From PCOS to PMOS: reframing the clinical pathway around insulin sensitivity and weight-neutral metabolic risk

Polycystic ovary syndrome (PCOS) is a heterogeneous condition associated with reproductive, metabolic, pregnancy, and psychological morbidity across the life course. Polyendocrine metabolic ovarian syndrome (PMOS) was recently proposed through a multistep global consensus process, with implementation across guidelines and health systems still under way. This Perspective argues that the clinical value of the naming proposal will depend on whether it redirects care beyond ovarian morphology and body size. Insulin resistance can serve as an actionable management hub linking reproductive endocrine dysfunction with longer-term metabolic risk in a substantial subgroup, but it is neither universal, the sole cause of the syndrome, nor a diagnostic criterion. Routine fasting insulin measurement or homeostatic model assessment of insulin resistance should therefore not be introduced as diagnostic requirements. Instead, we propose a weight-neutral, insulin-sensitivity-centered, life-course pathway aligned with existing guideline recommendations. Glycemic status, lipids, blood pressure, cardiovascular risk, pregnancy planning, psychological health, and risk-directed liver assessment should be considered according to clinical guidance without using BMI as an exclusion criterion. Lifestyle intervention should be evaluated through metabolic, functional, reproductive, and quality-of-life outcomes, not weight change alone. Metformin and GLP-1 receptor agonists should remain confined to guideline-supported indications and evidence limitations. Whether PMOS improves risk recognition, guideline adherence, patient experience, or continuity of care remains to be established.