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!

Why are ladies not warned about the risk of placenta accreta following c sections?

How much bleeding during periods is bad for you/dangerous?

My periods have got heavier and less painful with each pregnancy. 7 pregnancies later they are almost painless but extremely heavy. Tranexamic acid has helped a bit but I've refused the mirena or ablation because of previous birth trauma with my youngest. Is it ok for me to just carry on losing that much blood? I'm not anaemic and apart from being a massive inconvenience and costing me £30+ every month in pads is it going to cause me any damage? My gp keeps nagging me to try the mirena but I can't bring myself to. I've had a lot of tests but everything came back normal so don't know why I bleed so much.

I bleed over 200 mls over a 2/3 day menstrual period (mooncup user, easy to measure). I’m in constant pain if I don’t take ibuprofen during this time. GP said I should just manage it.

What would you advise?

I’ve just had a hysteroscopy for postmenopausal bleeding. outcome was a polyectomy plus biopsy and comment that a large fibroid completely fills my uterine cavity. I had my menopause over 15years ago. gynocologist says no need for a follow up appointment so what should I do? this was the second procedure for the same thing since 2011. I always get a lot of low back and pelvic pain but gp not interested

My friend is possibly approaching menopausal age. Her periods have in last couple of months become so heavy she is flooding a tampon in less than an hour. I said she should see a Dr, but she says it's normal in the run up to going through the menopause. Is this right?

Do all vaginas look kinda similar? Would you recognise one if you saw it twice?

kaytee87 - not sure I would say normal, but it is incredibly common for women to have problems with sex after having a baby, including painful intercourse. If it is painful, this will impact on your ability to become aroused or orgasm, and hence on your sex drive.
Lots of physical and emotional reasons for this, often both.
Please seek help for this - from Gynaecologist in case there is any suturing that was done incorrectly that could be re-done after or at your next delivery, and from gynae with training in psychosexual medicine to address any emotional/non-physical causes. It is treatable.
Most women don’t seek help, and think they need to suffer in silence.

Episiotomies mostly needed at forceps deliveries, esp if rotational. You are much less likely to need an assisted delivery at a second baby, and so less likely to need an epis. You may still have a small tear. Depends on size and position of baby, need for speedy delivery, and most
of all experience of person delivering you. Doctors tend to be much less patient and be less practised than midwives at easing the baby out whilst trying to avoid perineal trauma, but to be fair, we don’t do many normal deliveries - only ones where baby stuck and or distressed.

How unusual is a uterine rupture in a first pregnancy and what are the consequences?

I ask because I have had 1 consultant (the one who stitched me up afterwards) telling me it's probably best not to have more kids and another consultant refusing to sterilize me and told me to go away and have more babies.

The difference in opinions have always made me ponder.

OP can you shed much light on what recovery from a bilateral laparoscopic cystectomy looks like? I got diagnosed 6months a go and finally getting the surgery in a few weeks after months of pain, bleeding, constipation etc.

Excited for that but no one has told me anything other than the risks and the fact it's only a max one night in hospital :(

No questions, but just enormous admiration for you. I have various gynae issues due to the Birth From Hell with DC1 17 years ago (reconstructive vag surgery once he had finally been delivered; cervical prolapse which means I can't have a Mirena Coil, etc, etc) - but I think you are all absolutely brilliant.

Wow, lots of posters. Just got home so will try and catch up (whilst avoiding football!)

Sunshiness - in an ideal world in the UK, if primary care nurses and doctors were correctly trained in women’s health, were aware of and happy to implement current guidelines, and community gynaecology was correctly commisioned and financed, the traditional system would be fine for most of women. There will always be rare exceptions, eg: women who have cervical cancer despite normal 3yrly smears.

We are still very lucky to have free contraception and smear screening supystem here, which I think is not case for any other country!

In most of Europe, and elsewhere, it is routine to have a yearly checkup with a gynaecologist, in order mainly to access contraception. Women will be advised to also have breast examination,, ultrasound scan of pelvis (maybe breasts too, smear and STI screen - whether these are clinically indicated or not, it seems. With my cynical head on, that may be related to the fact that you can self-refer to a consultant ( not in UK mostly) and all this is private and incurs a cost to the woman.

As long as someone is informed as to the need for tests and likelihood picking anything up with “extra” tests, that it’s their choice if they have the money to spare. In most cases thes are not clinically indicated though. I think there is a place for accessing private care for this if you are clear what you are paying for, eg: convenience of appointment, examination by clinician of your choice (who you may know and feel more comfortable with), seniority.

My ds was born in his umbilical sac. The dr said that was quite rare and it was lucky. She was Japanese and said sailors used to take umbilical sacs to sea with them for good luck!!!

Any views?

FilledSoda - LS is common, and may not be the only cause of vaginal irritation - usually affects vulva only.
Vaginal atrophy (thinned irritated sore itchy tissues) due to lowering oestrogen levels in years leading up to and list enopause is the most common reason. If you responded to vagifem (local oestrogen) initially, it is very likely some or all of your symptoms were due to this. Local treatment may not now be enough - you may require an increased dose (and this needs to be continued indefinitely) or full HRT. Completely treatable.

Very, but sadly, interesting that this thread is full of requests for actual medical advice rather than about the profession of gynaecology. Women’s health and I think women’s own attitude to it is shocking old fashioned in the UK. If GPs are so pressured for time and resources I don’t know why they don’t routinely refer to specialists for anything more than run of the mill issues. A gynae at early stages would do so much for women’s health.

I used to live in the uk and was brought up thinking gynaecological help was something you sought in extreme cases. I live in the USA now and OBGYN visits are totally normal: you visit them without referral once a year for a routine check up, go straight to them when you’re pregnant and generally see the same (invariably) woman straight through to delivery, and there’s absolutely no mysticism about it. Ok, sometimes it’s overmedicated, but I’ve yet to hear of conditions like endo being ignored by an obgyn. If a woman suffers with it it’s normally because she’s reluctant herself to discuss what she considers to be embarrassing. There’s no lack of resource available to her.

What's your view of the current postponement of mesh surgery for SI & POP and your experience of patients with successful outcomes vs complications? I've had a TVT, which, touch wood, has been a total success (I sought out a top surgeon and was lucky to have private insurance so had the choice), but of course I'm concerned for the future. Am hopeful that surgeon skills are one of the factors that means future risk of complications is low.

Do you think that if women saw a gynecologist regularly like once a year ovarian cancer could be detected early? All those stories of women having large masses in their abdomen before having any symptoms surely wouldn't happen?

Plumsofwrath - that sounds amazing. I didn’t see the same midwife more than once during both my pg. Going to the GP about gynae problems is tricky as although we have two female docs and they both work part time so getting appointment is difficult. One of the consulting rooms opens out directly onto the waiting rooms (and the other door out of that room opens directly onto the reception desk) so having gynae exams in there is TENSE. I hate it. I’d much rather go and see someone who looks at fanjos all day, who is experienced and somewhere I feel comfortable. Moan over. Now back to my blardy thrush...should I go back to the doc....?

Why are missed pill rules so horribly complicated and/or how can you remember them simply?

And how many people really have syphilis?

And what do you prefer operating on?

Would you ever advocate HRT past what seems to be the general cut off age with GPs of 55/5 years on it (when there are no other risk factors)?

Ihope/namethat
I originally wanted to do neurology when very idealistic, then GP. I was a mature student at medical school, and didn’t want lengthy postgrad training. Unfortunately, when I did O&G as a student, I knew that was for me, plus my attachment in contraception. I did general medicine and surgery initially as a junior.

Reasons why it’s great:
Just felt drawn to it! Childbirth just fascinating.
I’m not bothered by “taboo” areas and perversely quite like addressing this need.
Most people not “ill”and most things very treatable - so professionally satisfying .
I prefer looking after women - less whinging than men overall, sorry.
I can do a little to address ingrained patriarchy in medicine, and life generally
Mixture of medicine and surgery which most specialties don’t have.
Now I am older and don’t do hospital O&G - no shift work, no nights/weekends, no Bank Holidays - so very family friendly

How do you eat lunch minutes after digging around an intimate area? Doesn’t bother me, never has. Women’s genitalia not “dirty” to me, so no different to examining any other body area - nicer than some. Years on labour ward where you may be continually in theatre doing emergencies soon ensure you are hungry and tired enough to grab food and rink at any minute!

What sort of things do you discuss with your partner about work of an evening? not a lot! Keeping confidentiality important, and he’s non-medical so not massively interested. I also tend to rant about the problems in the NHS when I get going, which must be very repetitive for him! He is extremely supportive of my career, though, always has beeen.

Do you and your colleagues have codes for its not very pleasant down there? never! Only reason for it being not pleasant would be extremely poor hygiene, and those women usually have had very deprived lives and/or significant mental health problems. Would never dream of commenting or making fun of this. I can’t say this applies to everyone I’ve ever worked with, as there are misogynists in all walks of life, sadly.

Wondering if you can help me OP! I was sterilised 10 months ago at the birth of my 4th child. Since then periods have been heavy but been spotting very lightly thorough my cycle. Been examined and my cervix looks normal but I'm booked in for a colposcopy and a scan to check my clips are in place! Do you think the sterilisation has anything to do with the spotting? And I'm 2 days late and I'm not normally late.

I’m female, you have probably gathered...most trainees are now women, and probably more than half of consultants. Traditionally, 0&G was always extremely male dominated - but then so was medicine overall and any surgical specialty.
As the status and pay of medicine have decreased, the proportion of women in it has increased..... good and bad!

The first few days where I get increased cervical mucus before ovulation it’s heavily tinged with old blood. Then goes clear as I get close to ovulation. Smear yes fine. Only happened since I had my baby (emcs under ga) think I’m perimenopaisal - any ideas

Why does gynaecology seem to be so male dominated as a specialism?