From polycystic ovary syndrome to polyendocrine metabolic ovarian syndrome: rationale, evidence, and implications of a global name change

Polycystic ovary syndrome (PCOS) affects approximately 9-13% of women of reproductive age worldwide, an estimated 170 million individuals, depending on which diagnostic criteria are applied [1,2]. It is one of the most common endocrine disorders in this population. Even though it is so common, PCOS has often been underdiagnosed, care has been fragmented, and research funding has been limited [3,4]. Part of the problem comes from its name, which can be misleading [3,4]. The term 'polycystic ovary' suggests that the disorder involves abnormal ovarian cysts, but this is not actually the case. Instead, ultrasound usually shows arrested follicular development caused by neuroendocrine and metabolic problems, which is a different issue [5].In May 2026, Teede et al. published the outcome of an unprecedented global consensus process involving 56 organisations, 14,360 survey responses from patients and health professionals across all world regions, modified Delphi surveys, nominal group workshops, and marketing analysis [5]. The resulting new name, polyendocrine metabolic ovarian syndrome (PMOS), omits the misleading cyst reference and explicitly captures the condition's endocrine, metabolic, and ovarian dimensions. This opinion article evaluates the evidence base underpinning this rename, examines its clinical and psychosocial implications, and identifies the implementation priorities essential to converting a nomenclature change into genuine improvement in patient outcomes (Figure 1). The historical framing of PCOS as a primarily gynecological or ovarian disorder has led to its broader effects being treated as separate issues. However, international guidelines have tried to address this. The 2018 and 2023 International Evidence-Based Guidelines recognize a range of metabolic, reproductive, psychological, and skin-related features and note that gaps in practice and delays in diagnosis persist even with these guidelines [3,4]. The 2023 update added anti-Müllerian hormone (AMH) as another option for adult diagnosis, highlighted the importance of metabolic and cardiovascular risks, and placed greater emphasis on psychological health [4]. Yet clinicians continue to show variable awareness of diagnostic criteria and the breadth of PMOS features [6].PMOS involves multiple interacting endocrine axes. Elevated gonadotropin-releasing hormone pulse frequency drives excess luteinizing hormone secretion, augmenting ovarian androgen production. Insulin resistance is present in approximately 85% of affected individuals, including 75% of lean women, and acts synergistically to amplify androgen excess and disrupt steroid hormone balance [5,7,8]. Abnormal AMH signaling, altered adipokine profiles, and excess adrenal androgens further compound endocrine dysregulation [5,7]. Cardiometabolic sequelae are well-documented: type 2 diabetes, dyslipidemia, metabolic dysfunction-associated fatty liver disease (MAFLD), hypertension, and elevated cardiovascular disease risk represent the downstream morbidity that the old name systematically obscured [3,4,7]. Calling the condition 'polyendocrine' is based on evidence, not just style. Recently, experts have suggested shifting from glucose-focused to insulin-focused screening for PMOS. This change could help identify metabolic and reproductive problems earlier, which the old name did not highlight [8]. Including 'metabolic' in the name makes it clear that checking insulin sensitivity, blood sugar, and cardiovascular risk should be a main part of diagnosis, not an afterthought.There is strong evidence supporting the psychosocial reasons for renaming PCOS, beyond just scientific accuracy. Qualitative studies using social constructionism have shown that women with PCOS often face serious biopsychosocial challenges, feel socially isolated, and are frequently dissatisfied with their healthcare experiences [9]. Studies in clinical settings have consistently found higher rates of depression, anxiety, and stress among people with PCOS, with the odds of anxiety and depression much higher than in those without the condition, regardless of cultural background [10,11].A systematic review also showed that all major meta-analyses agree on the increased psychological burden in PCOS, such as body image issues, eating disorders, and psychosexual problems. Despite this, many clinicians are still not well informed about these links [12].The term 'polycystic ovary' has added to the challenges faced by patients, especially in cultures where fertility is closely tied to social identity and self-worth [5]. By removing the cyst reference and focusing on endocrine and metabolic aspects, PMOS shifts attention away from reproductive failure as the main feature of the condition. Still, it is important to communicate carefully: patient education materials should avoid linking 'metabolic' to weight-blame, since the metabolic features of PMOS are substantially genetically driven and not attributable to lifestyle alone [3,5].Up to 70% of people with PMOS remain undiagnosed globally [5,6]. Several factors contribute to this, including confusion among clinicians about which criteria to use in different situations [6], differences in diagnostic cut-offs across the NIH, Rotterdam, and AE-PCOS criteria [2], limited access to labs in some areas, and poor communication between patients and clinicians, partly because of the condition's name. A qualitative study in Australia found that clinicians varied widely in how they diagnosed and explained PCOS, and many were unsure about the risks of both overdiagnosis and underdiagnosis [6].Even where international guidelines are well known, there are still gaps between evidence and practice [3,4].Adopting PMOS should help make diagnoses clearer by shifting the focus from just ovarian morphology to the patient's metabolic and endocrine profile. Still, simply changing the name is not enough to solve the underlying issues. There needs to be real investment in educating clinicia