PCOS often isn’t about ovaries and cysts – and its new name better reflects what women go through

Many women with polycystic ovary syndrome don’t have ovarian cysts, despite what its name suggests. Now renamed polyendocrine metabolic ovarian syndrome (PMOS), the condition is increasingly understood as a hormonal and metabolic disorder. Experts told CNA Women what the change means for diagnosis, treatment and long-term health.

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The condition known as polycystic ovary syndrome (PCOS) is now called polyendocrine metabolic ovarian syndrome (PMOS). The name change was announced on May 12, 2026, at the European Congress of Endocrinology in Prague and published in the medical journal, The Lancet.

Dr Veronique Viardot-Foucault, director of clinical endocrinology at the Department of Reproductive Medicine at KK Women’s and Children’s Hospital, said the idea of renaming PCOS was first raised in 1995 and revisited in 2012. Both times, it did not succeed due to a lack of global leadership, agreement on an alternative name, patient alignment and engagement.

The name change was the result of 14 years of collaboration between international societies and patient groups across six continents.

Dr Viardot-Foucault said the successful outcome was largely driven by patients, who often describe the former name – PCOS – as confusing, misleading and overly focused on fertility.

For example, a patient might seek help for increased hair on certain parts of their body or have irregular periods, and be diagnosed with PCOS. The term suggests polycystic ovaries, which may not match their experience.

The condition may also be managed with a fertility lens even though having children may not be the patient’s concern when they’re diagnosed.

“Medically, PMOS is now understood as a complex, lifelong condition influenced by genetic, developmental, metabolic and environmental factors,” said Dr Viardot-Foucault.

“It affects multiple hormone systems, including reproductive hormones, insulin regulation and brain-hormone signalling, with wide-ranging effects on metabolism, skin, mental health and overall well-being.”

A MULTIDISCIPLINARY APPROACH TO PMOS

There is no change in the diagnosis criteria and treatment of PMOS. However, its new name puts the spotlight on the metabolic and endocrine nature of the condition.

Dr Clara Ong, obstetrician and gynaecologist at Parkway MediCentre, said the term ‘polyendocrine’ acknowledges that the condition isn’t just an issue with the hormones produced in the ovaries – mainly oestrogen and progesterone – but involves other hormones throughout the body. And ‘metabolic’ explicitly shows that insulin resistance, risk of diabetes, cholesterol issues and cardiovascular health are core features of the condition.

The condition was also often grouped under fertility rather than as a chronic metabolic disease, said Dr Viardot-Foucault. Moving the name away from gynaecological connotations places greater emphasis on the type of care women should receive.

A coordinated, multidisciplinary approach is critical, involving primary care practitioners, endocrinologists, gynaecologists, dermatologists, dietitians and mental health professionals, she added.

“The role of gynaecologists is still relevant as women with irregular periods, fertility concerns, pelvic symptoms or suspected PMOS should still see a gynaecologist, or start with their primary care doctor,” said Dr Viardot-Foucault. “Metabolic issues like insulin resistance are often managed jointly with primary care, endocrinology and dietitians.”

Dr Tng Eng Loon, senior consultant endocrinologist at Nobel Diabetes, Thyroid and Endocrine Centre, said the hope is that the name change will cause health professionals to pay attention to the hormonal and metabolic issues in PMOS and not solely manage the gynaecological aspects.

He added that the name change also removes the stigma of sub-fertility associated with the term PCOS. In some cultures, women with the condition carried a psychological burden from their perceived failure to meet fertility expectations, as well as deal with non-feminine features like male-pattern hair growth, a PMOS symptom.

HOW IS PMOS DIAGNOSED?

As PMOS can mimic other medical conditions such as thyroid dysfunction and pituitary disorders, the first step is to order blood tests to rule these out, said Dr Viardot-Foucault, director of clinical endocrinology at the Department of Reproductive Medicine at KK Women’s and Children’s Hospital.

Next is to confirm the PMOS diagnosis via blood tests for testosterone and anti-mullerian hormone (AMH). A pelvic ultrasound may also be done.

More blood tests are then ordered, such as screening for possible complications or associations like insulin resistance.

A woman will be diagnosed with PMOS if she has at least two of the three main findings:

• Irregular, infrequent menstrual periods or no periods at all.
• Increase in facial or body hair and/or blood tests showing high testosterone levels.
• An ultrasound scan showing multiple small cysts in at least one ovary or a blood test showing elevated AMH levels. The latter is a marker of ovarian reserve, or the number of eggs remaining in a woman’s ovaries; an unusually high result may suggest PCOS, according to the Thomson Medical website.

THE ROLE OF INSULIN IN PMOS

Dr Ong said that up to 70 per cent of women with PMOS are insulin resistant. This often leads to higher insulin levels in the body and makes it harder to maintain normal blood glucose levels. Therefore, PMOS patients have an increased risk of developing diabetes.

Additionally, excess insulin damages blood vessels and causes chronic inflammation.

“Excess insulin may also cause some women with PMOS to be overweight or obese, particularly in the belly,” Dr Ong added. “This abdominal fat, known as visceral fat, can cause higher ‘bad’ cholesterol and decrease ‘good’ cholesterol. All these factors lead to an increased risk of high blood pressure and heart disease."

Dr Viardot-Foucault stressed that women with PMOS who aren’t overweight should be screened as well, as around 20 to 30 per cent of lean women with the condition also have insulin resistance.

Women with PMOS also have a higher risk of developing metabolic complications, such as gestational diabetes and preeclampsia, during pregnancy and would need close monitoring, she added.

“If a pregnant woman develops high blood pressure or diabetes, her baby is more likely to have growth problems, be born early, have an unusually high or low birth weight, or experience low blood sugar after delivery,” Dr Viardot-Foucault added.

WRONGLY FOCUSED ON CYSTS AND OVARIES

Parkway MediCentre’s Dr Ong said the name PCOS reflected only one organ and failed to capture the disorder’s multi-system nature – women with the condition don’t always have ovarian cysts.

“For too long, the name PCOS reduced a complex, long-term hormonal or endocrine disorder to a misunderstanding about cysts and a focus on ovaries,” said Dr Ong. “This contributed to missed diagnoses and inadequate treatment.”

She added: “What we now know is that there is no increase in abnormal cysts on the ovary and the diverse features of the condition were often unappreciated.”

Dr Tng revealed that an international survey in 2015 found it took more than two years to diagnose PCOS in 33.6 per cent of women with the condition. Also, 47.1 per cent of women with PCOS had seen at least three health professionals before the diagnosis was made.

He said one of the reasons for the delay in diagnosis is because the term PCOS misled health professionals into thinking that women with the condition only present with symptoms relating to abnormal periods or fertility issues.

Therefore, the subset of women with PMOS who present with hormonal, metabolic, dermatological and psychological issues may be misdiagnosed as having other medical problems.

Dr Tng added that one fundamental symptom of PMOS is male-pattern hair growth, when there is excessive hair growth on the chin, chest, upper thighs, back or sideburns. This indicates excessive androgen hormone levels.

Other symptoms include severe acne, weight gain or failure to lose weight, a constant sensation of hunger, depression and anxiety.

There has also been confusion on how to diagnose the condition as different diagnostic criteria have been proposed over the years, said Dr Tng. He cited a survey on Singaporean health professionals conducted in 2022, which showed that 60.5 per cent of clinicians were unable to identify the clinical features of PMOS correctly.

Parkway MediCentre’s Dr Ong said the name change empowers doctors to treat patients’ hormones, metabolism and overall well-being as one single, interconnected system. And this potentially may lead to fewer missed diagnoses and reinforce the need for long-term care.

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