PMOS beyond the reproductive years: menopause and long-term health outcomes

Polyendocrine metabolic ovarian syndrome (PMOS) is one of the most common endocrine disorders affecting reproductive-aged women and is increasingly recognized as a lifelong condition rather than one confined to the reproductive years. As women age, some reproductive manifestations of PMOS evolve in a favorable direction, with improvements in menstrual regularity, ovulatory function, ovarian morphology, and biochemical hyperandrogenism. These changes may make diagnosing a woman in her 30's and 40's with PMOS challenging, yet the symptom improvements do not appear to represent resolution of the underlying disorder. Emerging evidence demonstrates that women with PMOS continue to experience an increased burden of metabolic dysfunction, cardiovascular disease, and psychological comorbidity into midlife and beyond. This narrative review summarizes current evidence regarding age-related changes in the reproductive and endocrine phenotype of PMOS, challenges in diagnosis as the disorder changes with age and the long-term cardiometabolic, psychological, and cognitive health implications of the disorder. We also highlight limitations of the existing literature, including the relative paucity of longitudinal studies extending past menopause, and identify priorities for future research. Recognition of PMOS as a lifelong endocrine disorder has important implications for risk assessment, preventive care, and multidisciplinary management throughout the lifespan.