Women’s health: how to get what you need from your GP

Have you ever struggled to get your gynaecological symptoms taken seriously, or failed to get the referral you need? You are not alone. Millions of women across the UK live with painful gynaecological conditions, and some go completely undiagnosed for years.

We asked Mumsnetters to share their questions for Consultant Gynaecologist Dr Sujata Gupta of Circle Health Group and were overwhelmed with responses from users who have struggled with their gynaecological health. Scroll down for Dr Gupta’s answers, plus tips on how to get the care and information you need from your GP.

Why women’s health issues are being ignored

The varied and often overlapping nature of symptoms relating to women’s health conditions (which include vaginal dryness, bleeding, and pain during sex) often make them difficult to diagnose, so they are sadly often missed.

The general societal stigma surrounding women’s health can also prevent women from speaking openly with their GP due to feelings of embarrassment. This general stigma then fuels a lack of information and awareness around women’s health more generally, stopping women from getting the treatment and understanding of their condition that they need. It also makes many women embarrassed or reluctant to speak openly with their GP.

When they do pluck up the courage to approach their GP, some find that they aren’t taken seriously, treated like a hypochondriac, or have had their symptoms dismissed as simply being ‘normal’. Unfortunately, many doctors don’t get enough training about gynaecological issues, which exacerbates the problem of many women going undiagnosed and missing out on the treatment they need.

The impact of this is huge. Findings from the Circle Health Group Women’s Health Matters survey 2021 (an anonymous survey of 10,000+ women across the UK) found that 90% of women with endometriosis experienced negative impacts on their mental health, 80% of respondents with suspected or diagnosed adenomyosis felt dismissed throughout their healthcare journey and 75% of women with dysmenorrhea said it caused them to be absent from work.

What can be done?

Thankfully, these failures within the UK healthcare system have been recognised.

Reports, such as the First do no harm report, have shown that it is often women who the healthcare system fails to keep safe and fails to listen to.

The government has announced plans for a new Sexual and Reproductive Health Strategy, which they plan to publish later this year. This is expected to introduce plans for mandatory teaching and assessment modules on women’s health for all new doctors in the UK. They will also be embarking on the first Women’s Health Strategy for England, with the aim of improving the health and wellbeing of women across the country.

Talking about your health is not only important to help identify and diagnose physical conditions, but ensure your overall mental health and wellbeing too. Whilst women’s health issues can be sensitive, the more we talk about them and change the associated stigma, the more women will feel confident to come forward and discuss their concerns with medical professionals.

Circle Health Group wants to empower women to take control of their own health and get the support that they need. Read on for some practical ways you can take matters into your own hands.

How can I get the help I need?

1. Keep track of your symptoms

The National Institute for Health and Care Excellence (NICE) advises doctors to encourage women to keep a symptom diary for gynaecological problems. If you go to your appointment with this already in hand, you’re already one step ahead.

Don’t be scared to take in a list with you - this can help you stay focused and don’t forget anything important.

2. Be specific

Don’t just focus on the symptoms - be sure to include details such as how long they last, any patterns and whether they are associated with any other symptoms - no matter how small.

What is the impact of the symptoms? For example, is it damaging your sex life? Have you cancelled social events? Are your confidence and mental health being affected?

Explain how the symptoms are affecting your day-to-day life - it’s often the combination of symptoms and their impact that can help reach a diagnosis and may determine any referral made by your GP.

3. Educate yourself and discuss your findings

Whilst this should never replace the advice and guidance of a medical professional, seeking out information about your symptoms, including finding support within the Mumsnet forums, can help you learn about what could be causing them and what you might be able to do to help.

Don’t be afraid to ask your GP direct questions related to your research, such as ‘do you think this could be endometriosis?’. If your GP isn’t sure - ask for a referral for diagnosis.

4. Don’t be embarrassed

Remember, doctors hear about, see and examine all sorts of conditions on a daily basis and therefore what may be embarrassing for you, certainly won’t be for them.

If you feel really uncomfortable discussing intimate issues, you can ask to see a female doctor where possible.

5. Seek a referral

For many gynaecological problems, NICE recommends a referral to a specialist as soon as symptoms are reported. If you think you need to be referred to a specialist, tell your GP and ask them to do so. If they disagree, ask them why.

If you still aren’t getting the response you need, there’s always the option of going private as well. You don’t have to have health insurance to access treatment or diagnosis with Circle Health Group. And you don’t necessarily need a referral either. If you want to speak to a specialist, simply call Circle Health Group on 0808 274 5396 and find an appointment with one of their consultant gynaecologists at a time and location that suits you.

What gynae services are available from Circle Health Group?

There are a wide range of women’s health and gynaecological services available with Circle Health Group which include:

• Breast screenings - including examining breast changes, breast pain and cysts.

• Period health - identifying irregular or heavy periods which may be caused by conditions such as endometriosis and adenomyosis.

• Cervical and HPV screening - as well as colposcopy procedures for the treatment of abnormal cervical cells.

• Treatment of fibroids, ovarian cysts and polyps - including full hysterectomy and treatment for uterine cancer.

• Diagnosis and treatment for endometriosis - such as pelvic ablation and excision.

• Support for menopause and perimenopause - including hormone replacement therapy.

• Family planning advice - including advice and guidance for those having difficulty conceiving and laparoscopic sterilisation.

• Sexual health - including treatment of conditions such as vaginimus which can cause painful intercourse.

How to find a specialist gynaecologist

Initially, you should approach your GP, who can refer you to a gynaecologist on the NHS.

Your GP may, however, want to try a variety of treatments before they refer you to a specialist consultant, especially if there is a significant waiting time.

If you are struggling to get a referral, or simply don’t want to wait for an appointment, you can pay to see a private GP who can refer you in just the same way. Circle Health Group offers virtual appointments for as little as £30.

Recommended check-up times for women’s health

Whilst it’s important to keep a close eye on your overall health, there are various women’s health screenings that can be carried out regularly to help identify conditions before experiencing symptoms. You will usually receive a letter from the NHS inviting you to make an appointment when it’s time.

These include:

• Cervical smear tests - recommended every three years for ages 25 to 50. Between the ages of 50 to 64 you’ll need to be checked every five years.

• Breast screening - from the age of 50-53 through to 71, you will be invited for a mammogram breast screening every three years to help detect any early signs of breast cancer.

Q&A with Dr Sujata Gupta

We asked Mumsnetters to pose their questions to Dr Sujata Gupta in a Q&A on our forums. As an expert in the medical and surgical treatment of complex endometriosis, Dr Gupta is committed to helping women feel seen and heard in their treatment journey for chronic gynaecological issues. Here are her answers.

1. How do you get a GP to take heavy periods seriously? Would a specialist help understand and treat the underlying cause of heavy periods? Is it worth insisting on that? Lovelydovey

“If you are reporting heavy periods to your GP, then any doctor needs to take your word for it. You don’t need to have any special tests or investigations in order to get a diagnosis. So, put simply, if a patient reports heavy periods that are affecting their quality of life, then a medical practitioner is supposed to take it seriously.

“So my advice would be, when you mention heavy periods, it would also be helpful to describe how it affects your overall quality of life. For example, do you need to use double protection when on your period, such as a tampon and a pad at the same time? Does this stop you from doing your everyday activities? Does it stop you from going to school, college, or work? Or looking after your children? Does it stop you from socialising? And also, do you feel lightheaded or tired? This could be a sign of underlying anaemia.”

2. Why are vaginal swab tests so limited to investigate gyne issues? ToastofLandon

“Vaginal swabs have traditionally been used to look for certain types of infections. They still are used for this, hence why we only use vaginal swabs if we are looking for a genital infection. Vaginal swabs don’t give us any further information about any other gynaecological problems.”

3. How do we tackle medical gaslighting and disbelief of women’s symptoms? The average time to diagnosis for endometriosis is eight years, mine took twice that despite persistently seeking help for my unmanageable symptoms. How do we change the stigma in the medical community, where women’s suffering and pain is not taken seriously? GodspeedJune

“My advice would be to talk about how your symptoms impact your quality of life. So if you have significant pelvic pain, if the pain is cyclic in nature, if the pain is associated with other symptoms such as pain during sex, or pain during intimate examination, or if you have pain while passing urine or opening your bowels, then these could all be symptoms of underlying endometriosis.

“If your clinician is not suggesting this as a possible underlying cause, then my advice would be to ask a more direct question such as ‘“could this be because of endometriosis?” and if your doctor is not able to give you a clear answer, then ask for an onward referral to a specialist.”

4. My question is about pain medication - specifically how do we make sure women get effective pain medication for period pain, endometriosis and cervical smear tests etc? Willowkins

“Highlight how the pain is affecting your quality of life and in most instances your GP will be able to offer you some simple pain medication.

“With endometriosis, if this is impacting your quality of life significantly, then my advice would be a referral to a specialist.

“For a cervical smear, most patients do not need pain medication, but some patients do as they can find it extremely painful, especially if they have underlying conditions such as endometriosis, which can make any intimate examination more painful. In this case, you can request pain medication such as paracetamol or ibuprofen an hour before your smear test to help manage your pain.

5. I’m currently suffering from quite a few symptoms, a change in my period cycle, dryness, increased UTIs, flushes, plus a lot of other symptoms which are all signs of perimenopause. I’m in my early 40s but I’ve heard that GPs only recognise this as an issue for over 45s. Will I be taken seriously and given the exact help that I need if I go to my GP about this? Oootapasooo

“Essentially, symptoms of perimenopause can start as early as 10 to 15 years before the natural age of menopause. For most women, the natural age of menopause is around 50 to 51, but some women will start experiencing symptoms of perimenopause from their early 40s. Usually, these symptoms are changes in your cycle, vaginal dryness, hot flushes, changes in your mood and irritability, and increased UTIs. If this is the case, then I would suggest – apart from mentioning the symptoms – you ask your doctor directly: “Could these be symptoms of perimenopause?”

“Certainly, if you are younger than 40 and experiencing these symptoms, then ask for a blood test to look at serum FSH (follicle-stimulating hormone). Serum FSH is not routinely needed for women above the age of 45, but should always be considered in women less than the age of 45. If there is evidence of early onset menopause, then I would recommend referral to a specialist menopause clinic.

“Normal FSH does not mean that you are not perimenopausal, as levels of FSH can fluctuate. For that reason, if your symptoms are suggestive of perimenopause and their cause cannot be determined, have a conversation with your doctor around perimenopause and the use of HRT.”

6. I had fibroids and the lady doing my ultrasound mentioned that uterine emboliszation might be a good option. I'd never heard of it before. What are the pros and cons? I've been referred to a gynaecologist but have no idea how long the wait will be so I want to be prepared with knowing about options beforehand. Hopezibah1

“Fibroids are extremely common. Sometimes, when they are big or causing symptoms, your doctor will treat the problem with uterine emboliszation. The advantage of uterine emboliszation is that it avoids the need for major surgery. The procedure is performed by a consultant radiologist, who specialise in radiology and imaging. The procedure is usually done as a day-case, meaning you will be sent home on the same day. There is usually minimal discomfort during and after, and the procedure works by blocking the blood supply to the fibroids. A consultant radiologist is able to assess which cases are suitable for this procedure, as not all women will be appropriate candidates for it.

“It usually takes a few months to know how effective the treatment has been, but most women notice their symptoms such as heavy bleeding are reduced after it. Most clinicians will arrange a follow-up scan in a year’s time to assess whether the size of the fibroid has reduced. For women with certain types of fibroids this is certainly a good option.”

7. I'm pretty sure I have a prolapse after the birth of my two kids. There's a bulge on the back wall that prevents me using tampons anymore (they just fall out). It's not causing me any other issues. I saw the GP who thinks I do have a some sort of prolapse and referred me to gynaecology. That was six months ago and I've recently been told it will be at least October until I get seen. Is there anything I should do or avoid in the meantime? TaraRhu

“Vaginal prolapse is not uncommon, especially amongst women who have given birth vaginally. While you are waiting to see a specialist, I would suggest performing regular pelvic floor exercises to reduce the risk of further progression of the prolapse and to strengthen your pelvic floor muscles.

“I would also recommend avoiding any significant weight bearing (e.g. heavy lifting) and significant straining, which can sometimes happen if you have constipation or chronic cough. So, if you do have either of these issues, then I would suggest increasing the amount of fibre in your diet to avoid the risk of constipation, as well as undertaking regular pelvic floor exercises.”

8. I have a large ovarian cyst that the doctor wants to remove along with my tubes and ovaries. I am 48. The cyst is a 10cm simple cyst, confirmed by MRI. I don't want surgery but feel pressured into it. Is it possible that the cyst could go away on its own? Nowtygaffer

“I would consider this to be a cyst of significant size. For most women, cysts that are less than 6cm in size and not causing any symptoms can disappear on their own.. However, as your cyst is 10cm, I would consider this to be a reasonable size for surgery. If there are no concerns about the nature of the cyst and should you wish to preserve your opposite ovary then you can certainly discuss this as an option with your gynaecologist.”

9. I am 45 and have menorrhagia. Not only are my periods heavy and crampy, they come every 16 days. Two different brands of the mini pill made things worse and I had constant bleeding with both. After several years on Tranexamic Acid, it stopped making much of a difference. I don't want the coil so GP has suggested endometrial ablation but the success rates don't seem that high. I just want to regulate my periods better and go back to every four weeks, I can live with heavy bleeding and clotting. What's your advice please? Should I try HRT? BurnstonesMama

“As you’ve mentioned, you are 45 years of age and your periods are getting heavy and your cycles getting shorter. I’m assuming that you have had an ultrasound scan and your doctor has no concerns about this. You’ve already tried the progesterone-only pill. An alternative to the progesterone-only pill would be something called Norethisterone, which is often given as a 5mg tablet that you take three times a day. You can take this cyclically for three weeks followed by a week’s gap, and you can continue this to help with your periods.

“In my opinion, this is too many tablets to take, and although you have mentioned you are not keen on the coil, the coil actually is a much lower dose of progesterone and is usually quite effective. The coil can also be used alongside HRT, where it provides you with the progesterone needed for HRT. You can use oestrogen either in the form of a gel or a spray or patch. This combination usually works well for women who also have troublesome periods.

“You could also try tablet form of HRT which would mean using oestrogen either as a gel, patch, or a spray, and using a tablet called Utrogestan, which you will have to take cyclically. My concern with this is that you may still continue to have heavy bleeding.

“Endometrial ablation is an established technique for the treatment of heavy periods and works for more than 80% of women. If you are adverse to any hormonal preparation then it is an alternative, although I would stress that if you are considering going on HRT then HRT itself is a hormonal treatment, for which you will need to take progesterone alongside oestrogen.

“Lastly, there is the option of hysterectomy, which is a major surgery, but some women who struggle with taking progesterone with HRT will choose to have a hysterectomy so that they can take oestrogen-only HRT.”

10. I'm postmenopausal, and struggling with vaginal atrophy (VA). Have been prescribed oestrogen pessaries, which made no difference, and am currently using the cream. I asked for a ring, but was given the cream, with no explanation. I still bleed as a result of sex, and get frequent UTIs.

As a lovely little side bonus of some or all of this, I have also been struggling with urinary incontinence. I cannot seem to get a GP to take any of this seriously enough to take forward solutions for me - so is that it for me now? Notaflyingmonkey

“Your symptoms are certainly suggestive of vaginal atrophy. As you have highlighted that you are already using oestrogen pessaries, you may sometimes need more frequent dosing of these. If you have already tried 10 days of oestrogen pessary followed by a twice weekly dose, you may repeat a further 10-day course of oestrogen pessaries. You can certainly have a vaginal ring as well and you can request this through your GP.

“With regards to urinary incontinence again, if the vaginal pessaries haven’t worked, and you have tried pelvic floor exercises and these haven’t worked, then I would ask your GP to refer you to pelvic floor physio and usually they are able to then refer you onto a urogynae specialist if necessary.”

About Circle Health Group

Circle Health Group offers the UK's largest national network of private hospitals.

They offer a range of expert treatment services for women at different stages of their healthcare journey, including gynaecology, breast health, periods, incontinence and menopause.

Here’s what they have to say:

“Millions of women in the UK struggle with the effects of a gynaecological condition, yet they often go undiagnosed for years. Many struggle to access the right information, or feel embarrassment, which prevents them from asking their doctor the appropriate questions and getting diagnosed sooner.

We want to empower women to understand their health better and overcome the stigma surrounding women’s health by sharing more information on gynaecology, including how best to reach a diagnosis and treatment.”