Why Renaming PCOS to PMOS Could Reshape Women’s Health Care and Research

In a recent interview with Nutritional Outlook, board-certified OB/GYN Sameena Rahman, MD, who is also the founder of the GYN & Sexual Medicine Collective, discussed the growing movement to rename polycystic ovary syndrome (PCOS) as polyendocrine metabolic ovarian syndrome (PMOS), arguing that the updated terminology more accurately reflects the condition’s systemic nature and long-term metabolic implications.

Rahman explained that PCOS has historically been misunderstood as primarily a reproductive or ovarian disorder, despite its established associations with insulin resistance, inflammation, dyslipidemia, cardiovascular disease risk, and altered glucose metabolism. Under the current diagnostic framework, patients are typically diagnosed based on two of three criteria: elevated androgen levels or symptoms of hyperandrogenism, irregular or absent ovulation, and polycystic-appearing ovaries. However, Rahman emphasized that many patients with the condition do not actually present with ovarian cysts, contributing to confusion and delayed diagnosis.

According to Rahman, the inclusion of “metabolic” in the updated terminology is intended to shift both clinical perception and research priorities. She noted that insulin resistance can stimulate excess androgen production in the ovaries, contributing to hormonal imbalance, chronic low-grade inflammation, and visceral fat accumulation, all of which can reinforce cardiometabolic dysfunction over time.

The interview also explored how the name change could encourage earlier intervention and broader multidisciplinary involvement beyond obstetrics and gynecology. Rahman argued that primary care physicians, cardiologists, endocrinologists, pediatricians, and family medicine providers should all play a role in identifying and managing the condition, particularly given the elevated risks for diabetes, endometrial cancer, gestational complications, and cardiovascular disease.

Rahman additionally highlighted the global prevalence of the condition, with certain populations experiencing disproportionately higher rates due to underlying metabolic risk factors. She described the terminology update as both a scientific and equity-driven shift intended to reduce stigma, improve screening practices, and expand awareness that PMOS extends far beyond fertility concerns alone.

A transcript of Rahman’s conversation can be found below.

Sebastian Krawiec: To start, why don't you just briefly describe what PCOS is, and then we’ll get into why "metabolic" is now being prioritized in the new name for the condition.

Rahman: PCOS, Polycystic Ovarian Syndrome as it has historically been referred to, is really a systemic, a constellation of symptoms, that are reflective of what's happening in multiple systems in your body. So essentially it is an inflammatory condition that you live with for a lifetime. We don't have a cure for this syndrome at this time, but it is a cardiometabolic syndrome that has a like an endocrine component to it. And we diagnose it based on the fact that you should have 2 out of 3 in a category of symptoms. Usually it's something related to increased androgens, so it's either blood levels that look elevated, testosterone, or DHEA that looks elevated on blood work, or clinical symptoms of high testosterone, which can be anywhere from facial hair to hair loss, to also acne and other concerns.

That’s the androgen component. The other component really has to do with your menstrual cycle and what's happening to your menstrual cycle. A lot of people have what we call anovulatory cycles, or cycles where they're not ovulating every month. They skip cycles, their cycles become longer in length. That's the second component. You could have something happening irregularly with your menstruation.

The third way to diagnose it, or the third component that could be seen in diagnosis is ovaries that have a polycystic appearance. Multiple functional cysts that are arrested in development that look like a chain of cystic appearance of the ovaries or an elevated anti-mullerian hormone, which also is indicative of what's happening in your ovaries. Historically, you would have needed two out of three of those to make the diagnosis of PCOS, and then we would treat based on the predominant symptoms. But we know that it can impact cardiovascular health. It can cause prediabetes and diabetes in some. And we know it can also lead to a lot of other concerns, Dyslipidemia and other things. That's why, you know, as we're coming to it, the change of the name is so critical because it's not limited to what's happening in the ovaries.

Krawiec: So why don't you kind of elaborate more on that. The metabolic angle of the disease.

Rahman: I think for those of us that have been treating this condition, have advocated for a change in name, because it really is a misnomer to think that this is all about, you know, the ovaries having a polycystic appearance. But when we prioritize metabolic in the name and remember, the way we name things and conditions in medicine drives what happens to those patients and outcomes. It drives research, it drives, who takes care of that patient and in which silo in medicine is responsible for that disease. Really changing it to metabolic, understanding that this is a multi-system disease—it shifts our understanding in not only the condition, but how we treat it and who should treat it. For years, people focused so much on the ovaries and the cysts when many people don't have cystic ovaries.

Remember, you only need 2 out of 3 of those to meet the diagnosis. The diagnostic criteria has not changed. Many patients didn't have cysts and weren't told were told they didn't have PCOS when they did. It is a heterogeneous syndrome, like not every PCOS patient looks the same. I think it's really important to understand that it's a systemic endocrine and metabolic disorder that affects more than just your reproductive potential. We know fertility is a big part of it, but it also affects more than what's happening with your menses. It's really critical because at the end of the day, patients can have insulin resistance. They can have, inflammation and altered glucose metabolism that can lead to all these cardiologic issues.

Essentially, heart disease is still the number one killer in women. We have to think about these things early. If we diagnose these things early and we think about it differently, we can save so many more people and so many more lives, and improve the quality of so many people's lives. With that metabolic component, it was really important to say that this is a condition everyone should be. Everyone that treats women should be comfortable treating. This is a condition that is just not limited to your ovaries.

Krawiec: I wonder if we can dig into that a little bit more in terms of like how insulin resistance, inflammation and hormone imbalance kind of, kind of coalesce and drive PMOS.

Rahman: I think it's important when your body becomes sort of less responsive to insulin and it churns out more insulin—your pancreas does—to compensate. As a result, these elevated insulin levels will then stimulate your ovaries to do more. Your ovaries are responsible for 50% of your androgen productions, which are your DHEA and testosterone and also your regulation of ovulation. If the signals get crossed because of insulin resistance playing a role in PMOS, then your ovaries are now churning out more androgens, which leads to some of the symptoms that we talked about, high testosterone. But then as a result, you get this chronic low-grade sort of inflammation that will continue to sort of amplify what's happening hormonally and from a metabolic perspective. At the end of the day, you get a disruption in the signals that feed each other over time.

The inflammation is feeding the metabolic dysfunction. You get the visceral fat accumulation, that midsection fat that again, also contributes to so much of the inflammation. It becomes a cycle of feeding each other to the point that we just know that there's an interconnection and ovarian tissue. We know there's an interconnection of what's happening with our ovaries and our metabolic function. The condition just continues to get worse unless you're actually treating some of the issues around the metabolic concerns. We're trying to treat your insulin resistance. We're trying to treat Dyslipidemia and all the other things that can lead to worsening cardiovascular disease, as well as improving your reproductive health. They're just intricately related.

Krawiec: You mentioned the diagnostic criteria didn't really change. It's just the name. So, what is it about kind of the updated terminology that you think will help maybe reduce stigma, improve care, and encourage earlier intervention?

Rahman: That’s a big question and a big hope for us that if we change the name, the stigmatization around PCOS is reduced. Again, looking at this as a purely ovarian pathology that is just affecting your ability to get pregnant, “oh, you're just somebody that doesn't menstruate regularly.” We know that people, when they have irregular cycles and anovulatory cycles, and specifically patients that have PMOS, are at even higher risk of endometrial cancer. This is when we see endometrial cancer in younger patients because of this unopposed picture of estrogen creating an imbalance in the endometrium, the lining of the uterus.

Instead of looking at this as somebody that has ovarian cyst, yyou get frightened about the fact that something's happening with your reproductive health, not understanding that this is a whole system issue. Now that we've changed the name, this no longer becomes just an OB/GYN problem. A lot of patients would tell me they saw their primary care for this years ago or maybe the pediatrician, years ahead could have picked up on it because it is a cardiometabolic issue. It's a systemic issue. If we're treating all symptoms, we should pay attention to it, versus it getting siloed and being dismissed because we know women's health conditions and OB/GYN conditions historically get dismissed more. That if we're just dismissing this to the OB/GYNs to treat it, we're missing opportunities of early intervention.

We now know that we should be screening, even adolescents for lipid concerns because atherosclerosis can start so early. If we're screening people for PMOS earlier and understanding that this is a condition that can affect you throughout your lifetime, we're going to screen earlier. We're going to possibly have better pregnancy outcomes because patients with PMOS have higher rates of gestational diabetes and larger babies and other, obstetric complications that we can improve some of those outcomes. Then hopefully, we can improve not only reproductive outcomes, but cardiovascular, right? If again, if heart disease is the number one killer in women, maybe we're going to work to intervene early in these patients to say, we need to adapt more lifestyle modifications, we need to treat your insulin resistance, we need to work harder to improve your sleep and all the things so that you don't go down the road of early cardiometabolic death related to some of these things that could have been picked up earlier. And again, changing the name also will change the who decides to do the research. It's not just going to be the OB/GYNs wanting to do the research. We're going to hopefully have cardiology wanting to get involved. We want internal medicine to be involved. We want family practice. We want all the people across the spectrum understand that this is a research item that they should all be concerned about.

Krawiec: This has global implications, right? This is a global change. Not so much just a North American problem, in terms of terminology. This is across the board.

Rahman: One hundred percent. I think it's like 1 in 8 women globally or something like 170 million, 180 million women have PCOS across the country. It's not a small number. We know pockets of it exist in more places than not. I think 1 in 4 South Asians have it, because of the high preponderance to diabetes and cardiovascular disease. In certain populations of women of color, we see it more.

This is an equity issue as well, because we're talking about a global phenomenon where women from all socioeconomic backgrounds can be impacted by it, and some are getting more dismissed than others because this is just a reproductive issue. This is just a menstrual issue. But no, hey, you know what? We should intervene earlier across the board. People from around the world should know this is an issue that, they can research in and they can treat because again, this is such a high number of women that have it across the world. I think by increasing awareness, we always kind of set the stage in North America to really have global implications. I think once we change the name, then other people will get on board and understanding this disease process better, and getting women the treatment and the care they deserve.