From PCOS to Polyendocrine Metabolic Ovarian Syndrome (PMOS): Implications for Adolescent Gynecologic Care

Polyendocrine metabolic ovarian syndrome, formerly polycystic ovary syndrome (PCOS), affects approximately 6.3% of adolescents worldwide. Diagnosis in this population remains challenging due to overlap with normal pubertal physiology. Currently, international guideline adolescent-specific criteria require both oligo-anovulation and hyperandrogenism while excluding ovarian criteria due to poor specificity during early post-menarchal years. For decades, the term "PCOS" has remained scientifically inaccurate (there are no increased abnormal cysts) and conceptually restrictive, centering on ovarian morphology while failing to reflect the broader endocrine, metabolic, psychological, dermatological, and reproductive dimensions of the condition. Moreover, evidence shows that the name PCOS was perceived by adolescents, their parents, and health care professionals as confusing and stigmatizing, contributing to diagnostic delay and communication barriers. A rigorous global consensus process involving 56 organizations, multiple stages, over 22,000 survey responses, and iterative Delphi rounds led to the new name polyendocrine metabolic ovarian syndrome. This new terminology more accurately reflects underlying pathophysiology by removing focus from incorrect ovarian cyst-based terminology and acknowledging endocrine and metabolic underpinnings. Importantly, extensive implementation is underway, including changing ICD codes and reclassifying the disorder beyond the ovary, vital to broadening research, education, and care. For clinicians caring for adolescents, the new name, classification, and implementation strategy offers a valuable opportunity to reframe diagnosis and management. Meaningful adolescent partnership will be critical to ensure that this renaming and conceptual shift translates into improved understanding and more comprehensive patient-centered care.