August 27, 2026
11 min read
Key takeaways:
- The new name, PMOS, does not fully encapsulate the condition’s complexities, some experts say.
- Others said that, while not perfect, the new name is a huge step forward in education and clinical care.
Many experts agree that polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome, better reflects the hormonal and metabolic aspects of the condition.
But some argue that PMOS still falls short in becoming a comprehensive moniker for the complex syndrome.
Anuja Dokras, MD, MHCI, PhD, director of the Penn Polyendocrine Metabolic Syndrome Center and Founder’s Professor of Women’s Health at the University of Pennsylvania, was one of the senior authors of the initial paper that announced the name change in The Lancet. She told Healio that PCOS “was problematic” for two main reasons.
The first issue with the PCOS name was that “the ovarian findings are follicles, not pathologic cysts,” and, while ovarian cysts can be large and cause pain, “this does not occur with the small follicles.” Plus, the original name “framed the condition primarily as a reproductive or gynecologic disorder, even though my research and others have shown endocrine, metabolic, psychological and dermatologic manifestations” throughout a patient’s life.
“Clinically, the consequences of narrow framing were delayed or missed diagnosis, fragmented care, and an emphasis on menstrual cycles or fertility without adequate attention to long-term risks such as diabetes, cardiovascular disease and mental health conditions,” Dokras said. “My research has shown that women take from 6 months to 2 years to be diagnosed and typically see two to four providers before diagnosis is established.”
The debate
The old name “created uncertainty about whether care belonged solely in gynecology rather than being shared across primary care, endocrinology, adolescent medicine, cardiology, mental health and other specialties as needed,” Dokras said. But in the new name, “the word ‘ovarian’ appropriately reflects a central component of the condition, while ‘polyendocrine’ and ‘metabolic’ deliberately broaden the frame beyond gynecology.”
Andrea Dunaif, MD, the Lillian and Henry M. Stratton Professor of Molecular Medicine and chief of the Hilda and J. Lester Gabrilove division of endocrinology, diabetes and bone disease at the Icahn School of Medicine and the Mount Sinai Health System in New York, represented the Endocrine Society during the PCOS/PMOS renaming process. She told Healio that the need for a new name is not in dispute, but PMOS is not the right term.
“In 2012, the NIH Evidence-Based Methodology Workshop formally concluded that ‘PCOS’ was ‘a distraction and an impediment to progress’ and recommended renaming the disorder to reflect its endocrine and metabolic biology,” Dunaif, who is also an Healio | Endocrine Today co-editor, said. “A successful replacement should move the disorder’s conceptual center beyond the ovary. Retaining ‘ovarian’ leaves PCOS anchored to the gynecologic framework the renaming was intended to correct.”
Dokras said that when looking at “a complex condition such as PMOS, no name can capture every manifestation or determine exactly which specialist should manage each patient,” and the new name “should not be interpreted as assigning” one specialty ownership.
“Most patients can be managed through coordinated primary care and women’s health care, with referral to endocrinology, cardiology, dermatology, reproductive medicine, mental health or other specialists according to phenotype and risk. The goal is multidisciplinary accountability, not transferring the condition from one silo to another,” she said.
Addressing multidisciplinary care
The metabolic complications of PCOS/PMOS extend to other specialties, such as cardiology.
Dunaif said that OB/GYNs can screen for cardiometabolic risk, but the “specialists responsible for PCOS’s nonreproductive comorbidities often fail to diagnose the disorder or appreciate its implications for the conditions they manage.”
“PCOS has been recognized as a major metabolic disorder for decades. Our research in the 1980s and 1990s identified intrinsic insulin resistance and demonstrated a markedly increased risk for type 2 diabetes with substantially earlier onset. Metabolic syndrome and other cardiometabolic risk factors are also well established,” Dunaif said. “Yet the long-term cardiovascular consequences remain inadequately defined because few cohorts have followed women into the ages when events become prevalent.”
It is also important for gastroenterologists and psychiatrists to be aware of PCOS/PMOS, Dunaif said, because these patients see increased risks for liver issues, anxiety and depression.
In one study that she presented at ENDO 2022, Dunaif and colleagues analyzed a health insurance database to examine which specialists women with PCOS/PMOS see. They found that women with PCOS/PMOS were more likely to see providers across multiple medical and surgical fields, including cardiology, gastroenterology, neurology and pulmonology.
“We could not determine whether those clinicians recognized PCOS or whether individual visits were related to it. What is clear is that these physicians are already caring for affected women,” she said. “PCOS education therefore needs to extend beyond gynecology, endocrinology and dermatology to the broader medical workforce.”
As Healio previously reported, Dokras recently released a paper showing that PCOS/PMOS may be an independent predictor of atherosclerotic CVD (ASCVD) events, including coronary artery disease, cerebrovascular disease and peripheral artery disease. The study, published in The Lancet Obstetrics, Gynaecology, & Women’s Health, revealed that participants with PCOS/PMOS had a greater prevalence of comorbidities, including obesity, diabetes, hypertension, hyperlipidemia, obstructive sleep apnea, metabolic dysfunction-associated steatotic liver disease, infertility and depression. However, the association between PCOS/PMOS and ASCVD was only partially mediated by these comorbidities.
“This means CVD risk factors do not fully explain our findings,” Dokras said. “Hyperandrogenism, chronic low-grade inflammation, vascular dysfunction and adverse lipoprotein patterns observed in PMOS may also contribute to ASCVD risk.”
For OB/GYNs, Dokras said “the key is not to wait” for CVD symptoms.
“Starting with the first PMOS diagnosis visit, OB/GYNs should routinely assess blood pressure, smoking, physical activity, weight trajectory, family history of premature cardiovascular disease, glycemic status and lipids, while recognizing that PMOS itself may identify a group needing closer long-term cardiovascular attention,” she said. “Concerning findings include hypertension, diabetes or prediabetes, elevated LDL cholesterol or triglycerides, metabolic syndrome, tobacco use, strong family history, or multiple risk factors. Our study also suggests that screening and counseling should not be limited to patients with obesity or other obvious traditional risk factors.”
Harmony Reynolds, MD, an American Heart Association volunteer expert and director of the Sarah Ross Soter Center for Women’s Cardiovascular Research at NYU Langone Health, told Healio that “PMOS is one of the female-specific risk factors called out in the 2026 dyslipidemia guidelines as a reproductive marker that clinicians should take into account when considering who may benefit from LDL lowering medication.”
“In a patient at borderline risk otherwise, PMOS could tip the scale toward treatment,” she said. “Ideally, given how common PMOS is, affecting 8% to 12% of women, primary care providers will incorporate the diagnosis into preventive decision-making. Cardiologists should get involved when there are remaining questions on the part of the patient or the primary care provider about what preventive care would be helpful, and certainly when there are cardiac symptoms.”
Dokras agreed that “cardiovascular prevention can begin with OB/GYNs and primary care clinicians through systematic screening, counseling, treatment of modifiable risk factors and appropriate referral.”
“The larger message is that cardiovascular health should be part of standard PMOS care rather than addressed only after disease develops,” she said. “Preventive cardiology consultation is reasonable for patients with concerning symptoms, markedly abnormal risk factors, a strong family history of premature CVD, etc.”
Affecting men?
Dunaif said that another one of the major problems she sees in the new name is that “it is a genetic disorder, and it affects men.”
Therefore, retaining “ovarian” in the new name “confines the disorder to women despite more than 20 years of physiologic studies documenting reproductive and cardiometabolic phenotypes in male relatives of women with PCOS,” she said.
A 2022 study indicated that men can develop the characteristics of PCOS/PMOS. The study, which included genetic data from 176,360 men in the United Kingdom, revealed that men with genetic risk factors for PCOS/PMOS see increased risks for CVD, diabetes, obesity and male pattern baldness. Additionally, a 2020 review stated that “male equivalent PCOS may be considered a well-defined entity involving specific hormonal and metabolic patterns.” The review authors wrote that male equivalent PCOS “occurs in male members of a family with a PCOS history,” and is “characterized by the clinical signs of androgenism, complete hair loss, and the same hormonal pattern seen in PCOS, except for testosterone levels that seems to be in the subnormal range.” They added that “the metabolic pattern should be represented by hyperinsulinemia and insulin resistance with a side role for overweight and obesity in the case of occurrence,” and that “these patients have high risk [for] developing CVDs, metabolic syndrome and carotid atherosclerotic plaques.”
A 2018 systematic review and meta-analysis also revealed evidence of clustering for a variety of conditions —dyslipidemia, hypertension and metabolic syndrome — among the fathers and brothers of women with PCOS/PMOS as well as the mothers and sisters. Then, in 2026, researchers who conducted a genome-wide association study found that both men and women had polygenic risk scores associated with adverse cardiometabolic outcomes in PCOS/PMOS. They concluded that “PCOS susceptibility confers balanced pleiotropic influences on fertility in women, and life-long adverse metabolic consequences in both sexes.”
Dunaif said the “data are methodologically distinct and concordant,” so “a name intended to reflect PCOS biology should not be restricted to one sex when the underlying pathophysiology extends to men.”
“If we want this disorder, the gravity and the impact on health to be recognized, the fact that it affects both sexes and is a major metabolic condition is going to be much more persuasive than keeping ‘ovarian’ in the name, which will keep it in the gynecologic domain,” Dunaif said.
Dokras said that PCOS/PMOS “is not diagnosed in men” because it “is currently defined as a condition involving ovarian and menstrual dysfunction.”
“There is research suggesting that male relatives of women with PMOS may share some genetic, androgen-related or metabolic traits, and have a higher prevalence of cardiovascular risk factors, but that is not the same as evidence that men have PMOS as presently defined,” she said. “This is an important research area, but the evidence currently is not sufficient to redefine the clinical syndrome. Retaining ‘ovarian’ therefore reflects the current diagnostic construct and biology.”
Dunaif stressed that while no male case definition has been created, “the clinically relevant point is that male relatives of women with PCOS have increased cardiometabolic risk, and that risk should be recognized, just as a family history of type 2 diabetes is an established factor in clinical risk stratification.”
A work in progress
Dokras said the term PMOS “more accurately reflects the biology and clinical presentation” of the condition and is a step in the right direction.
“‘Polyendocrine’ recognizes that multiple hormonal pathways are involved; ‘metabolic’ brings insulin resistance and cardiometabolic risk into the core understanding of the condition; and ‘ovarian’ retains the important reproductive features and removes the misnomer ‘polycystic.’ The new name signals that this is a multisystem, not simply an ovarian or fertility disorder,” Dokras said.
However, she also said that “medical terminology should evolve when scientific understanding changes.”
“The old term has been around for about 90 years and was inaccurate. There has been significant progress in our understanding of PMOS over the past several decades, so waiting for a theoretically perfect name did not seem right,” Dokras said. “PMOS is a more accurate term based on the evidence available today. … Future refinement should remain a possibility if new biology, diagnostic markers, or outcome data justify it. That is a strength of evidence-based medicine, not a weakness.”
But Dunaif said there is no need to wait in order to understand that the condition “cannot be defined solely by ovarian dysfunction plus metabolic features.”
“We already have compelling evidence for an ovary-independent phenotype in men and for genetically distinct reproductive and metabolic subtypes of PCOS. Those findings fundamentally change the conceptual model of the disorder, yet they were not considered in developing or evaluating the new name,” she said.
And that omission, Dunaif said, exposed a fundamental issue with the renaming process: “scientific accuracy was presented as its first principle, but the process used to select the name did not systematically evaluate the genomic evidence most relevant to defining the disorder.”
“If the purpose of the name change was to move PCOS beyond a gynecologic frame, the process needed substantive participation from the specialties responsible for those nonreproductive manifestations,” she added. “Cardiology, diabetology, general internal medicine, psychiatry and related fields were not scientifically engaged.”
However, Dokras said the published report includes more than 14,000 survey responses from both patients with the condition and multidisciplinary healthcare professionals across the world regions.
“The process was intentionally global and multistep, engaging 56 professional medical organizations representing OB/GYN, endocrinology, pediatrics, nutrition, exercise physiology, dermatology, primary care, psychology and imaging as well as patient organizations and using iterative international surveys, modified Delphi methods, nominal-group workshops, and implementation analyses,” Dokras said, adding “the decision was not informal or made by a small, single-specialty group.”
“It was a structured consensus process grounded in current scientific understanding and extensive stakeholder input,” Dokras continued. “We acknowledge limitations, including lower participation from some geographic regions. No consensus process achieves perfect representation, and continued engagement, evaluation and transparent critique are essential during implementation.”
But Dunaif said the 14,000 survey responses reflect preferences rather than scientific validity, especially since the survey did not ask participants to “evaluate the genomic evidence, the male phenotype or evidence that PCOS comprises genetically distinct conditions.”
“The number of respondents is therefore irrelevant to whether the resulting name is scientifically accurate,” Dunaif said. “A survey cannot evaluate evidence that respondents were never given.”
Dunaif further noted that an extensive consensus process “is not the same as scientific review,” so the 56 organizations were essentially not as involved as they should have been.
“The scientific framework for the renaming came principally from the 2023 International Evidence-Based Guidelines. Those guidelines were developed to answer prioritized questions about clinical assessment and management. They were not designed to determine disease pathophysiology, classification, genetics or nomenclature. Critically, they did not consider genomic analyses, disease subtyping or the literature on male phenotypes,” she said. “The surveys cannot remedy that omission because the relevant science was not presented in them either.”
She highlighted an additional problem as well: the final name and the “scientific objections raised during the process” were not reviewed by independent experts in relevant fields.
“Review remained within the Steering Committee and the Androgen Excess-PCOS Society Board. The published paper subsequently described the genetic basis of PCOS as ‘evolving’ and the male phenotype as ‘potential.’ Neither characterization reflects the published evidence,” Dunaif said.
What’s in a name?
Ultimately, the debate behind the name reflects a larger issue for the condition: it is under-researched and experts cannot improve care in a vacuum.
Dunaif said “the disorder needs to be rethought, not simply renamed.”
According to Dokras, “the name change is a starting point, not the solution by itself.”
“We need earlier diagnosis, better education across primary care and multiple specialties, consistent use of evidence-based guidelines and care that addresses reproductive, metabolic, cardiovascular and psychological health across the lifespan,” Dokras said. “We also need greater research investment, better representation of diverse populations, long-term outcome studies and integrated multidisciplinary care pathways that make recommended screening and follow-up easier to deliver. Importantly, patients should receive counseling that extends beyond fertility and pregnancy.”
Dokras also mentioned the broader response to the name, especially from patients. She said it has been “overwhelmingly positive,” particularly on social media.
In a sentiment analysis of more than 75 million posts — “the largest quantitative window into how people most affected by this condition received the change” — Dokras and colleagues found that roughly 80% of sentiment online was positive, explanatory or factual.
“The rapid and largely positive uptake by patients appeared to reflect validation and the response appeared almost cathartic,” Dokras and colleagues wrote. “When the new name arrived, most women did not need to be convinced. They had already intuited, through years of navigating a medical system that had partly failed them, that the old name had never quite captured their experience.”
This is more than “simple approval of a rebranding,” the researchers wrote. Instead, this “reflects the experience of starting to be finally acknowledged.”
“There is something the clinical and scientific community should sit with in that finding,” they wrote.
*Editor’s note: This is the second part of a two-part Healio Exclusive series on the PCOS name change. Part one can be seen here.
For more information:
Anuja Dokras, MD, MHCI, PhD, can be reached at adokras@pennmedicine.upenn.edu. Andrea Dunaif, MD, and Harmony Reynolds, MD, can be reached at primarycare@healio.com.
Sources/Disclosures
Source:
Healio Interviews
References:
Disclosures:
Dokras reports being a consultant for Eli Lilly, Mayhealth. NovoNordisk and Pfizer. Dunaif and Reynolds report no relevant financial disclosures.
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