From PCOS to PMOS: An EMAS clinical guide to the proposed terminology and its relevance to menopause care.

INTRODUCTION: Polycystic ovary syndrome (PCOS) has recently been renamed polyendocrine metabolic ovarian syndrome (PMOS). This change is particularly relevant after menopause, when menstrual dysfunction and ovarian morphology are no longer useful for assessment, while cardiometabolic and other long-term health risks remain clinically significant. AIM: To review the implications of the shift in terminology from PCOS to PMOS for women in the menopausal transition and after menopause and to provide guidance for assessment and management. MATERIALS AND METHODS: This EMAS Clinical Guide is based on a narrative review and expert consensus. PubMed and Web of Science were searched in June 2026 for evidence on PCOS/PMOS during and after menopause, with additional references identified from key guidelines and publications. International guidelines, position statements, systematic reviews, meta-analyses, randomized controlled trials, cohort studies, and other clinically relevant publications were considered. There were notable evidence gaps in relation to postmenopausal women. SUMMARY RECOMMENDATIONS: The proposed change from PCOS to PMOS reflects a broader understanding of the condition as a lifelong endocrine and metabolic disorder rather than a syndrome defined mainly by reproductive features and ovarian morphology. After menopause, given that current menstrual and ovarian morphology cannot be used to establish the diagnosis de novo, recognition of PMOS should rely primarily on a documented diagnosis before menopause or a well-characterized reproductive history consistent with the syndrome. Women with PMOS have increased risk of cardiometabolic conditions, including obesity, impaired glucose metabolism, type 2 diabetes, hypertension, dyslipidemia, and cardiovascular disease. Although evidence specifically in postmenopausal women remains limited, these risks remain clinically relevant during the menopausal transition and after menopause and should be considered during long-term follow-up. Clinical care should focus on cardiometabolic risk assessment, which should include evaluation of body weight, waist circumference, blood pressure, glycemic status, lipid profile, and other established cardiovascular risk factors. New, severe, or rapidly progressive hyperandrogenism after menopause should not be attributed to PMOS without further evaluation for alternative causes. Current evidence does not support additional endometrial, breast, or ovarian cancer screening or a separate osteoporosis screening strategy solely on the basis of PMOS. PMOS alone is not a contraindication to menopausal hormone therapy. Evidence specifically evaluating menopausal hormone therapy in women with PMOS is limited. Current recommendations are largely extrapolated from evidence and guidance for the general menopausal population. The decision to initiate menopausal hormone treatment and the choice of regimen and route should follow standard menopause guidance and be based on symptoms and the woman's overall individual risk.