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!

I have pcos and I'm scared of it. Getting regular periods but they only 3 days of proper bleeding then I have brown discharge. I have bad acne as well and even tho not planning on getting pregnant right now I'm worried if I can have kids. Anything I can do?
Where to go for support? Anything to take? Feel like my GP doesn't give me much support.

I'm 42 and have PCOS ( never treated for it) and on my second round of IVF. My mum recently had breast cancer but gene testing showed no BRCA problem but that her cancer was hormone sensitive. I was told it was safe to do this cycle of IVF. I have a strong fear that i will get some kind of gynaecological cancer - I was told that with pcos you are at higher risk of endometrial cancer. I'm also scared of getting breast cancer. Do you think, after having a second baby (if I do) , or when I give up on ivf, I should have a Hysterectomy.? Also, is it now unsafe for me to have hrt when I go through the menopause?

thank you! This worrries me all the time!

Raindrops - not my area of expertise at all, but I saw overall very positive experiences of mesh surgery for prolapse or incontinence as a trainee, especially for TVT.
The RCOG has temporarily withdrawn them pending more info.
The problem if they are withdrawn permanently if evidence if excessive harm is found, is that women will be left with little effective treatment for common, distressing conditions. The reason meshes were developed is that the traditional non-mesh procedures were much less effective, and more difficult. Very few surgeons are still skilled in these procedures.
The jury is out at present.

PMDD. It's a thing. Yet to meet a doctor who believes in it. Won't bore you with my personal story but please please please share your views on the best way to treat this debilitating illness. I have just come out of lurker ville and joined MN to ask this question, please answer

This thread seems to have been helpful for so many people thank you for being kind enough to do it op.
But on the flip side, it is really highlighting a sorry state of affairs for women and their health in the uk

LaCerbiatta - lots of support for some kind of screening for ovarian cancer. To be effective though, there are certain criteria for any screening, which boils down to does more good than harm , and cost effective in the NHS context.
Scans can pick up lots of things which look harmful but are not, and there is risk that investigation/surgery for these can needless distress or harm.
Combining scan with tumour markers can help but still not specific.

My own view is that this is acceptable to most women. I did gynae-oncology as a trainee, and saw countless really tragic cases of ovarian cancer, which often does not present until it is at an advanced stage and terminal. Affects women in 50’s - 60’s often, so at a stage where people had worked hard all their lives and were looking forward to retirement, to have it cut short.
I also access a scan every year specifically for ovarian masses, if that helps? Not logical, as breast cancer way more common and I just have normal mammograms for this... but ovarian cancer can have no or vague symptoms which are common anyway around menopause - weight gain, tired, change in bowel habit...

Thanks OP - nice to have the heads up about pain levels and recovery time. Have read everything on the internet from back at work the next day to in pain 3 months later so didn't know! Have told work 2 weeks and have my mum coming down to help after surgery :)

Am absolutely bricking it as hate all things medical and not had GA before, but knowing what to expect helps so, so much! Thanks again

Leghoul - missed pill rules should be fairly simple. COC slightly less so, as it depends where you are in the packet. All depends on when you last had sex, and when you next might be!
See FPA leaflets, downloadable from website, for clear advice.

I'm now through the menopause but this has resulted in bladder weaknesses! I sometimes feel as though I can also feel a textures protrusion down below. I sometimes wonder if the episiotomy that I had hascaused a weakness in that area? Is this something that I should see my GP about?

Oh, syphilis still quite common, more so amongst gay men. Much more common outside Western Europe, esp as not everywhere screens for it in pregnancy as we do. Treatable unless late stage.

I mainly do minor (but complex) contraceptive procedures and early termination of pregnancy now.
Both very fulfilling, as I can make a real difference to someone’s life, and that of their family ie: they are no longer worried they will become pregnant when they don’t want to be, or they have the choice
to not continue a pregnancy that is unwanted, for whatever reason.

@quince2figs
Recently publicised was the list of procedures that the government may axe from the NHS.
A lot of those procedures I noticed affected women and include gynaecological procedures which most women would consider essential and restoring quality of life and enable daily living.
It seems like discrimination/ lack of insight into the impact such cutbacks would have on women
What do you think about this?
What do you suggest to women to combat this possibility?

OnWhite - there is NOT a cutoff age or duration for HRT, but women are commonly advised this, absolutely incorrectly.
The very slightly increased risk of breast cancer on HRT rises after 5 years - but this risk is so small in most women, in comparison to other bigger risks (obesity, alcohol, age) , that stopping just on this basis makes little sense.
It should be a decision between woman and dr, based on awareness of risks and benefits. The benefits can be enormous. See BMS guidance.
Personally, I’m never coming off mine!

Chocolate - no, clips should not cause spotting. Sounds like you are having all the correct investigations...have you done a pregnancy test?

Mummy - not uncommon to get spotting at ovulation, but other causes need ruling out - cervical appearance, scan, hysteroscopy maybe, swabs for infection.

Todays - would go for a trusted colleague in my own unit. Have done this for both babies and for coil fits!

RealMary -I am so, so sorry for what happened to you

OP just saw this thread haven't rtft but want to post this quickly before my battery dies 😂

I have PCOS. I am very overweight and I really really struggle with it. I also have terrible acne and facial hair. The facial hair has gotten 10x worse this past year or so.

I haven't seen a gyn since I was diagnosed (Which took the better part of 10 years) last year. The gyn mentioned that I would be a candidate for laser hair removal but I don't think I could live with the interim growth.

The weight acne and facial hair has had a massive impact on my self esteem I used to be daily confident and happy in my own skin now I'm just a mess.

My question is... would the laser hair removal be worth it?

Also is there anything else I could be doing to help my pcos? I have the Mirena to control my nightmare periods.

Brilliant thread OP.

I’m 29 weeks with twins. Twin number 2 is currently breech. My consultant has made it clear he would prefer me to have a vaginal birth over c section. He wants to induce me at 37 weeks, administer epidural and turn breech twin manually if required. I’m terrified at the prospect. He’s told me there’s no difference for risk to babies in a vaginal birth versus c section, and c section carries more risk to the mother.

What are your thoughts? I’m 39 and this is my first pregnancy.

Vivarium - women’s health physics should be part of the multi-disciplinary team in all reasonably sized urogynae units. Absolutely vital.

I'm due to have a laparoscopy and hysteroscopy done on Monday - what is the recovery ACTUALLY like? I had a section 14 months ago and didn't find it too bad at all!

physios, not physics!

Is it worth me pursuing more medical investigation?

I suffer from really heavy periods. A few years ago I had two particularly heavy, miscarriage like, bleeds in the space of three weeks. My GP put it down to stress. A few months later I pushed for a scan and the radiographer found a polyp but my GP didn't act on it, just told me to continue with tranexamic acid, which only works if I take it at the very first sign of my period starting or it doesn't work at all

After another heavy bleed I had another scan and again a polyp was found, but instead of seeing my regular GP after I was referred to a different clinic where I saw a different GP who had a particular interest in gynaecological matters. She told me that the scan found nothing wrong, even when I mentioned a polyp being found both times I had a scan, and offered me a mirena coil which I turned down due to me not getting on at all with hormone based contraceptives.

I am now in my late 30s, is this just something I have to live with till I reach the menopause? Thank you for starting this thread, I've given up seeking healing through my GP

what could cause heterogenous uterus if nothing else seen on scan?

just wanted to thank you for posting this thread quince, as im sure you're busy. Enormously interesting to hear your honest opinions.

mad - yes, increasingly we are understanding that symptoms of perimenopause can start in 40’s and even late 30’s. Oestrogen supplementation (HRT) a good idea for many, but some crossover with PMS.
Would suggest asking GP to refer you to nearest NHS menopause clinic. Sadly ....you guessed it.... not enough of these.