First steps in testing after second MMC

[sweetpea2000]

I've just had a second MMC following another one in the summer.

I know it's not technically treated as 'recurrent' until you have 3. And I understand why, as 2 consecutive MCs are still more likely to be sporadic/ chromosomal than have an underlying cause.

However I'm feeling fragile, and reluctant to just try again if there is an underlying cause that could be treated next time.

I'm happy to pay for it, but just trying to get my head around the right tests, which is pretty overwhelming.

My pregnancies ended at 8 and 6 weeks. From the reading I've done (Lesley Regan's book) it seems like that is most likely due to 'sporadic' chromosomal causes OR a recurrent issue with clotting/ immunological factors. Does that sound right? It's all so confusing and I feel like I need PhD just to be able to plan a safe pregnancy.

From what I've read online, there are 'tier one' tests which are commonly covered by the NHS in recurrent miscarriage clinics. These look at Antiphospholipid Syndrome (APS) and other clotting problems, as well as anatomical irregularities, and Karotyping.

Is that right? And then if those tests are inconclusive, there are 'tier two tests' which include NK cells and other more controversial immunological factors.

I'm just wondering if it's worth me getting the 'tier one' tests done privately. I know I'm not eligible on the NHS, but am willing to go privately to eliminate any obvious problems before next time. Can anyone make a recommendation of where to get this done?

Thank you!

Hi there, so sorry for your second loss, it sucks. Ive just gone through my second miscarriage at similar times to yours, and my gp agreed (after some pushing) to do some tests for me now and to prescribe me progesterone next time i get a positive, as ive had bleeding in both my pregnancies. Have a look at tommys site and the tests they offer at their recurrant miscarriage centres, they have a really good checklists. my gp agreed to some of them, however if i want ultrasound of uterus/ APS tests and more specialist tests ill need to wait for third miscarriage or pay privately to do before then, which im considering.

Hi @Skattycatty123, so sorry you have been through this too. I was so nervous the second time around but also mindful that it was statistically unlikely to happen again. I can't believe it has.

Do you know which tests your GP has referred you for? Is it hormonal factors? I thought APS and anatomy would be covered in the first tier of testing.

I'm really keen to have these tested before next time, so I know I have at least eliminated some causes of recurrent loss. Ideally somewhere that I could then pursue the next level of tests if they are inconclusive or if the unthinkable does happen again.

Hi i replied before but for some reason it looks like my reply didn't post, even though it said it did! Let me know if you can see my reply to your last post, if not ill send it again x

@Skattycatty123 I can see one initial reply from you sent at 17:44 - is that the one you mean?

Ah my last reply must not have posted. Basically the tests you mention as tier one are absolutely ones the recurrant miscarriage clinic would do but unfortunately my gp won't refer me there until i (fingers crossed not though) have 3 consecutive ones. He's agreed to do some tests via the gp surgery, but only after i specifically asked for them and i got the list of tommys website of ones they typically do in their clinic and another couple tests . The ones he's agreed to do are coeliac screen / vitamin d / diabetes / thyroid /ovarian reserve / some test i think for polycystic ovaries. He also said i had a blood clotting screen after my first miscarriage but that was ok, you may be able to ask gp for that. (due to having a missed miscarriage and needing extra hospital input etc). He's also agreed to prescribe me progesterone for when i have another positive test, as there is some evidence it helps for women with early bleeding in pregnancy (from tommys website). Have you spoken to your gp re additional tests? Ive also booked in with a private gynecologist on Thursday and am going to ask her if worth doing detailed ultrasound of womb/ aps tests now or whether to just try again and hope for best (with GPs added tests). Hope this makes sense!!

Hi @Skattycatty123, okay, that makes sense.

I'm reluctant to wait for an NHS referral even if I'm eligible, as I've heard that the recurrent miscarriage clinics have been shut for ages because of lockdown, and I guess will have very long waiting lists. I don't know that for a fact though.

It would be great to hear how you get on with the private gynaecologist consultation tomorrow, and what they recommend.

Have you done any reading up the causes/ possible treatment routes? It's really interesting (and overwhelming) as there seem to be two schools of thought - the NHS one which is more conservative, and then the more experimental immunological route. I've read Lesley Regan's and Alan Beer's books to represent each standpoint. It seems they fundamentally disagree with each other's logic on the causes and methods of treatment, which makes this feel so confusing!

Hi @sweetpea2000

Firstly I'm so sorry for your loss, its such an awful thing to go through.

I had a miscarriage at 6 weeks in May last year and then a MMC in December at almost 10 weeks, so I know exactly how you're feeling. I also wanted to explore all options before trying again, even if I don't get any answers. I think it's a way of feeling more in control of the situation for going into it next time?

I was refused from my GP so I went to a private consultant at a Nuffield hospital (I'm in the North East so I went to Teeside) and I am just waiting on my results now.

I was recommended the following blood tests:
Thrombophilia
Lupus anticoagulant
Anticardiolipin antibodies
Basically what I understand from all of this they are testing my blood clotting and consistancy.

And like @Skattycatty123 he's agreed to proscibe me with progesterone next time as there is some positive studies it can help with your womb thickness. I've been tested for PCOS before and my consultant commented then that I have a thin lining, so I feel so much better knowing I'll have the progesterone next time round.

The other test he mentioned was a hysterosalpinogram (HSG) which is where they put die through your tubes and uterus, but I had already previously had that done when going for fertility tests.

The cost of my consultation and blood tests so far was just under £500, but the cost of the HSG I had previously was also around £500.

I would also recommend the book it starts with the egg by Rebecca Fett. I found it quite interesting and I'm following the supplement recommendations for reoccurring miscarriage.

I totally feel the same about feeling like you need a PhD to understand all of this stuff!!

Thanks @KB86. I'm so sorry for your loss too. It's so hard to have it happen once, let alone twice.

It seems like the first steps they investigate are hormonal, anatomical and clotting factors then. I had a basic ultrasound done as part of a fertility MOT and it didn't show up any abnormalities but I don't know if an HSG would also be recommended.

I'd definitely like those blood tests done, as according to the reading I've done, issues with clotting can cause pregnancies to fail around the 6-10 weeks mark, when the placenta is getting established. Or it could just be sporadic chromosomal abnormalities. around this stage. It's so hard to know! The hospital are testing my most recent miscarriage so I can at least know with this one whether it was chromosomal or not, although that doesn't rule out an underlying problem altogether (and I don't know the cause of the first) so I'm keen to have tests either way.

I'm researching clinics to get their recommendation on tests. The range of tests and corresponding costs seem to vary a lot.

£500 sounds very reasonable If they do find an issue with blood clotting factors then it seems like there is a high success rate treating with Aspirin and Heparin, so it definitely makes sense to know in advance.

It seems the experts are divided on everything. A nurse at the EPU told me yesterday that taking aspirin daily from a BFP may help and "can't hurt". If that's the case, why don't they tell all women to do that? Or at the very least advise women to do it after one miscarriage?

But then Lesley Regan, who is the leading authority on miscarriage in the NHS, says Aspirin should only be taken if you know you need it, as it can increase the risk of miscarriage in some people. It's so confusing.

I have read It Starts With the Egg and had mixed feelings about it to be honest. I've started taking Ubiquinol supplements and generally try to follow a mediterranean diet, but I thought a lot of the lifestyle advice in the book was overkill and could leave women feeling like they have to follow all these rules to have a hope of getting pregnant.

I hope the Ubiquinol is helping, but it's expensive. And if its benefits are proven, why isn't it promoted by the NHS or even unanimously by private fertility clinics?

It's really hard when you want to do everything right, but there is so much conflicting information out there.

It would be great to hear how you get on with your tests if you feel comfortable sharing, and I will do the same too.

Hi @sweetpea2000

So i got my results back yesterday and they found something in my bloods! I have another consultation booked in on Tuesday to discuss them. He's told me to do some reading on it before my appointment next week.

My thrombophilia screening shows that I am heterozygous for factor V leiden mutation. So that means I have one normal gene for blood clotting and one abnormal that doesn't know when to stop clotting. So I think I'll be put on aspirin and blood thinners, but I will wait to see what the advice is next week.

I'd also heard a lot of mixed thoughts on the aspirin, and did consider taking it during my second pregnancy but decided against it. But when I discussed that with the consultant he said the same as Lesley Regan, so I personally feel better getting the tests done to know for sure.

I know what you mean about some of the stuff in the book being overkill. I'm following some of it, but to be honest that's more just lockdown as I feel like I don't have any need to wear make up or nail varnish! I didn't discuss the supplements with the consultant on my first appointment, but I think I'll ask for his opinion on the Ubiquinol when I chat to him next week.

I wasn't expecting the hospital to test my latest miscarriage, but I received a letter about 1 month later saying they did and there was nothing untoward. Do you think that means they have ruled out it being chromosomal?

Hope you're making some progress on finding the right clinic to go to :)

Hi @KB86 just a quick question as i have limited time at work atm but just wanted to ask ee your blood result), did your consultant say anything re having to wait 3 months for taking aps blood testd after a pregnancy? My gynecologist said yesterday there was no point having aps blood test done until 3 months have gone since i have been pregnant, as it renders them uninterpretable. But i havent read that anywhere! Sweet pea will also reply to you when i have more time after woek!! Xx

Hi @KB86 I think that's great that they have identified that issue with the initial tests, and can prescribe the treatment accordingly. So good that you got it checked out now. Keep us posted on the next steps for your treatment.

On the miscarriage testing, I've read on here that the wording is really unclear when they report back. It might be worth following up with the hospital or your GP to help interpret the results?

I'd be interested to hear what your consultant says about the Ubiquinol. The dose recommended in that book is costing me about £50 per month, and my DP refers to it as my 'sugar pills'! I'm just sceptical as it's rated so highly in that book (and in some articles online) but not recognised by the NHS or in the leading books on miscarriage either.

@Skattycatty123 no he didn't! And I did give him all my dates during the first appointment (my bloods were about 6 weeks after the MC) he did say that 2 out if the 3 tests would have to be repeated after 12 weeks if they came back abnormal though, so maybe that's the same thing but he just wanted to test now anyway? He didn't give me the reason why and I didn't think to ask. I'll let you know on Tuesday if I need the one I've had a negative result on retesting x

Hi, so ive had it confirmed now by two gynecologists that the APS tests unfortunately need to be done 3 months after pregnancy to ensure they are interpretable. Other than that the private gynecologist said parental kareotyping could be done but that will be like a 1000 for both myself and partner. Tbh i think that considering that statistics are still relatively good after two miscarriages, ie more chance of sucessful than not, im gonna go with drs tests for now, and they are going to see if they can get a detailed ultrasound done via mhs, if not i may opt to got private for that. Other than that if im not pregnant by march I'll get the APS test done and possibly other thrombolia tests done as they seem the most important. I feel like if i start testing all the more obscure reasons for recurrant miscarriage before even knowing if i am a recurrant miscarriager might not be in my best interests and might cause extra stress, does that make sense?? Reagan doesn't believe in the progesterone however her book from 2018 doesnt have the newest info available, and ive got some hope for it. How are you guys feeling? Im now two weeks post second miscarraige and still getting mu head around it emotionally. Plus a goos friend decided it was a good idea to tell me she was 9 weeks oregn, just after i told her i had my second miscarru... Not very smooth!!

Hi @Skattycatty123 that makes total sense. It's important for us to remember that after two miscarriages, it's still more likely to be a sporadic rather than recurrent cause, and we are still much more likely to have a successful pregnancy next time than not.

I think in Regan's book it said that underlying chromosomal issues with the parents (which would be tested in your parental karyotyping tests) are very rare so it almost certainly doesn't make sense to test for that now.

I am thinking the same as you - I don't want to stop TTC, but I would like to get the blood tests done in the meantime, to test for any clotting or autoimmune issues that could easily be treated if needs be.

And though the experts don't agree on Progesterone supplements, they certainly agreed that they don't hurt.

Pregnancy announcements are very hard to hear at this stage, I completely agree. I'm using lockdown to be able to get some much needed space from the wider world!

Hi guys, just wanted to give you an update as I've had the 2nd consultation today.

So the Factor V Leiden that has been identified in my blood would have been there from birth and you either have it or you don't, so this isn't one of the ones that you need to be retested for post miscarriage. If I'd tested positive for any of the other things I would need to be retested, so I think this is probably what the gynecologists is referring to?

He's advised that when I get my next BFP (fingers crossed) I contact him and he will prescribe me heparin and progesterone pessaries, and I'll take aspirin. Then I will just book in for a midwife appointment at the 8 week mark, and they will decide if I get any additional monitoring (he thinks I will be put down the consultant route with having 2 MCs and this blood condition). The heparin has much more positive research around it, and he said it could reduce the chances of miscarriage with someone who has my condition by half!

@Skattycatty123 2 weeks isn't long at all, and any kind of pregnancy announcement will be really difficult to take in at any stage. It's not that you're not happy for people, it's just that you're sad for you and your partner which is totally normal. I'm almost 7 weeks now, I had been doing better until I got my 1st period last weekend and all my hormones just made me really emotional.

@KB86 I asked about the CoQ10 and he said he hadn't heard of it! So no update on if that's worth taking or not, sorry :( I think I'll carry on taking it though as I can't see it doing any harm.

Hope you're both doing OK today. I have my fingers crossed one of us will have some good news to share soon x

@KB86 so great to hear you have identified something already, especially with such a clear treatment. I remember reading about that condition in Lesley Regan's book, and the Heparin treatment. Does it feel like a relief?

I have my (online) consultation at St Mary's tomorrow. Not sure what to expect - I have already filled in a giant questionnaire so assume it will be going over my history followed by telling me which tests are recommended.

I'll ask about the Ubiquinol too... looking back on the advice in In Starts with the Egg, beneficial results have only ever been seen in rats, not in humans... I think it's dubious that none of the fertility and early pregnancy consultants seem to recommend it or even know about it. Definitely does no harm but it's pretty expensive - about £50 per month at the recommended dosage of 200mg daily. I feel almost superstitious about it now though, like I can't stop, even if it is a placebo!

@KB86 so glad they found something, is it a relief? Ah yea that makes sense as the leiden factor is a mutation i think not antibodies like in APS so won't be varied pending pregnancy hormones. And sweet pea, good luck tomorrow!!! Im still on the fence as to whether to do any tests privately before a third pregnancy, i guess i could get the thrombolia onws eg factor leiden done but just not sure whether to do it before (possibly but fingers crossed not!) having a third mc. Getting the more basic test resylts back from gp tomorrow, eg coeliac or diabetes etc.

And sweet pea good luck tomo, let us know how it goes!!

On another note, Are you guys actively trying again yet? I miscarried ca 2 weeks ago or so and got a flashy smiley on CB advanced digital today. First miscarriage we concieved first cycle trying, anf second one third month trying, im worried now its gonna takr ages in between. But it seems like the consultant and the gp i spoke to said if its gone fast before it will go fast again. Thats another rhing Reagan mentions a bit, the idea of worse selection process eg easier implementation but poor quality embryos that wouldn't normally implant, have you guys read re that? Sorry for rambling post, so many thoughts 😂

Sorry for your losses OP. Sounds like you have already done alot of reading up. How old are you? Has your partner had a semen analysis yet? The HSG (using radiation) and hycosy (using ultrasound) both check for tube patency and the shape of your uterus, including things like fibroids. Its usually a standard, basic test in infertility clinics. Seems that information can be inconsistent on many things.

I've TTC 10yrs, 3 losses and had my 2nd failed IVF in Dec. I 'thought' I'd finally been referred to the recurrent MC clinic last year. After 6mths of waiting to be contacted, I found out that my referral wasnt accepted, because my 1st loss was due to TFMR (trisomy 13) and not a natural MC!!! To say I'm livid is an understatment. I actually spoke to the consultant today, after the recent IVF failure. She is sending me for the APS blood test, as noticed I've never had it done. In 10yrs, they have never done it and no consultant has ever suggested it!!!

Where are you buying your ubiquinol? I have 200mg capsules from NUYU brand from ebay which are £15 a month. I specifically asked the consultant about supplements like that and he said that if they arent prohibitively expensive, then its worth a try. I also started DH on a lycopene supplement which can apparenlty help improve sperm quality/moltility etc.

If not done so, get the ball rolling with your and get whatever tests you can get done with them. Dont forget that many major hospitals with fertility clinics, will also see private patients and do inial tests. Current restrictions might still mean along wait. Prices might be better in a hospital than say a Harley St clinic that is purely private. My IVF clinic are still seeing people now. They have 2 tiers for fee paying patients. The cheaper self funded option has a 4mth wait, due to limited numbers in their clinic. If I wanted to pay (approx) £1000 extra for cosultant led, I could basically start next week!!!

Yes it feels like a massive relief, I think just knowing I'll be doing something differently next time and reducing my risks on one complication will hopefully make me less anxious. He's basically just said good luck and I'll hopefully hear from you soon!

@Skattycatty123 we didn't try before my 1st period. Just to add another complication in I've never had chicken pox! I was put at risk twice with it during my second pregnancy (I mean thank god for social distancing at the minute, so it wasn't too much of a risk) but I freaked out, so I decided to get vacinnated for that after I had the MC. I'm due to ovulate this weekend, so this will be our first time actively trying again. Good news that you fell pregnant quickly both times. My 1st time was over a year (hense me going for fertility checks) and I actually fell pregnant that time using chlomid which they give to people who have PCOS as I was diagnosed with that. Then my 2nd pregnancy was 1st time trying! I've since been told by 2 different consultants they don't think I have PCOS as it was only ever diagnosed by a scan and it's quite difficult to diagnose properly. I don't have all of the typical symptoms so my current consultant said he didn't think it was worth me paying the money to get it checked out at the minute.

@sweetpea2000 good luck with everything today! Hopefully you get some good feedback from them and some steps for going forward.

@Eleoura I'm so so sorry for what you have been and are going through. I've been TTC for 2 years now, so I can't even imagine how it must feel after 10 years. I can't believe they said that they would see you and have now changed on it! I don't blame you for being livid. My tests and consultant fee came in at just under £500, although I'm sure I'll be getting an invoice for the phone consultation last night. £1000 seems a little expensive if you've already had the hycosy? Pleased that they are doing some tests on you now, and fingers crossed you get some answers soon.

@Eleoura I am so sorry to hear of what you've been through. I am so angry on your behalf that your referral wasn't followed through, and you didn't have the relevant tests before now. It's is all so confusing to navigate and so hard to feel the onus is on us to find our way through the maze and get the help we need. I really hope you get the care you deserve now.

My consultation yesterday was really helpful. He has recommended that I have (what he considers to be) all the relevant tests right now, regardless of whether my most recent miscarriage turns out to be chromosomally abnormal or not, since the first loss was over 8 weeks.

This is a whole range of blood tests for clotting and auto-immune factors, plus a saline ultrasound of my uterus, just to check there's no scarring after the surgical management (he doesn't expect there to be).

He also mentioned that I may have polycystic morphology, as my AFC and AMH are quite high. I was surprised by this, as I have always had regular cycles and ovulated regularly, but he emphasised that it is not the same as PCOS, but just might affect the treatment regimen he recommends. It also sounds like it will be something I take every month from ovulation, rather than waiting for a BFP.

I haven't hard the list of tests that he recommends for me yet, but from the price list and previous posts on here, I am expecting it to come in between £1-£2k.

He confirmed not to take Aspirin unless we have identified a reason to take it, as in some people in can increase the risk of MC. It annoys me that the EPU told me to take it on the basis it "can't hurt", when it can. Even within the NHS, there is so much conflicting advice.

I was going to ask about Ubiquinol, but he raised it before I did, and recommended that both my partner and I take 200mg daily. I asked him if it's true that some formulas have greater bioavailability than others, hence the difference in price range, and he said he thinks they are all the same, so it's fine to get the cheapest ones. So I am extra grateful for your recommendation @Eleoura!

@Skattycatty123, yes I remember that theory in Dr Regan's book about some women being more susceptible to miscarriage because their body has a lower threshold of viability for implantation and allows more non-viable embryos to implant. I think she calls it an "unfussy uterus"... I don't think you should assume this is you, just because you've got pregnant quite quickly both times. Lots of couples are lucky enough to get pregnancy within 1-3 months each time. But even IF it was the case, it wouldn't stop you having a healthy pregnancy as you would still get a healthy embryo to implant in time.

I felt much better for having the consultation, and having a plan. Plus I am only getting the faintest of lines on a pregnancy test already, one week after the MC, so think my body is recovering well.

Then...I had another pregnancy announcement in a Whatsapp group and it really knocked me sideways. I don't even really know them well! My partner doesn't understand at all why it affects me so much, but it really helps to know that other women on here get it. I think it's just the idea of how happy they must be, and how it's happened for them in the same space of time that we have been trying since our first loss. And the idea that we could (should!) have been announcing ours in just two weeks, but we are back in TTC limbo.

I know there are no 'whys' as to why it happens, and life isn't fair etc...but it hurts so much! In this respect I am really grateful for lockdown and the chance to cocoon away at home.

@sweetpea2000- Thanks for the update and I'm so glad you found a good consultant. The saline ultrasound you mention sounds like a hycosy. Similar to the HSG, but no radiation, as done using ultrasound. I had it done and it was fine. You will read others that had pain, but I honestly didnt. I know that test alone is £400 at my clinic.

I took 2 paracetamol beforehand, they explained the procedure throughout and it was fine. My tubes were clear though, and I know those that had blocked tubes found it uncomfortable. The worst part for me was when the liquid comes back out after they squirt it in. It trickled down over my bum (anus) and made me almost laugh out laugh as it was really tickly!!! I certainly wasnt expecting that!

I also know what you mean by the mis-information about aspirin. At my 1st IVF consultant meeting, she mentioned in passing that I 'might' need aspirin if I got pregnant. When i rang to confirm the pregnancy, I told the nurse this who apparently checked with a consultant, then advised yes, I should start taking aspirin. When I spoke to another consultant again after that MC, he almost implied that the apsirin 'might' have been an issue, and they usually dont recommend till later in pregnancy, unless I had a known clotting disorder! Genetics showed that the prengnancy had a chromonsonal issue, so that was likely the MC cause, but it made me wonder.

Best of luck and keep us updated xxx

Hi @KB86 and @sweetpea2000 how are you both?? Im pregnant again and im so incredibly anxious. Waking up several times a night to check for blood, repeating pregnancy tests (spending a fortune). Still very early days but just thought id update you guys. Im taking progesterone but nobody's prescribed Aspirin, dunno whether it would be reckless to self medicate without actually knowing i have a clotting disorder?? Some information seems to say it can actually cause more harm than good if you take it and you don't know you have a clotting disorder. Anyways hope you are both well xx

@Skattycatty123 congratulations. Sorry to hear you are so anxious but I think it’s natural and I know exactly how you feel.

My consultant said I should only take aspirin if I am diagnosed with a clotting disorders as it has been proven to increase the risk of MC in some people, and that’s also what I read in Lesley Regan’s book (although they are from the same hospital so not that surprising that they agree).

If this has been evidenced by research (he mentioned the name of the studies so they must be out there, peer reviewed and published) I don’t understand why all NHS doctors aren’t saying the same thing. Other doctors are telling people it’s fine to try it and can’t do any harm. And my EPU also told me it ‘can’t hurt’.

Could you go back to the doctor who carried out your tests and is prescribing the progesterone to ask them about this?

Sending you lots of love and support in the meantime.

Hi @Skattycatty123 congratulations, that's lovely news! How many weeks are you?

I totally understand the feeling anxious, I know I was after my first loss so I'm expecting to be even more anxious next time round. Have you read anything by Zoe Clark-Coates? She has a few books out around baby loss after being through it herself, and she has a new book out called pregnancy after loss that has good reviews. Might be worth checking out.

I'd personally be quite nervous to take aspirin without knowing, I know I considered it last time and decided againt it.

It's will be our 1st month TTC again this month. I missed 2 cervical screening appointments last year with being pregnant both times. You have to wait 3 months after a MC to have one, as you are still classed as prenatal which is just crazy :( so I thought it would be best to wait for that before we started trying again x

Hi, thanks both for replying!! Im not sure how many weeks, i havent had a period since mc in January, but i am pretty sure i ovulated much later in cycle than usual. So im guessing its extremely early on, like 4 weeks possibly, and i tested negative Wednesday and Thursday last week, only started testing positive Friday. Because gp wouldn't give me prescription until i had a positive, i wanted to make sure i caught it as early on as possible, or a chemical, because even if it is ill be referred to recurrant clinic.

It was my gp actually who prescribed progesterone, after asking gynecology for advice when id asked about it after reading info from tommys. Im booked in with a private consultant on march 3rd but very worried it will be too late by then. Gp has also referred me to gynecology as i asked but will likely take ages to get appointment. I might ask if gp can ask them re Aspirin, but i think everyone is very reluctant on prescribing it unless clear indications. Nhs wont offer early reassurance or care because of covid restrictions but will be booking early reassurance scan if i even get that far 😭. Just trying to find strategies to cope with rhe anxiety but its tough as im up all night checking for bleeding so am literally exhausted the whole time.

@KB86 ah that makes total sense, definitely good to be up to date with smears!!

Xx