PCOS Gets a New Name - Part 1
Last month, The Lancet announced a name change for the condition known as polycystic ovary syndrome, or PCOS, to “polyendocrine metabolic ovarian syndrome (PMOS).” PMOS is the most common hormone disorder in women of reproductive age, affecting about 1 in 8 women.
The original name PCOS fails to capture the many differing ways this condition can show up in the body, and it characterizes it solely as a female reproductive disorder instead of a system-wide metabolic disorder.
What’s In a Name?
“Polycystic ovarian syndrome” was given its name in 1935 by American gynecologists and has persisted for almost a hundred years until now. The National Institute of Health (NIH) defined this condition starting in 1990 as a reproductive disorder characterized by hyperandrogenism (elevated male sex hormone levels) and chronic anovulation (no ovulation and/or irregular periods).
In 2003, the Rotterdam Criteria expanded the diagnostic criteria, becoming the most common diagnostic method used today. This set of criteria requires the presence of two out of the following three characteristics:
Hyperandrogenism (confirmed by hormone tests and clinical symptoms)
Oligoanovulation (infrequent or absent ovulation) and/or anovulation
Polycystic ovaries
The third criterion introduces the term “polycystic,” which is where all the confusion starts. This terminology has led to misunderstandings and inaccuracies in the detection and diagnosis of the syndrome by healthcare practitioners, not to mention the fear it can cause in the individual themself.
The use of “polycystic” is incorrect because it depicts the presence of abnormal cysts in the ovaries. (An example of a “pathological” cyst is a “chocolate cyst,” which forms from uterine lining tissue, fills with blood, and is often a sign of endometriosis.) More common are the cysts that form naturally in or on the ovary, which are usually harmless sacs filled with fluid that disappear on their own. Just because you have large ovarian cysts does not mean you have PMOS.
In reality, these “cysts” are simply follicles that did not fully develop, fill with fluid, and still contain immature eggs that were not released as expected during ovulation. While the presence of these underdeveloped follicles is typically harmless, it’s more significant that their failure to develop into mature follicles causes the anovulation and infertility associated with this condition.
At Tao of Wellness, we have successfully treated PCOS—now increasingly recognized as PMOS (Polymetabolic Ovary Syndrome)—for decades using the holistic principles of Traditional Chinese Medicine. Long before modern medicine acknowledged the multiple factors involved, Chinese medicine viewed these conditions as interconnected imbalances involving hormones, metabolism, digestion, stress, and reproduction. By addressing the root causes through individualized care, we have helped thousands of women regulate their cycles, improve metabolic health, manage weight, and achieve successful pregnancies.
The Stigma and the “Myth”
Some of the common symptoms reveal where the stigmatization around this syndrome comes from. Increased androgen levels (or a relative elevation of male hormones) can cause hirsutism, or hair appearing in a male growth pattern, in 60-90% of women with this syndrome. Extra or coarser hair may grow on the face, abdomen, and arms, but it’s important to note that this can vary by ethnicity.
Excess androgen levels can also cause acne, which can affect up to half of diagnosed women. It’s obvious how societal beauty norms can worsen the discomfort of having excess body hair or acne, which generates shame and embarrassment around physical appearance.
The associated prevalence of obesity in women diagnosed with this syndrome further contributes to the stigma. Studies have found that 30% of women with a Body Mass Index (BMI) greater than 40 (severe obesity) have PMOS, versus just 5% of women with a BMI of less than 25 (healthy range). (While there are limitations to the use of Body Mass Index as an indicator of health, it remains a standardized way of measuring the height-to-weight ratio.)
High levels of abdominal fat are a better indicator of the increased presence of the metabolic syndrome that often accompanies PMOS. In a society that upholds thin bodies as the standard of beauty, combined with the explosion in GLP-1 usage, it’s no wonder that the weight aspect of PMOS can feel deeply stigmatizing.
The final component of PMOS that can deeply damage self-identity and self-worth is infertility. Research shows that ovulatory disorders are the most common cause of female infertility today. Especially if you’ve gone through multiple rounds of fertility treatment and braved the emotional and physical toll of each round, it can be incredibly frustrating when results remain out of reach. It’s easy to default to the idea that your body is broken, your reproductive system is damaged, or you’re not a “real woman.” This is the myth that we hope to disrupt.
A More Comprehensive Framing
Fifteen years of focus groups, research, and global consensus-building among diverse stakeholders led to the re-naming of PCOS as “polyendocrine metabolic ovarian syndrome (PMOS).” This new name highlights the interactions among multiple hormones and metabolic systems, while maintaining the role of the ovaries and eliminating the misleading reference to cysts.
Our hope is that this renaming brings to light the ways in which the body is not so much broken as it is stuck in a state of stress-induced adaptation. Well-intentioned efforts to manage the symptoms of PMOS can push the body further into a state of agitation, which is already affected by the stressors of our modern world.
Instead of viewing PMOS as evidence of a damaged system, Traditional Chinese Medicine sees it as a strategic choice that the body makes to reserve ovulation and fertility until the nervous, endocrine, and metabolic systems are balanced. In other words, until the body feels safe, it will put its resources towards survival, not reproduction.
This is part one of a two-part series on PCOS (PMOS) by Dr. Yu-Shien Ni, who is co-authoring the book The PCOS Myth with Dr. Mao Shing Ni on integrative approaches to managing PCOS with acupuncture and Chinese medicine. We invite you to reach out to her if you or someone you know is suffering from this often-misunderstood condition.