PCOS becomes SMOP: symptoms, causes, prevention, treatment, and care pathways

PCOS is the leading cause of infertility worldwide because women with PCOS experience anovulatory menstrual cycles—that is, menstrual cycles without ovulation.

Important distinction: infertility does not mean sterility! Women with PCOS can get pregnant. However, it will usually be more difficult and take longer for them to conceive.

This hormonal variation causes severe fertility issues. Androgens, the male hormones, are present in excessive amounts in the woman’s body. Their presence disrupts the proper development of follicles in the ovary.

With the new term **SMOP**, the condition is finally viewed in its entirety, with a full 360-degree perspective. The new name completely redefines the therapeutic target. The goal is now the **whole metabolism**. This is a major step forward for your health.

SMOP stands for:
S-yndrome
M-etabolic: insulin resistance, weight gain (though not always).
O-varian: refers to ovulation disorders and irregular menstrual cycles.
P-olyendocrine: involves all hormonal axes (acne, hyperandrogenism, etc.)

Insulin resistance plays a key role (even if it’s not the only manifestation) in PMOS.

◇ Insulin is a hormone produced by the pancreas. Its main role is to move sugar (glucose) from the blood into the cells (muscles, liver, fat) so it can be used for energy or stored. Insulin also acts on the ovaries by stimulating the production of androgens and blocking the production of a protein called SHBG (which neutralises part of the androgens).

◇ In SMOP, women are **insulin resistant**. This means their cells respond poorly to insulin, so glucose remains in the blood instead of being taken up. As a result, **blood sugar rises**. Excess insulin triggers overproduction of androgens by the ovaries. And this excess has a knock-on effect 

• on ovulation, 
• but also on weight gain, 
• this can also explain your chronic fatigue 
• and your persistent sugar cravings.

The well-known androgens (**testosterone**) produced in excess due to hyperinsulinemia disrupt the normal communication between female hormones and the pituitary gland.

➡︎ In a patient without SMOP, estrogens (female hormones) and progesterone send signals to the pituitary gland (in the brain) to regulate the production of LH (Luteinizing Hormone) and FSH (Follicle-Stimulating Hormone).

Here’s a reminder:

• **LH** is essential for releasing the egg during ovulation.
• As for **FSH**, this hormone is essential for stimulating the ovarian follicles.

➡︎ In a patient with PMOS, excess androgens mislead the pituitary gland. It produces more LH than necessary. And unfortunately, this creates a vicious circle: the more androgens there are, the more LH increases, and the more the ovaries produce androgens.

◇ As a result of excess LH, ovulation does not occur properly. The ovarian follicles fail to mature, and the menstrual cycle becomes disrupted, which can lead to irregular, very infrequent or absent periods.

Other visible, physical consequences of excess LH and androgens in women include:

• Acne.
• Excess hair growth or hirsutism.
• Hair loss.

PMOS is a complex hormonal disorder: not all women affected have the same symptoms or the same underlying causes. To better tailor treatment, three main PMOS profiles are often distinguished, based on the dominant mechanisms.

Identifying your dominant profile changes everything for you. You can focus on what really matters and avoid ineffective and unnecessary treatments and tests. You can then implement truly personalised solutions.

The metabolic profile depends on your insulin. It concerns 70 to 80% of women with **SMOP**.

➡︎ Key points to remember about the metabolic profile:

• Marked insulin resistance (IR).
• Obesity or overweight (especially abdominal fat), but it can also affect slim women.
• Blood sugar imbalance: high risk of prediabetes or type 2 diabetes.
• Dyslipidemia: high triglycerides, low HDL (“good cholesterol”).
• Excess androgens (high testosterone): acne, hirsutism (excess hair growth), alopecia (hair loss).
• Anovulation: irregular or absent periods, infertility.

The inflammatory type reacts to stressors from your environment or your diet. Around 20 to 30% of women with SMOP have an inflammatory profile.

➡︎ Key takeaways from the inflammatory profile:

• Chronic inflammation (elevated inflammatory markers such as CRP or IL-6).
• Possible autoimmune symptoms (fatigue, joint pain, digestive issues).
• Excess androgens (as in the metabolic profile), but less closely linked to IR.
• Irregular periods, acne, hirsutism.
• May be slim (not always overweight).
• Increased sensitivity to stress (linked to cortisol).

The adrenal profile works differently from the other types. Here, chronic stress boosts your androgens via your adrenal glands. Your weight or insulin levels may still appear normal. Unlike the other profiles, in this case the adrenals are the main source of androgens. The adrenal profile accounts for 10 to 20% of PMOS cases.

➡︎ Key points to remember about the adrenal profile:

• Excess androgens of adrenal, not ovarian, origin.
• Blood test: elevated DHEA-S (a marker of adrenal androgens) in response to stress or a hormonal imbalance, while testosterone may be normal.
• Chronic fatigue: often linked to an imbalance in cortisol.
• Exaggerated response to stress: the adrenal glands produce too much cortisol and too many androgens.
• Cortisol often too high or too low (**disrupted circadian rhythm**).
• Symptoms similar to other PCOS profiles: acne, hirsutism, irregular periods.
• Often slim, without marked insulin resistance.

◇ You need to prioritize foods with a **low glycemic index**. The idea is to avoid insulin roller coasters that exhaust your body. This helps limit androgen overproduction and therefore the harmful overstimulation of your ovaries.

To do this, you can:

• Reduce fast sugars (white pasta, white bread, sodas, pastries). They spike blood sugar and worsen insulin resistance.
• Prioritize low-glycemic-index foods: vegetables, whole grains, proteins (meat, fish, eggs), healthy fats (avocado, nuts, olive oil).
• Avoid overly restrictive diets: properly supervised intermittent fasting can help, but you must absolutely avoid deficiencies.

Learning how to eat in an appropriate, anti-inflammatory way takes time. It’s a long process, but a fascinating one! The internet is full of websites and blogs on the topic. There are also cookbooks available. You can start by following reputable content creators who are authorities in the field, such as elisegilmor.

Regular movement naturally improves your cells’ sensitivity to insulin. Even moderate activity transforms your metabolic health. Exercise improves insulin sensitivity: 

•  Thirty minutes of brisk walking a day makes a difference!
• Strength training: muscles use glucose without needing much insulin.

Small daily changes end up radically transforming your hormonal landscape. That’s the key to stabilising your PMOS.

➡︎ Metformin is a medication that improves insulin sensitivity (often prescribed for PCOS).

➡︎ The contraceptive pill can regulate cycles and reduce androgens (but it does not treat insulin resistance).

➡︎ Myo-inositol is a natural compound that helps restore ovulation. It improves the quality of your oocytes by mimicking the action of insulin. It’s a valuable support for your hormonal balance at the cellular level.

➡︎ Magnesium, zinc and vitamin D are key micronutrients. They support the enzymes responsible for breaking down excess hormones. These nutrients help regulate your blood sugar effectively. Your supplements should be tailored to you after a full blood workup. This helps avoid any unnecessary overdosing.

➡︎ To manage certain physical symptoms, you can look into treatments for hirsutism. These medical options can sometimes complement a natural approach for better comfort.

Tracking your basal body temperature lets you confirm whether ovulation has actually occurred. It’s far more accurate than just relying on the presence of a period. You finally understand what’s really going on.

Observing your cervical mucus is a valuable indicator of your estrogen levels. It reveals your fertile window, which is often disrupted in SMOP. You learn to decode your body’s signals.

Learning to decode the signs also means getting to know yourself better and understanding yourself more. It means taking control of your body as a woman and no longer just enduring or stressing about it. 

There is no curative treatment that permanently eliminates SMOP (formerly PCOS). However, there are many medical options to reduce symptoms and restore stable ovulation (if pregnancy is desired). The medical strategies are very diverse and will depend on each woman’s individual needs and on her profile, if you’ve been following along.

➡︎ To reduce hirsutism and acne, a combined oestrogen–progestin pill is often the first-line option.

➡︎ To restore effective ovulation, you may be offered ovulation induction treatment (with clomiphene citrate or injectable exogenous gonadotropins).

➡︎ If that’s not enough, assisted reproductive technology (ART/IVF) can also be an option. To manage all the “side issues” and disabling symptoms of PCOS, you can absolutely turn to various specialists (mentioned above).

After age 40, metabolic risks increase significantly. Long-standing insulin resistance can then progress to type 2 diabetes or cause serious blood pressure problems.

Regular lab monitoring therefore becomes essential. Keeping an eye on your cholesterol and fasting blood glucose allows you to adjust your lifestyle before complications become entrenched.

Studies also show an increased risk of ADHD.

➡︎ Contrary to popular belief, symptoms sometimes persist. Even without a cycle, your metabolic terrain remains fragile, and insulin resistance can continue to wreak silent havoc on your body.

➡︎ You also need to keep a close eye on your bone health. Past hormonal imbalances affect bone mineral density, which makes screening for osteoporosis truly essential after your periods stop.

➡︎ Heart protection must remain your absolute priority. Cardiovascular risk naturally increases at menopause, so it’s crucial to maintain a very strict lifestyle during this period.

PCOS affects many women. And even though there is currently no cure on the market, there are ways to reduce side effects and restore viable ovulation.

The shift from PCOS to PMOS marks a medical revolution, moving the focus from the ovaries to a global metabolic imbalance. This approach targets systemic insulin resistance, offering a lasting solution to hormonal disorders. The goal? To finally transform the care pathway into a comprehensive health strategy.


We also encourage you to visit websites of associations dedicated to this condition, such as Asso’SOPK. You’ll find many personal stories and in-depth information there. Stay strong!