Last piece made the case that three months post-publication is far too early to judge whether the PCOS-to-PMOS reclassification meant anything. This piece is the reason why: the authors themselves built an 8-stage, multi-year implementation plan, and it’s worth laying it out in full — both because almost nobody covering this in May actually did, and because it gives all of us a concrete scorecard to hold the process to instead of a vague sense of “did it work.”
Here are the eight stages, as published in The Lancet, with where things stand as of this writing.
Stage 1 — Publication and academic dissemination. The Health Policy paper itself, plus accompanying commentaries, clinical reviews, editorial correspondence, and updates to textbooks and educational materials. Status: underway. This is the stage we’re currently in.
Stage 2 — Resource development. Co-designed patient and health professional resources, in multiple languages, across different platforms and delivery formats. Status: early — this is the kind of thing that takes months to build properly, not weeks.
Stage 3 — Global communication and engagement. A structured rollout: society toolkits, multilingual clinician and patient materials, multimedia dissemination, professional education programs, and coordinated global events. Status: this is the stage where most patients and most clinicians would actually start hearing about it consistently — worth watching for over the next year.
Stage 4 — Integration within health care and health information systems. This is the unglamorous, structurally important one: getting the new terminology into electronic health records, including SNOMED CT coding, and engaging directly with EHR vendors and the universities and textbook publishers that train the next generation of clinicians. Status: this is the stage that determines whether your own chart says PMOS or still says PCOS five years from now. It’s also the stage most likely to lag, because EHR vendors move slowly and coding changes are notoriously bureaucratic. [likely]
Stage 5 — Policy and research alignment. Engagement with governments, research funders, journal editors, regulators, and industry (including pharma) to align research classification, publication norms, and funding categories with the new name.
Stage 6 — International classification and global bodies. Formal engagement with international bodies, including the World Health Organization, to get PMOS into disease classification systems like the ICD. This is a slow-moving, bureaucratically heavy stage almost by design — ICD updates aren’t fast anywhere in medicine.
Stage 7 — Transition and future refinement. A managed 3-year transition window, with ongoing monitoring, evaluation, and openness to refining the terminology further as evidence on subtypes accumulates. This stage is explicitly built to run in parallel with the others, not after them.
Stage 8 — Guidelines. Integration into the International Guideline — already used in 195 countries — which is scheduled for its next update in 2028.
Why 2028 is the actual date that matters
Everything before stage 8 is groundwork. The International Guideline is the document that actually shapes how clinicians worldwide are trained to diagnose and manage the condition, and it doesn’t get touched again until 2028. That’s the moment the reclassification either shows up as real, guideline-level clinical change, or it doesn’t. Everything between now and then — the toolkits, the EHR conversations, the ICD engagement — is infrastructure being built toward that date, not the outcome itself.
I’ll be honest about what I don’t know here: whether stage 4 (EHR integration) moves at the pace the authors are hoping for is genuinely uncertain, and it’s the stage I’d bet is most likely to slip, based on how slowly health IT systems generally move in general. [guessing] That’s exactly the kind of thing worth checking back on rather than assuming either way.
Next in this series: the skeptical case — why renaming a medical condition has historically had a mixed track record of actually changing clinical behavior, and what would have to be different this time for PMOS to avoid the same fate.
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