PMOS — Polyendocrine Metabolic Ovarian Syndrome (formerly PCOS)
Polyendocrine Metabolic Ovarian Syndrome (PMOS) is the new name for polycystic ovary syndrome (PCOS), announced in May 2026 after a global consensus process published in The Lancet
Why the change: the old name suggested an ovarian cyst problem; the condition is really hormonal and metabolic, with no excess of abnormal ovarian cysts, and the narrow name contributed to missed diagnoses
About 1 in 8 women (over 170 million worldwide) are affected, and up to 70% are undiagnosed
Insulin resistance is present in up to 85%, including about 75% of women with a BMI of 25 or less
The diagnostic criteria have not changed; the name will be fully adopted in the 2028 international guideline update, after a three-year transition
First exclude other causes: pregnancy, thyroid disease, high prolactin, non-classic congenital adrenal hyperplasia, Cushing syndrome and androgen-secreting tumours (list from memory)
Hyperandrogenism: clinical (acne, excess hair growth, scalp hair loss) or biochemical (raised free testosterone or free androgen index)
Ultrasound: use a transvaginal scan when possible; the follicle and ovarian volume thresholds are from memory (at least 20 follicles in an ovary, or volume of 10 mL or more)
Adolescents: irregular cycles are normal in the first years after the first period; scans and AMH are poorly specific, so do not use them
Ask about: cycle pattern, hair growth and acne, weight change, fertility plans, mood and sleep, snoring, and family history of diabetes (from memory)
Examine: BMI and waist, blood pressure, hirsutism score (Ferriman-Gallwey), acne, scalp hair loss, and dark velvety skin (acanthosis nigricans) (from memory)
Ask permission before weighing, and avoid weight stigma
Blood tests: testosterone or free androgen index, plus tests to exclude other causes; 75 g oral glucose tolerance test, lipids
| Area | What to do | How often |
|---|---|---|
| Glucose | 75 g oral glucose tolerance test (the most accurate test) | At diagnosis, then every 1–3 years |
| Lipids and blood pressure | Lipid profile and blood pressure at diagnosis | Blood pressure every year |
| Sleep apnoea | Assess when symptoms are present, such as snoring and daytime sleepiness | When symptoms occur |
| Depression and anxiety | Screen every woman; offer psychological therapy such as CBT when needed; be aware of eating disorders and body image concerns | At diagnosis and as needed |
| Endometrium | Higher risk of hyperplasia and cancer (absolute risk is low); no routine screening; prevent with weight management, cycle regulation, and regular progestogen | Do not let her go months without a bleed |
Healthy eating and physical activity are central at every life stage; aim to prevent weight gain, and to lose weight when needed
No single diet or exercise plan has been shown to be better than another; choose one she can keep up
Even a modest weight loss can improve cycles, androgen levels and fertility (from memory)
Anti-obesity drugs or bariatric surgery may be considered by general population guidelines
Offer support, not blame
| Problem | First choice | Points to remember |
|---|---|---|
| Irregular periods and hyperandrogenism | Combined oral contraceptive pill; lower-dose preparations preferred | Also protects the endometrium; check the contraindications (last point from memory) |
| Metabolic features | Metformin | More effective than inositol; inositol has limited benefit |
| Unwanted hair | Cosmetic measures and laser; the combined pill | Antiandrogens only when other treatments fail or cannot be used; they need reliable contraception (last point from memory) |
| Needs a regular bleed but not the pill | Cyclical progestogen | Prevents endometrial overgrowth (from memory) |
| Line | Option |
|---|---|
| First | Letrozole for ovulation induction |
| Second | Clomiphene (alone or with metformin), gonadotrophins, or laparoscopic ovarian surgery |
| Third | IVF, possibly with in vitro maturation, when the other treatments have failed |
Before conception: optimise weight, glucose and blood pressure; offer an OGTT before pregnancy where possible
In pregnancy: PMOS raises the risk of gestational diabetes, hypertension and pre-eclampsia, miscarriage, preterm birth and caesarean birth; repeat the OGTT at 24–28 weeks
Metformin does not prevent gestational diabetes or pre-eclampsia; it may reduce preterm birth
Telling a woman she “does not have PCOS” because her ultrasound shows no cysts
Diagnosing it in a teenager by ultrasound or AMH
Treating only the periods or the hair and missing glucose, mood and sleep
Using a glucose-only fasting test when an OGTT would find the problem
Leaving a woman with months of amenorrhoea and no endometrial protection
Giving clomiphene first when letrozole is the first-line drug
Blaming her weight
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