Q&A on women’s health with BMI Healthcare - ANSWERS BACK

[HeatherMumsnet]

Were running a Q&A on Womens Health with BMI Healthcare who are offering you the opportunity to ask questions to a panel of specialist Womens Health consultants.

The experts include Consultant Gynaecologists Robert MacDermott, Alvan Priddy, Faz Pakarian, Tom Farrell, Sangeeta Das, Gabrielle Downey; Consultant Gynaecologist & Obstetrician, Parjit Bhattacharjee and Consultant Obstetrician and Gynaecologist, Ami Shukla. Post your questions to BMI Healthcare before midnight on 16 October and well upload their expert answers to this thread on 24 October.

BMI Healthcare recently ran a Mumsnet survey and found that 93% of Mumsnetters have had at least one gynaecology problem, ranging from problem periods to difficulty conceiving and 64% have experienced at least one issue in the last 12 months alone. So whether its heavy periods, a niggling pain or menopausal symptoms, we could help shed light on some of your personal issues.

This Q&A is sponsored by BMI Healthcare

[BMIExperts]

@FeatherFeather11

Hello,

I'm 34 and my partner is 39. We've been trying to conceive since September 2011 to no avail. In 2007, I had my right Fallopian tube removed as emergency surgery - it had twisted on itself several times but it wasn't and ectopic. Last December, After lots of tests, both me and him, all came back fine (great sperm count, great egg reserves) except for the fact that I was diagnosed with pcos. I have very irregular periods (ranging from 8 day cycles to 54 days in the last year) I was on clomid from February this year for five months - first month 50mg, then on to 100mg. I ovulated twice in that time (using a trigger shot). Have taken a break from clomid and just went back on last week at 150mgs. My grist scan is on Friday to see if I've responded.

My question is: is it worth giving iui or injectibles a try before moving on to IVF? Or is the one Fallopian tube/pcos a straight sentence to the IVF cave? Really would like to try all other options before doing IVF as it just feels so invasive.

Also, is there any point in requesting I be put on metformin or femara?

Many thanks!
Feather

Mr Priddy responds:

There appears to be 2 problems making it difficult for you to conceive, you have 1 tube and have PCOS with irregular cycles such that you are not ovulating. Despite using clomid treatment for 5 months it appears you only ovulated in 2 months.

I agree with you that IVF should be a last resort.

You have not mentioned the option of laparoscopic ovarian drilling/diathermy, which is the most appropriate treatment at this time. It would be of benefit to you as it would check whether your remaining left tube is open/patent. Also it will treat your PCO and has an 80% chance of making you ovulate consistently (without clomid).

If you are ovulating regularly and your tube is open, you have a much better chance of conceiving naturally.

In addition it is unusual to have a spontaneous twisted tube, as you had on the right. The laparoscopy will also carefully check the left tube and look to see if it is normal or if you have a left para-fimbrial cyst which could make it more likely for the tube to twist (and the cyst can be treated). A hysteroscopy can be done at the same time to check the uterine cavity is healthy for embryo implantation.

I would not recommend IUI (as you only have 1 tube). Also FSH injections have potential side effects (including ovarian hyperstimulation syndrome and multiple pregnancy), are expensive and require regular ultrasound scan monitoring, so I would instead recommend laparoscopic ovarian drilling.

Patients who have only 1 tube such as after an ectopic, and are ovulating, can still conceive. Therefore I would recommend you try for 6-12 months after the laparoscopic ovarian drilling, before considering IVF.

If you are ovulating on clomid alone or in future with laparoscopic ovarian drilling, there is no need to take metformin/femara as well. However if the clomid at a dose of 150mg is not working, using metformin as well as clomid, has been shown to be more helpful in causing ovulation.

I wish you every success.

[BMIExperts]

@mtpg

On 9th Aug I was 6+2 pregnant. According to my Gynaecologist the pregnancy was healthy, strong heartbeat. On 2nd Sept I started spotting dark brown, on 4th Sept became bright red,we went to A&E, where no scan was available because was evening and the blood test showed failed pregnancy(Progesterone low) , on 6th Sep started cramping and bleeding heavily, we went back to A&E where the miscarriage was confirmed and I was advised to wait for the bleeding to stop naturally, 2 weeks later on 20th Sept the heavy bleeding started again, went to A&E had an ERPC. Ovulated 2 weeks later. I've got Metformin 2x500 mg per day from GP, due to PCOs.
Questions:
When should we try for baby again?
Would Using Natural Progesterone Cream help to keep the baby?

Miss Das responds:

There is no ideal duration of time to wait before you can try for a pregnancy again. However, it is recommended that you wait until your normal period commences. This helps to date the duration of the new pregnancy more precisely and also ensures that any remaining problems from the miscarriage are fully resolved.

There is no strong evidence to support the use of natural progesterone in a naturally conceived pregnancy. The ongoing international trial aims to answer this question.

[BMIExperts]

@AHardDaysWrite

I had a second degree tear after the birth of my first child, which was stitched and seemed to heal without problems. However I found intercourse impossible afterwards as it was so painful. I was referred to a gynaecologist who said I had a lot of scar tissue and my vaginal entrance was narrower than normal as a result of the stitching. He performed a Fenton's procedure under GA which did solve the problem and I was able to conceive again. We could not have intercourse throughout my pregnancy as I found it painful as a result of swollen/engorged labia (a side effect I had in my first pregnancy so not connected to the Fenton's). I gave birth by elcs, partly to avoid further perineal trauma, partly because my first birth was a shoulder dystocia and I didn't want to risk this again. I wasn't therefore expecting any problems with intercourse post-birth but it's very painful once again. Is there a possibility that the long period of no intercourse whilst I was pregnant has allowed some scar tissue to come back? Is it likely that I will need another Fenton's procedure?

Miss Das responds:

No. New scar tissue does not form due to prolonged period of not having sexual intercourse. The pain could be due to generally low levels of estrogen soon after childbirth which cause thinning and dryness of vaginal tissue.

Consultation with GP or Gynaecologist is recommended for full and proper management.

[BMIExperts]

@Fragpole

I have recently been diagnosed with Adenomyosis but do not really know anything about this condition. I have severe back pain and pelvic pain at various points in my cycle and would be interested in hearing advice on what pain relief is most suitable. Currently the only thing that relieves the discomfort is a hot water bottle on my lower back which is fine at home but not at work.
I am under 40, work full time, have completed my family and would appreciate any advice to help me cope day to day with this discomfort.
Many Thanks

Mr MacDermott responds:

Adenomyosis is a form of endometriosis in which the lining of the uterus is found growing within the outer muscle coat of the uterus. The lining responds to changing hormone levels and women typically have pain before and during their periods. They may also find intercourse painful. The diagnosis can be based either on symptoms, a pelvic examination or imaging such as ultrasound or MRI.

If symptoms are mild then simple analgesia may be sufficient. Women with more severe symptoms could consider hormonal or surgical treatment.

Progesterone is a hormone that can be given either as a tablet or, more commonly these days, as the Mirena coil. This is a contraceptive coil that releases progesterone slowly to the womb over 5 years. When given continuously, progesterone causes the adenomyosis tissue to shrink.

GnRH analogues are drugs that work by inducing a temporary menopause. They can be very effective but are usually only given for 6 months as longer usage can cause osteoporosis. Advice should be sought from your GP.

Laparoscopy is a keyhole operation that can be used to look for endometriosis elsewhere within the pelvis. If present, this can be treated and may reduce pain. This may be the best option for women who are trying to conceive.

The adenomyosis tissue can only be removed surgically by performing a hysterectomy and this may be an option as your family is complete. The risks of surgery would need to be considered on an individual basis but, with keyhole hysterectomy now commonplace, it could be the right treatment for you.

[BMIExperts]

@ZippityDoodahday

My periods are very heavy & uncomfortable & I get severe mood swings leading up to my period. I BF so don't want to use hormonal contraception. What (if anything) can I do/take to make my flow lighter & improve my mood?

Mr Farrell responds:

The Mirena coil would be the best option to try. Whilst the Mirena coil contains a very small amount of progesterone hormone, it is available to use when breastfeeding and has a proven beneficial effect on the heaviness and duration of your period, and some women say improves the associated PMS. You would also receive contraception with the Mirena.

Treating PMS without the use of hormones is difficult. Simple changes to diet and lifestyle, reducing alcohol and caffeine intake and cutting down cigarettes may all have a beneficial effect on the mood swings. Vitamin B6 (pyridoxine) has been shown to help with mood swings but will not affect your menstrual flow. Tranexamic acid and non-steroids anti-inflammatory drugs will help with menstrual flow, especially if your cycle is regular, however they are unlikely to have any impact on the mood swings.

I would suggest you consider the Mirena coil in the first instance.

[BMIExperts]

@blamber

How long does it take normally to get regular cycles back after being on the pill for about 15 years, and when is it time to start thinking there are underlying problems?

I stopped the pill in April, and I had my first ovulation in August (I used ovulation sticks and taking my temperature). After this, I got my period only a week later. In the next cycle, ovulation was again late with my period following a week later. After this period, it took four weeks to ovulate and I'm now wondering when my period will be. So I have been having problems with delayed ovulation and a short luteal phase and I'm worried there might be hormonal issues, but my GP says it's normal after the pill. I cannot remember what my cycles were like before the pill.

Thank you!

Miss Shukla responds:

It can take up to 12 months after being on pill for long period of time. Initially your ovulation can be irregular. Usually if your problem does not settle after six months from stopping the pill you can have hormonal profile. Especially if you are planning for a pregnancy you may want to start primary investigation. If you are not, you may want to wait for a little bit longer. Actual decision is taken depending on your intention regarding your fertility, presence of any other problems like heavy or irregular cycle etc. It will be worth talking to your GP about it.

[BMIExperts]

@Spottybra

I'm too embarrassed, I can't believe I've just deleted my question in an anonymous forum.

Big breath;

If we use anything prior to having sex, for example a massage oil or lubricant (i give dh lots of massages for pulled muscles which leads to sex) I end up with thrush. The sex shop we go to have sold so many different lubes to us they are starting to stock new lines. Seriously. It only started about 20months ago. A thrush cream containing nystatin from the Gu clinic works but I just want it all to stop now. I wasn't like this before.

I have changed contraception to no avail. I don't use or do anything different from when I was normal.

I just want my sex life back without thrush. How can I do this?

Miss Downey responds:

The first thing I would advise is to be certain your symptoms are as a result of thrush (a yeast infection) by having swabs done. There are two main types of thrush, the most common of which is easily cured with conventional treatment. The less common type needs prolonged treatment of between 4-12 weeks.

Your partner may also need to be treated, thus I would advise you both go to the doctor the next time you have an attack.

The oral contraceptive pill can increase your chances of having persistent thrush in some women. A visit to your GP to chat things through would be helpful.

If the symptoms are not as a result of thrush, then you may have an allergy to things like condoms or the lubricants you use. It would therefore be advisable to change the type of condoms used to latex free and read the contents of the lubricants carefully or avoid them all together. Your GP will advise which creams to use rather than the sex shop as they are more knowledgeable about causes and potential cures or your local GU clinic.

[BMIExperts]

@buttermellow

I have had a long, long history of gynae problems (since birth really) I have,

• horribly sore/heavy periods that have seen me admitted to hospital (I end up throwing up - at worst 8 times a day, feverish, hallucinations, diarrhea, sweating, insomnia, fainting), deep pelvic pain that feels almost as there's a weight pulling my cervix down..

• vulval/vaginal abnormalities including congenital severe hypertrophy (that's been corrected to some extent through surgery), cysts/over production of skin oils, excema, dermatitis, vaginal pain/dryness/tightness

• breast tenderness/lumpiness

• excess facial hair/hair on back, bottom, tummy

• put on weight too easily

• acne at age 22, greasy hair, oily skin

• complete intolerance of combined/mini pill and northisterone

I have been told there's most likely some hormonal cause, although all ultrasound scans of ovaries have come back normal so no PCOS apparently. GP/consultant think I might have endo or fibroids, am having a scan soon again to see if there's any changes in uterus/ovaries. Have regular blood tests to check hormones and they always come back entirely normal.

I did ask if an MRI/CT would help but GP said it wouldn't make much difference?

I've ended up with vaginismus and sexual dysfunction type issues (essentially, I can't have sex) after years of issues, and being sent for sex therapy with consultant soon, possibly getting dilator therapy.

I'm having the mirena coil fitted under epidural in 3 weeks, having a transvaginal scan and a pelvic exam at the same time.

I'm just getting fed up of everything being wrong there, have had well over 60 examinations (usually once a month or so), and have completely disconnected from down below. I don't see it as mine, if that makes sense. Apparently this sex therapy and mirena will help - but at the same time, I've somehow got to accept the fact that I'm still going to be having regular examinations, to check my coil as obviously due to this vaginismus it'll be a long time before I can comfortably check.

I am half wondering if there's a condition that could be at the heart of all this, that's maybe not been picked up on yet - or is it just the case of lots of different conditions? I know you'd be very very limited in terms of offering a diagnosis online which is not what I'm expecting, but if you could maybe suggest what might be the cause of everything?

Should say I do get fantastic care from my local gynae team and GP - both are wonderfully helpful - but be glad to have a second opinion.

Thanks in advance.

Miss Downey responds:

I am sorry to hear about your complex gynaecological problems. As there are a few issues I will deal with each separately.

To have Polycystic ovarian syndrome you need 2 out of 3 things:

1. Excess testosterone (measured by a blood test with a protein called SHBG)
2. Lack of periods
3. Polycystic ovaries on scan

Thus you can have the condition but normal looking ovaries. I think you would benefit from having these tests are there are lots of treatments that can help. For excess spots, hair etc there are two drugs that are useful: Cyproterone Acetate and Metformin. A specialist gynaecologist will be able to help you.

If you have not yet had a laparoscopy (look inside your tummy with a telescope) then that would be very useful to look for the various causes of pelvic pain and painful periods such as endometrioisis.

Finally, vaginismus can be treated with botox. It will help with the muscle spasm. If there is another cause of your painful intercourse a specialist in vulval disease may help.

Given your very complex problems this advice is aimed at sending you in the right direction and I hope you get all the help you need.

[BMIExperts]

@sharond101

I have low oestrogen levels. I am 31. Other than poor fertility does this have any other affects on my health?

Mr MacDermott responds:

There are several causes of a low oestrogen level at your age. However, the first thing to clarify is the accuracy of the diagnosis as blood tests typically only measure the level of one hormone, oestradiol.

There are a number of other important oestrogens in the body and in order to confirm the diagnosis, I would expect your periods to be absent and the lining of your uterus to be thin on ultrasound.

Causes of a low oestrogen level include a low body weight, fluctuations in weight, exercise-induced, early menopause and a benign tumour of the pituitary. It is important to see a doctor to try to get a diagnosis as the treatments and outlook differ.

Regardless of the cause, the health consequences of low oestrogen levels are similar – women can experience a range of symptoms that commonly occur at the menopause. These include hot flushes, mood changes, dry skin, low libido, urinary incontinence, vaginal dryness and pain during sex.

A more serious consequence is osteoporosis (thinning of the bones) and it is very important for you to receive treatment if your low oestrogen levels persist for more than a year or two. At the age of 31 women are normally offered a choice between taking the standard contraceptive pill or hormone replacement therapy (HRT).

[BMIExperts]

@TEErickOrTEEreat

Although I have some of the symptoms of peri-menopause, including hot flashes, night sweats and an irregular cycle, my hormones all read at normal levels when tested.

Is there something else that could be causing these symptoms at my age (44) and is there anything that can be done other than HRT? (I get migraines when additional hormones are added to my body.)

Miss Shukla responds:

You can have perimenopausal symptoms much before the actual hormone levels go up. These symptoms can be there for as long as 10 years before your actual menopause. There are certain medicines that can give similar symptoms. Very rarely there are other conditions that can cause these symptoms.

If you don’t wish to use hormones, you can try other medicines to control hot flushes. Though, your GP must ensure that you are not on any other drugs or there is no other contraindication for you to take these medicines.

[BMIExperts]

@saltedcaramelplease

I suffer from acne, have excessive body hair and am not overweight but not slim. My acne was always worse around the time of my period where I would get deep, painful spots on my chin.

I have started suffering from migraines 5 years ago if I had too much chocolate/caffeine. The migraines gradually worsened to the point where I couldn't eat have anything with chocolate or even fizzy drinks. I would get migraines with aurora and feel incredibly nauseous.

In January 2013 My periods stopped. I went to a gyno and they did multiple tests every few months (hormone checks, blood tests and ultra sounds) but they never found anything in the results. In December 2013, they said the only possible thing was that the lining looked thin so I probably wouldn't be having a period soon and that my ovaries look slightly fibrous but definitely NOT poly-cystic.

My gyno was convinced my lack of menstruation was something to do with stress/emotional since there were no physical problems or symptoms. This was definitely not the case.

After a year of no periods they gave me hormone pills to 'force' a period.
During that time, I got I also got a migraine. I hadn't had a migraine is over a year because I was avoiding my trigger but I wondered if the migraines were affected by hormones. I knew of birth control pills helping/worsening headaches.

After I finished the pills I did a test and ate bunch of chocolate over a few weeks (some days more than others). I started drinking coffee again too and never had a headache yet alone a migraine.

When I went to see my gyno I mentioned the possible link as it was the only symptom I had ever really had for my lack of periods other than having less breakouts.

He said there was no connection and the only 3 things that were the cause were stress, excessive exercise and a physical problem.

I continued enjoying coffee and caffeine and my periods came back after almost 1.5 years without a natural period. My skin also got worse (though I haven't had any painful spots yet) I don't think this is coincidence.

Am I correct in thinking that the two are related or is it a weird coincidence? Are there any other foods that "balance" hormones? I thought maybe my hormone levels had always been off and when my periods stopped they were 'normal' (which the blood test revealed. I'm worried that my migraines will return again.

Mr MacDermott responds:

The combination of acne and excess body hair suggests the presence of elevated levels of testosterone due to Polycystic Ovary Syndrome (PCOS). This condition is more common in women who are overweight and usually results in infrequent or absent periods.

In your case, PCOS was excluded and the lining of your uterus was thin – which means that your oestrogen levels were low. This situation is commonly seen in women who are underweight, have lost a lot of weight or perform a lot of exercise. However, sometimes there is no clear explanation and this appears to be the case with you. It is a difficult condition to treat and so I am pleased that the situation has corrected itself.

Although your hormone levels have been “normal”, there are limitations to laboratory tests and the true test of normality is whether your periods come regularly or not. I am therefore not surprised that you have started to see some of your old cyclical symptoms. I am afraid it is not possible to predict whether your migraines will recur but the triggers for these can change over time and you may be lucky.

[BMIExperts]

@ILoveAFullFridge

I started peri-menopause at 41, found the symptoms unbearable, and within 2y was on HRT. Mirena plus Evorel 50 made a wonderful difference, but after 2-3y the symptoms returned. Also, I began to be sensitive to the glue. My GP switched me to Sandrena 1.0, which was OK - reduced the symptoms, but more side-effects and more mini-bleeding. A year later, the meno-symptoms began again. GP upped me to Sandrena 1.5, which helped for a while, but again the symptoms ate creeping back.

Please tell me: what's going on? What can I do about it? Is there an HRT regime that will properly help me? I cannot cope with the meno symptoms!

Also, I have developed a painful tongue. It feels like I have burned my tongue (I haven't), the tip is red, and I often have sore 'pimples' on it. I know that a scalded feeling in the mouth can be associated with menopause, but is the rest, too?

Miss Shukla responds:

You can try using HRT with 2 mg of Estrogen. If you don’t want to use hormones, you can use non-hormonal preparations like selective serotonin uptake inhibitors.

For your tongue problems certainly you should see your doctor to establish the cause.

[HeatherMumsnet]

The experts' answers have now been posted. Thanks to everyone who participated.

[eurochick]

I think Mr Priddy needs to go back to med school if he thinks everyone has a 14 day luteal phase...

[ILoveAFullFridge]

Have I just been told to take Prozac for menopause symptoms?

[buttermellow]

B-b-botox?? (splutters).. oh my God, the thought of having a botox injection down there.. if it helps though..

Not sure if you'll see my reply but thank you very much Miss Downey for the advice .. if I could go to Birmingham and make an appointment to see you I would!!

[Fragpole]

Thank you Mr MacDermott for your overview of Adenomyosis I appreciate it after finding it difficult to locate information about the condition. This Q and A has been very timely and I feel much better prepared for the next appointment with my gynaecologist. I am still not sure how I feel about a hysterectomy but now I have time to do some research and think about it before I need to decide.
Great Q and A HeatherMumsnet, thank you.

[Boodle9]

I know the professionals don't recommend temping and ovulation sticks, but my clear blue fertility monitor, basal body temps, cramps and cervical fluid all indicated ovulation around day 15-16. When my period follows no later than cycle day 24, there is surely a luteal phase issue. I appreciate the response but the more I read elsewhere, the more I think this idea of a 14 day luteal phase no matter what, is unrealistic. Incidentally, my GP did a progesterone test at cd17 and it was very low and didn't indicate ovulation at day 10. I suppose I should have mentioned this in my original question. You live, you learn...

[HeatherMumsnet]

You can now read the archived Q&A here: www.mumsnet.com/qanda/problems-conceiving-and-gynaecological-issues-bmi-qanda

[dee1969]

Hi Im 44, I have partial epilepsy I don't have fits I just used to have slight spells of vagueness. I am on 3 x 300mg of epilim daily. Since being prescribed the medication I have other symptoms that I never had before, my concentration is shot to pieces at times, if im doing something I automatically block anything else out including if someone is talking to me. I have put on loads of weight because I binge eat, my monthly cycle is completely up the wall. My last period was three and a half weeks, three weeks very heavy( a Pack of sanitary towels per day), that is getting more and more common that I am on for that length of time. Im b12 deficient and have to have injections for this as well so sometimes I can barely get up in the morning. My doctor is pretty useless when I went for my 6 months check up I spent an hour walking to the doctors as I cant drive for a year and public transport is rubbish here. to be asked when did I have my last fit doh I don't have fits all he had to do was look at my records and what contraception was I on. I was sterilized ten years ago... My consultant just dismisses me all I get is the yes hmm yes conversation. Ive only seen him once since I was diagnosed.. When I was first diagnosed I was told by the doctors receptionist to come and get epilepsy medication, I didn't even know that was what was wrong with me, he didn't even know how often I had to take the medication. I asked him if I should google how often and my gp said yes that would be a good idea. I just want to be normal again

[dee1969]

forgot to add I was also prescribed Tranexamic acid but that has done nothing I have been on it for the past five months