It has been three months without a period. Acne is thick on your chin and jawline, and more hair comes out every time you brush it. You have an ultrasound, are told you have polycystic ovaries, and go home with a prescription to regulate your periods. While you take the medicine, your periods come regularly. A few months after stopping, the cycle spaces out again as before, and the acne comes back.
Others are slim, with a weight that has not changed for years, and still believe the condition only goes with being overweight, until they are diagnosed with it themselves.
International experts now call polycystic ovary syndrome by a new name, PMOS (polyendocrine metabolic ovarian syndrome; the old name was PCOS). The new name describes the nature of the condition more accurately: it involves insulin, hormones, weight, sleep and mood, and the ovaries are simply the place where it is easiest to see (Chedraui and Nappi, 2026).
What polycystic ovary syndrome is
PMOS affects about 5–18% of women. Joham and colleagues (2022) describe it as a condition that is at once reproductive, metabolic and psychological, with lifelong effects.
There is no single cause. Genetics and epigenetics, disturbances in the hypothalamus and the ovaries, excess androgens (the group of male sex hormones that a woman’s body also has at low levels), insulin resistance and fat tissue are all intertwined.
The “cysts” seen on ultrasound are small egg follicles that stopped growing partway, before they reached the point of ovulation. They are different from ovarian cysts.
What criteria the diagnosis is based on
Doctors use the Rotterdam 2003 criteria, which require at least two of the following three signs (Joham and colleagues, 2022):
- High androgens, seen on the skin as acne or excess hair on the face, chest or abdomen, or shown by a blood test;
- Irregular cycles, meaning infrequent periods or no period for several months;
- Polycystic ovaries on ultrasound.
Because only two out of three are needed, some people are diagnosed even with a normal ultrasound. On the other hand, many follicles on ultrasound with regular periods and no signs of high androgens are not enough for a diagnosis. The doctor also needs to rule out other hormonal conditions that look similar. In adults, an AMH blood test can be used instead of an ultrasound (Teede and colleagues, 2023).
Teenagers are assessed differently. Both high androgens and irregular cycles must be present, and the appearance of the ovaries is not used, because at this age many follicles on ultrasound are not very specific (Joham and colleagues, 2022). In the first few years after periods start, cycles are often not yet stable, so families tend to wait for their daughter to grow a bit older. If infrequent periods go on for a long time together with severe acne or excess hair, take your teenager to see a doctor, because PMOS is still often diagnosed late (Teede and colleagues, 2023).
How insulin resistance, androgens, weight and the cycle are connected
Insulin helps move sugar from the blood into the cells. When the cells respond poorly, which is called insulin resistance, the pancreas has to release more insulin to keep blood sugar in check. Insulin that stays high for a long time stimulates the ovaries to make more androgens.
Excess androgens make it hard for follicles to grow to the point of ovulation. Follicles that stop partway create the polycystic appearance, and irregular ovulation means infrequent periods. The same excess androgens also make the skin oily, cause acne and make hair grow thicker.
Fat tissue, especially around the belly, makes insulin resistance worse (Joham and colleagues, 2022). High insulin in turn makes the body store fat more easily, so keeping your weight steady may be harder. This may explain why medicine to regulate periods keeps the cycle regular while you take it, but once you stop, the cycle tends to space out again if insulin resistance is still there.
Insulin resistance has one visible sign, called acanthosis nigricans. These are dark, thickened patches of skin that feel smooth like velvet, on the neck and in the armpits.
PMOS also comes with metabolic and cardiovascular risks (Teede and colleagues, 2023). That is why follow-up needs to continue long term, even once your periods are regular.
Slim people can have PMOS too
Toosy and colleagues (2018) describe one type of PMOS that comes with excess weight and another in lean people, the latter being less common. Lean people with PMOS still have hormonal and metabolic changes. According to the authors, insulin resistance appears to be a built-in feature of PMOS, independent of obesity.
Because many people link this condition with weight, PMOS may be considered late in slim people. Advice to lose weight does not suit everyone. For slim people, the aim is to keep a stable weight, support ovulation when trying to conceive, and ease symptoms.
Mood and sleep are part of the condition too
The 2023 international guideline recognizes that psychological problems are very common in people with PMOS and places emotional health alongside physical treatment (Teede and colleagues, 2023). Many people feel anxious, low or self-conscious about acne and hair, sometimes about their weight, and don’t always say so during the visit. The guideline also cautions against weight stigma.
PMOS is also linked to sleep apnea (Teede and colleagues, 2023). If you snore loudly, have stretches of silence followed by a sudden strong breath, and wake up with a heavy head, tell your doctor.
When trying to conceive and during pregnancy
PMOS is a common reason why trying for a baby takes longer than expected, mainly because ovulation is irregular. Irregular ovulation does not rule out pregnancy. Many people with PMOS do become pregnant, some once their cycles become regular again, others with help from a fertility specialist.
Once pregnant, people with PMOS are in a higher-risk group (Teede and colleagues, 2023) and need close monitoring from early pregnancy. If you have been trying to conceive for a long time without good news, both partners should get checked early. You can read more about when to get checked when trying to conceive.
How traditional medicine sees PMOS
Traditional medicine texts have no name for polycystic ovaries. Its signs fall under the conditions of delayed periods (月经后期 / 月經後期, yuè jīng hòu qī), absent periods (闭经 / 閉經, bì jīng) and difficulty conceiving (不孕, bù yùn). Through the four examinations (looking, listening, asking and taking the pulse), the doctor identifies the pattern, and the common patterns are:
- Kidney deficiency (肾虚 / 腎虛, shèn xū), with infrequent, scanty periods, a tired lower back and knees, and tiring easily;
- Phlegm-dampness (痰湿 / 痰濕, tán shī), with a heavy, sluggish feeling, a full belly, oily skin and a thick, greasy tongue coating;
- Liver qi stagnation (肝郁 / 肝鬱, gān yù), with frequent stress, irritability, breast tenderness before periods, and a cycle that shifts with your mood;
- Blood stasis (血瘀, xuè yū), with dark menstrual blood, clots and abdominal pain during periods.
Many people have two patterns overlapping, such as Kidney deficiency with phlegm-dampness.
Your visit at Tam Duc
The first visit with Dr. Pham Tran Dan Tam (MD, Specialist Level I in Traditional Medicine) lasts about 30–45 minutes. It starts with your period calendar over the past few months and signs of high androgens such as acne, body hair and scalp hair. Then come weight, sleep, mood and what you want most right now. Bring your period calendar, earlier test results and a list of the medicines and supplements you take, because some herbs change the effects of conventional medicines (Ulbricht and colleagues, 2008).
The doctor does a modern medical examination together with the four examinations of traditional medicine (looking, listening, asking, taking the pulse). Ultrasound and tests for hormones, blood sugar and insulin are suggested when needed, before treatment begins.
The clinic also uses Applied Kinesiology (AK), that is, muscle testing, to check stress and which minerals and medicinal substances suit you. Muscle testing adds to hormone tests and ultrasound; it does not replace them. Read more: is muscle testing safe?
Treatment and follow-up at Tam Duc
Eating, movement and sleep
A healthy lifestyle is the foundation of treatment. Joham and colleagues (2022) list balanced eating, regular physical activity, avoiding weight gain, and losing weight when needed. For slim people, the aim is to keep a stable weight (Toosy and colleagues, 2018).
The doctor asks about your weight as one piece of information, then works with you to choose a few changes you can keep up. That might mean meals with enough vegetables and protein, fewer sweets and sugary drinks, a form of exercise you enjoy, and regular sleep times. If the examination shows you are low in micronutrients, the doctor considers supplements.
Herbal decoctions, acupuncture and moxibustion
Herbal decoctions are modified according to your pattern, leaning toward strengthening the Kidney, transforming phlegm, soothing the Liver or getting the blood moving, and are adjusted after each follow-up visit. If you are busy, the decoction can be cooked for you. Acupuncture, sometimes with moxibustion (warming points with burning mugwort), is done by the doctor personally, to help regulate the cycle, ease stress and improve sleep.
Research on herbal decoctions and acupuncture specifically for PMOS is still limited, and responses vary from person to person. The doctor assesses progress through your period calendar, symptoms and follow-up tests.
Working with endocrinology and fertility specialists
At times you may need hormonal medicine, medicine to improve insulin resistance, or help with ovulation. In that case Dr. Tam works with an endocrinologist or fertility specialist, and prescribes herbal decoctions that take into account the medicines you are already taking.
Frequently asked questions
Can PMOS be cured for good?
PMOS has lifelong effects (Joham and colleagues, 2022). So the goal is long-term control: more regular cycles, skin and hair that bother you less, and a stable metabolism. Symptoms can ease a great deal once lifestyle and metabolism are addressed, but you should still have regular check-ups.
Will I have to take hormonal medicine forever?
Hormonal medicine is prescribed for a specific goal, such as regulating the cycle, reducing acne or reducing excess hair. How long you take it depends on that goal and on your condition. Ask the prescribing doctor rather than stopping or extending it on your own, and look after your lifestyle alongside it.
How much weight do I need to lose?
The weight goal depends on the person. Slim people don’t need to lose weight, only to keep it stable. People who are overweight have their own goal based on their cycle, test results and overall health. The doctor assesses this through how you eat, sleep and move, and your test results.
Worth keeping
- Keep a period calendar for at least three months, with the start date, how many days you bleed and how heavy the flow is;
- Check in the mirror whether the skin on your neck or in your armpits has dark, thick, velvety patches;
- If an ultrasound shows many follicles, ask the doctor which criteria the conclusion is based on;
- Cut down on sugary drinks;
- Choose a form of exercise you enjoy and keep it up every week;
- If you snore loudly and still feel tired in the morning, tell your doctor;
- Don’t stop the hormonal medicine you are taking on your own.
If your cycles have been infrequent for a long time, if acne and hair worry you, or if you are trying to conceive, you can book an appointment with Dr. Pham Tran Dan Tam (MD, Specialist Level I in Traditional Medicine) to be examined and find the cause.
References
- Joham AE, Norman RJ, Stener-Victorin E et al. (2022). Polycystic ovary syndrome. Lancet Diabetes Endocrinol 10(9):668-680. https://doi.org/10.1016/S2213-8587(22)00163-2;
- Teede HJ, Tay CT, Laven JJE et al. (2023). Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Eur J Endocrinol 189(2):G43-G64. https://doi.org/10.1093/ejendo/lvad096;
- Toosy S, Sodi R, Pappachan JM (2018). Lean polycystic ovary syndrome (PCOS): an evidence-based practical approach. J Diabetes Metab Disord 17(2):277-285. https://doi.org/10.1007/s40200-018-0371-5;
- Ulbricht C et al. (2008). Clinical evidence of herb-drug interactions: a systematic review by the Natural Standard Research Collaboration. Curr Drug Metab 9(10):1063-120. https://doi.org/10.2174/138920008786927785.
- Chedraui P, Nappi RE (2026). From ‘polycystic ovary syndrome’ to ‘polyendocrine metabolic ovarian syndrome’: why terminology matters. Gynecol Endocrinol 42(1):2680750. https://doi.org/10.1080/09513590.2026.2680750
