Polycystic ovary syndrome (PCOS) has a new name: Polyendocrine Metabolic Ovarian Syndrome (PMOS). This change follows a rigorous international consensus process involving more than 14,000 patients and healthcare professionals and 56 international organizations. The recommendations were published in The Lancet in June 2026, and implementation is now underway across clinical guidelines, research, and disease classification systems. A global transition period of approximately three years is expected.

While the name has changed, the diagnostic criteria and evidence-based management remain largely unchanged. The new terminology better reflects the multisystem nature of the condition.

A New Name for a Misunderstood Condition

The name, polycystic ovary syndrome, was misleading because it suggested that ovarian cysts were the defining feature of the disorder. In reality, PMOS is a complex endocrine and metabolic syndrome affecting more than 170 million people worldwide. Many affected individuals do not have ovarian cysts, and many people with polycystic-appearing ovaries do not have the syndrome. The new name recognizes that PMOS is a multisystem disorder involving reproductive, endocrine, and metabolic dysfunction—not simply an ovarian condition—and emphasizes the importance of holistically managing its reproductive, metabolic, and endocrine effects to reduce long-term health risks. 

The previous terminology likely contributed to delayed diagnosis (with up to 70% of affected individuals remaining undiagnosed), fragmented care, stigma, and decades of under-recognition and underfunding of research.

Diagnosis

PMOS is diagnosed using the internationally endorsed modified Rotterdam criteria. After excluding other conditions that can mimic PMOS, adults must have at least two of the following three features:

1. Oligo-anovulation
2. Clinical or biochemical hyperandrogenism
3. Polycystic ovarian morphology on ultrasound, or elevated anti-Müllerian hormone [AMH] when ultrasound is unavailable or impractical (note that AMH only valid if at least 8 years post-menarche)

1. Oligo-anovulation

Evidence of ovulatory dysfunction includes:

• Primary amenorrhea by age 15 or more than 3 years after thelarche (breast development)
• 1 to <3 years after menarche: a pattern of menstrual cycles lasting fewer than 21 days or more than 45 days
• ≥3 years after menarche through the menopausal transition: a pattern of menstrual cycles lasting fewer than 21 days, or more than 35 days, or fewer than 8 cycles per year
• Any menstrual cycle lasting more than 90 days occurring at least one year after menarche

2. Hyperandrogenism

Hyperandrogenism may be diagnosed clinically or biochemically.

Clinical features

• Hirsutism (modified Ferriman-Gallwey score ≥4–8 depending on ethnicity)
• Persistent inflammatory acne
• Androgenic alopecia

Biochemical features

Elevated serum androgen concentrations, including:

• Total or free testosterone
• Androstenedione
• DHEAS

Normal androgen levels do not exclude PMOS if one or more clinical features are present.

3. Polycystic Ovarian Morphology (only 8 years after menarche)

This may be demonstrated by:

• Ultrasound ≥20 follicles in one ovary using modern high-resolution transvaginal ultrasound, or
• Ovarian volume ≥10 mL

Ultrasound should not be used for diagnosis until 8 years after menarche, as multifollicular ovaries are common during adolescence.

Anti-Müllerian Hormone (AMH)

In adults, AMH may be used as an alternative to ultrasound when imaging is unavailable or impractical. Current guidelines recommend using assay-specific reference ranges rather than a universal cutoff. AMH should not be used for diagnosis in adolescents or within 8 years of menarche.

Excluding Other Conditions

Alternative diagnoses should be excluded early in the evaluation, including:

• Pregnancy
• Thyroid disease
• Hyperprolactinemia
• Nonclassic congenital adrenal hyperplasia
• Other causes of androgen excess when clinically indicated

Initial Laboratory Evaluation

Ideally, hormone testing should be performed during the early follicular phase (cycle days 2–4) in patients who are menstruating. The extent of laboratory evaluation should be individualized based on the patient's presentation and clinical setting. 

The table below shows common lab tests in PMOS, their purpose, and typical findings:

PMOS Diagnosis Flow Chart

(Click here to save a high-resolution PDF of the flow chart)

Treatment Essentials 

PMOS is a lifelong condition requiring individualized, multidisciplinary care. Lifestyle modification remains the foundation of treatment.

Menstrual Regulation

Combined oral contraceptive pills (COCs) remain first-line pharmacologic therapy for patients not seeking pregnancy. When appropriate, consider a monophasic pill containing 20 μg (0.02 mg) ethinyl estradiol combined with a low-androgenicity progestin such as:

• Norgestimate
• Drospirenone
• Desogestrel

Patients with chronic anovulation due to PMOS have an approximately two- to threefold increased risk of endometrial hyperplasia and endometrial cancer because of prolonged unopposed estrogen exposure. For patients with persistent anovulation who are not attempting pregnancy, regular endometrial protection should be provided with one of the following:

• Combined hormonal contraception
• Cyclic progestin therapy (micronized progesterone 200 mg PO QD X 10-14 days OR medroxyprogesterone  5-10 mg PO QD X 5-10 days) at least every 3 months
• A levonorgestrel-releasing intrauterine device (IUD)

Managing Hyperandrogenism

• Spironolactone (Spironolactone should be used with effective contraception because of the potential risk of blocking the sexual development of a male fetus.)
• Laser hair removal or light-based therapies

Managing Metabolic Risk

• Screen for glucose intolerance at diagnosis and every 1-3 years with 75-g OGTT 
• Blood pressure annually
• Lipid panel and smoking counseling at diagnosis
• Lifestyle intervention remains first-line.
• Metformin is recommended for patients with insulin resistance, prediabetes, type 2 diabetes, or other metabolic features and may be used alone or alongside lifestyle intervention and hormonal therapy.
• GLP-1 receptor agonists may be considered for patients with obesity or overweight and metabolic complications as part of a comprehensive weight-management strategy. Recent meta-analyses demonstrate improvements in weight loss and insulin resistance, although long-term reproductive and endocrine outcomes remain uncertain. 

Managing Fertility

• For ovulation induction, letrozole is the preferred first-line medication.

Long-Term Management

Patients with PMOS should undergo routine screening for:

• Depression and anxiety 
• Eating disorders 
• Cardiovascular risk factors 
• Dysglycemia 
• Obstructive sleep apnea when clinically indicated 

Patients with chronic anovulation are also at increased risk of endometrial hyperplasia and endometrial cancer. Ensure ongoing endometrial protection through combined hormonal contraception, cyclic progestins, or a levonorgestrel-releasing IUD when pregnancy is not desired.

Take-Home Message

The condition formerly known as PCOS is now called Polyendocrine Metabolic Ovarian Syndrome (PMOS). While the diagnostic criteria and evidence-based treatments remain largely unchanged, the new name more accurately reflects the complex endocrine, metabolic, and reproductive nature of this common disorder. Recognizing PMOS as a multisystem condition should promote earlier diagnosis, more comprehensive care, reduced stigma, and continued advances in research.

References

• Teede HJ, Khomami MB, Morman R, et al. Polyendocrine Metabolic Ovarian Syndrome, the New Name for Polycystic Ovary Syndrome: A Multistep Global Consensus Process. The Lancet. 2026.
• Elhassan YS, Hawley JM, Cussen L, et al. Society for Endocrinology Clinical Practice Guideline for the Evaluation of Androgen Excess in Women. Clinical Endocrinology. 2025.
• International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. 2023.
• Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome. Obstetrics & Gynecology. 2018.
• New Insights into the Relationship of Anti-Müllerian Hormone with Polycystic Ovary Syndrome and Its Diagnostic Accuracy: An Updated and Extended Meta-analysis Using a Marginal Beta-Binomial Model. American Journal of Obstetrics & Gynecology. 2025.Buragohain S, Sarma I, Saikia D, et al. Effectiveness of GLP-1 Receptor Agonists in Patients With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Cureus. 2026.
• OR 
• Lin J, Yang R, Zhuang J, Zhang W, Tong Q, Liu J, Kang Y, Yuan Y. The efficacy and safety of novel antidiabetic agents in polycystic ovary syndrome: a network meta-analysis. J Ovarian Res. 2026 Mar 21;19(1):167. doi: 10.1186/s13048-026-02078-x. PMID: 41862977; PMCID: PMC13126963.