Polyendocrine Metabolic Ovarian Syndrome: beyond the myth, towards better care

In May 2026, one of the most common yet misunderstood condition affecting women, underwent a landmark change in terminology. Polycystic ovary syndrome (PCOS) was formally renamed polyendocrine metabolic ovarian syndrome (PMOS), reflecting a growing recognition that the condition extends far beyond the ovaries alone.

PMOS is the most common endocrine condition in women of reproductive age, affecting about one in eight Australian women. Despite its high prevalence, diagnosis and management remain inconsistent, often leaving women with years of uncertainty regarding symptoms, fertility, and long-term health implications..

PMOS is not simply an ovarian disorder, but a broader endocrine condition that affects reproductive, metabolic and psychological health across the lifespan. Women with PMOS can experience irregular periods, clinical hyperandrogenism, difficulties conceiving, increased risk of endometrial hyperplasia and metabolic complications including insulin resistance, higher risk of type 2 diabetes and cardiovascular disease. The psychological impact is significant too, with higher rates of anxiety, depression, and body image concerns.

Diagnosis is frequently delayed. Many women first present when trying to conceive, but by then symptoms have often affected their health and wellbeing for a long time. Variable understanding of the condition and inconsistent communication regarding its significance can contribute to confusion and fragmented care. Greater consistency in diagnosis and patient education could improve long-term outcomes.

PMOS care and challenges

Optimal management requires tertiary-level multidisciplinary services, a coordinated approach for patient care, as well as the opportunity for research and health care professional education. The coordination of care also involves engagement of primary care health professionals, hence communication between all service providers, including care plans, is of paramount importance.

This service integrates endocrinology, gynaecology, dietetics, exercise physiology, dermatology, psychology, and fertility expertise. Importantly, interventions should be delivered in a supportive and non-stigmatising manner, with emphasis on sustainable health outcomes. 

Diagnosis has been refined in the International Evidence-based Guideline for the assessment and management of polycystic ovary syndrome 2023. In adults, PMOS is diagnosed when two of three features are present: 

1. ovulatory dysfunction
2. clinical or biochemical hyperandrogenism 
3. polycystic ovarian morphology on ultrasound (≥20 follicles per ovary or ovarian volume ≥10 mL) or elevated anti-Müllerian hormone (AMH). 

If both irregular cycles and hyperandrogenism are present, ultrasound or AMH testing is not required. In adolescents, both hyperandrogenism and ovulatory dysfunction are required, and ultrasound/AMH are not recommended due to poor specificity. 

Diagnostic challenges remain important. Women with hypothalamic–pituitary–ovarian signalling disorders associated with hypogonadotrophic hypogonadism may demonstrate polycystic ovarian morphology despite having a fundamentally different underlying disorder. Other causes of hyperandrogenism such as congenital adrenal hyperplasia, Cushing’s syndrome, ovarian hyperthecosis and severe insulin resistance need to be considered. In adolescents particularly, caution is required to avoid overdiagnosis during a stage when irregular menstrual cycles are relatively common.

Why the name change matters

The term “polycystic ovary syndrome” no longer reflects contemporary understanding of the condition and has contributed to significant misunderstanding among patients and clinicians alike. Despite its name, the syndrome is neither defined by ovarian cysts nor confined to the ovaries.

Recognition that the terminology was scientifically inaccurate and often misleading prompted an international renaming initiative involving clinicians, researchers and patient advocacy groups. In May 2026, a global consensus process published in The Lancet, proposed the term “polyendocrine metabolic ovarian syndrome” (PMOS), reflecting the broader hormonal and metabolic nature of the disorder. While terminology alone will not resolve the challenges women face, clearer language may improve understanding, reduce stigma, and support more holistic models of care.

Implications and next steps

PMOS is common, complex, and lifelong. The updated 2023 international guideline provides an opportunity to strengthen care in Australia by aligning clinical practice with best available evidence. Several areas stand out:

Diagnosis: Clearer criteria reduce reliance on ultrasound, particularly in adolescents, and provide options such as anti-Müllerian hormone (AMH) for adults. Embedding these updates into daily practice will improve consistency and reduce uncertainty for both clinicians and patients.

Education: Ongoing professional development can help clinicians feel more confident discussing the full spectrum of PMOS — not just reproductive issues but also metabolic health, psychological wellbeing, and endometrial protection. 

Models of care: Multidisciplinary approaches highlight the benefits of coordinated services. Broader access to similar models could allow more women to benefit from integrated care, whether in metropolitan or regional settings.

Mental health: Routine screening for depression and anxiety, and referral where needed are recommended. Incorporating this into standard practice would acknowledge the psychological impact of PMOS and ensure women receive timely support.

PMOS is highly prevalent and carries significant long-term health implications. Continued investment in research, service development, and education will help improve outcomes across the lifespan. With greater awareness, earlier recognition, and a focus on holistic management, Australian clinicians are well placed to lead improvements in care.

This article was update on 15 May 2026.

Associate Professor Catharyn Stern is a fertility specialist, gynaecologist and reproductive endocrinologist. She is Head of Reproductive Services at The Royal Women's Hospital, a senior clinician at Melbourne IVF and Head of Fertility Preservation for both institutions. She is affiliated with the University of Melbourne Department of Obstetrics and Gynaecology (RWH).

Dr Michal Kirshenbaum is a fertility specialist,  gynaecologist and reproductive endocrinologist. She works as a fertility specialist at Melbourne IVF and at the reproductive services at the Royal Women’s Hospital. She is affiliated with the University of Melbourne and her clinical and research interests include fertility preservation and optimisation of ovarian stimulation protocols.