Episode 15 - PCOS management in general practice - Dr Simon Nothman
PMOS management: looking beyond the fertility appointment
A diagnosis of Polyendocrine Metabolic Ovarian Syndrome (PMOS), formally known as polycystic ovary syndrome, or PCOS, can raise questions about periods, skin changes, future pregnancy and longer-term health. Some patients arrive after years of irregular cycles, while others first hear the term following an ultrasound. Their needs can differ considerably, even when they share the same diagnosis.
In this episode of Fertility in General Practice, host Dr Ali Hodgkinson speaks with fertility specialist Dr Simon Nothman about diagnosis, assessment and ongoing care. The discussion positions the GP as the person helping coordinate the wider team, keeping attention on the patient's health beyond a single symptom or reproductive goal.
Establishing the diagnosis carefully
Dr Nothman discusses the diagnostic features of PMOS/PCOS, including ovulatory dysfunction, clinical or biochemical signs of androgen excess and polycystic ovarian morphology. He explains why the combination of findings matters, and why an ultrasound appearance on its own should not be treated as the whole diagnosis.
The episode also explores the importance of excluding other explanations. Thyroid conditions, elevated prolactin and functional hypothalamic amenorrhoea can enter the differential diagnosis. A careful history and appropriate assessment help avoid attaching a PCOS label to a patient whose symptoms need a different explanation or treatment plan.
Different presentations, different priorities
The conversation considers the different PMOS/PCOS phenotypes and the variation in symptoms and risks between patients. Not everyone will have obvious androgen-related symptoms, and not everyone will present with the same menstrual pattern.
Lean PMOS/PCOS is also discussed. Body size alone does not provide a complete picture of metabolic health or remove the need for appropriate assessment. At the same time, clinicians need to remain alert to other causes of irregular or absent periods, rather than assuming that every patient with a similar scan has the same condition.
Think beyond reproductive symptoms
Dr Nothman explores longer-term metabolic and gynaecological considerations, including diabetes risk and endometrial health. The episode encourages an approach that looks beyond whether a patient is currently trying to conceive.
Mental health is another central theme. Anxiety, body image concerns and fertility-related distress can affect how a patient experiences the condition and engages with care. Asking about wellbeing, sleep and the practical effect of symptoms can help identify support needs that a laboratory result or ultrasound cannot show.
Contraception is part of the management conversation
Patients may assume that irregular ovulation means they cannot become pregnant. The episode emphasises that a PCOS diagnosis is not contraception. Reproductive intentions should be discussed directly, including with patients who are not currently planning a family.
The choice of contraception may also relate to bleeding patterns, androgen-related symptoms and protection of the endometrium. Dr Nothman discusses why these goals need to be considered together with the patient's preferences and medical history. There is no single contraceptive option that is automatically best for everyone with PCOS.
Lifestyle and medicines need an individual plan
Nutrition, activity, sleep and stress feature in the conversation as parts of ongoing care. These discussions should be practical and supportive, recognising that patients may already have received conflicting advice or felt blamed for their symptoms.
Dr Nothman also discusses metformin and GLP-1 medicines, including how pregnancy intentions affect treatment decisions. These are topics for an individual prescribing discussion, not instructions to start, stop or continue a medicine based on a podcast. GPs can help patients understand the purpose of a treatment, how it will be reviewed and what they should discuss before trying to conceive.
Coordinating a team around the patient
The episode describes the GP as a conductor, bringing together medical and allied health input where needed. A dietitian, exercise professional, psychologist or relevant specialist may each contribute, depending on the patient's needs and goals.
Continuity matters because priorities change. A patient seeking symptom control today may later want preconception advice or fertility treatment. A clear, shared plan helps connect those stages, with follow-up that addresses physical health, emotional wellbeing and reproductive intentions rather than treating each concern separately.
For GPs, the practical message is to keep the assessment broad and the plan personal. Reviewing what matters most to the patient can make a complex condition easier to discuss and manage over time.
Listen to the episode
Listen to Dr Simon Nothman and Dr Ali Hodgkinson discuss PCOS assessment and coordinated long-term care. The episode offers GPs a framework for looking beyond isolated symptoms while helping patients understand the reasoning behind their individual management plan.
About Dr Simon Nothman
Dr Simon Nothman is a Sydney fertility specialist whose interests include general and complex fertility concerns, male infertility, recurrent pregnancy loss, fertility preservation, preimplantation genetic testing and PCOS. He has extensive experience in reproductive medicine in Australia and Israel. His approach focuses on explaining options and evidence clearly, with treatment shaped around each patient's diagnosis, priorities and circumstances.
.png "Genea logo"){kind=logo}
.png)
