PMOS: Pivotal Moment for Metabolic Health

By Claire McDonnell, Regular LCDU Contributor and CEO of the Australasian Metabolic Health Society

One of the most common health conditions affecting women has been renamed, and the change could reshape how we understand, diagnose and manage it.

In an Australian-led global consensus, led by Professor Helena Teede at Monash University and published in The Lancet, Polycystic Ovary Syndrome (PCOS) has been renamed Polyendocrine Metabolic Ovarian Syndrome (PMOS).¹

The process involved 22,000 clinicians and researchers across 56 organisations, culminating in a meaningful shift in how medicine defines and understands a condition affecting approximately 1 in 8 women of reproductive age worldwide, with an estimated 70% remain undiagnosed.² 

Including the word metabolic is highly significant. It reflects growing recognition of the metabolic features that underpin the condition and influence long-term health outcomes.

The Metabolic Shift

Research linking PCOS to insulin resistance has been building for decades. When cells become resistant to insulin, the pancreas compensates by producing more of it. Chronically elevated insulin can then drive excess androgen production in the ovaries, contributing to the hormonal changes behind irregular menstrual cycles, fertility challenges, hirsutism and fatigue that characterise the condition.

The previous name, PCOS, provided an incomplete picture. Many women with the condition do not have polycystic ovaries, and the presence of ovarian cysts alone does not confirm the diagnosis. The former term directed attention towards symptoms rather than underlying mechanisms, influencing decades of clinical practice and treatment approaches.

Insulin resistance is estimated to affect the majority of people with PMOS, with prevalence estimates commonly ranging from 65–85% depending on phenotype and diagnostic criteria.³ The ovaries are central to the clinical presentation, but the condition extends far beyond ovarian function alone.

PMOS redirects attention to where it is needed. It places this condition within the broader family of metabolic disorders, alongside type 2 diabetes, cardiovascular disease and metabolic syndrome, sharing many of the same underlying drivers and opportunities for prevention and improvement through early intervention.

The Metabolic Opportunity

Evidence supporting metabolic treatment strategies already exists. A 2019 meta-analysis of randomised controlled trials found that low-carbohydrate dietary approaches significantly reduced insulin resistance, BMI and total testosterone in women with PCOS, while increasing sex hormone-binding globulin (SHBG), improving both metabolic and hormonal markers simultaneously.⁵ 

Additional research has demonstrated meaningful reductions in fasting insulin and HOMA-IR within as little as eight weeks.⁴ An NIH-funded SUPER trial is currently comparing a very low-carbohydrate diet with the DASH diet for PMOS management,⁶ providing the kind of rigorous comparative evidence that helps shape future clinical guidelines.

Dietary metabolic interventions offer an evidence-supported clinical tool to address key underlying mechanisms directly. The shift to PMOS strengthens the rationale for considering metabolic approaches, including carbohydrate restriction, among the available evidence-based management strategies.

The Need for Metabolic Education

Insulin resistance develops gradually, often for years before the clinical symptoms associated with PMOS become apparent. This presents an opportunity for clinicians to identify metabolic dysfunction early and intervene before hormonal dysfunction becomes entrenched, fertility is compromised, or downstream risks such as type 2 diabetes, cardiovascular disease, liver disease and endometrial cancer emerge.7

A consensus paper in The Lancet does not automatically update medical curricula or change what happens in consulting rooms. Translating scientific consensus into clinical practice requires deliberate investment in education and clinicians willing to engage with emerging evidence and apply it appropriately.

In practical terms, this means screening that extends beyond reproductive symptoms to include metabolic markers; dietary interventions considered early in care pathways rather than as a last resort; long-term follow-up that tracks metabolic health alongside reproductive outcomes; and medical education that reflects the metabolic underpinnings of this condition from the outset.

The evidence supporting a central role for insulin resistance in PMOS is substantial and continues to grow. The question now is how quickly clinical systems will evolve to reflect that understanding, and who will lead that change.

Metabolic health education sits at the heart of the Australasian Metabolic Health Society’s (AMHS) work. By equipping health professionals with the knowledge and practical skills to identify insulin resistance early and implement evidence-based dietary interventions, we can create genuine opportunities to improve both reproductive and metabolic health outcomes. AMHS is committed to advancing metabolic health education for healthcare professionals and the broader community.

Australia led the consensus process that produced this renaming. The next step is to lead the clinical translation. For the millions of women whose health depends on health professionals understanding this condition and its treatment options correctly, that translation will prove just as important as the name itself.

Claire McDonnell is CEO of the Australasian Metabolic Health Society, a not-for-profit dedicated to metabolic health education for clinicians across Australasia. Visit amhs.org.au to learn more.

References

1. Teede HJ, Gibson-Helm M, Laven JSE, et al. Polyendocrine Metabolic Ovarian Syndrome: a multistep international consensus process to rename PCOS. The Lancet. 2026. doi:10.1016/S0140-6736(26)00717-8.
2. Teede HJ, Moran LJ, Morman R, Gibson M, Dokras A, Berry L, Laven JSE, Joham A, Piltonen TT, Costello MF, Norman RJ, Bahri Khomami M. Polycystic ovary syndrome perspectives from patients and health professionals on clinical features, current name, and renaming: a longitudinal international online survey. EClinicalMedicine. 2025 May 28;84:103287. doi: 10.1016/j.eclinm.2025.103287. PMID: 40687737; PMCID: PMC12273733.
3. Legro RS, Arslanian SA, Ehrmann DA, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(12):4565–4592. (Supported by subsequent reviews including StatPearls: Polycystic Ovarian Syndrome, updated 2025.)
4. Zhang X, Zheng Y, Guo Y, Lai Z. The effect of low carbohydrate diet on polycystic ovary syndrome: a meta-analysis of randomized controlled trials. Front Endocrinol (Lausanne). 2019;10:657.
5. McGrice M, Porter J. The effect of a low carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. PLoS One. 2015;10(7):e0132975.
6. Greenwell S, Jakubowicz D, Hurst C, et al. SUPER: Study of a very low-carbohydrate diet versus DASH diet for polycystic ovary syndrome – trial protocol. 2024.
7. International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Monash University, ASRM, ESHRE and international partners.