Abstract
The May 2026 rename of polycystic ovary syndrome (PCOS) to polyendocrine metabolic ovarian syndrome (PMOS) was developed primarily within high-income clinical and academic settings, with the consensus authors acknowledging lower participation from low- and middle-income countries (LMICs). Yet LMICs account for the majority of the global PMOS burden and bear the highest absolute weight of its dominant complication, type 2 diabetes mellitus. The metabolic re-centring intended by PMOS is therefore arguably more relevant in LMIC settings than in the high-income contexts where the rename was negotiated. This Short Communication argues that implementation in LMICs cannot mirror implementation in high-income settings and proposes adaptations: a symptom-and-androgen-based diagnostic pathway with reduced imaging dependence; integration with existing non-communicable disease programmes rather than parallel specialist clinics; and an adolescent screening route through school health services. South Asia, where prevalence is among the highest globally, illustrates both the opportunity and the implementation gap.