Unpacking PCOS to PMOS: What the Name Change Means

In a landmark change, the condition formerly known as polycystic ovary syndrome PCOS was renamed as PMOS polyendocrine metabolic ovarian syndrome at the European Congress of Endocrinology in Prague and detailed in the landmark consensus paper published in the Lancet. We spoke with experts Dr. Chitra Selvan, professor endocrinology, MS Ramaiah Medical College, Bangalore and Dr. Tejal Lathia, DM endocrinology, Apollo hospitals and the Hormone & Bone center in Navi Mumbai on their opinions.

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What is the definition of PCOS (now called PMOS), and what symptoms typically lead to a diagnosis?

The definition and diagnostic criteria for PCOS (now referred to as PMOS) remain unchanged despite the recent name change. The change in terminology does not affect how the condition is diagnosed or treated. A diagnosis is made in individuals over the age of 20 if they meet 2 out of the following 3 criteria:

1. Irregular menstrual cycles defined as cycle length longer than 35 days or having fewer than nine menstrual cycles in a year.
2. Signs of excess androgens (male hormones) such as persistent acne or increased thick, coarse hair growth on the face or other parts of the body.
3. Presence of a specific number of ovarian cysts on ultrasound. An additional test, anti-Müllerian hormone (AMH) levels, may also be used if the level is above a certain cutoff based on age, ethnicity, and race.

Ultrasound is not used to diagnose PCOS/PMOS in girls younger than 20 years, particularly in the first few years after menstruation begins (menarche), because ovarian cysts are common and considered a normal finding at that age. The name change reflects a better understanding of the condition. The previous name, Polycystic Ovary Syndrome, placed too much emphasis on ovarian cysts, whereas the condition involves multiple hormonal and metabolic factors beyond the presence of cysts.

What have we learned about PCOS over the past few decades that the original name did not capture?

The term Polycystic Ovary Syndrome (PCOS) placed too much emphasis on ovarian cysts, even though the "cysts" are not true cysts. They are small (2–8 mm), immature egg follicles that have grown but have not been released during ovulation. They are not cancerous, do not rupture, and do not cause any pain or other life-threatening complications. They represent an exaggeration of normal ovarian physiology rather than a disease process. The presence of ovarian cysts is also not unique to PCOS. Cysts can occur in conditions that prevent ovulation, such as hypothyroidism, elevated prolactin levels, or pituitary disorders. It can also occur if one is not getting their periods. This is one of the reasons why the condition needed a name that reflects its broader nature rather than focusing on cysts alone. Research has shown that the condition involves multiple hormone systems and metabolic pathways. In addition to the ovaries, changes in hormone regulation from the brain (GnRH), insulin resistance, excess androgen production, genetics, and even the gut hormone axis all contribute to the condition. This evolving understanding led to the need for a name that better reflects its complexity.

What does PMOS stand for, and what does the new name mean?

PMOS stands for Polyendocrine Metabolic Ovarian Syndrome. Although it is a longer name, it better reflects what we now know about the condition. The term "polyendocrine" recognises that multiple hormone systems are involved, including insulin, GnRH, FSH, and androgens, rather than the ovaries alone. It also acknowledges the role of obesity and insulin resistance in the development of the condition. The addition of "metabolic" is particularly important because it highlights that PMOS is much more than a reproductive or gynaecological condition. Women with PMOS are at increased risk of type 2 diabetes, gestational diabetes, cardiovascular disease, and other metabolic complications. Recognising this shifts the focus towards long-term health rather than only fertility or menstrual problems. The word "ovarian" remains in the name because the ovaries are still involved, but they are no longer considered the sole focus of the condition.

How does recognising PMOS as a metabolic condition change the way women are cared for?

Traditionally, care often centred on helping women conceive or managing symptoms related to menstruation. Once a woman delivered a healthy baby, follow-up usually ends. Recognising PMOS as a metabolic condition means that care should continue throughout life. Women should be counselled about their future risk of diabetes, heart disease, and other metabolic disorders and receive regular follow-up and preventive care. The condition should be managed as a lifelong health issue rather than one that ends with successful pregnancy.

Was the name change a global consensus, or was it mainly driven by India or Asia?

The name change emerged from a global consensus and was strongly influenced by patient advocacy. Thousands of people living with the condition contributed to the process, ensuring that patient perspectives were incorporated alongside expert opinion. This represents a significant step towards more patient-centred guideline development. However, representation from the Global South remains limited. Although two-thirds of people living with PMOS are from Asia and other low- and middle-income countries, these regions have historically had less influence in shaping international guidelines. This is an example of medical colonisation because drivers of these guidelines are not the majority of the people living with the condition. Metabolic diseases such as PMOS, type 2 diabetes and cardiovascular disease are more common and often occur at younger ages in Asia.

Does PMOS behave differently in people from the Global South?

The condition usually develops in younger women regardless of geography, but body composition appears to play an important role. Even at lower body mass index (BMI), increased visceral fat can increase the risk of PMOS. Lean women with PMOS (frequently seen in the global south) often face unique challenges because weight loss is not an effective treatment option for them. This highlights the need for an individualised approach that goes beyond BMI and considers metabolic risk, body composition, and other contributing factors.

Has the diagnostic process changed?

No. The diagnostic criteria remain the same, and the recent update is only a name change. There has been no change to the way PMOS/PCOS is diagnosed. One important point, is the recognition of lean PMOS, which is particularly common in South Asian populations. Many individuals may have a normal body mass index (BMI) but still develop insulin resistance because they have relatively lower muscle mass and higher visceral fat. As a result, they may experience irregular periods and other features of PMOS despite appearing to have a healthy weight. The new name highlights the metabolic nature of the condition and may encourage women, especially those with a normal BMI but irregular menstrual cycles, to undergo screening for blood sugar abnormalities and other metabolic risk factors before planning a pregnancy. This could also influence public health policies by promoting earlier detection and intervention.

Which doctor should someone with PMOS consult?

Women should enter the healthcare pathway whenever they first seek help. Whether they visit a dermatologist for acne or excess facial hair, a gynaecologist for irregular periods, a general practitioner, or an endocrinologist, the priority is that the condition is recognised and diagnosed early. The inclusion of the terms "polyendocrine" and "metabolic" in the new name may lead more women to seek an endocrinologist, particularly in urban areas where specialist care is available. However, PMOS should not be considered the domain of endocrinologists alone. Dermatologists, gynaecologists, general practitioners, and other healthcare professionals all have an important role in identifying the condition, initiating appropriate investigations, and guiding care.

Has the treatment protocol changed, or is it likely to change?

The treatment itself has not fundamentally changed, but the new name encourages a more comprehensive evaluation and long-term management plan from the very first point of contact. For example, a young woman may initially consult a dermatologist because of acne or excess hair growth. Traditionally, treatment might focus only on those symptoms for several years before underlying metabolic problems, such as diabetes, are identified. The hope is that the new framework will prompt healthcare professionals to evaluate the whole person much earlier by checking not only reproductive hormones and thyroid function but also blood sugar levels, lipid profile, and other metabolic parameters. Treatment should continue to address the symptoms that brought the person to the clinic, such as acne or irregular periods, while also linking them to lifestyle modifications and metabolic health. This allows patients to understand how diet, physical activity, blood sugar control, and weight management are connected to their symptoms. The name change also encourages clinicians to rule out other conditions that can mimic PMOS before making a diagnosis. Rather than focusing on a single symptom, the aim is to develop a comprehensive, long-term care plan that includes appropriate investigations, lifestyle interventions, treatment of current symptoms, and ongoing monitoring for future metabolic risks.

Should patients continue seeing the same doctor if their symptoms don't improve?

Continuity of care is important, especially if the initial treatment does not work. Rather than consulting multiple doctors without completing an evaluation, it is better to return to the same healthcare provider so they can review the response to treatment, reassess the diagnosis, and investigate whether another condition may be causing the symptoms. Many conditions can mimic PMOS, and in most cases they can be identified through a careful medical history and a few basic tests. These evaluations should ideally be done early rather than only after treatment has failed. For example, we have seen women with premature menopause being wrongly diagnosed & treated for PCOS. Conditions such as thyroid disorders, high prolactin levels, premature ovarian insufficiency, Cushing's syndrome, and acromegaly can also present with symptoms similar to PMOS. Early and correct diagnosis can prevent years of inappropriate therapy.

How would the care pathway differ if someone first consulted a gynaecologist for irregular periods?

The symptoms that bring a woman to the clinic, such as irregular periods, acne, or excess hair growth, are often the first signs of PMOS. Women with PMOS have an increased risk of gestational diabetes, type 2 diabetes, hypertension, cardiovascular disease, heart attack, stroke, and endometrial cancer. These risks continue even after menopause, making long-term follow-up and preventive care essential. Many women are unaware of these long-term health risks, and continuity of care is often lacking. Important health information, such as a history of gestational diabetes during pregnancy, may not always be available to future healthcare providers, even though it significantly increases the risk of cardiovascular disease later in life. Greater awareness among patients and better coordination within the healthcare system is needed.

Does PMOS have different stages or grades that predict future risk?

At present, PMOS is not classified into stages or grades that determine an individual's future risk of complications. However, different phenotypes of the condition have been identified. Women with hyperandrogenism (elevated androgen levels) are more likely to have associated metabolic abnormalities. In contrast, women who have irregular periods without evidence of excess androgens may have a lower metabolic risk. While these phenotypes can help identify women who may benefit from closer monitoring, there is currently no formal staging system that predicts the likelihood of developing future complications.

How are you explaining the name change from PCOS to PMOS to your patients?

The name change is not yet widely known among patients, although awareness is expected to grow over the coming weeks. There will likely be a period of adjustment for medical societies, scientific literature, insurance systems, and research funding, as they update terminology.

What message should women who were diagnosed with PCOS years ago take away from the name change?

The most important message is that PMOS is a lifelong condition, and care should not stop after pregnancy or once reproductive concerns have been addressed. Many women believe that once they have menopaused, PCOS is no longer relevant. Women with PMOS should continue to get regular metabolic screening, with yearly checks of blood sugar, cholesterol, blood pressure, and body weight, to identify and prevent complications such as type 2 diabetes and cardiovascular disease. Women who had gestational diabetes, should be educated about these future risks. One practical approach is to provide women with written information after delivery explaining their future risk of diabetes, the importance of regular screening, breastfeeding, and postpartum weight management. Making this a routine part of maternity care could help bridge the gap in long-term follow-up. Patient support groups have been very strong for PMOS. Patients often learn and accept information more readily from peers in a safe space. Obesity is also now recognised as a chronic condition. Whether or not a woman has PMOS, those living with obesity should undergo regular metabolic checks as well.

How can we explain the name change to PMOS so that it is easy for everyone to understand?

The key is to keep talking about it. The Endocrine society does a lot of podcasts, webinars etc. Over the past few weeks, the publication has started a cascade of discussions with gynaecologists, physicians, diabetes specialists, and people living with the condition. In women’s health, any publicity is good publicity. While there is still a long way to go, the increased conversation is a move in the right direction.

Will the treatment guidelines change because of the new name?

The name change itself does not alter the treatment guidelines. Recent international guidelines have already shifted towards a much more comprehensive approach to care by placing mental health and psychological well-being at the centre of care. This did receive trepidation in our country but there is growing evidence that women living with PMOS experience a high burden of anxiety, depression, and other psychological concerns. As PMOS is recognised as a lifelong condition and added management burden, treatment needs to go beyond managing symptoms. We tell women to eat healthy but provide no further information or ongoing support on how to manage diet throughout their lives. Healthcare systems need to provide the necessary support to help patients sustain these changes. Future guidelines are likely to become even more comprehensive and individualised. The new name finally aligns with what the guidelines have already been advocating. While the new terminology recognises the endocrine and metabolic aspects, it does not reflect the psychological impact in the name.

Is there a link between childhood obesity and PMOS?

Yes. As childhood obesity becomes more common, the prevalence of PMOS and type 2 diabetes is also expected to increase. Childhood obesity often tracks into adulthood, meaning that most children who are obese remain obese as adults. Obesity worsens insulin resistance, which plays a central role in the development of PMOS. However, PMOS is not diagnosed in adolescents using the same criteria as adults because the diagnostic tests are not reliable enough in this age group. This is why a formal diagnosis is generally not made before the age of 20 using adult criteria.

Can someone develop PMOS after gaining weight in adulthood, even if they were lean as a child?

Weight gain alone does not usually cause PMOS. If someone gains weight without having the underlying hormonal and genetic factors associated with PMOS, they may develop irregular periods but not features related to hyperandrogenism. In many cases, menstrual cycles become regular again after weight loss. Weight gain can worsen or unmask the condition, but it is usually not the sole cause.

What can someone do after being diagnosed with PMOS? Can it be reversed or put into remission?

We must understand that PMOS was not so prevalent few hundred years, so it not our bodies that have changed but the world we live in. This is important as it helps shift the blame from the body to the environment. Modern lifestyles characterised by highly processed foods, reduced physical activity, poor sleep, and increased stress can trigger or worsen the condition in people who are genetically predisposed. People with PMOS should recognise that they need to make a plan as to how to live in this environment. This means making sustainable choices, such as eating nutritious meals most of the time while still allowing occasional treats, maintaining regular physical activity, and prioritising sleep that aligns with the body's natural day-night rhythm. Living with PMOS also involves emotional and social challenges, particularly for young women. The pressures and challenges of the young related to appearance, skin, body image, and social life are often not understood and dismissed. Many young women are financially dependent on their families, making access to treatment such as laser difficult. Family members and caregivers should be more mindful, kind and listen without judgement in supporting young women.

Does having PMOS affect menopause or increase the risk of osteoporosis?

There does not appear to be a direct relationship between PMOS and the age at which menopause occurs, the severity of menopausal symptoms, or the risk of osteoporosis. However, PMOS is associated with an increased risk of developing type 2 diabetes at a younger age. If diabetes develops, it can affect bone quality and may indirectly increase the risk of osteoporosis.

What are the key takeaways for someone newly diagnosed with PMOS?

• Seek a comprehensive evaluation by an endocrinologist or physician who can rule out other conditions that can mimic PMOS, as some of these are easily treatable. Identifying the correct cause will improve symptoms such as irregular periods, acne, or excess hair growth.
• Get screened for metabolic conditions such as diabetes, high cholesterol etc.
• Build a strong support system including family and friends because this journey can be long and difficult and to provide tools to learn and manage better. Managing PMOS is a lifelong journey. Support from family, friends, healthcare professionals, and peer groups can make lifestyle changes easier to maintain and improve overall well-being.
• Be patient with lifestyle changes. You may not see results immediately and improvements in weight, blood test results may take time, but will definitely have long-term benefits.
• Pay attention to emotional well-being. Concerns about body image, low motivation, or low mood may sometimes be related to underlying conditions such as sleep apnoea or other health issues that can be evaluated and treated. With the right support, it is entirely possible to live well with PMOS.

What should patients know about lifestyle changes and newer treatment options?

With the new focus on metabolic, the onus of lifestyle modification solely on the patient can become a source of blame or guilt. Many young women are already balancing education, careers, relationships, and stress of managing a disease. Simply telling someone to "improve your lifestyle" without acknowledging these challenges can place an unfair burden on them. It is also important to recognise that not everyone responds to lifestyle changes in the same way. Some women make significant efforts but still struggle to lose weight because of the underlying biology of the condition. Newer medications, such as GLP-1 receptor agonists and GLP-1/GIP dual agonists, may be appropriate for women with obesity and PMOS. These medications are not specific treatments for PMOS but can support weight management, improve menstrual regularity, reduce acne, and enhance quality of life. They should be viewed as legitimate medical treatments rather than shortcuts or signs of failure. The goal is to help reduce the long-term risk of diabetes, etc. while continuing lifestyle measures.

What are the key messages about the transition from PCOS to PMOS?

The change from Polycystic Ovary Syndrome (PCOS) to Polyendocrine Metabolic Ovarian Syndrome (PMOS) reflects our improved understanding of the condition. In many ways, the name has finally caught up with treatment approaches and clinical guidelines that have been evolving over the past several years. Rather than focusing only on the ovaries, the new name recognises that this is a complex endocrine and metabolic condition requiring lifelong, holistic care. An encouraging aspect of this transition is that patient voices and lived experiences were incorporated into the consensus process, highlighting the growing importance of patient involvement in healthcare decision-making.

For people diagnosed with PMOS, the name change is a reminder to take an active role in managing their health. It is important to seek comprehensive care, ensure that healthcare providers are evaluating both reproductive and metabolic health, and avoid a fragmented approach where only individual symptoms are treated. Lifestyle measures remain an important part of management, but there are also effective medical treatments available when needed.

The new terminology also serves as a reminder to healthcare professionals to adopt a holistic approach to care, considering the endocrine, metabolic, reproductive, and psychological aspects of the condition. This broader perspective can help improve long-term health outcomes and quality of life for women living with PMOS.