When Does Polyendocrine Metabolic Ovarian Syndrome (PMOS) Change Definition? A Lifespan Perspective on Menopause and Metabolic Health.

Abstract

The evolving concept of Polyendocrine Metabolic Ovarian Syndrome (PMOS) reflects a growing recognition that this condition extends beyond reproductive dysfunction and ovarian morphology to encompass complex interactions among metabolic, endocrine, inflammatory, and cardiometabolic pathways. While PMOS is most commonly diagnosed during the reproductive years, increasing numbers of affected women are now entering perimenopause and menopause, highlighting important limitations of current diagnostic paradigms. Traditional reproductive markers-including ovulatory dysfunction and ovarian morphology-become progressively less informative with advancing age, raising questions about whether the diagnosis remains relevant after menopause. Despite the attenuation of ovarian manifestations, many women with a history of PMOS continue to exhibit persistent metabolic and endocrine abnormalities, including insulin resistance, visceral adiposity, dyslipidemia, metabolic dysfunction-associated steatotic liver disease, chronic low-grade inflammation, and elevated cardiovascular risk. Emerging evidence suggests that these metabolic consequences may persist across the lifespan and contribute to trajectories of accelerated cardiometabolic aging. This review examines the challenges of applying reproductive-age diagnostic frameworks to midlife and older women and proposes a lifespan model in which PMOS evolves from a predominantly ovarian and reproductive syndrome into a broader metabolic-endocrine phenotype. We explore the clinical implications of this transition for risk assessment, long-term surveillance, and therapeutic decision-making during perimenopause and beyond. As understanding of PMOS continues to evolve, menopause may represent not the end of the syndrome, but rather a shift in its clinical expression. Reframing PMOS as a dynamic lifespan condition may provide a more comprehensive approach to the care of women across aging and support the development of age-appropriate diagnostic and management strategies.