PCOS, SMOP: ovarian or metabolic disease?

A more accurate name than “polycystic ovary syndrome”

A global consensus

In May 2026, an international team of researchers published in The Lancet the results of collaborative work that lasted 14 years. 56 medical and patient organizations, includingEndocrine Societyparticipated. More than 14,000 global survey responses were analyzed.

PCOS (polycystic ovarian syndrome) officially changes its name to SMOP, for “ Metabolic Ovarian Polyendocrine Syndrome ” (in English : Polyendocrine Metabolic Ovarian SyndromePMOS). It is a scientific recognition of the reality of this syndrome, poorly named from the start. The old name was “inaccurate because it suggested pathological ovarian cysts, masked diverse endocrine and metabolic features, and contributed to late diagnoses, fragmented care, and stigma”write the authors in The Lancet.

A three-year transition period

Professor Helena Teede, an endocrinologist at Monash University (Australia) and leader of this process, said in a press release from theEndocrine Society : “It was heartbreaking to see the delays in diagnosis, the lack of awareness of this neglected disease and the inadequate care provided to those who suffer from it. » The transition period to the new name is expected to last three years. The 2028 international recommendations should include the new name of the syndrome.

“Cysts” that are not

The misunderstanding arose in the 1930s, when doctors Irving Stein and Michael Leventhal observed larger-than-average ovaries in female patients. They then thought of cysts. In reality, as dietician-nutritionist Angélique Houlbert explains in her book The PCOS diet, “These are actually accumulated follicles, whose growth has stopped and which have therefore not reached maturity.”

Accumulated follicles, whose growth has stopped

The stopping of maturation of these follicles is due to a problem with hormonal signaling. Normally, the pituitary gland releases two hormones, FSH and LH, in a coordinated manner, which govern the ovarian cycle. In SMOP, this balance is disrupted: the LH level is abnormally high compared to that of FSH, which prevents the maturation of follicles and excessively stimulates the production of androgens (male hormones) by the ovaries.

A syndrome with many faces

This hormonal disruption has consequences far beyond ovarieshence the new name SMOP which integrates the metabolic and hormonal dimension of the disease. Because SMOP manifests itself through a set of symptoms that affect the entire body.

Symptoms

• Irregular cycles, direct consequence of ovulation disorders. SMOP is the leading cause ofinfertility feminine according to Inserm.
• Hyperandrogenism: acne, excessive hair growth (hirsutism), hair loss.
• Insulin resistance: present in the majority of affected women, it promotes weight gain, particularly abdominal weight gain.
• Impact on mental health: anxiety, depression, are frequently associated with the syndrome.
• Long-term metabolic risks: type 2 diabetes, cardiovascular diseases, metabolic syndrome.

Insulin at the heart of the problem

Whether OPMS is a complex hormonal disorderinsulin resistance plays a central role. When cells respond poorly to insulin, the pancreas produces more to compensate. This excess insulin stimulates the production of androgens, such as testosterone, which disrupt the maturation of follicles.

For this reason, diet and lifestyle must be taken into account in the support of SMOP. Reducing glycemic peaks, limiting ultra-processed foods and favoring proteins, quality fats and fiber helps improve insulin sensitivity, and therefore reduce hyperandrogenism and its associated symptoms.

However, the causes of SMOP are not clearly identified. Genetic and environmental factors are probably involved. Genes predisposing to the syndrome have been identified. Endocrine disruptors could also play a role in the onset of the disease, although no proof has been established to date.

A diagnosis still too often delayed

Despite its prevalence – 1 in 8 women affected worldwide – SMOP is still poorly diagnosed. The average time between the appearance of the first symptoms and diagnosis is often several years. The old name may have contributed to this: by focusing attention on the ovaries and “cysts”, it directed diagnoses towards gynecology alone, forgetting the endocrine, metabolic and psychiatric dimensions.

What the new name changes

The choice of the term “polyendocrine” in the new name indicates that several endocrine axes are simultaneously involved: the pituitary-gonadal axis (FSH, LH), the pancreas and insulin, the adrenal glands (which also produce androgens), even the thyroid, which is sometimes also affected.

For the women concernedthis name change could have concrete consequences: more comprehensive care, faster access to appropriate specialists (endocrinologist, nutritionist, psychiatrist), and better institutional and media recognition of their illness.

What treatment?

There is no cure for SMOP. Management is symptomatic and multidisciplinary. Medically, oral contraceptives are often prescribed to regulate cycles, and metformin to improve insulin sensitivity. Nutritionally, a diet with a low glycemic index, rich in fiber and protein, may be recommended. Regular physical activity, particularly weight training, also improves insulin sensitivity.

Read: Treat polycystic ovary syndrome naturally (subscribers)

To remember

• PCOS officially becomes PCOS (metabolic ovarian polyendocrine syndrome).
• More than an ovarian disease, it is a global hormonal and metabolic disorder.
• It affects 1 in 8 women worldwide, but is often diagnosed years late.
• Insulin resistance is a key mechanism on which diet can act.
• The transition to the new name will be complete in 2028.

To go further: The PCOS diet

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