What's the Link Between PMOS, Eating Disorders, and Disordered Eating?

The hormonal disorder polyendocrine metabolic syndrome (PMOS)— formerly known as polycystic ovarian syndrome (PCOS)—may seem unrelated to eating disorders or eating habits in general, but there’s actually a close and complex connection between the two. A growing body of research shows that PMOS increases the risk of developing certain eating disorders, and PMOS can also influence the treatment approach that works best for women affected by both conditions.

If you’ve been diagnosed with PMOS, you may feel some relief at having a name for the symptoms you’re dealing with—especially if you struggled to get diagnosed for some time, which is the case for a lot of people. Though this hormonal disorder affects around 10 percent of women of childbearing age, most aren't properly diagnosed until they've spent at least a few frustrating years visiting various healthcare providers.

Once diagnosed, however, there are additional challenges that can come up, one of them being issues around eating. Often, the first thing doctors recommend to treat PMOS is lifestyle modifications like changes to diet and exercise, with the goal being weight loss. But this guidance ignores the concerning fact that women with PMOS also have an increased risk of developing bulimia, binge eating disorder (BED), and disordered eating.

“If someone has PMOS and an eating disorder—diagnosed or undiagnosed—and you tell them to focus on weight loss and dieting, you could worsen their disordered eating habits,” says Laura Cooney, MD, MSCE, associate professor of reproductive endocrinology and infertility at the University of Wisconsin. “Plus, you aren't treating them as a whole person who has both of these conditions.”

The link between PMOS and disordered eating is real and serious, but if you’re navigating both conditions, there are things you can do to manage PMOS while working toward (or protecting) eating disorder recovery. Read on to learn about the link between PMOS and eating disorders, how providers can support patients with both conditions, and how anyone living with PMOS can overcome disordered eating.

The impact of PMOS on mental health

Articles about PMOS tend to focus on the physical symptoms of the condition, which include acne, irregular menstrual cycles, fertility issues, weight gain, and excessive hair growth. However, PMOS can also affect psychological well-being. If you have PMOS, it might impact your mental health in a number of different ways, including:

Reduced self-esteem and poor body image

Diet culture continues to hold people to unrealistic expectations when it comes to physical appearance. Our society unfortunately idolizes thin people with flawless skin, forgetting that many of the images we see in the media are often air-brushed, heavy with makeup, or otherwise altered. These standards can cause anyone to struggle with self-esteem and body image, but they can be particularly hard for those affected by PMOS, who may be dealing with symptoms that go against these unattainable standards.

Weight stigma

According to Jessica Baker, PhD, Senior Researcher at Equip, people who have PMOS often live in larger bodies, and may experience weight stigma, or discrimination and stereotyping based on body size. Baker says that this stigma can come not only from society at large, but also from healthcare providers, which can be particularly harmful.

Anxiety and depression

An estimated 28 to 39 percent of people with PMOS have anxiety, and between 11 and 25 percent have depression. There may be many reasons for this, including hormonal changes as well as the mental and emotional toll of dealing with PMOS-related weight stigma, infertility issues, and body dissatisfaction—not to mention the stress of trying to get diagnosed in the first place and then manage the condition.

Decreased quality of life

Combine the above factors with the physical symptoms of PMOS, and it's a lot to handle. Given all that, it’s not terribly surprising that many people with PMOS report a decreased quality of life. They may also withdraw from social activities, intimate relationships, and other opportunities to interact with others, which can heighten all of these psychological symptoms.

Understanding disordered eating in the context of PMOS

Although we know what PMOS and disordered eating are related, at this time, “we don't have a full understanding of how PMOS can potentially contribute to eating disorders,” Cooney says. “Multiple factors could go into it.” These factors may include hormonal changes, anxiety, depression, and more.

Hormonal imbalances

Hyperandrogenism (high levels of male hormones, such as testosterone) can increase anxiety and depression. It may also boost appetite while decreasing impulse control, a combination that some research suggests may explain why people with PMOS are at particular risk of developing bulimia compared to other eating disorders.

Anxiety and depression

As outlined above, many people with PMOS experience anxiety or depression, or both, and this can play into the risk of developing disordered eating habits. As Cooney puts it, anxiety and depression “often go hand-in-hand with eating disorders.”

Insulin resistance

Our bodies produce the hormone insulin to regulate blood sugar levels. People with PMOS often develop insulin resistance (IR), which is when cells in the body don't respond to insulin. Insulin resistance, in turn, is associated with overeating, which plays a role in eating disorders like bulimia and binge eating disorder.

Brain changes

The hypothalamus is a part of the brain that regulates appetite, and research shows that it appears to function differently in people living with PMOS. This may contribute to eating beyond fullness.

Emotional eating

To cope with anxiety, depression, mood swings, and the stress of living with PMOS, people may turn to emotional eating. Emotional eating on occasion isn’t necessarily a bad thing, but when it becomes a pattern, or is a person’s only coping mechanism, it can turn into an eating disorder (in fact, research shows that emotional eating may lead to binge eating disorder). For people with PMOS, Baker says, emotional eating may become a pattern, since the behavior leads to relief from their negative feelings.

Unhelpful advice

In addition to the pressures from society to be thin, both uneducated healthcare providers and influencers on social media may recommend weight loss or dieting to people with PMOS. But many people with PMOS have already tried dieting without success (not surprising, since diets don’t work), and this advice may further fuel underlying body dissatisfaction and disordered eating. “It could also lead to increased shame or guilt if they're trying to lose weight but are having trouble reaching the goal their healthcare provider set,” Baker adds.

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How providers can support patients with PMOS

Given the complex relationship between PMOS and eating disorders, healthcare providers play a crucial role in helping patients address both conditions. Treatment should be individualized and holistic, and aim to support both physical and mental health. “Nothing with our bodies occurs in isolation, so just focusing on weight or diet or just giving medication isn't necessarily going to be helpful,” Baker says. “We need to consider the person's whole identity—their mind, body, spirit, and soul—and the whole of their experiences—their environment and stressors. We can't look at just one thing in a vacuum.”

Here are some ways that providers can support patients who are managing an eating disorder and PMOS.

Screen everyone

Given the prevalence of disordered eating in PMOS patients, one of the most important things for healthcare providers who treat patients with PMOS is to screen everyone for eating disorders. “Awareness is so important,” Cooney says. “If you have someone with PMOS and an eating disorder, any treatment needs to focus on the eating disorder first.” Most patients won't come out and say, “I have an eating disorder,” so it's the job of the provider to open the lines of communication and remain nonjudgmental. These guidelines on screening best practices can be helpful.

Provide comprehensive care

The physical symptoms of PMOS—such as hair growth and weight gain—can feed into the impact PMOS has on mental health—such as anxiety, depression, and eating disorders. In order to properly treat a patient with PMOS, providers must address all of these needs. This is where having a team of experienced therapists, dietitians, and other experts to refer patients to is imperative. “The problem with healthcare is you have short visits, you're trying to fix someone's periods and help them with hair growth and screen them for diabetes, and the mental health and eating disorders piece gets pushed to the back burner,” Cooney says. “Healthcare providers need to have partnerships with outside providers who are able to give patients the time for that piece.”

Encourage mindful eating

Women with PMOS are already more likely than people without PMOS to distrust medical professionals' opinions. Recommending weight loss may further promote distrust, as well as harm anyone with an eating disorder.

Instead, to support a healthy relationship with food, providers should focus on mindful eating, Cooney says. Mindfulness practices have been shown to increase the awareness of hunger, fullness, and cravings, and to decrease psychological distress. These are all things that people with PMOS may struggle with.

Additionally, weight-neutral approaches that center around enjoyable physical activity, healthy eating, and other lifestyle behaviors independent of body weight may be helpful.

Emphasize well-being over weight

“There's no conclusive evidence that someone's weight is causing PMOS and that, if they lose weight, their PMOS symptoms will go away,” Baker says. Additionally, various risks associated with PMOS—such as diabetes, high blood pressure, and high cholesterol—can't be measured by the scale. When providers shift the focus off of weight, they can instead focus on metabolic markers for these conditions, which can be measured via blood tests.

“A lot of lifestyle changes don't always come with a change to the number on the scale,” Cooney adds. “It can be really rewarding to show a patient with PMOS that yes, your weight may be the same, but these metabolic numbers are improving or stable—which is good. This is a win.”

What to do if you’re struggling with PMOS and disordered eating

If you have PMOS and currently have some disordered eating habits or think you may have an eating disorder, you're not alone. The good news is that with the right support, you can both manage your PMOS and overcome any harmful eating behaviors. The sooner you seek treatment for an eating disorder or disordered eating, the higher your chance of achieving full recovery and avoiding serious health consequences, so don't hesitate.

Here are some things to keep in mind as you get started with recovery:

Find the right therapist for you

In an ideal world, you’d find a therapist who has experience treating patients with both PMOS and eating disorders—but the most important thing is to see a therapist that you feel comfortable with and can be honest with. Open communication is key to address all of your emotions and behaviors.

Consider a support group

Knowing you're not alone can go a long way toward supporting your mental health. Thankfully, there are many support groups for both eating disorders and those navigating PMOS, which can meet either in-person or virtually. Attending these sessions gives you a chance to get things off your chest, relate to others, learn helpful strategies, and get emotional support. Cooney refers her patients to PMOS Challenge, which offers advocacy and support groups, and there are a number of online eating disorder support groups that may be helpful.

Seek eating-disorder-informed providers

Many providers subconsciously hold weight biases, and some may prescribe weight loss for PMOS, both of which can be especially harmful if you’re dealing with disordered eating. To protect yourself against this, try to find providers who offer a weight-neutral or health at every size (HAES) approach. “HAES says folks can be healthy at any weight or size,” Baker explains. “What needs to be the focus are additional metrics of health, like hormonal levels, metabolic factors, glucose levels, thyroid health, cardiac risk—those sorts of things.”

Build a positive relationship with food

Mindful eating and intuitive eating are two similar yet different approaches to fostering better body image and a positive relationship with food. With mindful eating, you increase awareness of your hunger cues and respond to them by consciously choosing something to eat and then giving that meal or snack your full attention. On the other hand, intuitive eating is centered around letting go of food “rules,” honoring your hunger and fullness cues, and finding movement you enjoy. Many registered dietitians can help you with either or both of these practices.

Get informed

“It can be hard to find accurate information about PMOS online,” Cooney says. One vetted resource she suggests is the AskPMOS app. Developed by PMOS experts, it provides information about the condition as well as forums where you can join discussions with other patients.

The Equip takeaway: Tackling PMOS and eating disorders together

Eating disorders are common in women with PMOS. And since lifestyle modifications are the first-line treatment for the condition, uneducated healthcare providers may recommend weight loss or diet and exercise practices that can worsen disordered eating, negative body image, and mental health.

Instead, providers should take a patient-centered approach to care, seeking to develop an individualized plan for each person. The emphasis should be on improving quality of life and health markers, rather than weight. To provide this comprehensive care, doctors need to partner with eating disorder-informed therapists, dietitians, and other experts who can help patients address any underlying eating disorders or disordered eating.

At the same time, patients should feel empowered knowing there are weight-neutral and HAES-informed providers who can help them manage their PMOS, let go of their disordered eating habits, and embrace a life free of self-judgment.

If you have PMOS and are struggling with disordered eating habits, our team can help. Schedule a call today to talk through your concerns and explore treatment options.

FAQ about PMOS and eating disorders

What is PMOS and how can it influence eating disorders?

PMOS is a hormonal disorder that can lead to physical symptoms—like increased hair growth, weight gain, and acne—that can affect body image and self-esteem. These factors, combined with PMOS-related symptoms like hormonal imbalance, insulin resistance, anxiety, and depression, may lead those struggling with PMOS to develop disordered eating behaviors to cope.

How do hormonal imbalances in PMOS affect eating behaviors?

Hormonal fluctuations in PMOS can disrupt appetite regulation, potentially contributing to patterns like emotional eating and binge eating.

In what ways can healthcare providers support patients with PMOS to prevent disordered eating?

Providers can help prevent and treat eating disorders in PMOS patients by promoting a holistic approach that focuses on overall health rather than weight. Providers should screen for signs of eating disorders to provide early intervention and, if an eating disorder is detected, refer patients to eating disorder-informed providers.

How can people manage both PMOS and eating disorders effectively?

Effectively managing eating disorders and PMOS may involve some combination of medical treatment for PMOS symptoms, therapy to provide psychological support, nutritional counseling, and support groups. Focusing on self-care and seeking professional help from providers who take a holistic approach to care is crucial. At Equip, PMOS patients may work with an Equip medical provider to manage PMOS-related symptoms and concerns while they focus on recovery with the rest of their treatment team.