Lifestyle remains a first-line therapy in PMOS. Insulin resistance remains one of the biggest issues with PMOS. In fact, it’s estimated that up to 80% of those PMOS sufferers with a higher BMI have insulin resistance. Changes with nutrition and movement can have an enormous impact in improving insulin sensitivity and reducing the effects of PMOS. 

Dietary changes improve insulin sensitivity in PMOS. There is strong evidence in the benefits of the Mediterranean Diet, and a whole‑food, low‑glycaemic, higher‑protein eating pattern can reduce insulin spikes and support more predictable energy and appetite. Including a diet rich in antioxidants helps reduce oxidative stress, which is also impactful in chronic low-grade inflammation.

Resistance training and aerobic exercise (as simple as regular walking) also help stabilise blood glucose and improve metabolic health, including reducing androgen (male hormone) levels. These changes do not need to be restrictive. They simply create a steadier hormonal environment for your body to work with. 

Celery Health works with dietitians and exercise physiologists who specialise in this area. Whilst many of those with PMOS are now engaging with medical therapies such as injectable weight loss medications, it’s important to remember that if you’re planning on conceiving, you’re advised to cease your GLP1-agonists 6-8 weeks before conceiving.  Diet and lifestyle become even more important over this time. Get in touch if you’d like to know more.

There is strong evidence that Metformin is effective in those wanting to improve the metabolic impact of PMOS.

Metformin is commonly used in PMOS to improve insulin sensitivity, metabolic health, and slow the progression to Type 2 Diabetes in those with altered glycemic control.

It’s important to remember that Metformin isn’t used primarily in fertility treatment with PMOS, but it may support cycle regularity and ovulation in some people. So warning! If you’re not planning on conceiving, you should consider birth control backup.

If you are working on conception, Metformin can be used as an ‘add-on’ adjuvant to simple fertility therapies such as Letrozole when insulin resistance is present.

Metformin is relatively cheap compared to weight-loss medication. 

The oral contraceptive pill is a first-line therapy for menstrual irregularity and the reduction of hyperandrogenism (the presence of high male hormones). It’s used to reduce androgen‑related symptoms such as acne and excess hair growth, and provides predictable bleeding patterns, which also helps reduce endometrial lining thickening.

The OCP is not a treatment to take if you want to conceive or want to track ovulation patterns with PMOS.

Taking the OCP is a very personal decision and isn’t for everyone, particularly if you’re working towards preconception and fertility goals. 

GLP‑1 agonists/ weight loss injectables (Ozempic/ Wegovy/ Saxenda) medications are a very effective treatment option for people with significant insulin resistance, Type 2 Diabetes or weight‑related challenges.

For women with PMOS, normal blood sugar levels and a BMI of 30 or above, they are a very appropriate therapy in combination with lifestyle changes. GLP-1 agonists affect satiety and appetite, and it’s generally recommended that doses start low and be increased slowly to avoid side effects.

Current evidence indicates that, for those with PMOS, weight loss improves cycle regularity, ovulation, insulin sensitivity and rates of natural conception. This is very important if you are planning to have a baby in the next 6-12 months.  These drugs support weight loss and indirectly also have reduce testosterone levels and hyperandrogenism. 

If you’re not planning on conceiving, don’t forget to consider other contraception techniques and remember the OCP may not be absorbed readily if using a GLP-1 agonist.

Finally, the evidence is still out on GLP-1 agonists and the effects on a growing foetus, so those who are actively trying to conceive or starting IVF should stop 6-8 weeks beforehand to metabolise or ‘wash out’ the drug.

These medications are not for everyone, but they can be incredibly useful tools when weight challenges and metabolic drivers are a major part of your symptoms. If you’d like to learn more, reach out to speak to one of our specialist team.

For those with PMOS trying to conceive, Letrozole is a first-line ovulation induction agent commonly used and has excellent evidence around live birth rates in women with PMOS.

Letrozole stimulates FSH release and improves follicle growth and ovulation. Live birth rates are significant when used in women with PMOS as a first-line fertility treatment. Clomiphene is used as a second-line agent, and it remains an effective alternative.

The best fertility treatment options for those with PMOS depends on age, ovulation pattern, metabolic health and any additional fertility factors. An An expert endocrinology fertility specialist can help determine the most appropriate pathway if you’re known to have PMOS and want to conceive.

Some medications target individual symptoms. For example, spironolactone is often used for acne or excess hair growth because it reduces the effect of androgens on the skin and hair follicles.

These treatments are usually added when symptoms are more severe or when other options have not been enough on their own.

Celery Health works with endocrinologists who specialise in managing PMOS and helping you become symptom-free.

Evidence suggests that certain supplements – particularly myo-inositol and omega-3 fatty acids can improve insulin sensitivity and metabolic markers in PCOS. Vitamin D (when deficient) shows increased insulin sensitivity and may support menstrual regularity.  NAC and CoQ10 provide additional supportive benefits, including improved egg quality in IVF populations and reduced oxidative stress. There is evidence that lipid profiles improve, as do oxidative stress markers. However, for their standalone effects on fertility outcomes compared with medications, there is no strong evidence, which is important if you have PMOS and are actively trying to conceive.

Supplements should be viewed as great adjuncts, not replacements for evidence-based medical and lifestyle treatment of PMOS, especially if you’re trying to fall pregnant.