PCOS is being renamed PMOS, and a study found no extra ovarian cysts

Key takeaways

• In May 2026, an international team led by Monash University’s Helena Teede announced in The Lancet that polycystic ovary syndrome will become polyendocrine metabolic ovarian syndrome, or PMOS, after a three-year transition¹².
• Under the 2023 International Guideline, adults can be diagnosed with an AMH blood test in place of an ultrasound, but teens need both irregular cycles and signs of high androgens⁵.
• Insulin resistance affects more than half of women with PCOS, and the guideline advises a blood sugar check at diagnosis and every one to three years, whatever your weight⁵⁶.
• In a 750-woman trial funded by the NIH, letrozole led to a live birth for 27.5% of women, compared with 19.1% on clomiphene, about 8 more births per 100 by our math¹¹.
• The guideline says inositol supplements offer limited benefit, and a 2024 review of 30 trials called the evidence limited and inconclusive⁵¹⁰.

For decades, the name told women what to look for: cysts on the ovaries.

In May 2026, researchers in Finland and Australia tested that idea directly. In a study in JAMA Internal Medicine, they compared ultrasounds of 1,235 women in their mid-30s, 223 of them with polycystic ovary syndrome¹⁵. Simple cysts, endometriomas and dermoid cysts were no more common in the women with the condition than in those without it¹⁵. The University of Oulu calls it the first study to examine the question systematically¹.

Follicles told a different story. These small sacs hold developing eggs, and 20 or more showed up in 62% of the women with the condition, compared with 12% of the others¹⁵. Grants from the Research Council of Finland and the drugmakers Roche and Novo Nordisk helped pay for the underlying data collection¹⁵.

A day later, a larger team that included the same researchers published the condition’s new name in The Lancet: polyendocrine metabolic ovarian syndrome, or PMOS¹². The paper says the chosen words reflect a condition that involves several hormone systems, metabolism and the ovaries².

It’s common. The 2023 International PCOS Guideline estimates that 10% to 13% of women worldwide have it, or between 1 in 10 and 1 in 8 by our math⁵.

It can affect periods, skin and hair, fertility, mood and blood sugar. Helena Teede, the Monash University endocrinologist who led the renaming, has said that because of its name, the syndrome wasn’t taken seriously, and diagnosis and care suffered¹.

Below: how diagnosis works, why insulin sits at the center, and how natural and medical treatments compare. We still say “PCOS” here because the switch will take three years¹.

The new name came from more than 22,000 survey answers

The renaming wasn’t a quick rebrand. The Lancet paper describes rounds of global surveys, including answers from 14,360 people with PCOS, plus expert workshops, with 56 academic, clinical and patient organizations funding and steering the work². The University of Oulu counts more than 22,000 survey responses over a 15-year effort, and says 84% of patients and health professionals backed a change¹.

The plan calls for a three-year transition, backed by education for patients and clinicians. The new name will be built into the next international guideline, due in 2028¹.

Some agencies have started. NIH’s child-health institute now describes PCOS as “also known as Polyendocrine Metabolic Ovary Syndrome (PMOS),” on a page reviewed in July 2026³. Note the small difference: NIH writes “Ovary,” while the Lancet name uses “Ovarian”²³.

The change doesn’t create a new disease¹. The 2023 guideline’s diagnosis and treatment advice still apply. Terhi Piltonen, an Oulu professor who helped lead the effort, said the team wanted a name that was scientifically sound, made sense in many cultures and didn’t deepen stigma¹.

Two of three features make the diagnosis, and a blood test can replace the ultrasound

The 2023 International Evidence-based Guideline was led by Monash University and funded by Australia’s National Health and Medical Research Council⁴⁵. It drew in 39 professional and consumer groups covering 71 countries, and its partners included the American Society for Reproductive Medicine and the Endocrine Society⁴.

For adults, the diagnosis requires two of three features, after other causes are ruled out⁵:

• High androgens, male-type hormones, shown in blood tests or by signs such as excess hair growth or acne.
• Irregular or absent ovulation, usually seen as irregular periods.
• Polycystic ovaries on ultrasound, meaning 20 or more follicles in at least one ovary, or a high level of AMH (anti-Müllerian hormone) in the blood.

The AMH option is new. It’s meant for adults only, and the guideline says it shouldn’t be used as a single test⁴⁵.

Teens are different. Because irregular cycles can be normal soon after a first period, teens need both high androgens and irregular ovulation⁵. Ultrasound and AMH aren’t recommended within eight years of a first period. A teen with some features can be checked again later⁵.

Your cycle is part of the test

The guideline spells out what counts as irregular⁵:

• In the first year after a first period, irregular cycles are normal.
• From one to three years after, cycles shorter than 21 days or longer than 45 days are irregular.
• After three years, cycles shorter than 21 days or longer than 35 days, or fewer than eight periods a year, are irregular.
• After the first year, any single cycle longer than 90 days counts.

That’s where cycle awareness, a value many natural-health readers already practice, pays off. A simple record of period start dates can show a clinician the pattern.

Other signs NIH lists include skipped or absent periods, very heavy periods, hair growth on the face, chest, belly or upper thighs, severe or persistent acne, oily skin, and dark, velvety skin patches⁶. As many as 7 in 10 women with PCOS have excess hair growth, according to the federal Office on Women’s Health⁹.

Insulin drives many symptoms, at any body size

Insulin resistance, a poor response to insulin, affects more than half of women with PCOS⁶. The pancreas makes more insulin to compensate, and the body then makes more androgens, NIH explains⁷. High androgens can stall the follicles that hold developing eggs and disrupt the brain signals that trigger ovulation⁷.

Our companion article on insulin’s partner hormones explains why insulin resistance also rises in puberty and pregnancy. Genes matter, too: PCOS runs in families, and researchers have found 19 gene variants tied to it⁷.

The metabolic risks are real. NIH says metabolic syndrome shows up in roughly a quarter to nearly half of women with the condition, and more than half will develop prediabetes or type 2 diabetes by their early 40s⁶. The CDC states it more starkly, saying more than half develop type 2 diabetes by 40⁸. NIH’s wording, which includes prediabetes, is the more careful of the two.

Because of that, the guideline advises checking blood sugar at diagnosis in all adults and teens, then every one to three years⁵. It calls the 75-gram oral glucose tolerance test, a fasting blood test before and after a sugary drink, the most accurate option, whatever a person’s weight⁵.

Other risks to know:

• Pregnancy. Women with PCOS have higher rates of miscarriage, gestational diabetes, preeclampsia and cesarean birth⁹. The guideline suggests a glucose test before pregnancy or at the first prenatal visit, and offering one to everyone with PCOS at 24 to 28 weeks⁵.
• Heart. The risk of heart disease is higher, but the absolute risk before menopause is low. The guideline advises a cholesterol test at diagnosis and a blood pressure check every year⁵.
• The uterus. Before menopause, women with PCOS face a markedly higher risk of endometrial hyperplasia, an overgrowth of the uterine lining, and endometrial cancer. The overall chance is still low, so routine screening isn’t advised⁵.
• Sleep apnea, pauses in breathing during sleep⁶.

Lifestyle comes first, but no single diet has won

The guideline recommends healthy habits for everyone with PCOS. It found no sign that one diet makeup beats another, so it points to general healthy-eating advice shaped to each person’s preferences⁵.

For movement, it follows general guidelines: 150 to 300 minutes of moderate activity or 75 to 150 minutes of vigorous activity a week for adults, plus muscle strengthening on two days. Teens should aim for 60 minutes a day⁵.

Weight is a sensitive subject, and the guideline treats it that way. It tells clinicians to minimize weight stigma, ask permission before weighing someone, and use “higher weight” instead of labels like “obese”⁵. Our article on weight bias in health care offers scripts for those conversations.

For people who want to lose weight, a modest amount can matter. The Office on Women’s Health says losing 10% of body weight, 15 pounds for a 150-pound woman, can make cycles more regular and improve the chance of pregnancy⁹.

But dieting carries its own risk here. The guideline tells clinicians to consider eating disorders and disordered eating in women of any weight, especially during weight management⁵. If food, weight or exercise starts to feel out of control, the National Alliance for Eating Disorders runs a free weekday support and referral helpline at 1-866-662-1235.

These levers fit natural-health values: food, movement and paying attention to your body. They work best as care, not punishment.

PCOS: what the guideline recommends

This table is our own, built from the 2023 guideline. It’s a starting point for a talk with your clinician, not a treatment plan.

The guideline uses should for firmer advice and could for conditional advice⁵. Its authors rated most of the evidence behind it low to moderate in quality⁴. Our ratings for key options come in the next section.

Goal	Main options	How firm the advice is	Notes
Regular periods, less unwanted hair	Combined birth control pill, with lower doses preferred5	Called first-line, though the formal advice is conditional (could)5	Hormonal birth control also lowers endometrial cancer risk9; anti-androgen pills aren’t FDA-approved for PCOS and can harm a pregnancy9
Blood sugar and metabolism	Healthy habits for all; metformin for adults with a BMI of 25 or more5	Firmer (should be considered)5	Metformin isn’t FDA-approved for PCOS and does little for acne or hair9
Weight, if a goal	Habits; liraglutide, semaglutide or orlistat alongside them5	Conditional, based on expert consensus5	PCOS trials are small13
Ovulation to conceive	Letrozole5	Firm: first-line5	Off-label in many countries5
Mood	Screening for depression in all, anxiety in adults5	Firm (should screen)5	Ask at diagnosis and later visits
Supplements	Inositol, by personal preference5	Conditional (could)5	Experimental for fertility5

Letrozole beat the old standard

Clomiphene used to be the standard first fertility pill for PCOS¹¹. In 2014, a trial led by Richard Legro of Penn State compared it with letrozole in 750 women ages 18 to 40, for up to five cycles¹¹¹².

Letrozole led to a live birth for 27.5% of women, compared with 19.1% on clomiphene¹¹. By our math, that’s about 8 more babies per 100 women, or one extra birth for every 12 women treated. Penn State reported fewer twin pregnancies with letrozole, 3.9% versus 6.9%¹². Major birth defects were rare in both groups, and the difference wasn’t statistically significant¹¹.

The trial was funded by the NIH¹¹¹². The 2023 guideline now names letrozole first-line⁵.

GLP-1 drugs: early PCOS data

Weight-loss drugs such as semaglutide are now on the guideline’s list for some women, as a consensus suggestion rather than an evidence-based one⁵. The PCOS-specific review we could check is small and dated. A 2016 review pooled seven small trials of liraglutide in 178 women over about three months¹³. BMI fell by 1.65 points and testosterone dropped slightly, but fasting insulin and a measure of insulin resistance didn’t change¹³.

Check who has ties to whom. Several guideline authors disclosed consulting, speaking or grant ties with drug companies, including drugmaker Novo Nordisk⁴.

Inositol and spearmint tea: popular, lightly tested

Inositol, sold as myo-inositol, D-chiro-inositol or blends, is promoted for possible insulin-sensitizing effects¹⁰. A 2024 review done to inform the guideline pooled 30 trials with 2,230 participants¹⁰.

It found inositol may help some metabolic measures, and D-chiro-inositol may help ovulation, but it may do little for other outcomes¹⁰. Compared with metformin, inositol may be less helpful for excess hair and waist-to-hip ratio, with likely no difference in fertility outcomes¹⁰. Myo-inositol likely causes fewer stomach side effects than metformin¹⁰. The authors called the evidence limited and inconclusive¹⁰.

Trial doses ranged from 1 to 4 grams of myo-inositol a day, often with folic acid¹⁰. The 40-to-1 ratio used in some blends was proposed based on mouse research¹⁰. At least five trials named the company that made the product tested, including Lo.Li. Pharma for two of them, though naming a maker doesn’t prove it paid for the study¹⁰.

Spearmint tea has one small trial behind it. In that 2010 study, described in a review of herbal teas for PCOS, 42 women drank spearmint or placebo tea twice a day for a month¹⁴. Free and total testosterone fell, and women rated their unwanted hair as improved. But a clinician-scored measure of hair growth didn’t change¹⁴. The same review found that only 4 of 104 herbal trials for PCOS tested a tea¹⁴.

Approach	Rating	What the research shows
Letrozole to help ovulation and birth	Strong evidence	Higher live-birth rate than clomiphene in a 750-woman trial11
A special “PCOS diet” beats general healthy eating	Not enough evidence	No diet makeup proved better5
Inositol for metabolic measures	Promising but early	Possible benefit; review called evidence inconclusive10
Inositol for fertility	Not enough evidence	Guideline calls it experimental5
Spearmint tea for unwanted hair	Promising but early	Hormones fell in one month-long trial; measured hair didn’t change14
GLP-1 drugs for PCOS symptoms	Promising but early	Small, short liraglutide trials13

Tell your clinician about any supplement you take, and don’t swap one for a prescribed medicine on your own.

Mood, body image and being heard

The guideline’s authors noted that psychological symptoms are very common in PCOS⁴. The CDC also links PCOS to depression and anxiety, though it says the connection isn’t fully understood⁸.

So the guideline advises screening everyone with PCOS for depression, and adults for anxiety, at diagnosis and later as needed⁵. If low mood brings thoughts of suicide or self-harm, call or text 988 to reach the Suicide & Crisis Lifeline.

Being heard is part of care. The renaming drew on thousands of survey answers from people with the condition². Bring that same spirit to your visits: a record of your cycles, a list of symptoms and your own goals.

When to see a clinician

• Your cycles are often shorter than 21 days or longer than 35, or you have fewer than eight periods a year, three or more years after your first period⁵.
• Any single cycle runs longer than 90 days after your first year of periods⁵.
• You notice new hair growth on your face, chest or belly, severe or persistent acne, or dark, velvety skin patches⁶.
• You have PCOS and are planning a pregnancy or are pregnant. Ask about a glucose test early and at 24 to 28 weeks⁵.
• You have PCOS and haven’t had a blood sugar test in one to three years, or a blood pressure check this year⁵.
• You feel low or anxious most days. Ask to be screened⁵.

A later article in this series covers fertility myths and when to seek an infertility evaluation.

Questions readers ask

The bottom line

PCOS is getting a new name because the old one pointed at cysts, and a 2026 study found no more of them in women who have it. The condition is about hormones, metabolism and the ovaries, and it affects roughly 1 in 10 to 1 in 8 women.

The 2023 guideline offers a clearer path: diagnosis from cycles, androgen signs and either an ultrasound or an AMH test; regular blood sugar checks at any weight; healthy habits without a mandated diet; and guideline-backed medicines such as the pill, metformin and letrozole. Inositol and spearmint tea are reasonable to discuss, but their evidence is still early.

Related reading

• Insulin has a team that pushes back, as puberty and pregnancy show
• Insulin resistance is common even without obesity, and its popular test isn’t standard
• Metabolic syndrome is just five numbers that together still predict trouble
• Doctors share the public’s weight bias, and you can protect your care from it
• Real hormone problems have names and tests, which “balance your hormones” claims lack

Sources

1. University of Oulu. “Women’s most common hormonal disorder gets a new name.” News release, May 12, 2026. oulu.fi
2. Teede HJ, Bahri Khomami M, Morman R, et al. “Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process.” The Lancet, 2026;407(10545):2329-2339, published online May 12, 2026 (Cardiff University repository record). pubmed.ncbi.nlm.nih.gov
3. Eunice Kennedy Shriver National Institute of Child Health and Human Development. “Polycystic Ovary Syndrome (PCOS).” NIH, reviewed July 2, 2026. nichd.nih.gov
4. Teede HJ, Tay CT, Laven J, et al., International PCOS Network. “Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.” Human Reproduction, 2023 (Monash University record). research.monash.edu
5. Monash University and International PCOS Network. “Summary: International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2023.” PDF copy hosted by Monash IVF. assets.monashivf.com
6. Eunice Kennedy Shriver National Institute of Child Health and Human Development. “What are the symptoms of PCOS?” NIH, reviewed August 21, 2024. nichd.nih.gov
7. Eunice Kennedy Shriver National Institute of Child Health and Human Development. “Polycystic Ovary Syndrome (PCOS)” fact sheet. NIH, accessed October 2026. nichd.nih.gov
8. Centers for Disease Control and Prevention. “Diabetes and Polycystic Ovary Syndrome (PCOS).” CDC, reviewed May 15, 2024. cdc.gov
9. Office on Women’s Health. “Polycystic ovary syndrome.” U.S. Department of Health and Human Services, updated October 24, 2025. womenshealth.gov
10. Fitz V, Graca S, Mahalingaiah S, et al. “Inositol for Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis to Inform the 2023 Update of the International Evidence-based PCOS Guidelines.” Journal of Clinical Endocrinology & Metabolism, 2024 (University of Adelaide repository). digital.library.adelaide.edu.au
11. Legro RS, Brzyski RG, Diamond MP, et al. “Letrozole versus Clomiphene for Infertility in the Polycystic Ovary Syndrome.” New England Journal of Medicine, 2014 (VCU Scholars Compass record). scholarscompass.vcu.edu
12. Penn State Health News. “Letrozole more effective than standard drug for infertility in women with PCOS.” July 9, 2014. pennstatehealthnews.org
13. Niafar M, Pourafkari L, Porhomayon J, Nader N. “A systematic review of GLP-1 agonists on the metabolic syndrome in women with polycystic ovaries.” Archives of Gynecology and Obstetrics, 2016 (University at Buffalo record). researchconnect.buffalo.edu
14. “The Effect of Herbal Teas on Management of Polycystic Ovary Syndrome: A Systematic Review.” Journal of Midwifery and Reproductive Health, Mashhad University of Medical Sciences. jmrh.mums.ac.ir
15. Piltonen TT, Kuusiniemi E, Teede H, et al., for the WENDY Research Group. “Ovarian Cysts in Polycystic Ovary Syndrome.” JAMA Internal Medicine, 2026;186(8):1041-1043, published online May 11, 2026 (research letter; corrected June 15, 2026). pubmed.ncbi.nlm.nih.gov