Gynae, Endocrinologist or Fertility Specialist?

[ChateauMargot]

FINALLY got my GP to refer me to a specialist for suspected PCOS (ultrasound showed cysts and underdeveloped follicle; long cycles; acne...but because day 3 bloods were normal, she'd refused to refer me the first time around).

So, hurrah for persistence (and a bolshy letter from my family GP back home!)

She was, however, clearly nonplussed and quite huffy about it, and said that there was no way that she could refer me to a 'fertility specialist' on the NHS. I said that I'd assumed I would be seeing an endocrinologist, and she said 'you can if you want to, but it's usually gynaes who deal with PCOS'. Is this true? Essentially, I want someone who a) knows about PCOS and b) can prescribe Clomid, etc. if necessary.

Any tips would be very helpful. Apparently she's going to put a referral through 'to the hospital', although I'm not sure to what department (we were talking on the phone, and she hung up rather abruptly...)

[ChateauMargot]

bump

(I'm sure there's got to be someone here who know about this stuff..!)

[ChateauMargot]

.

[joycep]

Didn't want your post to go unanswered - there must be a lot of people on here who have PCOS. I know people who have PCOS and have beend treated with Clomid by a gynae. Tbh i'm not too sure on the role of the endo - are they more specialist?

I think you need a new GP though!!

[ChateauMargot]

Thanks, joycep! Was starting to feel like the smelly kid in the playground for a moment there...

Endos deal with hormones, which is why I'd thought (and my previous GP suggested) that this be the person I go to for PCOS. But this new doc seemed to think that because it's women's fertility-related, it should be a gynae.

Am happy with either as long as they know what they're talking about and can get me on Clomid if needed...

[joycep]

Yes I'm sure either can help as long as you have a good efficient one. It's so annoying it's such a battle to get good assistance. Best of luck!

[AttilaTheMeerkat]

CM

Think you also need to start looking for another GP practice asap, no point whatsoever in having an unhelpful GP who you can't work with.

You need a referral to a gynae as they would be able to prescribe clomid as well if they thought you were suitable.

Although clomid is often used as the first line of treatment with regards to PCOS, it is not suitable for all PCOSers to take as it can increase LH levels markedly. If you are prescribed clomid you must be monitored whilst on it as you won't know otherwise whether its doing what it is supposed to be doing. Clomid's main job is to work the ovaries harder.

(Unless the GP compared both LH and FSH against each other on day 3, the test result is meaningless. It can also appear "normal" if the results are looked at separately).

[ChateauMargot]

Thanks, Attila.

The Lh/FSH ratio was ok (5.1 and 6.1 I think)...but with my cycle being as long as it is, it's perfectly possible that that changes later on, ie. after day 14 or 21.

[MrsHY1]

Hi ChateauMargot
Where in the country are you?
Reason I ask is that I'm in London and never had a problem getting a referral to the Assisted Conception Unit at my local hospital (a whole dept. full of fertility specialists!) on the NHS. I've just completed my patient questionnaire and am now waiting for them to get in touch with me, probably to request an ultrasound on day 1-4 of my period - am trying to be patient!!!
I was diagnosed with PCOS about 8 yrs ago and have been on metformin for 5 years - during which time my symptoms have changed markedly (no acne, lost weight, no hairiness where it shouldn't be, regularish periods). Every six months or so I get referred back to Kings to see an endo and gynae to be reviewed. But for me, the metformin was about symptom control - never until late last year about reproducing! Now it's about reproducing, I'm under the care of the ACU, and will probably have to go through the same tests all over again. Now KICKING myself that when I last saw my gynae and endo in Aug of last year that I should have asked them for Clomid there and then!!
x

[SlightlyBabyCrazed]

Hi Chateau,

I have had a long running PCOS issue (over 10 years since first diagnosed), which mostly went ignored until I irritated my GP so much and after way too long TTC with zero joy got referred.

I first went to gynae, who referred me for scan after scan and blood after blood test. My prolactin levels have identified as the main problem. Gynae then referred me to the endocrinologist (bypassing GP altogether), at same time gynae referred me to the fertility clinic (same consultant now my gynae and FC consultant!).

Endo told me that I defo had PCOS and gave me cabergoline with a 2 month trial more bloods and then maybe metformin. I then went and saw the FC and he told me that I wasn't completely PCOS and he should know he worked on the condition for 2 years!

At no point have I been given clomid as my bloods have all suggested I ovulate regularly, however they never ask about when - so I made him listen last month and told him I don't ovulate until day 18 at earliest, to which he suggested we test this month and if it is past day 16 the lining is too old and unsuitable - kind of the reverse of the short luteal phase that is referred to all over the forums - but makes total sense. So this month if ovulate after day 16 they will medicate me and do IUI.

It's been a long road TTC - 3 years now, give or take the odd month or two off - try not to think about how long so as not get down about it.

Sorry if this is a bit rambling, but think it answers your question - get a referral to the gynae first and they should sort the rest out for you!

Good luck,
SBC

[ChateauMargot]

Apologies for taking so long to reply - have been away.

Thanks fo ryour responses. MrsHY, I'm in London, too - have just had my appointment with an endocrinologist confirmed for May. Fingers crossed it's a fertility specialist - I will be fuming if not! Interesting to hear your story - more reason to push for Clomid, then.

SBC, interesting about late ovulation - I will also ask about this...

[Florin]

I have pcos and go to a gyne specialist. I have had ovarian drilling by him but now got long cycles so hoping to go back for clomid. I think gene specialist is best place to start.

[poutintrout]

SBC Can I ask you a question? How did/do you pinpoint exactly when you ovulate? I ask because I was interested to read about late ovulation and it being a possible problem if you ovulate after day 16. I wonder if this could be a factor for me (I have mild PCOS & have ovulated each time it's been tested, I therefore cannot have Clomid and just keep getting sent by my gynae for blood test after blood test which all come back normal). I only know when I ovulate based on EWCM and it is generally at least day 16 or so but I'm not entirely sure how close to day 16 it is because I don't use OPKs - I read that OPKs can give false readings if you have PCOS.

God that is a long rambling way to ask do you use OPKs or did the hospital test this another way.

I have another gynae appointment coming up and wonder whether it might be worth mentioning this seeing as I'm just fobbed off every time with more blood tests.

Good luck with your appointment Chateau. I hope you don't mind me hijacking with this question!