PCOS (PMOS): Symptoms, Causes, Diagnosis & Treatment

Medically reviewed by: [Yasmen] · Last updated: October 2026

Polycystic ovary syndrome, or PCOS, affects hormones, menstrual cycles, fertility, metabolism, skin, and emotional health. In May 2026, experts officially renamed it polyendocrine metabolic ovarian syndrome (PMOS).

The new name will take time to become familiar. You may still see PCOS on medical records, websites, and prescription information during the transition.

If you have irregular periods, acne, unwanted facial hair, trouble getting pregnant, or concerns about insulin resistance, this guide explains what the condition is, how doctors diagnose it, and which treatments can help.

Key Takeaways

PCOS is now officially PMOS. Both names mean the same condition.
You do not need ovarian cysts to be diagnosed.
You do not need to be overweight. Insulin resistance occurs in lean women too.
Under the 2023 guideline, many people can be diagnosed without an ultrasound or AMH test.
Treatment depends on your goals: regulating periods, improving metabolic health, managing skin and hair symptoms, or getting pregnant.
There is no cure, but symptoms and long-term risks can be managed well.

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What Is Polycystic Ovary Syndrome?

PCOS is a long-term hormonal and metabolic condition. It often affects how the ovaries release eggs and how the body responds to insulin.

Some people don't ovulate regularly. Others produce higher levels of androgens, such as testosterone. These changes can cause irregular periods, acne, excess facial hair, and fertility problems.

The structures called "cysts" on an ultrasound are follicles, a normal part of the ovary, rather than pathological cysts. A person with PMOS can also separately develop a true ovarian cyst, and that is treated as its own issue.

PCOS Is Now Called PMOS: What Changed?

The renaming followed a global consensus published in The Lancet, after a 14-year process with input from more than 14,000 patients and health professionals. The old name put too much attention on ovarian cysts and could suggest the condition only affects the ovaries.

The new name reflects three parts of the condition:

Polyendocrine: several hormonal systems may be involved.
Metabolic: insulin resistance and other metabolic changes can occur.
Ovarian: ovulation and ovarian function can be affected.

The transition will take three years, with the new name fully implemented in the 2028 International Guideline update.

Does the new name change your diagnosis?

No. PCOS and PMOS are the same condition. Your diagnosis stays valid, and your treatment doesn't need to change.

Will my medical record say PMOS?

Maybe not yet. One physician explained that there isn't a diagnostic code with the new name yet, so doctors can't officially change a diagnosis in the system. Expect both names for a few years.

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How Common Is PCOS or PMOS?

The WHO estimates that 10-13% of women are affected, and up to 70% don't know they have it. You will also see "1 in 8" (about 170 million women) and "1 in 10." The figures differ because studies use different criteria and populations, but all agree that it's very common and often missed.

Common Symptoms

Symptoms vary a lot, and you don't need all of them.

Irregular or missing periods

Long gaps between periods, or fewer than expected each year
No periods at all
Unpredictable or heavy bleeding

These happen because ovulation isn't occurring regularly.

Acne, facial hair, and scalp hair thinning

Persistent acne and oily skin
Extra facial or body hair (hirsutism)
Thinning scalp hair

Difficulty getting pregnant

Irregular ovulation makes fertile days hard to predict, and PMOS is a common cause of anovulatory infertility. But it doesn't mean you can't conceive. Many people do, naturally or with treatment.

Weight and metabolic changes

Some people gain weight easily. Others stay lean. PCOS can occur at any body size.

Darkened skin

Insulin resistance can cause acanthosis nigricans: darker, velvety skin around the neck, armpits, groin, or under the breasts. Skin tags are also common.

Mood and sleep problems

Anxiety, depression, and sleep apnea are more common. The 2023 guideline stresses the broader features, including metabolic risk, cardiovascular disease, sleep apnea, and the very high prevalence of psychological features.

What Causes PCOS?

No single cause is known. It appears to involve genetic, hormonal, metabolic, and environmental factors.

Family history. A family history of PCOS or type 2 diabetes raises the risk. It doesn't guarantee you'll develop it.

Insulin resistance. When cells respond poorly to insulin, the body makes more of it. Too much insulin can make the ovaries overproduce testosterone.

Androgen changes. Androgens are made by everyone. In PMOS, levels of activity can be higher, which drives acne, hair changes, and ovulation problems. It's also not only an ovary problem: the adrenal glands and peripheral tissues are now considered important androgen sources.

Is PCOS only for people who are overweight?

No. Insulin resistance affects up to 85% of women with PCOS, including 75% of those with a BMI of 25 or below. If you have these symptoms at a "normal" weight, ask for an assessment. Estimates vary between studies and testing methods, so treat the figures as a guide.

How Is PCOS Diagnosed? (2023 Guideline)

There is no single test. Adults need two of three: clinical or biochemical hyperandrogenism, ovulatory dysfunction, and polycystic ovaries on ultrasound. As of 2023, AMH can be used instead of ultrasound. Other causes, such as thyroid disease and high prolactin, must be ruled out first.

Do you always need an ultrasound?

No. For women with irregular cycles and hyperandrogenism, in about 70% of cases, ultrasound or AMH testing isn't required for diagnosis. For women with only one of those features, an ultrasound or an AMH test, but not both, is needed.

Three useful details:

"Irregular" has a definition. Cycles shorter than 21 days or longer than 35 days, from three years after the first period until perimenopause.
AMH isn't a stand-alone test. The guideline recommends against using AMH as a single diagnostic test.
Polycystic-looking ovaries aren't a diagnosis. Most patients whose polycystic ovaries are found incidentally on imaging do not have PCOS. Saying "you don't have PCOS because there are no cysts" is wrong too.

What tests might your doctor order?

Menstrual and medical history, blood pressure, and physical exam
Testosterone and other androgen tests (mainly when clinical signs are unclear)
Thyroid (TSH) and prolactin
Blood glucose, cholesterol, and triglycerides
Pelvic ultrasound or AMH in selected adults

PCOS diagnosis in teenagers

Teens need stricter criteria because irregular periods and acne are normal during puberty. Adolescents need both hyperandrogenism and ovulatory dysfunction, and ultrasound and AMH aren't recommended because they lack specificity in the pubertal transition.

PCOS Treatment Options

There is no cure. Treatment targets your symptoms, health risks, and goals. Existing drugs aren't licensed specifically for PMOS and are used off-label to target symptoms, so decisions should be shared with your doctor.

Goal	Common options	What the 2023 guideline says
Regular cycles, acne, hair	Combined hormonal pill; anti-androgens such as spironolactone (supervised, with pregnancy precautions)	Commonly used when you're not trying to conceive
Insulin resistance	Exercise, nutrition, metformin	Metformin alone should be considered in adults with a BMI of 25 or higher for weight and metabolic outcomes.
Supplements	Inositol	Metformin should be considered over inositol for hirsutism and central adiposity, though it has more stomach side effects. Specific inositol types and doses can't be recommended due to lack of quality evidence.
Weight-loss medication	GLP-1 drugs (liraglutide, semaglutide)	Shared decision-making is needed, as pregnancy safety data are lacking.
Getting pregnant	Letrozole, other ovulation induction, IVF	See below.
Mental health counseling	g, CBT, sleep treatment	Screening is recommended.

Two honest caveats: the guideline's evidence is generally low to moderate quality, and metformin isn't routinely recommended in pregnancy.

Lifestyle

Regular movement, fiber- and protein-rich meals, consistent sleep, and less sitting all help. No single "PCOS diet" has been proven better than other healthy eating patterns, and crash diets don't fix insulin resistance.

Protecting the uterine lining

If you go long stretches without a period, tell your doctor. Extended exposure of the uterine lining without progesterone can raise the risk of endometrial problems.

Fertility treatment

A 2026 meta-analysis of 32 RCTs found that letrozole gave higher ovulation, pregnancy, and live birth rates than clomiphene citrate, with lower multiple-pregnancy rates and comparable miscarriage risk. Other options include gonadotropins and IVF, depending on your situation.

Read: [PCOS Pregnancy and Fertility →] · [PCOS Infertility Rate →] · [PCOS and Ovulation Tracking →]

Pregnancy and PMOS

Many people with PMOS have healthy pregnancies, but careful monitoring helps. A meta-analysis of 104 studies and 106,690 pregnancies found higher odds of miscarriage, gestational diabetes, gestational hypertension, pre-eclampsia, and cesarean section, and the increased odds remained significant when age and BMI were matched.

That's a reason for planning and monitoring, not alarm. Read [PCOS Miscarriage Risk →].

Long-Term Health Risks

PMOS is more than a reproductive condition. Ongoing monitoring matters because it's associated with:

Prediabetes and type 2 diabetes
Abnormal cholesterol and high blood pressure
Gestational diabetes and pregnancy complications
Endometrial hyperplasia and endometrial cancer
Sleep apnea
Depression, anxiety, and disordered eating
A link with autoimmune thyroid disease (see [PCOS and Autoimmune Disease →])

Having PMOS doesn't mean you'll develop these. Your risk depends on age, family history, metabolic health, and lifestyle.

It Can Change Across Your Life

The phenotype can change at different life stages, which calls for a personalized approach to diagnosis and treatment. A teenager, a person trying to conceive, and someone later in life may need different advice, so keep follow-up going.

When Should You See a Doctor?

Make an appointment if you have:

Very irregular periods, or none for three months or longer without an explanation
Persistent or severe acne
New or increasing facial or body hair, or noticeable hair thinning
Difficulty becoming pregnant
Symptoms of high blood sugar, such as excessive thirst, frequent urination,n or constant fatigue
Heavy or prolonged bleeding

You don't need to wait until symptoms are severe. Not sure who to see? Read [How to Find a PCOS Specialist →].

Living With PCOS or PMOS

A diagnosis can feel overwhelming, especially when symptoms touch several parts of your life. One person mainly struggles with periods, another with acne or hair, and another finds out when trying to conceive.

Good care should address your symptoms, priorities, reproductive plans, metabolic health, and emotional well-being. If low mood or anxiety is affecting you, tell your doctor. It's part of the condition, not a personal failing. Regular follow-up lets your team adjust treatment as your needs change.

Conclusion

PCOS, now officially PMOS, is a hormonal, metabolic, and ovarian condition that reaches well beyond periods. You can have it without cysts, without being overweight, and without every textbook symptom.

If your periods, skin, hair, fertility, or metabolic health have changed, talk to a qualified healthcare professional. An accurate diagnosis opens up treatment that fits you.

Keep reading: [PCOS Pregnancy and Ovulation →] · [Teenage PCOS →] · [PCOS vs PMDD →] · [PCOS Yeast Infections →] · [PCOS News and Research Updates →] · [Síndrome de Ovario Poliquístico →]

References

Lancet/Monash PMOS rename coverage: biospectrumasia.com/news/121/27634/monash-university-leads-effort-to-rename-polycystic-ovary-syndrome-pcos-as-polyendocrine-metabolic-ovarian-syndrome-pmos.html
WHO fact sheet: who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
2023 International Evidence-based Guideline: academic.oup.com/jcem/article/108/10/2447/7242360
Australian summary of the 2023 guideline: mja.com.au/journal/2024/221/7/summary-2023-international-evidence-based-guideline-assessment-and-management
Pregnancy outcomes meta-analysis, Nature Communications, 2024: doi.org/10.1038/s41467-024-49749-1
Letrozole vs clomiphene meta-analysis, JBRA Assisted Reproduction, 2026: jbra.com.br/media/html/JBRA3215.html
Cleveland Clinic on the diagnostic code: consultqd.clevelandclinic.org/what-the-renaming-of-pcos-means-in-practice

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