More Than a New Name - How PMOS Reframes Clinical Care... PCOS Awareness Month Special - Dr Neeta R. Deshpande

PMOS in 2026: Why the Name Change Matters?

After decades of being known as polycystic ovary syndrome, PCOS has now been renamed polyendocrine metabolic ovarian syndrome (PMOS) to better reflect its broader clinical nature. The new name moves the focus beyond “cysts” and ovaries, recognising PMOS as a long-term endocrine-metabolic disorder involving hormonal, metabolic and ovarian effects. PMOS affects nearly 1 in 8 women globally, and the revised terminology is intended to correct the long-standing ovary-centric framing of PCOS, support earlier recognition of its metabolic-endocrine dimensions, and improve alignment between diagnosis, counselling and long-term care. (1,2)

Beyond Cysts: How Do We Recognise the Full Clinical Spectrum in PMOS?

PMOS extends well beyond ovarian morphology. After exclusion of other disorders, adults are diagnosed with PMOS based on at least two of the following: oligo-anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound or elevated anti-Müllerian hormone. It further describes PMOS as a multisystem condition with reproductive, gluco-cardio-metabolic, dermatological, and psychological features, including irregular menstrual cycles, infertility, pregnancy complications, obesity, dysglycaemia, hypertension, dyslipidaemia, acne, alopecia, hirsutism, depression, anxiety, poor quality of life and eating disorders. (3)

Metabolic Risk at the Core of PMOS Care

Metabolic abnormalities are central to PMOS, underpinning the condition from genetic origins to clinical manifestations. PMOS fundamentally stems from endocrine disturbances in insulin, androgens, neuroendocrine and ovarian hormones. Insulin resistance and compensatory hyperinsulinaemia can amplify androgen secretion and disrupt steroidogenesis, reinforcing the metabolic-endocrine interplay in PMOS. The International Evidence-based Guideline for the Assessment and Management of PCOS supports routine metabolic risk assessment in clinical care. Therefore, PMOS management should move beyond menstrual or dermatological symptom control to structured metabolic evaluation and long-term cardiometabolic follow-up. (3,4)

Five Care Transition Points of PMOS Clinicians Should Not Miss

PMOS needs to be screened, identified, and managed at key life transitions rather than approached as a one-time endocrine-reproductive diagnosis.

1. Adolescence is the first critical point: the adolescent-specific guideline 2023 states that PCOS (now, PMOS) diagnosis requires both irregular menstrual cycles, defined by time post-menarche, and clinical or biochemical hyperandrogenism, after excluding mimicking disorders; adolescents with only one feature may be considered “at risk” and require symptom management and ongoing follow-up. It also recommends lifelong health planning, including healthy lifestyles, screening for depression and metabolic features, and transition to adult care. (5)
2. The second transition is reproductive planning and early pregnancy. A 2024 systematic review and meta-analysis including 104 studies and 106,690 pregnancies reported that women with PCOS (now, PMOS) had higher odds of miscarriage, gestational diabetes mellitus, gestational hypertension, pre-eclampsia and caesarean section. The authors emphasised that PCOS status should be captured in women planning pregnancy or recently pregnant to support prevention and improve pregnancy outcomes.
3. The third transition is pregnancy, where the same review notes that the International Evidence-based PCOS Guideline recommends OGTT ideally at preconception, or at the first antenatal visit and again at 24–28 weeks if not done earlier. (6)
4. The fourth transition is postpartum weight and metabolic review, particularly after pregnancies complicated by GDM. A prospective case-control study found that women with PCOS and GDM had a 3.45-fold higher risk of persistent glucose metabolism impairment after delivery compared with non-PCOS women with GDM, supporting the need for postpartum glycaemic follow-up. (7)
5. The fifth is perimenopause and later-life follow-up, where a systematic review found higher BMI, waist circumference, insulin resistance, fasting glucose, diabetes, triglycerides, hypertension, myocardial infarction and stroke in peri/postmenopausal women with PCOS versus controls. (8)

Figure 1. Key PMOS transition points for endocrine-metabolic reassessment across life course & Potential of Metformin

Metformin: Integral to Endocrine & Metabolic Care in PMOS

Lifestyle management remains central to PMOS care; however, metformin has an evidence-based role where metabolic risk is prominent.

• The International Evidence-based PCOS Guideline 2023 states that metformin should be considered in adults with PCOS and BMI ≥25 kg/m² for anthropometric and metabolic outcomes, including insulin resistance, glucose and lipid profiles. (4)
• It also notes that metformin may be most beneficial in high metabolic-risk groups, including those with BMI >30 kg/m², diabetes, impaired glucose tolerance or high-risk ethnic backgrounds. (4)
• Metformin could also be considered in adolescents at risk of or with PCOS for cycle regulation, acknowledging limited evidence. (6)
• When metformin is prescribed, low-dose initiation, gradual 500 mg increments and extended-release preparations may minimise gastrointestinal side effects and improve adherence. (9)
• A 2026 network meta-analysis of 16 RCTs reported that metformin combined with GLP-1 receptor agonists produced the greatest reductions in weight and BMI among evaluated pharmacological strategies in women with PCOS, reflecting the synergistic effects of central appetite suppression with peripheral insulin sensitisation. (10)

ESG 2026 Position Paper on the Transition from PCOS to PMOS

The European Society of Gynaecology (ESG) highlights that PCOS terminology inadequately reflects the endocrine–metabolic nature of the condition. The position paper ESG supported the transition from PCOS to PMOS through a phased, patient-centred approach, recommending prolonged use of dual terminology, “PMOS (formerly known as PCOS)” to maintain continuity and patient understanding. The authors also recommend systematic integration of the terminology into guidelines and education, while reaffirming the central role of gynaecological endocrinology in patient management. (11)

Expert Perspective

PCOS (now, PMOS) requires care across the lifespan, with assessment of reproductive, gluco-metabolic, cardiovascular and psychological features, supported by lifestyle management and appropriate metformin use, when indicated. (4,9)

Key Takeaways

• PMOS shifts clinical attention from isolated symptom control to proactive identification of women likely to carry persistent metabolic risk across adolescence, pregnancy, postpartum and later life. (3,4,7,8)
• In this risk-based approach, metformin remains relevant as a selective metabolic intervention, particularly where insulin resistance, dysglycaemia or higher BMI may influence long-term outcomes and treatment continuity. (4,12)

Abbreviations: PCOS, Polycystic Ovary Syndrome; PMOS, Polyendocrine Metabolic Ovarian Syndrome; BMI, Body Mass Index; GDM, Gestational Diabetes Mellitus; OGTT, Oral Glucose Tolerance Test; ESG, European Society of Gynaecology; RCTs, Randomised Controlled Trials; GLP-1 RA, Glucagon-Like Peptide-1 Receptor Agonist.