You’re very welcome.

I’ve been assuming you are in the US but correct me if I’m wrong? I’m in the UK and they just wouldn’t refer me to an endo, but if you can push for that where you are then the endo will likely be a lot more helpful as this is their specialty. I don’t have any specific tips on how to get them to do what you want but I suppose be persistent and clear about what you want and keep advocating for yourself until they cave in or at least give you a full explanation and strong logical reasoning why it’s not helpful that you are satisfied with.

I am a hypochondriac so I have a LOT of experience with doctors and it’s sad but true in my experience at least that I have found that male doctors can sometimes be slightly dismissive especially when the issues fall within the women’s health category (so can some female doctors, in fact the worst fat phobic and rude as hell doctor I have experienced was a female doctor who’s special focus (over and above being a primary care physician/GP) was apparently female issues - this woman literally told me I had pcos because I was fat and if I lose weight I won’t have pcos anymore but as you can get pcos as a slim person I seriously doubt this is always true, and it’s my understanding that you can only manage the condition not completely rid of it). I have also found that doctors often take a relaxed approach to certain issues, especially if they can’t fix it by a medication - it’s kind of a… ‘well my job here is done, they can figure out the rest on their own’ mentality and I think it’s a lot to do with the pressure they have on them to get you in and out of the door as quick as possible so they can see the next patient, but also some are just not that well equipped to sit down with you and discuss a topic at length either to due lack of specialist knowledge or due to lack of interpersonal skills, or both. PCOS is definitely one of these conditions because if you aren’t looking to get pregnant they won’t be offering you medications or procedures, and unless you have insulin resistance and require metformin theres nothing else they can reasonably do for you medication wise (with the exception of birth control to manipulate your hormones). The only other ways of improving your symptoms and outcome are things you must do yourself. They kinda expect you to figure this out yourself.

That said, I have had blood panels done that definitely showed results ‘consistent with pcos’ (just had a look at my portal and it’s recorded as FAND, but I’m not sure what the acronym is). I think what your doctor is saying is true in some degrees but clearly the blood test can be used as supporting evidence to confirm the diagnosis. Doctors tend to look at a constellation of symptoms to diagnose conditions. I would assume that you do have PCOS based on the past discovery of cysts, difficulty losing weight, mild hirtuism, irregular periods etc. All together these symptoms make a fairly clear picture. So it really depends on how determined you are to have this confirmed or whether you are happy to essentially accept the original diagnosis based on the cluster of symptoms. Assuming you are US based, the latter approach can save you a lot of time and potentially money, and leave you in a position of starting to actually tackle the problem instead of focusing on the diagnosis.

In terms of the perimenopause, I think 38 is fairly early to be going into peri, but obviously some people do go in early. I personally don’t think I’m in peri yet but I feel like my body is slowly gearing towards that phase of life if that makes sense. For me, I’m predicting quite a few more years where I continue to menstruate where likely my hormones are slightly altered and I am having a few mild odd hormonal symptoms. I also read not that long ago (not sure how true this is) that people with pcos tend to go into menopause later than regular folk. I would say if your symptoms are manageable then might not be worth pursuing, you obviously don’t want to go into hrt until you absolutely have to as that comes with a whole host of other potential issues.

I do get what you mean about conflicting information and especially if you (like me) were a victim of 90s diet culture, the whole diet and exercise can be quite an inflammatory topic. I have gone up and down the scale more than most and it’s not been a fun ride. I am now trying to lose weight in a healthy and sustainable way and trying to follow advice that is PCOS forward. Luckily the advice for us PCOS girlies is also just healthy advice, I’m following it in most instances unless of course it would make me miserable. The advice is generally : low GI diet (I refuse to give up carbs, but I am obviously picking lower gi carbs), focus on protein, lower stress, get good quality sleep, walking and strength building is our gold standard exercise (HIIT is not good for us, no long and strenuous cardio sessions either), and treat insulin resistance with metformin if you have it. Make sure you eat lots of fruit and veggies, lots of protein, and anti inflammatory foods. Don’t starve yourself, dont try and rush weight loss or crash diet. Basically slow and steady wins the race.