Health
PMOS: What you should know before trying for a baby
Abayomi Ajayi
For many women, the first time they hear about polyendocrine metabolic ovarian syndrome, or PMOS, is when they start trying to have a baby and discover that getting pregnant isn’t as straightforward as they expected.
The warning signs may have been there for years. Periods came irregularly, sometimes disappearing for months. There may have been acne, unwanted facial hair, difficulty managing weight or unexplained changes in the menstrual cycle. But when pregnancy wasn’t yet the goal, seeing a fertility specialist didn’t seem urgent. That can be a mistake.
PMOS, previously known as polycystic ovary syndrome, or PCOS, affects about one in eight women, or more than 170 million women worldwide. It isn’t simply an ovarian or fertility problem. The condition can involve hormones, ovulation, metabolism, mental health, skin and reproductive health.
The good news is that having PMOS doesn’t mean you cannot become pregnant. What matters is understanding what’s happening before you start trying.
Start with your periods. Your menstrual cycle can provide one of the earliest clues that something isn’t quite right. A woman who consistently has very long or unpredictable cycles, or goes months without menstruating, should tell her doctor. Don’t simply assume that irregular periods are normal for you.
Your doctor will want to know when menstruation started, how long your cycles usually last, whether your periods are becoming less frequent and whether there have been long gaps between them. Irregular or absent periods can indicate that ovulation isn’t happening regularly. And when ovulation is unpredictable, so is the fertile window.
Before trying for a baby, therefore, there’s a simple question worth asking: “Am I ovulating regularly?” If the answer isn’t clear, that’s a conversation worth having before months of unsuccessful attempts. Are you actually ovulating? Having a period doesn’t automatically mean that ovulation is occurring every cycle.
With PMOS, ovulation may be infrequent or absent. That’s one reason pregnancy can take longer to achieve. If the main problem is anovulation, treatment may initially focus on restoring or inducing ovulation rather than moving straight to more complex fertility procedures.
Understanding the reason for difficulty conceiving is important. The treatment should follow the problem, not the other way round. Some women with PMOS have signs of excess androgen, commonly described as male hormones. These may include troublesome facial or body hair, persistent acne or thinning hair on the scalp. These symptoms should not simply be dismissed as cosmetic problems. Tell your doctor about them. A proper assessment can help determine whether excess androgen is part of the picture.
Don’t skip the blood sugar check. This may be one of the most important parts of a preconception visit. PMOS is associated with an increased risk of abnormal glucose regulation and type 2 diabetes. Importantly, that risk isn’t limited to women who are overweight. So don’t assume that because you feel well, have no obvious symptoms of diabetes and aren’t overweight, your blood sugar must be normal.
Check blood pressure and your wider health. A preconception visit should look beyond fertility. Blood pressure, weight and other cardiovascular and metabolic risk factors deserve attention. Your mental health matters, too. Women with PMOS can experience significant psychological symptoms, and emotional wellbeing and quality of life are important parts of care.
A good consultation should leave room for questions such as: Are you sleeping well? Are you constantly anxious about your fertility? Are you struggling with your body image? Are you experiencing depression or overwhelming stress? These aren’t side issues. They’re part of your health and should be treated that way.
Don’t assume PMOS is the only fertility problem. A PMOS diagnosis doesn’t automatically explain every case of infertility. You may have an ovulation problem related to PMOS and still have another reproductive issue. Your partner may also have a fertility problem. That’s why fertility assessment needs to be individualised. If pregnancy doesn’t occur, other factors affecting conception should be considered. The goal isn’t to blame PMOS for everything. It’s to find out what is actually preventing pregnancy.
Lifestyle matters, but forget the blame. “Lose weight” is probably one of the most familiar pieces of advice women with PMOS hear. Sometimes weight management can improve health and reproductive outcomes, particularly when excess weight is present. But the conversation shouldn’t be about blame. It should be about health. PMOS doesn’t look exactly the same in every woman, and treatment shouldn’t either.
You may have an ultrasound showing multiple small ovarian follicles and be told you have “polycystic ovaries”. That finding alone doesn’t establish the full syndrome. The diagnosis is based on the broader clinical picture. So don’t panic over an ultrasound report, and don’t assume that a normal-looking ovary means PMOS has been ruled out. In other words, the scan is only one part of the story.
Before you start trying, have the conversation. If you think you may have PMOS, a preconception appointment should be about more than fertility. It should help answer some basic questions: Are your menstrual cycles regular? Are you ovulating? Do you have signs of excess androgen? Has your blood glucose been properly assessed? Is your blood pressure and overall metabolic health satisfactory? Could anything else be affecting your fertility or your partner’s fertility? What lifestyle changes would improve your health before pregnancy?
Perhaps the most important question is: What should you do differently because you have PMOS? These questions can help turn a diagnosis into a plan.
When should you see a doctor? Don’t wait until you’ve spent months worrying that something is wrong. Consider seeing a doctor before trying for pregnancy if your periods are consistently irregular or absent; you have symptoms suggesting excess androgens, such as troublesome facial hair or persistent acne; you’ve previously been diagnosed with PMOS or PCOS; or you have concerns about blood sugar, blood pressure or other metabolic problems.
A preconception consultation is also sensible if you’ve had previous fertility problems or pregnancy complications. And if you’re already trying to conceive and pregnancy isn’t happening, seek medical advice rather than simply assuming you need IVF. If you have PMOS, the best fertility plan begins before the pregnancy test turns positive. PMOS isn’t simply about the ovaries. It’s about hormones, metabolism, ovulation, fertility and a woman’s health as a whole.
So before trying for a baby, don’t just ask, “Will I get pregnant?” Ask the bigger question: “Am I as healthy and prepared as I can be for pregnancy, and what should I do now to give myself the best chance?” That conversation could save months of uncertainty and, for some women, change the entire fertility journey.
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