did not menstruate often, according to a 2010 article in one medical journal.

“It’s an ancient disease,” Daoud said. “Ancient Greek philosophers wrote about this condition, describing women with beards, infertility and increased weight.”

But that textbook image of a woman with PMOS has changed dramatically due to the public discussions on social media and celebrities sharing their personal struggles.

“There is a recognition that this is an incredibly heterogeneous condition and that there is no kind of one 'look' for PMOS,” she said.

While it is genetic, environment also plays a big role in managing PMOS.

“I can't even tell you how many times I have heard from patients that everything was fine in high school,” Daoud said. “They had no issues, and then they went to college and suddenly everything went off the rails. College is a high stress environment with poor sleep, poor diet, generally, and not a lot of exercise is being had. And that is kind of like the four horsemen, if you will, of making PMOS worse.”

One common treatment for patients who have many missed periods is being placed on birth control pills

“It’s really an estrogen pill, and that regulates the period,” Liao said. “It also treats the imbalance that's going to lower testosterone.”

For patients who are getting a regular period but are gaining weight despite having a healthy diet and exercising, a medicine to treat insulin resistance may be prescribed, she said.

“It really does depend on the symptoms because there’s nothing that gets to the root of it,” Liao said. “There’s no treatment that goes to the ovary and corrects all this imbalance.”

Treatment approaches

Dominguez recalled having painful stomach cramps, rarely followed by a period. She noticed hair on her face growing thicker after an aunt took her for a facial waxing as a teen. The mood swings were tough and the weight gain was worse.

Doctors prescribed her medications to help with the insulin resistance and infertility. She had rounds of laser treatments for her excess facial and body hair.

“I always wanted to be a mom,” she said. “When I met my husband, he was understanding, and we said we are going to put it in God’s hands.”

For women with PMOS, symptoms "evolve" as they enter perimenopause and menopause, said Dr. Stephanie Trentacoste McNally, medical director at the Northwell Health Katz Institute for Women's Health and system director for the Center of Menopause and Midlife Health.

Their menstrual cycles that were once irregular may become more consistent or shorter and run closer together during perimenopause as hormonal patterns shift, she said.

McNally said this is a time when women who may have been focused on their severe PMOS symptoms should pay attention to other vital health issues such as their blood sugar, metabolic health, cholesterol, blood pressure, moods and weight.

And women should discuss any changes with their doctors including heavier, more frequent bleeding, mood issues that impact their daily life and shifts in energy.

While the treatment plan for each PMOS patient is unique, Daoud said there are a few things they all can do.

"Lifestyle adjustments that allow for stress management, restful and appropriate amounts of sleep, physical exercise that prioritizes resistance-based exercise, and a varied diet that relies more heavily on healthy fats, healthy proteins and high fiber is generally what I recommend across the board for all of my patients," she said.

Dominguez had weight loss surgery and with the help of medication became pregnant with her daughter, who was born in 2024. She and her husband are trying for a second child.

She believes women should advocate for themselves and find doctors who treat them with compassion, crediting her family and tight-knit church community for supporting her through the difficult times.

"I wasn't in it alone."