PMOS (formerly PCOS) and Your Heart Health: What the Latest Research Means for You
- Susan Hulland
- 2 days ago
- 8 min read
Understanding cardiovascular risk in PMOS (polyendocrine metabolic ovarian syndrome) and how personalised nutrition can support your long‑term wellbeing.
Have you been diagnosed with PMOS (formerly PCOS)? You might be navigating fatigue, cravings, irregular cycles, insulin resistance, or cholesterol changes and wondering what this means for your long‑term health.
One of the most important and often overlooked parts of PMOS care is cardiovascular health. New research from the past five years shows that PMOS is not just a reproductive condition. It is a lifelong metabolic condition with meaningful implications for your heart.
This blog breaks down what the evidence says, why it matters, and how nutrition can support your cardiometabolic health.
What Is PMOS? A Modern Lens on PCOS
PCOS (polycystic ovarian syndrome) has recently been renamed polyendocrine metabolic ovarian syndrome (PMOS) following an international consensus process. The new name better reflects that this is a lifelong endocrine and metabolic condition, not simply a disorder of the ovaries or fertility. This matters because metabolic health including blood sugars, cholesterol, inflammation, and blood pressure is closely tied to cardiovascular risk.
Many women seeking PMOS-informed nutrition care want clarity on how their diagnosis affects long-term wellbeing. Cardiovascular health is a key part of that picture.
PMOS Heart Health: Recent Studies
Higher Rates of Heart Disease and Stroke
A major 2024 systematic review and meta‑analysis of more than one million women found that those with PMOS have significantly higher rates of cardiovascular disease. This includes heart attack, ischaemic heart disease, stroke, and composite cardiovascular disease events. Women with PMOS had 1.7 times higher odds of cardiovascular disease and 2.5 times higher odds of heart attack compared to women without PMOS.¹
These findings informed the International Evidence-based Guidelines for the assessment and management of polyendocrine metabolic ovarian syndrome (formerly PCOS), which recommends routine cardiovascular risk assessment for all women with PMOS.²
Cardiometabolic Risk Occurs Across All Body Sizes
A 2023 review highlighted that cardiometabolic risk in PMOS is not limited to women in larger bodies. Even women with lean PMOS may experience dyslipidaemia, elevated blood pressure, impaired glucose tolerance, and chronic inflammation.³
This reinforces the importance of personalised nutrition rather than weight‑centric approaches.
Emerging Evidence for Atherosclerotic Cardiovascular Disease
Emerging evidence suggests PMOS may be associated with higher risk of atherosclerotic cardiovascular disease.⁴ These findings add to growing evidence that cardiovascular risk begins earlier in women with PMOS than previously recognised. PMOS often presents with metabolic complexity even in women with "normal" BMI.
PMOS Heart Health: Why PMOS Increases Cardiovascular Risk
PMOS involves several overlapping drivers that influence heart health.
Insulin Resistance
A common PMOS driver that contributes to higher LDL cholesterol (often referred to as "bad" cholesterol), elevated triglycerides, increased blood pressure, and systemic inflammation.⁵
Chronic Low‑Grade Inflammation
Inflammation affects blood vessels and increases the risk of plaque formation.⁶
Hormonal Dysregulation
Androgen excess and irregular ovulation influence metabolic pathways linked to heart health.⁷
Stress and Sleep Load
Cortisol dysregulation worsens blood sugar control and blood pressure.⁸
Under‑fueling and Irregular Eating
Skipping meals or long gaps between eating can worsen cravings, fatigue, and insulin resistance.
How PMOS Can Present Differently
PMOS is a highly heterogeneous condition, meaning symptoms and health impacts vary considerably between individuals. While diagnosis is based on established clinical criteria, women often experience different combinations of metabolic, reproductive, hyperandrogenic, and psychological features.
Understanding which features are most prominent for you can help guide a personalised nutrition and lifestyle approach that supports both symptom management and long-term health.
Metabolic Features
Metabolic features are common in PMOS and may occur across all body sizes. They are closely linked to insulin resistance and increased cardiometabolic risk.
Common features include:
Insulin resistance
Fatigue, particularly after meals
Increased hunger or food cravings
Difficulty maintaining stable energy levels
Elevated triglycerides or LDL cholesterol
Low HDL cholesterol
Skin tags or acanthosis nigricans
Impaired glucose tolerance or prediabetes
Why it matters
Metabolic changes can increase the risk of type 2 diabetes and cardiovascular disease over time. Nutrition strategies that support blood glucose regulation, improve lipid profiles, and reduce inflammation can have meaningful long-term health benefits.
Reproductive Features
Reproductive features relate to changes in ovulation and menstrual function.
Common features include:
Irregular or absent menstrual cycles
Infrequent ovulation
Difficulty conceiving
Mid-cycle spotting
Heavy or unpredictable menstrual bleeding
Why it matters
Irregular ovulation reflects underlying hormonal disruption and may also influence long-term metabolic health. Supporting regular eating patterns, adequate nutrition, and overall metabolic health can complement medical management.
Hyperandrogenic Features
Hyperandrogenism refers to higher-than-expected levels or effects of androgens (often called "male hormones"), which are a key feature of PMOS for many women.
Common features include:
Acne
Excess facial or body hair (hirsutism)
Scalp hair thinning or hair loss
Oily skin
Why it matters
Hyperandrogenism can significantly affect quality of life and is often linked with insulin resistance. Addressing metabolic health may help improve hormonal balance alongside
appropriate medical treatment.
Psychological and Sleep-Related Features
PMOS affects more than physical health. Many women experience psychological symptoms or sleep disturbances that can influence hormonal regulation, appetite, and overall wellbeing.
Common features include:
Poor sleep quality
Persistent fatigue
Anxiety or low mood
Increased stress levels
Difficulty concentrating or "brain fog"
Changes in appetite or emotional eating
Why it matters
Sleep, stress, and mental wellbeing are closely connected to metabolic health. Poor sleep and chronic stress can worsen insulin resistance, appetite regulation, blood pressure, and inflammation, making them important considerations when developing an individualised nutrition plan.
Every Woman's Experience Is Unique
Most women experience a combination of these features rather than just one. For example, someone may have insulin resistance and irregular cycles, while another may experience acne and disrupted sleep despite having relatively normal blood glucose levels.
Because PMOS affects multiple metabolic pathways, nutrition plays a central role in supporting long-term cardiovascular health. At Sage Dietitians, we take a whole-person approach to PMOS care. By understanding your unique combination of symptoms, health history, and lifestyle, we can develop a personalised nutrition plan that supports your hormones, metabolic health, and long-term wellbeing.
Nutrition Strategies to Support Heart Health in PMOS
Regular, Balanced Meals
Eating every three to four hours helps stabilise blood sugars and reduce cravings.
Fibre‑Rich Carbohydrates
Whole grains, legumes, vegetables, and fruit support cholesterol reduction and blood sugar stability.
Anti‑Inflammatory Dietary Pattern
Evidence supports dietary patterns rich in extra‑virgin olive oil, nuts and seeds, oily fish, colourful vegetables, herbs, and spices. These patterns improve cardiometabolic markers even without weight loss.
Omega‑3 Fatty Acids
Omega‑3s reduce triglycerides and inflammation.
Gentle, Sustainable Movement
Walking, yoga, and resistance training improve insulin sensitivity and endothelial function.
Sleep and Stress Support
Nutrition strategies must consider stress load, sleep quality, and recovery.
What a Nutrition Assessment May Include for PMOS
A comprehensive nutrition assessment for PMOS looks beyond food alone. Because PMOS affects metabolic, reproductive, and cardiovascular health, understanding the whole picture is essential for providing personalised nutrition advice.
Depending on your symptoms and medical history, a PMOS dietitian may consider factors such as:
Blood glucose regulation, including HbA1c or glucose patterns
Blood lipids, including cholesterol and triglycerides
Blood pressure and other cardiovascular risk factors
Menstrual cycle patterns and ovulatory health
Appetite, hunger, cravings, and energy levels
Digestive health and gut symptoms
Sleep quality, stress, and lifestyle factors
Current dietary patterns, food preferences, and nutritional intake
Looking at these factors together helps identify the key areas influencing your symptoms and long-term health, allowing nutrition recommendations to be tailored to your individual needs.
There Is No One-Size-Fits-All PMOS Diet
Despite what social media often suggests, there is no single PMOS diet that works for everyone.
The most effective approach depends on your individual health profile, symptoms, and goals. For some women, nutrition may focus on improving insulin sensitivity and blood glucose regulation. For others, the priority may be supporting cardiovascular health, managing cholesterol, reducing inflammation, improving energy levels, or establishing regular eating patterns.
Current evidence supports an individualised approach to PMOS nutrition that considers both metabolic and reproductive health, rather than relying on restrictive diets or eliminating entire food groups without a clinical reason.
Working with a PMOS Dietitian
Working with a dietitian experienced in PMOS can help translate the growing body of research into practical, sustainable nutrition strategies.
Rather than following a generic PMOS diet, nutrition care is tailored to your symptoms, medical history, lifestyle, and health goals. This may include support with insulin resistance, cholesterol management, fatigue, irregular menstrual cycles, appetite regulation, gut health, or improving long-term cardiometabolic health.
At Sage Dietitians, our approach is evidence-based, non-restrictive, and designed to support sustainable habits that fit your everyday life.
If you're looking for personalised PMOS nutrition support or would like guidance from a PMOS dietitian, we're here to help you develop a practical nutrition plan that supports both your current symptoms and your long-term health.
Frequently asked questions
How is PMOS different from PCOS?
PMOS (polyendocrine metabolic ovarian syndrome) is the updated name for PCOS, following an international consensus process. It's the same condition, the new name simply better reflects that it's a whole-body hormonal and metabolic condition, not just an ovarian or fertility issue.
Can you have PMOS without being overweight?
Yes, this is often called "lean PMOS." Women can experience insulin resistance, elevated cholesterol, high blood pressure, and inflammation regardless of BMI. Cardiometabolic risk in PMOS isn't determined by body size alone, which is why weight-focused approaches often miss the full picture.
Does PMOS increase the risk of heart disease?
Yes. PMOS is now understood as a lifelong metabolic condition, not just a reproductive one, and research links it to a higher risk of cardiovascular disease, including heart attack and stroke. This is one of the reasons routine cardiovascular risk screening is now recommended for women with PMOS.
Do I need to lose weight to manage PMOS symptoms?
Not necessarily. While some women benefit from weight changes, research shows metabolic and cardiovascular improvements in PMOS are achievable through dietary pattern changes alone, regardless of weight loss, which is why a weight-centric approach isn't the only path forward.
Is there a specific diet for PMOS (PCOS)?
There's no single PMOS diet that suits everyone. The most effective approach is personalised, based on your individual symptoms, bloodwork, and goals - whether that's improving insulin sensitivity, supporting heart health, or managing energy and cravings. A PMOS dietitian can help identify which areas matter most for you.
What foods should I eat to support PMOS and heart health?
Regular, balanced meals every three to four hours, fibre-rich carbohydrates, and an anti-inflammatory eating pattern - think olive oil, nuts, oily fish, and colourful vegetables, are consistently linked to better cardiometabolic markers in PMOS, independent of weight change.
What does a PMOS dietitian actually do?
A PMOS dietitian looks beyond food alone - assessing blood sugar patterns, cholesterol, blood pressure, cycle regularity, sleep, stress, and current eating habits to build a nutrition plan tailored to your specific combination of symptoms, rather than a generic protocol.
Reference List
Tay CT, Mousa A, Vyas A, Pattuwage L, Tehrani FR, Teede H. 2023 International Evidence-Based Polycystic Ovary Syndrome Guideline Update: Insights From a Systematic Review and Meta-Analysis on Elevated Clinical Cardiovascular Disease in Polycystic Ovary Syndrome. J Am Heart Assoc. 2024;13(16):e033572. https://doi.org/10.1161/JAHA.123.033572
Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, Costello MF, Joham AE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447–2469. https://doi.org/10.1210/clinem/dgad463
Helvaci N, Yildiz BO. Polycystic ovary syndrome as a metabolic disease. Nat Rev Endocrinol. 2025;21(4):230–244. https://doi.org/10.1038/s41574-024-01057-w
Wan Z, Zhao J, Ye Y, Sun Z, Li K, Chen Y, et al. Risk and incidence of cardiovascular disease associated with polycystic ovary syndrome. Eur J Prev Cardiol. 2024;31(13):1560–1570. https://doi.org/10.1093/eurjpc/zwae066
Cassar S, Misso ML, Hopkins WG, Shaw CS, Teede HJ, Stepto NK. Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies. Hum Reprod. 2016;31(12):2619–2631. https://doi.org/10.1093/humrep/dew243
Deng H, Chen Y, Xing J, Zhang N, Xu L. Systematic low-grade chronic inflammation and intrinsic mechanisms in polycystic ovary syndrome. Front Immunol. 2024;15:1470283. https://doi.org/10.3389/fimmu.2024.1470283
Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 2018;14(5):270–284. https://doi.org/10.1038/nrendo.2018.24
Zhang J, Ye J, Tao X, Lu W, Chen X, Liu C. Sleep disturbances, sleep quality, and cardiovascular risk factors in women with polycystic ovary syndrome: systematic review and meta-analysis. Front Endocrinol (Lausanne). 2022;13:971604. https://doi.org/10.3389/fendo.2022.971604
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