GP says no help available

[AmyA29]

I was diagnosed with PCOS in my late teens and was offered no treatment or support. I've always had regular periods but suffered with painful cramps, embarrassing hair growth and fatigue.
Myself and my partner tried to conceive for over 18 months before our GP finally agreed to refer is to gynecologist. But we found out we were pregnant before the referral was sent. Unfortunately this ended in a missed miscarriage at 12 weeks.
11 months later I became pregnant again, and now my almost 2 year old son is asleep in my arms 😁 during the pregnancy I was diagnosed with gestational diabetes which was managed purely by diet, I was told this may be linked to PCOS.
I recently started mounjaro for weight loss and within 2-3 months I was pregnant. As soon as I knew I was pregnant I stopped mounjaro but again I sadly suffered a missed miscarriage.
Its now been 4 months since the miscarriage and im really struggling with symptoms. I contacted my GP who basically said I can either go on birth control or get no help. Apparently only a gynaecologist will prescribe metformin and she won't refer me. She did offer a blood test but this still wouldn't change anything. In the UK you can only be referred for test into recurrent miscarriage after 2 or more miscarriages, but the 2 miscarriages have to be recurrent so im not eligible. Just left to suffer

I’m really sorry OP it is rubbish, I believe for recurrent miscarriage you need to have 3+ consecutively to be referred & seen on the NHS.

I would speak to a different GP and ask for a referral to gynae if it is PCOS symptoms you are struggling with though.

So you have had two miscarriages and you have one child in your current relationship - your child means you almost certainly won't be eligible for any NHS fertility treatment such as IVF.

Is it the 'painful cramps, embarrassing hair growth and fatigue' that you are struggling with at the moment? Have you restarted Mounjaro? What are you using for those symptoms at the moment? What is your BMI now? What is it that you hope metformin will help with?

Your GP has a point that most of the effective treatments for painful periods are contraceptive, so that's tricky if you are still TTC. Referral criteria to a recurrent miscarriage clinic is usually 3 early miscarriages or one over 10 weeks, but it can vary with location so worth checking your ICB website (or equivalent if you're in Scotland/Wales/NI).

(NB I'm a GP but obviously can't give personal health advice as per GMC social media rules but I might be able to guide you on some of the systems issues which I know can be tricky to navigate in the NHS).

I was prescribed Metformin by GP albeit it was over a decade ago. I do have a friend though who was also recently prescribed it through GP after a scan and blood tests for PCOS.

If you have PCOS and your GP won’t prescribe Metformin (which they should if you have been medically diagnosed, plus the generic stuff is cheap as chips and very safe, even in pregnancy), then you can ask your GP to refer you to an Endocrinologist who will be able to prescribe it. I have no idea how long the waiting list will be in your area but they should refer you if you ask (or they may suddenly find it easier then to prescribe it themselves 🙄).

Agree see if you can get metformin as it can reduce risk of miscarriage.
also see if you have thyroid issues. Tsh should be around 1 for conception

what is your bmi. I would probably keep trying to get bmi down.

You are assuming that the local endocrinologist doesn't reject referrals for PCOS - it's not uncommon for certain referrals to be auto-rejected e.g. rheumatology for suspected fibromyalgia/hypermobility.

NICE guidance on metformin is here https://cks.nice.org.uk/topics/polycystic-ovary-syndrome/management/management-adults/ and the European guidance is here https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Polycystic-Ovary-Syndrome

Fair enough. I was only sharing based on my experience. I was referred to Endocrinology by my GP, and the wait then wasn’t that long from what I remember- although they also didn’t have any problems prescribing Metformin themselves (I had been diagnosed with PCOS previously like the OP).

But I can definitely accept it might vary depending on where you are in the country, and perhaps I was lucky with that. Because trying to get an MRI on the other hand (for my eventually diagnosed severe back condition after I’d been telling them that there was something seriously wrong for years 🙄) - that was a complete nightmare.

@AmyA29 If you can afford £200-£300 go straight to a private consultant (via Doctify etc) to get metformin or whatever else they suggest. It's worth the money to see someone within days.

What blood test did the GP offer? Get lipids (cholesterol), HbA1c (blood sugar average over 3 months), fasting glucose + insulin, a total blood count and day 3 hormones. They should take it seriously from a metabolic angle even if they don't from a fertility.

The root of PCOS is insulin resistance. Eat like a diabetic would, walk a lot, try to build muscle. This will control high androgen symptoms, reduce chronic inflammation and lower the elevated PCOS miscarriage risk.