Polyendocrine Metabolic Ovarian Syndrome (PMOS): Renaming PCOS from Describing an Ovarian Disorder to a Systemic Disease with Multifaceted Metabolic Foundations

Abstract

Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine and metabolic disorders among women of reproductive age. Evolving diagnostic criteria—from the initial Stein–Leventhal report through the National Institutes of Health (NIH), Rotterdam, and Androgen Excess and PCOS Society (AE PCOS) frameworks, along with international guidelines—have advanced understanding of the condition. However, the former name, which highlights the morphological feature “cyst”, fails to reflect its systemic and multifaceted nature. In response, a global consensus process has introduced “Polyendocrine Metabolic Ovarian Syndrome (PMOS)” as the chosen term, designed to accurately mirror the underlying pathophysiology. This review explains the rationale for renaming and provides a comprehensive overview of the polyendocrine pathophysiology, phenotypic classification, metabolic associations, and systemic consequences. Within this framework, the transition from an ovary centric view to that of a systemic metabolic disorder enables a more integrated explanation of disease mechanisms; PMOS pathophysiology is viewed as the interplay of neuroendocrine disturbances, insulin resistance, adipose tissue dysfunction, and chronic low grade inflammation, with associated reproductive, cardiovascular, metabolic, and psychological outcomes. Phenotypic classification based on the Rotterdam criteria is proposed as a clinical tool for metabolic risk stratification, although insulin resistance can occur independently of phenotype. Renaming to PMOS, by accurately capturing the systemic nature of the syndrome, facilitates early screening, multidisciplinary care, and reduced disease burden, while its gradual alignment with international classifications ensures sustainable global adoption.