PMOS: A New Name. A Better Understanding.

For decades, the name polycystic ovary syndrome (PCOS) has failed to capture the true nature of the condition.

This year, following a 14-year international consensus process involving clinicians, researchers, professional societies, patient advocacy organizations, and more than 14,000 people with lived experience, it was officially renamed Polyendocrine Metabolic Ovarian Syndrome (PMOS). The new terminology, published in The Lancet, reflects one of the most significant shifts in our understanding of the condition since it was first described.

At first glance, a name change may not seem particularly important. Yet the response from both healthcare professionals and the PMOS community has been remarkable. Names matter. They shape how we understand our bodies. They influence the questions we ask, the research we prioritize, the care people receive, and sometimes even the stories we tell ourselves.

For many individuals living with the condition, the name polycystic ovary syndrome never quite fit. Some had no "cysts" on their ovaries. Others struggled less with irregular menstrual cycles and more with insulin resistance, weight changes, anxiety, infertility, elevated cholesterol, or long-term cardiometabolic health. Many discovered, often years later, that the diagnosis had implications extending well beyond their reproductive years.

The previous name focused our attention on the ovaries. The new name reflects what we now understand. invites us to see the whole picture. PMOS is a complex endocrine and metabolic syndrome that affects the whole person and evolves across the lifespan.

My hope is that this new name also encourages a broader approach to care - one that supports endocrine, metabolic, cardiovascular, reproductive, and psychological health throughout life. A diagnosis of PMOS is not simply an explanation for current symptoms; it is also an opportunity to better understand an individual's health and identify opportunities to reduce long-term risk.

Why Was the Name Changed?

The decision to rename PCOS was not made lightly.

It followed a 14-year international consensus process involving clinicians, researchers, professional organizations, and patient advocacy groups from around the world. The consensus recognized that the previous name no longer reflected our scientific understanding of the condition and, in many cases, contributed to misunderstanding, delayed diagnosis, fragmented care, and stigma.

The goal of the new terminology is straightforward: the name should reflect what we now know.

The ovaries remain an important part of the syndrome, but they are only one component of a much larger endocrine and metabolic picture.

Why the Old Name Was Misleading

One of the greatest sources of confusion surrounding polycystic ovary syndrome (PCOS) was that the name didn't accurately describe the condition.

Despite its name, many women diagnosed with PCOS did not have ovarian cysts. The "cysts" seen on ultrasound are actually small, immature ovarian follicles - normal egg-containing structures that have not completed the process of ovulation. They are follicles, not pathological cysts.

Adding to the confusion, not everyone with PCOS has this ultrasound appearance, and many women without the condition have polycystic ovarian morphology. In other words, the ovarian appearance alone neither defines nor excludes the diagnosis.

Over time, research has also shown that the ovaries are only one part of a much more complex picture. PMOS involves interactions between the brain, ovaries, adrenal glands, pancreas, liver, adipose tissue, and other organs that regulate hormones, metabolism, inflammation, and energy balance.

As our understanding evolved, it became increasingly clear that the previous name placed too much emphasis on one feature of the condition while overlooking the endocrine and metabolic processes that often have the greatest impact on long-term health.

The new name reflects that broader understanding. Rather than focusing on the ovaries alone, it recognizes PMOS as a complex endocrine and metabolic syndrome with lifelong reproductive, cardiometabolic, and psychological implications. This shift has fundamentally changed how we diagnose, assess, and manage the condition.

What Does PMOS Mean?

Polyendocrine

PMOS affects multiple hormone systems - not just the ovaries.

Communication between the brain, ovaries, adrenal glands, pancreas, adipose tissue, liver, and other organs contributes to the condition. Hormones involved in ovulation, insulin regulation, androgen production, appetite, and metabolism interact in complex and highly individualized ways.

This complexity helps explain why PMOS can look so different from one person to another. 

Metabolic

Perhaps the most important addition to the name is metabolic.

Over the past two decades, research has consistently demonstrated that PMOS is associated with increased risks of insulin resistance, prediabetes, type 2 diabetes, dyslipidemia, metabolic dysfunction-associated steatotic liver disease (MASLD), and cardiovascular disease.

These metabolic changes often begin years before blood sugar becomes abnormal and are not limited to individuals living in larger bodies. Many people with PMOS who have a normal body weight also experience insulin resistance or other metabolic abnormalities.

Including metabolic in the name, we acknowledge that this condition extends well beyond reproduction. It also reinforces the importance of recognizing cardiometabolic risk early, when there is the greatest opportunity to support long-term health.

Ovarian

The ovaries remain central to the syndrome.

Many women experience irregular ovulation, increased ovarian androgen production, and altered follicle development. These changes contribute to symptoms such as irregular menstrual cycles, acne, excess hair growth, scalp hair thinning, and fertility challenges.

What has changed is our understanding of why these ovarian changes occur. Rather than viewing the ovaries in isolation, we now recognize that they are responding to a complex network of hormonal and metabolic signals throughout the body.

Syndrome

A syndrome is a collection of features that tend to occur together rather than a single disease with one cause, one laboratory test, or one treatment.

PMOS is remarkably diverse. Some women experience significant androgen-related symptoms with relatively little metabolic dysfunction, while others have few reproductive symptoms but substantial insulin resistance or cardiometabolic risk. Many fall somewhere in between.

This diversity is one of the reasons there is no universal treatment plan for PMOS. Effective care begins with understanding each individual’s symptoms, priorities, stage of life, and overall health.

PMOS: More Than a Reproductive Condition

For many years, PMOS was viewed primarily through the lens of fertility.

While reproductive health remains an important part of the condition, we now understand that its effects extend well beyond the menstrual cycle. PMOS can influence endocrine, metabolic, cardiovascular, and psychological health throughout life.

Women living with PMOS may experience a wide range of symptoms and health concerns, including:

• Irregular or absent menstrual cycles
• Acne
• Excess facial or body hair
• Scalp hair thinning
• Difficulty conceiving
• Insulin resistance
• Weight gain or difficulty regulating weight
• Elevated cholesterol
• Metabolic dysfunction-associated steatotic liver disease (MASLD)
• Anxiety and depression
• Sleep disturbances
• An increased lifetime risk of type 2 diabetes and cardiovascular disease

One of the key biological drivers of PMOS is insulin resistance, although it is not present in everyone.

When the body's cells become less responsive to insulin, the pancreas compensates by producing more. Higher insulin levels stimulate the ovaries to produce more androgens while reducing the production of sex hormone-binding globulin (SHBG), increasing the amount of biologically active testosterone circulating in the body. This can contribute to irregular ovulation, acne, excess hair growth, scalp hair thinning, and difficulties conceiving.

Insulin also plays an important role in appetite regulation, energy storage, inflammation, and overall metabolic health. Over time, persistent insulin resistance can increase the risk of prediabetes, type 2 diabetes, and cardiovascular disease.

Insulin resistance is common in PMOS, but it is not universal. Likewise, metabolic dysfunction is not determined solely by body size. PMOS occurs in women of every body size, and many women with a normal body weight experience insulin resistance or other metabolic abnormalities.

Although carrying excess weight can amplify some of the metabolic features of PMOS, it does not cause the condition. Rather, PMOS develops through a complex interplay of genetics, early developmental influences, hormones, metabolism, and environmental factors. For some individuals, these biological pathways may begin before birth and continue to evolve throughout life.

Many women have spent years believing they simply lacked willpower or needed to try a different diet. We now recognize that the biology of PMOS itself can make weight regulation more challenging through its effects on insulin sensitivity, appetite regulation, and energy metabolism.

Rather than focusing on weight alone, our goal is to support metabolic health by improving insulin sensitivity, preserving muscle mass, optimizing nutrition, encouraging regular movement, and reducing long-term cardiometabolic risk. Weight may change as a result of these interventions, but it is not the sole measure of success.

PMOS Across the Lifespan

Perhaps the most important shift in our understanding of PMOS is recognizing that it is a lifelong condition.

Its manifestations evolve over time, and so should our approach to care.

During adolescence, irregular menstrual cycles, acne, or excess hair growth often present as primary concerns. In the reproductive years, conversations may naturally centre on ovulation, fertility, pregnancy planning, menstrual cycle regulation, and protecting the uterine lining.

These concerns remain important, but they are only part of the picture. From the time of diagnosis, PMOS also provides an opportunity to assess metabolic and cardiovascular health. Understanding insulin resistance, blood sugar regulation, cholesterol, blood pressure, sleep, nutrition, physical activity, mental health, and body composition helps identify opportunities to support long-term health long before disease develops.

The menopausal transition represents another important stage in the PMOS journey.

Women with PMOS tend to reach menopause, on average, two to four years later than women without the condition, likely because they begin life with a larger pool of ovarian follicles that declines more slowly over time. During perimenopause, some continue to ovulate more frequently than expected for their age. Although acne and excess hair growth often improve as androgen levels gradually decline, these symptoms may persist for some women.

As estrogen levels decline, cardiovascular risk increases for all women. For those living with PMOS, who already have a higher prevalence of insulin resistance, dyslipidemia, hypertension, and impaired glucose metabolism, midlife becomes an especially important opportunity to reassess and optimize cardiometabolic health.

After menopause, menstrual cycles, ovulation, and fertility naturally become less relevant, but the endocrine and metabolic features of PMOS do not simply disappear. Women with a history of PMOS continue to have a higher lifetime risk of type 2 diabetes, metabolic dysfunction-associated steatotic liver disease (MASLD), hypertension, cardiovascular disease, and obstructive sleep apnea. Weight regulation may also remain challenging.

This does not mean these conditions are inevitable. Rather, it highlights the value of ongoing preventive care. Addressing blood pressure, blood sugar, cholesterol, muscle mass, nutrition, physical activity, sleep, and other cardiovascular risk factors can have a meaningful impact on health. 

How Is PMOS Assessed?

PMOS is a clinical diagnosis, but receiving the diagnosis is only the beginning.

Our understanding of PMOS has expanded considerably over the past two decades, and assessment has evolved alongside it. Rather than focusing solely on reproductive symptoms, current international guidelines recommend evaluating menstrual health, androgen-related symptoms, cardiometabolic health, psychological wellbeing, and long-term health risks.

The goal is not simply to confirm the diagnosis. It is to understand how PMOS is affecting the individual sitting in front of us and to identify opportunities to improve health across the lifespan.

Depending on your age, symptoms, and stage of life, assessment may include the following.

Menstrual and Reproductive Health

Regular ovulation is an important marker of hormonal health. Understanding your menstrual history helps guide both diagnosis and treatment.

This discussion may include:

• Cycle length and regularity
• How your cycles have changed over time
• Symptoms of ovulation
• Fertility goals
• Previous pregnancies
• Current or previous hormonal contraception

When menstrual cycles are infrequent or absent, protecting the endometrium also becomes an important consideration.

Ovulation normally results in progesterone production, which helps balance the effects of estrogen on the uterine lining. When ovulation occurs infrequently, the endometrium may be exposed to prolonged estrogen stimulation without adequate progesterone. Over time, this increases the risk of endometrial hyperplasia and, in some individuals, endometrial cancer.

Fortunately, there are several evidence-based strategies to reduce this risk. The most appropriate approach depends on a woman's age, reproductive goals, menstrual pattern, and overall health.

Metabolic and Cardiovascular Health

One of the greatest advances in PMOS care has been recognizing the importance of cardiometabolic health.

Although reproductive symptoms often bring women to medical attention, metabolic changes may be present long before diabetes or cardiovascular disease develops. Identifying these changes early allows us to intervene before complications arise.

Depending on an individual's risk factors, assessment may include:

• Blood pressure
• Waist circumference, where appropriate
• Fasting glucose or an oral glucose tolerance test
• Hemoglobin A1c
• Fasting insulin, when clinically helpful
• A fasting lipid profile (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides)
• Apolipoprotein B (ApoB), which reflects the number of cholesterol-containing particles and often provides a more accurate assessment of cardiovascular risk than LDL cholesterol alone
• Lipoprotein(a) [Lp(a)], an inherited cardiovascular risk factor that is recommended to be measured at least once during adulthood

Together these assessments help us understand an individual's current metabolic health and help guide strategies to reduce further cardiovascular risk.

Psychological wellbeing

PMOS affects far more than physical health.

Research consistently demonstrates higher rates of anxiety, depression, ADHD, disordered eating, and body image concerns among women living with PMOS. These experiences are not simply consequences of the diagnosis—they are recognized features of the condition that can profoundly influence quality of life.

Supporting psychological wellbeing is an essential part of comprehensive PMOS care. This may include screening for mental health concerns, discussing stress, sleep, relationships, and quality of life, and ensuring appropriate support is in place when needed.

Looking at the Whole Picture

No single blood test defines PMOS, and no two people experience it in exactly the same way.

Assessment is about understanding how PMOS is affecting the individual today while identifying opportunities to protect long-term health. 

An Integrative, Evidence-Based Approach to Treatment

There is no single treatment for PMOS. Nor should there be.

PMOS is a heterogeneous condition, and every woman brings a unique combination of symptoms, priorities, health history, metabolic profile, and stage of life.

The goal of treatment is not to "fix" PMOS. It is to understand what is driving an individual's symptoms, reduce long-term health risks where appropriate, and help each person feel as well as possible.

For some, the priority may be regulating menstrual cycles. For others, it may be improving fertility, managing acne or excess hair growth, reducing insulin resistance, addressing weight concerns, improving metabolic health, or supporting quality of life through the menopausal transition.

Effective treatment begins with understanding what matters most to the individual.

Nutrition

There is no single "PMOS diet."

Current evidence supports dietary patterns that improve metabolic health and can be sustained over time rather than restrictive approaches that are difficult to maintain. A Mediterranean-style dietary pattern consistently demonstrates benefits for insulin sensitivity, cardiovascular health, and overall metabolic wellbeing.

Rather than focusing on calorie restriction, the Mediterranean diet encourages women to build meals around:

• Adequate protein
• Fibre-rich vegetables and fruit
• Whole grains and legumes
• Healthy fats
• Foods that promote satiety and support stable blood sugar

Regular meals and adequate protein intake help preserve muscle mass, support appetite regulation, and maintain metabolic health throughout life.

The goal is not dietary perfection. It is developing a way of eating that is nourishing, enjoyable, and sustainable.

Physical Activity

Exercise is one of the most effective therapies we have for PMOS.

Regular movement improves insulin sensitivity, cardiovascular health, sleep, mood, energy, and body composition while helping preserve muscle mass. Maintaining muscle mass becomes increasingly important throughout midlife and beyond, supporting metabolic health, physical function, and healthy aging.

For many women, an ideal program includes:

• Regular walking or other aerobic activity 
• Resistance training at least two to three times each week
• Activities that improve flexibility, mobility, and balance

The best exercise program is the one you enjoy enough to continue. Sustainable movement that can be maintained over time is far more valuable than pursuing perfection.

Sleep

Sleep is often overlooked in PMOS care.

Poor sleep can worsen insulin resistance, appetite regulation, inflammation, mood, and overall metabolic health. Individuals living with PMOS are also more likely to experience obstructive sleep apnea, particularly when additional cardiometabolic risk factors are present.

Supporting restorative sleep is an essential part of comprehensive care.

Supplements

Supplements can play a supportive role for some individuals, but they work best as part of a comprehensive treatment plan rather than in isolation.

Current evidence is strongest for:

• Myo-inositol, which may improve insulin sensitivity, menstrual regularity, and ovulation.
• Vitamin D, particularly when deficiency is present.
• Omega-3 fatty acids, especially for individuals with elevated triglycerides or increased cardiovascular risk.
• Berberine, which may be considered in selected individuals with insulin resistance or metabolic dysfunction.

As with all therapies, supplementation should be individualized and guided by each person's clinical picture, goals, and preferences.

Medications

Lifestyle measures provide an important foundation for PMOS care, but they are not always sufficient on their own.

For many women, medications can significantly improve symptoms, reduce long-term health risks, and improve quality of life. Using medication is not a sign that someone has failed, it is one of many evidence-based tools available to support health.

Depending on an individual's goals and clinical presentation, treatment may include:

• Metformin to improve insulin sensitivity and reduce progression toward type 2 diabetes.
• GLP-1 receptor agonists or dual GIP/GLP-1 receptor agonists for individuals with obesity or significant metabolic disease, alongside comprehensive lifestyle support.
• Hormonal therapies to regulate menstrual cycles and provide endometrial protection when ovulation is infrequent.
• Anti-androgen medications to treat acne or excess hair growth in selected individuals.
• Letrozole, the current first-line ovulation induction therapy for many women seeking pregnancy.

Treatment should always reflect an individual's goals and clinical presentation.

Looking Ahead

The transition from PCOS to PMOS represents much more than a change in terminology.

It reflects a broader understanding of women's health - one that recognizes the interconnectedness of our endocrine, metabolic, cardiovascular, reproductive, and psychological health across the lifespan.

For many women, the new name brings welcome validation. It acknowledges what patients and clinicians have long recognized: this condition is about much more than the ovaries.

More importantly, it encourages us to look beyond symptom management alone. It reminds us to recognize opportunities for prevention, to consider long-term health alongside immediate concerns, and to tailor care to each individual's biology, priorities, and stage of life.

My hope is that this new understanding leads to earlier recognition, more thoughtful conversations, and more personalized care throughout the lifespan. A diagnosis of PMOS should not simply explain today's symptoms, it should help guide decisions that support health for decades to come.

Selected References and Resources 

The science of PMOS continues to evolve rapidly. The references below represent selected foundational guidelines and recent reviews that informed this article and may be helpful for clinicians, students, and readers wishing to explore the evidence in greater depth.

Nomenclature and International Consensus

Teede HJ, Khomami MB, Morman R, et al.
Polyendocrine Metabolic Ovarian Syndrome, the New Name for Polycystic Ovary Syndrome: A Multistep Global Consensus Process.
The Lancet. 2026.

International Clinical Guidelines

Teede HJ, Tay CT, Laven JSE, et al.
Recommendations From the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.
Fertility and Sterility. 2023.

Cardiometabolic Health and Long-Term Risk

Pililis S, Tziomalos K, Goulis DG, et al.
The Cardiometabolic Risk in Women With Polycystic Ovarian Syndrome: From Pathophysiology to Diagnosis and Treatment.
Journal of Clinical Endocrinology & Metabolism. 2024. 

Shele G, Genkil J, Speelman DL.
Exercise Training in Polycystic Ovary Syndrome: A Systematic Review.
Sports (MDPI). 2020. 

Lim SS, Hutchison SK, Moran LJ, Teede HJ.
Obesity and Polycystic Ovary Syndrome: Contemporary Evidence and Management.
Obesity Reviews. 2024.

Nutrition and Supplementation

Zhang Y, Wang Y, Li X, et al.
Vitamin D Supplementation in Polycystic Ovary Syndrome: A Meta-analysis.
Medicine. 2026.

Moran LJ, Ko H, Misso M, et al.
Nutrition and Polycystic Ovary Syndrome: Current Evidence.
Nutrients. 2024.

Reproductive Health

Balen AH, Norman RJ, Legro RS, et al.
Current Perspectives on Fertility and Ovulation Management in PCOS/PMOS.
Reproductive Biology and Endocrinology. 2025.

Azziz R, Goodarzi MO, Dumesic DA, et al.
Advances in Understanding Ovulatory Dysfunction in PCOS.
Reproductive Biology and Endocrinology. 2023.

Menopause and Lifespan Care

El Khoudary SR, Teede HJ, Moran LJ, et al.
Polycystic Ovary Syndrome Across the Lifespan: Menopause and Healthy Aging.
Maturitas. 2024.

Elting MW, Korsen TJM, Bezemer PD, Schoemaker J.
Polycystic Ovary Syndrome and Menopause.
Gynecological Endocrinology. 2020.

Comprehensive Reviews

Shukla A, Aggarwal A, StatPearls Publishing.
Polyendocrine Metabolic Ovarian Syndrome.
StatPearls. Updated 2025.