Doctors visit for PCOS. What to expect

[Phantaja]

I'm 25 and have been off birth control for 15 months. I got pregnant once 5 months ago and it was ectopic. I haven't been able to get pregnant since.

I've been doing some research and I have a lot of signs and symptoms of PCOS, so I made an appointment with my GYN for Tuesday. What should I expect from this initial appointment?

[kriket]

Expect lots of blood tests and if you are overweight a lecture about being so. Also, a pap, the regular workup. Then if your blood comes back off you may have an ultrasound to look for cysts.

[leerypolyp]

Yeah, that.

Expect to encounter some resistance and to have to find a different practitioner or to fight for the bloodwork/interpretation you know you need. Sigh.

Okay, in reality, you may get someone who is knowledgeable about PCOS. But if your gyn goes right to "birth control pills -- lose some weight -- this bloodwork looks fine to me" then you might have to go elsewhere. I'm glad you've done some research and know what to expect -- they should run a FSH:LH test and check the ratio (not the total numbers), and look for some other things (free testosterone maybe, A1C).

I had to see an RE before I got good care, but once that was in the bag I was able to get follow-up from a variety of different HCPs.

[CanidFL]

Originally Posted by leerypolyp

Yeah, that.

Expect to encounter some resistance and to have to find a different practitioner or to fight for the bloodwork/interpretation you know you need. Sigh.

Okay, in reality, you may get someone who is knowledgeable about PCOS. But if your gyn goes right to "birth control pills -- lose some weight -- this bloodwork looks fine to me" then you might have to go elsewhere. I'm glad you've done some research and know what to expect -- they should run a FSH:LH test and check the ratio (not the total numbers), and look for some other things (free testosterone maybe, A1C).

I had to see an RE before I got good care, but once that was in the bag I was able to get follow-up from a variety of different HCPs.

I agree with this.

They should be doing blood work and an u/s for sure. Can you see an RE? That would be your best bet. Gyn typically just write a rx for birth control pills and tell you to loose weight. Or even worse.....just give you clomid without investigating if you are having infertility like mine did.

[kriket]

I do too (sadly) I didn't want to be discouraging. If you can get to an RE and not a OBGYN I would suggest that too.

Originally Posted by leerypolyp

Yeah, that.

Expect to encounter some resistance and to have to find a different practitioner or to fight for the bloodwork/interpretation you know you need. Sigh.

Okay, in reality, you may get someone who is knowledgeable about PCOS. But if your gyn goes right to "birth control pills -- lose some weight -- this bloodwork looks fine to me" then you might have to go elsewhere. I'm glad you've done some research and know what to expect -- they should run a FSH:LH test and check the ratio (not the total numbers), and look for some other things (free testosterone maybe, A1C).

I had to see an RE before I got good care, but once that was in the bag I was able to get follow-up from a variety of different HCPs.

[leerypolyp]

Yeah, actually, on further thought, you might as well just ask for the referral to an RE at the GYN appointment. So at the very least, you don't have to go back.

Oh, and I forgot, beware the hcp who goes straight to Clomid!

[Phantaja]

Sigh. I hadn't expected it to be a walk in the park, but this wasn't what I expected to hear either. I have too many symptoms, not to mention being pre-diabetic, for it not to be PCOS, so I was kinda hoping for some metaformin, a pat on the back, and few sympathetic words of encouragement from my GYN, with instructions to come back in 4 weeks because I'll probably be six weeks pregnant by then.

[leerypolyp]

Aw. It does suck. My sympathies.

However, this is something you'll be dealing with long-term, even if you do get pregnant right away -- you'll want to have an idea of what your lipid profile is like, in addition to a long term fertility-friendly way to manage the pre-diabetes (like....metformin!). It can affect pregnancy and breastfeeding as well, so think of it as a chronic condition to manage, and something for which you'll need a knowledgeable medical ally, at least at the beginning.

So...at least if you have to take things up a notch, it'll all be for the best in the end, right? Right? RIGHT? Hey, don't run away...

[chel]

Originally Posted by Phantaja

Sigh. I hadn't expected it to be a walk in the park, but this wasn't what I expected to hear either. I have too many symptoms, not to mention being pre-diabetic, for it not to be PCOS, so I was kinda hoping for some metaformin, a pat on the back, and few sympathetic words of encouragement from my GYN, with instructions to come back in 4 weeks because I'll probably be six weeks pregnant by then.

this is how my appt went. I was in for my yearly and asked my GYN about met. I wasn't TTC at the time. I never had blood test.

[ErikaG]

Originally Posted by Phantaja

Sigh. I hadn't expected it to be a walk in the park, but this wasn't what I expected to hear either. I have too many symptoms, not to mention being pre-diabetic, for it not to be PCOS, so I was kinda hoping for some metaformin, a pat on the back, and few sympathetic words of encouragement from my GYN, with instructions to come back in 4 weeks because I'll probably be six weeks pregnant by then.

For what it's worth, my experience was far more like this. It was reviewing some bloodwork that had been ordered a few weeks prior, an ultrasound appointment, a prescription for Metformin (because it was pretty obvious even though my bloodwork was remarkably normal that I have the non-insulin variant of PCOS) and a plan for the next few months-have lots of sex, and if you don't get pregnant, come back and see me, and we'll figure out what to do next. No lectures about my weight...no telling me I'd never get pregnant...nothing. We discussed a plan to get me pregnant, whether my husband should be screened for fertility issues as well, when to introduce Clomid, when to move on to the reproductive endocrinologist, etc.

It really depends on your care provider. My OB/GYN is amazing at delaing with PCOS, and worked with me to get pregnant and have my daughter, who is now six months old, and who is ready to help me ttc again in a few months. I've heard horror stories about the other doctors in his practice though. There are some great recommendations at soulcysters.net for doctors, and at http://www.cat-and-dragon.com/stef/fat/ffp.html as well.