Managing PMOS Symptoms: Expert Tips From a Women’s Health GP

Managing Polyendocrine Metabolic Ovarian Syndrome (PMOS) (formerly Polycystic Ovary Syndrome, PCOS) starts with a simple question: which symptoms matter most to you right now? There’s no single treatment, because the condition affects everyone differently. The right approach depends on your symptoms, your wider health, whether you need contraception and whether you’re trying to conceive.

Living with PMOS can mean juggling several symptoms at once: irregular periods, acne, unwanted facial hair, thinning hair, fatigue, or changes to your weight and metabolism. Or it might be just one or two that really bother you. Either way, PMOS rarely needs to be tackled all at once.

Here, Dr Yewande, a Women’s Health GP at Hertility, shares practical, evidence-based ways to manage some of the most common PMOS symptoms, and the treatments and support that can help. For a full overview of the condition, read our guide to everything you need to know about PMOS (PCOS).

Quick facts

• There’s no single treatment for PMOS (PCOS). Management depends on your symptoms, your wider health and whether you’re trying to conceive.
• Irregular or absent periods are common, and they may need treatment to protect the health of your womb lining, not just to make your cycle more predictable.
• There’s no single PMOS diet or best type of exercise for everyone.
• PMOS affects people of all body sizes, and weight loss should never be a condition of getting the right care.
• Acne, excess hair growth and scalp hair thinning can all be linked to higher androgen activity, but each may need a different treatment.
• PMOS is linked with higher rates of sleep apnoea, depression and anxiety, so fatigue and mental health symptoms deserve proper attention.
• Supplements may help some people, but the evidence is more limited than social media often suggests.

1. Keep track of your periods, even if they have always been irregular

If your periods have always been unpredictable, it’s tempting to accept long gaps as normal for you. But with PMOS (PCOS), how often you bleed matters as much as how predictable your cycle is.

A typical cycle lasts 21 to 35 days. With PMOS (PCOS), periods often come less frequently, stop altogether (amenorrhoea) or arrive erratically, because PMOS can disrupt ovulation.

Why frequency matters. After you ovulate, your body makes progesterone. If you rarely ovulate, your womb lining is exposed to oestrogen without that regular progesterone. Over time, this can make the lining thicken too much, a condition called endometrial hyperplasia. The relative risk of endometrial cancer is also higher with PMOS, although the absolute risk stays low meaning that even though the chance of developing endometrial cancer with PMOS is higher than if you didn’t have PMOS the actual risk of it occurring is low. That’s why long gaps in periods are still worth acting on rather than ignoring.

What can help? If you regularly go several months without a period, speak to your GP. Depending on your history and whether you need contraception, options may include hormonal contraception like the pill, a hormonal coil such as the Mirena, or intermittent courses of a progestogen to bring on a withdrawal bleed. If you’re trying to conceive, your options will be different, because the focus shifts to understanding and supporting ovulation.

Don’t wait for your cycles to settle before mentioning them. Keep a record for 2-3 months before your appointment of your cycle length (first day of one period to first day of the next), how long bleeding lasts, how painful it is, and flow (light, medium, heavy), so you can tell your doctor exactly how often you’re bleeding. 

Want to understand what’s happening with your hormones? Hertility’s Advanced Hormone and Fertility Test helps you build a clearer picture of your hormones and cycle, with results reviewed alongside your symptoms and health history.

2. Stop searching for the perfect “PCOS diet”

There’s no single diet proven to be best for PMOS (PCOS). Low-carb diets, keto, intermittent fasting and other eating plans are often promoted for PMOS (PCOS)., but the international guidelines doesn’t recommend one diet over another.

Rather than following strict rules, focus on an eating pattern that supports your health and that you can realistically keep up. For many people, that means:

• including a source of protein at meals, such as eggs, fish, yoghurt, tofu, beans or chicken
• choosing higher-fibre foods such as oats, wholegrains, beans, lentils, fruit and vegetables
• adding healthy fats from foods such as nuts, seeds, olive oil or avocado
• avoiding long periods without eating if these leave you excessively hungry or low in energy later
• reducing highly processed foods without feeling that they have to disappear completely

If insulin resistance is a concern, eating carbohydrates alongside protein, fibre and healthy fats can make meals more filling and help keep your blood sugar steady. But eating well with PMOS (PCOS), shouldn’t mean constant dieting or feeling guilty about food. The best approach fits your health, culture, budget, preferences and relationship with food. Read our guide on There a Best Diet for PMOS (PCOS)?.

If nutrition feels confusing, a Hertility Nutrition Consultation can help you build a plan around you, rather than another generic PMOS (PCOS)  meal plan.

3. Exercise for your health, not just the number on the scales

Exercise is one of the most useful tools for managing PMOS (PCOS)., even if your weight doesn’t change. Regular activity supports insulin sensitivity, heart health, sleep, mood and metabolic health. There’s no single “best exercise for PCOS”: current recommendations suggest around 150-300 minutes of moderate activity a week (or 75-150 minutes of more vigorous activity). Either way, add muscle-strengthening activity on at least two days a week. This is in line with UK physical activity guidelines.

That doesn’t have to mean intense workouts. Walking, cycling, swimming, Pilates, resistance training or a combination of these are all good options, and the best type is the one you’ll actually keep doing. If you’re currently doing very little, jumping straight to 10,000 steps and five gym sessions a week can make exercise feel impossible. Start smaller. A 15 to 20 minute walk most days is better than an ambitious plan you give up on after a fortnight.

4. If you’re constantly exhausted, don’t automatically blame PCOS

Fatigue is common with PMOS (PCOS), but it has many possible causes. Depending on your symptoms, your doctor may check for:

• iron, vitamin B12 or folate deficiency
• low vitamin D
• thyroid problems
• blood sugar problems
• poor sleep
• anxiety, low mood or long-term stress

PMOS (PCOS) is also linked with a higher rate of obstructive sleep apnoea, regardless of your weight. So if you snore heavily, wake up unrefreshed, get morning headaches or feel unusually sleepy during the day, mention it to your doctor. Sleep apnoea is treatable, and it’s often missed.

5. Your skin symptoms might be hormonal, and topical treatment may not be enough

Persistent acne or oily skin can be a visible sign of the hormonal changes linked to PMOS (PCOS). Higher androgen activity (including testosterone) can increase oil production and contribute to acne. This is particularly likely when it appears alongside irregular periods, excess facial or body hair, or scalp thinning.

Topical treatments. These can still be very effective. Depending on severity, options include benzoyl peroxide, azelaic acid, topical retinoids or other prescription treatments.

When acne keeps coming back. If your acne keeps returning or isn’t improving despite the right treatment, that’s a clue that hormones may be involved, because creams and gels can’t address a hormonal cause. For some people with PMOS (PCOS). The combined pill can help by reducing androgen activity. Other prescription options may also be considered, depending on your symptoms, history and whether you’re trying to conceive.

Not all acne is hormonal, and having acne doesn’t mean you have PMOS (PCOS), but if persistent breakouts happen alongside changes to your periods or hair, mention them together to your doctor rather than treating each one separately.

One safety note: some acne treatments, particularly retinoids, aren’t safe in pregnancy. Always tell your doctor if you’re pregnant, planning a pregnancy or could become pregnant. And if acne is affecting your confidence, you don’t need to wait until it’s severe to ask for help. A Hertility Women’s Health GP consultation can help you work out whether your acne is hormonal and talk through the treatments that fit your goals. Read more about skin and hair changes.

6. Hair changes can be difficult and PCOS can affect hair in different ways

PMOS (PCOS) can affect hair in seemingly opposite ways. Higher androgen activity can cause excess facial or body hair (hirsutism), while also being linked to thinning hair on your scalp.

Excess hair. Hirsutism often affects the chin, upper lip, chest, abdomen or back.

• Hair removal. Shaving, waxing and threading are all perfectly reasonable ways to manage it. Longer-term options include laser or light-based hair reduction, or electrolysis.
• Medication. The combined pill can reduce androgen activity and improve excess hair for some people. If symptoms remain significant, anti-androgens such as spironolactone may be considered. These need medical supervision, and reliable contraception if you could become pregnant.

Scalp thinning. This looks different. You might notice a widening parting, thinner hair around the crown or more visible scalp over time. But not all hair loss in someone with PMOS (PCOS)  is caused by PMOS (PCOS) .Iron deficiency, thyroid problems, stress and other types of hair loss can all look similar, so persistent or worsening thinning is worth getting checked rather than assumed.

Treatment depends on the cause. For hair loss linked to androgens, topical minoxidil may be considered. A thyroid problem or deficiency needs its own treatment. It should also be noted that because hair grows in cycles, it can take several months to see whether a treatment is working. Taking a photo every few months is a far easier way to track progress than checking every day.

7. Treat metabolic health as part of PCOS management

PMOS (PCOS)  isn’t only about periods and fertility. It’s also linked with changes in how your body responds to insulin, and a higher risk of metabolic conditions such as type 2 diabetes, hence the name change.

The international guideline recommends checking your blood sugar when you’re diagnosed and then every one to three years, depending on your other risk factors. Depending on your age, history and risk, your doctor may also check your:

• blood pressure
• cholesterol
• family history of diabetes or heart disease
• activity levels and sleep

These are often far more useful measures of your health than a number on the scales.

8. Don’t feel pressured to lose weight before you’re offered help

Weight management may improve some PMOS (PCOS)  symptoms for people living with a higher weight, particularly if they have insulin resistance. But weight loss isn’t a requirement for treatment. People with PMOS (PCOS)  at any body size can have irregular periods, androgen-related symptoms and metabolic complications. Current guidance specifically highlights the importance of avoiding weight stigma, and recognises that healthy lifestyle changes can help even without weight loss.

If weight management is something you want support with, the options go well beyond “eat less, move more”. Depending on your health and eligibility, they may include:

• support from a dietitian
• behavioural approaches
• metformin
• weight-management medication

GLP-1 medicines such as semaglutide or liraglutide may be considered for some adults with PMOS. The guidelines recommend using the same eligibility criteria as for anyone else. They aren’t a PMOS-specific treatment. They need an individual discussion about benefits, side effects, contraception and pregnancy plans, because you’ll need to stop them before trying to conceive.

9. Be selective with PCOS supplements

Supplements are one of the most heavily marketed parts of PMOS management, but none can cure the condition, and the evidence is often weaker than it looks online.

Inositol. Inositol is a naturally-occurring sugar produced in the body and is the most studied supplement in this area. The 2023 international guideline says it could be considered based on personal preference. The review behind the guideline found it may improve some metabolic measures, such as insulin sensitivity, but has limited benefits for ovulation, excess hair growth and weight.

Vitamin D. Correcting a deficiency matters for your general health, but vitamin D isn’t a treatment for PMOS itself.

Omega-3. It may support some metabolic markers, such as cholesterol, but the evidence is still developing.

Be cautious with:

• berberine, which has safety concerns, especially if you’re trying to conceive
• “hormone-balancing” blends, which often contain many ingredients at low doses

If you take metformin or another medication, or you’re trying to conceive, check with your GP or pharmacist before starting any supplement. Read our full guide on the best supplements for PMOS (PCOS).

Not sure what’s worth taking? A Hertility Nutrition Consultation can help you work out what, if anything, is right for you, rather than guessing from social media.

10. Don’t ignore your mental health

PMOS (PCOS) symptoms can have a real effect on how you feel about yourself. Acne, facial hair, hair loss, unpredictable periods, fertility worries and difficult experiences around weight can all affect your confidence and quality of life.

Anxiety and depression are also more common in people with PMOS so mental health deserves to be part of your PMOS care, not an afterthought.

If how you’re feeling is affecting your daily life, please speak to your GP or another healthcare professional. Hertility’s counselling support is there if it helps to talk to someone who understands the hormonal side too. Read more about mood and mental health.

11. If you’re trying to conceive, you don’t necessarily need to “fix” your PCOS first

Having PMOS doesn’t mean you’ll struggle to get pregnant. For some people, fertility isn’t affected at all. For others, the main challenge is irregular or absent ovulation. If you ovulate less often, there are fewer chances to conceive, and your fertile window is harder to predict.

That’s also why tracking can be tricky with PMOS. Higher or fluctuating luteinising hormone (LH) can give false results on ovulation tests, and apps that predict ovulation from past cycles are less reliable when your ovulation moves around from month to month. Our guide to tracking ovulation with PMOS explains what works.

If you’re trying to conceive, having sex regularly, around every two to three days, takes the pressure off pinning down one exact day. And if your periods are very irregular or you’re going months without a bleed, you don’t need to spend months tracking on your own before asking for help. A GP or fertility specialist can check whether you’re ovulating and what else might be involved.

A fertility assessment shouldn’t stop at PMOS (PCOS), either. Your age, your partner’s sperm health, the health of your fallopian tubes and womb, and conditions such as endometriosis may all need looking at.

If irregular ovulation is the main issue, well-established treatments can help. The 2023 guideline recommends letrozole as the first-line medication to help you ovulate. Read more about getting pregnant with PMOS.

When should I see a doctor about PCOS?

PMOS (PCOS) changes over time, so the plan that suited you a few years ago may not be right now. It’s worth checking in with a healthcare professional if:

• your periods stop for several months
• your symptoms suddenly become much worse, or you develop new ones that don’t fit your usual pattern
• treatment isn’t helping despite giving it enough time to work
• you’re worried about your blood sugar, cholesterol or wider metabolic health
• your symptoms are affecting your confidence, relationships or daily life
• your circumstances change, such as starting or stopping contraception, planning a pregnancy, or shifting priorities

PMOS (PCOS) management shouldn’t be a one-off conversation at diagnosis. It’s completely reasonable to review what’s working, what isn’t, and whether your needs have changed.

Getting the right support for your PMOS with Hertility

PMOS (PCOS) can affect several areas of your health at once, so good support is about more than a single hormone result. At Hertility, we can help from investigation and diagnosis through to ongoing management, depending on your symptoms and what matters most to you.

If you think you might have PMOS (PCOS) Hertility’s Advanced Hormone and Fertility Test checks the relevant reproductive hormones and interprets them alongside your cycle history, symptoms and wider health. If a closer look at your ovaries would help, a Pelvic Ultrasound Scan can assess your ovaries and womb and count your follicles, with results reviewed by a gynaecologist. Together, these help work out whether you meet the criteria for PMOS and rule out other causes.

Once you have answers. A Hertility Women’s Health GP can support you with managing irregular or absent periods, acne and hair changes, contraception, medication, metabolic health, and fertility or preconception concerns. You can also get more specialist help:

• a Nutrition Consultation for insulin resistance, metabolic health, supplements or weight goals, without restrictive diets
• counselling if PMOS is affecting your mental health, body image or wellbeing

Not sure where to start? Take the Online Health Assessment and we’ll build a personalised plan around your symptoms and priorities.

References

1. Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction. 2023;38(9):1655–1679. https://doi.org/10.1093/humrep/dead156
2. NICE Clinical Knowledge Summaries. Polycystic ovary syndrome. https://cks.nice.org.uk/topics/polycystic-ovary-syndrome/
3. UK Chief Medical Officers. Physical activity guidelines, 2019. https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report
4. NHS. Tiredness and fatigue. https://www.nhs.uk/conditions/tiredness-and-fatigue/
5. NHS. Sleep apnoea. https://www.nhs.uk/conditions/sleep-apnoea/
6. NICE. Acne vulgaris: management (NG198). https://www.nice.org.uk/guidance/ng198
7. NHS. Acne: treatment. https://www.nhs.uk/conditions/acne/treatment/
8. NHS. Hair loss. https://www.nhs.uk/conditions/hair-loss/
9. NICE. Semaglutide for managing overweight and obesity (TA875). https://www.nice.org.uk/guidance/ta875
10. Fitz V, Graca S, Mahalingaiah S, et al. Inositol for polycystic ovary syndrome: a systematic review and meta-analysis to inform the 2023 update of the international evidence-based PCOS guidelines. Journal of Clinical Endocrinology & Metabolism. 2024;109(6):1630–1655. https://pmc.ncbi.nlm.nih.gov/articles/PMC11099481/