“The way I explain to patients is that PMOS is inherently a metabolic disease,” says obesity medicine–certified physician Samantha Schon, MD, a reproductive endocrinologist and an associate professor in the department of obstetrics and gynecology at the University of Michigan in Ann Arbor. “The fundamental drivers of PMOS are insulin resistance and hyperandrogenism.”
Insulin resistance is when your body’s cells don’t respond to insulin, a hormone that moves glucose from your blood into your cells.
Hyperandrogenism means that you have higher levels of androgens, such as testosterone, than women typically have. This can lead to symptoms like acne, excess body hair, male-pattern baldness, and irregular periods.
Insulin resistance can increase insulin levels in the blood, says Dr. Schon. This condition, called hyperinsulinemia, stimulates an increased production of androgens and suppresses the production of proteins, like sex hormone–binding globulin, that normally bind to and deactivate circulating androgens.
This dynamic leaves even higher levels of active androgens circulating in the body, exacerbating PMOS symptoms and driving further metabolic consequences. As Schon explains, “The relationship is complicated, but it’s important to know that insulin resistance and hyperandrogenism work synergistically to increase the risk of metabolic disorders.”
According to research, about 70 percent of women with PMOS have insulin resistance.
Prevalence may change depending on weight, with data suggesting that, in PMOS, both hyperinsulinemia and insulin resistance affect up to 90 percent of women with obesity and 60 percent of women who are lean.
Chronically high blood sugar from insulin resistance can lead to prediabetes and type 2 diabetes.
The long-term risks to health are significant. Half of women who have PMOS develop type 2 diabetes by age 40, according to the Centers for Disease Control and Prevention.
Women with PMOS also have more than a twofold risk of developing hypertension (high blood pressure), and more than a threefold risk of developing dyslipidemia (abnormal lipid levels), compared with women without PMOS.
Because people with PMOS are inconsistently screened for metabolic dysfunction, the name change is even more critical, as it reframes patients as having a “lifelong endocrine-metabolic condition” that should set the stage for early blood sugar testing and closer blood pressure and cardiometabolic risk factor monitoring, research suggests.
That’s where talking to your healthcare provider about regular testing comes in.
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