What is Polyendocrine Metabolic Ovarian Syndrome? | The New Name for PCOS (Episode 626)

Full Transcript: Episode 626

Lisa Hendrickson-Jack:

This is the Fertility Friday Podcast, episode number 626. Today, I’m sharing a brand new episode in our FAM research series. The paper in question today is called Polyendocrine Metabolic Ovarian Syndrome, the new name for PCOS, a multi-step global consensus process.

If you have been on the interwebs or the social medias, you have probably seen mention of this landmark decision. Since we are doing the FAM research series, I thought that this would be a great paper to talk about this week. It’s so interesting to see such a big change being made.

According to the paper itself, this change came after 11 years and over 22,000 patients and clinicians who’ve been surveyed weighing in on this. So this has been in the process for quite some time. I’m curious to see what people have to say about it, what people think about it, if people think it’s going to make a difference, if they think maybe changing a name isn’t the biggest change they needed to make.

What we’re going to talk about is the paper itself and the rationale behind making these changes and some of the new research and even diagnostic criteria that have come out in recent years.

Many of us are familiar with the statistic that it takes an average of nearly 20 years for new research to become public practice. I can remember on this podcast for many years when we would talk about PCOS — this concept of renaming it and focusing on the metabolic piece of it has been happening for decades. This has been a topic of discussion for decades because ultimately the term PCOS makes it seem like it’s about the ovaries when really the condition itself is a metabolic one, and the shifts and changes in the formation of ovarian cysts and the cycle irregularities are simply a symptom and sign of what’s happening metabolically.

Given that the focus of a lot of my work is to spread the idea that the menstrual cycle is truly a vital sign, PCOS is an excellent example of that — because the shifts and changes that we see in the menstrual cycle are simply a result of what is happening underlying metabolically.

In some ways, this name change is great. There’s a lot of promise here. This could really help women and change the way this condition is looked at, and have clinicians look at it more seriously — specifically from the metabolic standpoint, instead of looking at it solely as an ovarian issue. But on the other hand, I’m a little skeptical and I’m curious if this name change is necessarily going to change the way this condition is treated in practice.

But let’s get into it.

The new name is polyendocrine metabolic ovarian syndrome — PMOS. They have removed the word “cystic.” This paper literally came out days before this episode is going live, published officially on the 12th of May, 2026. Another paper came out on the 11th of May, 2026, that was looking at the cystic part of it.

I’ll read a quote from the Lancet paper that is officially naming the new name: “Polyendocrine metabolic ovarian syndrome, PMOS, previously named PCOS, affects one in eight women. However, the term PCOS is inaccurate, implying pathological variances, obscuring diverse endocrine and metabolic features, and contributing to delayed diagnosis, fragmented care, and stigma.”

One of the things that the researchers are talking about is that it implies there is actually a pathological ovarian cyst situation happening when it’s not that — it’s just that there’s the formation of several, many cysts. But the cysts themselves aren’t necessarily pathological. They’re kind of saying the name implies that there’s an actual problem with these cysts, but really we’re just seeing multiple cysts.

It’s, again, a symptom of the underlying metabolic issues — which is why we’re seeing multiple follicles kind of arrested in this stage of development, not necessarily moving towards ovulation. That’s the hallmark sign of PCOS, which then leads to these long irregular cycles because you just have these multiple cysts forming. They’re just kind of like hanging out, but they’re not developing.

In a typical healthy cycle, you do have a small pool of follicles at the beginning of the menstrual cycle, but one then becomes a dominant follicle and develops and moves forward toward ovulation. But in PCOS — or PMOS — what we often see is that you have this holding pattern where these multiple follicles are just kind of arrested at a stage of development. A dominant follicle is not being chosen to move forward and ovulate. But what the researchers are saying is: it’s not that the cysts are pathological. It’s just that this is a hallmark sign of this situation.

The researchers also state — with more of a focus on the metabolic issue — that 85% of women with PCOS have insulin resistance. 75% of lean women with PCOS — lean just meaning that these women don’t necessarily have a high BMI — but anywhere from 75% to 85% of women with this condition show insulin resistance. And they’re hoping that with this name change, they’re shifting the focus to the metabolic issues and focusing more on the condition itself instead of being focused on the ovarian piece of it.

Also, the cardiovascular risk is worth noting. Women with PMOS, formerly PCOS, have two and a half times the risk of experiencing a heart attack, and nearly twice the odds of experiencing a stroke. With numbers like this, with such an increased cardiovascular risk, focusing on the metabolic piece, focusing on the health piece — what they’re hoping for is that it’s really going to encourage practitioners to look at this condition differently.

In terms of prevalence and statistics, an estimated over 170 million women are dealing with PCOS across their reproductive years. It’s estimated that about 15% — so one out of six women — are dealing with this issue. And up to 70% of those women are not diagnosed.

In a previous FAM research series episode, I shared some statistics around diagnosis as well. On average, it takes at least two years and multiple practitioners for women to be diagnosed with PCOS, or this new term PMOS. There is an issue with diagnosis and I’ve observed a lot of different issues with diagnosis.

One issue is that for practitioners who do know that this is a metabolic condition, they’re often looking for women to kind of fall into a certain body type. But when we look at the diagnostic criteria, it has nothing to do with your body type.

The prior diagnostic criteria has been two out of the three Rotterdam criteria. They’re looking for irregular cycles and anovulation, or they’re looking for elevated androgen levels, or they’re looking for the polycystic ovaries. They’re looking for two of the three of those. Notice that none of those criteria say anything about a woman’s weight.

I’ve worked with clients who did not necessarily have a high BMI but had classic hallmark symptoms of this condition — irregular cycles and high androgens. And sometimes a blood test is not required to identify high androgens. If you have cystic acne, if you have hirsutism, then those are clinical signs of high androgens.

The new criteria they’ve adjusted will say that clinical signs of hyperandrogenism combined with irregular cycles are sufficient — they don’t actually need to also do a blood test. They can diagnose you just based on that. If you’re not showing hirsutism or cystic acne or other clinical signs of high androgens, then they would do a test to determine androgen levels.

Interestingly, in 2023, in addition to the criterion of having polycystic ovaries, they actually added elevated AMH levels as a potential diagnostic criterion. And also they’re emphasizing that an ultrasound is not required for diagnosis. An ultrasound was not required for diagnosis before, but potentially because of the way that the condition was positioned, there were just a lot of women being diagnosed maybe just because of an ultrasound — where maybe they weren’t even looking at the androgen levels or some of the other symptoms, just diagnosed based on the ovaries.

Now it seems like the diagnostic criterion is a little bit more specified. They’ve also increased the number of follicles that is required for a diagnosis based on the ovaries. But overall, it’s just de-emphasizing the role of the polycystic ovaries.

The Androgen Excess Society was arguing that this is an androgen excess condition and we should really be focusing on the high androgens piece of it. But either way, I think what is coming out of this is that they want to focus more on the metabolic piece, they want to de-emphasize the ovarian cyst piece, and kind of have clinicians look beyond that. It seems like everyone was really hyper-focused on that.

What I’ll say about the AMH is that when I was writing Real Food for Fertility and writing the PCOS chapter, there was plenty of research that indicated that elevated AMH levels were highly correlated with PCOS. And why is that? AMH is a hormone that is produced in relation to the size of the pool of follicles developing in your ovaries. That’s why it’s used as a proxy for ovarian reserve. Young women have higher levels because they have a higher follicle pool, and as we get older it declines. But women with PCOS are known to have elevated AMH levels, and that can be an indication that if they were to go through an IVF procedure, they would be more likely to over-stimulate.

For adult women specifically — this AMH criteria is not used for adolescents — they could actually have an AMH test done, and that could be part of the two out of the three. But they do encourage clinicians not to use both the ultrasound and the AMH. It’s one or the other, to discourage over-diagnosis.

I do have questions. I’m a little bit skeptical. I think overall this could be a move in the right direction. For new medical professionals learning this for the first time, having that name really focus on the metabolic aspect of it, the endocrine dysfunction, the metabolic dysfunction behind this condition — putting that first and having it be part of the name does convey that this is not just about the ovaries. It does convey that the bigger issue is the underlying metabolic problem.

Interestingly, many clinicians knew this already. There’s a part of me that’s like, well, how is this going to change things? My big question and my big skepticism is: when we change the name, does that mean how this condition is addressed in conventional medicine is also going to change?

It’s not new information that this is a metabolic condition. However, when a woman goes to the doctor and says she has irregular cycles, she is put on the pill. My question is, in theory this is great — but is the experience of these women who are going to the doctor for irregular cycles or for hyperandrogenism or for both, is that going to change because they changed the name? Does changing the name mean that when women have irregular cycles, all of a sudden they’re not going to be put on the pill? Because the pill does not address the metabolic issues whatsoever. The pill does not address the endocrine dysfunction. The pill does not address the underlying cardiovascular risk or the insulin resistance or anything like that.

Is anything changing? We’ll have to wait and see.

On the one hand, it’s exciting to see changes. It’s exciting to actually see diagnostic criteria change in response to the research. It feels like we’re making progress. But at the end of the day, I just want to see if this is going to improve the lives of the women in question.

What I’ve seen in practice is women out there with classic, obvious signs of PCOS — PMOS now — who have long irregular cycles clearly spotted on their menstrual cycle charts, signs of androgenism, the coarse hair, the acne, super obvious — but maybe they’re thin, and so they don’t get a diagnosis because the doctor is looking for someone with a higher BMI. Or women who don’t seem to meet the criteria of PCOS — their cycles are totally regular, they don’t seem to have high androgens, but they have cysts on their ovaries. And all of a sudden they are told they have PCOS and all this stuff is going on. But as someone who works with women with their cycles and their charts, you’re kind of like, I don’t know if that’s what’s really going on here.

Hopefully, beyond the name itself, the change in how they are talking about diagnosing it could be a bit of a game changer — because they’re being more specific and precise. They’re de-emphasizing the importance of the polycystic ovaries and focusing more on the irregular cycles, the signs of androgens, and even potentially the AMH test. If they started to do AMH testing as opposed to relying on cysts on the ovaries, that has potential. There was a really high correlation with elevated AMH levels and this condition. That would be the piece I’m a little more curious about, to see if that would make a difference.

But diagnosis is one thing. I don’t know if changing the name changes the treatment. To say we’re going to change the name, we’re going to try to diagnose people more effectively — but when they’re diagnosed, we’re still just going to put them on the pill. Then what does that do?

I’m sure they’ve thought of that. It’s very possible that by shifting the focus to the underlying metabolic condition, the treatment could be different. But up until this point, the primary treatment for PCOS conventionally has been birth control pills or metformin, which is aimed at the metabolic issue. Metformin is given to women who are wanting to get pregnant — obviously if you’re on the pill, it makes it kind of hard to get pregnant. So it’s the pill for everyone who’s not trying to get pregnant, and then metformin for the women who are trying to get pregnant, because metformin is an insulin-sensitizing drug. And metformin is associated with a lot of different side effects. But that’s kind of how conventional medicine has been treating it.

So that’s my take on it. I’m kind of like, this seems like a good thing. I feel like it raises awareness. I’ve been saying — I’m on record over the years on the podcast saying — what if they called it cardiometabolic syndrome? That kind of makes more sense, right? But does that change how women are going to be cared for and treated? We’ll just have to wait and see.

I hope that you enjoyed today’s episode. I may release another episode next week talking more about the other new paper that came out this week, talking about whether these cysts are really pathological. It kind of goes together. I may do this as a two-part series.

If you’re tuning into this episode, feel free to hit me up on social media. I’m on Instagram at Fertility Friday. What do you think about this change? Do you think this is positive? Do you think it’s going to result in positive changes for women everywhere — improved diagnosis, anything like that? Do you think I’m being too negative by being a little bit critical and suspicious of whether this is actually going to change how this condition is treated? I would love to hear from you. Hit me up on the socials and we’ll keep this conversation going.

I hope you have a wonderful week, weekend, whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.