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The National Institute for Health and Care Excellence has published the first national guidance for NHS treatment of polyendocrine metabolic ovarian syndrome (PMOS).
The draft guidance, published on 1 July 2026, is the first of its kind for a UK population and addresses the management of PMOS, as well as common problems associated with it such as acne, hirsutism (excessive hair growth) and obstructive sleep apnoea.
It recommended off-label use of progestogens to manage irregular menstrual cycles, off-label use of combined oral contraceptives or spironolactone to manage hirsutism and off-label use of metformin to manage metabolic health issues.
Previously known as polycystic ovary syndrome — or PCOS — PMOS affects around one in eight women and is characterised by irregular periods, high testosterone levels and ovaries with multiple small follicles.
The guidance emphasised the need to use effective contraception with spironolactone owing to its teratogenic potential.
Weight-loss medications should not be used to treat fertility problems in people with PMOS unless as part of research, it noted.
The guidance also included advice on fertility treatment for people with PMOS, as well as strategies for weight loss. It highlighted that weight gain and obesity are common in people with PMOS, and weight management can be particularly challenging.
PMOS should be suspected in the case of irregular or absent periods or symptoms or signs of excessive levels of male hormones in girls aged over ten years, women, trans men and non-binary people — excluding adults who have had, or are not having, gender-affirming hormone therapy or gender reassignment surgery), NICE recommended.
Sharon Manship, a lay member on NICE’s guideline committee, who lives with PMOS, said it took her more than ten years to be diagnosed.
“My hope is that with this new guideline, people with PMOS will be taken seriously, diagnosed earlier and provided with evidence-based support and care from healthcare professionals from the outset, rather than having to go what I went through,” she added.
In its draft guidance, NICE also recommended that an annual review be offered to all patients diagnosed with PMOS, highlighting that the condition is linked with a range of health risks, including type 2 diabetes mellitus, cardiovascular disease, sleep apnoea, fatty liver disease, mental health problems and complications in pregnancy.
Marie Anne Ledingham, consultant clinical adviser for women’s and reproductive health at NICE, commented: “PMOS is a common but often overlooked condition that can have a major impact on health and wellbeing. Recommending a simple annual review is an important step towards ensuring people get the ongoing care and monitoring they need.
“The new guideline will help improve consistency of care, increase awareness of the condition, and support earlier diagnosis and management.”
The draft guideline is open for consultation until 11 August 2026. NICE said it expects to publish the final guideline on PMOS in December 2026.
