Why Polycystic Ovary Syndrome (PCOS) Is Changing Its Name

Polycystic Ovary Syndrome, internationally known as PCOS, is one of the most common endocrine and metabolic disorders affecting women of reproductive age. It is estimated to affect approximately 8% to 13% of women worldwide, while a significant proportion remains undiagnosed for many years.

Although the term has been used for decades, the modern scientific community now believes that it does not accurately reflect the overall nature of the condition. The term “polycystic ovaries” often creates misconceptions, because many women with PCOS do not actually present with ovarian cysts, while many women with polycystic ovarian morphology do not suffer from the syndrome.

Today, we know that PCOS is not simply a gynecological disorder. It is a complex metabolic and hormonal syndrome that affects multiple systems of the body and is associated with:

Insulin resistance
Hyperandrogenism
Ovulatory dysfunction
Chronic low-grade inflammation
Increased cardiometabolic risk
Difficulty losing weight
Increased risk of developing type 2 diabetes mellitus

This modern approach was formalized in 2026 through an international consensus process published in the prestigious medical journal The Lancet, with the support of major scientific organizations, including the Endocrine Society. Within this framework, the new term Polyendocrine Metabolic Ovarian Syndrome (PMOS) was proposed, as it was considered to more accurately reflect the overall metabolic and endocrine nature of the disorder.

The new terminology aims to highlight that the syndrome does not affect only the ovaries, but has a broader impact on metabolism, hormonal balance, inflammation, and cardiometabolic risk, reflecting the modern understanding of a multisystem disease.

This change reflects a new era in Preventive and Functional Medicine, where the focus shifts from ovarian morphology to a woman’s overall metabolic health. The change in terminology is not merely symbolic. It represents a deeper understanding of the disease and its systemic impact throughout the body. Interest is no longer limited to fertility and menstrual cycle regulation, but also extends to the prevention of chronic metabolic and cardiovascular diseases that may appear many years later.

PCOS as a Metabolic and Endocrine Syndrome

For many years, the diagnosis of PCOS was based mainly on gynecological criteria, such as menstrual irregularities and polycystic ovarian morphology. However, modern research demonstrates that the true “root” of the condition lies much deeper.

Insulin resistance is now considered one of the most important mechanisms underlying the syndrome. When cells do not respond properly to insulin, the body produces higher amounts of the hormone in order to maintain normal glucose levels. This hyperinsulinemia directly affects the ovaries and stimulates androgen production.

This may lead to:

Acne
Oily skin
Excess hair growth
Irregular menstrual cycles
Difficulty conceiving

At the same time, many women with PCOS present elevated inflammatory and oxidative stress markers. This chronic inflammatory state appears to affect:

Mitochondrial function
Oocyte quality
Metabolic health
Vascular system function

The gut microbiome also appears to play an important role. Modern studies demonstrate that women with PCOS frequently exhibit alterations in gut microbiota composition, which are associated with increased inflammation, insulin resistance, and difficulty regulating body weight. This explains why two women with the same diagnosis may present completely different clinical manifestations. Some primarily experience metabolic disturbances and weight gain, while others develop more pronounced reproductive or dermatological symptoms.

Modern medicine now approaches PCOS as a multisystem disorder involving interactions among genetic, hormonal, metabolic, and environmental factors. This new perspective opens the way for more personalized prevention and treatment strategies.

Multi Omics Testing and the Future of Prevention

Functional and Preventive Medicine now utilizes advanced Multi Omics technologies for investigating complex metabolic disorders such as Polyendocrine Metabolic Ovarian Syndrome (PMOS).

The term Multi οmics describes the combined analysis of multiple biological layers, including:

Genomics, analysis of genes and genetic variations affecting body function
Metabolomics, study of metabolites and biochemical pathways related to energy production and metabolism
Lipidomics, analysis of lipids and fatty acids that influence inflammation, cellular membranes, and cardiometabolic risk
Hormonomics / Endocrine profiling, evaluation of hormones and hormone metabolites related to endocrine system function
Microbiomics, study of gut microorganisms and their effects on metabolism and inflammation

The goal is not only to diagnose disease, but also to understand the deeper biological mechanisms contributing to its development. This approach is particularly important in PMOS because each woman presents a different metabolic and hormonal profile. Multi Omics testing enables:

Early detection of metabolic abnormalities
Evaluation of inflammatory burden
Better understanding of gut microbiome function
Identification of nutritional deficiencies
Development of more personalized preventive interventions

Through this approach, intervention may occur before serious complications such as type 2 diabetes mellitus, non alcoholic fatty liver disease, or cardiovascular disease become established. This methodology represents a core element of Functional Medicine, which aims to understand not only what is happening, but also why it is happening in each individual organism.

Laboratory Testing for the Investigation of PMOS

Comprehensive PMOS evaluation includes both conventional laboratory testing and Functional Medicine assessments that allow a more personalized approach.

(a) Conventional Laboratory Tests
The evaluation of PMOS typically begins with conventional laboratory testing, which helps assess metabolic, hormonal, and cardiometabolic function. The basic diagnostic evaluation of PMOS includes tests that assess:

Glucose metabolism and insulin resistance (Fasting Glucose, Fasting Insulin and HOMA-IR, Glucose and Insulin Response Curve, Glycosylated Hemoglobin). These tests evaluate metabolic risk and help identify prediabetes or type 2 diabetes mellitus. Hyperinsulinemia is considered a central pathophysiological mechanism of PMOS.
Lipid and cardiometabolic profile (Total Cholesterol, HDL, LDL, and Triglycerides). These tests comprise the standard lipid profile and are used to assess cardiometabolic risk. Women with PMOS more frequently present with dyslipidemia, which is associated with insulin resistance and an increased risk of cardiovascular complications.
Hormonal function and hyperandrogenism (Total and Free Testosterone, DHEA-S, SHBG, LH, FSH, Prolactin). These markers help evaluate hyperandrogenism and overall hormonal balance, while also contributing to the exclusion of other causes of menstrual irregularities.
Thyroid function and inflammatory markers (TSH and Thyroid Hormones, hs CRP, Vitamin D). Thyroid disorders may mimic or worsen PMOS symptoms, such as fatigue and weight gain. In parallel, chronic low-grade inflammation and disturbances in immunometabolic balance appear to play an active role in insulin resistance, metabolic dysfunction, and the increased cardiometabolic risk associated with PMOS.

(b) Functional Medicine Testing
Modern Preventive and Functional Medicine increasingly utilizes advanced functional and Multi omics analyses, which can provide a more personalized understanding of the metabolic, hormonal, and inflammatory mechanisms associated with PMOS. These approaches are aimed not only at diagnosing the condition, but also at identifying biological factors that may affect each woman differently. Functional evaluation of PMOS may include tests that assess:

The function of the gut microbiome and its relationship with inflammation, metabolic dysfunction, and insulin resistance (EnteroScan®). In PMOS, disturbances associated with inflammation, increased intestinal permeability, and metabolic dysfunction are frequently identified. The results may contribute to the development of more personalized nutritional and probiotic interventions.
Cellular metabolism, mitochondrial function, energy production, and oxidative stress (MetaBolomiX™, DetoxScan®). These analyses may help identify underlying metabolic abnormalities, chronic oxidative burden, and inflammatory mechanisms associated with chronic fatigue, difficulty losing weight, and metabolic dysfunction commonly observed in women with PMOS.
Hormonal balance, hormone metabolism, and stress-axis function (HormoneScan®). Evaluation at this level contributes to a more comprehensive assessment of hormonal disturbances associated with PMOS, including menstrual irregularities, androgen excess, chronic fatigue, and metabolic dysfunction, while providing information that may not always be detected through conventional blood testing.
Fatty acid profiles and inflammatory mechanisms associated with cardiometabolic risk (ΩmegaScan®). In women with PMOS, imbalances in fatty acid composition appear to be associated with increased inflammation, insulin resistance, and metabolic dysfunction.
Potential deficiencies in vitamins, minerals, and other micronutrients that influence metabolic, hormonal, and cellular function (NutriScan®, Metals & Traces®). Deficiencies in magnesium, zinc, vitamin D, B-complex vitamins, and other essential micronutrients are commonly observed in women with PMOS and may contribute to impaired energy production, increased inflammation, and metabolic dysfunction.

(c) Imaging Techniques
Imaging studies may also be included in the evaluation of PMOS. Ovarian ultrasound is commonly used to assess ovarian morphology and identify the presence of polycystic ovarian appearance. In addition, liver ultrasound may be recommended to evaluate for non-alcoholic fatty liver disease (NAFLD), a condition that appears more frequently in women with PMOS due to its close association with insulin resistance and metabolic dysfunction.

Therapeutic Approaches

Treatment of PMOS should be individualized and should target not only symptoms, but also the deeper metabolic mechanisms underlying the condition.

(a) Conventional Therapies

Oral contraceptive pills are frequently used to regulate menstrual cycles and reduce hyperandrogenism. However, they do not address the underlying metabolic dysfunction of the syndrome.
Metformin is used to improve insulin sensitivity and may assist with cycle regulation and weight management. The most common side effects include gastrointestinal disturbances and possible vitamin B12 depletion during long term use.
In women with pronounced excess hair growth or acne, anti-androgen medications may be used, while ovulation induction therapies are applied in cases of infertility.
In recent years, newer treatments targeting glucose metabolism and weight control have also been introduced, particularly in women with severe metabolic burden.

(b) Natural Therapies and Functional Medicine Approach

Nutrition and lifestyle represent the most important pillars in PMOS management. In particular, the Mediterranean diet appears to contribute to:

Improved insulin sensitivity
Reduced inflammation
Stabilization of glucose and insulin levels
Improved hormonal balance

Importance should also be placed on avoiding ultra processed foods and ensuring adequate intake of fiber, high quality protein, and antioxidants.

Regular physical activity helps reduce visceral fat, improve glycemic control, and regulate hormonal balance. Even moderate weight loss may significantly improve menstrual regularity and metabolic function.

At the same time, sleep quality and stress management significantly affect cortisol and metabolic regulation. Chronic stress appears to worsen inflammation and insulin resistance.

Finally, certain nutritional supplements have shown promising evidence in PMOS:

Myo inositol and D chiro inositol: Contribute to improved insulin signaling and ovulation. Typical dosages range from 2 to 4 g daily.
Omega 3 fatty acids: Exhibit anti-inflammatory properties and may improve lipid profiles and inflammatory markers.
Vitamin D and Magnesium: Correction of potential deficiencies may support metabolic and hormonal balance.
Berberine and Cinnamon: Certain botanical extracts appear capable of supporting metabolic function and glucose regulation in women with PMOS. However, their use should occur under medical supervision because of possible interactions with medications.

The use of dietary supplements should be undertaken only under the guidance of a qualified healthcare professional, particularly in individuals receiving medication or presenting with underlying medical conditions.

Conclusion

The name change to PMOS reflects the modern understanding of a complex metabolic and endocrine disorder that affects the entire body and not only the ovaries.

Modern Preventive and Functional Medicine places particular emphasis on the early identification of metabolic, hormonal, and inflammatory disturbances associated with PMOS, often before significant clinical complications become apparent. Advanced Multi omics technologies and functional analyses now allow for a more comprehensive and personalized approach, contributing to a deeper understanding of the biological mechanisms that may affect each woman differently.

The goal of this approach is not only the management of symptoms, but also the long-term support of metabolic, hormonal, and overall health through more individualized prevention and therapeutic strategies.

References

Teede H, Khomami M, Morman R et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. The Lancet, 2026
Dalamaga M. What’s in a name? From PCOS to polyendocrine metabolic ovarian syndrome: A metabolic reframing, promise, controversies, and challenges ahead. Metabolism Open. 2026;100479. doi:10.1016/j.metop.2026.100479
Escobar-Morreale HF. Polycystic ovary syndrome: definition, etiology, diagnosis and treatment. Nat Rev Endocrinol. 2018 May;14(5):270-284. doi: 10.1038/nrendo.2018.24. Epub 2018 Mar 23. PMID: 29569621.
Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018;110(3):364-379. doi:10.1016/j.fertnstert.2018.05.004