Not sure if your symptoms are ‘normal’? Ask the London Gynaecology specialists - £200 voucher to be won!

[CeriMumsnet]

Whether it’s telling yourself that heavy periods are “just one of those things”, dealing with pelvic pain that you’ve learnt to push through or experiencing symptoms that don’t quite feel right, for so many women, gynaecological health comes with unanswered questions. And too often, those questions are minimised, delayed or quietly worried about alone.

That’s why three specialist consultants from London Gynaecology are here to help.

From contraception and fertility, to fibroids, endometriosis, PCOS, painful periods and early pregnancy concerns, London Gynaecology experts Mez, Ora and Baljinder will be answering your questions openly and honestly, offering clarity, reassurance and practical next steps.

Share your question by 4 March for expert gynaecologist advice and a chance to win a £200 voucher (T&Cs). The London Gynaecology specialists will be online in from the end of Feb to answer your questions.

About the Experts
Mehrnoosh Aref-Adib (Mez), MRCOG
Consultant Obstetrician and Gynaecologist
Mez supports women with both common and complex gynaecological concerns, from fibroids, endometriosis and PCOS to ovarian cysts, heavy or painful periods, early pregnancy concerns and abnormal smear results. With particular expertise in ultrasound scanning, colposcopy and minimally invasive (keyhole) surgery, she focuses on using the least invasive approach appropriate, helping women feel informed and in control of their treatment decisions. Recently referenced on the Blended podcast hosted by Kate Ferdinand, Mez is known for her calm, clear and reassuring approach.

Ora Jesner, MBBS FRCOG
Consultant Obstetrician and Gynaecologist
Ora specialises in urgent and early pregnancy gynaecological care. Women often see her for early pregnancy pain or bleeding, concerns about miscarriage or ectopic pregnancy, as well as fibroids, endometriosis, adenomyosis and vulval symptoms. She leads the Emergency Gynaecology Unit at Whipps Cross Hospital and offers outpatient hysteroscopy, minimally invasive surgery and contraception procedures, including coil insertion and removal. As a mother of four, Ora understands first-hand the emotional and practical realities of navigating health concerns while caring for a family.

Baljinder Kaur Chohan (Bajinder), MBBS BSc BA MRCOG DFSRH
Consultant Obstetrician and Gynaecologist
Baljinder supports women with a wide range of gynaecological and early pregnancy concerns, including menstrual problems, pelvic pain, PCOS, fibroids, contraception advice and early pregnancy assessment with ultrasound. With over eight years’ experience as a consultant at Royal Berkshire Hospital, where she also holds a joint Clinical Lead role, Baljinder combines clinical expertise with deep empathy. As a mother of two, she appreciates the challenge of managing your own health while juggling work, children and everything else life throws at you.

There are quite a few reasons periods can become heavy — or fluctuate in heaviness from one cycle to the next and at 37 it’s definitely worth looking into rather than just putting up with it.

Common causes include fibroids (benign muscular growths in the womb) and adenomyosis, where the lining of the womb grows into the muscle wall and can make periods heavier and longer. Neither of these always causes pain, so heavy bleeding may be the only symptom.

Hormonal variation can also play a role. Each month the womb lining thickens under hormonal influence, and that process is controlled by the brain — so stress, illness, travel, or weight changes can all affect how heavy a period is. Less commonly, thyroid problems or bleeding disorders can contribute as well.

If you haven’t had a scan already, it would be sensible to see a gynaecologist for an ultrasound and some blood tests to check for underlying causes. You absolutely do not have to accept heavy bleeding as “normal.” It’s very treatable, and no one should be coping with leakage, double protection, or disruption to daily life.

Once the cause is identified, there are plenty of effective treatment options and you deserve a proper assessment so you can get the right one for you. Please feel free to call our team at London Gynaecology if you require advice on the the right consultation for you, please call our team at 020 7101 1700.

Ovarian cysts are extremely common, and having had one in the past doesn’t automatically mean you’re prone to ongoing problems. There are several different types.

The most common are functional cysts, which form as part of the normal ovulation process. These often come and go on their own and usually cause no symptoms at all.

Other types, such as dermoid cysts (the ones that can contain hair, teeth, or other tissue), don’t resolve by themselves and can gradually enlarge. That’s why they’re usually removed if they grow beyond about 5 cm or start causing discomfort.

The fact that your cyst recurred after being drained and then needed removal doesn’t necessarily mean you’ll continue to develop cysts. It may simply have been one of those isolated situations. Most women develop small cysts at various points in their lives without ever knowing.

If you feel well now and have no symptoms, there’s no reason to worry. If you’d like reassurance, a pelvic ultrasound every 18 months or so is reasonable — more for peace of mind than because you’re at high risk. The key message is that cysts are very common, most are harmless, and unless you develop symptoms such as persistent pain, bloating, or changes in your cycle, there’s no need for concern.

Adenomyosis is extremely common, and the unpredictable nature of symptoms is something I hear from many women I look after. I recently did a hysterectomy for a 44 year old who had suffered for over a decade and her life has changed. But that is an extreme treatment.
There is no cure at the moment, but there are good ways to manage symptoms, especially when tailored to your plans around fertility.
In terms of pregnancy, many women with adenomyosis conceive naturally and go on to have normal pregnancies. It is actually more common in women who have had children. There may be a slightly higher miscarriage rate compared with women without adenomyosis, but the majority still achieve healthy pregnancies.

During pregnancy, symptoms often improve because ovulation stops and hormone levels stabilise. After pregnancy, symptoms can sometimes return, although some women do notice a long-term improvement. For managing pain outside of diet and exercise, hormonal treatment remains the most effective option and this includes the Mirena coil, the combined pill, or progesterone-only methods. These work by keeping the lining thin and reducing inflammation within the muscle of the womb. When family is complete and symptoms are severe, some women ultimately choose hysterectomy, which is a major surgery but can be life-changing for those who have struggled for years. In terms of supplements, evidence is still developing, but some women find benefit from anti-inflammatory approaches. NAC (N-acetylcysteine) has shown promise in early studies for reducing pelvic pain and inflammation. Magnesium and omega-3 supplements can also help with cramping and general inflammatory symptoms. An anti-inflammatory diet, rather than strict eliminations, is often more helpful.

And while not medical advice, there are supportive communities online where women share what has helped them for example, The AdenoGang on Instagram is run by someone who has lived experience with the condition. You’re absolutely not alone with this, and your symptoms aren’t your fault. There are options beyond diet and exercise, and it would be worthwhile to review these with a gynaecologist so a proper plan can be built around your wish for pregnancy and long-term symptom control.

At 48, what you are experiencing is very likely related to perimenopause, as more frequent and irregular bleeding is common when hormones begin to fluctuate. However, having roughly two periods a month with cramping most of the time is not something you should simply accept, especially since this change is recent. The fact that your scan did not show fibroids is reassuring, but it is still worth having blood tests such as a full blood count and thyroid function, as low iron or thyroid problems can worsen bleeding. Because the bleeding is persistent, a hysteroscopy may be the next appropriate step. This is a procedure where a thin camera is passed through the cervix so we can look directly inside the womb. It helps identify issues that do not always show up clearly on ultrasound, such as small polyps or areas of thickened lining, and can often treat them at the same time. There are several treatment options that can make a big difference. A Mirena coil is one of the most effective ways to control heavy or frequent bleeding because it keeps the womb lining very thin and often reduces bleeding dramatically. Other hormonal treatments can also regulate cycles. If problems continue despite treatment and everything looks normal inside the womb, procedures like endometrial ablation or, for women who are truly exhausted by years of bleeding and have completed their family, hysterectomy can be considered. These are not first-line options but they can be life changing. HRT may help some perimenopausal symptoms but it does not always improve irregular bleeding on its own unless combined with the right type of progesterone, which is why many women use a Mirena alongside HRT if needed. So while this pattern can be part of perimenopause, it still deserves proper assessment. A visit to your gynaecologist for blood tests and possibly a hysteroscopy will help confirm the cause and guide you, if you wish to expedite this, you can visit our clinics and book in with me or my collagues for a conultation.

NSAIDs are often very helpful for heavy periods in teenagers because they reduce the amount of prostaglandins the body produces, which can lessen both bleeding and pain. They are generally safe for short term or cyclical use in a 13-year-old, but long term continuous use can sometimes irritate the stomach or, rarely, affect the kidneys, so it is sensible to review things if she is using them too much. Using them only during the period and taking them with food keeps the risk low, and if needed an antacid or protective medication can be added. Hormonal treatments are very safe in this age group, despite common fears. Options like the combined pill or progesterone-only methods are widely used in teenagers and can make a huge difference to quality of life. A paediatric gynaecologist can assess whether a scan or blood tests are needed and help choose the safest option for her. In my own practice, and even with my own 15-year-old daughter, hormonal treatment has often been the most effective solution when heavy periods were affecting daily life. Non-medical measures can also help, including good exercise routines, iron supplementation if she is low, vitamin D, omega-3, and ensuring adequate nutrition, but most girls with very heavy bleeding do need proper medical management. It is absolutely worth getting her reviewed so she does not continue struggling each month. We have specific consultant that can help, our co-founder, Pradnya Pisal, deals with paediatric gynaecology.

Given that this itch has been happening for 20 years, always in the same place, often just before your period or at night, and with a previous skin sample showing nothing abnormal, it is very unlikely to be vulval cancer. Vulval cancers usually cause progressive and persistent changes such as sores, lumps, bleeding, colour changes, or pain, and they do not follow a hormonal or cyclical pattern for decades. The timing you describe strongly suggests a hormonal sensitivity where the drop in oestrogen before a period makes the vulval skin more reactive. Even so, if you are worried, the most sensible next step is to be checked again for reassurance. There are several benign skin conditions that can cause long-term itching in one area. Lichen sclerosus is one possibility, an inflammatory condition that can make patches of skin thin and itchy, although it does not always show clearly on biopsy. Other possibilities include eczema, dermatitis, or long-standing irritation from friction or dryness. Simple measures often help, such as using gentle moisturisers, avoiding perfumed products, and sometimes a short course of a mild steroid cream if the skin is inflamed. Many of our colleagues will be able to assist in this, book a consultation with our team to discuss your concerns and if there are any suitable tests, we can perform those too. https://www.london-gynaecology.com/team/

I’m sorry you had such a hard time. To reassure you it is unlikely that the balloon induction caused permanent internal damage. Sixteen months later, your symptoms are more often linked to postpartum hormonal changes such as low oestrogen, especially if you breastfed, combined with pelvic floor overactivity or residual tissue sensitivity rather than structural injury from the balloons themselves. However, given the level and duration of your pain, it would be appropriate to examine you to assess vaginal tissue health, pelvic floor tone, cervical tenderness, and any scarring, and to consider a pelvic ultrasound to exclude deeper causes such as adenomyosis or endometriosis so that we can guide you toward effective treatment. Feel free to find a good consultant at London Gynaecology, our team would be able to help assess the issue. Good luck and am sure you can feel better soon!

As a gynaecologist, I can reassure you that many women have fibroids without experiencing heavy bleeding at all. Fibroids are one of my favourite conditions to discuss because they are so individual-some cause no symptoms whatsoever, while others can lead to a wide range of issues depending on their size, number and location. In many cases, fibroids are completely silent and are found only during a routine scan. When they are not causing symptoms, there is usually no need for treatment, though I do recommend an ultrasound every 18 months or so to monitor them. Fibroids affect up to 80 percent of women at some point, yet they are often not talked about enough, and understanding their variability can help women feel much more in control of their health.

From a gynaecology perspective, bleeding heavily for 4–5 days followed by continued bleeding for a total of 9–10 days every cycle is not considered normal, especially when this pattern began only after your periods returned post-partum. The combination of prolonged bleeding, very heavy early-cycle flow, and severe PMS or ovulation-related pain suggests that this is affecting your quality of life and warrants further investigation. Although women are often reassured that difficult periods are 'normal' you deserve proper evaluation, including a pelvic ultrasound scan, full blood tests, and an assessment for conditions such as adenomyosis, fibroids, hormonal imbalance, or post-surgical changes. The good news is that there are multiple treatment options, both hormonal and non-hormonal, that can significantly reduce bleeding and pain. Please do seek a review with a gynaecologist, as this pattern should not simply be accepted without proper checks.

From a gynaecology perspective, daily bleeding for this length of time is not typical and should be investigated, even in someone on HRT. It is unusual to reach the end of perimenopause with continuous bleeding of this pattern, and the change after nearly two years with no periods suggests that something within the uterus needs checking. This can range from the coil sitting slightly out of position to breakthrough bleeding from your own fluctuating hormones, as some women still ovulate even while on HRT. Given the duration and variability of the bleeding, I would recommend a pelvic ultrasound scan to assess the lining of the womb and the position of the coil, and you may also need a hysteroscopy, which allows direct visualisation of the uterus to rule out polyps or other structural causes. Hormone blood tests are generally not useful in this situation because levels fluctuate through the day and will not be accurate while taking HRT. I only check them when someone feels unwell despite being on the maximum dose, to ensure absorption of HRT. It’s important that this ongoing bleeding is properly investigated, and I would encourage you to see a gynaecologist for further assessment.

If you previously had a single fibroid removed, the likelihood of developing new fibroids at age 62 is generally low, as fibroids are driven by hormonal activity and tend to shrink after menopause. The risk of recurrence also depends on factors such as the number of fibroids you originally had and whether you are using HRT, as oestrogen can sometimes encourage fibroid growth. Even so, at your age it is reassuring that significant new fibroid growth is uncommon. Some evidence suggests that maintaining good vitamin D levels and, in some cases, using green tea extract may help reduce the risk of fibroid recurrence. Overall, it is unlikely that you will develop problematic new fibroids, but if you experience any new bleeding or pelvic pressure, it would be worth having a scan for reassurance. We conduct pelvic ultrasound scans with sonographers for a more cost effective consultation and if there is a need to talk to our gynaecologist, you can add that on as well.

I’m really sorry you’ve been experiencing this, and it absolutely deserves more attention than simply being told to moisturise! Persistent splitting or tearing of the vulval skin is not something you should have to live with, and I would strongly encourage you to see a different GP or ask directly for a referral to a gynaecologist – even better a vulval specialist. While regular moisturising can help with products like Cetraben or even coconut oil that can be soothing you are very likely to benefit from topical oestrogen, which can strengthen and restore the vulval and vaginal tissues even if you are under 45. And its perfectly safe! You should also be examined for possible skin conditions, such as inflammatory vulval disorders (like eczema or lichen sclerosus), which can cause thinning and fragility of the skin and are often very treatable once identified. I genuinely hope you get a proper assessment and the treatment you need, because this is highly manageable with the right care.

I am not certain what you mean by abnormal cell changes- but if you mean changes on the cervix (CIN)- such as those detected through cervical screening and usually related to HPV then yes, you can safely use HRT, including oestrogen gel. HRT does not worsen or accelerate cervical abnormal cells, nor does it affect the progression of HPV-related changes. These areas of the body respond differently to hormones than the lining of the uterus, so systemic or topical oestrogen is not a concern in this situation.

When people mention abnormal cell changes, they could be referring to a few different things, so it’s always worth clarifying. It could also mean cell changes in the lining of the womb (the endometrium- this does change the conversation, because unopposed oestrogen can worsen endometrial thickening. In these cases you need progesterone protection (such as a Mirena coil or combined HRT). Other skin changes can be vulval but HRT is usually still safe. Please do repost your questions if you wish.

Yes, it’s absolutely possible to experience monthly hormonal changes and PMS-type symptoms even if you have an IUD and no periods. Most people with a hormonal IUD still ovulate as the coil mainly works by thinning the lining of the womb and thickening cervical mucus, not by reliably stopping ovulation. So if you are still ovulating, you will continue to experience the natural rise and fall of oestrogen and progesterone across the cycle, which can trigger symptoms such as mood changes, breast tenderness, bloating, or pelvic discomfort- just without the menstrual bleeding, because the lining stays very thin. A smaller group of people do stop ovulating with the IUD, in which case symptoms are usually much milder. If symptoms feel severe or are affecting quality of life, it’s worth discussing with a gynaecologist, as there are many ways to manage this.

Yes, this can be completely normal. When your own hormone levels were dropping in perimenopause, your periods naturally became lighter and less frequent. Now that you’re taking HRT, the added oestrogen can stimulate the lining of the womb again, which often results in heavier or more regular bleeding for the first few months. This usually settles as your body adjusts and as the progesterone component keeps the lining under control. If the bleeding is inconvenient or doesn’t settle, one very effective option is a Mirena coil. It provides the progesterone directly to the womb lining, keeps it very thin, and many women stop having periods altogether while still using oestrogen for symptom control. It’s safe, very commonly used alongside HRT, and can make the overall experience much easier. If the bleeding becomes extremely heavy or persists beyond the first 3–6 months of HRT, it’s worth a review, but what you’re describing is a typical response.

One of the main causes is PMS. In the second half of your cycle, progesterone rises. For many women, higher progesterone can temporarily lower levels of serotonin, the brain’s ‘feel-good’ hormone. This shift can lead to fatigue, low mood, irritability, and a general sense of heaviness or exhaustion. At the same time, your body is also preparing for a potential period, which naturally increases metabolic demand and can make you feel more drained. It’s also important to consider other contributing factors. Low iron, low vitamin D, thyroid issues, or B-vitamin deficiencies can all worsen premenstrual tiredness, so a simple set of blood tests is worthwhile. If periods are heavy, even borderline low iron stores can amplify fatigue. A pelvic scan may be useful if the periods themselves have changed, to rule out structural causes that could be worsening symptoms. Lifestyle factors can play a role too like what you eat before your period, fluctuations in blood sugar, how intensely you exercise, sleep quality, and stress levels can all influence how that premenstrual week feels. Some women benefit from adjusting nutrition, adding magnesium or B-complex vitamins, or moderating exercise intensity during this phase. If the tiredness is strongly cyclical and clearly linked to hormones, hormonal contraception (such as the combined pill or a hormonal IUD combined with oestrogen) can help smooth out fluctuations and reduce PMS-related symptoms. If fatigue is severe or new for you, it’s worth getting checked to rule out anything else contributing.

The Mirena coil was originally licensed for 5 years of contraceptive use, but this has now been extended to 8 years for contraception. When it is being used as the progesterone component of HRT, it is still recommended to be changed every 5 years, as that is the duration for which it reliably protects the womb lining.If the recommended removal date has passed, the health risks are generally very low. The main issue is that it may no longer be effective for contraception, so there is a real chance of pregnancy if you are sexually active. Coils that are left in for many years beyond their expiry can, in a small number of cases, become embedded in the uterine wall or slightly more difficult to remove, and there is a very small increased risk of infection, but serious complications are rare. If your coil is overdue for replacement, it’s advisable to arrange a review and have it exchanged, especially if you rely on it for contraception or for HRT protection.

Bleeding or spotting most days for over a month at age 47 is very commonly linked to perimenopause, as hormone levels fluctuate and the lining of the womb becomes more unpredictable. However, before assuming this is the only cause, it’s important to have a pelvic ultrasound scan to check the thickness of the endometrium and rule out benign issues such as polyps, which can cause exactly this pattern. It’s also worth ensuring your cervical screening (smear test) is up to date. Once everything has been checked and confirmed normal, sequential HRT can indeed help regulate the cycle and reduce the constant spotting though it’s most appropriate if you are also experiencing other menopausal symptoms like hot flushes, sleep disturbance, or mood changes. Another option, if regulation is your main aim, is a standard hormonal contraceptive such as the combined pill, which can give more predictable bleeding patterns during perimenopause or a mirena coil (which may stop the periods completely).

If you’re still having periods at nearly 53, you do still need contraception, and a copper coil can be a very good option at this stage of life. If your current copper coil was inserted after the age of 40 (from the information it looks roughly like it was) it can safely stay in place until you reach menopause without needing to be replaced. The usual guidance is that once you are over 50, you can stop contraception one year after your final natural period but because it can be hard to know exactly when that final period has happened, we often advise leaving contraception in place until age 55, when the chance of pregnancy becomes negligible.

So in your case, if the coil was inserted after 40, you can keep it until menopause or up to age 55 if you prefer not to switch to another method. If it was inserted before 40, then strictly speaking it is past its recommended lifespan and should be removed or replaced, even though the overall risk at your age is low. If you’re unsure when it was inserted or if any symptoms arise (new pain, abnormal bleeding), a quick check-up or scan can help confirm everything is still safe.

I am sorry to hear this. Pain during penetrative sex, especially when it feels like you ‘can’t take’ the penetration, is not something you should ignore, and it’s very appropriate to be checked. There are several possible causes. Low oestrogen which is common in your 40s and perimenopause can make the vaginal tissues thinner, drier and more sensitive, leading to pain and bleeding after sex. Endometriosis or adenomyosis can also cause deep pain during penetration. Lack of lubrication, pelvic floor muscle tightness, or infections can contribute too. Given you’ve had five vaginal births, structural issues such as prolapse or scar tissue can also create discomfort. It’s reassuring that your smear and colposcopy in 2023 were normal, but any bleeding after intercourse warrants a pelvic examination, swabs, and often a pelvic scan to understand what’s going on. Please do arrange a review with a GP or gynaecologist as you absolutely deserve proper assessment and treatment options.

I’m so sorry you’re going through such a severe and complex form of endometriosis. Stage 4 disease with an 8 cm endometrioma, hydrosalpinx, kissing ovaries and bowel involvement is extremely difficult to live with, and it’s completely understandable to feel overwhelmed while waiting for the MDT to decide whether surgery is possible. In situations like yours, I do often consider Ryeqo as a reasonable option. Although it is still relatively new and we do not yet have long-term data, we do understand its mechanism well, and similar medications (Gnrh agonists not antagonists). I tend to offer it to women who are waiting for surgery, cannot have surgery at the moment, or want to see whether medical suppression improves their quality of life before undertaking a major operation. If this were my own daughter in the same position, I would encourage her to try it while waiting for the MDT outcome. If it helps, that’s progress, if it doesn’t, you can stop it quickly and nothing is lost. It is simply a tool to manage symptoms, not a cure but sometimes that relief is hugely valuable. When it comes to chemical menopause, I would use it myself if my symptoms were severe and surgery wasn’t immediately possible. It can give powerful relief by quietening the ovaries and reducing inflammatory activity in the pelvis. I would, however use it as a short term solution because endometriosis tends to return once you stop the medication.

Fertility is another important aspect at 37, and any decision should ideally involve a fertility specialist as part of the MDT. Medical treatments like Ryeqo or chemical menopause suppress ovulation temporarily, but do not prevent you from trying to conceive later. Surgery may help, but in advanced disease the risks and benefits need careful, honest discussion as you may lose some ovarian reserve.

If I were approaching menopause myself, I would absolutely take HRT ( I am very pro HRT for the right reasons in the correct people). It is one of the best-studied treatments we have, and when used appropriately it supports bone, heart and brain health and significantly improves quality of life. For most women, the benefits far outweigh the risks.

I do believe that women’s health conditions have been overlooked for decades and my colleagues and I are always trying to talk about things (like this mumsnet but also Instagram lives, webinars, teaching). Endometriosis, adenomyosis, fibroids, PCOS and chronic pelvic pain have all suffered from underfunding and under-research. Many women are still told that their symptoms are normal or that severe period pain is just something to live with which infuriates me! Historically, we simply didn’t have many treatment options beyond contraceptives, so those became the default.

If I could tell my younger self or any young girl one thing, it would be that severe period pain is not normal and you do not have to suffer in silence. In fact I tell my daughter this and had her seen by a gynaecologist (not myself!). You know your own body better than anyone else, and if something feels wrong, you deserve to be listened to. Tracking symptoms, seeking specialists early, and advocating for yourself are vital. Pain is real, and it is treatable, and there is nothing dramatic about wanting answers or relief.

Sorry to hear this as recurrent thrush is incredibly frustrating, and you’re right that it affects quality of life. In medical terms, recurrent means four or more episodes per year, and there are several things worth checking and several treatments that can genuinely make a long-term difference. One often-missed cause is low ferritin as you can have a completely normal full blood count but still have ferritin levels that are too low for your immune system to function well. For recurrent thrush, ferritin ideally should be above about 70, so it’s worth asking to have this checked. It’s also important to ensure there is no undiagnosed diabetes, as even mild glucose intolerance can make thrush more persistent. Long-term treatment does exist and can be effective. The standard medical option is a maintenance course of fluconazole for example, weekly tablets for six months which can significantly reduce flare-ups. Another evidence-based option is a two-week course of intravaginal boric acid, which can help reset the vaginal environment, particularly when symptoms keep returning despite standard treatments. Alongside this, simple daily measures make a real difference: avoiding tight clothing, using only water or very gentle cleansers externally, keeping the area dry, wearing cotton underwear, and avoiding irritants such as scented products or harsh washing detergents. Probiotics are good. There isn’t one single cure that eliminates thrush forever, but there are strategies that can dramatically reduce how often it comes back. If you haven’t had a proper work-up or a long-term plan before, it’s absolutely worth speaking to a gynaecologist who will take this seriously and you don’t have to just live with it.

Bleeding from the vagina only when you empty your bowels is not normal and it should be taken seriously. Even if it feels minor or you can’t see any visible tear, this pattern needs proper investigation. Straining during a bowel movement puts pressure on the pelvic organs, and depending on your age and hormone status, several things could cause bleeding with that pressure. Vaginal atrophy, cervical ectropion, cervical or endometrial polyps, or a vaginal wall prolapse can all bleed in this way. Less commonly, endometriosis involving the cervix or vagina can cause bleeding triggered by bowel movements. These conditions are treatable, but they cannot be diagnosed without an examination and a scan. A pelvic ultrasound is the minimum investigation needed, along with a speculum examination. If your gynaecology wait is sixty-two weeks, there are still steps you can take. You can ask your GP to arrange an ultrasound directly so you do not have to wait for the specialist appointment. If your bleeding is postmenopausal, prolonged, or completely new for you, your GP can consider an urgent referral. Some areas also have community women’s health services with much shorter waiting times than hospital gynaecology. A routine cervical smear should also be done if you are due. If it is accessible for you, a one-off private ultrasound can provide valuable information while you wait to be seen. Please do not accept being brushed off. Vaginal bleeding linked to straining needs proper assessment at any age. If you want to tell me your age and whether you are menstruating, perimenopausal, or on HRT or contraception, I can help narrow down which causes are most likely in your case but you should still see your doctor.

As a gynaecologist, I can reassure you that many women do experience stronger bowel-related cramps during their period. During menstruation, the womb produces chemicals called prostaglandins, which help the uterus contract to shed the lining. These same prostaglandins can also affect the bowel because the uterus and bowel sit very close together in the pelvis. When prostaglandin levels are higher, the bowel becomes more sensitive and can contract more strongly, which is why needing to have a bowel movement during a period can trigger sharp, period-type pains. Another possibility is endometriosis, which is a condition where tissue similar to the lining of the womb grows outside the uterus. When it affects the area between the womb and the bowel, or the bowel surface itself, it can cause pain specifically during periods because that tissue responds to hormones in the same way the womb lining does. In women who notice bowel pain only at period time, this is something we always keep in mind, especially if there are other symptoms such as very painful periods, pain during sex, or heavier or more irregular bleeding. Your recent change from the depo injection to the implant means your hormones have become more cyclical again, which often brings back period symptoms you may not have had for years. If the pain is manageable and only occurs during menstruation, it may simply be prostaglandin-related. If it becomes severe, affects day-to-day life, or is accompanied by other symptoms, it would be sensible to have it checked, ideally with a pelvic ultrasound and a review by a clinician experienced in pelvic pain and endometriosis.

Urticaria has many possible causes, and although hormones can sometimes play a role, it is usually not directly caused by HRT. The first thing to look at is the timing. If your hives began soon after starting or increasing your oestrogen gel, then stopping it was a reasonable first step. If the urticaria has not improved after stopping the gel, it becomes less likely that the oestrogen was the trigger. In that situation, switching to a different form of oestrogen, such as a patch or spray, is usually safe if you still need HRT, because people can react differently to the base ingredients used in gels.The Mirena coil is very unlikely to suddenly cause urticaria if you have had it in place for years. If it was inserted recently and the hives started soon afterwards, then it is worth discussing, but a long-standing Mirena that has never caused issues before would not typically trigger new skin symptoms at 54. Menopause itself can sometimes make the skin more reactive because oestrogen affects the skin barrier and immune system, but true urticaria is much more commonly due to allergy, infection, autoimmune activity, medication sensitivities or even stress. Given your symptoms are significant, it would be sensible to see an allergy or dermatology specialist to investigate properly.