Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process.

# Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process *The Lancet 2026* Health Policy Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process Helena J Teede, Mahnaz Bahri Khomami*, Rachel Morman*, Joop S E Laven, Anju E Joham, Michael F Costello, Madhuri Patil, D Aled Rees, Lorna Berry, Melanie G Cree, Han Zhao, Robert J Norman*, Anuja Dokras*, Terhi Piltonen*, on behalf of the Global Name Change Consortium† Polyendocrine metabolic ovarian syndrome (PMOS), previously named polycystic ovary syndrome (PCOS), aects Published Online one in eight women. However, the term PCOS is inaccurate, implying pathological ovarian cysts, obscuring diverse May 12, 2026 endocrine and metabolic features, and contributing to delayed diagnosis, fragmented care, and stigma, while https://doi.org/10.1016/ S0140-6736(26)00717-8 curtailing research and policy framing. Building on an international mandate for change, we outline an unprecedented, *Contributed equally rigorous, multistep global consensus process for the name change. Funding and governance were established with †Members listed in the appendix engagement of 56 leading academic, clinical, and patient organisations. Using iterative global surveys (with responses (pp 25–27) from 14 360 people with PCOS and multidisciplinary health professionals from all world regions), modified Delphi Monash Centre for Health methods, nominal group technique workshops, and marketing and implementation analyses, we identified principles Research and Implementation, prioritising scientific accuracy, clarity, stigma avoidance, cultural appropriateness, and implementation feasibility. An Monash University, Melbourne, accurate new name was prioritised over retaining the PCOS acronym or a generic name. Implementation approaches VIC, Australia (Prof H J Teede PhD, prioritised evolution rather than transformation. Preferred terms were polyendocrine, metabolic, and ovarian, M B Khomami PhD, reflecting the condition’s multisystem pathophysiology, and polyendocrine metabolic ovarian syndrome was the A E Joham PhD); Endocrine and consensus new name. Accuracy was improved by omitting cysts and by capturing endocrine, metabolic, and ovarian Diabetes Units, Monash Health, dysfunction. A co-designed global implementation strategy, including a transition period, education, and alignment Melbourne, VIC, Australia (Prof H J Teede PhD, with health systems and disease classification, is under way. A E Joham PhD); Verity, London, UK (R Morman); Division of Background and rationale cysts are not increased.8–10 These factors delay diagnosis— Reproductive Endocrinology Polycystic ovary syndrome (PCOS) aects 170 million with up to 70% of aected individuals remaining and Infertility, Department of Obstetrics and Gynaecology, women during their reproductive years alone.1 Following undiagnosed—and also contribute to widespread Erasmus University Medical exclusion of other disorders, the condition is diagnosed knowledge gaps and patient dissatis faction.11–13 In 2012, Centre, Rotterdam, based on adults (aged ≥20 years) meeting at least two of the US National Institutes of Health Oce of Disease Netherlands the following International Guideline criteria: (1) oligo- Prevention Evidence-based Methodology Workshop on (Prof J S E Laven PhD); Women’s anovulation, (2) clinical or biochemical hyper androgenism, and (3) polycystic ovaries on Key messages ultrasound or elevated anti-Müllerian hormone (AMH).2,3 Adolescents (aged 10–19 years) require the presence of • Polycystic ovary syndrome affects more than 170 million women globally, yet its the first two criteria.4 PCOS has long been primarily current name is inaccurate and misleading, obscuring the condition’s multisystem perceived as a gynaecological or ovarian disorder; endocrine and metabolic features, reinforcing stigma, delaying diagnosis, and however, mounting research, evidence synthesis, and hindering effective clinical care, research, and policy alignment. International Guidelines have shown that PCOS is • Through an unprecedented, rigorous global consensus process engaging patients, underpinned by endocrine disturbances in insulin, multidisciplinary health professionals, and organisations across world regions, a new androgens, and neuroendocrine and ovarian hormones.2–5 name—polyendocrine metabolic ovarian syndrome—was agreed, omitting the Features can be metabolic (ie, obesity, dysglycaemia, misleading reference to ovarian cysts and accurately reflecting the diverse features of type 2 diabetes, hypertension, dyslipidaemia, metabolic the condition. dysfunction-associated steatotic liver disease, cardio- • Consensus for the new name was built by use of robust, transparent methods, vascular disease, and sleep apnoea), reproductive including modified Delphi survey processes, nominal group technique workshops, and (ovulatory disturbances, irregular menstrual cycles, implementation and marketing analyses, ensuring scientific accuracy, cultural infertility, pregnancy complications, and endometrial appropriateness, stigma avoidance, and feasibility of adoption. These processes cancer), psychological (depression, anxiety, poor quality optimised representativeness, legitimacy, and transparency, and served to enhance of life, and eating disorders), and dermatological (acne, engagement to underpin implementation. alopecia, and hirsutism).2–5 BMI is generally higher in • Coordinated implementation is under way in health systems, research institutions, people with PCOS than in those without the condition, funding bodies, education providers, clinical guidelines, and disease classification and contributes to its severity.6 Overall, PCOS has systems (including ICD coding), and is supported by a global transition period and multisystem health impacts and represents a growing continuous evaluation. health and economic burden.1,7 • Aligning nomenclature with scientific evolution and improving accuracy will enhance However, the broad clinical features of the condition awareness, diagnosis, care quality, research coherence, and patient experience, are not captured in its current name, as although arrested strengthening policy, advocacy, and health outcomes globally. follicular development is common, pathological ovarian www.thelancet.com Published online May 12, 2026 https://doi.org/10.1016/S0140-6736(26)00717-8 1 Health Policy Health, School of Clinical PCOS highlighted the challenges and inaccuracy of the education and implementation strategies. An Medicine, University of New current name, and recommended a change to better accompanying impact assessment indicated that the South Wales, Sydney, NSW, reflect the condition.14 Despite the strong rationale perceived benefits of a name change outweighed the Australia (M F Costello DMedSc); (panel 1) and long-standing recognition that PCOS is an risks.9 As a result of these data, the compelling evidence Dr Patil’s Fertility and Endoscopy Clinic, Bengaluru, inaccurate and misleading term, eorts to change the base, and strong patient advocacy and leadership by India (M Patil MD); name have repeatedly stalled. Patient groups, alongside Verity, a UK-based charity and advocacy organisation, Neuroscience and Mental leaders in the field of reproductive medicine, such as Monash University’s Centre for Research Excellence in Health Innovation Institute, Dr Ricardo Azziz, Prof Andrea Dunaif, Women’s Health in Reproductive Life and the Androgen School of Medicine, Cardiff University, Cardiff, UK Prof Bart CJM Fauser, Prof Robert J Norman, and Prof Excess and PCOS Society launched a global initiative (Prof D A Rees PhD); Polycystic Helena J Teede, have persistently advocated for with a clear mandate for a name change.9 Ovary Syndrome Association of change.8,9,15,16 Expert commentaries, guidelines, and Throughout this process, we sought to obtain funding; Australia, Melbourne, VIC, Australia (L Berry); Division of surveys have rearmed the limitations of the narrow establish governance; further engage people with PCOS, Paediatric Endocrinology, reproductive focus and inaccuracies, noting ongoing multidisciplinary health professionals, and their member Department of Pediatrics, confusion among people with PCOS and clinicians, organisations across world regions; and undertake global University of Colorado fragmented policy and advocacy eorts, and downstream surveys and workshops through modified Delphi and Anschutz, Aurora, CO, USA (M G Cree PhD); State Key consequences for diagnosis, care, outcomes, and nominal group techniques. We aimed to establish Laboratory of Reproductive research.2,8,9,15 However, previous renaming eorts failed principles, approaches, preferred terms, a new name, Medicine and Offspring Health, to gain traction, with barriers including a lack of inclusive and implementation priorities.9 Ultimately, this Health Centre for Reproductive global leadership and the need for a coordinated Policy initiative outlines both the consensus process and Medicine, Institute of Women, Children and Reproductive international consensus process, alignment between a pragmatic global implemen tation strategy to correct Health, Shandong University, patient advocacy groups, agreement on an alternative inaccuracies, recognise diverse clinical features of the Jinan, China (H Zhao PhD); name, and a comprehensive implementation strategy.8,9 condition, and strengthen research, education, and Robinson Research Institute, The need for greater awareness, advocacy, education, and clinical care to improve health outcomes globally for Adelaide Medical School, Adelaide University, Adelaide, implementation, alongside international collaboration people with polyendocrine metabolic ovarian syndrome SA, Australia and resourcing, was also recognised.9 A longitudinal (PMOS). (Prof R J Norman MD); global study engaged people with PCOS and health Department of Obstetrics and professionals in serial surveys and workshops and Global engagement and processes Gynaecology, University of Pennsylvania, Philadelphia, PA, highlighted ongoing confusion around the name.9 The Australian National Health and Medical Research USA (Prof A Dokras PhD); Overall, 84% of respondents endorsed a global consensus Council awarded funding to the Centre for Research Department of Obstetrics and process to identify and implement a new name, alongside Excellence in Women’s Health in Reproductive Life, Gynaecology, Research Unit of which provided leadership alongside the Androgen Excess and PCOS Society, an international multidisciplinary Panel 1: Context and the case for a new name society focused on advancing education and awareness, and Verity, a leading patient charity and advocacy group. The term polycystic ovary syndrome (PCOS) has long been recognised as inaccurate and We established an international steering group with potentially harmful. The following evidence-based considerations informed the need for members from across lead agencies, and identified and a new name: engaged patient groups and professional societies from • The term polycystic ovary implies the presence of pathological ovarian cysts, which are the International PCOS Guideline Network, with not a feature of the condition. This misnomer contributes to misunderstandings purposive extension to broader disciplines and world among patients, clinicians, policy makers, and the public. regions.2 In April, 2025, letters to organisation members • PCOS encompasses diverse endocrine, metabolic, reproductive, psychological, and were distributed to encourage participation in tasks such dermatological features. The current name reflects only one organ and fails to capture as survey dissemination, workshop representative the disorder’s multisystem nature. nomination, and contribution to implementation and • Confusion arising from the current name can delay diagnosis and hinder effective dissemination of the new name. Building on previous communication between patients and health professionals, contributing to patient survey results, global surveys were co-designed and dissatisfaction with care. disseminated, and international consensus workshops • The reproductive focus of the name can reinforce stigma, particularly in sociocultural were convened by use of robust methods aligned with the contexts where fertility carries high value. Many individuals report distress associated James Lind Alliance processes (panel 2).17–19 with the name itself. • The misnomer complicates epidemiological classification, research comparability, and Delphi surveys health system coding. A more accurate name is expected to improve scientific The new surveys built on the results of two previously coherence, research funding, and policy alignment. published surveys and workshops in 2017 and 2023, and • International guidelines, expert groups, and patient organisations have repeatedly were informed by literature review and consultation with called for renaming, with serial surveys and workshops culminating in a mandate to health professionals and people with PCOS.9 We used a change the name through a rigorous, global consensus process. purposive, stratified non-probability sampling approach, • A new name must support long-term clinical care, research, and global adoption, and recruiting participants via partnering professional enable a smooth transition from existing terminology. societies and patient organisations, with targeted 2 www.thelancet.com Published online May 12, 2026 https://doi.org/10.1016/S0140-6736(26)00717-8 Health Policy sampling to achieve multidisciplinary representation Clinical Medicine, Medical Panel 2: Overview of the consensus process across world regions. Extended recruitment timelines Research Centre, Oulu and dissemination strategies aimed to maximise reach, We conducted a structured, multistep global process to University Hospital, University of Oulu, Oulu, Finland including engagement with harder-to-reach populations establish a new name for polycystic ovary syndrome, (Prof T Piltonen PhD) through language translation and use of multiple online incorporating patient and professional perspectives across all Correspondence to: platforms. No formal sample size calculation was done; world regions. Key stages included: Prof Helena J Teede, Monash the sample size was guided by our aim of achieving • Funding: we obtained resources for the name change Centre for Health Research and broad global representation across regions and process and translation (in September, 2024) Implementation, Monash University, Melbourne, VIC 3168, disciplines. • Governance and stakeholder engagement: we established Australia Survey A (appendix p 1) included a historical an international governance framework and recruited helena.teede@monash.edu introduction and rationale, an outline of the mandate for patient organisations, professional societies, and lived See Online for appendix a name change, a linked explanatory statement, ethics experience and multidisciplinary health professional approval, and implied consent details. Demographic data experts (in December, 2024) included age, country, and participant type (ie, people • Delphi surveys: building on 7708 previous survey with PCOS or health professionals). Questions were responses, two further global surveys (launched in largely similar across patient and health professional April, 2025, and January, 2026,) generated a further surveys, other than the use of plain language and 14 360 responses from 10 411 patients and 3949 health explanation of technical terms for people with PCOS. professionals, that identified principles, approaches, Likert scales and free text response options were provided. terminology, and combinations for a new name Additional naming principles included scientific accuracy, • Nominal group workshops: in November, 2025, and ease of communication, stigma avoidance, and cultural February, 2026, we held serial online workshops with appro priateness. Approaches presented included participants from all world regions for systematic iterative adopting a generic name, an accurate name reflecting testing of endocrine, metabolic, and reproductive terms, features of the condition, or a name that retained the combinations, and acronyms, with prioritisation based on acronym PCOS with dierent terms. Each proposed accuracy, acceptability, and cultural appropriateness approach included a list of terms and name options. The • Marketing and communication analysis: we applied principles, preferred approach, and related options for branding and communication frameworks to assess this approach were carried forward to subsequent stages. feasibility, clarity, and transition strategies for candidate Participants could opt to leave their email addresses for names in December, 2025 future involvement. • Prioritised outcome: agreement among patients and Survey A was provided on multiple online platforms health professionals on the new name (polyendocrine (ie, Qualtrics, Google Forms, and WeChat) in English, metabolic ovarian syndrome) occurred in February, 2026 Chinese, German, Persian, and Malaysian to optimise • Implementation strategy: in 2025 and 2026, we global reach. These languages were pragmatically developed a transition roadmap to support adoption selected and provided based on the most common across clinical practice, research, education, and public spoken languages globally and the availability of communication workshop participants for translation, validation, and dissemination. For many other world regions, English proficiency was considered sucient. All languages were with PCOS included leaders in patient advocacy accepted in free text comments. The survey link was organisations and community-based participants. Health disseminated via engaged societies and patient groups professionals included representatives from key (through newsletters, dedicated email communication, disciplines and leading world experts. Recruitment and conference announcements), social media (ie, X and sources included members of the steering committee, LinkedIn), and steering committee networks, and was lead agency governing bodies, and single nominees from open from April 1 to Oct 1, 2025. Survey results guided each engaged society or patient advocacy group. To preparatory work for the workshops, including engage broadly across world regions and disciplines, background research on naming options. additional representatives were identified via networks Survey B was generated to address specific controversies and self-nomination in survey A. All participants were emerging from workshop A, including the reproductive invited to complete an online expression of interest form term and final preferred name (appendix p 15). This on workshop availability, country, ethnicity, nominating survey was disseminated by email to survey A participants organisation, and disciplines; health professionals were who had provided their email address, and to workshop also asked about their experience in clinical care for A attendees, and was open from Jan 20 to Jan 31, 2026. PCOS, and people with PCOS were asked for their time since diagnosis. The steering committee approved the Workshops final workshop invitation list, with invitations then sent Recruitment of attendees was rigorous and purposive, as by email. No financial incentives were oered for we aimed for engagement across world regions. People participation, other than reimbursement for time and www.thelancet.com Published online May 12, 2026 https://doi.org/10.1016/S0140-6736(26)00717-8 3 Health Policy contribution from lead patient representatives on the feedback was shared broadly by co-chairs and confidential steering committee. Independent observers were online individual voting was conducted to rank priorities. recruited and trained to facilitate. Before workshop A, participants had to complete a code Patient involvement of conduct (appendix p 20) covering expected behaviours, Verity, a UK patient charity and advocacy group, led the confidentiality, and agreement to respect publication reinvigoration of the renaming initiative in 2023. The embargo and streamlined communication and messaging Australian Health Research Alliance guidance on patient with signed agreement. The workshop agenda and a involvement was followed throughout the name change 15-min video presentation on the history of the name process, supporting an active, respectful partnership in change, purpose, workshop processes (including which people with PCOS were valued for their lived transparent participant recruitment), consensus methods, experience, and were involved as active contributors with and participants’ roles and responsibilities, were shared power.20 This involvement captured patients’ real- disseminated to all participants. Principles and world needs and values from global and multicultural approaches generated from survey A were presented to perspectives to foster relevant, inclusive, and impactful underpin the workshop’s structure and activities. outcomes. People with PCOS were integrally involved in Preparatory sessions and guiding documents were all stages of governance, survey co-design, workshop provided for breakout group chairs (ie, people with development, presentations, dissemination, and PCOS), co-chairs (health professionals), and independent communication. Survey results were disaggregated by observers. The workshop was conducted via Zoom with participant group. dedicated IT support provided by Monash University. The implementation strategy was co-designed by Workshop A involved a brief introduction, outline of the implementation science experts in partnership with code of conduct, presentation of survey results on people with PCOS. These were based on the principles principles and approaches, and presentations of the most derived from survey A, the previous survey’s impact accurate and supported terminology. Participants then assessment,9 the Consolidated Framework for engaged in breakout discussions, followed by individual Implementation Research21 and the Expert online voting on preferred terms. The process was Recommendations for Implementing Change strategies,22 repeated after combining the terms to form the new professional marketing input, and workshop feedback. name. Breakout groups were preassigned to ensure Ethics approval was obtained from the Monash Health balanced representation across people with PCOS, Ethics Committee (project numbers 07070C and 78892). disciplines, and world regions. All groups included participants from three to five world regions, three to Outcomes and consensus four people with PCOS, and at least three disciplines. The steering group comprised a Chair (ie, author HJT), Each group was co-chaired by a patient and a health two people with PCOS (authors RM and LB), and professional, with independent observers present to seven multidisciplinary health professionals (authors oversee adherence to the code of conduct. Each participant HJT, JSEL, AEJ, MFC, RJN, AD, and TP) from had a timed opportunity to raise any clarifications, three continents, and an academic project lead (MBK). concerns, or considerations. After breakout discussions, The Androgen Excess and PCOS Society Board was an advisory body and included health professionals and academic leaders from multiple world regions and Survey A Workshop Survey B (n=3656) registrations* (n=293) disciplines. Organisations were from across world (n=60) regions and diverse health professional disciplines, Obstetrics and gynaecology 1183 16 117 including obstetrics and gynaecology, fertility, Reproductive endocrinology 664 15 94 endocrinology, paediatrics, dermatology, imaging, Endocrinology 366 13 50 primary care, nutrition science, and psychology (appendix p 23). Primary care 267 3 36 Nutrition or exercise 215 2 64 Survey and workshop reach and participant Nursing or midwifery 136 2 39 characteristics Paediatrics 62 5 17 Survey A included responses from 9358 people with Dermatology 8 1 2 PCOS and 3656 health professionals. 27 people with Psychology 34 1 24 PCOS and 63 health professionals participated in the Academia or laboratory work 292 2 81 workshops, and 1053 people with PCOS and 293 health Questions in surveys A and B were not mandatory, and multiple responses were professionals in survey B, with broad global represen- allowed. Totals therefore might not equal the number of respondents. tation (appendix p 24). Given the extensive, multichannel *Five participants who attended workshop A were unable to attend workshop B. dissemination strategy, a response rate for survey A Table 1: Health professional disciplines represented across workshops could not be determined. Health professionals and surveys A and B represented a wide range of disciplines (table 1). 4 www.thelancet.com Published online May 12, 2026 https://doi.org/10.1016/S0140-6736(26)00717-8 Health Policy Workshop A was held in November, 2025, with Survey A Survey B 90 attendees from multiple world regions (table 1). Survey B was distributed to participants who had Patients Health professionals Patients Health professionals (n=9358) (n=3656) (n=1053) (n=293) consented to recontact (n=2733), with 1346 responses received (response rate 49%). Participant characteristics Age, years for surveys A and B, including age distribution, duration 18–25 1563 (19%) 103 (3%) 116 (11%) 3 (1%) of PCOS in patients, and years of PCOS-related 26–35 4230 (50%) 724 (24%) 461 (44%) 38 (13%) experience among health professionals, are shown in 36–45 1866 (22%) 866 (28%) 292 (28%) 82 (28%) table 2. 46–55 523 (6%) 696 (23%) 112 (11%) 93 (32%) ≥56 187 (2%) 612 (20%) 57 (5%) 74 (25%) Principles Prefer not to say 75 (1%) 47 (2%) 6 (1%) 2 (1%) The guiding principles presented in panel 3 were armed Duration of PCOS, years in the survey results and endorsed at workshop A (table 3), <1 1052 (14%) NA 43 (4%) NA with most people with PCOS and health professionals 1–5 2450 (31%) NA 299 (31%) NA supporting the principles. Patient support was strongest 6–10 1564 (20%) NA 199 (20%) NA for stigma avoidance, and health professionals for ≥11 2736 (35%) NA 440 (45%) NA accuracy. These principles were carried forward PCOS care, years throughout the consensus process (table 3). ≤5 NA 812 (27%) NA 105 (24%) 6–10 NA 624 (21%) NA 84 (19%) Approaches 11–20 NA 716 (24%) NA 118 (27%) The approach prioritised on survey was to adopt a new, >20 NA 845 (28%) NA 134 (30%) symptom-based name (as voted for by 86% of people with PCOS and 71% of health professionals). The second Percentages are calculated based on available responses for each variable; denominators therefore vary due to non- response. NA=not applicable. PCOS=polycystic ovary syndrome. ranked approach was adoption of a generic name, such as diabetes or asthma (favoured by 45% of people with PCOS Table 2: Participant characteristics across surveys and 54% of health professionals), and the third was retaining PCOS as the acronym (20% of people with PCOS and 40% of health professionals; table 3). This Panel 3: Summary of naming principles approach was endorsed in workshop A. Prominent Principles guiding the development of a new name for polycystic ovary syndrome were themes in the free text comments highlighted long-held established through global Delphi surveys and multistakeholder workshops. patient frustrations over the need for a name that was • Support for clinical care, research, and improved health outcomes: the name should accurate, enhanced understanding of broader features, facilitate diagnosis, improve awareness, optimise care, and enhance research and and included a focus on recognition that this was a female understanding of the condition to improve health outcomes condition. Some responses noted the need to be aware of • Scientific and medical accuracy: the name must reflect the underlying endocrine and implications for individuals of diverse genders. Concerns metabolic pathophysiology and avoid inaccurately including ovarian cysts. were also expressed that if no change to the PCOS • Clarity and communication: the terminology should be readily understood by acronym occurred, the consensus process’s impact would patients, clinicians, researchers, and the public be diminished. Based on these results, only the approach • Avoidance of stigma: terms perceived as potentially stigmatising—particularly those for a new, accurate, symptom-based name was explored linked directly to reproduction or fertility—should be avoided in the workshops and carried forward in subsequent • Cultural and linguistic appropriateness: the name must be acceptable and steps. interpretable across diverse cultural, linguistic, and regional contexts. • Feasibility of implementation: the name should allow for a practical transition in Key terms clinical, research, and policy environments Survey A’s results, presented in table 3, show that endocrine and polyendocrine, metabolic and cardiometabolic, and ovulatory, ovary, and reproductive were terms supported by most participants. In workshop A, genetics, pathophysiology, and clinical features, the after presentation of the survey results, preferred approach, potential for the reproductive term to cause social principles, and evidence summaries for accuracy, breakout stigmatisation and harm in some cultures or world groups confirmed support for a name change. Only regions was recognised. Alternative terms such as two workshop participants were unsupportive of a name ovulatory were felt to be less stigmatising but did not change, citing evolving science related to the genetic encompass broader reproductive features or extend component of PCOS, the potential for a male phenotype, beyond menopause. Workshop A voting largely aligned and concerns around rebranding and marketing. with survey A’s results, prioritising endocrine and Endocrine and metabolic terms were supported; metabolic terms. After discussions, ovulatory was however, consistent concerns arose around the preferred over reproductive, despite concerns that the reproductive term. Although accurately aligned to term could be too narrow. www.thelancet.com Published online May 12, 2026 https://doi.org/10.1016/S0140-6736(26)00717-8 5 Health Policy Potential names name and highlighted the need for further engagement In workshop A, the preferred terms were combined into processes. candidate names (table 3) and assessed for duplication, pronunciation, stigma, and cultural implications. Some Additional steps terms were excluded (eg, metabolic endocrine Review of all survey responses and breakout discussions, reproductive syndrome, as its acronym would duplicate and reconsideration of alternative terms with majority that of Middle East respiratory syndrome). Endocrine support, highlighted polyendocrine and ovarian as metabolic ovulatory syndrome, although ranked top potential alternative terms. Pro bono assessment from initially, was found to overlap with the so-called emo leading experts in a global marketing agency, including youth subculture, in which emotional expression— the use of artificial intelligence marketing, did not particularly melancholy, alienation, romantic despair, identify any additional terms or names beyond those and anxiety—was central to identity formation. These already considered. The recommendation was for issues, along with concerns on the most appropriate evolutionary rebranding—which supports some reproductive term, precluded consensus on a final new continuity with an existing name or acronym and is framed as an update—rather than revolutionary rebranding, which implies a new condition. Survey B in Survey A (April Workshop A Survey B Workshop B to October, (November, (January, (February, January, 2026, yielded 1346 responses (from 1053 people 2025; 2025; ranked 2026; ranked 2026; ranked with PCOS and 293 health professionals) from across all support %) first %)* first %) first %) world regions. Terms presented included ovary and Naming principles ovulatory, with ovulatory ranking the highest on surveys Scientific accuracy 67%    (table 3); thematic analysis of free text responses Patients 60% ·· ·· ·· confirmed limitations of these terms, with incomplete representation of ovarian, endocrine, and follicular Health professionals 86% ·· ·· ·· disturbances, and irrelevance after menopause. Ease of communication 68%    Polyendocrine was included as an option, alongside Patients 62% ·· ·· ·· endocrine, based on majority support from survey A, Health professionals 85% ·· ·· ·· workshop concerns on the cultural implications of the Avoidance of stigma 71%    acronym EMOS, and because it oered an evolutionary Patients 66% ·· ·· ·· marketing approach with similarity to the current Health professionals 85% ·· ·· ·· acronym, PCOS. Workshop B presentations and Cultural appropriateness 60%    breakout groups reviewed all survey results and free text Patients 53% ·· ·· ·· comments for ovary-related terms (ie, ovulatory and Health professionals 80% ·· ·· ·· ovary from survey A, and ovarian from previous surveys, Naming approaches with 62% of people with PCOS and 67% of health Generic name 48% NA NA NA professionals supporting the latter on surveys). Patients 46% NA NA NA Ultimately, workshop voting prioritised ovarian Health professionals 54% NA NA NA (encompassing endocrine, follicular, and ovulatory Unchanged PCOS acronym, new 25% NA NA NA disturbances), over ovary or ovulatory. terms Patients 20% NA NA NA New name Health professionals 39% NA NA NA The top ranked name on survey B was polyendocrine Accurate name 82%    metabolic ovulatory syndrome. Workshop B revised this Patients 86% ·· ·· ·· to polyendocrine metabolic ovarian syndrome. All Health professionals 70% ·· ·· ·· participants supported the new name, except for Key terms two participants who also did not support a name change. Endocrine features The need for careful attention in language translation Endocrine 85% 65%  NA was also captured. Patients 89% NA ·· NA Health professionals 74% NA ·· NA Implementation Polyendocrine 81% 35% NA  The co-designed implementation strategy was presented Patients 88% NA NA ·· and discussed in workshop breakout groups. Individual Health professionals 60% NA NA ·· feedback was collected from breakout groups and in live Metabolic features online surveys to finalise the strategy (panel 4). Cardiometabolic 52% 21% NA NA Patients 52% NA NA NA Implications (Table 3 continues on next page) This unprecedented and comprehensive international health policy initiative was ultimately focused on 6 www.thelancet.com Published online May 12, 2026 https://doi.org/10.1016/S0140-6736(26)00717-8 Health Policy implementation for global-level impact. The robust Survey A (April Workshop A Survey B Workshop B process generated representativeness, legitimacy, and to October, (November, (January, (February, transparency, with engagement of people with PCOS, 2025; 2025; ranked 2026; ranked 2026; ranked health professionals, and 56 organisations across world support %) first %)* first %) first %) regions. Building on a mandate for change, 14 360 survey (Continued from previous page) responses and multiple workshops with around Health professionals 52% NA NA NA 90 representatives generated agreed principles, Metabolic 76% 79%   supporting better outcomes for people with PCOS, Patients 74% NA ·· ·· scientific accuracy, ease of communication, avoidance of Health professionals 80% NA ·· ·· stigma, cultural appropriateness, and optimising Reproductive features implemen tation. The preferred approach was evolution Reproductive 54% 40% NA NA to a new accurate name that retained some similarity to Patients 52% NA NA NA PCOS to enable its implementation. Ultimately, Health professionals 63% NA NA NA prioritised terms were polyendocrine, metabolic, and Ovary 42% NA NA 25% ovarian, and the preferred name for the condition Patients 38% NA NA 8% formerly known as PCOS was polyendocrine metabolic Health professionals 53% NA NA 30% ovarian syndrome (PMOS). An implementation strategy Ovulatory 54% 60% 51% 5% was codeveloped and is under way. Patients 51% NA 49% 8% A clear rationale and mandate for change underpinned Health professionals 64% NA 64% 5% this consensus process.9 The need to correct the Gynaecological NA NA 37% NA inaccurate polycystic term (which implies pathological Patients NA NA 40% NA ovarian cysts)10 and recognise the multisystem features of Health professionals NA NA 27% NA the condition2 were prioritised by patient and health Repro† NA NA 13% NA professional groups. and government agencies.14 Patients NA NA 11% NA Widespread delayed diagnosis, knowledge gaps, and patient dissatisfaction with information provision and Health professionals NA NA 9% NA care, are well documented.9,12,13 Although International Ovarian NA NA NA 70% Guidelines, evidence-based resources, and ongoing Patients NA NA NA 85% patient and health professional advocacy have contributed Health professionals NA NA NA 65% to improved awareness, confusion associated with the Names and acronyms for combination of terms name has persisted, reinforcing the mandate for change Endocrine metabolic ovulatory NA NA 22% NA syndrome (panel 1).9 Renaming a medical condition is a complex Patients NA NA 22% NA process that requires funding, governance, broad Health professionals NA NA 24% NA engagement, and adherence to robust methods and processes. Such a change also necessitates stakeholder Ovulatory metabolic endocrine NA NA 11% NA syndrome engagement to ensure representativeness, legitimacy, Patients NA NA 10% NA and transparency, and to optimise implementation.9 Health professionals NA NA 19% NA Throughout this process, we built on a clear mandate for Polyendocrine metabolic ovarian NA NA 66%  change, secured funding, established leadership and syndrome‡ governance, delivered a coordinated global consensus Patients NA NA 69% ·· process, obtained broad and inclusive engagement Health professionals NA NA 57% ·· between people with PCOS and multidisciplinary health professionals, and achieved agreement on principles and Tick marks indicate the option was prioritised and carried forward to the next stage of the consensus process. NA=not assessed. *Ranked first indicates the percentage of respondents who selected the option as their highest-ranked (most approaches. We applied iterative Delphi surveys and preferred) choice. †Repro was provided as an option for reproductive, with examples including repro-endocrine or nominal group workshop techniques that were linked to repro-metabolic. ‡Polyendocrine metabolic ovarian syndrome was substituted for endocrine metabolic ovulatory a robust implementation strategy.17,18,20–22 This approach syndrome given its majority support in survey A workshop A, marketing recommendations and cultural addressed barriers and surpassed previous stalled considerations, and to address challenges associated with the acronym of endocrine metabolic ovulatory syndrome (EMOS). PCOS=polycystic ovary syndrome. renaming attempts to exemplify an inclusive, iterative process that could help guide future name change Table 3: Iterative development of naming components across surveys and workshops initiatives. PMOS encompasses multiple interacting endocrine abnormalities, rather than an isolated ovarian diagnostic feature, with elevated ovarian—and often disorder.5,23–25 Meta-analyses of large-scale genomic adrenal—androgens contributing to hirsutism, acne, analyses and recent definitive studies confirm that alopecia, and metabolic features.2,28,29 Central PMOS has polygenic origins across neuroendocrine, neuroendocrine abnormalities include increased metabolic, and reproductive pathways.26,27 gonadotropin-releasing hormone pulsatility, with Hyperandrogenism is a defining endocrine and consequent elevations in luteinising hormone that drive www.thelancet.com Published online May 12, 2026 https://doi.org/10.1016/S0140-6736(26)00717-8 7 Health Policy polyendocrine condition that extends beyond ovarian Panel 4: Eight stages for global implementation of the new name for polycystic pathology. ovary syndrome, polyendocrine metabolic ovarian syndrome Metabolic abnormalities underpin PMOS, from genetic The implementation strategy was informed by considerations highlighted in survey origins to clinical manifestations.2,5,26,35 Insulin resistance responses, and was co-designed with consumers, marketing and implementation aects the majority of people with PMOS and contributes experts, and governance bodies (including health professional experts), and was based to androgen excess, which, together with low-grade on implementation science frameworks. inflammation and dysfunctions in adipokine signalling and the sympathetic nervous system, drives metabolic Stage 1: publication and academic dissemination dysfunction.5,36 Obesity—particularly central adiposity— Publication of this Health Policy, supported by accompanying commentaries, clinical is increased in people with PMOS, implicated as causal reviews, editorial correspondence, and updates to textbooks and educational materials. on mendelian randomisation studies, and exacerbates Stage 2: resource development symptom severity.2,37 Lifestyle, pharmacological, and Co-design of patient and health professional resources in multiple languages and for surgical weight management interventions have shown diverse platforms and delivery modes. clinical benefit.37–40 Cardiometabolic complications, such as impaired glucose tolerance, gestational diabetes, Stage 3: global communication and engagement metabolic dysfunction-associated steatotic liver disease, Implementation of a structured communication strategy, including society toolkits, type 2 diabetes, dyslipidaemia, hypertension, and multilingual patient and clinician resources, multimedia dissemination, professional vascular dysfunction are increased in PMOS, exacerbated education programmes, and coordinated events for patients and health professionals by obesity, and drive cardiovascular disease risk.2,5,35,41,42 worldwide. Evidence from women who are predominantly premenopausal shows that the odds ratios of composite Stage 4: integration within health care and health information systems cardiovascular disease (1·68), myocardial infarction Incorporation of the new terminology into electronic health records, including within Systematized Nomenclature of Medicine—Clinical Terms, and engagement with major (2·50), and stroke (1·71) are increased in those with PMOS compared with those without PMOS.43 Collectively, electronic medical record vendors and key stakeholders in health-care provider education (eg, universities and textbook publishers). this evidence shows that metabolic features are inherent in PMOS, which firmly endorses incorporation of the Stage 5: policy and research alignment metabolic term in the revised nomenclature. Engagement with governments, research funders, journal editors, regulators, and the Ovarian dysfunction is a defining feature of PMOS, health-care industry (including the pharmaceutical industry), to support adoption across with genetic origins and disturbances in endocrine and research classifications, publication processes, and funding systems. paracrine function during and beyond reproductive life stages.5 Neuroendocrine abnormalities disrupt ovarian Stage 6: international classification and global bodies steroidogenesis and impair follicular maturation. Such Formal engagement with international bodies, including WHO, to progress integration dysfunction is exacerbated by hyperinsulinaemia-driven into disease classification systems, including the ICD. dysregulation of granulosa and theca cells, which Stage 7: transition and future refinement worsens hyperandrogenism.5 These abnormalities A managed transition period of 3 years with monitoring and evaluation, consideration of disrupt folliculogenesis and result in accumulation of emerging evidence on subtypes, and refinement of terminology as scientific small antral follicles, as seen in the classic understanding evolves. ultrasonographic appearance of this condition.44 Elevated AMH occurs with disordered folliculogenesis, and is Stage 8: guidelines now included in adult diagnostic criteria.2,32 Clinically, Integration into the International Guideline, which is already used in 195 countries and these abnormalities manifest as ovulatory dysfunction, will next be updated in 2028. menstrual irregularity, and infertility, endorsing the explicit inclusion of ovarian in the new nomenclature. excessive ovarian androgen.24 Insulin resistance and Other features of the condition, such as psychological compensatory hyperinsulinaemia, present in 85% of and dermatological changes, are important but are aected individuals (75% of lean women [with BMI largely secondary to endocrine changes, and these terms ≤25 kg/m²] with PMOS),30,31 amplify androgen secretion were not supported for inclusion in the new name.9 and disrupt steroidogenesis, highlighting the metabolic– The implementation strategy for the new name was endocrine interplay.30,31 Altered AMH concentrations, generated through use of a structured, co-designed ovarian endocrine function, adipokine signalling, and process grounded in the Consolidated Framework for gut–hormone intera ctions influence clinical features, Implementation Research and Expert Recommendations including reproductive and metabolic manifestations.5,32 for Implementing Change.21,22 Led by implementation Furthermore, the comb ination of endocrine disturbances experts and informed by implementation priorities underpin pregnancy risks, which are compounded by identified from the surveys and workshops outlined metabolic features.33,34 Collectively, these complex here,9 patients’ and health professionals’ input, and endocrine abnormalities underscore the multisystem marketing specialists, the multistage global manifestations of PMOS and support reframing it as a implementation strategy aids transition to the new name 8 www.thelancet.com Published online May 12, 2026 https://doi.org/10.1016/S0140-6736(26)00717-8 Health Policy and incorporates evaluation (panel 4). This strategy for health-care systems, policy, and research, and for includes: publication and academic dissemination; advancing understanding and treatment of the condition. development of multilingual resources for people with Transition to the new name will occur over 3 years, PCOS and clinicians; coordinated global communication supported by a multifaceted implementation strategy. and engagement; integration into electronic health Overall goals include greater awareness, enhanced records and health-care education systems; alignment diagnosis, improved care quality and patient satisfaction, with policy agencies, research funders, and journal and optimised outcomes across the broad features of the processes; formal engagement with international condition. The transition is underpinned by a global classification bodies, including WHO, for adoption in the implementation and embedded evaluation strategy. ICD; and a managed 3-year transition and planned Contributors integration into the 2028 update of the International HJT is the lead investigator and led this Health Policy initiative from Guidelines, which are already used in 195 countries.2 This funding to conception, engagement, analysis, interpretation, and drafting the publication. AEJ, RJN, and MFC are investigators of the implementation strategy is supported by an embedded Centre for Research Excellence in Women’s Health in Reproductive Life. evaluation plan. Key considerations include meaningful Authors included members of the Steering Committee and Androgen language translation and cultural appropriateness, Excess and Polycystic Ovary Syndrome Society Board who contributed to especially where reproductive implications and infertility the concept, design, governance, and completion of this Health Policy. HJT, MBK, and RM led survey development, dissemination, and can be linked to the supposed value or worth of an analysis, and workshop design and analysis. All named authors and aected individual. This approach creates the those in the international network (appendix pp 25–27) engaged in the implementation architecture to support consistent global surveys and workshops, could access the data on request, and uptake of the new name for sustainable change across contributed to data interpretation in the workshops, and to editing and revising the manuscript. All authors had final responsibility for the policy, research, health systems, practice, and outcomes. decision to submit for publication, and all provided their approval for This Health Policy initiative has both strengths and submission. limitations. A major strength is the unprecedented Declaration of interests partnership and involvement with stakeholders (ie, people HJT is the primary investigator of the Australian National Health and with PCOS and health professionals) across all stages, Medical Research Council (NHMRC)-funded Centre for Research including governance, conceptualisation, co-design, Excellence in Women’s Health in Reproductive Life (APP number 1171592), and is supported by an NHMRC Fellowship (APP number recruitment, interpretation of results, participation in 2009326). She is the unpaid President of the International Society of consensus workshops, and implementation. Robust Endocrinology and lead on the International Polycystic Ovary Syndrome consensus methods were applied. The consensus process Guidelines and the National Institute for Health and Care Excellence presents an exemplar to overcome barriers in name (NICE) Guidelines Committee. RM has received grants from Waterloo Foundation and Verity for administrative support, the James Lind change processes as scientific understanding evolves. Alliance Priority Setting Partnership, and the All-Party Parliamentary Limitations of this Health Policy initiative include Group. She has received support from Roche Pharmaceutical for travel disproportionate representation across world regions and and time to film patient story videos. She is an unpaid Trustee of Verity disciplines, with lower participation from middle-income and a member of the International Guidelines Steering Group and the NICE Guidelines Committee (honoraria). JSEL has received grants and and low-income countries, and from Asia, Africa, and personal fees from Astellas, Ferring, Gedeon Richter, and Siemens. South America. Furthermore, the use of a purposive, non- He is a member of the Androgen Excess and Polycystic Ovary Syndrome probability sampling approach and voluntary participation (AE-PCOS) Society Board and a member of the Data Safety Monitoring could introduce selection bias and hinder generalisability. Board of the LOCI trial. He is the Chief Executive Ocer and owner of JSEL Consultancy. AEJ has received honoraria from Amgen, Novo In addition, response rates could not be determined for Nordisk, and Eli Lilly for presentations. She served on the Board of survey A due to broad dissemination. Despite these Directors of the AE-PCOS Society and has received free continuous limitations, analysis of survey results by region did not glucose monitoring devices (ie, Freestyle Libre, Dexcom G7, and identify major dierences in the final terms or name OnePlus) for research or clinical purposes. DAR is the Chair of the steering committee for the LOCI trial, a topic adviser for the NICE preferences. The overwhelming majority of participants Guideline Committee, a board member of the AE-PCOS Society, and in earlier surveys and workshops supported a name participates in the All-Party Parliamentary Group on Polycystic Ovary change, and the principles, approach, and terms used. Syndrome. RJN reports support from the Centre for Research Excellence in Women’s Health in Reproductive Life, consulting fees from Westmead Fertility and VinMec Hospital, is Chair of the Data Safety Conclusion Monitoring Board for a Chinese natural therapies and miscarriage study In this common yet historically neglected female (NCT02633878), and is Chair of the Clinical Advisory Committee at condition aecting more than 170 million individuals Westmead Fertility. AD serves as Executive Director of the AE-PCOS Society. TP has received project grants from Novo Nordisk, the Research worldwide, we led global engagement of people with Council of Finland, and the Sigrid Juselius Foundation; consulting fees PCOS and health professionals through a structured, from Exeltis and Astellas; honoraria from Exeltis, Gedeon Richter, multistep, robust process to generate a new name that Stragen, and Bayer; and travel support from Gedeon Richter. She is the avoids misleading references to ovarian cysts and unpaid President of the AE-PCOS Society. All other authors declare no competing interests. accurately reflects the condition’s diverse and multisystem features. The condition formerly known as Data sharing We can share de-identified, individual participant-level survey data once PCOS now has a new name: polyendocrine metabolic all analyses are completed and after receipt of a request detailing the ovarian syndrome. This change has global implications study hypothesis and statistical analysis plan. All requests should be sent www.thelancet.com Published online May 12, 2026 https://doi.org/10.1016/S0140-6736(26)00717-8 9 Health Policy to the corresponding author (helena.teede@monash.edu). The steering 13 Dokras A, Saini S, Gibson-Helm M, Schulkin J, Cooney L, Teede H. committee of this study will discuss all requests and decide, based on Gaps in knowledge among physicians regarding diagnostic criteria the scientific rigour of the proposal, whether data sharing is appropriate. and management of polycystic ovary syndrome. Fertil Steril 2017; All applicants will be asked to sign a data access agreement. 107: 1380–1386. 14 National Institutes of Health. Evidence-based methodology Acknowledgments workshop on polycystic ovary syndrome, December 3–5, 2012: The leadership of the Centre for Research Excellence in Women’s Health executive summary. https://prevention.nih.gov/sites/g/files/ in Reproductive Life, administered by Monash University, Verity, and the mnhszr241/files/2018-06/FinalReport.pdf (accessed April 29, 2026). Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society, 15 Azziz R. Polycystic ovary syndrome: what’s in a name? was foundational. The support and broad engagement across J Clin Endocrinol Metab 2014; 99: 1142–45. 56 organisations were essential to optimise reach and participation. 16 Dunaif A, Fauser BCJM. Renaming PCOS—a two-state solution. Patient organisations and individuals provided important input at all J Clin Endocrinol Metab 2013; 98: 4325–28. stages, including governance (Verity), survey co-design (Verity, PCOS 17 Linstone H, Turo M. The Delphi method: techniques and Awareness Association, PCOS Challenge, and patient representatives applications. Addison-Wesley Publishing Company, 1975. across world regions), and cultural perspectives. Survey and workshop 18 Teede HJ, Johnson A, Buttery J, et al. Australian Health Research participants were fundamental to this process and are key to its Alliance: national priorities in data-driven health care improvement. implementation. Anna Clare, Andrea Dunaif, Priyal Ghandi, Anna Med J Aust 2019; 211: 494–497. Halminen, Gustavo Martínez, Yasmin Nicholas-Reid, Tiia Tuovinen, and 19 The James Lind Alliance. The James Lind Alliance guidebook, Christine Updegra contributed to the surveys and workshops. We also version 10. The James Lind Alliance, 2021. thank our independent workshop observers, Angela Damianopoulos, 20 Ng AH, Reeder S, Jones A, et al. Consumer and community Angela Jones, Matthew Keath, Ashley Ng, Catherine Anne Pigott, involvement: implementation research for impact (CCIRI): Jenny Proimos, and Sandra Reeder, for overseeing adherence to the code implementing evidence-based patient and public involvement of conduct and supporting equitable and respectful participation. This across health and medical research in Australia—a mixed methods Health Policy was funded by the Australian National Health and Medical protocol. Health Res Policy Syst 2025; 23: 25. Research Council (NHMRC) Centre for Research Excellence in Women’s 21 Safaeinili N, Brown-Johnson C, Shaw JG, Mahoney M, Winget M. Health in Reproductive Life (APP number 1171592) and HJT’s NHMRC CFIR simplified: pragmatic application of and adaptations to the Consolidated Framework for Implementation Research (CFIR) for Investigator Fellowship (APP number 2009326). 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This is an with polycystic ovary syndrome: a prospective cohort study. Open Access article under the CC BY 4.0 license. Research (Wash D C) 2025; 8: 0664. www.thelancet.com Published online May 12, 2026 https://doi.org/10.1016/S0140-6736(26)00717-8 11 --- [PDF原文](https://sci-net.xyz/storage/7932541/2fa2071d036dae8ebb6d22e4cd93f44765b429b4df6c0d04ff655bc57e36219f/Polyendocrine-metabolic-ovarian-syndrome-the-new-name-for-polycystic-ovary-syndrome-a-multistep.pdf) DOI: 10.1016/S0140-6736(26)00717-8