PMOS (PCOS) Treatment in Singapore: Polyendocrine Metabolic Ovarian Syndrome Care

In May 2026, an international consensus published in The Lancet renamed polycystic ovary syndrome (PCOS) as polyendocrine metabolic ovarian syndrome (PMOS). The new name better reflects that the condition affects hormones and metabolism throughout the body, not just the ovaries, and that many women with it do not have ovarian cysts.

The condition itself, how it is diagnosed and how it is treated have not changed. You may still see “PCOS” on medical records, insurance forms and prescriptions while the new name is adopted over the next few years.

At LW Cho Endocrine Clinic, we follow the internationally recognised Rotterdam Criteria to ensure an accurate diagnosis of PMOS in Singapore. To be diagnosed with this condition, a woman generally needs to meet at least two of the following three criteria:

1. Irregular or absent menstrual periods.
2. Clinical or biochemical signs of high androgen (male hormone) levels, such as excess body hair or acne.
3. Presence of multiple small follicles on the ovaries as seen via ultrasound.

It is important to understand that “polycystic” was a misnomer, which is one reason the condition has been renamed; these are not actual cysts but rather underdeveloped follicles containing eggs that haven’t been released. Dr. Cho takes a comprehensive approach, looking beyond just a single symptom to see the whole hormonal picture. Because other conditions like thyroid issues or high prolactin can mimic these symptoms, we perform a detailed evaluation to rule out other causes before confirming a diagnosis.

PMOS is a diagnosis by exclusion.  Therefore, other endocrine conditions that can present similarly such as Cushing’s Syndrome, hyperprolactinemia and androgen secreting adrenal tumours need to be excluded before the diagnosis of PMOS is made.

Tests usually include testosterone and SHBG, LH and FSH, prolactin, thyroid function, 17-hydroxyprogesterone, HbA1c or a glucose tolerance test, a cholesterol panel and a pelvic ultrasound.

The choice often depends on your primary concern, but since this is fundamentally a hormonal and metabolic disorder, seeing an Endocrinologist is highly beneficial. While a Gynaecologist focuses specifically on the reproductive organs and can help with period regulation or surgery, an Endocrinologist like Dr. Cho specialises in the entire endocrine system.

At LW Cho Endocrine Clinic, we focus on the “why” behind your symptoms, addressing the hormonal imbalances, insulin resistance, and metabolic issues that cause the irregular periods and skin changes in the first place. Many patients find that a collaborative approach works best, but starting with an Endocrinologist ensures that the underlying hormonal drivers of the condition are managed, which often improves reproductive health as a natural byproduct.

This is a very common concern, and the short answer is no. The “cysts” associated with this condition are actually tiny, benign, fluid-filled sacs called follicles, which contain immature eggs. In a healthy cycle, one of these follicles would grow and release an egg (ovulation), but in women with hormonal imbalances, these follicles stop growing too early and remain in the ovary.

These follicles do not turn into ovarian cancer. However, because the condition can lead to infrequent periods, the lining of the womb (endometrium) can become too thick overtime, and potentially can turn cancerous. This is why we focus on ensuring you have regular cycles or use medication to protect the uterine lining, rather than worrying about the follicles themselves being tumours.

While there is currently no permanent cure that makes the condition disappear forever, effective PMOS management allows most women to live a life completely free of bothersome symptoms. At LW Cho Endocrine Clinic, we view it as a manageable metabolic tendency rather than a disease.

Through a combination of lifestyle adjustments, such as a low-glycemic index diet and regular physical activity, and medical treatments like insulin sensitizers or hormonal regulators, we can balance your hormones. Many of our patients find that once they achieve a healthy weight and stabilise their insulin levels, their periods become regular and their skin clears up, essentially putting the condition into remission.

Yes, many women with this condition conceive naturally. The primary challenge is that irregular ovulation makes it difficult to time intercourse correctly. If you are only ovulating a few times a year, your window of opportunity is much smaller than someone with a 28-day cycle.

At LW Cho Endocrine Clinic, we help optimise your natural fertility by addressing insulin resistance, which often restores regular ovulation on its own. By tracking your cycles and using metabolic support, many women find they are able to conceive without needing invasive fertility treatments. We focus on getting your body into its healthiest hormonal state to give you the best possible chance of a natural conception.

For those who need a little extra help to ovulate, several effective options are available for treating PMOS in Singapore. Letrozole has increasingly become the preferred first-line treatment as it often results in higher live birth rates and fewer side effects compared to older medications like Clomiphene (Clomid).

Additionally, Dr. Cho often prescribes Metformin, which is an insulin-sensitizing medication. While primarily used for diabetes, it is highly effective for women with hormonal imbalances because it lowers insulin levels, which in turn lowers testosterone and helps the ovaries function more normally. These medications are often used in monitored cycles to ensure they are working effectively and safely.

Preparation is key to a smooth pregnancy. We recommend a pre-conception phase focused on three pillars:

• Weight Optimisation: Even a modest 5-10% reduction in body weight can significantly improve hormonal balance and ovulation.
• Nutritional Support: Switching to a high-fibre, low-sugar diet helps stabilise insulin. We also recommend starting a high-quality folic acid supplement or prenatal vitamin at least three months before trying to conceive.
• Activity: Regular exercise improves insulin sensitivity, which is vital for egg quality. By stabilising your metabolic health before you get pregnant, you reduce the risk of complications later on and create a healthier environment for your baby to grow.

It is important to be aware that this condition does carry an increased risk of certain pregnancy-related complications. These include gestational diabetes, pre-eclampsia (high blood pressure during pregnancy), and a slightly higher risk of early pregnancy loss.

However, these risks can be significantly mitigated through proactive care. At LW Cho Endocrine Clinic, we work closely with our patients to manage their blood sugar and hormonal levels before and during the early stages of pregnancy. With close monitoring and a healthy lifestyle, the vast majority of women go on to have successful, healthy pregnancies and healthy babies.

Beyond the immediate symptoms of irregular periods and acne, the hormonal imbalances associated with this condition have long-term implications for your general health. The most significant risk is Type 2 Diabetes, due to chronic insulin resistance. Patients are also at a higher risk for high blood pressure, high cholesterol, and sleep apnea.

Another important factor is endometrial health; if you have fewer than four periods a year, the lining of the womb can thicken, increasing the risk of endometrial hyperplasia or cancer later in life. This is why Dr. Cho emphasises long-term monitoring. By keeping your metabolic health in check now, you are protecting yourself against heart disease and diabetes for decades to come.