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!

Thank you tilly

Just seen what you posted about contraception in the younger population and am because the "not wanting any hormones" is me to a T. I'm (irrationally) worried about the Pill and the link to breast cancer, but being on the most popular ones made me sick and headachey all the time. I'm under 30, have PCOS and I'm finished having children. My GP has said the copper coil is my best option - I'd love to hear your thoughts on this if you have time. I've heard so many horror stories about the Mirena so not sure I'd been as keen for that option.

Thanks for replying.

Would having a third c-section have caused the endometriosis? I was fine before! What's the best method for diagnostics? Can it be cured? Would you recommend a coil?

chaosisaladder I'm exactly the same. Well, I'm early 30s so a bit older but haven't used hormonal contraception since I was 25. I have spaced my children and am now done having babies. DH refuses to get the snip (his body his choice) but condoms for another 15+ years doesn't seem like the best option though maybe it is the only one... Hormonal contraception of various kinds gave me migraines, bad moods and random bleeding; and I'm put off the mirena in case it causes more of that and/or sits uncomfortably. I also quite like being aware of/in time with my natural cycle, however hippy-dippy that sounds...

Having now RTFT, and read a bit more about your background, I have a question too!

I am 26, had a medical termination at 5 weeks aged 21, and after my periods were horrific, I ended up on the pill and they gradually improved. I had been on and off the pill from 15-21 (recurrent thrush meant I stopped a couple of times out of desperation but thankfully that somehow fixed itself), and I was on the pill again from 22-25 and came off it a year ago. We have been TTC for about 8 months with no luck, and my periods are relatively irregular now and the last two have been really awful again. During my spells off the pill (a couple of years in one go, maybe six months in another) my periods had been fine.

I've got an ultrasound soon, and I'm really worried I won't be able to get pregnant, pretty much my biggest fear when I had the termination. Do you think that no luck TTC for 8 months at my age and worsening periods like this are signs of a potentially considerable problem? I'm also worried at how bad women's services seem to be, it doesn't give me hope. Never felt very listened to for any gynae issues previously so it all fills me with dread

@OhTheRoses ( lovely name) thanks very much for your post and advice it’s help make up my mind. My beloved maternal gran also had a dowagers hump. I think I’ll be booking that bone scan. I hope your bone health is on the up now!

unadventure - I do. We do see activists in some areas, who are mainly not physically aggressive, but extremely disturbing for the women attending the clinic.
I do worry that this will escalate in the future.

whatabout - yes, it would be well worth it. I am not up to date with criteria for bone density scans, but it may be that your GP does not feel you are high risk enough. All omen’s bone density will drop sharply at menopause due to lower oestrogen levels, and the problem is that if this becomes lower than the normal range (osteopenia) or pathologically low (osteoporosis), then the risk of fracture is high. Women rarely have any symptoms until they get a fracture. My grandmother had horrendous osteoporosis at an early age, so I am very aware how disabling it is (due to having hysterectomy for heavy bleeding in her 30’s and removal of ovaries too “while they were there”. No one got HRT then.

Bone density scans are simple and not too costly, if that helps. Even if it is normal, maybe consider HRT for symptom relief of flushes and prevention of further bone density decline?

Thanks @quince2figs ( do you have an allotment by the way?!). I did discuss with my GP and as you suspected she didn’t feel I met the criteria. My mum died at 54 of a SAH ( she was on HRT) so I’ll never know her risk. My gran had an assortment of elderly aunts whom I knew in my teens and most were in a neck brace! I just think it makes sense to know before a fracture, then remedial action can be taken. As for hot flushes. I don’t know whether it’s the weather or it’s me these days

Fascinating thread, thanks quince.

I found out recently at a scan that I have a retroverted uterus. Seems a strange thing to discover at 35 when I've had many ultrasounds when not pregnant because of a history of ovarian cysts! So I have a few questions:

• can pregnancy and/or labour (I've had three children, all born vaginally with relatively easy & quick labours) change the way your uterus lies?
• could this be why cervical smears are very painful for me and the nurse always struggles to find my cervix?
• are there any problems associated with retroverted uteri?

Another question on a different topic: how often do you do "update" training? As they discover more about conditions that affect gynaecological issues, are there regular courses etc to keep doctors up to speed with new info? And how do you stay on top of it all?

I'm booked in for a hysteroscopy to investigate bleeding after sex which has gone on since I came off the pill. Scans have shown nothing but suspected adenomyosis. Problem is, I'm terrified of the procedure as I have read dozens of horror stories about women being in agony, keeping after etc and I'm going away for my wedding anniversary the day of the appointment. I've been told the chances are it's hormonal and told the mirena is the best course of action. I don't want this as again, I've read far too many horror stories about continual bleeding, acne, weight gain and depression. I'm prone to all of this anyway and I know I won't cope if I get these side effects, it will push me over the edge with depression I'm sure. So I am thinking of declining the procedure as what's the point if I don't want the only corrective action they are offering? I am considering the progesterone only pill instead as if I suffer side effects I can just stop taking it. In your opinion, how common are these side effects when taking the POP? Thank you for reading.

Starry, that is an extremely reasonable request for an elective C/S. You are correct, you have the option to request one irrespective of any previous birth problems, and the hospital cannot force you to have a vaginal birth. In the unlikely event that your consultant declined, you ask for a second opinion from another consultant. Hope all goes well.

Dame - as you say, yours was caught by chance. It is routine for scans to look at the placenta and it’s site, but I imagine that picking up either of these conditions(which do not always coexist) would be difficult, and need an extremely experienced Sonographer or fetal medicine specialist.

Vocal - third degree tears more likely with first babies to some extent, as more likely to need induction/augmentation/assisted delivery. A few other risk factors which are independent of whether it’s your first. Most women have scans of the anal sphincter to check it has healed fully, as if not, risk of recurrent tear or symptoms higher.
Not very common to have another, mostly as midwife is very aware to avoid it, by episiotomy if needed.

Many posters asking about number of sections - there is no number that is safe or a limit that can be applied for all.
As the number of sections increases, overall the risk goes up - but I have delivered women who have had 5,6,7,8 sections at a very uncomplicated op. Conversely another woman may have complications at her first.
We no longer advise that women “should” or “must” limit their pregnancies to a certain number, but ensure that all are fully informed of the risks for them. Anyone still peddling the 3 sections rule is way out of date.

Thank you quince2figs
Not sexually active but still controlling periods so the worry was infection

Dancein - really not sure - bleeding vaginally at 65 is absolutely not normal, and it needs to be made sure that there is not bleeding from inside the uterus or any ovarian masses. Not sure why fibroids alone would be removed at this age, rather than a hysterectomy, and it would be rare they would cause postmenopausal bleeding. Bleeding from the vaginal walls itself commonly due to atrophy.
Itching could be infection, atrophy or a dermatological problem, and very rarely a vaginal malignancy. Pressure likely to be atrophy or pelvic floor weakness, but also due to any other masses.
I would suggest a second opinion, particularly due to the bleeding.

Dina - LS requires a specialist vulval clinic, often run by a gynaecologist and dermatologist. Requires stron steroid cream for management.

over50 - tricky. The Mirena itself shouldn’t cause any nerve tingling, but theoretically fibroids could if they are large, or very many small ones pressing on a nerve.
Menopause quite commonly seems to be associated with pins and needles/restless leg type symptoms, and it could be that 50mg of oestrogen is insufficient to treat that.
More logical to consider fibroid shrinking (or even hysterectomy) than removing the Mirena, as your heavy bleeding very likely to return.

bunny - you may have some scar tissue, both from the ruptured ectopic, and from the surgery. This could cause pain.
I’m not sure what they would have seen in an early pregnancy scan to indicate endometriosis, though. Suggest that now you have delivered, you ask for a gynae referral.

Melanie - birthweight of your last baby would be a decent reason for an elective section if you had more - but your history of uncomplicated big babies already means that risks prob low

Many thanks quince. I realise it’s difficult to give opinions on little info, but very grateful. It can be very frustrating seeing different consultants over the past year and they all tell you what it isn’t!

Hi OP,
I had a very large borderline mucinous ovarian cyst removed in my 20s. They only removed the affected ovary and tube, as I hadn't had any children yet. I had follow ups for a couple of years afterwards, and was then discharged with no further treatment needed.

I have now had all my children and I'm in my early 40s.

Should I be concerned about a re-occurrence in my remaining ovary, or is it unlikely after 14 years?

cudby -
Local anaesthetic response varies from person to person, but I would say that we are fairly poor making sure pain relief is adequate for suturing after a baby, and expect women to put up with it. Pudendal block good for assisted delivery, but not always for suturing - and it’s a bit of an art getting pudendal in the right place.
Family history in labour - no evidence for any pattern, but not aware anyone’s studied this.
Admission in labour, absolutely, there is a historical and patronising tendency for midwifery staff to deny admission, or suggest women are not in labour, based on just looking at them.....clearly this is not accurate. Even if someone is not in established labour, if they are frightened and in pain, they require admission.
We need to improve early labour care drastically. This is now exacerbated by the lack of staff and beds in many units, which means that women may be in advanced labour by the time they have a labour ward bed, which in a first baby at least is too late for adequate monitoring and analgesia.

Ohthe - scanning for cord round the neck more than once could be helpful, but may untangle.cord around the neck once is pretty normal, and either untangles or does not hamper delivery. Position of baby (by definition) changes as labour progresses through the birth canal.
So no, probably would not be helpful.
Apart from the above, there are not enough doctors around in labour ward to scan to this experienced level for every woman, and this would medicalise what is likely to be a normal labour hugely.