The Lancet's breakthrough

Polycystic ovary: the syndrome changes name and becomes 'metabolic

For the first time, the international scientific world recognises that this is not just a gynaecological condition

by Francesca Indraccolo

28 May 2026

Dolore all'addome in una donna: sintomo di un problema alle ovaie Alamy Stock Photo

3' min read

Translated by AI

Versione italiana

Key points

The ovary is not the focus of the disease
Clinical Theory and Practice in Italia
How the diagnostic framework changes
The disease and the male equivalent
Cures in a new direction

3' min read

Translated by AI

Versione italiana

Polycystic ovary syndrome changes its name. The revolution is not only linguistic, but above all scientific. The publication in the scientific journalThe Lancet of the international paper that introduces the definition 'Polyendocrine Metabolic Ovarian Syndrome' (PMOS) instead of Polycystic Ovary Syndrome (PCOS) represents a breakthrough in the understanding of the syndrome and marks a clean break with decades of reductive interpretation of the disease. For the first time, the international scientific world recognises that this is not simply a gynaecological pathology, but a systemic and not exclusively reproductive endocrine-metabolic syndrome with implications throughout a woman's life.

The paradigm shift, announced at the European Congress of Endocrinology (ECE) held in Prague a few days ago, was welcomed, but represents the first step in a still unfinished path on this condition that affects one in eight women. If a condition is described as predominantly ovarian, the path tends to focus on fertility, menstrual cycles and ultrasound appearance, while metabolic risk, cardiovascular prevention, mental health and quality of life may remain underestimated.

The ovary is not the focus of the disease

According to the scientific association EGOI-PCOS, the change has not yet come to fruition. 'Within the new name,' explains Professor Vittorio Unfer, gynaecologist and president of EGOI-PCOS, 'the word 'ovarian' still survives. That is, the idea that the ovary represents the centre of the disease survives, a conceptual error that for years has conditioned diagnosis, research and treatment. Instead, the ovary is one of the target organs of a much broader endocrine-metabolic dysregulation, dominated by insulin resistance, hyperinsulinaemia and hyperandrogenism'.

The excess of insulin alters glucose metabolism, stimulates ovarian and adrenal production of androgens, amplifies metabolic inflammation and feeds the vicious circle responsible for the clinical manifestations of the syndrome: alterations in the menstrual cycle, anovulation, infertility, acne, hirsutism, visceral obesity, hepatic steatosis, type 2 diabetes and increased cardiovascular risk.

'To still speak of 'polycystic ovary' or even 'ovarian syndrome',' Professor Unfer continues, 'is to keep looking at the tip of the iceberg. Rather, for the Italia group, the document is a belated confirmation of a paradigm shift that has been advocated for years'.

Theory and Clinical Practice in Italia

Behind this international turnaround there has also been a long scientific exchange built up over the years between EGOI-PCOS, ESHRE and the Monash University led by Professor Helena Teede, one of the world's most authoritative figures in the study of the syndrome. 'For years,' Unfer continues, 'the group has been pursuing multidisciplinary management of the syndrome, with endocrinologists, gynaecologists, nutritionists, dermatologists and cardiologists, to overcome the old specialist fragmentation. A model that today finds one of its most concrete expressions in the new EGOI-PCOS multidisciplinary outpatient clinics, such as the public one inaugurated a few weeks ago at the San Camillo-Forlanini hospital in Rome. Here, the patient is treated as a person with a complex endocrine-metabolic syndrome involving metabolism, hormonal structure, cardiovascular risk and family genetic predisposition'.

How the diagnostic framework changes

The 10-15% prevalence commonly attributed to PCOS derives from conventional diagnostic criteria, which are mainly built on reproductive and morphological parameters. When the assessment shifts to the endocrine-metabolic level, the picture takes on other contours.

"In adolescents, diagnosis represents one of the most controversial and delicate areas. Menstrual irregularities, acne and ovarian multifollicular morphology may in fact overlap with physiological pubertal maturation. In this context, labelling a girl prematurely as sick risks turning a developmental phase into a stigmatising diagnosis. This is why EGOI-PCOS proposes an approach centred on the concept of the 'patient at risk', with a focus on early metabolic indicators,' Professor Unfer specifies.

This view of the disease changes the diagnostic evaluation in adult women. "In these cases, diagnostic inclusion requires a precise endocrine-metabolic characterisation, reducing the risk of over-diagnosis that accompanied the traditional definition of the syndrome for years," Unfer adds.

The disease and the male equivalent

The paradigm shift even affects the very concept of 'gender disease'. The growing attention to the genetic and endocrine-metabolic bases of the syndrome has led several researchers to hypothesise the existence of male equivalents characterised by insulin resistance, metabolic alterations, cardiovascular predisposition and shared endocrine dysfunctions. 'If this prospect is confirmed, the last cultural barrier that continues to confine the syndrome to the gynaecological universe will also finally collapse,' says the professor.

Treatment in a new direction

The therapy also reflects this revolution. The goal is no longer just to regularise the cycle or induce ovulation. "Today, the focus of clinical management becomes long-term metabolic control: diet, physical activity, cardiovascular prevention, reduction of metabolic inflammation, and the use of insulin-sensitising agents are playing an increasingly central role. Because the real game is not only played on fertility. It is played on the metabolic and cardiovascular risk that accompanies these patients throughout their lives,' Unfer concludes.