1. Introduction

Polycystic ovary syndrome (PCOS), first described by Stein and Leventhal in 1935, is one of the most common endocrine disorders among women of reproductive age ^[1]. Although it was long regarded primarily as a gynecologic condition, PCOS is now recognized as a complex endocrine–metabolic disorder with important reproductive, metabolic, dermatologic, psychological, and cardiovascular consequences ^[2].

In this context, a recent international consensus published in The Lancet proposed renaming polycystic ovary syndrome as polyendocrine metabolic ovarian syndrome (PMOS) to better represent the multisystem nature of the disorder ^[3]. The new term foregrounds the endocrine, metabolic, and ovarian dimensions of the syndrome and addresses limitations of the historical name, which placed disproportionate emphasis on ovarian morphology and could incorrectly imply the presence of pathologic ovarian cysts ^[3][4]. Although the terminology was established through a broad international consensus process, global implementation is ongoing, with a transition period anticipated for incorporation into clinical practice, education, and medical classification systems ^[3].

Adopting the term PMOS has implications beyond nomenclature. It more accurately conveys clinical heterogeneity and pathophysiologic complexity, including the interactions among ovulatory dysfunction, androgen excess, and metabolic abnormalities that contribute to cardiometabolic risk and psychosocial burden ^[2][3][5]. The term may also support a fuller understanding of the disorder among both healthcare professionals and patients, encouraging multidisciplinary, individualized care ^[3][4]. For consistency with the proposed nomenclature, PMOS is used throughout this chapter, while PCOS is retained when referring to historical terminology, established diagnostic frameworks, or titles of cited publications.

The multisystem concept is supported by evidence showing that insulin resistance and obesity occur in a substantial proportion of affected women and are associated with progression to type 2 diabetes and cardiovascular complications ^[5][6][7]. Mental health impairment and reduced quality of life are also common ^[2][5][8], as are dermatologic manifestations of androgen excess, including acne, hirsutism, and female-pattern hair loss [9]. PMOS is a major cause of anovulatory infertility and contributes materially to the overall burden of infertility ^[7][9]. Despite this clinical burden, the condition remains underrecognized, partly because of its heterogeneous presentation and the conceptual limitations of the historical name ^[3].

Clinical heterogeneity reflects complex interactions among neuroendocrine, metabolic, and ovarian disturbances ^[10]. Early identification during routine primary-care encounters is therefore important, particularly when menstrual irregularity, clinical signs of androgen excess, excess weight, or relevant family history are present. A modern approach requires coordinated, patient-centered care in which the family physician supports early recognition, initiates appropriate evaluation, and provides longitudinal follow-up.

2. Clinical Manifestations and Diagnosis in Family Medicine

PMOS encompasses a broad spectrum of reproductive, metabolic, dermatologic, and psychological manifestations arising from the interaction of androgen excess, insulin resistance, and ovulatory dysfunction [3,5,6]. The main clinical domains are summarized below.

• Reproductive manifestations include oligo-ovulation or anovulation, irregular menstrual cycles, and infertility. PMOS is a major cause of anovulatory infertility and is also associated with an increased risk of selected pregnancy complications ^[2][3][9].
• Metabolic manifestations include central adiposity, insulin resistance, impaired glucose regulation and type 2 diabetes, hypertension, atherogenic dyslipidemia, metabolic dysfunction-associated steatotic liver disease (MASLD), obstructive sleep apnea, and elevated cardiovascular risk ^[2][3][5]. Low-grade systemic inflammation, insulin resistance, and androgen excess may reinforce one another and contribute to lifelong cardiometabolic risk ^[5][6][7].
• Dermatologic manifestations are largely related to androgen excess and include hirsutism, persistent acne, and female-pattern hair loss ^[2][8]. The apparent severity of hirsutism may be underestimated because many women use cosmetic hair-removal methods. Severe or persistent acne beyond adolescence should also raise suspicion of androgen excess ^[2].
• Psychological manifestations include depression, anxiety, disordered eating, body-image distress, and reduced quality of life. These are not secondary concerns; they form an important component of the syndrome’s multidimensional burden ^[3][9].

This diversity of presentation contributes to delayed recognition and adversely affects health and quality of life ^[5][9]. The historical term “polycystic ovary syndrome” may also have contributed to diagnostic confusion by suggesting that pathologic ovarian cysts are required and by obscuring the metabolic dimensions of the disorder ^[3][7].

2.1. Diagnostic framework

Diagnosis is established after exclusion of alternative etiologies. Under current international guidance, the diagnosis in adults generally requires at least two of the following: (1) oligo-ovulation or anovulation; (2) clinical or biochemical hyperandrogenism; and (3) polycystic ovarian morphology on ultrasonography or an elevated anti-Müllerian hormone (AMH) level used in accordance with validated guidance ^[2][3][9]. In adolescents, both ovulatory dysfunction and clinical and/or biochemical hyperandrogenism are required; ovarian ultrasonography and AMH should not be used as stand-alone diagnostic criteria because normal pubertal physiology can mimic PCOS features ^[2][3][10].

In primary care, suspicion is usually prompted by the combination of menstrual disturbance, clinical signs of androgen excess, and metabolic risk factors identified during an integrated history and examination. Sudden-onset or rapidly progressive virilization—such as severe hirsutism, deepening of the voice, rapidly progressive alopecia, or clitoromegaly—requires urgent assessment for an androgen-secreting tumor or another serious endocrine cause.

3. Opportunistic Screening and Early Recognition in Primary Care

The Gynecology and Reproductive Health Group of the Romanian National Society of Family Medicine proposes opportunistic screening for PMOS in primary care using a brief questionnaire that can be incorporated into routine consultations. The objective is not population diagnosis through a questionnaire, but greater awareness, earlier identification of women who merit evaluation, and more timely access to appropriate care.

The proposed screening approach focuses on women aged 18–35 years, an interval of high clinical relevance in which early recognition may help prevent or reduce reproductive and cardiometabolic consequences. It is particularly pertinent for women with irregular cycles, hirsutism, persistent acne, female-pattern hair loss, excess weight or abdominal obesity, infertility, or a family history of type 2 diabetes or metabolic syndrome. The family physician can recognize suggestive features and initiate basic clinical and metabolic assessment.

The modern PMOS concept promotes an integrated, multidisciplinary approach that extends beyond reproductive assessment to include metabolic, cardiovascular, dermatologic, and psychosocial health. Within this model, the family physician contributes to patient education, coordination of investigations, preventive care, and long-term monitoring ^[3][10].

To translate these principles into practice, a brief screening questionnaire was developed around key manifestations of the syndrome. It addresses menstrual history, clinical signs of androgen excess, body weight, and blood pressure. The questionnaire has no diagnostic validity on its own; rather, it helps identify women who may require further clinical and laboratory evaluation.

Educational materials and practical tools can support prevention, health education, and early case finding. Future development of validated digital tools and electronic registries could improve systematic identification and long-term follow-up. Initial assessment should proceed systematically from clinical suspicion and basic metabolic evaluation to specialist referral, diagnostic confirmation, individualized management, and longitudinal primary-care follow-up.

4. Integrated Management, Prevention, and Follow-up

PMOS is a chronic, heterogeneous condition with reproductive, metabolic, dermatologic, and psychological manifestations. It therefore requires integrated care and continuing surveillance. The family physician has a central role in early recognition, prevention, monitoring, and coordination with gynecology, endocrinology, fertility services, dermatology, nutrition, psychology, and other disciplines as needed ^[2][11].

4.1. Lifestyle Measures and Prevention

Lifestyle intervention is foundational and should be discussed with all women with PMOS, irrespective of body mass index ^[2][5]. Management may include regular physical activity, individualized nutrition counseling, sleep optimization, and behavioral strategies. The goals are improved overall health, prevention of weight gain, preservation of healthy body composition, and reduction of metabolic risk ^[2][10].

For women with excess weight, sustainable lifestyle changes can improve metabolic and reproductive outcomes ^[2][11]. Physical activity should follow evidence-based recommendations for the general population and be adapted to ability, comorbidities, and preferences. Benefits can occur even without marked weight loss, including improved insulin sensitivity, fitness, and quality of life ^[5].

Nutrition counseling should avoid overly restrictive or stigmatizing approaches. No single dietary pattern has proven universally superior in PMOS; emphasis should therefore be placed on nutritionally adequate, culturally acceptable, and sustainable eating patterns ^[2]. Health education and behavioral support are essential for adherence and durable benefit ^[2][10][11]. Weight-related discussions should be respectful, permission-based, and attentive to the increased prevalence of body-image distress and disordered eating.

4.2. Prevention of Metabolic and Cardiovascular Complications

PMOS is commonly associated with insulin resistance, dysglycemia, dyslipidemia, hypertension, and metabolic syndrome, all of which increase cardiometabolic risk ^[5][12]. Baseline and periodic assessment should be individualized and generally include weight-related measures, blood pressure, lipid profile, and glycemic status ^[2][10]. A 75-g oral glucose tolerance test is the most accurate test for assessing glucose metabolism in women with PMOS and should be considered particularly when additional risk factors are present ^[2].

Risk assessment should also consider smoking, family history, sleep apnea symptoms, MASLD risk, pregnancy history, and use of medications that may affect weight or metabolism. Abnormal findings should be managed according to current evidence-based cardiovascular and diabetes-prevention guidance, while avoiding the assumption that PMOS alone determines an individual woman’s outcome.

4.3. Pharmacologic Management

Pharmacologic treatment should be individualized according to predominant symptoms, metabolic profile, contraindications, and reproductive goals ^[2][5][10]. Shared decision-making is essential because priorities vary considerably among women and may change over time.

Women without an immediate pregnancy goal

Combined oral contraceptives, generally using the lowest effective estrogen dose, are first-line pharmacologic therapy for menstrual regulation and clinical manifestations of androgen excess when no contraindication is present. Persistent hirsutism or acne may also be treated with cosmetic and dermatologic measures. In selected cases, an antiandrogen such as spironolactone may be considered, but only with reliable contraception because of potential fetal harm ^[2][10][13].

Metformin may be considered in adult women with PMOS and a body mass index of at least 25 kg/m² to improve anthropometric and metabolic outcomes, including insulin resistance, glucose regulation, and lipid parameters. It is used alongside, not as a substitute for, lifestyle intervention ^[2][13]. Decisions should account for gastrointestinal tolerability, vitamin B12 monitoring where appropriate, and the patient’s metabolic risk profile.

Women seeking pregnancy

For anovulatory infertility associated with PMOS and no other infertility factor, letrozole is recommended as first-line pharmacologic treatment for ovulation induction ^[2][14]. Preconception care should include optimization of weight-related health, blood pressure, glycemic status, folate intake, medication safety, vaccination status, and management of comorbidities. Metformin may be considered for metabolic indications, particularly when body mass index is at least 25 kg/m², and may improve ovulatory function in some women ^[2][10]. Timely referral to fertility services is appropriate when pregnancy does not occur after an individualized period of treatment or when additional infertility factors are suspected.

4.4. Psychological Health and Quality of Life

PMOS is associated with increased rates of anxiety, depression, disordered eating, body-image concerns, and impaired quality of life. Psychological burden may be intensified by androgen-related symptoms, fertility concerns, weight stigma, and difficulty achieving therapeutic goals. Mental-health assessment should therefore form part of routine, patient-centered follow-up ^[2][10]. Early identification of emotional difficulties and facilitated access to counseling or other support services may improve adherence, clinical outcomes, and quality of life ^[2][13]. Urgent risk assessment is required when self-harm or suicidal ideation is disclosed.

4.5. Longitudinal Monitoring

Follow-up should reflect the individual clinical phenotype, treatment, life stage, and risk factors. Periodic review may include menstrual and reproductive health, androgen-related symptoms, blood pressure, weight trajectory, glucose metabolism, lipid profile, sleep, psychological well-being, and health-related quality of life ^{[2][3][10][13]}. The interval should be shorter when results are abnormal, treatment is changing, pregnancy is planned, or adherence and tolerability require close review.

Continuing education and active patient involvement are essential. Supporting self-management and shared decision-making can improve adherence, sustain lifestyle changes, and help align treatment with individual priorities ^[2][13]. Clear communication is especially important during the transition from PCOS to PMOS terminology so that women understand that the name has changed, not the underlying condition or the validity of their previous diagnosis.

5. Implications for Family Medicine

The proposed PMOS terminology reinforces a care model that is naturally aligned with family medicine: whole-person assessment, continuity, prevention, coordination, and attention to family and social context. Primary-care records often contain the earliest signals—cycle irregularity, acne, weight changes, elevated blood pressure, dysglycemia, fertility concerns, or emotional distress—before the syndrome is recognized as a unified clinical entity.

In practical terms, family physicians can improve care by asking brief menstrual and androgen-symptom questions during relevant consultations; measuring blood pressure and assessing metabolic risk; excluding common alternative diagnoses; identifying red flags; initiating evidence-based lifestyle and preventive care; and coordinating specialist input. Opportunistic screening tools can support this process, but they require validation before they can be recommended as diagnostic or population-screening instruments.

The shift in nomenclature also creates an educational opportunity. Explaining that “polycystic” ovaries are neither necessary nor sufficient for diagnosis can reduce confusion, while the words “polyendocrine” and “metabolic” encourage attention to the syndrome’s broader health effects. Nevertheless, implementation should remain evidence based, culturally sensitive, and mindful that changing terminology alone will not overcome inequities in access, diagnostic delay, or weight stigma.

6. Conclusions

Polyendocrine metabolic ovarian syndrome is a complex endocrine–metabolic disorder with reproductive, metabolic, cardiovascular, dermatologic, and psychological consequences. The proposed nomenclature more accurately reflects its multisystem character and supports integrated, individualized care. Family physicians are well positioned to facilitate early recognition, assess cardiometabolic and psychological risk, implement preventive measures, and provide longitudinal coordination. Opportunistic case finding may shorten diagnostic delay, but screening tools should complement rather than replace clinical assessment and current diagnostic criteria.

This entry is adapted from: 10.26416/Med.171.3.2026.11574