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Since May 2026, an international consensus has adopted a new terminology: Polyendocrine Metabolic Ovarian Syndrome (PMOS), replacing the former term Polycystic Ovary Syndrome (PCOS).
This change better reflects the endocrine and metabolic nature of the condition, which cannot be reduced to the presence of "polycystic ovaries" or ovarian cysts. In fact, women with PMOS do not have ovarian cysts, but rather an excess of antral follicles, which represent the final stage of follicular maturation before ovulation.
Polyendocrine Metabolic Ovarian Syndrome (PMOS), formerly known as Polycystic Ovary Syndrome (PCOS), is one of the most common endocrine disorders, affecting approximately 1 in 8 women of reproductive age.
It is a chronic condition characterized, to varying degrees, by ovulatory dysfunction, hyperandrogenism (excess male hormones), and metabolic abnormalities. Not all women experience the same symptoms.
Diagnosis continues to rely on the Rotterdam criteria, after excluding other disorders that may explain the symptoms, such as hyperprolactinemia, thyroid disease, congenital adrenal hyperplasia, Cushing's syndrome, and others.
A diagnosis is established when at least two of the following three criteria are present:
Contrary to what the former name suggested, these are not true ovarian cysts, but rather an accumulation of immature follicles.
The new name emphasizes that this disorder is both polyendocrine and metabolic.
Many patients exhibit insulin resistance, even in the absence of overweight or obesity. This abnormality increases the risk of prediabetes, type 2 diabetes, weight gain or difficulty losing weight, dyslipidemia, hypertension, obstructive sleep apnea, metabolic dysfunction-associated steatotic liver disease (MASLD/NASH), and long-term cardiovascular disease.
For this reason, management should be comprehensive.
PMOS may also have a significant impact on mental health, with higher rates of anxiety, depression, and impaired quality of life. International guidelines now recommend systematic screening for these comorbidities.
PMOS is a constitutional disorder that generally begins at puberty and persists throughout reproductive life, although menstrual cycles often become more regular with age. A family history is common.
Management depends on each woman's symptoms, reproductive goals, and metabolic profile.
Regardless of pregnancy plans, adopting a healthy lifestyle, including a balanced diet (low in rapidly absorbed sugars) and regular physical activity, is the cornerstone of treatment.
These lifestyle measures are considered an integral part of therapy. When appropriate, they may be accompanied by weight loss.
Cardiovascular and metabolic risk factors should also be routinely screened for and managed.
For patients with insulin resistance or prediabetes, metformin may be considered in selected cases, in addition to lifestyle interventions.
When infertility results from ovulatory dysfunction, several therapeutic options are available.
Letrozole (Femara®) is currently recommended as the first-line treatment by the European Society of Human Reproduction and Embryology (ESHRE) because it achieves higher ovulation and pregnancy rates than clomiphene citrate. However, it is not currently approved for this indication in France.
Clomiphene citrate (Clomid®) may also be prescribed at a dose of one to two tablets daily, usually from day 2 to day 6 of the menstrual cycle.
Several alternatives may be considered:
In vitro fertilization (IVF) may be recommended when previous treatments have failed or when another infertility factor is present (such as tubal or male factor infertility).
Women with PMOS have an increased risk of developing ovarian hyperstimulation syndrome (OHSS). Consequently, a freeze-all strategy is often preferred, consisting first of oocyte retrieval followed by embryo cryopreservation, and subsequently frozen embryo transfer in a later cycle, thereby minimizing the risk of complications.
Polyendocrine Metabolic Ovarian Syndrome (PMOS), formerly known as Polycystic Ovary Syndrome (PCOS), is a chronic endocrine disorder affecting reproductive, metabolic, dermatological, and psychological health.
The presence of multiple small follicles on ultrasound represents only one aspect of the syndrome and is neither necessary nor sufficient to establish the diagnosis.
Current management should be comprehensive, individualized, and focused equally on metabolic health, fertility, and quality of life.
