Ask the gynaecology consultants at Spire Healthcare your questions on all things gynaecology - £200 voucher to be won

[LucyBMumsnet]

Gynaecology isn’t a topic that’s likely to come up in everyday conversation. However, many people are seeking answers to their gynae-related questions and finding the right time or person to ask can be a challenge. That’s why Spire Healthcare has recruited a panel of gynaecology experts who will be here to answer your questions about all things related to gynaecology.

Here’s what Spire Healthcare has to say: “Spire Healthcare is a leading independent hospital group in the United Kingdom, with 39 private hospitals and eight clinics across England, Wales and Scotland. Working in partnership with around 7,500 experienced consultants, Spire Healthcare delivered tailored, personalised care to almost 750,000 inpatients, outpatients and day case patients in 2020.

The Group’s well located and scalable hospitals have delivered successful and award-winning clinical outcomes, positioning the Group well with patients, consultants, the NHS, GPs and Private Medical Insurance providers. 90% of Spire Healthcare’s hospitals are rated ‘Good’ or ‘Outstanding’ by the CQC (or the equivalent in Scotland and Wales).”

Want to find out more about who will be answering your questions? Read about the panel of experts below:

Dr Gail Busby
Dr Gail Busby is a Consultant Gynaecologist specialising in paediatric, adolescent and adult gynaecology conditions. She qualified in Trinidad in 1996, before amassing a wealth of experience at Liverpool and London. Her clinical interests include menstrual disorders, endometriosis, laparoscopic surgery, hysteroscopy and post-menopausal problems.

Mrs Sarah Hussain
Sarah has been a consultant gynaecologist for 33 years. She has a special interest in incontinence, prolapse of vagina and uterus, heavy and painful periods and abnormal bleeding, menopause, endometriosis and fibroids.

Mr Mohamed Mabrouk
Mohamad is a Consultant Gynaecologist and adjunct professor in Gynaecology in the University of Southern Denmark. His special interests are endometriosis, advanced laparoscopic and hysteroscopic surgery and menstrual disorders. He has extensive experience in laparoscopic surgery for endometriosis and is dedicated to helping women with endometriosis have a better quality of life and improve their fertility.

Maybe you have a question about recovery after childbirth or strengthening your pelvic floor muscles? Perhaps you’d like information on the things all women should know about their health or if they should have regular gynaecology check-ups? Whether your question is about menstrual disorders, childbirth injuries or incontinence, post it on the thread below. The expert consultants from Spire Healthcare will be back in July to answer a selection of your questions.

Everyone who shares a question on this thread will be entered into a prize draw where one lucky Mumsnet user will win a £200 voucher for a store of their choice (from a list).

Thanks and good luck!
MNHQ

Insight Terms and Conditions apply

@Salt14

Just been diagnosed with a large complex cyst in my right ovary. It’s 5x3cm. I’m in the 6 week waiting period for a follow up scan. I’m experiencing extreme exhaustion, especially the first couple of days of my period. Could this possibly be linked?

Dear @Salt14, thank you for your question.

They might be related as some of the symptoms caused by complex ovarian cysts include painful periods and chronic fatigue. Best wishes with the follow up scan.

• Mohamed

@marriednotdead

Hi, I'd love some help please. I'm 55, post menopausal and have been on continuous HRT since 2013. Had a second unexplained bleed in March so was referred under 2 week pathway.

I have a history of endometriosis, my womb lining measured 8mm on scan so they attempted hysteroscopy under GA at the end of April. They couldn't open my cervix wide enough to get the scope in (angle of womb/cervix) so ended up performing biopsies using small curettage. I came round in agony, fortunately I had insisted on GA as my pain threshold is low.

Mid May, while all seemed fine, I had the follow up call with the consultant who said my biopsies were clear and so they discharged me.

8 weeks and two courses of Metronidazole for BV later, I'm STILL experiencing continuous bleeding although the infection cleared at least 4 weeks ago. I was swabbed in an STD clinic for that and they said that my cervix looked fine. The antibiotics definitely impacted the amount (I was flooding before it kicked in) and I had a break from bleeding for 2 whole days after the second course

My GP put me back on the 2 week pathway a fortnight ago as they have no other solution- I wondered if they'd nicked a polyp or something similar and that might be the issue- but apparently due to some restructuring in the department, the hospital have no idea how long before I can even have this emergency appointment.

I have even toyed with the idea of taking an extra half a patch (it's been done unsuccessfully before so not being reckless!) to see if it makes any difference. All feels rather desperate.

Hi @marriednotdead, thank you for your question.

I think it would be beneficial if you could have a hysteroscopy in order to fully assess your endometrium, in light of your recurrent postmenopausal bleeding.

Hysteroscopy and biopsy is the gold standard investigation, and while a negative biopsy is somewhat reassuring, in light of your persistent bleeding, I think it may be worth another try under general anaesthetic, perhaps using a narrower hysteroscope. I don't think that increasing your HRT would be a particularly good idea without doing this first.

• Gail

@soundsgreektome

Why would a woman of 48, with no previous history of endometriosis develop it at this age? Ovarian cysts, and adhesions between bowel and uterus diagnosed. Never really had any issues, except heavy, painful periods per children. Recently lots pain on first day of period, which prompted investigatons.

Hi @soundsgreektome, thank you for your question.

Endometriosis is a common disease, but can have a very variable presentation. Some women have apparently mild disease on ultrasound scan or laparoscopy, but can have very severe symptoms of pelvic pain, painful periods, painful sex. In other women, quite considerable disease on imaging or laparoscopy may produce minimal or no symptoms.

Many gynaecologists will have had the experience of performing a laparoscopy for an unrelated reason in a woman without symptoms (e.g. sterilisation) and finding significant endometriosis in the pelvis. So, it is quite possible that you haven't developed the endometriosis anew at age 48, but perhaps you have just passed over a threshold where it has become symptomatic.

It is also possible that if you periods have recently got heavier (as is often the case in the few years before the menopause), that the increased flow, especially if you are passing clots, may account for your painful periods. If you have had a significant change in you menstrual habit (heavier, more prolonged or more frequent periods) over the age of 45, this may warrant investigation in its own right.

• Gail

@rubyslippers

Cervical erosion - being treated for this (had a cauterisation) but doesn’t seem to have worked Been told it may have to be treated under GA - it’s been horrible to live with the effects so far so hoping the next steps would actually fix the issue - any reassurance would be appreciated Thanks

Hi @rubyslippers, thank you for your question.

A cervical ectropion (we no longer use the term erosion, as it sounds like the cervix is being worn away and is not really a good term) is a condition in which the tall spongy cells that are supposed to line the canal of the cervix descend and are present on the part of the cervix that protrudes into the top of the vagina. This part of the cervix (the ectocervix) should be covered with flat hardy cells (rather like flagstones) in order to withstand the trauma of intercourse without bleeding.

This movement of the more delicate cells is usually due to the influence of oestrogen. They are therefore common in women of reproductive age, and even more common in women who have higher oestrogen levels, e.g. puberty, pregnancy and women on combined hormonal contraception. Assuming your last smear is normal, if the cervical ectropion is causing symptoms e.g. bleeding between periods or bleeding after sex, cryocautery (freezing the cells), or cold coagulation (burning the cells) is often offered as an outpatient, without or with local anaesthetic respectively.

Sometimes the cells persist, making a repeat procedure necessary. If despite this, they persist, they can be cauterised with diathermy (burned more thoroughly) under general anaesthetic. Although this does not always resolve the problem, in the majority of cases, the cells are destroyed and replaced with the 'flagstone' cells, thereby hopefully solving the problem. I hope this helps.

• Gail

@Molehillfromamountain

What can cause a thickened uterine lining, approximately 20mm? Would this always be a cause for concern or can it be within a normal range?

Hi @Molehillfromamountain, thank you for your question.

We know that the thickness of the lining of the womb varies considerably in women of reproductive age. An endometrial thickness of 20mm may be normal, or may indicate an abnormally thickened endometrium or that there is a polyp (like a skin tag of the lining of the womb) within the cavity of the womb, which when measured together with the actual lining makes it seem thicker.

Our index of suspicion is determined by other factors, e.g. why the scan was performed (e.g. for abnormal bleeding), an increased body mass index (BMI), medications (e.g. Tamoxifen) and age over 45 years old. These would all increase our concern and would be likely to prompt further investigation. In a relatively young woman with no abnormal bleeding and no other risk factors, a repeat ultrasound scan may all that is needed, to ensure that the endometrial thickness is reduced after a period. What we do know is that in postmenopausal women, the endometrium should be thin the normal values depend on whether or not a woman is on HRT or has had any postmenopausal bleeding but should be less than 4mm in a woman who has had postmenopausal bleeding not on HRT and less than 5mm in a woman who has had postmenopausal bleeding on HRT.

• Gail

@sharond101

I am going through early menopause but cannot tolerate HRT. How important is it to replace the low estrogen in terms of protecting my heart and bones? Iam 38.

Hi @sharond101, thank you for your question.

Oestrogen is vitally important for maintaining bone, heart and general health prior to the menopause. The average age of the menopause in the UK is 51. It is recommended that women who have a significantly early menopause have oestrogen supplementation until about the age of 50.

If the uterus is still present, a progestogen also needs to be added in order to protect the endometrium (womb lining) from developing abnormalities that could lead to endometrial cancer. If premature ovarian insufficiency (early menopause) has definitely been diagnosed by blood tests, I would encourage you to maybe try differing preparations of oestrogen (e.g. tablet, patch, gel) to try to find one that suits you. If you have not had a hysterectomy, you will also need a progestogen which can be delivered via various means as well (tablet, combined patch, Mirena coil).

If you cannot tolerate HRT, another option you may choose to consider would be using the combined contraception pill, which would also give you oestrogen and protect your bones (although this may be slightly less protective than HRT). If you have inconsistent ovarian function, or need contraception, this may be a good option for you. Of course the usual contraindications to the combined pill will apply - increased body mass index (BMI), history of migraine with aura, smoker over the age of 35 etc. if you have any of these, you should not be taking combined hormonal contraception.

• Gail

@atracurious

Having had chlamydia, what are the chances it causes difficulties with fertility later on? Is there anything you can do to optimise your fertility after treatment for it?

Hi @atracurious, thank you for your question.

Chlamydia is the most frequent sexually transmitted infection, and in most cases there are no symptoms and the infection is picked up on screening. Chlamydia infection can progress to Pelvic Inflammatory Disease (PID) which the possible long-term gynaecological consequences of infertility, ectopic pregnancy, recurrent PID and chronic pelvic pain. These can result from damage of the cilia (tiny hairs within the Fallopian tubes which move the egg or embryo towards the uterus), fallopian tube blockage or closure or adhesion (scar tissue) formation among pelvic organs.

The risk of developing PID in a patient between the taking of swabs and treatment (approximately 2 weeks) is around 3%. The risk of infertility after an episode of severe PID is of the order of 16%. Repeated infections with Chlamydia probably increase the chances of development of PID with its associated long-term effects. There is nothing you can do to improve your fertility after an episode of Chlamydia apart from getting prompt treatment. The best advice is to try to prevent another infection, e.g. by using barrier contraception (condoms) and/or if you think you may be at risk, to have regular screening so that it can be picked up early and treated before it develops into PID.

• Gail

@Youngatheart00

Nabothian cysts - why do they form and can they be removed? Having issues with bleeding with smear and sometimes during sex.

Hi @Youngatheart00, thank you for your question.

Nabothian follicles are a normal part of the cervix that produce mucus. Sometimes the outlet of these follicles become blocked by skin cells or grown over by the lining cells of there cervix. They then cannot expel the mucus which then builds up to form a small cyst (or cysts) on the cervix. These are not dangerous in any way.

This is a very common, and indeed, normal phenomenon. If the cysts become enlarged or are multiple or causing issues (e.g. difficulty getting an adequate smear test), they can be drained. If you are having bleeding after a smear test or after sex, it may be that you also have a cervical ectropion, which I have spoken about above.

• Gail

@IslandLulu

I have a question re post menopausal bleeding.

If ultrasound has ruled out cancers and fibroids, what could it be please? Thanks :-)

Hi @IslandLulu, thank you for your question.

Postmenopausal bleeding can be caused by any abnormality of the female genital tract. It can be caused by vaginal lesions (e.g. polyps or trauma - for example from a vaginal ring pessary); cervical lesions (e.g. cervical polyp, abnormal cells on the cervix -so an examination and/or smear test is important if not up to date, cervical ectropion - perhaps if on HRT); endometrial (womb lining) issues (e.g. overgrowth of the lining -hyperplasia, or cancer, or more benign issues on the womb lining such as a polyp).

It may be that the lining of the womb, cervix or vagina is so thin due to lack of oestrogen that they may bleed spontaneously. The most important issue to rule out is that of a vaginal, cervical or endometrial sinister lesion by clinical examination, smear test if due or overdue, ultrasound scan and or hysteroscopy and endometrial biopsy. It is also with noting that bleeding from the urinary tract (e.g. urethra - the tube that takes urine from the bladder to the outside may appear as postmenopausal bleeding.

• Gail

@popsocks

I would like to be sterilised. I have asked for this and they keep saying no, try xyz first. I am 41, have 2 children and am in no doubt at all, I don't want anymore. Various pills have not worked out for me and I am reluctantly having an IUD fitted soon. I am willing to try this before yet again asking to be sterilised. Why won't they let me until i have tried everything else?

Hi @popsocks, thank you for your question.

At age 41 in a woman who has completed her family, I would personally have no hesitation in offering sterilisation. The caveat to this is if a laparoscopy is contraindicated or likely to be very difficult (e.g. due to significantly elevated body mass index, multiple previous abdominal surgeries, significant co-morbidities (e.g. severe heart or lung disease, uncontrolled diabetes etc)). In this instance, a more conservative technique which will provide reliable contraception while minimising risks to the patient may be preferable.

• Gail

@marmiteloversunite

I'm 51 and was thrown into menopause at 48 due to chemo for breast cancer. I haven't had any periods since chemo apart from about once a year I have one. Why would this happen?

Hi @marmiteloversunite, thank you for your question.

It may be that you are having the odd burst of ovarian activity which then triggers a period. This however is a diagnosis of exclusion, and if you have been previously confirmed as menopausal (or not had a period for a full year), it is important that you are investigated for this bleeding with a clinical examination and an ultrasound scan at the minimum. Any further actions or management would depend of the outcome of these.

• Gail

@littlecottonbud

My periods were really heavy with flooding for the first 2 to 3 days, a tampon and pad were not enough, after the birth of my 1st son, and I breastfed for 18 months , (2 years post partum) my periods are lighter, but really random, how long do you think they will return to a regular cycle, and would the debilitating flooding return.

Hi @littlecottonbud, thanks for your question.

If you've absolutely stopped breastfeeding then it usually takes around 6 months after stopping breastfeeding for your periods to become normal. However, if you're occasionally feeding this may take longer. It may be worth doing some hormonal invastigations if you are concerned.

• Sarah

@DinkyDaffodil

I am 4 years post partum from DS2, and still have leakage, and dread sneezing when out in public, I did pelvic floor exercises, and did stretching with oil of my perineum, and did not tear when I delivered 2 babies - so cannot understand why I still have leakage. Pelvic floor exercises have not helped - and I don't think it's bad enough for surgery - so what's your best advise ?

Hi @DinkyDaffodil, thanks for your question.

Your urethral sphincter may be weak hence why you are leaking. Occasionally you may have mixed incontinence, ie. some degree of urge incontinence. It might be necessary for you to have some investigations to check this out such as urodynamic investigations.

• Sarah

@HangingOver

Is week long ovulation pain on one side really no big deal? GP didn't seem concerned.

Hi @HangingOver,

Some women may have slightly longer ovulation pain, but might be worthwhile checking for endometriosis if it is affecting your normal life.

• Sarah

@languagelover96

Tips on endometriosis management wanted

Hi @languagelover96, thanks for your question.

For endometriosis management, I'd recommend a holistic approach, regular yoga exercise, meditation, the combined oral contraceptive back to back, or Mirena IUS or progesterone only pill. Avoid food rich in oestrogens.

• Sarah

@voyager50

I had PCOS years ago but since I have been on the mini pill I don't have any symptoms - if I come off it are they likely to return?

Hi @voyager50, thanks you for question.

The mini pill only acts as a contraception and may stop periods by making the endometrial lining very thin. It does not treat polycystic ovarian syndrome, hence if you have PCOS it is likely to return to pre-mini.

• Sarah

@Blooter

Does PCOS increase your risk of ovarian cancer? Other than a low GI diet and healthy lifestyle is there anything else that would help reduce symptoms e.g. natural supplements?

Hi @Blooter, thanks for your question.

PCOS is associated with endometrial cancer if oestrogen level are high and you have no periods. Inositol supplements may help.

• Sarah

@ILoveMyCaravan

At the age of 44 I had a vaginal hysterectomy which included removal of both ovaries and of course the cervix. I am now 58. I have not had a smear test since due to no longer having a cervix but I've always wondered if I should have one if cancer could be detected in the vaginal wall or in the scar tissue where the cervix was? I still receive invitations for a smear in the post but have been too embarrassed to ask if I should have one 😬

Hi @ILoveMyCaravan, thanks for your question.

Once you have had a hysterectomy you don’t need smears. If your hysterectomy was because of cervical cancer or precancerous cells then you should be invited for vault smears.

• Sarah

@StarlingsDarlings

Is there a link between endometriosis and diminished ovarian reserve (low AMH)? If so, why is this?

Hi @StarlingsDarlings, thanks for your question.

Yes, often women with endometriosis have various procedures and hence there ovarian reserve is reduced.

• Sarah

@Cotswoldmama

It's well in know that breast cancer can be hereditary can cancer of the womb also be? I got asked at a breast appointment about cancer if the ovaries but no mention of cancer if the womb which my grandmother had. Are breast cancer and cancer of ovaries related in someway?

Hi @Cotswoldmama,

Yes, ovarian, breast and endometrial cancer form a triad and there is an increased possibility of having cancers.

• Sarah

@Tenohfour

My menstrual cycle has been irregular for a year (used to have a regular 30 day cycle now ranging from 35 to 45 days). My doctor doesn't seem concerned and my smear test was normal. I am 37. Is this normal, and could it be a result of having the copper IUD?

Hi @Tenohfour, thanks for your question.

Infrequent periods are likely to be related to hormonal changes which may be related polycystic ovarian syndrome perimenopausal. As you are only 37 it is more likely to be related to polycystic ovaries. This won't be related to the copper IUD.

• Sarah

@Bitofachinwag

Is it really ok to leave the Mirena coil in for the rest of your life (when you are too old to need it for contraception)?

Hi @Bitofachinwag, thanks for your question.

It is a foreign body and therefore is usually advised to remove. However, I can't see why it would cause any problems, especially as it has been in situ for so many years and not been of any trouble.

• Sarah

Thank you all for your questions. We hope that our answers have helped you. If you'd be interested in finding out more about Spire Healthcare , you can click here.

• Mohamed, Sarah and Gail

Thank you for answering my question and for the information provided to the other posters on here, I really appreciate it. Thank you MN too for inviting the team.

Thanks to everyone who posted a question for the consultants at Spire Healthcare to answer. The winner of the prize draw is @Tuberoses - congratulations