PMOS (formerly known as PCOS, read more about the name change HERE) affects 1 in 8 women and menstruators worldwide (probably more). That's more than 170 million people and yet estimates suggest that up to 70% of those who have it haven't been diagnosed.
One main reason for this is that the symptoms are easy to explain away, downplay or chalk up to stress, diet or just "how your body works." Since the condition looks different from person to person, getting a diagnosis has historically required a LOT of persistence.
Here's what to look for if you suspect you have PMOS.
The Diagnostic Criteria
PMOS is currently diagnosed using what's called the Rotterdam criteria. To receive a diagnosis, you need to meet at least TWO out of three of the following:
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Irregular or absent ovulation: This usually shows up as irregular periods — cycles that are longer than 35 days, unpredictable, or absent altogether. If your period has always been hard to predict or you regularly go months without one, that's worth flagging. Irregular ovulation also means irregular or absent LH surges, which you can actually track at home with ovulation test strips.
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Signs of elevated androgens ("male" hormones): This can show up in blood work as elevated testosterone or DHEAS, but it can also show up on your body. Think: persistent acne, especially along the jaw and chin; excess hair growth on the face, chest, or abdomen; and thinning hair or hair loss on the scalp. These are signs that androgens are elevated and they're often dismissed as cosmetic concerns rather than clinical ones.
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"Polycystic" ovaries: An ultrasound may show ovaries that appear enlarged with a higher-than-normal number of small follicles. Note: these are not cysts, they're arrested follicles that didn't complete ovulation (they look like cysts, hence polycystic). You can have PMOS without this finding on ultrasound.
The Symptoms That Often Get Missed
Beyond the three diagnostic criteria, PMOS comes with a broader symptom picture that's worth understanding.
Insulin resistance affects the majority of people with PMOS and it doesn't always present the way people expect. You might notice that you gain weight easily (particularly around the abdomen), struggle to lose it despite effort, experience energy crashes after eating carbohydrates, or have persistent cravings. These aren't personality flaws, they're metabolic signals.
Mental health impacts are real and well-documented. Research consistently links PMOS to higher rates of anxiety, depression and disordered eating. If you've been managing mental health challenges alongside irregular cycles or hormonal symptoms, the connection may be worth exploring.
Fertility challenges are common, but they're not universal. Not everyone with PMOS struggles to conceive, but irregular ovulation does reduce the predictability of the fertile window. If you're trying to conceive and your cycles are inconsistent, tracking ovulation with LH strips can help identify whether you're ovulating at all and when.
What Getting Diagnosed Actually Looks Like
There's no single test for PMOS. A proper workup typically includes blood tests to assess hormone levels (testosterone, LH, FSH, AMH, thyroid, insulin and glucose), an ultrasound and a full conversation about your cycle history and symptoms.
Because the symptoms overlap with other conditions — thyroid disorders, elevated prolactin, congenital adrenal hyperplasia — those need to be ruled out first. PMOS is what's called a diagnosis of exclusion, meaning other causes need to be considered before landing on it.
This is part of why diagnosis takes time. It's also part of why having a clear picture of your symptoms before walking into an appointment matters.
When to See a Doctor
If any of the following apply to you, it's worth bringing up PMOS with your healthcare provider:
- Your cycles are consistently longer than 35 days or you don't get a period at all
- You have persistent hormonal acne, especially on the jaw
- You have unexplained excess facial or body hair
- You're experiencing hair thinning or loss
- You've been trying to conceive without success and aren't sure if you're ovulating
- You have a family history of PMOS, type 2 diabetes, or cardiovascular disease
You don't need to have all of these. Two is enough to start the conversation.
You Know Your Body
One of the most consistent things reported by people with PMOS is that it took years to get a diagnosis, not because the symptoms weren't there but because they weren't taken seriously or because they were told their irregular cycles were "normal."
If something feels off, it's worth pushing for answers. Especially if you're tracking your cycle and noticing patterns that don't add up, that data is worth bringing to your doctor.
Sources: The Lancet (May 12, 2026); Rotterdam Criteria (ASRM/ESHRE); HuffPost Health; AJMC; Endocrine Society