Background 

Polycystic ovarian syndrome (PCOS) or polyendocrine metabolic ovarian syndrome (PMOS) is characterized as hormonal dysfunction associated with excess androgens, or male hormones, causing hirsutism (excess hair growth on face and body) and acne, irregular menstruation or ovulation patterns that lead to issues with conception and infertility, and/or polycystic ovaries. Globally, this disorder affects 13% of people who can reproduce, however, a majority 70% of people remain unaware of having PCOS/PMOS. As the name suggests, PCOS is centered around the ovary, while the actual condition has many effects on the endocrine, reproductive, and metabolic systems, and polycystic ovaries are not always found. PCOS/PMOS is a genetic condition with a wide range of symptoms that vary widely per person. As one of the leading causes of infertility and ovulation issues, PCOS/PMOS also comes with increased risk for insulin resistance, obesity, metabolic syndrome, sleep apnea, cardiovascular issues, type 2 diabetes, endometrial cancer, and mental health issues. 

PCOS/PMOS is a chronic illness, and can greatly affect the quality of life for people across the globe. Widely underrecognized, the renaming of PCOS to PMOS brings attention to many people receiving delayed diagnoses after seeing more than  3 providers. 84% of women receive incomplete information on proper lifestyle changes, treatment to improve their quality of life, and long-term complications like weight fluctuations,  changes to menstruation, and insulin resistance from health care professionals. With weight considerations, people who are overweight have higher risks for cardiovascular issues, insulin resistance, type 2 and gestational diabetes, stroke, high blood pressure, and high cholesterol, leading to other chronic comorbidities and worsening PMOS. Demographics largely impacted with increased risk profiles include people of South Asian, Black, and Hispanic descent, who also face barriers in accessing healthcare, gaps in patient education, and genetic predispositions. 

Public Health Policy Influences

Changing the name of what was misunderstood to be a gynecological issue to reflect its actual multi-system impact prompts a change in public health policy, and education surrounding PMOS. Bringing awareness to the reality of the condition can work to improve health outcomes of millions of people across the globe, contribute to more inclusive consideration in clinical settings, influence policymakers to attribute research expansion for PMOS and women’s health, and reinforce the necessity of the change. The economic burden of delayed diagnosis and chronic disease complications in PMOS costs the United States $15 billion annually, while disorders that present as symptoms like depression, other mental health issues, and eating disorders cost an additional $4 billion as of 2021. Related chronic conditions and other disorders are characterized as largely preventable and manageable when given access to proper health and dietary education. Adherence to the DASH diet, often used for hypertension, and vitamin D supplementation may be helpful for some types and when tested for these underlying conditions that can contribute to PMOS. 35-80% of women with PMOS have insulin resistance, and 70% have high cholesterol, and 40-80% are overweight or obese, which can worsen PMOS. Public health efforts like providing these educational and nutritional resources on PMOS can increase early intervention, better treatment methods, and enable patients and providers to work together to reduce the public health burden. Providing information on creating a balanced lifestyle, including diet and exercise works towards effective management of PMOS. The name change recognizes the complexity of PMOS, and equips public health policy to move towards improving the quality of life for people with PMOS by reducing the lack of control patients feel, and the resulting struggles with mental and physical health.

Current Diagnostic Experiences

In the United States, polycystic ovaries were considered the defining characteristic for diagnosis, which many people do not necessarily have. Later, the United Kingdom’s Rotterdam diagnostic criteria were developed to recognize PCOS. Two out of three considerations needed to be met for diagnosis, if not dismissed for lack of polycystic ovaries on ultrasound. These measures include high androgens, irregular or no menstruation, and/or polycystic ovaries. These criteria do not consider the increased risks for other non-communicable diseases that coincide with the condition, like insulin resistance, cardiovascular issues, obesity, diabetes, dyslipidemia, fatty liver (nonalcoholic), and other chronic health issues. Due to the complexity and vast considerations to be taken, this creates challenges for diagnosis, especially throughout the lifespan. Adolescence and puberty often create different manifestations, and confusion in separating the process from PMOS, delaying diagnosis and treatment. Overlap with PMOS symptoms is also present in thyroid disorders, Cushing’s syndrome (excess stress), adrenal tumors, and other disorders that function on similar pathways. Name revision of the disorder identified four different types that include combinations of the three identifying characteristics, effective lifestyle changes, and medical support per type throughout the lifespan.

Public Health Communication

Facing the challenge of renaming PCOS to PMOS is a product of over 50 organizations with goals rooted in patient advocacy and increased care with improved diagnosis processes by 71% of healthcare professionals who expressed that the initial name of polycystic ovarian classification was misleading, supported by 86% of patients with PCOS. Working for upwards of 14 years, many healthcare organizations observed how the mischaracterization of PCOS dismissed underlying health concerns and provided an inaccurate portrayal of a complex condition. Affecting over 170 million women across the globe, the renaming enables reconsideration of the diagnostic criteria, and stigma surrounding the condition is a grave public health concern. The discussion on the reasonable effects of PMOS on the whole body improves public health communication as healthcare shifts the focus of the ovarian cyst target to include the metabolic concerns. Recognizing the effects and symptoms of PMOS on other body systems decreases the minimization of a far-reaching complex disorder that contributes to delayed or incorrect diagnoses and subsequent improper treatment plans, improving patient health outcomes. 

Establishing a global terminology that both patients and providers recognize is important to improve education and access to care. Replacing a name that fosters misconceptions like polycystic ovarian syndrome (PCOS) with a more accurate description erases the misunderstanding that people with PCOS only have an ovarian issue. Polyendocrine metabolic ovarian syndrome (PMOS) signals patients and providers to consider underlying issues, developing health risks, and the consideration of individualized treatments to target the root cause of a complex health issue. Influencing health communication, the renaming of PCOS to PMOS unifies understanding of the disorder across the public health landscape. 

Future Prospects 

The renaming of polycystic ovarian syndrome (PCOS) to polyendocrine metabolic ovarian syndrome (PMOS) highlights the change to diagnosis determination allowing for wider patient education, and risk management for other comorbidities at the root rather than only utilizing temporary solutions. For approximately 13% of people who live with PMOS, the more inclusive name allows for better health care and individualized treatments. Misunderstandings with the previous name created healthcare gaps, allowing the worsening of the condition, and can intensify negative patient health outcomes with effects on metabolic, cardiovascular, and reproductive systems. When poorly managed, PMOS can contribute to a higher risk of diabetes, heart conditions, and other preventable chronic comorbidities. Due to the wide array of possible symptom combinations and varied patient health histories, individual variability and manifestations of PMOS make the condition increasingly complex to treat. 

Increased awareness of PMOS due to the name change has brought attention to understanding how the condition affects the whole body rather than just the ovaries, and focuses on specific management techniques instead of blanket treatments. Shedding light on the importance of early intervention, increased holistic awareness, and decreasing stigma on the subsequent symptoms like fatigue and tiredness, facial hair and acne from excess androgens, weight and metabolic dysfunction, the renaming of PCOS to PMOS emphasizes the important changes being made in women’s and reproductive health to accurately define health and treat health issues.

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