How to Prepare for Your GP Appointment

If you think you may have PMOS, making that first GP appointment can feel surprisingly difficult.

Perhaps your periods have always been irregular. Maybe you have developed acne, facial hair or thinning hair. Perhaps you are struggling with fertility, weight changes or fatigue. Or you may simply have a collection of symptoms that nobody has yet connected.

Preparing beforehand can help you use your appointment well and give your GP a clearer picture of what has been happening.

This does not mean arriving with a self-diagnosis or demanding a long list of blood tests. It means being able to describe your symptoms, menstrual history and wider health clearly so that you and your doctor can decide what needs investigating.

Before your appointment: write down your symptoms
PMOS can affect much more than periods, so think about the whole picture.

Make a note of any symptoms you have experienced, including:

• irregular, infrequent or absent periods
• very long menstrual cycles
• acne or persistently oily skin
• increased facial or body hair
• thinning scalp hair
• difficulty conceiving
• unexplained weight changes or difficulty managing weight
• darkened skin around the neck, groin or underarms
• fatigue or significant daytime sleepiness
• snoring or waking feeling unrefreshed
• anxiety, low mood or changes in body image.

You do not need to have all of these to have PMOS.

Also note when symptoms started and whether they have changed. Gradual facial hair growth over several years, for example, gives your doctor different information from very rapid new hair growth accompanied by other marked hormonal changes.

Take your menstrual history with you
Your cycle history is particularly useful because one of the main diagnostic features of PMOS is ovulatory dysfunction.

If possible, make a note of:

• the age you started your periods
• roughly how frequently you have them
• your shortest and longest recent cycles
• whether you sometimes go several months without a period
• any prolonged or unusually heavy bleeding
• whether your cycles changed after stopping hormonal contraception.

A period-tracking app can be useful, but a simple calendar or written record works just as well.

If you have gone for long periods without menstruating, tell your GP. Infrequent periods matter not only for diagnosis but because prolonged untreated amenorrhoea can increase the risk of endometrial hyperplasia.

Tell your GP about medication and contraception
This is especially important if you take the combined oral contraceptive pill or another hormonal treatment.

Hormonal contraception can change androgen production and increase sex hormone-binding globulin, or SHBG, making biochemical assessment of androgen excess more difficult.

That does not mean you should stop contraception yourself before your appointment.

Instead, tell your GP exactly what you are using, how long you have used it and what your periods and symptoms were like before you started. If hormonal testing is necessary, your doctor can advise whether medication affects the interpretation and what the safest next step should be.

Bring a list of other medicines and supplements too.

Family history can provide useful clues
PMOS has a strong genetic component, so tell your GP if your mother, sisters or other close relatives have PMOS or similar symptoms.

It is also useful to mention a family history of type 2 diabetes, gestational diabetes or cardiovascular disease, because PMOS is associated with increased metabolic risk.

And if you have previously had gestational diabetes yourself, make sure this is included.

What is your GP actually looking for?
PMOS is not diagnosed by one blood test. In adults, diagnosis is generally based on finding at least two of three features after other possible explanations have been excluded:

Ovulatory dysfunction, usually demonstrated by irregular or absent menstrual cycles.

Clinical or biochemical hyperandrogenism, meaning physical signs, such as acne or facial hair, or laboratory evidence of increased androgen activity.

Polycystic ovarian morphology, assessed by ultrasound, or raised AMH where appropriate.

If irregular cycles and hyperandrogenism are already present, an ultrasound or AMH measurement may not be necessary.

This is why simply asking for an ovarian scan is not the best way to investigate suspected PMOS. You can have PMOS without polycystic-looking ovaries, and you can have polycystic ovarian morphology without having the syndrome.

What blood tests might be considered?
Exactly which tests are appropriate will depend on your symptoms, age, medication and medical history.

To investigate biochemical hyperandrogenism, the international guideline recommends total and free testosterone, with calculated free testosterone or the Free Androgen Index commonly used in assessment.

If testosterone is not elevated but androgen excess is still suspected, other androgens such as androstenedione or DHEAS may sometimes provide additional information.

Your GP may also investigate other conditions that can produce similar symptoms. Depending on your individual presentation, this can include thyroid dysfunction, raised prolactin and non-classic congenital adrenal hyperplasia. This differential diagnosis is important. Irregular periods, acne, hair growth and hair loss are not exclusive to PMOS.

If androgen levels are markedly elevated, or symptoms such as hirsutism or virilisation have developed rapidly, further investigation may be needed to exclude less common causes.

Don't forget metabolic health
One of the biggest changes in our understanding of PMOS is recognising that assessment should extend beyond reproductive hormones.

Women with PMOS have an increased risk of impaired glucose tolerance and type 2 diabetes regardless of age or BMI.

The 2023 international guideline recommends assessing glycaemic status at diagnosis. A 75g oral glucose tolerance test, or OGTT, is considered the most accurate method of assessing glycaemic status in PMOS. If an OGTT cannot be performed, fasting glucose and/or HbA1c may be considered, although they are less accurate in this population.

This is worth knowing because a normal body weight does not automatically mean that metabolic screening is unnecessary.

Current international guidance also recommends assessing cardiovascular risk factors. This includes a lipid profile at diagnosis and blood-pressure assessment, with future monitoring depending on individual risk.

So, if the conversation focuses entirely on your periods, it is reasonable to ask: “Do we also need to consider my metabolic health?”

What about insulin testing?
This is an area where there is considerable confusion online. Insulin resistance is an important part of PMOS physiology, but the international guideline does not currently recommend routinely available insulin assays for diagnosing or monitoring insulin resistance in everyday clinical practice because currently available measures are not sufficiently accurate or standardised.

That may seem contradictory, particularly when insulin plays such an important biological role in PMOS. The distinction is that insulin resistance is mechanistically important, but routine clinical insulin measurements do not yet provide a sufficiently reliable diagnostic measure of it.

This is why the guideline concentrates on assessing glycaemic status and wider metabolic risk.

Tell your GP what matters most to you
PMOS management should not revolve solely around fertility.

You might be most concerned about facial hair. It might be acne.

You might want to understand why your cycles have disappeared.

You might be trying to conceive.

Or perhaps your greatest concern is fatigue, weight changes, anxiety or your future risk of diabetes.

Say this.

The international guideline specifically emphasises person-centred care and recognises the significant effects PMOS can have on quality of life, body image and psychological wellbeing.