More than 170 million women worldwide have polyendocrine metabolic ovarian syndrome. More than 119 million of them do not know it. That is the estimated 70 percent undiagnosed rate, a figure that has persisted for decades despite the condition being one of the most common endocrine disorders in women of reproductive age.
The rename from PCOS to PMOS in May 2026 was not just a terminological update. It was, in large part, a direct response to this diagnostic crisis. Understanding why so many women are missed, and what the new name is designed to change, matters.
The Number: 70% Undiagnosed
The statistic comes from multiple population-based studies that screened unselected women using the Rotterdam diagnostic criteria. When you screen women who have never sought medical attention for hormonal or menstrual symptoms, a substantial proportion meet diagnostic criteria for the syndrome without ever having been told.
Average time to diagnosis for those who do get diagnosed is over two years. Many women report visiting three or more doctors before receiving an answer. In surveys, patients consistently describe feeling dismissed, being told their symptoms are normal, or being prescribed birth control as a blanket solution without investigation.
Why So Many Women Are Missed
The diagnostic gap has multiple causes, and they compound each other.
The Lean PMOS Problem
The stereotype of a PMOS patient is an overweight woman with acne and facial hair. But PMOS occurs across the entire weight spectrum. Lean women with the condition are routinely missed because they do not “look” like the textbook picture. Their irregular periods are attributed to stress. Their fatigue is attributed to lifestyle. Their subtle hormonal symptoms are never investigated.
Symptom Normalization
Many PMOS symptoms are so common that they get normalized rather than investigated. Irregular periods in adolescence are attributed to puberty. Acne is treated with dermatological products rather than hormonal workup. Difficulty losing weight is attributed to diet and exercise habits rather than metabolic dysfunction.
Fragmented Specialist Care
A woman with PMOS might see a gynecologist for irregular periods, a dermatologist for acne, an endocrinologist for insulin resistance, and a mental health professional for anxiety and depression. If none of these specialists connects the dots, the underlying syndrome goes unrecognized. The condition falls between specialties.
Ultrasound Over-Reliance
Perhaps the most damaging diagnostic pattern is the over-reliance on ovarian ultrasound. Under the Rotterdam criteria, polycystic ovarian morphology is only one of three diagnostic features, and you only need two of three. A woman with anovulation and hyperandrogenism meets criteria regardless of her ultrasound. But in practice, many clinicians treat a normal ultrasound as a rule-out, telling patients they do not have the condition when they may well have it.
How the Old Name Made It Worse
The name “polycystic ovary syndrome” did three specific things that worsened the diagnostic gap.
First, it anchored the condition to ovarian cysts that many patients do not have. When a patient hears “polycystic ovary syndrome” and then learns her ovaries look normal on ultrasound, the cognitive dissonance is enough to make both patient and provider dismiss the possibility.
Second, it framed the condition as a gynecological problem, which meant many primary care providers and non-gynecological specialists did not feel equipped or obligated to screen for it. The metabolic features were treated as comorbidities rather than core features.
Third, it contributed to stigma. “Polycystic” sounds pathological. Patients reported feeling that the name implied something was wrong with their ovaries specifically, adding shame to an already difficult diagnosis.
What the PMOS Name Changes
The PMOS rename addresses each of these problems directly. By removing “polycystic,” it eliminates the misleading implication about cysts. By leading with “polyendocrine metabolic,” it signals to every provider who encounters the term that this is a systemic condition requiring metabolic screening. And by retaining “ovarian” without centering it, the name preserves the reproductive connection without reducing the condition to it.
The 56 organizations backing the rename are also working on implementation strategies including ICD coding updates, medical education curriculum changes, and clinical guideline revisions. The goal is not just to change the word on the page but to change the clinical behavior it triggers.
The Hidden Cardiovascular Risk
One of the most consequential effects of underdiagnosis is missed cardiovascular risk. A 2024 meta-analysis published in the Journal of the American Heart Association confirmed that women with PMOS have significantly elevated risk for cardiovascular events including heart attack and stroke, independent of body weight.
This risk begins decades before events typically occur. Insulin resistance, dyslipidemia, chronic inflammation, and endothelial dysfunction accumulate throughout reproductive years. If a woman is not diagnosed with PMOS, she is not being screened for these risk factors, and opportunities for early intervention are lost.
PMOS is not just a reproductive condition. It is a cardiometabolic risk condition. The rename explicitly acknowledges this by placing “metabolic” in the name, ensuring that cardiovascular screening becomes part of standard PMOS care rather than an afterthought.
Signs You May Have Undiagnosed PMOS
No self-assessment replaces a medical evaluation, but the following patterns should prompt a conversation with a healthcare provider experienced in PMOS:
Menstrual irregularity: Cycles consistently longer than 35 days, fewer than 8 cycles per year, or amenorrhea (no period for 3 or more months in a row).
Hyperandrogenic symptoms: Adult acne that does not respond to standard dermatological treatment, excess facial or body hair, thinning hair on the scalp, oily skin.
Metabolic indicators: Difficulty losing weight despite consistent effort, dark skin patches on the neck or underarms (acanthosis nigricans), strong carbohydrate cravings, family history of type 2 diabetes.
Mood and energy: Persistent fatigue not explained by sleep habits, anxiety or depression with onset in adolescence or early adulthood, brain fog.
Fertility challenges: Difficulty conceiving after 12 months of unprotected intercourse, recurrent early pregnancy loss.
If three or more of these patterns describe your experience, PMOS should be actively investigated.
What to Do If You Suspect PMOS
Request a comprehensive workup that includes total testosterone, free testosterone, SHBG, DHEA-S, LH, FSH, fasting insulin, fasting glucose, HbA1c, and a lipid panel. A pelvic ultrasound is useful but should not be the sole determinant. Under the Rotterdam criteria, you need two of three features for diagnosis: oligo-anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology.
If your provider dismisses your concerns or relies solely on ultrasound, consider seeking a second opinion from an endocrinologist with PMOS experience. The condition is real, common, and treatable. Being undiagnosed is not the same as not having it.
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