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Oluyemisi Famuyiwa/LinkedIn and Kevin Pho/kevinpho.com

Sep 21, 2026, 12:05

Kevin Pho։ Why PCOS Is Now PMOS

Kevin Pho, Founder and Editor of KevinMD, shared on LinkedIn։

“A reproductive endocrinologist will not accept a normal fasting glucose as evidence that nothing is wrong.

That is not caution. It is mechanism. The pancreas compensates for poor insulin signaling until the situation is genuinely bad, so the test most used to rule it out is the one least able to do it.

Oluyemisi Famuyiwa, a reproductive endocrinologist and infertility specialist, explained on The Podcast by KevinMD why polycystic ovary syndrome is now polyendocrine metabolic ovarian syndrome, or PMOS, and the argument is not cosmetic. A name that points at one organ produces tunnel vision, and the metabolic, hepatic, endometrial, and mood dimensions go unexamined, including the ones that matter long after the reproductive years.

The mechanism is worth carrying into clinic. Insulin branches, and the branches are weighted differently by tissue. When the muscle route is blocked at the receptor and beyond, glucose stays in the blood, and the pancreas makes more insulin, all of which reaches the ovarian route, which was never blocked. The ovary makes androgens.

The liver, under the same excess, makes less sex hormone-binding globulin, so less of that androgen gets bound and blunted.

If you see women in primary care, this is your differential, and it rarely arrives labeled as a fertility problem.

Four things from her workup worth keeping:

Fasting glucose and fasting insulin are starting points, not answers. When suspicion is high, she escalates to a two-hour glucose panel.
BMI is a poor proxy. Lean patients present with hyperandrogenemia and irregular cycles, and a weight-first filter does not find them.
The panel is wider than the reproductive hormones. Complete metabolic profile, free and total testosterone, androstenedione, 17-hydroxyprogesterone, and a lipid panel, because dyslipidemia travels with this condition.
Treatment targets the presentation, not the label. Metformin sensitizes to insulin and can also lower ovarian androgen production, and exercise opens a separate route into muscle when the usual transporter is jammed.

She also names the part that gets skipped. The growth pathway stays open, so the endometrium is in this, and so is mood.

Her operating principle is short. It is multi-organ, so it should be approached as a team effort, which is why she works the metabolic side with internal medicine and endocrinology rather than holding the whole picture inside one specialty.

Search ‘The Podcast by KevinMD’ wherever you listen to podcasts: Spotify, Apple.

What is the one test you would add to your standard workup for a patient with irregular cycles and a normal fasting glucose?”

Kevin Pho։ Why PCOS Is Now PMOS