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Endocrinology

Cite as: Archiv EuroMedica. 2026. 16; 4. DOI 10.35630/2026/16/Iss.4.16

Received 31 May 2026;
Accepted 20 July 2026;
Published 3 August 2026

THE IMPACT OF LIFESTYLE: THE EFFECTS OF DIET, EXERCISE AND INOSITOL SUPPLEMENTATION ON THE COURSE OF POLYENDOCRINE METABOLIC OVARIAN SYNDROME (PMOS): NARRATIVE REVIEW

Maria Miller¹ , Aleksandra Kamińska² ,
Kornelia Fimiarz³ , Aleksandra Kłosowicz¹ ,
Aleksandra Pakulska¹ , Aleksandra Błoch¹ ,
Natalia Rządzińska¹

¹ Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland
² Medical Center HCP in Poznan, Poland
³ Nicolaus Copernicus Hospital in Gdansk, Poland

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  mario.maria.miller@gmail.com

ABSTRACT

Background

Polyendocrine metabolic ovarian syndrome (PMOS), previously known as polycystic ovary syndrome (PCOS), is a complex endocrine and metabolic disorder associated with insulin resistance, hyperandrogenism, ovulatory dysfunction, and metabolic complications. Lifestyle modification is considered an important component of PMOS management.

Aims

To summarize current evidence regarding the effects of dietary interventions, physical activity, sleep quality, and inositol supplementation in women with PMOS.

Materials and methods

A narrative review of the literature was conducted using the PubMed and Google Scholar databases. The final literature search was performed on July 8, 2026. English-language peer-reviewed publications published between 2009 and 2026, including systematic reviews, meta-analyses, randomized controlled trials, cohort and observational studies, narrative reviews, and case series, were analyzed. Earlier landmark studies and international clinical guidelines were included when relevant. Following literature screening and eligibility assessment, 49 publications were included.

Results

Current evidence suggests that dietary modification, regular physical activity, and inositol supplementation may improve insulin resistance, menstrual regularity, ovulatory function, hyperandrogenism, and selected metabolic parameters. Sleep disturbances are common in women with PMOS and appear to be associated with adverse metabolic and psychological outcomes; however, evidence regarding sleep interventions remains limited.

Conclusions

Lifestyle modification may support the comprehensive management of PMOS. The strongest evidence supports dietary interventions, physical activity, and inositol supplementation, whereas further high-quality studies are needed to clarify the role of sleep optimization and determine the long-term effectiveness of individual lifestyle interventions.

Keywords: polyendocrine metabolic ovarian syndrome; PMOS; polycystic ovary syndrome; PCOS; lifestyle modification; diet; physical activity; sleep; inositol; insulin resistance

INTRODUCTION

On 12 May 2026, the name polycystic ovary syndrome (PCOS) was officially changed to polyendocrine metabolic ovarian syndrome (PMOS). The change was announced by an international panel of experts, and the results were published in the medical journal The Lancet. The new terminology reflects the complex endocrine and metabolic nature of the disorder, emphasizing that reproductive abnormalities represent only one aspect of the disease. This updated concept also highlights the clinical importance of lifestyle interventions, including dietary modification and physical activity, as fundamental components of PMOS management [1].

PMOS is a common endocrine and metabolic disorder that affects the health of women of reproductive age [2]. This condition affects between 6% and 21% of the female population, depending on the studied population and the diagnostic criteria used [3]. According to the current international diagnostic criteria, the diagnosis of PMOS requires the presence of at least two of the following three diagnostic features: ovulatory dysfunction, clinical and/or biochemical hyperandrogenism, and polycystic ovary morphology (PCOM). PCOM is assessed by ultrasound or, in adult women, may be inferred from elevated serum anti-Müllerian hormone (AMH) levels. AMH, a marker of ovarian follicle number, is used as an alternative to ultrasound assessment of PCOM in appropriate clinical settings rather than as an independent diagnostic criterion [4]. The different combinations of these diagnostic features result in considerable clinical heterogeneity of the syndrome. The classic phenotype is characterized by hyperandrogenism with ovulatory dysfunction, with or without PCOM [5].

PMOS is characterized by a broad spectrum of reproductive, endocrine, and metabolic manifestations. Reproductive abnormalities include ovulatory dysfunction, infertility, and adverse pregnancy outcomes [6]. Endocrine manifestations are primarily related to hyperandrogenism, which may present clinically as hirsutism, androgenetic alopecia, or acne and is confirmed by biochemical evidence of androgen excess [7]. Metabolic dysfunction is a hallmark of PMOS, with approximately 75% of affected women exhibiting insulin resistance; acanthosis nigricans may also occur as a clinical marker associated with insulin resistance and hyperinsulinemia [8].

Insulin resistance and compensatory hyperinsulinemia contribute to weight gain and play a key role in the development of metabolic abnormalities, including an increased risk of type 2 diabetes mellitus. Women with PMOS are also at increased risk of obesity, cardiovascular disease, hypertension, obstructive sleep apnea, dyslipidemia, and metabolic syndrome [5]. Obesity affects approximately 30–75% of women with PMOS, depending on the population studied, while approximately 20–30% meet the diagnostic criteria for metabolic syndrome [5,9–11]. In addition to these reproductive, endocrine, and metabolic abnormalities, PMOS is associated with an increased prevalence of psychological disorders, particularly anxiety and depression, although the underlying mechanisms remain incompletely understood [5].

Given the multifactorial nature of PMOS and the central role of metabolic dysfunction in its pathophysiology, comprehensive lifestyle management has become an essential component of treatment [4,12]. Dietary modification, regular physical activity, adequate sleep, and selected nutritional supplements, particularly inositol, have been shown to influence key pathophysiological mechanisms of PMOS, including insulin resistance, hyperandrogenism, chronic low-grade inflammation, and ovulatory dysfunction [4,12–15]. These interventions are therefore considered important adjuncts to pharmacological therapy and may contribute to improvements in both reproductive and metabolic health [4,12].

Although numerous studies and systematic reviews have evaluated individual lifestyle interventions, including dietary modification, physical activity, sleep, and inositol supplementation, relatively few have considered these interventions together within a comprehensive lifestyle management framework [4,12–14]. To the best of our knowledge, no comprehensive review has specifically integrated dietary strategies, physical activity, sleep quality, and inositol supplementation within the framework of the newly adopted PMOS concept. Such an integrated approach is scientifically justified because these factors influence common pathophysiological mechanisms and may act synergistically to improve clinical outcomes [4,12].

AIMS

The present review aims to summarize and critically evaluate current evidence regarding the role of dietary strategies, physical activity, sleep quality, and inositol supplementation in the management of PMOS, as well as to discuss their potential interactions in improving reproductive, metabolic, and psychological outcomes. Specifically, this review evaluates the available evidence regarding dietary strategies, physical activity, sleep quality, and inositol supplementation, identifies the strengths and limitations of the evidence for each of these areas, and highlights priorities for future research. By addressing these complementary components of lifestyle management together, this review provides a comprehensive perspective that may support the development of more individualized and evidence-based therapeutic strategies for women with PMOS.

MATERIALS AND METHODS

This article is a narrative review. A review of the available literature was conducted to summarize current evidence regarding the role of dietary interventions, physical activity, sleep quality, and inositol supplementation in the management of polyendocrine metabolic ovarian syndrome (PMOS). The final literature search was conducted on July 8, 2026. Eligible studies included systematic reviews, meta-analyses, randomized controlled trials, cohort studies, observational studies, narrative reviews, and case series published between 2009 and 2026 that evaluated the effects of dietary interventions, physical activity, sleep, or inositol supplementation in women with PMOS (formerly PCOS). Earlier landmark studies and international clinical guidelines were included when considered essential for understanding the diagnosis, pathophysiology, or management of PMOS. Only peer-reviewed articles published in English were included. Conference abstracts, editorials, letters to the editor, expert opinions without supporting clinical evidence, non-peer-reviewed publications, duplicate records, animal studies, in vitro studies, and articles not directly related to lifestyle interventions or their effects on reproductive, metabolic, endocrine, or psychological outcomes in women with PMOS were excluded.

The database search identified 177 publications (99 in PubMed and 78 in Google Scholar). After removal of 34 duplicate records, 143 publications were screened by title and abstract. Of these, 76 were excluded because they were not relevant to the objectives of the review, were conference abstracts, non-peer-reviewed publications, or did not address lifestyle interventions in women with PMOS (formerly PCOS). The remaining 67 full-text articles were assessed for eligibility. A further 18 publications were excluded because they did not meet the predefined inclusion criteria, lacked clinically relevant outcome data, or substantially overlapped with more recent publications. Ultimately, 49 publications were included in the final narrative review.

The literature search was conducted using the PubMed and Google Scholar databases. Because this was a narrative review, the search was performed iteratively using predefined keywords and Boolean operators rather than according to a formal systematic review protocol.

In PubMed, the following search terms and their combinations were used: polycystic ovary syndrome, polyendocrine metabolic ovarian syndrome, PCOS, PMOS, diet, dietary intervention, Mediterranean diet, ketogenic diet, low glycemic index diet, physical activity, exercise, sleep, sleep quality, inositol, myo-inositol, D-chiro-inositol, insulin resistance, hyperandrogenism, metabolic syndrome, and fertility. Representative search strings included: (polycystic ovary syndrome OR PCOS OR PMOS) AND diet, (polycystic ovary syndrome OR PCOS OR PMOS) AND physical activity, (polycystic ovary syndrome OR PCOS OR PMOS) AND sleep, (polycystic ovary syndrome OR PCOS OR PMOS) AND inositol, PCOS AND insulin resistance, and PCOS AND hyperandrogenism.

In Google Scholar, searches were performed using the same core search terms and analogous keyword combinations, including: PCOS diet, PMOS diet, PCOS physical activity, PCOS exercise, PCOS sleep, PCOS inositol, PCOS insulin resistance, PMOS lifestyle, and PMOS management.

RESULTS

The main lifestyle interventions discussed in this review, including dietary strategies, physical activity, sleep optimization, and inositol supplementation, are summarized in Table 2. The table presents the proposed mechanisms of action, principal clinical outcomes, limitations of the available evidence, and key supporting references for each intervention.

Dietary interventions

A healthy diet has a lifelong impact on patients with polyendocrine metabolic ovarian syndrome. Based on the research carried out, several types of diet have been identified that make life easier for women with PMOS. These include diets rich in fibre, fatty acids and omega-3 fatty acids [16] and the ketogenic diet [17]. In addition, due to insulin resistance associated with the condition, patients should consume foods with a low glycaemic index, as these help prevent sudden spikes in insulin levels [18].

A low-glycaemic index diet

A low-glycaemic index diet consists of foods that cause blood glucose levels to rise gradually. Stable blood glucose levels prevent excessive testosterone production and help control acne, hirsutism and irregular menstrual cycles [19]. Furthermore, research suggests that a low-GI diet helps manage metabolic and hormonal disorders in women with polyendocrine metabolic ovarian syndrome [18].

Foods in a low-glycaemic diet include whole grains, pulses, fruit and vegetables, which are rich in anti-inflammatory compounds. Studies have shown that a low-glycaemic index diet reduces uric acid levels [20], reduces inflammation and lowers oxidative stress in patients, which has a positive effect on their fertility. In a randomised controlled trial involving 37 women, 18 of them followed a diet consisting of foods with a normal glycaemic index, whilst 19 of them followed a low-glycaemic diet. The results of this study showed that patients following a low-GI diet experienced an increase in ovulatory cycles and an improvement in insulin resistance, alongside a reduction in testosterone levels [21]. Furthermore, this diet improves metabolic parameters, lowers triglyceride levels and reduces fasting insulin levels [22].

The ketogenic diet

The ketogenic diet consists of high-fat foods with an adequate protein content and a low carbohydrate content [23]. This combination puts the body into a state known as ketosis. In a state of ketosis, due to low carbohydrate intake, the human body switches to deriving energy primarily from fats rather than from glucose [24]. A ketogenic diet promotes weight loss. Women diagnosed with polyendocrine metabolic ovarian syndrome often struggle with being overweight or obese, which exacerbates hormonal imbalances. Putting the body into a state of ketosis leads to fat being burned instead of glucose. This makes weight loss more effective [25]. Furthermore, studies have shown that the ketogenic diet reduces androgen levels and improves reproductive hormone levels [17], which is particularly important for patients with polyendocrine metabolic ovarian syndrome. However, when it comes to the ketogenic diet, it is worth noting that it is not recommended in the long term, as it has a lower nutritional value [26]. This diet excludes, amongst other things, many fruits, vegetables and wholegrains, which can consequently lead to vitamin deficiencies; it is also low in fibre, which can cause constipation [27].

A high-protein diet and a diet rich in omega-3 fatty acids

Research shows that a high-protein diet also helps with weight loss, which is crucial for women struggling with PMOS [28]. As with a low-glycaemic index diet or a ketogenic diet, a high-protein diet combined with high-fibre foods slows down the absorption of glucose into the bloodstream and prevents sharp spikes in blood insulin levels [29]. A diet rich in omega-3 fatty acids is also worth considering, as these have anti-inflammatory properties that may help reduce androgen levels in metabolic syndromes, including polyendocrine metabolic ovarian syndrome. Good natural sources of these fatty acids include fish, particularly salmon, sardines and mackerel. Furthermore, plant-based products such as chia seed oil and linseed oil are another source of omega-3 fatty acids [30-31]. A high intake of these fatty acids has a positive effect on the lipid profile and adiponectin levels, and helps regulate the menstrual cycle in women. In addition, their consumption improves mental wellbeing, which is particularly important for women with depression resulting from PMOS [32-33].

Inositol

Improved insulin sensitivity and blood sugar control in PMOS can also be achieved through the use of supplements. When combined with a low-glycaemic index diet, insulin-sensitising drugs appear to reduce the severity of PMOS symptoms and restore ovulatory function. The most common drug that increases insulin sensitivity is metformin. Its positive effect on fertility has been studied; however, its use is associated with a number of side effects, such as nausea, diarrhoea and a potential risk of foetal abnormalities [34]. In light of this, extensive research has been carried out into other drugs that increase insulin sensitivity but do not cause side effects. Myo-inositol (MI) and d-chiro-inositol (DCI) are two stereoisomers of inositol that may have therapeutic benefits in PMOS. It has been found that inositol supplementation reduces ovulatory dysfunction, insulin resistance, hyperinsulinemia and hyperandrogenism, thereby improving fertility and reproductive outcomes whilst reducing the number of adverse effects [35]. However, there are not many studies involving large groups of patients comparing the use of metformin and inositol; nevertheless, one study has shown that metformin plus 400 μg of folic acid taken orally for 6 months restored spontaneous ovulation in 65% of patients, compared to 50% of patients taking 1500 mg/day of metformin [34]. A meta-analysis of studies involving 601 women with PMOS showed that treatment with inositol or myo-inositol, d-chiro-inositol, or both together increases the rate of ovulation and the frequency of menstrual cycles sixfold, without any adverse side effects. In addition, a consistent improvement in glycaemic parameters (fasting glucose levels, insulin levels, insulin resistance) was observed in women who took inositol compared with those receiving a placebo. Meta-analysis also showed that levels of total androgens, serum testosterone and dehydroepiandrosterone (DHEA) decreased, whilst SHBG levels improved [35]. MI mechanisms improve ovulatory function, whilst DCI mechanisms improve glycaemic parameters and reduce hyperinsulinemia [34].

Aerobic exercise

Aerobic exercise refers to any activity that involves a large group of muscles and is performed continuously and rhythmically [36]. Research shows that physical activity, and aerobic exercise in particular, has a positive effect on managing the symptoms of polyendocrine metabolic ovarian syndrome, with evidence suggesting improved insulin sensitivity [37], improved cardiovascular health and hormonal balance [38]. A woman who does aerobic exercise – such as cycling, swimming, running or walking – increases her body’s sensitivity to insulin by improving its uptake from the blood into the muscles. Such physical activity can also help regulate periods by lowering insulin levels [39] and contributes to improved ovarian function [40]. A study of women with PMOS found that those who performed aerobic exercise for 12 weeks (three 20-minute sessions) experienced a reduction in BMI and body fat, alongside an increase in FSH, free testosterone and sex hormone-binding globulin [41]. In accordance with international guidelines on the treatment of polyendocrine metabolic ovarian syndrome, it is recommended that adult women, i.e. aged 18-64, engage in at least 250 minutes of moderate-intensity exercise or 150 minutes of high-intensity exercise, with the most desirable approach being to perform physical activity twice a week but not consecutively [42]. It is worth noting that it is not so much the amount of exercise as its intensity that contributes to improved health outcomes. High-intensity exercise may have the greatest impact on cardiorespiratory capacity, insulin resistance and overall body composition [43].

Resistance exercise

Resistance exercise is a form of strength training that involves exercises designed to increase muscle strength and endurance by working against some form of resistance. Research has shown that a combination of aerobic and resistance exercises helps alleviate symptoms in women with polyendocrine metabolic ovarian syndrome. A systematic review comprising seven RCTs showed that regular exercise helped improve reproductive function, hormonal balance and the regularity of menstrual cycles [44]. The results of the analyses also indicate that women with PMOS should engage in high-intensity physical activity for at least 120 minutes a week in order to achieve health benefits [45].

Sleep

Sleep disorders and mental health issues, various types of anxiety and depression are very common among women with PMOS [46]. Chronic sleep deprivation is associated with an increased risk of obesity and type 2 diabetes [47-48]. Melatonin, the main hormone secreted by the pineal gland, is responsible for regulating the circadian rhythm. Recent observations have shown that women with polyendocrine metabolic ovarian syndrome have reduced levels of melatonin in their follicular fluid. Melatonin receptors in the ovary and the follicular fluid are responsible for the regular secretion of sex hormones during the various phases of follicular development. Melatonin is a powerful antioxidant responsible for protecting ovarian follicles during their maturation [49].

Overall, the findings summarized in Table 2 indicate that lifestyle interventions constitute complementary components of PMOS management. Dietary modification, physical activity, sleep optimization, and inositol supplementation target overlapping pathophysiological mechanisms and may collectively improve reproductive, metabolic, endocrine, and psychological outcomes. However, the quality and quantity of available evidence vary across interventions. The strongest evidence supports dietary modification, physical activity, and inositol supplementation, whereas high-quality interventional studies evaluating sleep remain comparatively limited [4,12–14,17,18,28,35,43,44,49].

DISCUSSION

Polyendocrine metabolic ovarian syndrome (PMOS) is a complex endocrine and metabolic disorder requiring long-term multidisciplinary management, with lifestyle modification representing an important component alongside pharmacological therapy [1,4,6]. The findings summarized in this review suggest that lifestyle interventions may represent an important component of comprehensive PMOS management. However, the strength of evidence differs between individual interventions and should be interpreted accordingly [4,12].

Among the analyzed lifestyle strategies, the largest body of evidence is available for dietary modification, regular physical activity, and inositol supplementation. These interventions are consistently recommended in the 2023 International Evidence-based Guideline because they primarily target insulin resistance, metabolic dysfunction, and hyperandrogenism, which are central mechanisms underlying PMOS [4,42]. Nevertheless, the available evidence is heterogeneous with respect to study design, intervention duration, dietary composition, and outcome measures [12,18,26,43].

Low-glycemic index diets appear to provide the most consistent metabolic benefits. The analyzed studies suggest improvements in insulin sensitivity, fasting insulin concentrations, ovulatory function, and androgen levels [18,21,22]. In contrast, although ketogenic diets have demonstrated favorable effects on body weight and reproductive hormone profiles, the available evidence is derived mainly from short-term studies, and concerns remain regarding their long-term safety, nutritional adequacy, and sustainability [17,26,27]. Similarly, current evidence indicates that high-protein diets and dietary patterns rich in omega-3 fatty acids may improve body weight, lipid metabolism, inflammatory status, and selected metabolic parameters [28,30–33]. However, differences in dietary composition and study methodology limit direct comparisons between studies and preclude firm conclusions regarding the superiority of one dietary approach over another [26,28,31].

Regular physical activity also appears to improve several clinical aspects of PMOS, particularly insulin sensitivity, body composition, cardiovascular fitness, and menstrual function [40–45]. Current international guidelines recommend combining aerobic and resistance exercise as part of routine management [4,42]. Nevertheless, the optimal exercise intensity, frequency, and duration remain uncertain because substantial heterogeneity exists among intervention protocols included in published studies [43–45].

The evidence supporting inositol supplementation has strengthened considerably in recent years owing to several systematic reviews and meta-analyses [13-14,34,35]. Available data suggest beneficial effects on ovulation, menstrual regularity, insulin resistance, and hyperandrogenism, with a favorable safety profile [13-14,34,35]. However, uncertainty remains regarding the optimal myo-inositol to D-chiro-inositol ratio, treatment duration, and patient populations most likely to benefit from supplementation [13-14].

Sleep quality has received increasing attention as a potential contributor to PMOS pathophysiology. The available evidence suggests that sleep disturbances are common among women with PMOS and may contribute to insulin resistance, obesity, psychological symptoms, and endocrine dysfunction [15,46–49]. However, compared with dietary interventions, exercise, and inositol supplementation, relatively few interventional studies have evaluated whether improving sleep quality directly translates into better reproductive or metabolic outcomes [15,46,49]. Consequently, although adequate sleep should be considered an important component of a healthy lifestyle, further prospective studies are needed to clarify its therapeutic role in PMOS management [4,15].

An important observation emerging from this review is that lifestyle interventions appear to influence overlapping pathophysiological mechanisms rather than isolated clinical manifestations. Improvements in insulin sensitivity, chronic low-grade inflammation, body composition, and hormonal balance may collectively contribute to better ovulatory function and overall metabolic health [2,4,18,26,35,40,43]. However, the currently available evidence provides stronger support for improvements in metabolic and endocrine outcomes than for direct improvements in fertility, which remains insufficiently investigated in many studies [4,12,26,35].

Limitations

This review has a number of limitations. This paper adopts a narrative approach to the literature review, which does not meet the criteria for a systematic review. Some of the studies analysed involved small sample sizes and were based on different methodologies, making it difficult to draw clear comparisons between the results. The literature review was limited to two databases and publications from 2009 to 2026, which may have resulted in the exclusion of relevant studies published in other databases. These limitations should be considered when interpreting the results of this review. Nevertheless, the data presented clearly indicate that lifestyle changes in women with PMOS can help improve metabolic and hormonal parameters and have a positive impact on their quality of life.

CONCLUSIONS

In summary, lifestyle modification may represent an important component of the overall management of polyendocrine metabolic ovarian syndrome (PMOS). The available evidence suggests that dietary interventions, regular physical activity, adequate sleep, and inositol supplementation may contribute to improvements in selected metabolic and endocrine parameters, as well as menstrual regularity and ovulatory function.

Among the lifestyle interventions reviewed, the strongest evidence supports dietary modification, regular physical activity, and inositol supplementation, whereas evidence regarding sleep optimization remains comparatively limited and is based mainly on observational studies. Although the available findings are encouraging, differences in study design, intervention protocols, and outcome measures should be considered when interpreting the results.

Overall, a comprehensive lifestyle approach, integrated with standard medical care, may support the management of PMOS and contribute to improvements in patients' overall health and quality of life. Further large-scale, well-designed randomized controlled trials are needed to establish the long-term effectiveness of individual lifestyle interventions and to determine the optimal strategies for different patient populations.

DISCLOSURE

Author Contributions

Conceptualization: Maria Miller, Aleksandra Kłosowicz, Kornelia Fimiarz. Methodology: Aleksandra Pakulska, Aleksandra Kłosowicz. Formal analysis: Kornelia Fimiarz, Aleksandra Kamińska, Natalia Rządzińska. Investigation: Maria Miller, Aleksandra Błoch, Aleksandra Pakulska. Writing-rough preparation: Aleksandra Kamińska, Natalia Rządzińska, Maria Miller, Aleksandra Błoch. Writing-review and editing: Aleksandra Kłosowicz, Kornelia Fimiarz, Aleksandra Pakulska. Supervision: Natalia Rządzińska, Aleksandra Błoch, Aleksandra Kamińska.

All authors have read and agreed with the published version of the manuscript.

Funding

This research did not receive any funding.

Conflict of Interest

Authors declare no conflict of interest.

Use of Artificial Intelligence

Artificial Intelligence was used for language editing and stylistic correction.

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