Polyendocrine Metabolic Ovarian Syndrome (PMOS): The New Name for PCOS — and What It Really Means for Your Health

If you have ever been told you have polycystic ovary syndrome (PCOS) — or you have wondered whether you might — there is something important you should know. In May 2026, after a global consensus process involving more than 14,000 women, doctors, and researchers worldwide, the condition was given a new name: polyendocrine metabolic ovarian syndrome, or PMOS (1).

This is not just a name change. It is a long-overdue acknowledgement of something women have been trying to tell us for decades: this condition was never really about your ovaries.

For most of medical history, we focused on the violins. We named this condition after the most visible "instrument" — the ovaries — and we built diagnosis and treatment around them. But the violins were never the problem. The whole orchestra was. The conductor was rushing, the brass was overpowering everything, and the violins were just doing their best to keep up. And it has taken until now for medicine to catch up with what your body has been trying to say.

Why the name had to change

For decades, the term polycystic ovary syndrome told women that they had a problem with their ovaries. It implied cysts — and it pointed at one organ as if it were the source of everything else.

Here is what we now know:

• The "cysts" on ultrasound are not actually cysts at all. They are clusters of small, immature follicles — the tiny fluid-filled sacs in the ovary that each contain an egg — that have not been able to develop properly (1).
• The condition involves the endocrine system (your hormones), the metabolic system (how your body uses and stores energy), and the brain–hormone signalling that drives reproductive function (1,2).
• Up to 70% of women with this condition remain undiagnosed, in large part because doctors and patients have been looking in the wrong place (1).

The new name captures all three things at once. Polyendocrine means it involves multiple hormone systems. Metabolic acknowledges the insulin and metabolic features at the heart of the condition. Ovarian keeps the link to the most visible signs, without pretending they are the whole story (1).

If you have ever sat in a clinic and felt that the explanation didn't quite match the way your body was feeling, you were right. PMOS is a body-wide hormonal condition that happens to show up most visibly in the ovaries — not a condition of the ovaries themselves.

That distinction changes everything: how we diagnose it, how we treat it, and what you can do about it.

What PMOS actually is

PMOS is a lifelong hormonal and metabolic condition affecting roughly one in eight women — around 170 million women worldwide (1,3). It usually begins in the teenage years or early adulthood, but its effects extend across the entire lifespan (2).

Three things are happening at once, and they drive each other in a loop:

1. Insulin resistance — the woodwinds that have tuned out. Insulin's job is to tell your cells when to take in glucose from your blood. In PMOS, your cells stop responding properly to that signal — they've tuned out. So your pancreas has to send more and more insulin, like calling louder and louder to a section that isn't listening. This affects around 85% of women with PMOS, and remarkably, around 75% of lean women with the condition — meaning this is not just a "weight problem" (1,4,5). Insulin resistance is one of the most under-recognised features of PMOS, and in my view the most important to identify early.

2. Higher levels of androgens — the brass section playing too loudly. Androgens are sometimes called "male-type" hormones, although every woman makes them too. In PMOS, the ovaries — and often the adrenal glands — produce more of them than they should. This is what drives features like acne, unwanted hair growth, scalp hair thinning, and irregular cycles (1,2,6).

3. Brain–ovary signalling — the conductor that's lost the beat. The hypothalamus, the part of the brain that conducts your reproductive hormones, sends out signals at the wrong rhythm. This drives the ovaries to produce more androgens and disrupts ovulation — the release of an egg from the ovary each month (1,2).

Here is the part that took medicine far too long to understand: these three things fuel each other. High insulin pushes the ovaries to make more androgens. High androgens worsen insulin resistance. The disrupted brain signalling adds further fuel to both. This is why focusing on the ovaries alone has never worked — you have to address the whole orchestra (2,7).

What this can look and feel like

PMOS does not look the same in every woman. Some experience prominent cycle changes. Others struggle most with the metabolic side. Some have mainly skin and hair concerns. Many have all of it, in different combinations.

The common features cluster into four groups (1,2):

Reproductive features

• Irregular or absent periods
• Difficulty falling pregnant
• Heavier or unpredictable bleeding
• Recurrent miscarriage
• Higher risk of pregnancy complications

Metabolic features

• Weight gain, particularly around the abdomen
• Insulin resistance and higher fasting insulin
• Higher fasting glucose and HbA1c (a three-month average of blood sugar)
• Increased risk of type 2 diabetes
• Higher blood pressure
• Higher cholesterol and triglycerides
• Metabolic dysfunction-associated steatotic liver disease (the new name for fatty liver disease)
• Sleep apnoea — often missed

Dermatological features

• Acne, particularly along the jawline and chin
• Hirsutism — unwanted hair growth on the face, chest, abdomen, or back
• Scalp hair thinning or hair loss (sometimes called androgenic alopecia)

Psychological features

• Higher rates of anxiety and depression
• Disordered eating and body image distress
• Lower self-esteem and quality of life
• Distress related to fertility, appearance, and feeling unwell without an explanation (1,2,8)

The mental health features are often the most overlooked. Many of my patients have been offered an antidepressant before anyone investigated their hormones, and the emotional weight of being unwell and dismissed is significant. I want to name this clearly: psychological symptoms in PMOS are not separate from the hormonal picture — they are part of it (8).

How common PMOS really is

PMOS affects approximately one in eight women globally, with reported rates ranging between 5% and 18% depending on the diagnostic criteria used (1,2,3). To put that in perspective: in any group of eight to ten women you know, one or more is likely affected. This is not a rare condition. It is one of the most common chronic hormonal conditions in women — and it has been hiding in plain sight under a name that obscured what it really was.

How PMOS is diagnosed

Diagnosis in adults is based on the 2023 International Evidence-Based Guideline criteria (2,9). To make the diagnosis, two of the following three need to be present, and other causes need to be excluded:

1. Ovulatory dysfunction — irregular or absent periods that suggest you are not ovulating regularly
2. Hyperandrogenism — either clinical signs (acne, hirsutism, hair thinning) or biochemical signs (elevated androgens on a blood test)
3. Polycystic ovarian morphology (the specific appearance of the ovaries — many small immature follicles arranged around the edge) on ultrasound — OR — elevated anti-Müllerian hormone (AMH) on a blood test

That last point is one of the most important updates from the 2023 guidelines. AMH — a hormone that reflects the number of small follicles in the ovaries — can now be used instead of ultrasound for diagnosis in adults (2,10). For many women, this is far easier than an internal scan and just as accurate.

Importantly, where a woman has both irregular cycles and clear signs of hyperandrogenism, ultrasound or AMH testing is not even required for diagnosis (2,9).

For adolescents, the criteria are stricter — both hyperandrogenism and ovulatory dysfunction need to be present, and neither ultrasound nor AMH is recommended, because the changes of normal puberty can look very similar to PMOS (2,11).

If you have been told your bloods are "normal" but you know something is not right, this is where it pays to ask: which bloods? Were androgens checked properly? Was AMH measured? Was insulin tested, not just glucose? Has anyone looked at the broader pattern, rather than each result in isolation? These are the questions that often unlock a diagnosis that has been missed for years.

Tests worth asking your doctor about

If you suspect PMOS — or already have a diagnosis and want a fuller picture of where things sit — there are several tests that genuinely matter. Some are part of the standard guideline-recommended workup. Others give a deeper view that can be useful but are not always offered routinely.

A hormone panel. This typically includes total testosterone and SHBG (sex hormone-binding globulin — a protein that carries testosterone in the blood; when SHBG is low, more "free" testosterone is biologically active), which together give a much better picture than testosterone alone. AMH can support diagnosis. Progesterone measured around day 21 of the cycle (one week before a period is due) can confirm whether ovulation has actually occurred — useful when cycles are present but irregular. Where there is any uncertainty, TSH (thyroid), prolactin, and 17-hydroxyprogesterone are usually checked too, to rule out conditions that can look similar to PMOS (2,9).

Metabolic screening. The 2023 Guidelines recommend assessing glucose tolerance in everyone with PMOS, ideally with an oral glucose tolerance test (OGTT) — where blood is taken before and two hours after a glucose drink — because this catches insulin resistance and early diabetes more reliably than a single fasting glucose or HbA1c (2). HbA1c (your three-month average blood sugar) and fasting glucose are also useful and easier to access. Fasting insulin is worth asking for — it is not part of the standard guideline workup, but in my clinical experience it is one of the most informative tests in PMOS, because it picks up insulin resistance years before glucose starts to rise. A calculated HOMA-IR (which simply combines your fasting glucose and fasting insulin in a formula to give a single number reflecting how insulin-resistant your body is) can be a useful way to track this over time.

A cardiovascular panel. The Guidelines recommend a lipid profile (total cholesterol, LDL, HDL, triglycerides) and a blood pressure check in everyone with PMOS, with frequency based on individual risk (2). ApoB — a marker of the actual number of cholesterol-carrying particles in your blood, rather than just the cholesterol they contain — is increasingly recognised as a more accurate predictor of cardiovascular risk than LDL alone. It is not part of the standard guideline panel but is worth asking about, particularly if there is a family history of early heart disease.

Other things worth considering. A liver function test and a check for fatty liver (also called metabolic dysfunction-associated steatotic liver disease) are increasingly recommended given how common this is alongside PMOS. Screening for sleep apnoea is part of the 2023 Guidelines, especially where snoring, daytime fatigue, or weight changes are present (2). And as already mentioned, routine screening for depression and anxiety is now strongly recommended in every woman with PMOS (2).

Why PMOS matters across your whole life

PMOS is not just about your reproductive years. It is a lifelong condition with consequences for several major areas of women's health — and this is precisely why early recognition matters so much.

Women with PMOS have a substantially higher risk of type 2 diabetes, with insulin resistance and glucose problems often appearing a decade earlier than in the general population (1,2,12). Cardiovascular disease risk is also higher: a recent meta-analysis informing the 2023 guidelines found a 68% higher odds of cardiovascular disease overall, a 2.5-fold higher odds of heart attack, and a 71% higher odds of stroke compared with women without PMOS (1,13). This is largely driven by the cluster of insulin resistance, weight, blood pressure, and cholesterol changes that travel together.

Because cycles are infrequent in PMOS, the endometrium — the lining of the uterus — can be exposed to oestrogen without the protective effect of progesterone for long stretches. This raises the risk of endometrial cancer roughly two-to-three-fold compared with women without the condition (1,2). This is one of the strongest reasons to ensure cycles occur at least every three months, even if assistance is needed.

Recent large meta-analyses have also confirmed higher risks in pregnancy — including early miscarriage, gestational diabetes, hypertension in pregnancy, pre-eclampsia, preterm delivery, and caesarean delivery — independent of age and weight (2,14,15). Knowing your PMOS status before pregnancy allows for proactive monitoring and care.

If reading that list feels heavy, please pause. The point is not to alarm you. The point is that knowing this — early — gives you real leverage. Lifestyle, medical care, and proactive screening can substantially change the long-term trajectory. This is the empowering truth that the old name obscured.

PMOS through perimenopause and beyond

Many women I see for the first time in their 40s and 50s have lived with undiagnosed PMOS their whole adult lives. Naming it finally explains a lifetime of patterns.

In general, the hormonal features tend to soften with age — cycles often become more regular before they stop, and androgen levels gradually fall (16). The metabolic features, however, tend to persist — insulin resistance, central fat, blood pressure changes — and perimenopause can amplify them as the protective effects of oestrogen are also being lost (1,16). The perimenopause years are therefore a particularly important window for women with PMOS, not a time to assume the condition has "gone away."

What helps — lifestyle medicine, first and always

The 2023 International Guidelines are clear: healthy lifestyle should be recommended to all women with PMOS, regardless of weight, fertility goals, or age (2,9). The evidence is that lifestyle change benefits women with PMOS even without weight loss (2).

Here is where I want to be honest with you: there is no single "PMOS diet" or "PMOS exercise plan." The research is clear that no one dietary pattern is superior for PMOS, and the same applies to exercise (2,9). What matters far more is consistency, sustainability, and alignment with your own life. This is good news, because it gives you freedom to build a way of eating and moving that works for you.

The principles that work most reliably in clinic:

Nutrition. A whole-food, plant-rich diet that supports stable blood sugar is the foundation. This means meals that combine fibre, plant protein, healthy fats, and slow carbohydrates rather than ones built around refined carbohydrates and ultra-processed foods. Patterns such as the Mediterranean and DASH diets translate beautifully to a plant-focused approach (2). The levers that tend to make the biggest difference are protein at every meal, plenty of fibre (from legumes, whole grains, vegetables, fruit, nuts, and seeds), plant-based fats like olive oil, avocado, and nuts, and polyphenol-rich vegetables and fruit to reduce the low-grade inflammation that drives much of PMOS.

A continuous glucose monitor (CGM) can be a remarkably useful tool for women with PMOS. It shows you in real time how your body responds to specific foods and meals — and because insulin and glucose patterns vary so much between individuals, this is often where genuine progress begins. You can read more about CGMs here.

Movement. Both resistance training and aerobic exercise (activity that gets your heart rate up and your breath moving — walking, cycling, swimming, dancing) improve insulin sensitivity in PMOS (2). Strength training in particular is powerful — every kilogram of muscle gained becomes a more efficient "sponge" for glucose, which directly reduces the insulin load on the body. In my clinical experience, the combination that works best is two to three sessions of resistance training per week, plus regular daily movement you enjoy.

Sleep and stress. Both sleep deprivation and chronic stress worsen insulin resistance and amplify androgen production (2,17). For many women with PMOS, addressing sleep is one of the highest-impact things they can do. Aim for seven to nine hours of consistent, quality sleep, and take sleep apnoea seriously if it is present. Stress management — through breathwork, time in nature, meditation, gentle yoga, or therapy — is not a luxury here. It is part of the core treatment.

Mental and emotional support. The 2023 guidelines now strongly recommend routine screening for depression and anxiety in women with PMOS, and psychological support as first-line treatment where these are present (2). Cognitive behavioural therapy (CBT), in particular, has good evidence for both mood and lifestyle change. If you are struggling, please ask for support — you should not have to carry this alone.

What helps — medical treatment options

Medical treatment in PMOS is not about "fixing" a broken system. It is about giving you tools to manage specific features, in ways that align with your goals and life stage. The right combination is different for every woman.

Combined oral contraceptive pill (COCP). First-line medical treatment for irregular cycles and hyperandrogenism (acne, hirsutism) in women not trying to conceive (2,18). Low-dose preparations are recommended. The pill works by regulating cycles, reducing androgen production, and protecting the endometrium.

Metformin. An insulin-sensitising medication recommended for adult women with PMOS and a BMI of 25 or above, particularly for metabolic features including insulin resistance, glucose, and lipids (2,19). It can also be used for irregular cycles if the pill is not suitable.

Inositol. A supplement that has become popular in PMOS. The honest position on the evidence: a 2024 systematic review found evidence of benefit for some metabolic measures and possibly for ovulation, but no clear effect on many other outcomes (20). The 2023 guidelines state that inositol "may be considered" in PMOS based on individual preferences, noting limited harm and a more favourable side-effect profile than metformin (2,20). It is not currently recommended as a stand-alone fertility treatment.

Berberine is another supplement sometimes used for insulin resistance in PMOS (it is a plant compound found in herbs such as goldenseal and barberry, and has been used in traditional Chinese medicine for centuries) — it is one to discuss specifically with your doctor if you are considering it.

Anti-androgens. Medications such as spironolactone can be considered in combination with effective contraception for hirsutism that has not responded adequately to the pill alone (2,21).

Letrozole. First-line medication for ovulation induction in women with PMOS who are trying to conceive — more effective than older options such as clomiphene (2).

Anti-obesity medications and bariatric surgery. Both are supported in the 2023 guidelines for weight management in women with PMOS, alongside lifestyle change, following general population guidelines (2,22). Effective contraception is required with anti-obesity medications, given limited pregnancy safety data.

Cosmetic and skin treatments. Laser and light therapies for hirsutism are evidence-based and can substantially improve quality of life (2). Worth considering for women whose hair growth is significantly affecting their wellbeing.

What you can do, practically

If PMOS is part of your picture — whether newly diagnosed, long-known, or now finally making sense — here is where I would start.

Every day

• Build meals around plant protein, fibre, and slow carbohydrates
• Move your body in some way you enjoy
• Prioritise sleep — protect at least 7 hours
• Notice and tend to stress before it tends to you

Every week

• 2 to 3 sessions of resistance training
• Some higher-intensity movement if your energy supports it
• Plan meals to take the decision-making pressure off busy days

Every few months

• Track how your body is responding — energy, cycle, sleep, weight, mood
• Reflect on what is working and what is not
• Adjust gently rather than overhauling everything

At least once a year

• Review blood pressure, fasting glucose, HbA1c, fasting insulin, and lipid profile
• Discuss when cycle regulation is needed (at minimum every three months) to protect the endometrium
• Screen for depression and anxiety, and ask for support if needed
• Consider whether your current medical management still fits where you are now

A final word

The shift from PCOS to PMOS is more than a new name. It is the moment medicine stopped staring at the violins and finally listened to the whole orchestra — to your insulin, to your hormones, to the way your brain and your ovaries communicate, to the metabolic terrain underneath it all.

The ovaries were never the whole story. They were the most visible part of a much larger picture — a picture that includes the way your body uses insulin, the way your hormones are produced and balanced, the way your brain communicates with your reproductive system, and the way all of this interacts with the rest of your health across your lifetime.

If you have ever felt that the explanation didn't match your experience, or that something was being missed when you walked out of an appointment — you were right. The science has finally caught up with what women living with this condition have been saying all along.

What I want you to take from this article is not fear, but clarity. PMOS is a condition you can understand, work with, and influence — at every stage of life. Lifestyle medicine is the foundation of treatment, not a soft alternative. And medical tools, when needed, work best on top of that foundation.

If you would like personalised support understanding your own metabolic and hormonal picture, my self-paced course Metabolic Harmony was designed exactly for this — to help you understand how your body regulates weight, energy, and hormones, and to give you the practical tools to support yourself well. If you would prefer one-to-one support, you can also book a consultation.

You are not broken. Your body is not failing you. It is doing exactly what it has been wired to do, in an environment it was not designed for — and with the right understanding and support, there is so much you can bring back into rhythm.

Dr Taisia Cech

A gentle note: this article provides general educational information and is not personalised medical advice. PMOS shows up differently in every woman. Please consult your healthcare provider before making changes to your treatment, especially if you have medical conditions or are pregnant.

References

1. Teede HJ, Bahri Khomami M, Morman R, Laven JSE, Joham AE, Costello MF, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. Lancet. 2026. https://doi.org/10.1016/S0140-6736(26)00717-8

2. Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Eur J Endocrinol. 2023;189(2):G43–64.

3. Neven ACH, Forslund M, Ranasinha S, et al. Prevalence of polycystic ovary syndrome: a global and regional systematic review and meta-analysis. Hum Reprod Update. 2026. https://doi.org/10.1093/humupd/dmaf030

4. Cassar S, Misso ML, Hopkins WG, Shaw CS, Teede HJ, Stepto NK. Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies. Hum Reprod. 2016;31(11):2619–31.

5. Stepto NK, Cassar S, Joham AE, et al. Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic–hyperinsulaemic clamp. Hum Reprod. 2013;28(3):777–84.

6. Bizuneh AD, Joham AE, Teede H, et al. Evaluating the diagnostic accuracy of androgen measurement in polycystic ovary syndrome: a systematic review and diagnostic meta-analysis to inform evidence-based guidelines. Hum Reprod Update. 2025;31(1):48–63.

7. Stener-Victorin E, Teede H, Norman RJ, Legro R, Goodarzi MO, Dokras A, et al. Polycystic ovary syndrome. Nat Rev Dis Primers. 2024;10:27.

8. Joham AE, Norman RJ, Stener-Victorin E, Legro RS, Franks S, Moran LJ, et al. Polycystic ovary syndrome. Lancet Diabetes Endocrinol. 2022;10(9):668–80.

9. Teede HJ, Mousa A, Tay CT, Costello MF, Brennan L, Norman RJ, et al. Summary of the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome: an Australian perspective. Med J Aust. 2024;221(7):389–95.

10. van der Ham K, Laven JSE, Tay CT, Mousa A, Teede H, Louwers YV. Anti-Müllerian hormone as a diagnostic biomarker for polycystic ovary syndrome and polycystic ovarian morphology: a systematic review and meta-analysis. Fertil Steril. 2024;122(4):727–39.

11. Peña AS, Witchel SF, Boivin J, et al. International evidence-based recommendations for polycystic ovary syndrome in adolescents. BMC Med. 2025;23:151.

12. Moran LJ, Misso ML, Wild RA, et al. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2011;17(6):741–60.

13. Tay CT, Mousa A, Vyas A, Pattuwage L, Tehrani FR, Teede H. 2023 international evidence-based polycystic ovary syndrome guideline update: insights from a systematic review and meta-analysis on elevated clinical cardiovascular disease in polycystic ovary syndrome. J Am Heart Assoc. 2024;13(7):e033572.

14. Bahri Khomami M, Shorakae S, Hashemi S, et al. Systematic review and meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Nat Commun. 2024;15:5591.

15. Bahri Khomami M, Hashemi S, Shorakae S, et al. Systematic review and meta-analysis of birth outcomes in women with polycystic ovary syndrome. Nat Commun. 2024;15:5592.

16. Helvaci N, Yildiz BO. The impact of ageing and menopause in women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 2022;97(3):371–82.

17. Shorakae S, Ranasinha S, Abell S, et al. Inter-related effects of insulin resistance, hyperandrogenism, sympathetic dysfunction and chronic inflammation in PCOS. Clin Endocrinol (Oxf). 2018;89(5):628–33.

18. Forslund M, Melin J, Alesi S, et al. Combined oral contraceptive pill compared with no medical treatment in the management of polycystic ovary syndrome: a systematic review. Clin Endocrinol (Oxf). 2023;99(1):79–91.

19. Melin J, Forslund M, Alesi S, et al. The impact of metformin with or without lifestyle modification versus placebo on polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Eur J Endocrinol. 2023;189(2):S37–63.

20. Fitz V, Graca S, Mahalingaiah S, et al. Inositol for polycystic ovary syndrome: a systematic review and meta-analysis to inform the 2023 update of the international evidence-based PCOS guidelines. J Clin Endocrinol Metab. 2024;109(6):1630–55.

21. Alesi S, Forslund M, Melin J, et al. Efficacy and safety of anti-androgens in the management of polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials. EClinicalMedicine. 2023;63:102162.

22. Samarasinghe SNS, Leca B, Alabdulkader S, et al. Bariatric surgery for spontaneous ovulation in women living with polycystic ovary syndrome: the BAMBINI multicentre, open-label, randomised controlled trial. Lancet. 2024;403(10443):2489–503.