FROM PCOS TO PMOS:

what you need to know

FROM PCOS TO PMOS: what you need to know

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

12 May 2026 saw a historic shift in women’s health. One of the most common hormonal conditions affecting women worldwide, Polycystic Ovary Syndrome (PCOS), was officially renamed as Polyendocrine Metabolic Ovarian Syndrome (PMOS).

PMOS is a complex, chronic condition that affects approximately one in eight women (over 170 million people) globally. It is characterised by hormonal imbalances involving insulin, androgens (male hormones such as testosterone), and neuroendocrine hormones. It can have a devastating effect on multiple body systems:

Reproductive health (irregular or absent periods, difficulty conceiving)
Metabolic health (insulin resistance, increased risk of type 2 diabetes)
Cardiovascular health (elevated risk of heart disease)
Mental health (higher rates of depression and anxiety)
Skin and hair (acne, excess body hair, hair thinning)

Despite how widespread it is, the World Health Organisation estimates that 70% of those affected globally have never received a diagnosis. This is largely due to the old name.

The name change signals that the medical community is finally seeing the full picture of what women with this condition have been experiencing. The fatigue, the weight fluctuations, the irregular menstrual cycles, the skin changes, and the mental health struggles will no longer be seen as separate, unrelated complaints. They are part of a recognised, complex, whole-body condition that deserves comprehensive, coordinated care.

Don’t be afraid to advocate for yourself. Ask your doctor about metabolic screening. Ask about a holistic treatment plan. The condition cannot be prevented nor cured, but it can be managed. Early diagnosis and treatment are important in preventing long-term complications like infertility, obesity, diabetes, and heart disease.

WHY WAS THE OLD NAME CHANGED?

Not only did the old name misrepresent the condition; it also caused harm:

INACCURACY

The term “polycystic ovary syndrome” was never truly accurate. It implied the defining feature of the condition was pathological cysts on the ovaries, but that was never really the case. What ultrasound scans actually reveal are small antral follicles: immature follicles that have not developed properly. These are not cysts in any clinical sense.

The old name also narrowed the entire condition down to the ovaries and to reproduction, ignoring its broad metabolic and hormonal reach. This had real, tangible consequences for patients. The inaccurate name obscured the diverse endocrine and metabolic features, thereby contributing to delayed diagnosis, fragmented care, and stigma, while curtailing research and policy framing.
STIGMA

Women were frequently dismissed or misunderstood. Some were told their symptoms were purely a “fertility problem.” Others cycled through doctors for years before receiving any clear diagnosis. Many were simply sent away with a prescription for the oral contraceptive pill, which masks symptoms but does not address the underlying metabolic and hormonal drivers.

HOW WAS THE NEW NAME CHOSEN?

The renaming process took more than a decade and was rigorous, global, and deeply inclusive, arguably for the first time in medical history. South Africa played a direct role in the international committee that facilitated this name change, with local fertility experts (such as Dr. Jack Biko of SASREG, the South African Society of Reproductive Medicine and Gynaecological Endoscopy) ensuring African voices were represented in the global consensus.

The final choice, PMOS, was popular for its scientific accuracy, clarity, stigma avoidance, cultural appropriateness, and implementation feasibility:

Polyendocrine: recognises that multiple interacting hormonal systems are involved, including insulin, androgens, and neuroendocrine hormones
Metabolic: acknowledges the condition’s strong links to insulin resistance, weight, cardiovascular health, and metabolic dysfunction
Ovarian: retains a reference to the female reproductive system, specifically the hormonal changes and follicle responses in the ovary
Syndrome: correctly reflects that this is a collection of features, not a single-cause disease

WHAT THIS CHANGE MEANS FOR WOMEN

EARLIER AND MORE ACCURATE DIAGNOSIS

Because the new name correctly frames PMOS as a complex endocrine-metabolic disorder and not merely a gynaecological one, clinicians are expected to cast a wider diagnostic net. Symptoms such as insulin resistance, metabolic irregularities, and cardiovascular risk factors will be treated as core diagnostic features, not secondary concerns.

This shift should help the many women who currently slip through the cracks, like those who do not present with the “classic” signs of irregular periods or excess body hair, but do have significant metabolic dysfunction.
HOLISTIC TREATMENT; NOT JUST THE PILL
This is one of the most significant changes expected in treatment approach. Rather than simply prescribing oral contraceptives, clinicians are now guided to treat PMOS as the whole-body hormonal and metabolic condition it is.

This means:

Routine metabolic screening from the point of diagnosis, including tests for insulin resistance, blood sugar levels, and cardiovascular risk; even in adolescents

Lifestyle interventions (diet, exercise, weight management) positioned as foundational to care

Growing interest in metabolic therapies, including GLP-1 receptor agonists, a class of medication also used in the management of type 2 diabetes, for appropriate patients

Tailored treatment based on a patient’s predominant profile: whether their condition is primarily metabolic, androgen-driven (acne, hirsutism, hair loss), or reproductive in nature
REDUCED STIGMA AND BETTER PATIENT UNDERSTANDING

The word “cysts” triggered enormous anxiety and misunderstanding, with women fearing they had diseased or damaged ovaries. The new name removes that false framing. Understanding that PMOS is a hormonal and metabolic condition may help patients engage more meaningfully with their care, reducing shame and improving long-term adherence to treatment.
WHAT HAPPENS IF YOU HAVE AN EXISTING DIAGNOSIS?
If you have already been diagnosed with PCOS, you do not need to be retested. Existing diagnoses will transition to PMOS within electronic health records during the 2026–2028 transition period. Your medical history remains intact.

The three-year transition period will be used to:

Update clinical guidelines, including the International Guideline currently used across 195 countries, which will be fully revised under PMOS terminology by 2028

Incorporate PMOS into electronic health records and disease classification systems (including formal engagement with the WHO to update ICD codes)

Educate universities, textbook publishers, journal editors, and healthcare providers

Engage governments and research funders to align research classification and policy

Launch multilingual patient education materials to support patients globally

During the transition, it will be normal to see PCOS and PMOS used side by side. Some clinics and labs will update quickly; others will take longer.

PMOS IN SOUTH AFRICA

PMOS is believed to affect around 2.5 million South African women and account for up to 40% of all female infertility cases here. These numbers may be vastly underestimated, however, as up to 70% of cases remain undiagnosed due to gaps in awareness, recognition, and care. South Africa’s extremely high obesity rate is a significant contributor to our high rate of PMOS, as 68% of South African women are either overweight or obese. Excess weight has been shown to play a part in the development of PMOS.

SYMPTOMS OF PMOS

Symptoms can differ between different people, and can even change of time:

Excess hair growth (hirsutism): Unwanted hair growth on the face, chin, chest, back, or abdomen.
Skin issues: Oily skin and severe, persistent acne.
Hair loss: Male-pattern baldness, scalp hair thinning, or hair recession at the temples
Weight changes: Difficulty losing weight, weight gain, or rapid weight accumulation, particularly around the abdomen.
Insulin resistance: High blood sugar levels or a higher risk of developing Type 2 diabetes.
Skin discoloration: Patches of dark, thickened, velvety skin (acanthosis nigricans), often in the underarms or on the back of the neck.
Fatigue: Persistent tiredness or lack of energy.
Mental health problems: Mood swings, anxiety, depression, and sleep disturbances (like sleep apnoea).

CAUSES OF PMOS

The exact cause of PMOS is unknown, but it is driven by a combination of genetics, hormonal imbalances, and metabolic issues.

The primary contributing factors include:

Insulin resistance: Up to 70% of women with PMOS have bodies that do not respond effectively to insulin. To compensate, the body produces excess insulin, which stimulates the ovaries to produce high levels of androgens (male hormones).
Elevated androgens: High levels of male hormones (like testosterone) prevent the ovaries from releasing eggs regularly (ovulation), leading to irregular periods, acne, and excess body hair.
Genetics: PMOS runs in families. If a close relative has the condition or type 2 diabetes, your risk significantly increases.
Chronic low-grade inflammation: Many people with PMOS experience chronic inflammation that stimulates the ovaries to produce more androgens.
Obesity and lifestyle: Being overweight or obese exacerbates insulin resistance and hormonal imbalances. However, lean individuals can also develop PMOS due to genetic and endocrine factors.

EFFECTS OF PMOS

The primary effects of PMOS are experienced across four key areas:

1. ENDOCRINE AND REPRODUCTIVE EFFECTS
Irregular periods: Anovulation (infrequent or no ovulation) leads to missed, irregular, or excessively heavy periods.

Infertility: Because eggs are not released regularly, it is a leading cause of female infertility.

Elevated androgens: High levels of male hormones (like testosterone) cause hormonal imbalances.
2. METABOLIC EFFECTS
Insulin resistance: Roughly 50% to 70% of women with PMOS experience insulin resistance, causing elevated blood sugar and chronic inflammation.

Long-term risks: It increases the risk of type 2 diabetes, high blood pressure, fatty liver disease, and cardiovascular disease.
3. PHYSICAL EFFECTS
Skin & hair: Elevated androgens often cause adult acne, excess body and facial hair (hirsutism), and male-pattern hair thinning on the scalp.

Weight changes: Weight management challenges are common, with up to 80% of affected women being overweight or obese.
4. PSYCHOLOGICAL EFFECTS
Mental health: The hormonal shifts make individuals three times more likely to experience depression and up to five times more likely to experience anxiety.

Quality of life: Visible physical symptoms can significantly impact self-esteem and overall well-being.

MANAGING PMOS

There is no cure for PMOS, and management requires a whole-body approach focusing on root metabolic and hormonal drivers. Treatment combines foundational lifestyle changes, targeted medications, and mental health support, as well as regular long-term monitoring by a healthcare provider.

PMOS is a lifelong condition, and effectively managing it relies on a personalised approach tailored to your specific symptoms and goals (e.g. fertility, metabolic health, or skin concerns). These include:

FOUNDATIONAL LIFESTYLE CHANGES
The cornerstone of PMOS management is addressing underlying insulin resistance and chronic inflammation.

Blood-sugar-balancing diet: Prioritise high-fibre vegetables, lean proteins, healthy fats, and low-glycaemic carbohydrates over refined sugars and ultra-processed foods. Eating meals at regular intervals helps stabilise blood sugar and reduce energy crashes.

Strategic exercise: Combine moderate cardio (like walking or cycling) with strength training. Building muscle mass directly improves your body’s insulin sensitivity.

Sleep & stress management: Prioritise 7 to 9 hours of quality sleep to help regulate cortisol and insulin levels. Stress management (such as yoga, meditation, or therapy) is crucial as high stress physically exacerbates hormonal symptoms.
TARGETED MEDICAL TREATMENTS
Lifestyle changes are often paired with medications to alleviate specific physical and hormonal symptoms.

Hormonal birth control: Commonly prescribed to regulate menstrual cycles, clear up acne, and reduce excess androgen levels.

Insulin-sensitising medication: Drugs like Metformin are used to directly lower blood sugar and improve metabolic function. In certain cases, GLP-1 receptor agonists are utilised to help with metabolic health and weight management.

Anti-androgens: Medications that block male hormones are sometimes introduced to reduce unwanted facial/body hair and hair thinning.
SUPPLEMENTS AND FERTILITY SUPPORT
Targeted supplements: Many experts and guidelines recommend discussing supplements which improve insulin resistance and menstrual regularity with your doctor.

Ovulation induction: If your primary goal is pregnancy, fertility-focused therapies are used to encourage spontaneous ovulation.
PSYCHOLOGICAL AND EMOTIONAL WELLBEING
PMOS deeply affects mental health due to challenging physical symptoms and chronic hormonal shifts, leading to higher risks of anxiety and depression.

Specialised care: Cognitive Behavioral Therapy (CBT) or participating in support groups that specialise in PMOS/PCOS are recommended. Recognising that the condition has a genetic and metabolic origin can also remove self-blame.
ONGOING MONITORING

DIAGNOSING PMOS

Diagnosis focuses on ovarian, hormonal, and metabolic health. Providers follow internationally recognised guidelines, which require that a patient must meet at least two out of the following three criteria, provided other similar conditions are ruled out:

1. OVULATION DYSFUNCTION
2. HYPERANDROGENISM
3. OVARIAN CHANGES

Patients are evaluated using blood tests, metabolic assessments, and pelvic ultrasounds.

If you suspect you may have PMOS, it is important to consult your healthcare professional as soon as possible so you can begin treatment to manage your symptoms. Because PMOS is a whole-body endocrine condition, early diagnosis and monitoring are vital for preventing long-term metabolic or cardiovascular complications. You can consult a gynaecologist, a reproductive endocrinologist, or a specialised endocrinologist.