I’m a consultant gynaecologist - AMA

[quince2figs]

I have worked in a variety of settings - hospital obstetrics and gynaecology incl labour ward, PMS and menopause, currently community contraception and unplanned pregnancy services, NHS and non. Ask away!

Redbox - yes, your mum needs a test to check that the uterus lining is normal, as well as the scan she has already had.
Normally a hysteroscopy, which is a telescope into the uterus, under local or general anaesthetic. Really small procedure. Her symptoms could be due to atrophic vagina, but unlikely. Please keep encouraging her to see GP for referral. Any outcome very likely to be completely treatable.

Not sure if you can answer this but is it dangerous to leave a coil in longer than intended....like a couple of years longer....asking for a friend....

elQuinto - great question. Women’s knowledge of their own bodies and things like normal labour or menstrual cycle are generally poor in UK.
School Sex Education only recently became compulsory, hopefully that will improve things. As parents we should be responsible for ensuring that our children know the relevant facts (difficult though if we don’t!).
Never too late to retrain, you know - I went to med school with quite a few people in their 40’s

Had a third csection (2 yrs ago) and sex is very painful. Orgasm hurts, best I can describe is that the area aches and when everything contracts it's just really achey and sore (not sure but somehow it feels like things are internally stuck together - bowel and uterus maybe?)

Also, do you know why I bleed vaginally after a bowel movement? Doesn't happen all the time, but usually after sex or three or four days after the end of my period. The blood is definitely vaginal and usually bright red - hospital/doctors have no idea.

Unknown - there is not a minimum age/number of children for sterilisation. It is at the surgeon’s discretion though, so can say no, but you can seek another opinion.
We do far less these days, as lots of women did change their minds and seek reversal ( no guarantee of success and not on NHS now). IVF possible after steri instead, but expensive and also no guarantee of success.
The main reason, though , is that steri is no longer the most effective option for avoiding pregnancy!
Implant/IUS/vasectomy all more effective and less risky than abdominal surgery. Copper coil as effective. IUS lots of additional benefits.

Cattenberg - Labour and passage of baby through birth canal squeezes out lots of lung secretions and mucus. This won’t happen in a C/S, so babies can have some degreee of respiratory distress. Minimal risk of this if over 39weeks.

I’ve not had any IVF experience, so sorry couldn’t give you an answer on this.

horsebiscuit - specific support and advice incl physio should be available in NHS in all areas, so not sure why your GP could not refer you. Very glad you have found some improvement.
So depressing though isn’t it - shows how little value is put on women’s everyday health, at best.....and really how valueless we seem to be to society once our childbearing years are waning.

Londoner, the advice you have been given sounds a bit confusing - how exactly are you supposed to deliver your baby without pushing?!

Sounds like they are suspecting an incompetent cervix, but your history does not sound typical of this, just a quick labour.
They would offer you scans of cervical length in the next pregnancy, which would then determine if a cervical stitch needed. This is usually offered after premature labours or late miscarriage, which it sounds as if is not the case with you.

Suggest you discuss again, to be clear on options - but likely not to be able to decide until you have had scans.

No particular need to have planned C/S due to the tears, unless they are now causing you problems.

Pilots - symptoms suggest the IUS has come down low in the uterus or come out - a scan and medical review advised. Hope she is ok.

Thanks for all the questions, I am really enjoying this but need to sleep now
I work long days, so will have some more time to catch up on answers tomorrow eve and weekend.
Sorry my responses are 2-3 pages after all the questions....

You said you have 2 children. What terminology do you use when talking to them about their bottoms?

I'm somehow guessing you say vulva, not foof, but am curious to know!!! (I'm a paeds reg and I use front bottom and back bottom but this seems definitely untrendy these days...!)

Also - please can I ask your advice re shoulder dystocia and subsequent deliveries? My DD2 was 2 weeks overdue and 4.3kg (slightly unbelievably as I'm normally size 10 and had a small bump). Very fast 2nd stage around 15mins I think. Delivered at home to ever more panicked looking experienced community midwives and had significant shoulder dystocia (7mins head to body, required I think the whole HELPER pneumonic except an epis, certainly had multiple types of internal manoeuvres before she came out). I'm sure they did everything right (apart from the neonatal resus where I offered to help as they had rubbish chest rise but for some reason they looked at me weirdly and didn't want me to help...)

I know shoulder dystocia has a 1 in 10 risk of a recurrence. I'm hoping to have 1 more child only ( DH yet to agree to this ), would you think elective CS perhaps best in this circumstance?

I don't fancy major abdo surgery but if it's definitely only going to be one CS then it's lower risk so maybe better option than risking another shoulder dystocia? Currently my pelvic floor is OK (not perfect), didn't have any major tears so maybe best to quit vaginal deliveries whilst I'm ahead???!

I guess alternative might be delivery suite delivery, induced at 39 weeks or so, so baby smaller and less risk of shoulder dystocia. Doesn't fill me with happiness prospect of no birth pool and continuous monitoring. Anyway DD2 is fine which is the main thing but I'm just not sure if elective CS for last pregnancy in future is sensible or overkill

Anyway thoughts would be great. Thank you, have really enjoyed reading this AMA!.

Hits - I don’t know anything about physio training, am surprised there are no women’s health attachments during this. Suggest you seek out advice and an elective period with a large unit

peppers - some uteruses just don’t like having coils put in them, and take a few weeks to settle down - but may not, and end up having them removed. 4 weeks is a time where you would expect most to at least be improving.
copper coils more likely to cause pain and bleeding as the copper is irritant, but this is more usually heavier regular periods, not very prolonged bleeds like this.
If you are anaemic just as a result of this bleeding, it needs removing!
If you were anemic or had heavy/painful periods beforehand, then no, a copper coil was the wrong choice.
Check the scan has been interpreted correctly as to site of coil - it may be be too low in uterus (and would still need removing/exchanging).
There are various types of coil -some smaller than standard copper ones available which might lessen symptoms, but would strongly recommend you consider an IUS instead. This tends to do the opposite, as the small amount of hormone thins the uterine lining and will stop periods (or make them v.light) over a few months. There are 2 newer, smaller versions of the IUS now as well as Mirena, which may suit.
Age and whether/how you have had children are themselves not the issue - it’s the size and shape of your uterus, and how your body responds to a coil, which is extremely variable.

I am 47 and have never had a coil and was only on the pill for a short time at university. Have 3 children, vaginal deliveries. What HRT options are available to me? Is the Mirenal coil an option? Am i likely to have issues, having never had a coil fitted and not really had hormones before.

For the lady aaking about shoulder dystocia, in case of interest, I had severe sd with the first, very hairy, nothing with second and then shoulder dystocia again with number 3 but it was managed better and not as severe as the midwife anticipate it a bit better. Pelvic floor is ok but I have very bad rectal issues, not sure if that is from the sds. Number 1 and number 3 have the same large shaped heads!

Dd (21) has suspected endometriosis. This has been complicated by a long bout of severe gastritis after taking naproxen for the pain. She has been ill since the start of January and had to drop out of her final year of university (hopefully returning in October). She has been debilitated by this - is this normal? Her mental health is now being seriously affected by all of this. She is waiting for a laparoscopy. I would like to be able to give her some hope that she will get her life back at some point!

quince2figs - thanks so much for taking the time to answer these questions, it’s been really interesting to read!

I’ve a 3 week old (yay) and was just wondering - is there anything you’d recommend all ladies do after giving birth for their gynaecological health?

I’d a fairly straight forward birth, I did have a kiwi cup (who knew there was more than one type of vacuum?) with an episiotomy, and I’ve slight bit of leakage but I’m assuming I need to work my pelvic floor again

I have a bad bladder prolapse after having ds (5 years ago.)

I can't wear tampons without them falling out and pee myself constantly.

I'm in the States and hoping to have another child so haven't had the op yet as it's expensive.

Is it a big op? Are there exercises I can do to make it better in the meantime? Is the op worth having? Will it be sore afterwards? Tia.

Thank you for doing this

What do think about the rise in the fertility awareness method and do you think it should be taught in schools?

Great thread!
Sorry for changing the direction but I'm very interested in litigation.
Have you had to go to court often to defend your practices?

Also, how many (if any) peripartum hystetectomies have you performed or assisted in?

Sorry to bother you but a v v quick question, I had a tape fitted to remedy a prolapse after DS birth 12 years ago and I am terrified that it is going to cause me hideous complications as publicised recently.

Is there only one kind of tape?
Is it worth doing some digging to see if I can find out what kind (guy who fitted it was struck off for something unrelated to tapes) of tape it is if there are different kinds.

Many thanks for answering my question quince2figs. If I have a second DC, it will help me make an informed decision.

Thank you for answering these questions quince2figs.

I'm interested in your advice on contraception.

I'm currently pg with DC2, due on Sunday. Planning on BF as I did the first time. Not planning any further DC. I'm 34. I have tried various pills and never got on well with them (weight gain, loss of libido, mood swings, unplanned pregnancy). At this stage, I feel very reluctant to accept any kind of hormonal contraceptive. Am I being unreasonable to discount them all? What would you advise as options to consider?

Would the choice I make at this point have any impact on options available to me at the time of menopause? Having watched my DM go through it, refuse HRT or any other interventions, and be both unhappy and unreasonable over a period of years, I am keen to ensure that I am a good candidate for whatever is on offer when the time comes.

Hello quince. I’m 51 and after about 18months of fierce hot flushes I seem to have ridden out the worst symptoms of the menopause without HRT. I am concerned about osteoporosis though ( my BMI is about 22,I eat a varied diet and walk lots). Would it be worth going for a bone density scan ( I’d be happy to pay for one)?

Hi op. I’m wondering if you could clarify something for me. I’m in the early stages of pregnancy second time. This time a really want an elective c/s due to the problems with a tear I had first time. Not as bad as third degree although this was suspected, infection, stitches broke down, slow recovery and a buggered pelvic floor as well as the horrible post natal depression thanks to the fact I couldn’t lift without my insides feeling like they would come out and was stuck isolated at home.

An elective c/s would be so much more preferable to me this time, as whilst I acknowledge the damage may very well be done, and the considerable risks of c/s surgery, I don’t want to risk a third degree tear this time or more mental health/birth trauma.
I’m requesting a c/s, yet to see a consultant, but I know the nice guidelines say I should be entitled to one, and if the doctor doesn’t agree they should refer me to a one who is willing.
Would it be unheard of for the hospital just to refuse me, and force me to deliver vaginally again, or should this not Happen?