Polyendocrine metabolic ovarian syndrome (PMOS) is a common hormonal disorder affecting women during their reproductive years. Until recently known as polycystic ovary syndrome (PCOS), the condition has been officially renamed to better reflect its endocrine, metabolic and ovarian abnormalities, rather than simply the presence of ovarian cysts. Experts say the previous name was misleading because many women with the condition do not actually have ovarian cysts.
PMOS can cause irregular menstrual cycles, excessive facial or body hair, acne, infertility, weight gain and insulin resistance, while also increasing the long-term risk of conditions such as type 2 diabetes, cardiovascular disease and metabolic dysfunction-associated fatty liver disease. Although its exact cause remains unknown, researchers believe genetic, hormonal and lifestyle factors all play a role.
A new Lancet Health Policy paper has once again highlighted the enormous global burden of the condition. According to the study, PMOS affects around one in eight women globally, making it one of the most common endocrine disorders among women of reproductive age. Researchers estimate that the condition affects more than 170 million women worldwide. They also note that despite its high prevalence, up to 70 per cent of affected individuals remain undiagnosed, largely because the earlier name, fragmented understanding of the disease and poor awareness often delayed recognition and treatment.
The burden appears to be even higher in India. Several studies have suggested that nearly one in five women may have PMOS, although prevalence varies depending on the population studied and diagnostic criteria used. Given these numbers, it is important to understand why experts believed the condition needed a new name and how the previous terminology may have contributed to delayed diagnosis, fragmented care and stigma.
PMOS is far more than an ovarian disorder
The Lancet Health Policy initiative was not designed to address a long-standing concern within the medical community - the inaccurate name 'polycystic ovary syndrome'. The paper describes an unprecedented international effort involving patients, clinicians, researchers and advocacy organisations to develop a scientifically accurate and less stigmatisising name for the condition.
According to the authors, "Polyendocrine metabolic ovarian syndrome (PMOS), previously named polycystic ovary syndrome (PCOS), affects one in eight women. However, the term PCOS is inaccurate, implying pathological ovarian cysts, obscuring diverse endocrine and metabolic features, and contributing to delayed diagnosis, fragmented care, and stigma, while curtailing research and policy framing."
The researchers explain that PCOS had long been perceived primarily as an ovarian or reproductive disorder. However, decades of research now show that the condition involves disturbances in multiple hormone systems, particularly insulin, androgens and neuroendocrine pathways, resulting in a broad spectrum of metabolic, reproductive, psychological and dermatological manifestations.
The paper notes that women with PMOS may experience obesity, insulin resistance, impaired glucose tolerance, type 2 diabetes, hypertension, dyslipidaemia, cardiovascular disease, menstrual irregularities, infertility, pregnancy complications, anxiety, depression, acne, alopecia and hirsutism. Importantly, these diverse health effects were never reflected in the previous name.
Researchers further point out that although multiple immature ovarian follicles are commonly seen on ultrasound, pathological ovarian cysts are not actually increased in the condition. This misconception has contributed to confusion among patients and healthcare providers alike.
The authors also highlighted the consequences of the misleading terminology.
"The current name (referring to the older name - PCOS) reflects only one organ and fails to capture the disorder's multisystem nature. Confusion arising from the current name can delay diagnosis and hinder effective communication between patients and health professionals, contributing to patient dissatisfaction with care."
They further noted that the reproductive focus of the name can reinforce stigma, especially in societies where fertility is closely linked to social expectations.
How experts arrived at the new name PMOS
The renaming process followed one of the largest international consensus exercises undertaken for any medical condition. According to the researchers, the initiative involved 56 leading academic, clinical and patient organisations, with participation from patients and healthcare professionals across multiple world regions.
Building on previous consultations, the researchers conducted iterative global surveys involving 14,360 participants, including 10,411 women living with the condition and 3,949 multidisciplinary health professionals. These findings were supplemented through modified Delphi surveys, nominal group workshops, marketing analyses and implementation studies to identify a name that was scientifically accurate, culturally appropriate, easy to communicate and less stigmatising.
According to the paper, "Preferred terms were polyendocrine, metabolic, and ovarian, reflecting the condition's multisystem pathophysiology, and polyendocrine metabolic ovarian syndrome was the consensus new name. Accuracy was improved by omitting cysts and by capturing endocrine, metabolic, and ovarian dysfunction."
Researchers explained that the term "polyendocrine" acknowledges the multiple hormonal systems involved in the disease, "metabolic" reflects insulin resistance and associated metabolic abnormalities, while "ovarian" recognises the characteristic ovarian dysfunction without incorrectly referring to cysts.
The authors also emphasised that implementation will occur gradually rather than abruptly. A global transition strategy is already under way, involving updates to clinical guidelines, educational material, electronic health records, disease classification systems and future WHO coding.
The study further notes that improved terminology could have implications far beyond language. According to the researchers, an accurate name is expected to improve awareness, facilitate earlier diagnosis, strengthen research consistency, improve policy development and reduce stigma experienced by patients.
The paper concludes that the transition is expected to improve health outcomes by promoting better recognition of the condition's multisystem nature and ensuring that healthcare providers consider its metabolic and endocrine consequences alongside reproductive health.
Limitations of the study
The researchers acknowledged that despite the rigorous methodology, the Health Policy initiative has several limitations that should be considered while interpreting the findings.
Although the consensus process involved participants from across the world, representation was uneven. Participation from low-income and middle-income countries, particularly regions including Asia, Africa and South America, was comparatively lower than representation from high-income settings.
The authors also noted that recruitment relied on purposive, non-probability sampling and voluntary participation. As a result, selection bias cannot be ruled out and the findings may not be fully generalisable to all patient populations or healthcare systems.
According to the study, "Limitations of this Health Policy initiative include disproportionate representation across world regions and disciplines, with lower participation from middle-income and low-income countries, and from Asia, Africa, and South America. Furthermore, the use of a purposive, non-probability sampling approach and voluntary participation could introduce selection bias and hinder generalisability."
The researchers also explained that because Survey A was disseminated through multiple international platforms and organisations, it was not possible to calculate a formal response rate.
"In addition, response rates could not be determined for survey A due to broad dissemination. Despite these limitations, analysis of survey results by region did not identify major differences in the final terms or name preferences," they further stated.
The authors emphasised that the overwhelming majority of participants across earlier surveys and workshops consistently supported changing the name. They concluded that the consensus process successfully balanced scientific accuracy, patient priorities, cultural appropriateness and implementation feasibility while creating a framework for future adoption of the new terminology.
What experts say?
According to Dr Gayathri Karthik Nagesh, Program Director, Department of Obstetrics & Gynaecology, Aster CMI Hospital, Bengaluru, renaming PCOS as PMOS is clinically important because it reflects the condition's endocrine, metabolic and reproductive nature, rather than focusing only on the ovaries.
"The earlier name incorrectly suggested that ovarian cysts were the defining feature, creating confusion among patients and healthcare providers. The new name is expected to improve awareness, promote earlier diagnosis, reduce stigma and encourage multidisciplinary care," she said.
Dr Gayathri said she has seen many women whose diagnosis was delayed because they believed they could not have PCOS unless an ultrasound showed ovarian cysts. Others ignored symptoms such as irregular periods, acne, excess hair growth or weight gain because their scans appeared normal.
She explained that PMOS results from a combination of genetic, hormonal and environmental factors, with insulin resistance, obesity, metabolic abnormalities and a family history of the condition or type 2 diabetes increasing the risk.
She added that PMOS is not limited to irregular periods or infertility.
"Women may also experience acne, excessive facial or body hair, scalp hair thinning, unexplained weight gain, darkening of the skin around the neck or underarms, and difficulty losing weight due to insulin resistance," she said.
“If left untreated, PMOS can increase the risk of type 2 diabetes, hypertension, abnormal cholesterol, fatty liver disease, cardiovascular disease, anxiety, depression and endometrial cancer,” she added, highlighting the importance of early diagnosis and treatment.
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS
