A couple of days ago on a hot May day, a niche group of people across the world celebrated. The reason the endocrinologists were rejoicing was the change in the nomenclature of a single condition, only one letter had changed, and it seemed as if the festivities were a bit disproportionate. The Endocrine Society, a global network of people dealing with hormones, announced that PCOS (Polycystic Ovarian Syndrome) would henceforth be known as PMOS (Polyendocrine Metabolic Ovarian Syndrome).

While the endocrinologists celebrated, the rest of the world wondered, inspired by the bard: Doesn’t a rose by any other name smell as sweet? The Endocrine Society, however, did not do this out of mere whimsy. As an article in The Lancet pointed out, the new name emerged out of a multistep global consensus process over the years. The authors of the paper Helena J. Teede et al argued that the term PCOS was ‘inaccurate’ as it relied only on the presence of ovarian cysts, thereby hiding the multitude of factors that contribute — including diverse endocrine and metabolic features. Thus constrained, it contributes to delayed diagnosis, fragmented care and comes in the way of curtailing research and policy on the issue.

The significance lies not only in the fact that the definition has broadened the panel of factors that will facilitate better diagnosis, but also that PCOS affects a staggering number of women — it is estimated that the syndrome affects 170 million women during their reproductive years alone.

Welcome initiative

“It is an extremely welcome initiative. It has been in the works for a few years, of course,” says Usha Sriram, endocrinologist and diabetologist, founder of DIWAS, an organisation built around women’s health. “PCOS restricts and reduces it to about cysts and gave it an ovarian-reproductive emphasis. It is not a one-off reproductive abnormality. This is a syndrome that could have a life-long impact on more than just reproductive health.”

She further adds: “When people google PCOS, what comes up is ‘difficulty conceiving, pregnancy loss and gestational diabetes mellitus.’ That is also the general perception — linked as it is to fertility, it has become associated with a lot of stigma.”

Jaishree Gajaraj, senior obstetrician and gynaecologist, also welcomes the move, attesting that a great deal of misdiagnosis and overdiagnosis also happens with PCOS, apart from self diagnosis too. She believes that this nomenclature change will make a very big difference in clinical practice, and help facilitate appropriate diagnoses and treatment.

Tejasvi Seshadri, consultant paediatric, adolescent endocrinologist, at Rainbow Hospitals, Bengaluru, says this reclassification will be useful to let the world know that it is not a condition isolated to the ovaries, but impacting general health and well-being too.

Going on to explain that paediatric endocrinologists already follow this comprehensive approach and involvement of hormones that this change has advocated, Dr. Seshadri says “we are also looking at poly endocrine factors in children, not judging just by the arrested follicle development (commonly associated with PCOS) because disruptions in the early years of menstrual health are normal and can result in this.”

“We run a basic hormone assay for the child, rule out diabetes and pre-diabetes, and insulin resistance, dyslipidemia, MASLD (all part of metabolic dysfunction). Once the child has been diagnosed, then we recommend lifestyle changes, and on a case-to-case basis, perhaps medications. Not every child gets the same treatment,” she adds.

Global implementation

The Lancet paper lists an eight-stage process of global implementation of the new name, from publication and academic dissemination to developing resources for the project, integrating it into health care systems to transition and refinement, leading up to integration into the international guidelines in 2028 Dr. Usha says implementation will depend on the professional societies working towards this goal. It is important to build awareness among the community simultaneously, she adds.

Jayashree Gopal, endocrinologist and diabetologists, has a different take. Several attempts have been made in the past to bring focus on the metabolic aspects, in fact, once the change suggested was Metabolic Reproductive Syndrome. But PCOS has been around for about a 100 years, and I believe that gynaecologists, at least in urban areas, are aware of the metabolic aspects of the syndrome. Will this name change actually bring about change?

“It depends really. There is another category of metabolic disorder that was renamed recently — Non Alcoholic fatty liver disease became Metabolic Dysfunction-Associated Steatotic Liver Disease, and that caught on pretty fast, probably because of the association of the former with alcohol,” Dr. Gopal explains.

On the other hand, as Dr. Usha Sriram points out, the condition now defined as pre-diabetes was known by many fangled names until this one has come to stay.