PMOS Doesn’t End at Menopause and Neither Should Its Care
Although Polyendocrine Metabolic Syndrome is typically identified earlier in life, its effects often persist into perimenopause and menopause, when age-related hormonal changes can further intensify symptoms and risks.
Study Snapshot: Polycystic Ovary Syndrome, which was just renamed Polyendocrine Metabolic Syndrome (PMOS), is the most common hormonal and metabolic disorder affecting women of reproductive age, impacting up to 13% of women and contributing to nearly 40% of infertility cases worldwide. It is associated with insulin resistance, hormonal imbalance, inflammation and metabolic dysfunction, often leading to irregular cycles, weight gain, chronic pain and increased risk of diabetes and cardiovascular disease. These symptoms can also reduce quality of life, even when formal mental health diagnoses are not present. Although PMOS is typically identified earlier in life, its effects often persist into perimenopause and menopause, when age-related hormonal changes can further intensify symptoms and risks. However, women in these later stages remain underrepresented in research.
To address this gap, FAU researchers reviewed more than 2,200 studies published between 2000 and 2024, identifying 29 peer-reviewed studies focused on non-pharmacological and non-surgical approaches for women with PMOS during midlife and reproductive aging. These studies – including clinical trials, cohort studies and reviews of women in perimenopause and menopause – examined lifestyle changes, supplements, chronic pain and quality of life. Published in the American Journal of Lifestyle Medicine, the findings show that lifestyle interventions, particularly diet and exercise, are most consistently supported, while evidence for complementary therapies is limited and chronic pain and mental health remain largely understudied.
Polycystic Ovary Syndrome, which has just been renamed Polyendocrine Ovarian Syndrome (PMOS), is the most common hormonal and metabolic disorder affecting women of reproductive age, impacting up to 13% of this population and contributing to nearly 40% of infertility cases worldwide. The condition is marked by a complex combination of hormonal imbalance, insulin resistance, metabolic dysfunction and inflammation, often leading to irregular menstrual cycles, weight gain and increased cardiovascular and diabetes risk.
Beyond these physical effects, many women also experience chronic pain and reduced quality of life, even when traditional mental health diagnoses such as depression or anxiety are not formally present.
While PMOS is typically identified earlier in life, its impact does not end with reproductive years. As women transition through perimenopause and menopause, normal hormonal changes can overlap with long-standing PMOS-related dysfunction, making symptoms more difficult to distinguish and, in some cases, more severe. This can amplify risks related to metabolic health, chronic pain and overall well-being, yet midlife and older women remain underrepresented in PMOS research and treatment studies.
As a result, important questions remain about how best to manage PMOS across the lifespan, particularly in later life stages where cardiometabolic risks are heightened and evidence is limited.
To address this critical gap, Florida Atlantic University researchers conducted a scoping review that synthesized evidence on non-pharmacological and non-surgical approaches for managing PMOS in adult women, including those in perimenopause and menopause. The review focuses on lifestyle modifications and complementary therapies, as well as interventions targeting PMOS-related chronic pain and mental health challenges during midlife and reproductive aging. It also examines how these symptoms, along with psychological distress, contribute to reduced quality of life in this population.
Researchers analyzed more than 2,200 scientific articles published between 2000 and 2024, narrowing the field to 29 rigorously selected peer-reviewed studies that provide the strongest available evidence. These studies included clinical trials, cohort studies and reviews involving adult women with PMOS during perimenopause, menopause or both. Together, they examined lifestyle changes, supplements, chronic pain and quality of life.
The results, published in the American Journal of Lifestyle Medicine, show a clear pattern: lifestyle interventions – especially diet and exercise – are the most consistently studied and most beneficial approaches. Exercise was the only intervention linked not only to physical health improvements, but also to better mental health outcomes. Dietary approaches were frequently associated with improvements in metabolic health, such as insulin regulation and body composition.
In contrast, complementary therapies were widely studied but far less conclusive. Across more than 15 categories of supplements – including vitamin D, omega-3s, probiotics, herbal remedies and plant-based extracts – research showed potential metabolic and hormonal benefits, but very little focus on mental health or chronic pain. In fact, only two studies addressed chronic pain at all, and both relied on dietary supplements rather than structured pain-management strategies.
“Our findings underscore a major imbalance in the evidence base: while diet, exercise and supplements are frequently explored for metabolic outcomes, key issues like chronic pain and mental health – both critical to quality of life in PMOS – are largely overlooked,” said Candy Wilson, Ph.D., APRN, primary author, professor and associate dean for research and scholarship in FAU’s Christine E. Lynn College of Nursing.
The results point to a clear need for more integrated, person-centered care strategies that combine lifestyle and complementary approaches while directly addressing the physical, psychological and pain-related burdens of PMOS during midlife.
“Our research highlights how little evidence exists for managing key aspects of PMOS beyond metabolic health during midlife,” said Lea Sacca, Ph.D., senior author and an assistant professor of population health in FAU’s Charles E. Schmidt College of Medicine. “While diet and exercise continue to show measurable benefits, we see a striking lack of research focused on chronic pain and mental health in this population. Addressing these gaps will be critical for developing more complete, effective approaches to care that reflect the full impact of the condition.”
In the United States alone, an estimated 5 to 6 million women are affected, although as many as 70% remain undiagnosed. The condition is strongly linked to metabolic dysfunction, with about 50% to 70% of women experiencing insulin resistance and facing a fourfold increased risk of developing type 2 diabetes. PMOS is also associated with significantly higher risks of hypertension, cardiovascular disease and stroke, even independent of body weight.
Beyond metabolic health, PMOS has broad physical and psychological effects. Up to 80% of women are overweight or obese, and as many as 80% experience elevated androgen levels that disrupt hormonal balance. Women with PMOS are also three times more likely to experience depression and up to five times more likely to experience anxiety, contributing to reduced quality of life. Long-term studies show nearly a 50% increased risk of premature mortality, largely driven by cardiometabolic disease.
“We must reframe PMOS as a lifelong condition that extends beyond the reproductive years,” said Wilson. “As women enter perimenopause and menopause, cardiometabolic, pain and psychological risks can persist or worsen. Nurses are well positioned to recognize these overlapping risks, provide holistic care and support long-term self-management aligned with patient goals.”
Study co-authors are Lenny Chiang-Hanisko, Ph.D., an associate professor in FAU’s Christine E. Lynn College of Nursing; Sahar Kaleem, an FAU medical student; Moradi Aljadani, Ph.D., a Ph.D. graduate of FAU’s Christine E. Lynn College of Nursing; Jennifer Mendonca and Shaima Arshad, FAU medical students; Nicole Pirrone, NP, a Ph.D. student in the Christine E. Lynn College of Nursing; and Tiffany Follin, medical librarian, FAU Schmidt College of Medicine.
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