I spent years confused about PCOS. A Lancet review finally explains why

If you’ve ever had a doctor tell you that you might have polycystic ovary syndrome or disorder (PCOS/PCOD) without running tests, you’re not alone.

Ever since my ovaries got kicking, I remember visiting every shade of doctor — allopathic, homeopathic, ayurvedic — trying to find out what was wrong with my cycles. It was a period when such talks were hushed and sanitary products were sold in newspaper wrapping stuffed in black plastic bags. The mere optics of hiding itself gave it away.

Anyway, it is safe to say: I never felt heard or treated. Doctors kept changing advice faster than I changed cities. Some said I had PCOS, some denied it. Few ran tests. Some friends were told they didn’t look 'like a PCOS case' (read: fat).

We got contraceptive pills to 'fix' periods, Metformin for insulin resistance and anti-androgens for acne to treat the symptoms, not the cause.

Now, a study is suggesting we may not even be calling it the right thing all this while. If you, like me, have been waiting for answers, here are a few points from the 4,000-5,000-word review published in The Lancet by an international panel of researchers, clinicians and patient advocates worth noting.

Let's start with the name. The review proposes renaming polycystic ovary syndrome or PCOS to

polyendocrine metabolic ovarian syndrome or PMOS

.

The old name was found misleading because many with PCOS did not have ovarian cysts. In fact, the paper indicated the name may have delayed diagnosis and confused patients, even doctors, by focusing on ovaries rather than the endocrine and metabolic dysfunction driving the condition.

The paper’s biggest message is that the condition affects multiple systems — hormones, metabolism, heart health, fertility and mental health — and should be treated as a full-body condition rather than a fertility disorder.

The transition to the new term, PMOS, might take three years, with integration into global guidelines planned by 2028. The proposed terminology is still subject to wider clinical adoption and guideline integration.

Size does not define PCOS. The review cites evidence suggesting insulin resistance may be present in up to about 85% of people with PCOS, including many lean women. And even women with a body mass index (BMI) below 25 can have insulin resistance.

Because the paper reframes PCOS as “polyendocrine” and “metabolic", it could now, thankfully, lead to earlier screening for diabetes, cholesterol, and liver health, as well as cardiovascular risks. It notes underlying hormonal and metabolic abnormalities may exist before symptoms become obvious after puberty.

The paper adds that elevated Anti-Müllerian Hormone (AMH) levels — a hormone often used to assess ovarian function and egg reserve — would be included in adult diagnostic criteria. This could help improve diagnosis, especially among women previously missed as they did not fit the 'image'.

No surprise that no doctor asked me to test AMH in more than 40 years of trying to understand what was happening, which explains why the paper calls it a “common yet historically neglected female condition”.

The international review found many patients reported delayed diagnosis, dismissal of symptoms and poor communication from healthcare providers.

The paper states people with PCOS face higher risks of diabetes, fatty liver disease, high blood pressure, cholesterol abnormalities, cardiovascular disease, heart attacks and strokes, reinforcing calls for earlier screening. It also said hormonal dysfunction can disrupt ovulation and follicle development, contributing to irregular periods and pregnancy-related complications.

Researchers noted that symptoms like anxiety, depression, acne, excess hair growth, and body-image distress are common and they may be signs of a deeper hormonal and metabolic imbalance rather than separate issues.

And, if you were told PCOS ends with menopause, wait. The paper discusses PCOS going beyond reproductive years, including cardiovascular and metabolic risks later in life.

The review argues that treatment often focused on managing visible symptoms — irregular periods, acne, infertility or weight gain — instead of addressing the interconnected hormonal and metabolic drivers underneath.

As for relief, the paper says lifestyle changes, medications and even bariatric surgery can improve symptoms and metabolic health. So, hopefully, we are moving towards treating the root of the condition.

The review drew on 14,360 survey responses globally, including 10,411 patients and 3,949 health professionals, and said the condition affects more than 170 million people worldwide. Earlier, World Health Organization estimates had put the global figure closer to 116 million.

Maybe women were never overreacting. The medical understanding of PCOS itself was still evolving.

If you still want to read the full report, it's here.