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!

@quince2figs and @graphista - thank you. I really do think GPs need more robust training in endo diagnosis and treatment pathways. I was only diagnosed with endo when my symptoms got so bad I was taken from A&E for an appendectomy - my appendix turned out to be tickety-boo and is still in situ - can't say the same for my womb and ovaries, alas!

TheVast - yes, non-mesh surgery, physio and medication.

Thank you for this thread OP!

Well timed for me, today I went to early pregnancy clinic. Dates say I'm 7 weeks, going by LMP. Dr reckoned baby measured 6+4, which he was happy about. Heartbeat seen on scan.

However, Dr showed me haematoma on my womb, likely cause of blood loss (but made no mention of reference to pain, and I forgot to ask). He said they normally dissolve and go away themselves. They will re-scan me in a week's time to check it has started to shrink. Not sure what will be done (maybe just continue to rescan) if it hasn't, as Dr said miscarriage may occur if it doesn't resolve itself.

How worried should I be about this haematoma/risk or miscarriage.

I am struggling with heartburn, should I be worried this early on in pregnancy that I'm having it? (This is dc3, in the postnatal period after, 4 weeks, I was admitted to hospital via A&E with severe abdo pain. Turned out it was a gallstone stuck leaving the gallbladder, presumably as it started working again fluids were flushing any existing stones out). Am I in trouble? Am likely to have gallstones causing problems DURING PREGNANCY this time around?)
(I have tried asking anyone I saw GP etc about this, but they were all v dismissive "Previous stone wouldn't cause problems during a previous pregnancy etc". I fear now they were too dismissive of my concern).

Heartease - see my posts of this evening - vaginal delivery riskier for baby at a population level, but not on an individual level - as you don’t know what your outcome will be with vaginal delivery.
C/S has different and some serious risks, especially for the mother, and risk goes up some with each subsequent procedure.
When I did obstetrics, I DID tell women this! But also pointed out that it was meaningless for them unless they had access to a crystal ball.

Scan pic.

Biologi - not likely to be improving matters much, but this is an area where it is unclear what the best treatment is and research is lacking.
RCOG guidelines exist, and I have found that COC or Mirena can help greatly.

Megan - glad to be of help - that is a big fibroid. Good luck tomorrow.

Iwoke, no not normal, esp if codeine not touching the pain. You need referral to gynae, as endometriosis or adenomyosis sound highly possible.

Eve - sorry, not my area as this is fetal medicine - I can only remember that all women I saw with this inpregnancy and at delivery were fine!

I am a Physiotherapy student and would love to get into women's health, more obstetrics than gynae I think. Do you happen to know if I would have to specialise? Can you give me any advice on the best way to get into it? Some rotations are available on gynae once I'm qualified but I'm not sure how as this isn't covered at uni.

Had a copper coil inserted 4 weeks ago, been to a&e twice since then with unbearable stabbing pains in my uterus. Had an internal scan and X-ray and the coil is in the correct place, have pain meds to take as and when I need them along with something to slow the bleeding and help with pain.
I've been bleeding for 2 weeks now REALLY heavily, I'm having to change my mooncup every hour or else it overflows.

I just can't bare it anymore! Love the idea of it but I just don't think it's right for my body. Should I persevere or go back and see if they will take it out? I'd be willing to try a Mirena instead, do you know if it would hurt lots?
I'm only 22, anaemic and have never been pregnant I should have never let them put the copper one in!!!

Do you have an opinion on people with auto-immune conditions being fitted with a mirena coil, and should those who take immunosuppressants have more regular smear tests. I've had conflicting advice.

Fascinating thread by the way, thanks for starting it.

ncfirthis - can’t fully comment on your case - but PCOS ifs often over diagnosed, and symptoms such as frequent bleeding or pain wrongly attributed to it.

This pattern of bleeding requires referral for a scan, a sample of lining if uterus, and ideally a hysteroscopy (telescope into uterus) to check no polyps etc.

Yoga - could well be endo returning, but symptoms could relate to other conditions too. Laparoscopy not a great test for endo, but not much better alternative. Common sense Is to treat symptoms, eg : continuous COC, Mirena to see if that helps, which can in turn help diagnose.

umpteen could be strophic vaginitis, any skin condition, BV (check this has been tested for by immediate microscopy in a sexual health clinic, at the time you have symptoms - GO swab for this useless) allergy, related to soap etc. But requires scan too due to pressure sensation.

I went to see a GP about what I thought was a septate hymen, GP had no real clue what was wrong and said it was likely due to trauma during sex and that I had essentially split myself in two (even though I told her it was there before I lost my virginity). Anyways, she said she would refer me to a gyna but the wait would take well over a year... Is that kind of wait typical on the NHS?

What’s the best way for women to have a hysterectomy granted? I have severe endometriosis and despite being a midwife, and very aware of the risks of hysterectomy / finality of it etc. my gynaecologist continues to tell me I’m too young yet and so the yearly laparoscopy’s continue. It’s not cost effective or ideal at all! Just what is the magical age that women can then be trusted to make the decision they no longer want a uterus?

iheart - Mirena a good option as you can the. Use oestrogen only HRT, not bleed and minimal risk of progestogenic side effects

KatyMac - yes I was taught as a junior to just do these in clinic without any pain relief or acknowledgement that they hurt like buggery. Same sort of pain as having a coil fit, and I use local anaesthetic gel, sometimes with injection too, plus advised paracetamol and ibuprofen an hour beforehand!
Damn sure that wouldn’t happen to men.
I actually think it is abusive and negligent to do this kind of procedure without preparation. Info and pain relief.

Dharma - they certainly should be.

I am off to sleep soon, but will try and answer most q’s tomorrow.

I am going to miss those where the question has been duplicated, or where the advice sought is very personal - there is a limit to how appropriate it is for me to give personalised and specific medical advice here - esp if anyone putting up part of their medical records, like scan images, or asking for emergency care advice. So sorry, please don’t do this, but do discuss with your doctor.
Really happy to continue answering general clinical musings where I can, and especially the q’s on system differences/problems/ thoughts for improvement.

ScreamingValenta - it was having surgery for ectopic pregnancy led to my Dx - it's a shocking state of affairs!

@quince2figs thank you for replying - I really appreciate it. I wasn't sure if I would be able to physically keep a Mirena in if I couldn't keep a copper coil in, or whether it has similar side effects to the progesterone in elleste in which case I'd rather stick with the utrogestan. Thanks again

Thanks for the advice Quince2figs - I will do that.

I had severe hyperemesis with my dd (7 hospital admissions) and was advised to have no more children. My hyperemesis with my son stopped at 20 weeks and was controlled with stemetil and zofran. I am extremely broody, would another pregnancy really be a no-no? Also had two sections (one emergency (failure to progress and failed ventouses and forceps) and one planned as had placenta praevia)) if that makes a difference