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!

OP you mentioned smear tests earlier. What do you reckon to Margaret McCartney's arguments against them?

I am genuinely curious as I always sre hcp saying smears save lives etc but when I ask them to tell me where specifically MM is going wrong, they can't / won't explain.

Would genuinely be interested in your thoughts!

Hi OP thank you for this thread. It’s been a really interesting read.

I will try to make my question brief. I had recurrent miscarriage before becoming pregnant with my DS. It was utterly miserable. The nhs found no reason for my losses but I had private tests, was diagnosed with ‘killer cells’ and ended up taking a low dose of steroids until 16 weeks. Anyway I just wondered what your view is on the killer cell theory?

I keep being told that another pregnancy may be plain sailing as ‘now your body knows what to do.’ Or ‘your body will have reset itself’. Is this true?

I started having peri-menopausal symptoms early (in my 30's). is this genetically linked? Also I have read something about carbohydrates/vegetarianism hastening menopause - is there any scientific basis in this? (wondering if all that toast has affected it!)

Ive been vegetarian since 12 and eat way too much carbs. I am 47 and am only just starting to experience the beginnings of perimenopause, bit of overheating, nothing else. So that certainly didnt hold true for me.

What would you recommend for a virginal prolapse that isn't causing major issues, but bothers me?

What would you do with a woman who has had a germ cell tumour, very low oestrogen (having symptoms - low anti m etc), was constantly bleeding (not heavy) so was given mirena to stop this. It resolved now back at square one, having constant night sweats and hot flushes. US is fine. Had to PEs so they won’t give me oestrogen.

Thank you so much OP, such an interesting thread.

I know you said it was just traditional for all medicine to be male dominated, but... Do you find it odd why a man would specialise in o&g?

I was really referring to this statement: 'You’re right, it seems for most women they have to be incredibly persistent and knowledgeable to access a Gynaecologist in secondary care, repeatedly fobbed of'

In our region every three to six months someone comes to our practice to discuss our referral rates, tell us off for being shit doctors for referring our patients to secondary care and tell us we are causing ruin to the health service by trying to actually access our secondary care colleague's knowledge. Their key focus is gynaecology and paediatrics at the moment. So we are under massive pressure to not refer. We are also penalised every time a patient is seen in clinic and discharged without follow up as it's considered these are obviously unnecessary referrals.
When we do refer patients wait over 9 months to be seen and so if we refer more that will only get worse.
I don't 'fobb patients off' for funsies or as some kind of power trip. But I do feel like I can't refer unless we've exhausted every single investigation and treatment option available to us in primary care. I'd love for it to be different. But we need to either reconsider the level of service we are prepared to accept or reconsider how much funding is provided.

CantChoose would you say it's now uncommon for referals to be seen in under 18 weeks? I went to see my GP the other day and was told it'd be well over a year to be passed on to a gynae for surgery. Do you think more women are starting to look at private care and paying out of pocket for services than before?

Great thread! Thank you Quince2figs. Very interested in your full support of HRT. What else can you tell us about it? DM had menopause at 48. I am 47 and thinking ahead...you mentioned oestrogen only etc...any preferences? When is best sooner or wait until symptoms are full on? Thanks

Yes, almost certainly. An 'urgent' respiratiory referral is now about 16 weeks in my trust - and we are better than most, apparently!!
If you really feel someone needs to be seen urgently you have to either continually ring or email the consultant (no time for this!) or send them in via a&e.
It also means that a not insignificant proportion of my routine appts are booked by patients coming in to ask me to try and get them seen sooner. Which I can't, usually.
Suspected cancer referrals are seen very quickly and efficiently though.
I don't really think it's the hospital's fault - I assume the consultants aren't sitting around drinking coffee and reading the paper instead of seeing patients either!
It's not just women. More people are seeking private care in general from my experience - not sure if that's seen statistically nationwide though, I work in a moderately affluent area so suspect I see more of this than average. Even private GP services. And I can't say I blame them to be honest! On the other hand I have patients who somehow manage to get in to see me several times a week for various nonsense problems - I think they just camp outside

CantChoose that's such a shame that it appears your hands are tied in such cases. Whilst I think our NHS is really good in some areas (ie when I had my appendix removed) it's such a shame that the point of access for many people has so many hurdles to jump through in order to improve their quality of life.

cantchoose - that must really wind you up about the time wasters. Do you think a more aggressive approach could be used to deter the health anxiety brigade taking up all the appointments?

I know someone that goes to the GP 4 or 5 times a month with various ailments, never anything serious. Last time was because they thought they had an ingrown toenail forming, but it wasnt. My mother goes to the GP every time she has a cold or sore throat, despute being told over and over that its pointles

@1sttimeunicorn did you go privately to Coventry for the uNK cells test (funded by Tommys research grants) or privately to one of the immunes consultants who argue for peripheral blood nk cells rather than uterine nk cells (ie blood test rather than endometrial biopsy)

NHS doesn't believe in either theory and so lots of people end up going private when being told by the NHS that it's 'just bad luck' if no obvious thrombophilia or parental karotyping issue or uterine pathology is found. NHS doesn't consider there's enough evidence to support nk cells treatment - the only way you're likely to get pred prescribed is if you get a letter from Prof Brosens or Quenby asking your GP to prescribe it, and if a kindly GP agrees to do so. Otherwise you'll need to go private. Coventry now fine that levels of uNK cells rise and fall so don't necessarily recommend pred any more, so worth going back to get a repeat biopsy before TTC again, as their recommendations are evolving in line with their research findings

Hello! Please help, I'm 10 weeks post partem and I had an episiotomy and kiwi delivery. That's all healed fine but I've been constipated and found that when I push a lump comes out of my vagina.

I went to the doctors worried it was a prolapse but my doctor said it wasn't and it was just the vagina wall coming down and to do my pelvic exercises and take lactulose

I was in and out in minutes and just wanted a second opinion if this is normal and to just keep doing exercises?

Thanks! X

Hi @bananafish81 thanks for the reply, I had the tests done via a blood sample in London but I know about Coventry etc. My GP has been firm that they won’t prescribe me the steroids as it’s not an accepted theory. At this point I think I will get the tests again when we look to TTC.
Are you involved in the profession or did you/are you going through the same? Hope all is well with you. Worked out for us but after 4 hard years. Hope to be lucky enough to have another but if not I will be happy to close that book with my DS. He’s all I could have hoped for after it all.

I am loving this and hope Quince has time to come back and do a few more of these over the week It is the best AMA yet.

As a woman with a GP who says he "doesn't do women's stuff" I am all ears for how to get referred to whom and when. My HRT atm is dealt with by the practice nurse who is desperate to get me off it after 5 years (and I have only been on it for 3 ) and cannot remember her sequi from her conti. I would love to be able to see someone who knows what they are doing.

@Melamin your GP has actually said that?! Won't do treatment for half of the population? That's horrific!

He didn't say that to me - he said it to a friend who went and asked for hrt. I haven't seen him as I was originally prescribed at a previous surgery which is why I see the nurse for reviews, but I have no one sensible to see for advice.

I can't see the point of being a GP with that attitude though.

The friend finally got help from a locum.

@1sttimeunicorn the debate is interesting as the immunes Drs who do the peripheral blood nk cells cytotoxicity tests argue that the uterine biopsies are irrelevant / useless - whereas Coventry argue the reverse (Prof Brosens told me it was 'bollocks', as peripheral blood levels are no indication of what's going on in the uterine environment)

However I know several people who suffered from RPL who were told by the NHS that nothing was wrong and it was just bad luck (only to go on and keep miscarrying) - who then went and got tested privately, found elevated nk cells cytotoxicity, and then once treated with pred & intralipids, went on to have successful pregnancies

I'm not a clinician, I've just had a lot of investigations and treatment for infertility and miscarriage. Sadly we weren't successful, as Drs on both sides of the Atlantic (including Prof Brosens at Coventry) confirmed that my womb was unable to sustain a pregnancy, and that we had exhausted all possible options - and thus the only way we would ever become parents would be via adoption or surrogacy with our frozen embryos. Congratulations on your DS, and keeping everything crossed for your journey whatever you decide

Yogaginrepeat (love your username)

That comment from a GP doesn't surprise me AT ALL.

Over the years I've had

"Well some women do have slightly heavier or more painful periods" - after an admission to a&e following up with GP as advised

"Well there's not much we can do, the best cure is pregnancy" - less than a year after 1st pregnancy AND I was 20 and single.

"What a lot of fuss over something every woman deals with" when I was in tears in agony and begging for better pain relief/help

"Ahhh been reading too many magazines I think" this one accompanied by smug patronising grin - when after reading an article, yes in a magazine - but about endo where it was ALREADY on my medical records that I had many of the symptoms. I was pretty sure from this point on what was wrong as I ALSO looked into other possible causes and there the symptoms DIDN'T match. This was followed by yet again "no no all perfectly within the normal range" - this was in response to explaining I was on 2 weeks off 2 weeks then on again, bleeding so heavily I needed to use max absorbency pad AND tampon, in pain worse than appendicitis, fainting, vomiting, dizziness, diarrhoea, pain when I wasn't on period, pain during sex etc etc

The most depressing part of that appointment was a trainee gp was also present and nodded along agreeing.

And yes I've also met FAR too many male gp's who won't even DISCUSS gynae issues - therefore THEY were wasting appointments (it's not just patients do this) by saying so and telling me to make an appointment instead either with (usually the only) female GP - can't imagine how much that fucked their careers either! Or the practice nurse - who at this point were unable to do prescriptions or referrals without backup from A DR.

@reeldoop honestly, no not really. Unfortunately it tends to deter people who are already worried about 'bothering' the doctor and those who don't care are pretty oblivious.
I don't mind the genuinely health anxious - I see that we need to help them with that as a mental health problem. Though of course it is challenging.
We have relatively few genuine time wasters but they do come and that's irritating. On a good day I try and view it as an opportunity to re-educate them. But on a bad day I'm less sympathetic .
I think I will dip out now at the risk of it becoming an AMA GP thread...

Very interesting thread.

OP, I've had my mirena in for six years now, I thought they only had a five year life but I was told I don't need it swapped yet? Is that correct?