Why PCOS is under-recognised?

A substantial number of our patients seem to be suffering from what Western medicine calls PCOS, which is short for polycystic ovary syndrome. The NHS estimates that 10% of women have PCOS, but many sufferers have not been formally diagnosed, surprisingly. It is clear, from scientific literature, that PCOS is very much under diagnosed. There seems to be a number of reasons for this.

Why the under diagnosis?

1. The diagnostic protocol is not always followed

The formal protocol for PCOS diagnosis employs the following 3 criteria:

  • Check the two hormone markers to see if AMH and testosterone levels are too high
  • See if there are symptoms of hair loss or growth, skin issues, irregular or missing periods (having just a few of these is enough to fulfil this criterion)
  • Conduct an ovary scan to see if there are multiple follicles

If 2 out of these 3 criteria are met, a diagnosis of PCOS is given.

However, patients tell us that their doctors sometimes only order the follicle scan, and then say they don’t have PCOS when the scans don’t show enough follicles to justify a diagnosis. 

2. AMH and testosterone are not tested

The common practice is that doctors don’t seem to routinely check AMH and testosterone levels. But even if they are, the reference ranges for AMH and testosterone are inflated, so the results may not be interpreted correctly.

The reference ranges for AMH were constructed by randomly selecting women from different age groups and then measuring their AMH. Women with PCOS — whether diagnosed or not — were included in the sample, and this skewed the measured average ranges up; a true AMH reference range shouldn’t include women with PCOS. The reference range for testosterone was constructed in a similar way, but didn’t need to take age into account.

As the AMH and testosterone levels are inflated, many women are given false negatives, even when their hormone levels are actually high.

On the other hand, it seems that some doctors do recognise this: We have had some patients who were correctly diagnosed with PCOS before coming to us, where their AMH and testosterone are within the “normal” reference ranges.

3. IVF, the “solution” that’s always offered

When patients are having fertility issues, they are routinely suggested to do IVF by GPs, gynaecologists and IVF doctors. From what our patients have told us, there seems to be little interest in finding out or treating causes of infertility, such as PCOS.

In fact, with IVF, the stress is on collecting as many eggs as possible. As the reference ranges for AMH are so inflated, many patients who have high AMH (which may point to PCOS) end up being told their AMH is too low for IVF.

What is the Western medical treatment for PCOS?

We understand that patients who are diagnosed with PCOS are either prescribed metformin or not given any treatment at all by their doctors. It should be noted that metformin is a diabetic medication. The reason why metformin may be prescribed is because some doctors believe PCOS patients are insulin resistant. However, it is increasingly clear that metformin does not work for a vast majority of PCOS patients — it has been estimated that metformin only works for about 5% of PCOS patients. This implies that the insulin-resistance hypothesis is not substantiated, at least, in clinical settings. As a result, the NHS is slowly withdrawing prescribing metformin for PCOS.

As there really isn’t an effective Western treatment, most PCOS patients are not treated at all. The lead-on from this is that some Western doctors may also not bothering diagnosing it either — if there’s no treatment they can offer, then why bother?

Why is PCOS a problem for fertility?

For women, egg quality is the single most important deciding factor for a successful pregnancy.

Egg quality is highly dependent on hormones: When your hormones are at the right levels and balanced, your egg quality is likely to be good. When they are not, your egg quality is likely to be compromised. When you have imbalanced hormones, you are more likely to experience difficulty in natural conception or IVF, and can have a high probability of miscarrying.

As PCOS is caused by hormonal imbalance, and hormonal imbalance is the cause for poor egg quality, PCOS is thus a problem for fertility.

So do I have PCOS?

Since PCOS is seriously under diagnosed, you may wish to look out for it by conducting your own observations, if not investigation. You may wish to check the following:

  • Do I have hair lost or hair growth e.g. a few hair around the chin area?
  • Do I have acne, pimples, spots, acne, oily skin, dry skin?
  • Do I have irregular or missing periods?
  • Have I been trying for over a year and cannot conceive?
  • Do I keep having miscarriages?
  • When I went for IVF, were there a high number of eggs collected, but few developing into embryos and/or failed implantations?

If the answers to the above are mostly “yes”, you may wish to get AMH and testosterone tested to see if they are on the high side (note the references ranges must be interpreted properly). We can help arrange and interpret the results of these tests.

Will IVF work?

IVF has the advantage of making sure that an egg meets a sperm. However, the reason why PCOS patients find natural pregnancy difficult is mainly because their egg quality is poor. As the IVF procedure will not, and is unable to, improve egg quality, it will simply collect poor-quality eggs. The original issue — poor quality eggs — remains.  

Would changing diet and lifestyle help?

Some patients come to us and say that they’ve made substantial changes to diet and lifestyle, and this seemed to have brought some benefits. However, when we look at their hormone levels, they still suffer from hormonal imbalance — high AMH and testosterone results. This is consistent with our clinical experience, where diet and lifestyle changes can help somewhat — but changing lifestyle and diet alone is not enough to bring hormones to normal levels.

What about supplements?

Many patients use supplements before they come to us. They tend to be taking them by faith without pre and post treatment testing of hormone levels. We may be wrong, but we are not aware of effective supplements that can reliably reduce AMH and testosterone levels.

How can we help?

At TCM Healthcare, we use natural herbal remedies to strengthen and regulate the entire reproductive system, as conceived by traditional Chinese medical theory and practice. When the reproductive system functions better, hormones also improve. We have an 80% success rate in lowering AMH and testosterone — we comparing results before and after treatment for all our patients.

You may wish to check out our testimonials and Google reviews.

We have also included relevant scientific papers on the resources page.

For PCOS test, please click test.TT

Book an appointment!

A booking fee of £100 (refunded when you attend) will be processed at booking. 

Late cancellation fee £50
We appreciate that you might not be well or have urgent matters to attend. As a result you may have to postpone the appointment. We would like to have at least 24 hours’ advance notice. A late cancellation fee of £50 is payable if advance notice is not given.

Are there patients we cannot help?

Yes. No medical system is foolproof and medical practitioners, however good, are not omnipotent. As great as our success rates are, they are not 100%. There are times patients do not respond to our treatments despite our best efforts.

Delayed improvements are possible when patients rest a little. However, even with rest, patients may still not respond well. Fortunately, these cases are in the minority. We minimise the number of these cases by trying to understand our patients’ conditions as much as possible before taking them on. We minimise time and financial commitments from patients by insisting they have hormone or sperm test results prior to treatment, and to get retested after 3 months — following our evidence-based approach.

At TCM Healthcare, we will always have your best interests in mind and we will do our best.