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!

aVast, complex area which I am way out of date on I am afraid. Ask to see your consultant or genetic counsellor again for further info on risks and benefits, and what you can expect if you do go ahead with surgery, incl HRT. Depends very much on your family history and age/parity.

maita - unlikely, but I would advise an ultrasound scan to rule out anything unusual such as an ovarian cyst.
Hormonal changes at ovulation may be responsible - maybe increasing pain sensitivity? It is normal for the uterus to contract in many situations, and I would guess that sometimes these are perceived as painful, some not.

Any advise re LS
I appreciate you’re answering so many questions.

KatyMac - I think most surgeons would offer you the option of both ovaries being removed:
If the ovary turns out to have any malignancy or borderline cells, then higher chance of happening in other ovary too - you would need another procedure even if you decided to have that done as soon as results back, or be worried and continue to have screening which isn’t actually diagnostic, for an unspecified period of time.
Even if your ovary they remove is normal (most likely to be), then keeping the other means you are at risk of future cancer in it.

Your ovaries will stop working by 55y if they already have not, so not impacting greatly on your need for HRT or quality of life - although you may require some temporary HRT as hypo-oestrogenic symptoms post-op can be troublesome.

Good that it is a simple cyst, but if it’s growing fast, at 50y I would certainly choose to have both removed. Hope all goes well.

I know you're working your way through and have many to answer but please do you have any advice for pmdd sufferers as asked a few pages ago?

Thankyou for taking time to answer everyone's questions. I think getting to chat to a female obs is amazing for us all!

OP I am being super greedy in posting again so pls don't answer me at the expense of responding to others, but.....

Purely out of curiosity, how many women give birth without feeling contractions?

I have had 3 dc vaginally - no pain relief at all - never felt a uterine contraction. My last labour, with twins, was induced with pessary - they monitored me from 8am-8.20 and monitor showed virtually nil uterine activity - left me alone to do a shift change - Twin 1 born at 8.33am in delivery room en suite with just me! I never felt a contraction or even real pain.

Unusual?

What have been your clients' experiences with TVTs?

How could OBGYN services in the U.K. be improved for survivors of sexual assault/abuse?

I know there is my body back but what more could be done to help these women utilising these services?

This is question about my 18year old daughter. A couple of months ago, while at university, she had a copper coil fitted at GP surgery. I think it was fairly traumatic, it took a while as one of the doctors was training the other one. After the procedure she was given fluclocaxacillin as a prophylactic because she had had a recent impetigo infection.
She said that she was very unwell afterwards and spent the best part of a week in bed with pain and an offensive discharge. Because she struggles to swallow capsules she only managed a couple of doses.
However she said the discharge stopped and she was no longer in pain. Unfortunately she never went back to GP when poorly as she thought it was ‘normal’.

She is currently abroad of complaining of some stomach pain.

I feel something isn’t right here at all. I didn’t know what was going on at the time as she presumed this was what normally happened following coil insertion. Should I insist she goes back to our home GP for a further check. I am worried she could has had an infection and it could still be brewing. If so, what checks would you recommend? Would the local GUM clinic be better in terms of their experience If she needs examination?

I’ll just post my question again, please can you express an opinion?
Is a bone density scan a good investment at 51 yo,about 18 months after last period, the idea being I’d rather find out now than after a fracture. Normal BMI, don’t know about my mums risk as sadly she died at 54. Thank you.

@HitsAndMrs I saw your post (don't know if OP answered). I'm a band 5 physio. To get into women's health physio I'd suggest finding a rotational band 5 job which includes women's health on the rotations. Also MSK physio helps too as a lot of women's health physio is done in outpatients and revolves around back/pelvic pain (not just pelvic floor function). When you've done the rotation you can get advice from seniors on what other courses etc to do and then apply for a specialist post if one comes up (although they are few and far between as there's little funding for them in the NHS).

Good luck

I have a question if it's not too late?

Any advice for a 35wk pregnant lady who still has a mild prolapse from birth of first child 14mths ago. I've seen a private women's health physio, do pelvic floor etc. I got referred to gynae Dr in acute NHS Trust as I was concerned about risk of worsening prolapse through a second vaginal birth but the dr was as much use as a chocolate teapot. 🤷🏻‍♀️

First birth was straight forward vaginal delivery (albeit very quick -

Wrt your comments on male Obs/Gyn doctors in response to Sunshine should males not be allowed to train in obs/gyn? A similar restriction is already in place for training in mammography - only female radiographers are trained and allowed to do mammogram in UK.

Thank you quince. It's technically in for contraception, but DH has since been vasectomised, and then we have recently separated anyway. It does still appear to be working in the sense that I have no periods, so I won't worry too much about getting it taken out yet

Why have diaphragms gone out of fashion?

whataboutbob may I answer please. If you can afford it, yes I think it's a good idea. Sadly I had mine after a fracture (foot) at 55; was put on a weekly bisphosphonate and then in three months fell and fractured a vertebrae. Of more importance is avoiding falls if you are prone. I have slowed down, take care and walk more carefully rather than dash at a trot and have found pilates a boon (also for my pelvic floor!).

Am now on annual infusions of zolendronate. But I had risk factors: grannie had a dowager's hump, I had severe graves diagnosed early 30s and lived on the edge of anorexia from about 21 to 27. Prevention all the way from my perspective though.

PS - I bounced back and got back to work after 9 days so it's not all gloom and don't be scared by the nos forum.

PCOS questions, Confused/Dale.
It’s really common, and often women have the fear of God put into them. It can affect fertility, but in most cases doesn’t, especially if you are still having regular periods. Assume you have full fertility.
For contraception, COC to induce a regular bleed and shed the endometrium, or a Mirena to thin the endometrium are both effective, and keep the uterus healthy.
There is an increased rate of endometrial hyperplasia, then cancer in long-term IF it is untreated and you are not having regular bleeds only. Similarly, no bar to HRT and recommend using a Mirena as part of this.

Frazzled - PMDD/PMS definitely real. I think it’s poorly understood by many, not least because there are few specialists around.
I was lucky enough to work for a fantastic consultant in this field when training, and there is a significant crossover with pregnancy-related anxiety/depression, and menopausal mood disruption.
There are RCOG guidelines on treatment. Many women find COC, maybe continuously, works well, or the Mirena. Otherwise, more specialised hormonal manipulation.

Shooting - menopause very commonly affects bladder function (urgency, urge and stress leakage, mild UTI-like symptoms). As tissues become thinner and we age, then risk of vaginal wall (less often, uterine) prolapse increases, so it may be a prolapse you can feel.
Suggest yes, see your GP. Vaginal only HRT is a really good option for this, as is standard HRT.

Thank you quince you're a star! Your time is valuable so I really appreciate you making the effort to reply.

Great AMA!

I've been referred for an Essure sterilisation op. Got to fill in a form to send off to the hospital. First question is 'are you allergic to nickel?' I am. Does that mean that the op is off? What are the sterilisation options for people with a nickel allergy?

Thanks :)

@loveaspiring the essure coils are made from nickel!

I'm very curious if OP can advise - I thought that as Essure had been removed from non US sale, and the manufacturer had asked hospitals in the UK not to use their stocks, that hospitals would stop offering hysteroscopic sterilisation

I'd have assumed that tubal ligation (presumably the standard form of female sterilisation?) would be the recommended route if Essure not viable

And presumably also desirable if essure has been withdrawn due to safety concerns?

What a great thread.

Dr. Quince, I had an unexplained persistent super-high fever at 37 weeks and my OBGYN decided to induce (USA) - I begged for a c-section and they agreed. They also tested me 3x for HIV. OMG.

Apparently, I would have run into trouble because I had a too-short umbilical cord and I might have haemorrhaged. Was this a brush with death? My husband claims it was, based on something the doctor said when I was drugged.

northern - there are 3 female only procedures on the list of 17:

Breast reduction - very much depends what the criteria are. This should still be available for physical reasons (backache, infection under breasts). For psychological distress, there is some evidence that surgery is not always effective, and that add easing psychological need first is helpful.

Hysterectomy for heavy menstrual bleeding only to be done if certain criteria met - I do think this is appropriate, as this is major surgery, which can have many unwanted sequelae, especially if done at a young age. Mirena and endometrial ablation procedures have revolutionised management of this condition, and I think should be tried first. Not clear if they mean ANY heavy bleeding - it implies that this refers to DUB rather than endometriosis, for instance.

D&C for the same - there was an outmoded school of thought that a “scrape” would actually cure HMB, which it does not. However, hysteroscopy and endometrial biopsy, which is a very similar procedure, is often needed to exclude pathological causes of bleeding in HMB, eg: if over 45y. We used to do so many D&C, most of which were unwarranted.