Neuroendocrine and Clinical Pathways to Recognition of Polycystic Ovary Syndrome (PCOS) During the Transition to Polyendocrine Metabolic Ovarian Syndrome (PMOS): A Narrative Review

Abstract

Polycystic ovary syndrome (PCOS), newly named polyendocrine metabolic ovarian syndrome (PMOS), is a heterogeneous endocrine-metabolic disorder with reproductive, dermatological, metabolic, and psychological manifestations. This narrative review examines delayed recognition through neuroendocrine heterogeneity, evolving diagnostic frameworks, symptom normalization, stigma, and fragmented healthcare. Mechanistic evidence supports roles for altered steroid feedback, accelerated gonadotropin-releasing hormone pulsatility, relative luteinizing hormone predominance, insulinmediated androgen excess, anti-Müllerian hormone signaling, and follicular arrest, but these findings are not diagnostic tests. The 2023 international guideline retains a modified Rotterdam algorithm for adults and uses distinct adolescent criteria. Ultrasound and anti-Müllerian hormone have restricted diagnostic roles and should not be used diagnostically in adolescents. An author-proposed cumulative information loss framework integrates evidence that symptoms may be normalized or concealed and clinical findings separated across encounters; the complete pathway is inferential and requires prospective validation. Established priorities include guideline-concordant diagnosis, planned adolescent reassessment, weight-independent metabolic and psychological assessment, and continuity of information. Proposed recognition checklists, integrated-care pathways, and neuroendocrine-targeted treatments require evaluation for effectiveness, feasibility, cost, harms, and equity.