Beyond Hormones: Understanding PMOS, Stress and Insulin Resistance

Written by: Dr. Ilma Imtiaz

Short answer: Polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS), is more than an ovarian condition. It is a complex endocrine and metabolic syndrome that can affect hormone regulation, metabolism and reproductive health. While there is no cure, evidence-based lifestyle strategies, including nutritious eating, regular physical activity, quality sleep and stress management, form the foundation of care. Some women may also choose evidence-informed supplements to support healthy glucose metabolism and metabolic wellness as part of an overall healthy lifestyle.

You may know this condition as polycystic ovary syndrome (PCOS). In 2026, an international consensus renamed it polyendocrine metabolic ovarian syndrome (PMOS) to better reflect what research has shown for years: this is a whole-body condition involving multiple hormonal and metabolic systems, not simply the ovaries.

Because much of the published research still uses the term PCOS, both names are used throughout this article. For many women, PMOS can affect menstrual cycles, fertility, blood sugar regulation, energy levels, body composition and long-term metabolic health. Understanding these connections shifts the conversation away from searching for a quick fix and towards building sustainable habits that support overall wellbeing.

What is PMOS?

PMOS is one of the most common endocrine and metabolic conditions affecting women of reproductive age, affecting an estimated 10–13% of women worldwide [1]. Yet up to 70% of women may remain undiagnosed, often because symptoms develop gradually and vary considerably from one person to another [2].

There is no single test for PMOS. Instead, healthcare professionals diagnose the condition using a combination of features, including irregular or absent ovulation, signs of higher androgen levels such as acne or excess facial or body hair and polycystic ovarian morphology on ultrasound.

Although PMOS is a leading cause of ovulation-related infertility, it is also a lifelong metabolic condition associated with insulin resistance and an increased risk of conditions such as type 2 diabetes [2]. Understanding PMOS as a whole-body condition helps explain why metabolic health is such an important part of long-term management.

Why insulin resistance matters

One of the advances in PMOS research has been recognizing the important role of insulin resistance [3]. Insulin is the hormone that helps move glucose from the bloodstream into cells for energy. When the body's cells become less responsive to insulin, the pancreas produces more to compensate. These higher insulin levels can influence both metabolism and hormone production.

Not every woman with PMOS has insulin resistance, but it is one of the most common metabolic features of the condition. Higher insulin levels may contribute to increased androgen production, affecting ovulation while contributing to symptoms such as acne, excess facial or body hair, and scalp hair thinning [4].

Insulin resistance may also influence appetite, energy levels and the way the body stores energy, helping explain why some women experience persistent hunger, carbohydrate cravings, fluctuating energy or weight that feels particularly difficult to manage [5].

Importantly, insulin resistance is only one part of the picture. Genetics, inflammation, lifestyle and environmental factors all contribute to PMOS, making it a complex condition involving multiple interconnected biological systems rather than a single underlying cause.

Stress, cortisol and "PMOS belly"

Many women notice that periods of ongoing stress seem to make their symptoms worse. Busy schedules, poor sleep or emotional stress may coincide with stronger cravings, lower energy or greater difficulty maintaining healthy habits.

Stress does not cause PMOS, but it may make living with the condition more challenging. During periods of stress, the body releases hormones such as cortisol, which plays an essential role in regulating energy, blood sugar, immune function and the body's response to everyday challenges [6]. The issue isn't cortisol itself; it's the effects of chronic stress on sleep, eating habits, physical activity and overall metabolic health.

Some studies have reported differences in cortisol regulation among women with PMOS, although the findings remain mixed and cortisol is not considered a diagnostic marker for the condition [7,8]. A helpful way to think about stress is as a volume dial rather than an on/off switch. It doesn't create PMOS, but it may amplify existing symptoms by making healthy routines more difficult to maintain.

Many women also describe having a "PMOS belly", persistent abdominal weight gain that feels unusually difficult to lose [4]. Although this isn't a medical diagnosis, it reflects a common experience. Rather than being caused by one single "belly fat hormone," abdominal weight is influenced by a combination of insulin resistance, hormonal changes, sleep, stress, physical activity, and overall energy balance. This is why there is rarely a single solution. Sustainable habits that support overall metabolic health are far more likely to benefit long-term health than restrictive diets, detoxes, or products promising rapid results.

Building a foundation: what can you do?

Although there is no cure for PMOS, there are many evidence-based strategies that can support long-term metabolic and reproductive health. Because every woman experiences PMOS differently, management should be individualized, practical and sustainable. International clinical guidelines consistently recommend lifestyle as the foundation of care, with supplements and medications considered alongside, not instead of, these healthy habits.

Rather than following restrictive diets or eliminating entire food groups, focus on an eating pattern that you can maintain over the long term. Meals centered on vegetables, fruit, wholegrains, legumes, healthy fats and lean sources of protein support overall health, while regular, balanced meals may also help support healthy energy levels and glucose metabolism [9,10].

Physical activity is equally important. Both aerobic exercise and resistance training have been shown to benefit women with PMOS by supporting cardiovascular health, muscle strength, insulin sensitivity, mood and sleep. The best form of exercise is the one you enjoy and can maintain consistently [10].

Finally, don't underestimate the importance of sleep and stress management. While improving sleep or reducing stress won't cure PMOS, both can make healthy habits easier to maintain and support overall metabolic wellbeing.

Where do inositol and berberine fit?

Once these lifestyle foundations are in place, some women choose to include evidence-informed supplements as part of their overall wellness routine. Two of the most researched ingredients are myo-inositol and berberine. Although they are often compared, they have different mechanisms of action and have been studied for different aspects of metabolic health.

Myo-inositol

Myo-inositol plays an important role in insulin signalling and has been widely studied in women with PMOS. A 2024 systematic review and meta-analysis conducted to inform the international PCOS guideline found that inositol may improve some metabolic and reproductive outcomes, although the overall certainty of the evidence remained limited [11].

More recent umbrella reviews have reported encouraging improvements in measures such as insulin resistance, ovulation and hormone balance, while also concluding that much of the available evidence is of low or very low certainty [12]. Taken together, current research suggests that myo-inositol may be a reasonable evidence-informed option for women seeking support for insulin function and menstrual health as part of a broader management plan.

Berberine

Berberine is a naturally occurring plant compound that has been extensively researched for metabolic health. In women with PMOS, systematic reviews suggest berberine may support healthy glucose metabolism, insulin-related markers, lipid balance and some body composition measures [13,14]. Beyond PMOS, berberine has also been widely studied in people with metabolic dysfunction, where research has reported improvements in markers of glucose regulation and lipid metabolism [15].

Why the form of berberine matters

One important consideration is that not all berberine supplements are formulated the same way. Traditional berberine hydrochloride (HCl) has relatively poor absorption, which has led to the development of newer delivery technologies. 

Berbevis® is a clinically studied berberine phytosome that combines berberine with a phospholipid delivery system designed to enhance absorption compared with standard berberine HCl [16]. It has been evaluated for supporting healthy glucose metabolism, insulin function, lipid balance, and overall metabolic health, including in women with PMOS [14]. 

In an eight-week pilot study of 12 women with PMOS [14], Berbevis® was associated with favorable changes in markers of glucose metabolism (including fasting glucose and HOMA), lipid metabolism, body composition, inflammation and hormone balance.

Improvements in acne severity were also reported, and the formulation was well tolerated. While encouraging, these findings come from a small pilot study and require confirmation in larger clinical trials. Together with the broader body of evidence on berberine, Berbevis® has been studied for supporting healthy glucose metabolism, insulin function and metabolic wellness as part of a healthy lifestyle.

Take-home message

PMOS doesn't define who you are or what your future looks like. While it can present unique challenges, understanding your body empowers you to make choices that support your long-term health.

Start with the foundations: nourishing food, regular movement, quality sleep and stress management. If you're considering supplements, choose products supported by clinical evidence and discuss what's right for you with your healthcare professional. Sustainable habits, not quick fixes, are what make the biggest difference over time.

Dr. Ilma Imtiaz has a background in biomedical and naturopathic research and recently completed her PhD at the National Centre for Naturopathic Medicine, Southern Cross University, Australia. She is a lead and co-author of multiple peer-reviewed publications, including experimental and review papers across herbal medicine, cancer biology and molecular mechanisms.

At the heart of her work is a passion for science communication, translating complex evidence into clear, engaging and accessible insights. She is committed to evidence-led wellness and supporting informed, balanced health decisions.

References

1. World Health Organization. Polycystic ovary syndrome. Updated 22 January 2026. Accessed 14 July 2026, https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome

2. Chan JL, Masini I, Pisarska MD. Polyendocrine metabolic ovarian syndrome (PMOS)/polycystic ovary syndrome (PCOS): current and future trends. The Journal of Clinical Investigation. 2026;136(12)

3. Sharma S, Gupta G, Sarath Babu V, et al. Perspectives of Polyendocrine Metabolic Ovarian Syndrome (PMOS): A systematic review. International Journal of Clinical Obstetrics and Gynaecology. 2026;10(3):569-577. 

4. Xu Y, Qiao J. Association of Insulin Resistance and Elevated Androgen Levels with Polycystic Ovarian Syndrome (PCOS): A Review of Literature. J Healthc Eng. 2022;2022(1):9240569. doi:https://doi.org/10.1155/2022/9240569

5. Stefanaki K, Karagiannakis DS, Peppa M, et al. Food cravings and obesity in women with polycystic ovary syndrome: pathophysiological and therapeutic considerations. Nutrients. 2024;16(7):1049. 

6. James KA, Stromin JI, Steenkamp N, Combrinck MI. Understanding the relationships between physiological and psychosocial stress, cortisol and cognition. Review. Front Endocrinol (Lausanne). 2023-March-06 2023;Volume 14 - 2023doi:10.3389/fendo.2023.1085950

7. Marschalek ML, Marculescu R, Schneeberger C, Marschalek J, Dewailly D, Ott J. A case-control study about markers of stress in normal-/overweight women with polycystic ovary syndrome and in controls. Front Endocrinol (Lausanne). 2023;14:1173422. doi:10.3389/fendo.2023.1173422

8. Benjamin JJ, Kuppusamy M, Koshy T, Kalburgi Narayana M, Ramaswamy P. Cortisol and polycystic ovarian syndrome - a systematic search and meta-analysis of case-control studies. Gynecol Endocrinol. Nov 2021;37(11):961-967. doi:10.1080/09513590.2021.1908254

9. Kazemi M, Kim JY, Wan C, et al. Comparison of dietary and physical activity behaviors in women with and without polycystic ovary syndrome: a systematic review and meta-analysis of 39 471 women. Hum Reprod Update. 2022;28(6):910-955. doi:10.1093/humupd/dmac023

10. Shahid R, Iahtisham-Ul-Haq, Mahnoor, et al. Diet and lifestyle modifications for effective management of polycystic ovarian syndrome (PCOS). J Food Biochem. 2022;46(7):e14117. doi:https://doi.org/10.1111/jfbc.14117

11. 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. J Clin Endocrinol Metab. May 17 2024;109(6):1630-1655. doi:10.1210/clinem/dgad762

12. Duan M, Yang M, Li C, Wu X, Yin X, Zhu HH. Effects of inositol in women with polycystic ovary syndrome: an umbrella review of meta-analyses from randomized controlled trials. Systematic Review. Front Endocrinol (Lausanne). 2026-February-11 2026;Volume 17 - 2026doi:10.3389/fendo.2026.1741509

13. Ha S, Song X. Berberine as adjuvant therapy for treating reduced fertility potential in women with polycystic ovary syndrome: A meta-analysis of randomized controlled trials. Explore (NY). Nov-Dec 2024;20(6):103040. doi:10.1016/j.explore.2024.103040

14. Rondanelli M, Riva A, Petrangolini G, et al. Berberine Phospholipid Is an Effective Insulin Sensitizer and Improves Metabolic and Hormonal Disorders in Women with Polycystic Ovary Syndrome: A One-Group Pretest-Post-Test Explanatory Study. Nutrients. Oct 19 2021;13(10)doi:10.3390/nu13103665

15. Guo J, Chen H, Zhang X, et al. The Effect of Berberine on Metabolic Profiles in Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Oxid Med Cell Longev. 2021;2021(1):2074610. doi:https://doi.org/10.1155/2021/2074610

16. Petrangolini G, Corti F, Ronchi M, Arnoldi L, Allegrini P, Riva A. Development of an Innovative Berberine Food-Grade Formulation with an Ameliorated Absorption: In Vitro Evidence Confirmed by Healthy Human Volunteers Pharmacokinetic Study. Evid Based Complement Alternat Med. 2021;2021:7563889. doi:10.1155/2021/7563889