Have you struggled to access gynae health support? Ask Consultant Gynaecologist, Dr Sujata Gupta, for advice - £200 voucher to be won

[GraceEMumsnet]

Created for Circle Health Group

Do you find it difficult to talk about gynae health with your GP? Have you had trouble accessing the right diagnosis or referral? Circle Consultant Gynaecologist Dr Sujata Gupta will be on hand to offer advice on how best to talk to your GP.

• Everyone who shares a question on the thread below will be entered into a prize draw.
  
• One lucky user will win a £200 voucher provided by Mumsnet.
  
• Sujata Gupta will be back online to answer a selection of your questions.
  

About Consultant Gynaecologist Dr Sujata Gupta:
“As an expert in the medical and surgical treatment of complex endometriosis, Dr Gupta is committed to helping women feel seen and heard in their treatment journey for chronic gynaecological issues. She has more than 15 years of experience in gynaecology, commonly performing hysterectomies and myomectomies to treat a broad range of women’s health problems. With a key focus on endometriosis, menopause, gynae cancers, and painful periods, Dr Gupta’s work is centred around helping women access the right information and treatment they need to manage and even overcome their gynaecological problems.”

Here’s what Circle Health Group has to say:
“Millions of women in the UK struggle with the effects of a gynaecological condition, yet they often go undiagnosed for years. Many struggle to access the right information, or feel embarrassment, which prevents them from asking their doctor the appropriate questions and getting diagnosed sooner.
We want to empower women to understand their health better and overcome the stigma surrounding women’s health by sharing more information on gynaecology, including how best to reach a diagnosis and treatment.”

Thanks and good luck with the prize draw!

MNHQ

Mumsnet Insight T&Cs apply

[LarkspurLane]

How is it best to go about getting testosterone added to your HRT routine?

[BooksAndCarrotCakes]

@Grosscostsagreed have you mentioned Vulvodynia to them? Vestibule Redness, Inflammation, Pain…..particularly longer than 3 months. Those my exact symptoms. Burning, pieces of glass, fire - how I would also describe it. Amitriptyline? Appreciate I could be totally off kilter here and may be something else.

[tropicalsound]

Until about 5 years ago, my periods were always infrequent but when i did get them they were a normal heaviness (1-2 heavy days at the beginning and then tapered off) and lasted about a week.

Then in 2017, during a really stressful time in my life, i started getting extremely light but almost constant bleeding. Since then, i haven't had a normal period but just these bouts of light bleeding lasting sometimes 6-8 weeks, sometimes just a few days, and sometimes with a long time in between them and sometimes just a few days in between. They also never had the same symptoms as my previous periods, just the bleeding, and i also no longer get any ovulation symptoms. Prior to having my first covid vaccine, i hadn't had any bleeding at all for about a year but it started again very quickly after having the vaccine.

I had to be very persistent with the GP to get a referral, and eventually only did because i told them I'd been trying for a baby for over a year and got referred to a fertility clinic. I had a few tests done including a calposcopy and ultrasounds, they didn't find any cysts but said it was "probably" pcos due to other symptoms i have.

I had one more appointment where they tested my partner's sperm and found it to have very low motility. The doctor didnt ask me any questions and just told me to lose weight. They put me on metformin but i had to stop taking it due to the side effects. I was supposed to have another appointment after this but i had to cancel it due to covid and haven't heard anything from them since.

My question is what could this persistent bleeding be caused by, it's not a normal symptom of pcos as far as I've read? Could it be early menopause or something else?

[Grosscostsagreed]

@BooksAndCarrotCakes my understanding is that vulvodynia is a diagnosis of painful vulva.....yes I do have that but that is an explanation of symptoms and something is causing the symptoms. I am taking amitripyline but that is only treating symptoms rather than cause. I am currently trying vaginal probiotics to try and replenish the lactobacilli, but this is all from my own research rather than any guidance from medical professionals.

[567and]

I had 8 months of awfully heavy and frequent bleeding. Spoke to a private GP as couldn’t get through to my NHS GP. They said possibly peri-menopause I needed blood tests from NHS GP, so when I finally got a (phone) appointment , the blood tests were ordered, but the only treatment/advice given was either the coil or POP. I wasn’t keen on the coil, so tried the mini pill, which I had to stop after 10 months as the side effects were not worth it. No other investigations to the heavy bleeding (I was bleeding through my clothes and was having a bleed for a week, stop for a week, then back in for a week), no face to face appointment, where the GP would have seen just how pale and worn down I was. The lack of care and time to help women is just unjustifiable. How is this being addressed, or are we just meant to put up and shut up?

[EuropeRoadtrip]

Please may you help me with this Dr Gupta?

I have experienced four years of secondary unexplained infertility. I used to have pain free periods, I have one child conceived 9 years ago who was conceived in the first month of trying.

We had an IVF cycle last year which ended in a miscarriage and another IVF cycle this year which produced one embryo which we froze. Both times we produced one blastocyst from the cycle.

My question is I have zero answers for the cause of our infertility. IVF doctors just say regardless of the cause IVF is the treatment.

I experience debilitating pain before my periods. It used to be 3 days before but it is now 6 days before. The only thing that helps is a massager placed on my lower abdomen constantly and a hot water bottle. I can’t help but think this is linked to my infertility. Scans have show mild diffuse adenomyosis but nothing else. Please can you tell me what you would suggest as a treatment for the pain, it interferes with my life on a monthly basis and I would love to find a solution to both my infertility and the pain.

Thank you.

[TaraRhu]

I'm pretty sure I have a prolapse after the birth of my 2 kids. There's a bulge on the back wall that prevents me using tampons anymore (they just fall out). It's not causing me any other issues. I saw the gp who thinks I do have a some sort of prolapse and reffferes me to gynocology. That was six months ago and I've recently been told it will be at least October until I get seen.

Is there anything I should do or avoid in the mean time? Also if the prolapse isn't that bad will they actually do anything? How is it assessed?

[puffylovett]

I’ve been waiting for a gynae appointment for over a year now (northwest). Referred for thickened lining and heavy periods, possible polyp.
my main question is - is it normal to experience spots and swelling down below just before a period?. They can be various sizes, sometimes a little like an ulcer and painful, and always signal imminent menstruation. I also feel very fluey for a day or two beforehand.
thank you.

[Coldscorpio]

I have ectropion. This has been reoccurring for the last twenty years - I am now 42. I have read ectropion can be caused by hormones, I have a Levette Coil - do you think this could be linked?

My latest GP appointment, he said he would contact gynie for advice but it may be ‘something I have to live with’.

This seems particularly awful to me, I am newly divorced and seeing someone new, every time we have sex I bleed. It’s knocking my confidence and putting me off being intimate.

I have other gynaecology issues, for example I have long periods whereby I was lucky to have a week each month without bleeding. I tried the mini pill and am now on the coil, I have bled continuously since January.

I feel no one is really listening. I asked for a hysterectomy and was told this is unlikely, you need to try all options first including the coil for at least a year.

[GraceEMumsnet]

Congratulations to the winner of the prize draw, @nowtygaffer !

[notaflyingmonkey]

@GraceEMumsnet is there a timeline for when we can expect any answers, please?

[GraceEMumsnet]

Hi @notaflyingmonkey , Dr Gupta will be sharing answers to a selection of your questions next week. Thanks!

[Unicornspirit]

Hi, how easily is adenomyosis missed on an ultrasound? Is it true that very often it can only be diagnosed after a hysterectomy?

[DrGupta]

@Lovelydovey

How do you get a GP to take heavy periods seriously? He doesn’t get how debilitating they are and simply insists on treating the consequential anaemia. Would a specialise help understand and treat the underlying cause of the heavy periods? Is it worth insisting on that?

Hi @Lovelydovey If you are reporting heavy periods to your GP, then any doctor needs to take your word for it. You don’t need to have any special tests or investigations in order to come to a diagnosis. So, in simple words, if a patient reports heavy periods which are affecting her quality of life, then a medical
practitioner is supposed to take it seriously.

So my advice would be, when you mention heavy periods it would be helpful to also describe how it affects your overall quality of life, for example do you need to use double protection such as tampon and pad at the same time? does this stop you from doing your everyday activities? does it stop you from going to school, college or work? or looking after your children? does it stop you from
socialising? And also, do you feel light headed or tired? This could be sign of underlying anaemia.

[DrGupta]

@ToastofLandon

I have 2 questions!

• Why are vaginal swab tests so limited to investigate gyne issues?
• Doctors never heard of some of the yeasts and bacterial infections that can be so debilitating for women? (E.g. ALL yeast strains, ureplasma and mycoplasma). How do we change this?

I’ve been backwards and forwards to my GP since September last year. Countless examinations and swabs, 2 lots of blood tests for diabetes, check hormones etc, plus a sexual health screening. Only when I paid privately for a vaginal microbiome test did I find out that my symptoms were caused by a Candida Glabrata yeast infection, which causes 10%-15% of yeast infections.

I’ve now been referred to a specialist for treatment which will take months. It’s frustrating because all the visits to my GP for tests could have been avoided if the testing was fit for purpose, and if GPs were more knowledgeable about gyne conditions.

Hi @ToastofLandon Vaginal swabs have traditionally been used to look for certain types of infections and they still are used for this; hence we would only use vaginal swabs if we were looking for evidence of any vaginal or genital infection. They don’t give us any further information about any other gynaecological problems.

[DrGupta]

@GodspeedJune

The opening post mentions women not accessing treatment due to embarrassment and stigma. I repeatedly reported endometriosis symptoms to various GPs and hospital consultants over a 15 year period before finally being diagnosed. I had many warning signs (chronic anaemia, needing prescription strength painkillers, painful sex, endometriomas seen on U/S, fatigue). Infact I was only diagnosed when it became apparent I was infertile and I have no doubt I’d still be undiagnosed if I hadn’t tried and failed to conceive.

I’d be keen to hear Dr Gupta’s view on how we tackle medical gaslighting and disbelief of women’s symptoms? The average time to diagnosis for endo is 8 years, mine took twice that despite persistently seeking help for my unmanageable symptoms. How do we change the stigma not within patients, but in the medical community, where women’s suffering and pain is not taken seriously?

Hi @GodspeedJune My advice would be to talk about how your symptoms impact on your quality of life. So if it is significant pelvic pain and if the pain is cyclic in nature, such as it comes round the time of your periods, if the pain is associated with other symptoms such as pain during sex or pain during intimate examination, sometimes pain while passing urine or opening your bowels, then all these could be symptoms of underlying endometriosis.

If your clinician is not suggesting this as a possible underlying cause then my advice would be to ask a more direct question such as ‘could this be because of endometriosis?’ and if your doctor is not able to give you a clear answer, then ask for an onward referral to a specialist.

[DrGupta]

@Willowkins

All these questions make me so sad. At least we're not getting the usual crew asking what we're complaining about because they're absolutely fine and they have no problems.

My question is about pain medication - specifically how do we make sure women get effective pain medication for (1) period pain (2) endo (3) cervical smear tests (4) anything else I haven't thought of?

Hi @Willowkins Highlight how the pain is affecting your quality of life and in most instances your GP will be able to offer you some simple pain medication.

With endometriosis, if this is impacting quality of life significantly then my advice would be a referral to a specialist.

For a cervical smear, most patients do not need a pain medication, but some patients do as they can find it extremely painful, especially if they have underlying conditions such as endometriosis, which would make any intimate examination more painful. In this case, you can request your doctor to offer you pain medication such as paracetamol or ibuprofen an hour before your smear test and this can make it less painful.

[DrGupta]

@oootapasooo

I’m currently suffering from quite a few symptoms, a change in my period cycle, dryness, increased UTIs, flushes, plus a lot of other symptoms which are all signs of peri menopause. I’m in my early 40s but I’ve heard that GPs only recognise this as an issue for over 45s. Will I be taken seriously and be given the exact help that I need if I go to my GP about this?

Hi @oootapasooo Essentially symptoms of perimenopause can start sometimes even 10-15 years before the natural age of menopause. For most women the natural age of menopause is around 50-51 but some women will start experiencing symptoms of perimenopause from their early 40s. Usually these symptoms are changes in your cycle, vaginal dryness, hot flushes, changes in mood and irritability, and increased UTIs. If this is the case, then I would suggest – apart from mentioning the symptoms – you can actually ask your doctor directly ‘could these be symptoms of perimenopause?’

Certainly, if you are less than the age of 40 and experiencing these symptoms then also always ask for a blood test to look at serum FSH. Serum FSH is not routinely needed for women above the age of 45 but should always be considered in women less than the age of 45, this is because if there is evidence of early onset menopause then I would always recommend referral to a specialist menopause clinic.

Normal FSH does not mean that you are not perimenopausal as often levels of FSH can fluctuate and for that reason if the symptoms are suggestive of perimenopause and no other underlying cause can be found for these symptoms, my advice would be to have a conversation around perimenopause and the use of HRT.

[DrGupta]

@hopezibah1

I had fibroids about 10 years ago that were removed. It turns out that I have fibroids again. I also have VERY heavy periods for about 24-48 hours but in the lead up to it very little bleeding for about 5 days. My GP says the options are birth control pill (which I'm not keen on these days after being on the pill for 20 plus years) or merina coil (which I tried before and bled all the time with). The lady doing the ultrasound mentioned that uterine embolization might be a good option. I'd never heard of it before. What are the pros and cons? I've been refered to gynaecologist but no idea how long the wait will be so I want to be prepared with knowing about options beforehand.

Hi @hopezibah1 Fibroids are extremely common and sometimes when they are big or causing symptoms then uterine embolization can be one of the options. The advantage of uterine embolization is that it avoids any major surgery. The procedure is performed by a consultant radiologist, these are doctors who specialise in radiology and imaging and the procedure is usually done as a day case and you will be sent home the same day. There is usually minimal discomfort, and the procedure works by blocking the blood supply to the fibroids. A consultant radiologist is able to assess which cases are suitable for this procedure, as not all women will be appropriate candidates for the procedure.

It usually takes a few months to know how effective the treatment has been, but after the procedure most women will notice that their symptoms such as heavy bleeding have reduced. Most clinicians will usually arrange a follow up scan in a year’s time to assess whether the size of the fibroid has reduced. For women with certain types of fibroids this is certainly a good option.

[DrGupta]

@TaraRhu

I'm pretty sure I have a prolapse after the birth of my 2 kids. There's a bulge on the back wall that prevents me using tampons anymore (they just fall out). It's not causing me any other issues. I saw the gp who thinks I do have a some sort of prolapse and reffferes me to gynocology. That was six months ago and I've recently been told it will be at least October until I get seen.

Is there anything I should do or avoid in the mean time? Also if the prolapse isn't that bad will they actually do anything? How is it assessed?

Hi @TaraRhu Vaginal prolapse is again not uncommon especially amongst women who have given birth vaginally. While you are waiting to see a specialist, I would certainly suggest regular pelvic floor exercises to reduce the risk of further progression of the prolapse and to strengthen your pelvic floor muscles.

I would also recommend avoiding any significant weight bearing [e.g. heavy lifting] and avoiding any significant straining, which can sometimes happen if you have constipation or chronic cough. So, if you do have either of these issues, then I would suggest perhaps increasing the amount of fibre in your diet to avoid the risk of constipation, as well as undertaking regular pelvic floor exercises.

[DrGupta]

@nowtygaffer

I have a large ovarian cyst that the doctor wants to remove along with my tubes and ovaries. I am 48. The cyst is a 10cm simple cyst, confirmed by MRI. I don't want surgery but feel pressured into it. Is it possible that the cyst could go away on it's own?

Hi @nowtygaffer As your cyst is 10cm in size I would consider this to be a cyst of significant size. For most women, cysts which are less than 6cm in size and are not causing any symptoms, there is a possibility of spontaneous resolution. However, as your cyst is 10cm I would consider this to be a reasonable size for surgery. If there are no concerns about the nature of the cyst and should you wish to preserve the opposite ovary should this be normal, then you can certainly discuss this as an option with your gynaecologist.

[DrGupta]

@BurnstonesMama

I am 45 and have menorrhagia. Not only are my periods heavy and crampy, they come every 16 days. Two different brands of the mini pill made things worse and I had constant bleeding with both; after several years on Tranexamic Acid, it stopped making much of a difference; I don't want the coil; so GP has suggested endometrial ablation but the success rates don't seem that high. I just want to regulate my periods better and go back to every four weeks, I can live with heavy bleeding and clotting. What's your advice please? Should I try HRT?

Hi @BurnstonesMama As you’ve mentioned you are 45 years of age and your periods are getting heavy and your cycles getting shorter, I’m assuming that you have had an ultrasound scan and your doctor has no concerns about this. You’ve already tried progesterone only pill. An alternative to the progesterone only pill would be something called Norethisterone, which is often given as a 5mg tablet that you take three times a day. You can take this cyclically for 3 weeks followed by a week’s gap, and you can continue this to help with your periods.

In my opinion this is too many tablets to take, and although you have mentioned you are not keen on the coil, the coil actually is a much lower dose of progesterone and is usually quite effective. The coil can also be used alongside HRT, where the coil provides with you the progesterone which is needed for HRT and you can use oestrogen either in the form of a gel or a spray or patch. From HRT point of view this combination usually works very well for women who also have troublesome periods and hence this would be my first recommendation to you.

You could also try tablet form of HRT which would mean again using oestrogen either as a gel, patch or a spray and using a tablet called Utrogestan which you will have to take cyclically. My concern with this is that you may still continue to have heavy bleeding.

Endometrial ablation is an established technique for treatment of heavy periods and it works for more than 80% of women. Hence if you are completely averse to any hormonal preparation then it is an alternative, although I would stress that if you are considering going on HRT then HRT itself is a hormonal treatment, for which you will need to take progesterone alongside oestrogen.

Lastly, there is the option of hysterectomy which is a major surgery, but some women who struggle with taking progesterone with HRT will chose to have a hysterectomy so that they can take oestrogen only HRT.

[DrGupta]

@notaflyingmonkey

I'm post menopausal, and struggling with vaginal atrophy (VA). Have been prescribed Oestrogen pessaries, which made no difference, and am currently using the cream. I asked for a ring, but was given the cream, with no explanation. I still bleed as a result of sex, and get frequent UTIs.

As a lovely little side bonus of some or all of this, I have also been struggling with urinary incontinence. I cannot seem to get a GP to take any of this seriously enough to take forwards solutions for me - so is that it for me now?

Hi @notaflyingmonkey Your symptoms are certainly suggestive of vaginal atrophy. As you have highlighted that you are already using oestrogen pessaries, you may sometimes need more frequent dosing of these. If you have already tried 10 days of oestrogen pessary followed by a twice weekly dose, you may repeat a further 10-day course of oestrogen pessaries. You can certainly have a vaginal ring as well and you can request this through your GP.

With regards to urinary incontinence again, if the vaginal pessaries haven’t worked, and you have tried pelvic floor exercises and these haven’t worked, then I would ask your GP to refer you to pelvic floor physio and usually they are able to then refer you onto a urogynae specialist if necessary.

[nowtygaffer]

Hi DrGupta,
Thankyou for your reply.
I will discuss the retention of the other ovary with my gynaecologist before the operation.
Thanks again!

[Willowkins]

Hi Dr Gupta, thanks for your reply. Respectfully, I would say that, for some women, Paracetamol and Ibuprofen (and Codeine for that matter) all taken together simply don't work. So my question remains, what do women need to do, either individually or collectively, to get the NHS to take women's pain seriously.