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!

banana - I didn’t have any infertility training, as this is a subspecialism of general O&G, and the units I did my training in had no fertility units.
I’m afraid I do think IVF will be mostly self-funded in a few year’s time, but the cost likely to reduce.

banana - local not used for Pipelle, which is why many women find them so painful -also because they tend to be sprung on women in outpatients with no warning.
Very similar to pain with coil insertions, which I do lots of - and very variable. Cervical block can stop the initial pain of cervical spasm, and ibuprofen plus paracetamol 1h before helps a far amount. You’re right, pain at the fungus not stopped with a cervical block, which is where gentle technique helps.
Pipelles by their nature are very limited in the amount of endometrium they reach, which is why a hysteroscopy to perform a full endometrial biopsy is the ideal.

Ohthe - sorry, I missed your other question. I never use “mum”, “dear” etc and never have. You rarely hear male patients addressed like this.
I prefer to use Mrs Smith, but many patients do not offer their title these days, and can no longer assume marriage, so always used to be being corrected to “partner” instead of husband.
So I tend to use first and last name, and introduce myself in the same way.

Hi Quince.
I would be interested to hear your opinion on the birth of my first DC. I feel like I care really close to losing him and have had trouble coming to terms with what happened. I got pregnant after IVF and the pregnancy was a worrying time because I had lots of sudden heavy bleeding caused by a haematoma. That stopper around 20 weeks but then I found out the placenta was covering my cervix. I was incorrectly told by a consultant that it had moved quite late on (36 weeks) at my last scan. Four days later after a small bleed and going into hospital for that I was rescanned and told it hadn’t moved after all and I would still have CS 2 weeks later. Then a nurse had trouble finding his heartbeat during routine obvs. It turned out it was so low she had confused his HB for mine. Despite the fact that he was very clearly in distress I was told they were not going to deliver him for another two weeks. I tried to convince them otherwise - I knew something was wrong but they wouldn’t listen. I can’t understand how they could have brushed off the fact that his heart rate was dipping so much? About 10 minutes later when I was still talking to the duty doctor I felt myself hadmorage and I was rushed into theatre and my son was deliverer. The next day one of the nurses offered for me to speak to some kind of patient group around the circumstances of his birth. I was just so relieved and caught up in the moment that I declined but I regret that so much. I can’t help thinking of what might have happened. Also I read a story in the news about a couple who lost a baby in similar circumstances at the same hospital - my question is - was I as close to losing him as I believe I was? Is it standard practice for some kind of review have taken place after this kind of circumstance? And what is your opinion on their decision not to deliver my son until the hemorage? I can’t understand how they were so blasé about his heart rate dipping so much.

Molly - that sounds awful and sorry you are still struggling with this.
You are much less likely for labour to be slow with second and any subsequent births, but pain relief will be very important for you.
No shame at all in not coping, it bloody hurts!
Suggest you discuss with your consultant ASAP. Unfortunately, you can not always be guaranteed of an epidural, say, as soon as you would like one, simply because the labour ward anaesthetist will be doing emergencies in theatre too.
Hope all goes well.

Shoving - would augegstvreferral to a gynaecologist with psychosexual training - to find out reason for pain (many possible) and address it.

Lapsing - no defined evidence of genetic link. Your management sounds slightly disorganised so far, to say the least. You need at least recent scan and blood tests for markers, and reassessment of whether these are doing any harm, or need surgery.

Tilly - I am aware this is happening, and I feel that vasectomies, as the only male option should be available on the NHS.

Absolutely agree that knowledge of normal labour and empowerment to believe that in most cases this will happen, is really important. Intervention clearly increases the risk of further intervention -but should be done for a reason ie: to reduce a greater risk. Without a crystal ball, we don’t know whether it was actually the first intervention that caused the outcome, or whether it might have happened anyway...that’s the challenge of labour!
I’m sure my view is skewed as doctors on labour ward only see complicated cases....but I am a realist enough that it didn’t stop me having 2 vaginal births with as little intervention as I could manage.

Clinkly, sounds like you have vulvodynia, which can be a challenge to manage, but should be seen in a specialist vulval clinic. It’s quite common,and has some great patient support sites.

Changing, sounds very much like you have PCOS. Blood hormone tests are quite specific markers and times of the month, and these aren’t always done correctly, so maybe check on these again. You do need ref to gynae, but of course if you conceive in the meantime, will be deferred until after pregnancy.

Lostmy - if a big baby with normal fluid is persistently in transverse lie, then yes, it is likely this is for a specific reason eg: placenta still low.
I guess time will tell -if he becomes head down, as he is big, unlikely to then move.

Rocket see earlier posts

Hi Quince! I'd love an answer to a question. I've had stage 1b1 cervical cancer and had a trachelectomy. Since then I've had a baby (33 weeks) with a TAC placed in pregnancy. I've had another TAC placed to avoid another premmie, as membranes bulged through the TAC at 22 weeks.

Now, 5 years post cancer and 4 years post birth I'm getting awful pains each month, when I ovulate and when my period is due. Also less severe pain on waking everyday. I think it's a combination of bladder adhesions and "cervical" scarring (I know it's not a real cervix, but it's that region). The cervix pain is the worst and makes me gasp with pain as it stabs suddenly. It comes like lightening so I can't take pain killers, although if it gets going sometimes it can be ongoing for a day so I'll load up with painkillers to try and control it.

I'm 41 and after a few IVFs I'm probably going to give up on a second child.

Anyway, to cut to the chase! I'm not really being listened to re the pains. Its hard to describe and the only option I think is a hysterectomy, but I'm not sure if that would help. Might just add more adhesions. The adhesions pain does seem to be easing off, so I'm not super keen on more surgery. Also, 5 years post cancer, is there any cancer safety benefit in having the hysterectomy? I'd always assumed I'd have one once I decided kids were finished, but now I'm not sure if it's recommended. I'm just not sure what to do and I've moved countries, so I don't feel like anyone really understands my history. Its disjointed and I get fobbed off a lot so I've kind of given up doctors as much as possible. The only option I've been suggested is open investigate surgery to look for adhesions. They can see lots of fluid around my ovaries (PoD) but seem unworried and no real action plan.

Any advice!

Does the Mirena make you fat? I am not currently on any contraception (bar the withdrawal method). It wouldn’t be the end of the world if I got pregnant again, although I’m not planning on it. I had the mini pill after DS was 6 months old, but I had horrendous recurring thrush, so I came off it when he was 18 months, and stopped bf then too. He’s now 4 and I haven’t been on contraception since. I keep dickering with the idea of getting a coil - periods are quite heavy (not painful) so not the copper one; and my twin sister had endless bleeding with the implant, which put me off. But I struggle to lose weight, so I’m a bit worried about the Mirena making it worse!

(Best option is DH having a vasectomy but he’s a bit iffy about it - and the risks for that involved loss of erectile function and urinary incontinence, so I do see his point.)

Hi is it normal to have such severe period pain that it wakes you up from your sleep? And despite taking pain killers, you are still in pain? I've had 2 ultrasounds both I'm told were all clear. But I don't think this can be normal. Is it also normal to spot for 6 days before your period?

@quince2figs just out of interest are you providing your GMC number via PM or otherwise to those posters you are at advising? As per GMC guidelines on social media.

Lapsing - the mainstay of most endometriosis non-surgical treatment is some kind of hormonal manipulation - and the hormones used vary. It is worth you trying an alternative to that which gave you headache, especially if the previous use was contraceptive methods.
Surgery is an alternative.

teainbed - no, I haven’t, as of course this would breach confidentiality of myself and the poster. I’ve just read the guidelines which suggest that I should identify myself by name....which I don’t feel would be appropriate or safe. It does not suggest I should publish my GMC number.

I don’t think I am ever going to catch up with the enormous amount of posts, and the number of them asking specific medical advice is surprising and somewhat depressing. As posted much earlier, I am not recommending specific treatment for an individual, but trying to give some more general info to signpost.

I’ll bow out at this point, therefore. Thanks to all those who took the time to post, and I hope you all manage to achieve some resolution of your problems. Lots of empowering info available on RCOG and other websites I have mentioned above.

Thank you OP and I am sorry your thread was hijacked. It id one of the best MN threads I've seen in 8 years on the site. You are a fantastic ambassador for your profession.

Thanks @teainbed hope you're pleased with yourself.

@teainbed great Thanks for messing this thread up! I’m going through an incredibly difficult time after baby loss and I was checking everyday for a reply to my post as were all the other woman in here. She wasn’t giving any diognosis for god sake she was just giving a bit of an insight into each of our issues. We aren't stupid you know! We understand that we need to see a doctor. But I’m waiting for a referral to the same hospital were my I lost my pregnancy and I nearly died so I just wanted to know a little of what to expect because being completely in the dark about your body is scary. So thanks for being a know no it all and fucking this really important and much needed thread.

OP thank you so much for your contribution, you’ve really helped lots of woman here 💐

Yes this is my favourite thread ever thanks op xxxx

Thank you OP for this thread ! yes I was told I'll probably have some scar tissue. It's mainly ovulation that is the most painful

Thanks for the thread OP. You dedicated a huge amount of time to replying to all the posts. Much appreciated.