PMOS Isn’t a Structural Problem. It’s a Communication Problem.

One of my mentors described PMOS (then PCOS) this way.

I’ve never forgotten it, because it changes how you think about the whole condition. It isn’t your ovaries malfunctioning in isolation. It’s a conversation between your brain, your ovaries, your adrenals, your insulin and your hormones that’s gotten a little mixed up along the way. For Awareness Month, I wanted to unpack what that actually means, and where TCM and acupuncture fit into your treatment plan.

A note on the name. If you’ve known this condition as PCOS, you haven’t missed anything. In May 2026, a global initiative of more than 50 patient and professional organisations, including the Endocrine Society, the AE-PCOS Society and Verity (PCOS UK), and informed by more than 22,000 patient responses alongside workshops with clinicians and women with lived experience, officially renamed Polycystic Ovary Syndrome to Polyendocrine Metabolic Ovarian Syndrome, or PMOS. This new name does make more sense as most people with this condition don’t actually have an increase in ovarian cysts, and the old name reduced a complex, lifelong hormonal and metabolic condition to a misunderstanding about cysts, something that’s genuinely contributed to missed diagnoses and inadequate care over the years. Patients themselves were the biggest drivers of the change, which the American Society for Reproductive Medicine formally endorsed later that same month. There’s a three-year transition period before it’s fully folded into international guidelines, so you’ll likely see both terms used interchangeably for a while yet.

What’s actually happening

PMOS affects roughly one in ten people who ovulate, making it one of the most common hormonal conditions we see. At its core, it involves higher levels of insulin, which push the ovaries to produce more testosterone. That testosterone interrupts the usual signal between the brain and the ovary, so follicles begin to grow each cycle… but many of them stall before they reach maturity. Without a mature, dominant follicle, ovulation doesn’t happen. No ovulation, no period (or a very unpredictable one).

This is why PMOS is diagnosed through a mix of signs: irregular or absent cycles, signs of higher androgens (acne, extra hair growth), and the follicle pattern we see on ultrasound.

What your AMH is actually telling you

AMH (Anti-Müllerian Hormone) estimates how many follicles are sitting in reserve. In PMOS, AMH levels are much higher than what’s typical, and it’s easy to read that as “great ovarian reserve.” It’s not quite that simple.

AMH levels are high in PMOS not because there are more good eggs waiting, but because there are more follicles getting stuck. Every cycle, a cohort of follicles starts developing, and in PMOS, androgens interrupt that development before it finishes, so follicles accumulate rather than mature and release. More stalled follicles means more AMH in circulation. It’s a sign of a bottleneck, not a bonus.

So when people ask me whether the goal is to “lower AMH,” I like to reframe the question. Lowering AMH isn’t really the lever we’re pulling. What we’re working toward is helping more of those follicles complete the journey, which is what tends to bring AMH down as a byproduct, not as the aim in itself. The number moving is a sign the conversation between your brain and your ovaries is getting clearer, not the mechanism that gets you there.

Where TCM comes in, and where the evidence still has gaps

In Chinese medicine, we look at PMOS through a slightly different lens. One of the patterns we see most often alongside raised androgens is what’s called Liver Qi Stagnation: a term for when the smooth, unimpeded flow of Qi, and with it emotion, gets stuck.

The signs are often ones you’ll recognise: irritability, PMS, breast tenderness before your period, clots, a cycle that runs erratic. But one sign has always struck me the most: a persistent lump-like sensation in the throat, called “plum stone qi.” It’s not a medical emergency, and it’s not really about your throat at all. Traditionally, it’s read as something unspoken, sitting there, unable to move. Qi that can’t flow through your body because it hasn’t been given a voice.

I don’t think it’s a coincidence that so many of my PMOS clients are people who’ve spent years making themselves smaller, staying quiet to keep the peace, swallowing what they actually wanted to say. Whether or not you believe the throat and the ovaries are connected, I’d still ask: what have you been sitting on lately? What haven’t you said?

Acupuncture works, in part, to help that Qi move again, alongside the more physiological work of calming the nervous system and supporting the signalling between your brain and your ovaries. The research on acupuncture specifically for PMOS is still catching up (most of it was published under the condition’s old name), and results across studies are mixed, especially for outcomes like pregnancy rates.

What the evidence supports more consistently is acupuncture’s role in supporting insulin sensitivity, easing the anxiety and low mood that so often travel alongside PMOS, and helping cycles find more rhythm. I treat it as one part of your care team, not a replacement for the rest of it.

Source: N. Carman, “A New Approach to PCOS, OHSS and Other Hormonal Issues,” Advanced Level Diploma Module 3, Fertility Support Training (The Fertility Support Company, UK) — published under the condition’s former name, PCOS, now PMOS.

PMOS and IVF

The egg that gets retrieved in any given stimulated IVF cycle actually began its development roughly three months earlier. That window, the ninety-ish days before a cycle starts, is where I think some of the most valuable work happens for those with PMOS. Working to settle insulin, calm inflammation, and help follicles develop as normally as possible so fewer stall before they’re ready.

Where follicles are already prone to getting stuck, that preparation isn’t just about ovulating more consistently in the meantime. It’s about giving the eggs your clinic goes on to work with better starting conditions, which can influence not only egg quality but how well those eggs go on to fertilise and develop into embryos. I won’t overstate the evidence here, research on acupuncture’s effect on IVF outcomes specifically is still mixed, but the underlying physiology of egg development is well established, and it’s one of the reasons I like to see clients three to four months out from a planned cycle, not the week before.

Building a team around your body

PMOS is more complicated than just some ‘stuck qi’ and best outcomes come from an integrated approach.

Acupuncture and Chinese herbal medicine, to support ovulation, ease the Liver Qi Stagnation pattern, and calm a nervous system that’s often been running hot for a long time.

Functional and biomedical testing, so we’re not guessing: fasting insulin, a full androgen panel, thyroid function. These numbers tell a story your symptoms alone can’t.

Conventional medical care, where it’s needed. Metformin, anti-androgens or ovulation induction all have a role too.

As well as consistent and specific diet and lifestyle changes to support hormones and metabolism.

Setting boundaries, saying no, expressing feelings and communicating are all part of the PMOS picture too.

The diet and lifestyle factors that actually matter

Every second person will tell you to try keto, or paleo, or cut dairy, or go gluten-free. I’d rather keep it simple, and focus on what actually moves the needle for insulin and inflammation:

Eat for steady blood sugar. A low-GI approach, built around whole grains, legumes and produce rather than refined carbohydrates, is one of the most consistent tools we have for improving insulin sensitivity in PMOS.
Cook warm, and cook whole. In TCM terms, we’re nourishing Spleen Qi, which is what builds the Qi and Blood your cycle runs on. Too much raw, cold or highly processed food asks more of your digestion than it can comfortably give.
Support your gut. Fermented foods, bone broth, and a diet rich in fibre all feed the gut-brain-hormone connection that’s more tangled up in PMOS than most people realise.

Move, and rest, in equal measure. Gentle, consistent movement supports insulin sensitivity. So does weight resistant training. So does sleep. Neither needs to be extreme, but more consistent.

*you can read more information on insulin resistance and fertility here.

Where to start

If PMOS/PCOS is part of your health story or you’re not sure but you’d like to know…

Book a Connection Call — a free, no-pressure 20-minute conversation to talk through where you’re at, and what support could look like from here.

Note: I’m not a trained writer, so I use AI to help translate my ideas into something clear and easy to read — the thinking, the story, and the editing are still mine. I’d rather spend my time learning better ways to treat you and help families become healthier, and I’m grateful for the help.