Until fairly recently PCOS was a very poorly understood condition. I think it was first recognized as a disorder in the '30s and named Stein Leventhol Syndrome (after the docs who recognized the pattern of symptoms...) The thing is even though it was recognized that a woman would present with overweight, no periods, excess hair, infertility... docs didn't know WHY. All you could do was treat symptoms - or really in the pre-BCP, pre-fertility drug era, really I guess you couldn't do much at all besides know you had a health condition which is some small comfort. Once clomid came on the market, the fertility aspect could be addressed... once BCPs came on the market, the lack of periods could be addressed... once electrolysis was available, the hair could be addressed... but still doctors didn't know WHY women had this problem. It was still just a constellation of crazy symptoms.
It was only I'd say ~10 years ago that it was discovered insulin is the culprit behind the condition, making this an endocrine problem as opposed to a gynecological one (which most people think of it as, due to the period/infertility aspects) They figured that tinkering with insulin levels could in turn have an effect on other hormone levels.
The problem is...
1. the drugs that work for this are for some reason STILL not approved for treatment of PCOS, so using them for such is considered "off label," and a lot of doctors are uncomfortable with prescribing a drug for "off label" use. They want to open the PDR and see "This drug can be used to treat type II diabetes or polycystic ovarian syndrome." Since they can't see that, they won't prescribe.
2. A lot of women are still going to the wrong doctor for this. While there *are* some gynecologists and general practitioners who are up on the latest news about this, a lot are not... but those are the kinds of docs women go to for answers. A woman needs to see an endocrinologist for treatment in most cases, but it just doesn't occur to most women who are having problems with their periods to go to a diabetes doctor.
I guess that's the problem in a nutshell...
Even if you go to the right doctor, though, there are endocrinologists who will prescribe metformin but not avandia... or will prescribe metformin but refuse to prescribe more than 2000mg a day... so even in the right circles, there exists a lack of knowledge. I guess it all really comes down to the understanding of this condition still being fairly new in the grand scheme of things. We've still come a long way from when I was first trying to get answers, circa 1993 or 94, when all I was getting was birth control pills, aldactone, and "we don't know what's wrong."
Why is it hard.... 
