Polycystic Ovary Syndrome: PCOS or PMOS? A Scientific Review of Nutrition, Hormones, and the Role of Lifestyle in Fertility

Introduction

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One of the most common challenges faced by women of reproductive age is Polycystic Ovary Syndrome (PCOS).

However, an important point is that, in recent years, the scientific understanding of this disorder has been evolving, and emerging research defines it as more than a simple ovarian condition.

In this article, drawing on reputable international sources such as the WHO and ASRM, we examine this disorder from a scientific perspective in a simple and practical way.

What Is PCOS?

Polycystic Ovary Syndrome is a chronic hormonal–metabolic disorder that affects ovarian function, the body’s metabolism, and the menstrual cycle.

It is one of the most important causes of ovulatory disorders and infertility among women of reproductive age.

According to international guidelines from official organizations such as ASRM, Monash, and WHO, this disorder is not limited to the reproductive years, and its effects may continue even after menopause.

Main Features of PCOS

Body system	Changes in PCOS	Symptoms
Hormonal system	Increased LH and androgen levels	Acne and excess hair growth
Ovarian system	Ovulatory dysfunction	Irregular periods
Metabolic system	Insulin resistance	Weight gain
Psychological system	Increased stress	Anxiety and depression

🧠 Diagnostic Criteria for PCOS

For a diagnosis of PCOS, at least two of the following three criteria must be present:

• Ovulatory dysfunction
• Increased levels of male hormones, known as androgens
• Polycystic ovarian appearance on ultrasound

What Are LH and FSH?

To understand PCOS, we need to become familiar with two key hormones.

FSH = Follicle-Stimulating Hormone

FSH is responsible for stimulating ovarian follicles and preparing them for egg development.

Its role can be compared to that of an “egg-development coach.”

When FSH does not function properly, follicles may fail to reach full maturity, and the egg may not become ready for release. As a result, fertilization or pregnancy may be delayed.

LH = Luteinizing Hormone, the Hormone Responsible for Egg Release

LH is responsible for the final stage of ovulation.

This is the moment when the egg is released from the ovary. In people with PCOS, LH levels are often excessively elevated, disrupting the natural balance of the menstrual cycle.

In many women with PCOS, the balance between these two hormones is disrupted:

• High LH
• Normal or relatively low FSH

This imbalance causes follicles to grow without being released, makes ovulation irregular, and ultimately makes pregnancy more difficult.

Global Prevalence of PCOS

According to recent meta-analyses published in 2026, the global prevalence of PCOS is estimated to be approximately 12%. In some regions, such as the Middle East and South Asia, prevalence may exceed 14% to 15%.

This means that approximately one in every eight to ten women of reproductive age may experience some degree of this disorder. These statistics demonstrate that PCOS is not a rare condition but a major public health challenge requiring a systematic approach to diagnosis and management.

• Global prevalence: approximately 12%
• Prevalence in the Middle East: approximately 15%
• Prevalence in Iran: approximately 14.6%

PCOS is a common global condition, not a rare disorder.

Nutrition in PCOS

One of the most important aspects of PCOS management is improving dietary habits.

Many people assume that reducing sugar intake only means eliminating table sugar, sweets, and soft drinks. However, the scientific reality is different.

Hidden sources of sugar and rapidly absorbed carbohydrates may include:

• White bread
• White rice
• Potatoes
• Industrially produced fruit juices
• Certain high-sugar fruits

These foods can cause insulin levels to rise rapidly. Therefore, people with PCOS should minimize their consumption of these foods and, with the approval of a specialist physician, may eliminate them from their diet for certain periods.

Contrary to common belief, the main goal of a PCOS diet is not only weight loss. The most important objectives are controlling insulin levels and reducing chronic inflammation in the body—two factors that have a direct role in ovulatory dysfunction and increased hormonal symptoms.

When the body is insulin-resistant, the ovaries are also affected. This can lead to increased androgen production, irregular menstrual cycles, and even worsening of physical symptoms such as acne and excess hair growth.

For this reason, an appropriate PCOS diet should be designed to prevent significant fluctuations in blood sugar and guide the body toward metabolic balance.

Suggested Food Table for PCOS

Role in the body	Effect in PCOS	Recommended foods	Food group
Reduces inflammation, provides high fiber, and improves digestion	Helps reduce insulin levels and improve ovulation	Spinach, broccoli, lettuce, and cucumber	🥬 Vegetables—the foundation of the diet
Creates longer-lasting fullness and stabilizes blood sugar	Reduces insulin fluctuations and supports hormonal balance	Egg whites, chicken, and fish	🍗 Proteins
Supports hormone regulation and cellular health	Reduces inflammation and supports ovarian function	Olive oil, avocado, and nuts	🥑 Healthy fats

Lifestyle in PCOS

In many cases, even small lifestyle changes can have a significant effect on PCOS symptoms.

Losing as little as 5% of body weight may improve ovulation. Regular exercise also increases insulin sensitivity, which contributes to improved hormonal balance.

Therefore, regular exercise can:

• Increase insulin sensitivity
• Regulate the menstrual cycle
• Support weight management

It may also be helpful to know that even a 5% to 10% reduction in body weight can have a significant effect on improving PCOS and restoring hormonal balance.

The Role of Stress in Worsening PCOS

When cortisol levels rise:

• Signals from the brain to the ovaries may become disrupted
• The balance between LH and FSH may become more disturbed
• Ovulation may become more irregular
• Physical symptoms such as acne and excess hair growth may worsen
• Fertility problems may develop or intensify
• The menstrual cycle may become less predictable

In fact, stress can worsen the hormonal imbalance already present in PCOS and cause symptoms to become more severe or unpredictable.

Chronic stress causes:

• Increased cortisol
• Hormonal disruption
• Worsening of PCOS symptoms

In the short term, cortisol helps the body cope with difficult situations. However, when stress becomes chronic, cortisol may remain continuously elevated, leading to disruption in other hormonal systems of the body.

One of the most important emerging scientific findings is that stress does not affect only sex hormones; it is also directly connected to the body’s metabolism.

Chronic stress may:

• Increase insulin levels
• Worsen insulin resistance
• Increase the body’s tendency to store fat

This is precisely the type of cycle observed in PCOS. This is why many women with PCOS report that symptoms such as weight gain, acne, or menstrual irregularity become more severe during stressful periods.

Managing PCOS does not involve only medication and diet. It should also include stress management and psychological well-being.

Recommended lifestyle changes include:

• Improving sleep quality
• Engaging in regular physical activity
• Using stress-reduction techniques such as deep breathing and yoga
• Receiving psychological and social support

These approaches are not regarded as alternative treatments, but rather as part of a comprehensive PCOS management plan.

The Role of Technology in PCOS Management

Today, PCOS management does not take place only in clinics.

Tools such as DLady can help users:

• Record their menstrual cycles
• Analyze hormonal patterns
• Match lifestyle factors with symptoms

The Role of Insulin in PCOS

One of the most important emerging scientific findings is that PCOS is not only a hormonal disorder; it is also a metabolic disorder and, in many cases, is associated with insulin resistance.

What Does Insulin Resistance Mean?

It means that the body’s cells do not respond properly to insulin, forcing the body to produce more insulin.

Insulin is not only a hormone responsible for controlling blood sugar. It also plays a very important role in hormonal balance. When the body becomes resistant to insulin, insulin levels rise, and this increase may stimulate the ovaries to produce more androgens.

Increased androgen levels are one of the main causes of symptoms such as acne, excess hair growth, and hair loss in women with PCOS.

For this reason, new guidelines identify lifestyle modification and metabolic control as the foundation of treatment, rather than relying only on medication.

Medical guidelines confirm that insulin resistance, which is common in PCOS, is directly associated with:

• BMI
• Abdominal fat
• Chronic inflammation

As a result, this condition may lead to:

• Increased androgen levels
• Worsening of acne and excess hair growth
• Ovulatory dysfunction

PCOS or PMOS? A New Scientific Perspective

In recent years, some researchers have proposed a new term called PMOS:

Polyendocrine Metabolic Ovarian Syndrome

This proposed name change is based on the understanding that:

• PCOS is not only an ovarian disorder
• It is a widespread metabolic–hormonal disorder

However, this term has not yet been officially adopted, and PCOS remains the globally accepted standard term.

Conclusion

PCOS is not a simple condition. It is a complex hormonal–metabolic disorder that requires long-term management.

PCOS can be managed, and with awareness, lifestyle modifications, and appropriate monitoring, its symptoms and effects on the body can be controlled.

Installing the DLady application and recording your symptoms in the Symptomos section can help you monitor your symptoms and receive more precise insights.