PMOS and Your Pelvic Floor: What You Need to Know
What Is PMOS?
PCOS (polycystic ovary syndrome) has now been renamed PMOS (polyendocrine metabolic ovarian syndrome) to better reflect the condition’s true complexity. Previously, the term PCOS inaccurately implied the presence of pathological ovarian cysts, while the condition actually involves multiple endocrine, metabolic, and ovarian dysfunctions.
PMOS can affect many different systems in the body and often presents differently from person to person. Common symptoms may include:
Irregular menstrual cycles
Ovulation dysfunction
Infertility
Insulin resistance
Weight gain
Acne
Hirsutism (excess facial or body hair)
Hair thinning
Fatigue
Increased risk of type 2 diabetes and cardiovascular disease
Because PMOS impacts hormones, metabolism, inflammation, and stress regulation, it can also influence pelvic floor function and overall core coordination.
How Does PMOS Affect the Pelvic Floor?
Hormonal changes associated with PMOS, including elevated androgen levels and irregular estrogen and progesterone levels, may affect tissue health, muscle tone, and pelvic floor function.
Muscle tone refers to how tense or relaxed a muscle is at rest. In the pelvic floor, muscles can become either too tight (high tone) or too lax and weak (low tone).
High-Tone Pelvic Floor
A high-tone pelvic floor means the muscles are constantly tightened or unable to fully relax. This may contribute to symptoms such as:
Pelvic pain
Pain with intercourse
Constipation
Difficulty fully emptying the bladder
Urinary urgency
Low back pain
Hip pain
Many individuals with PMOS also experience chronic stress, abdominal tension, pain, or breathing dysfunction, which can further contribute to pelvic floor overactivity and excessive gripping through the core and abdomen.
Low-Tone Pelvic Floor
A low-tone pelvic floor means the muscles may not be providing enough support or strength. This can lead to:
Urinary leakage
Pelvic heaviness or pressure
Decreased core support
Prolapse symptoms
Weight changes and abdominal bloating associated with PMOS may also increase pressure on the pelvic floor over time, contributing to feelings of heaviness, leakage, or discomfort.
Other Ways PMOS Can Contribute to Pelvic Floor Dysfunction
PMOS can impact more than just hormones. Many of the symptoms associated with the condition may indirectly affect pelvic floor health and core function.
Irregular or Painful Cycles
Heavy or irregular periods may contribute to cramping, pelvic pain, and low back discomfort. When pain is persistent, the pelvic floor muscles often become more guarded and overactive.
Constipation and Digestive Changes
Digestive symptoms and constipation can place repeated strain on the pelvic floor muscles, increasing tension and pressure within the abdomen and pelvis.
Stress and Nervous System Dysregulation
Chronic stress and pain can keep the body in a heightened state of tension. This may affect breathing patterns, abdominal pressure management, and pelvic floor coordination.
Difficulty Coordinating the Deep Core
The diaphragm, deep abdominal muscles, and pelvic floor are designed to work together as a pressure management system. When this coordination becomes disrupted, people may develop excessive abdominal gripping, shallow breathing, or difficulty properly activating their core.
How Can Pelvic Floor Physical Therapy Help?
Pelvic floor physical therapy can help address many of the symptoms and contributing factors associated with PMOS. Because hormonal imbalances, abdominal pressure changes, pain, constipation, and stress can all affect the pelvic floor, treatment is often focused on improving how the muscles function rather than simply “strengthening” them.
Treatment for an Overactive Pelvic Floor
For individuals with a high-tone or overactive pelvic floor, pelvic floor PT may help reduce:
Pelvic pain
Pain with intercourse
Urinary urgency
Constipation
Hip and low back pain
Abdominal tension and gripping
Treatment may include:
Breathing exercises
Relaxation strategies
Manual therapy
Stretching and mobility work
Nervous system downtraining
Pelvic floor muscle relaxation techniques
Treatment for Weakness or Poor Coordination
For individuals experiencing weakness or poor coordination of the pelvic floor, therapy may help improve:
Urinary leakage
Pelvic heaviness or pressure
Core support and stability
Exercise tolerance
Treatment may focus on:
Pelvic floor strengthening
Deep core coordination
Pressure management training
Functional movement retraining
Improving coordination between the diaphragm, core, and pelvic floor muscles
Pelvic Floor PT is About More Than Kegels
Pelvic floor physical therapy is highly individualized and often includes much more than strengthening exercises. Treatment may also help individuals with PMOS:
Safely return to exercise
Improve bowel and bladder habits
Decrease excessive abdominal gripping
Improve posture and movement patterns
Reduce strain and pressure on the pelvic floor
Better understand their symptoms and body mechanics
Ultimately, pelvic floor therapy aims to improve function, decrease discomfort, and help individuals feel more confident and connected to their bodies.