ENDOCRINOLOGY RCOG calls for action on women’s health


The Royal College of Obstetricians and Gynaecologists has outlined its five calls to action for the new UK government. The RCOG says that women’s health has


historically been left behind, with lack of adequate investment in both services and research, meaning missed opportunities to provide the right information, care and support at the right time across a woman’s life course.


The RCOG is calling for:


1 The government to prioritise women’s health and maintain a focus on implementing the Women’s Health Strategy and Women’s Health Hubs in the long term.


2 The government to significantly improve maternity care by implementing fully funded cross-government policies and programmes to ensure all women receive high-quality, personalised and safe maternity care.


3 The Department for Health and Social Care and NHS England to set up a joint taskforce to address the unique growth in waiting lists in gynaecology.


4 A commitment to parliamentary time for abortion law reform.


5 The Foreign, Commonwealth and Development Office to return spending on sexual and reproductive healthcare and rights (SRHR) to pre-cut levels of 5% of the overseas aid budget.


medium term, PCOS can lead to weight gain or difficulty losing weight, or even fertility problems – and for women who do conceive, they are at higher risk of developing gestational diabetes. Longer-term, it can cause challenges such as insulin resistance and diabetes. It can also increase the risk of endometrial cancer. In my practice, the presentation of these early symptoms is what drives most visits for PCOS, but I also know that often patients are treated for those symptoms without investigations into their underlying cause. The earlier PCOS can be diagnosed, the more we can do to help patients manage their symptoms and reduce both the physical consequences and emotional impact of those medium- and long-term symptoms. However, getting this early diagnosis can be challenging, due to the wide range of presenting symptoms and the complex pathways that we can send


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Dr Ranee Thakar, President of the Royal College of Obstetricians and Gynaecologists, said: “We are calling for the government to prioritise women’s health focusing on better healthcare access, safety improvements, and reproductive rights. Commitment to the


Women’s Health Strategy and the success of Women’s Health Hubs will be key to this. “Sexual and reproductive health should be a funding priority in both the UK and globally. If women and girls are to be supported to fully participate in social and political life and make decisions about their own bodies, they must be supported to have access to sexual and reproductive health and rights across the life course. Abortion law reform is essential to protect these rights in the UK, hence why we are asking the new government to commitment to parliamentary time to the matter. “Every woman should receive safe, compassionate and personalised maternity care, timely care for gynaecology conditions and access to sexual and reproductive health services, including abortion. “To prevent burnout among obstetricians and gynaecologists, we are also calling for the government to commit to vital action on workforce retention, flexible working, training and development.” View the full document at: https://brnw. ch/21wJE4t


patients down to reach a diagnosis. This means that PCOS is often diagnosed late, making it harder for patients to make crucial interventional lifestyle changes that could alter the course of their condition. While PCOS is typically labelled a gynaecological or ‘women’s health’ condition, it’s actually a long-term endocrine condition and should be recognised – and managed – as such. Insulin resistance should be a key driver of the conversation around the importance of diagnosing PCOS early so that pre- diabetic and diabetic symptoms aren’t left at risk of getting worse. While weight gain is a common symptom of PCOS, it’s harder to lose weight for those who are insulin resistant, and so managing symptoms can become harder the longer the condition remains undiagnosed. We can look at asthma as a helpful comparison: it’s another long-term condition which can’t be cured but can be


managed with appropriate intervention. Insulin resistance as a result of PCOS can’t be stopped, but it can and should be managed effectively. We should always try to provide corresponding holistic advice and support for patients with PCOS.


Diagnosing PCOS early – changing guidance, new approaches Globally, PCOS is diagnosed using the Rotterdam Criteria, of which any two must be met: n Ovulatory dysfunction n Clinical and/or biochemical signs of hyperandrogenism


n Confirmed presence of polycystic ovarian morphology (PCOM)


We tend to rely on the first two criteria to diagnose patients: the presentation of infrequent periods, and signs of hyperandrogenism. But we can enrich this clinical picture with insights gained from diagnostic procedures such as blood testing and imaging. The third element of the Rotterdam Criteria – a confirmed presence of PCOM – can be determined through either ultrasound, or, thanks to a recent addition to the criteria, by the detection of elevated serum anti-müllerian hormone. Using AMH levels to confirm the presence of PCOM means patients don’t have to have an additional appointment for an ultrasound, a procedure which, if performed transvaginally, can be uncomfortable and even unsuitable for some patients.1 Now, with the CE-mark approval for Roche Diagnostics’ AMHPlus immunoassay’s claim extension to detect PCOM, we have the first blood test for PCOS. This could be a game-changer: it offers the possibility of a quicker and more convenient diagnosis than via an ultrasound, which could aid patients with more rapid symptom management. A blood test can be seamlessly integrated into the diagnostic process: in most cases, clinicians will already be organising blood tests for a range of investigations, and so one additional test doesn’t demand any extra time from the patient. By contrast, ultrasound scans usually require patients to invest time and effort; as a result, ‘did not attend’ rates are as high as 70% in some parts of the country.


This can have consequences: we know that patients who do not attend their scan may become lost in the system, experience further delays, and disengage with the diagnostic process. These patients may experience worsening symptoms without ever having the reassurance of being supported with


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