Metformin, Spironolactone & Other Treatments for PMOS Symptoms

Polycystic ovarian syndrome (PCOS), now called polyendocrine metabolic ovarian syndrome (PMOS), is a hormonal and metabolic disorder that affects one in ten women of childbearing age. Women with PMOS may experience symptoms like irregular periods, insulin resistance, weight gain, infertility, acne, and hair loss or overgrowth. 

PMOS treatment focuses on managing symptoms through lifestyle changes and medication. In this guide, we break down the currently available treatments for PMOS and how they address specific symptoms.

The Top PMOS Prescription Treatments

There is no one single treatment for PMOS. The condition affects various aspects of metabolic and hormonal health, which can cause a range of symptoms that differ from person to person. Typically, healthcare providers customize a personalized treatment plan based on the patient’s specific symptoms and health.

PMOS / PCOS Insulin Resistance: Metformin

Insulin resistance is a hallmark symptom of PMOS. Insulin helps your body use sugar for energy and keep blood sugar levels stable. When your body becomes less responsive to insulin, as it does in women with PMOS and insulin resistance, your blood sugar levels rise. In response, your pancreas may increase insulin production, leading to symptoms like:

• Higher androgen levels
• Dark, velvety, and/or moist patches of skin on the neck, armpits, groin, inner thighs, or breasts
• Weight gain
• Increased risk of obesity and type 2 diabetes

Metformin is an oral diabetes medication that is commonly prescribed off-label to treat PMOS. Taking metformin can help your body become more responsive to insulin, which helps rebalance your blood sugar and hormone levels. Metformin has also been shown to reduce acne and infertility in women with PMOS. 

PMOS / PCOS Acne and Hair Thinning or Overgrowth: Spironolactone

Higher androgen levels — especially testosterone — can cause acne, thinning hair (alopecia), and an overgrowth of hair on the face or chest (hirsutism). Women with PMOS are twice as likely to have acne than women without PMOS, and up to 70% experience hirsutism. 

Spironolactone is a daily oral medication that may be prescribed for hypertension and heart failure, but is also an anti-androgen medication. It is commonly prescribed off label to reduce androgen levels in women with PMOS, which can help block androgen receptors in the skin to relieve acne, and counteract androgen’s effects to slow hair loss on the scalp as well as reduce hirsutism. 

Spironolacatone can cause menstrual irregularity as a side effect, so it may be combined with birth control pills to help regulate the menstrual cycle.

PMOS / PCOS Period Irregularity: Birth Control

Women with PMOS may go longer between periods, have fewer periods, or stop experiencing periods altogether. Higher androgen levels cause this symptom by interfering with ovulation, resulting in irregular periods.

Hormonal birth control — including pills, patches, or vaginal rings — can address these irregularities and restabilize your menstrual cycle. Because hormonal birth control lowers androgen levels, this treatment may also address other PMOS symptoms like excessive hair growth or acne.

PMOS / PCOS Stubborn Weight Gain: GLP-1

The metabolic disruptions of PMOS can also lead to weight gain, obesity, and difficulty losing weight. This can be frustrating, especially since weight loss is a recommended treatment for women who have both obesity and PMOS. Obesity can worsen several symptoms of PMOS, including insulin resistance and infertility.

If you’re trying to lose weight, your healthcare provider will likely recommend diet and exercise as your first steps. However, when it is not possible to lose the recommended amount of weight with diet and exercise alone, GLP-1s like Ozempic (semaglutide), Wegovy (semaglutide), and Zepbound (tirzepatide) can help. Note that Ozempic is currently only FDA-approved for treating diabetes, though some providers have prescribed it off label for weight loss.

These medications work for weight loss by making you feel more full and reducing cravings and overall appetite. They also help improve insulin sensitivity, which would also benefit women with PMOS and insulin resistance.

OTC Options For PCOS / PMOS

In addition to prescription treatment, there are several over-the-counter (OTC) options for PCOS/PMOS symptoms as well. For example:

• OTC hair removal creams can help remove excess facial or chin hair without shaving, and may thin hair over time.
• Topical creams or gels containing retinoids or salicylic acid can help manage acne.
• Topical minoxidil, available as a foam or liquid solution, can help slow hair loss.

Supplements may also help manage symptoms of PMOS, but it’s important to remember that they contain less potent active ingredients, so their effects may be less pronounced than prescription or OTC medication. 

Also, dietary supplements aren’t FDA-approved, so their safety and effectiveness can vary. However, some ingredients have established studies that suggest they may help alleviate specific PMOS-related symptoms. Review any natural or OTC supplements with your healthcare provider before adding them to your PMOS treatment plan to ensure the ingredients do not cause interactions with any of your other medications or conditions.

Berberine and Inositol Supplements For PCOS / PMOS

Two commonly recommended supplements for PMOS include berberine and inositol. 

• Berberine: Berberine is a plant substance that has been shown to improve insulin resistance in women with PMOS. It can also help with hormone balance by reducing testosterone levels, which may help with ovulation and fertility.
• Inositol: Inositol is found in foods like fruits, beans, grains, and nuts. It can help your body’s insulin response. Some research suggests inositol supplements can help reduce insulin resistance in women with PMOS, and it may also help regulate ovulation and menstrual cycles.

Other supplements that have been studied for PCOS/PMOS include vitamin D, curcumin, and CoQ10.

Good Habits For PCOS / PMOS Management

Lifestyle changes play an important role in managing PMOS symptoms. Combining these healthy habits with medication can significantly lessen your symptoms and reduce your risk of related conditions such as obesity, diabetes, and heart disease.

Weight Loss

Weight loss is often recommended to women who have both PMOS and obesity or are overweight. Research shows that losing 5% of your body weight (e.g. 10 pounds if you weigh 200 pounds) can significantly reduce insulin resistance and testosterone levels. Whether achieved through diet and exercise alone or combined with certain medications, weight loss can also improve other symptoms of PMOS, such as menstrual irregularity. 

Different Foods

Even if your doctor doesn’t recommend weight loss, they may still recommend improving your diet to make it more PMOS-friendly. This isn’t about following any particular diet, but rather about including specific foods that help support more balanced blood sugar and hormone levels.

For example, high-fiber and high-protein foods slow your body’s absorption of sugar, preventing blood sugar spikes. Meanwhile, foods that are rich in omega-3 fatty acids can improve insulin sensitivity, reduce chronic inflammation, and lower androgen levels.

Here’s a quick overview of foods to avoid and foods to eat more of when you have PMOS.

Exercise

Exercise is also recommended for women with PMOS — not only to help with weight loss, but also to reduce future weight gain. Exercise also lowers the risk of diabetes and heart disease, two conditions that are associated with PMOS. Regular exercise can help enhance the body’s insulin response and reduce belly fat, both of which support PMOS symptom relief.

In particular, experts recommend a combination of high-intensity aerobic exercise with strength training for women with PMOS. Aerobic exercise describes anything typically considered as cardio, such as bicycling, dancing, and jogging. Strength training can utilize free weights, resistance bands, or body weight exercises such as yoga and Pilates. 

Sleep Hygiene

Sleep hygiene describes a set of healthy habits that support better sleep quality. Think of it as similar to oral hygiene, but instead of supporting your teeth, it supports your sleep.

Everybody benefits from a good night’s sleep, but women with PMOS may need it even more because the condition can increase the risk of sleep apnea. Sleep apnea causes breathing issues during sleep, which lowers overall sleep quality. Poor sleep, in turn, can worsen insulin resistance. It can also make you feel more tired during the day, which can make it tougher to keep up with a regular exercise routine. 

To improve your sleep hygiene, start by making sure you have time to sleep at least 7 to 9 hours each night. Other healthy habits include:

• Following a regular sleep schedule by going to bed and waking up at the same time every day
• Avoiding caffeine, alcohol, heavy meals, and electronic use later in the day
• Winding down with a relaxing bedtime routine
• Getting a good amount of sunshine and regular exercise earlier in the day
• Keeping your bedroom cool, dark, and quiet

Questions To Ask Your Doctor

It’s a good idea to consult your doctor before starting any new medication, whether it’s a prescription drug, over-the-counter medication, or herbal supplement. They can help you determine the best treatment for your PMOS symptoms and check for any interactions based on your health history or other medications.

Some questions to ask your doctor about PMOS treatment include:

• Do you recommend any blood tests to check my hormone levels?
• What treatment options do you recommend, based on my symptoms?
• Are there lifestyle changes I should try first?
• What are the possible risks and side effects of this medication?
• What can I do to manage or prevent side effects?
• If I want to get pregnant or become pregnant, how might that change my treatment plan?
• If I have other health issues (such as diabetes), how can I manage those at the same time as my PMOS?

Find PMOS Treatment Options

While receiving your prescriptions through a traditional pharmacy is still an option, digital pharmacy platforms make PMOS treatment even easier to access. The best telehealth platforms are secure, efficient, and staffed by licensed pharmacists and healthcare providers. These platforms can help you get the right treatment for your symptoms without having to wait for your doctor to become available to renew a prescription.

If this is your first time using an online platform to get a prescription, look for these signs that the one you’ve chosen is safe and reputable:

• Trusted sourcing: Available medications are FDA-approved and dispensed by U.S.-based, licensed pharmacies.
• Prescriptions required: All medication requests are reviewed by a state-licensed provider before approval. 
• Backed by certifications: The platform has LegitScript certification and required state licenses.
• Transparent pricing: All prices are listed and clearly explained upfront.

For example, TelyRx operates its own pharmacies in Clearwater, Florida and Irving, Texas, and every order is filled by one of our experienced, licensed pharmacists. Even if you do not have an active prescription, you may request one through TelyRx. We work behind the scenes to have an independent provider licensed in your state review the request and your health attestation for safety. If approved, the provider writes a new prescription for you that TelyRx fills and ships to your door. 

Your Next Steps

There is not a single treatment for PMOS. Rather, there are a range of lifestyle changes, medications, and supplements that can address PMOS symptoms. If you’ve been struggling with infertility, weight gain, or new acne or facial hair, schedule time with your healthcare provider for a diagnosis and treatment plan that can relieve your symptoms and help you feel like yourself again.

Research and References

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