Q&A on women’s health with BMI Healthcare - ANSWERS BACK

[HeatherMumsnet]

Were running a Q&A on Womens Health with BMI Healthcare who are offering you the opportunity to ask questions to a panel of specialist Womens Health consultants.

The experts include Consultant Gynaecologists Robert MacDermott, Alvan Priddy, Faz Pakarian, Tom Farrell, Sangeeta Das, Gabrielle Downey; Consultant Gynaecologist & Obstetrician, Parjit Bhattacharjee and Consultant Obstetrician and Gynaecologist, Ami Shukla. Post your questions to BMI Healthcare before midnight on 16 October and well upload their expert answers to this thread on 24 October.

BMI Healthcare recently ran a Mumsnet survey and found that 93% of Mumsnetters have had at least one gynaecology problem, ranging from problem periods to difficulty conceiving and 64% have experienced at least one issue in the last 12 months alone. So whether its heavy periods, a niggling pain or menopausal symptoms, we could help shed light on some of your personal issues.

This Q&A is sponsored by BMI Healthcare

[babyrose]

My dh and I have been trying to conceive for 11 months now. I'm 32 and dh 34 we already have a ds who is now 3. My periods are regular 27-29 days. We are both quite healthy just don't understand why it's not happening.

[buttermellow]

I have had a long, long history of gynae problems (since birth really) I have,

• horribly sore/heavy periods that have seen me admitted to hospital (I end up throwing up - at worst 8 times a day, feverish, hallucinations, diarrhea, sweating, insomnia, fainting), deep pelvic pain that feels almost as there's a weight pulling my cervix down..

• vulval/vaginal abnormalities including congenital severe hypertrophy (that's been corrected to some extent through surgery), cysts/over production of skin oils, excema, dermatitis, vaginal pain/dryness/tightness

• breast tenderness/lumpiness

• excess facial hair/hair on back, bottom, tummy

• put on weight too easily

• acne at age 22, greasy hair, oily skin

• complete intolerance of combined/mini pill and northisterone

I have been told there's most likely some hormonal cause, although all ultrasound scans of ovaries have come back normal so no PCOS apparently. GP/consultant think I might have endo or fibroids, am having a scan soon again to see if there's any changes in uterus/ovaries. Have regular blood tests to check hormones and they always come back entirely normal.

I did ask if an MRI/CT would help but GP said it wouldn't make much difference?

I've ended up with vaginismus and sexual dysfunction type issues (essentially, I can't have sex) after years of issues, and being sent for sex therapy with consultant soon, possibly getting dilator therapy.

I'm having the mirena coil fitted under epidural in 3 weeks, having a transvaginal scan and a pelvic exam at the same time.

I'm just getting fed up of everything being wrong there, have had well over 60 examinations (usually once a month or so), and have completely disconnected from down below. I don't see it as mine, if that makes sense. Apparently this sex therapy and mirena will help - but at the same time, I've somehow got to accept the fact that I'm still going to be having regular examinations, to check my coil as obviously due to this vaginismus it'll be a long time before I can comfortably check.

I am half wondering if there's a condition that could be at the heart of all this, that's maybe not been picked up on yet - or is it just the case of lots of different conditions? I know you'd be very very limited in terms of offering a diagnosis online which is not what I'm expecting, but if you could maybe suggest what might be the cause of everything?

Should say I do get fantastic care from my local gynae team and GP - both are wonderfully helpful - but be glad to have a second opinion.

Thanks in advance.

[sharond101]

I have low oestrogen levels. I am 31. Other than poor fertility does this have any other affects on my health?

[Andcake]

I took 3 yrs trying to conceive after a diagnosis of 'low ovarian reserve' through low AMH, high FSH and low afc. I was written off for own egg IVF BUT kept on getting pregnant naturally and miscarrying. I finally through taking dhea and B6 had a successful pregnancy at the age of 40 and gave birth last year. I breast fed for 6 months. My periods came back in their usual slightly wonky 22-26 day cycle in February. I had a three normal style cycles for me but since around June have had a cycle which is all over the place some 60 days cycles some 25 days.

Some people say it takes a year for your cycle to settle down after pregnancy/ending BF but then as I had my low ovarian reserve diagnosis I wonder whether it is part of the menopausal transition. My dr is useless saying it could be either and hormone tests won't help (I must say I believe her (i've researched it heavily) about the hormone tests as my cycle is now so irregular we wouldn't be able to just where I am in my cycle'. I don't want to go on the pill.

the only plus side is that for the first time since adolescence i don't have acne.

i would like my normal cycle with usual 14 day ovulation ( after my 3 yrs of trying i I became a wizz at pinpointing ovulation through ewcm) to return as despite my age and previous worries i would love a 2nd miracle baby.

I feel well - but even if I get acne again would quite like my periods back.. 41 feels a bit early for it to totally stop. My mums last period was at 56.

At 30 days since my last period now I have no signs of either ovulation or AF.


is this normal for a late in life pregnancy, might my periods return to my normal is it still a hangover from pregnancy and BF. could it be the fact I am still having broken nights with LO?

any thoughts welcome - please don't just say go to your GP - done that bought the t-shirt and over the years feel I know more about fertility and womens issues than them.

[TEErickOrTEEreat]

Although I have some of the symptoms of peri-menopause, including hot flashes, night sweats and an irregular cycle, my hormones all read at normal levels when tested.

Is there something else that could be causing these symptoms at my age (44) and is there anything that can be done other than HRT? (I get migraines when additional hormones are added to my body.)

[blamber]

How long does it take normally to get regular cycles back after being on the pill for about 15 years, and when is it time to start thinking there are underlying problems?

I stopped the pill in April, and I had my first ovulation in August (I used ovulation sticks and taking my temperature). After this, I got my period only a week later. In the next cycle, ovulation was again late with my period following a week later. After this period, it took four weeks to ovulate and I'm now wondering when my period will be. So I have been having problems with delayed ovulation and a short luteal phase and I'm worried there might be hormonal issues, but my GP says it's normal after the pill. I cannot remember what my cycles were like before the pill.

Thank you!

[Spottybra]

I'm too embarrassed, I can't believe I've just deleted my question in an anonymous forum.

Big breath;

If we use anything prior to having sex, for example a massage oil or lubricant (i give dh lots of massages for pulled muscles which leads to sex) I end up with thrush. The sex shop we go to have sold so many different lubes to us they are starting to stock new lines. Seriously. It only started about 20months ago. A thrush cream containing nystatin from the Gu clinic works but I just want it all to stop now. I wasn't like this before.

I have changed contraception to no avail. I don't use or do anything different from when I was normal.

I just want my sex life back without thrush. How can I do this?

[Boodle9]

I've been trying to conceive, unsuccessfully for over two years. I am currently on clomid, despite progesterone tests confirming that I ovulate on my own. Prior to the clomid, I had quite short cycles (c.24 days)with what I believed to be a short luteal phase of 9 days (it has lengthened to a 14 day luteal phase on clomid). My consultant has said that a short luteal phase does not exist and that everyone is more or less 14 days. Is this true? I don't understand how I can get a positive day 21 progesterone test but then get AF 2-3 days later unless my luteal phase is short? Can you shed any light?

Also, when I have PMS, I have 1 -2 days of allergy/hayfever style symptoms; lots of sneezing, itchy skin and runny nose. Is this normal? It's only since I started TTC that I noticed a pattern of these symptoms appearing 2-3 days before my period.

[FeatherFeather11]

Hello,

I'm 34 and my partner is 39. We've been trying to conceive since September 2011 to no avail. In 2007, I had my right Fallopian tube removed as emergency surgery - it had twisted on itself several times but it wasn't and ectopic. Last December, After lots of tests, both me and him, all came back fine (great sperm count, great egg reserves) except for the fact that I was diagnosed with pcos. I have very irregular periods (ranging from 8 day cycles to 54 days in the last year) I was on clomid from February this year for five months - first month 50mg, then on to 100mg. I ovulated twice in that time (using a trigger shot). Have taken a break from clomid and just went back on last week at 150mgs. My grist scan is on Friday to see if I've responded.

My question is: is it worth giving iui or injectibles a try before moving on to IVF? Or is the one Fallopian tube/pcos a straight sentence to the IVF cave? Really would like to try all other options before doing IVF as it just feels so invasive.

Also, is there any point in requesting I be put on metformin or femara?

Many thanks!
Feather

[saltedcaramelplease]

I suffer from acne, have excessive body hair and am not overweight but not slim. My acne was always worse around the time of my period where I would get deep, painful spots on my chin.

I have started suffering from migraines 5 years ago if I had too much chocolate/caffeine. The migraines gradually worsened to the point where I couldn't eat have anything with chocolate or even fizzy drinks. I would get migraines with aurora and feel incredibly nauseous.

In January 2013 My periods stopped. I went to a gyno and they did multiple tests every few months (hormone checks, blood tests and ultra sounds) but they never found anything in the results. In December 2013, they said the only possible thing was that the lining looked thin so I probably wouldn't be having a period soon and that my ovaries look slightly fibrous but definitely NOT poly-cystic.

My gyno was convinced my lack of menstruation was something to do with stress/emotional since there were no physical problems or symptoms. This was definitely not the case.

After a year of no periods they gave me hormone pills to 'force' a period.
During that time, I got I also got a migraine. I hadn't had a migraine is over a year because I was avoiding my trigger but I wondered if the migraines were affected by hormones. I knew of birth control pills helping/worsening headaches.

After I finished the pills I did a test and ate bunch of chocolate over a few weeks (some days more than others). I started drinking coffee again too and never had a headache yet alone a migraine.

When I went to see my gyno I mentioned the possible link as it was the only symptom I had ever really had for my lack of periods other than having less breakouts.

He said there was no connection and the only 3 things that were the cause were stress, excessive exercise and a physical problem.

I continued enjoying coffee and caffeine and my periods came back after almost 1.5 years without a natural period. My skin also got worse (though I haven't had any painful spots yet) I don't think this is coincidence.

Am I correct in thinking that the two are related or is it a weird coincidence? Are there any other foods that "balance" hormones? I thought maybe my hormone levels had always been off and when my periods stopped they were 'normal' (which the blood test revealed. I'm worried that my migraines will return again.

[mtpg]

On 9th Aug I was 6+2 pregnant. According to my Gynaecologist the pregnancy was healthy, strong heartbeat. On 2nd Sept I started spotting dark brown, on 4th Sept became bright red,we went to A&E, where no scan was available because was evening and the blood test showed failed pregnancy(Progesterone low) , on 6th Sep started cramping and bleeding heavily, we went back to A&E where the miscarriage was confirmed and I was advised to wait for the bleeding to stop naturally, 2 weeks later on 20th Sept the heavy bleeding started again, went to A&E had an ERPC. Ovulated 2 weeks later. I've got Metformin 2x500 mg per day from GP, due to PCOs.
Questions:
When should we try for baby again?
Would Using Natural Progesterone Cream help to keep the baby?

[ZippityDoodahday]

My periods are very heavy & uncomfortable & I get severe mood swings leading up to my period. I BF so don't want to use hormonal contraception. What (if anything) can I do/take to make my flow lighter & improve my mood?

[pickofthepops]

Hi, am ttc and have been for a few years. Med history: Had lap for endo in march this year, consultant said things should be ok now. Age 39 with one child age 5, normal delivery. Regular periods 29 day cycle, albeit quite light and I don't feel ovulation as I used to, clearblue monitor shows ov about day 14 I only get a little ewcm about days 8-11. A lot of pmt second half of cycle. It's like my previous early pregnancy symptoms build up and then disappear about cd23. Could this be low progesterone? Had tests before which show all fine gynae wise other than the endo which was removed, mild pcos when younger bad skin etc.. Am trying to cut down caffeine (have a coffee each day), plus maybe one unit alcohol a day. I take zita west multivitamins. Could dehydration hamper ttc? I don't drink enough water I know. Have got quite down about this, GP checking out thyroid at the mo. Can I ask for progesterone cream from GP? Would I expect to feel ovulation still? It's the tearfulness and sore heavy boobs from cd17 which is horrible. Apologies for the waffly post.

Ooh, one other question, should I be asking for a test (killer cell?) to check if my body is rejecting hubby's sperm? I really do feel that something is building up each month but can't be sustained. I walk for an hour each day. Diet is ok. Really conscious of body clock and need to know what I can ask GP for in terms of tests. Would you recommend I try the pill for a few months to regulate or kick start fertility? One prob here I had a minor dvt in 2000/1 .. Not thought to be any genetic tendency. Should I ask GP for tests for hughes syndrome though? Thanks v much!

[swallowedAfly]

i used to suffer with horrendous pmt -still do but it is much improved by large dose agnus castus extract which works on the p gland to regulate hormone production and has gradually turned me around from 45-55 day cycles to 28-35 day long ones.

i can't take the estrogen due to a history of aura migraines and subsequent exponential risk of stroke allegedly if i take estrogen.

my question is what the hell is going to happen to me in the menopause? the pmt after a miscarriage and after stopping breastfeeding my son was insane enough for me to see a psychiatrist and bring on manic episodes, mixed states and all manner of hell. i'm wondering if the menopause is likely to be the next big hell-ride-rollercoaster for my mental health and i know i won't be able to take HRT due to stroke risk.

progesterone only treatments made things worse i found so even if they exist as hrt i can't take them.

the fact that agnus castus has worked on me tells me that yes i have an issue with my pituatory gland - is research even being done on this stuff? where is there good sources of information on problems with the pituatory gland?

if you have pituatory gland issues what happens when you hit menopause? i don't fancy ending up institutionalised at 50.

[Fragpole]

I have recently been diagnosed with Adenomyosis but do not really know anything about this condition. I have severe back pain and pelvic pain at various points in my cycle and would be interested in hearing advice on what pain relief is most suitable. Currently the only thing that relieves the discomfort is a hot water bottle on my lower back which is fine at home but not at work.
I am under 40, work full time, have completed my family and would appreciate any advice to help me cope day to day with this discomfort.
Many Thanks

[AHardDaysWrite]

I had a second degree tear after the birth of my first child, which was stitched and seemed to heal without problems. However I found intercourse impossible afterwards as it was so painful. I was referred to a gynaecologist who said I had a lot of scar tissue and my vaginal entrance was narrower than normal as a result of the stitching. He performed a Fenton's procedure under GA which did solve the problem and I was able to conceive again. We could not have intercourse throughout my pregnancy as I found it painful as a result of swollen/engorged labia (a side effect I had in my first pregnancy so not connected to the Fenton's). I gave birth by elcs, partly to avoid further perineal trauma, partly because my first birth was a shoulder dystocia and I didn't want to risk this again. I wasn't therefore expecting any problems with intercourse post-birth but it's very painful once again. Is there a possibility that the long period of no intercourse whilst I was pregnant has allowed some scar tissue to come back? Is it likely that I will need another Fenton's procedure?

[HesterShaw]

Surely a diagnosis of "unexplained" fertility is not an explanation. We have been TTC for four years since I was 34 without never even a positive pregnancy test. Husband's SA is very good, everything with me is apparently fine except (now) low AMH, but surely it was much less low when I was 34/35? What else could be wrong? How can it be so easy for some people and so impossible for others?

[ILoveAFullFridge]

I started peri-menopause at 41, found the symptoms unbearable, and within 2y was on HRT. Mirena plus Evorel 50 made a wonderful difference, but after 2-3y the symptoms returned. Also, I began to be sensitive to the glue. My GP switched me to Sandrena 1.0, which was OK - reduced the symptoms, but more side-effects and more mini-bleeding. A year later, the meno-symptoms began again. GP upped me to Sandrena 1.5, which helped for a while, but again the symptoms ate creeping back.

Please tell me: what's going on? What can I do about it? Is there an HRT regime that will properly help me? I cannot cope with the meno symptoms!

Also, I have developed a painful tongue. It feels like I have burned my tongue (I haven't), the tip is red, and I often have sore 'pimples' on it. I know that a scalded feeling in the mouth can be associated with menopause, but is the rest, too?

[HeatherMumsnet]

The Q&A is now closed. We'll send over a selection of questions to the experts and post their answers on this thread on 22 October.

[Icepickinyourheadofthepops]

Hi Heather MN am I looking in the wrong place for the answers back?

[BMIExperts]

The information given is based solely on the information the individual has given, the consultant does not have the full individual’s medical history and it is not a clinical diagnosis, guidance only. It is important for the individual to seek help and advice from their GP.

[BMIExperts]

@HesterShaw

Surely a diagnosis of "unexplained" fertility is not an explanation. We have been TTC for four years since I was 34 without never even a positive pregnancy test. Husband's SA is very good, everything with me is apparently fine except (now) low AMH, but surely it was much less low when I was 34/35? What else could be wrong? How can it be so easy for some people and so impossible for others?

Mr Bhattacharjee responds:

I do agree with you that the word ‘unexplained’ while trying to explain a cause for fertility does cause confusion. It only means that no plausible cause could be found from the necessary investigations.

I presume you and your partner had all relevant investigations. It is difficult to conjecture what your AMH could have been 4 years ago. However, since you are 38 now and have been trying for a relatively long duration, ideally you should consider assisted conception, particularly because of the AMH levels.

As for your last question, all of us are different. Some women are born with a low ovarian reserve and ovarian reserves can also decrease due to other extraneous reasons.

[BMIExperts]

@pickofthepops

Hi, am ttc and have been for a few years. Med history: Had lap for endo in march this year, consultant said things should be ok now. Age 39 with one child age 5, normal delivery. Regular periods 29 day cycle, albeit quite light and I don't feel ovulation as I used to, clearblue monitor shows ov about day 14 I only get a little ewcm about days 8-11. A lot of pmt second half of cycle. It's like my previous early pregnancy symptoms build up and then disappear about cd23. Could this be low progesterone? Had tests before which show all fine gynae wise other than the endo which was removed, mild pcos when younger bad skin etc.. Am trying to cut down caffeine (have a coffee each day), plus maybe one unit alcohol a day. I take zita west multivitamins. Could dehydration hamper ttc? I don't drink enough water I know. Have got quite down about this, GP checking out thyroid at the mo. Can I ask for progesterone cream from GP? Would I expect to feel ovulation still? It's the tearfulness and sore heavy boobs from cd17 which is horrible. Apologies for the waffly post.

Ooh, one other question, should I be asking for a test (killer cell?) to check if my body is rejecting hubby's sperm? I really do feel that something is building up each month but can't be sustained. I walk for an hour each day. Diet is ok. Really conscious of body clock and need to know what I can ask GP for in terms of tests. Would you recommend I try the pill for a few months to regulate or kick start fertility? One prob here I had a minor dvt in 2000/1 .. Not thought to be any genetic tendency. Should I ask GP for tests for hughes syndrome though? Thanks v much!

Mr Bhattacharjee responds:

Firstly, if you are 39 years of age and have been trying to conceive for a few years, ideally you and your partner should have investigations.

However, as you have mentioned, your Consultant has treated your endometriosis recently and has reassured you, he/she have probably done the relevant investigations, including a dye test at laparoscopy, to check the fallopian tubes.

The fact that you have regular periods and have symptoms of premenstrual syndrome, generally mean that you are probably ovulating fairly regularly. Nevertheless, with age, both the number and the quality of eggs decrease as does fertility.

Generally, you are doing all the right things about trying to stay healthy, including decreasing caffeine and alcohol.

I am not sure what tests you have already had but you can see your GP or a Gynaecologist to have baseline tests including Day 21-22 progesterone, HSG (if dye test was not done), partner’s semen analysis and a pelvic ultrasound scan. A hormonal profile may be necessary, depending on your symptoms.

As for your DVT and concerns about Hughe’s syndrome, it’s best to discuss this with your GP since he will have access to your history of the previous DVT. I would not suggest the pill for any of the reasons mentioned.

[BMIExperts]

@babyrose

My dh and I have been trying to conceive for 11 months now. I'm 32 and dh 34 we already have a ds who is now 3. My periods are regular 27-29 days. We are both quite healthy just don't understand why it's not happening.

Mr Bhattacharjee responds:

Regarding your question, I presume both you and your husband are fit and healthy. You have regular periods. You also have a 3 year old son.

The fact that you have regular periods means you are likely to be ovulating regularly. Since you have been trying for only 11 months I would suggest seeing your GP or be referred to a Gynaecologist to start the baseline investigations if you do not conceive over the next few months.

However, you need to bear in mind that conception depends on a lot of ‘non-medical’ factors, eg timing and frequency of intercourse.

[BMIExperts]

@Boodle9

I've been trying to conceive, unsuccessfully for over two years. I am currently on clomid, despite progesterone tests confirming that I ovulate on my own. Prior to the clomid, I had quite short cycles (c.24 days)with what I believed to be a short luteal phase of 9 days (it has lengthened to a 14 day luteal phase on clomid). My consultant has said that a short luteal phase does not exist and that everyone is more or less 14 days. Is this true? I don't understand how I can get a positive day 21 progesterone test but then get AF 2-3 days later unless my luteal phase is short? Can you shed any light?

Also, when I have PMS, I have 1 -2 days of allergy/hayfever style symptoms; lots of sneezing, itchy skin and runny nose. Is this normal? It's only since I started TTC that I noticed a pattern of these symptoms appearing 2-3 days before my period.

Mr Priddy responds:

I agree with your Consultant that the luteal phase is 14 days. As you have a 24 day cycle, it is likely that you are ovulating on day 10 and your peak progesterone rise should be on day 17 (although it still may be raised on day 21).

PMS is due to cyclical hormonal changes which can alter over time. The symptoms you describe can occur and stress, such as trying to conceive without success, can contribute to PMS.

I presume your other fertility investigations have been normal such as tubal patency, ultrasound scan, blood tests (hormone profile) and your partner's sperm test. If they are, I would not use clomid for longer than 3 months. I would then consider a laparoscopy and dye to check for rare causes of infertility such as endometriosis and peri-tubal/peri-ovarian adhesions.

If the laparoscopy is abnormal these conditions can be treated laparoscopically to improve your chances of conceiving.

If it is normal, I would advise trying for 6 months (as the pregnancy rate would be higher over this time). However if still not successful at that stage, I would recommend considering IVF.

I wish you every success.