One of the laser treatments offered under the NHS in our region is facial hair removal in patients who are diagnosed with hormonal disorders such as polycystic ovary syndrome (PCOS).
PCOS affects 5–10% of women and symptoms may include infrequent or absent menses, infertility, weight gain, excessive hair growth and acne. Obtaining a diagnosis of PCOS can be a difficult and lengthy process. In this centre alone we have seen several patients in whom PCOS was suspected clinically, but not diagnosed, thereby precluding these patients from treatment with NHS funding. In one instance, a patient was forced to seek private consultation from a specialist who was able to confirm the diagnosis of PCOS. Uncertainties in the diagnosis arise largely from the wide diagnostic criteria described by a consensus in 2003 of the European and American societies for Human Reproduction and Embryology.1 These guidelines state that PCOS can be diagnosed when two out of three criteria are satisfied; these being, evidence of infrequent or absent ovulation, ultrasonic evidence of polycystic ovaries (>12 cysts of 2–9 mm diameter), and biochemical or clinical evidence of hyperandrogenism. We suspect that patients who are eligible for NHS treatment of the symptoms of PCOS may be being denied laser or other treatment if they fail to meet just one of the diagnostic criteria. Where this is the case and there is clinical suspicion of PCOS, benefit may be gained from referral to a specialist team with a particular interest in PCOS. According to the criteria, a diagnosis of PCOS is still a possibility even in the face of normal biochemical and radiological tests that may have already been carried out by the GP.