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.

I am so sorry to hear this. It can genuinely be very difficult to tell whether bleeding is coming from the bladder or the uterus, especially when it only shows up on wiping. The bladder and the vagina sit extremely close together, and small amounts of blood can mix with urine or vaginal discharge in a way that makes the source almost impossible to distinguish without tests. Many women, and many doctors, struggle with this distinction. I recently cared for a patient whose situation highlighted exactly how confusing this can be. She had been referred to urology because everyone thought the blood was coming from her bladder and after investigations, it turned out to be a small uterine polyp that only bled intermittently. I have also seen the opposite happen vaginal bleeding mistaken for urinary bleeding for months. These cases show that even with medical training and examinations, it can still be unclear. When we try to differentiate the cause, we rely on a few things. A urine dipstick or urine microscopy taken at the time of symptoms can detect even tiny traces of blood from the urinary tract. A pelvic examination helps determine whether the cervix or vaginal walls are the source, though light bleeding is not always visible. If things remain uncertain, repeating a urine test when there is no vaginal bleeding can be very useful. A pelvic or bladder ultrasound can help if there is suspicion, although this is not done routinely. The definitive test is cystoscopy, which looks directly inside the bladder and is often what finally clarifies the diagnosis when symptoms have been subtle.I am sorry your diagnosis was delayed and am glad you now have the correct diagnosis and are under the right team for treatment. I wish you the very best with your treatment.

It’s completely understandable that you feel reluctant about having another coil, especially if previous insertions and removals caused cervical shock. Your symptoms absolutely need investigating, and it’s good that a biopsy has been arranged and this is the correct next step, particularly with continuous bleeding and a thickened lining at 58. Before choosing any treatment, we need to be clear about the cause. If you are using oestrogen as part of HRT, this is a very common reason for the lining to thicken and for bleeding to restart. In that situation, you must have reliable progesterone protection for the womb, and the Mirena coil is an effective and convenient way to deliver that protection directly to the uterus. However, it is not your only option. If you absolutely do not want another coil, you can instead use oral progesterone every day. This can keep the lining thin and reduce bleeding, although for some women it is less effective than the coil and can occasionally cause more breakthrough bleeding. Another option is to have a coil inserted under anaesthetic or sedation. Many women with cervical shock, past trauma, or extreme discomfort choose this, and it is a perfectly reasonable request and I believe nobody should have to endure a painful procedure awake if there is an alternative.

Some women continue to have periods well into their mid-50s, so it is not unheard of, but at 58 we must always rule out any concerning causes before making assumptions. The biopsy will give the information needed to guide treatment safely. The priority now is confirming the cause of the bleeding, and then tailoring the treatment to something you can tolerate comfortably

Your heavy periods are very likely the cause of your recurring anaemia but not the only cause, and you need proper investigation to understand why the bleeding is so significant. A pelvic ultrasound, blood tests including ferritin and thyroid function, and possibly a hysteroscopy (camera inside the womb) are important to look for causes such as polyps, a thickened lining or other structural issues. PCOS, perimenopause and added oestrogen from HRT can also make bleeding heavier. Because you do not wish to use the pill or a coil for faith reasons, it’s important to know that the Mirena is medically recommended not just as contraception but because it delivers the same progesterone you already take, directly to the womb lining where it works far more effectively. It keeps the lining thin and prevents heavy bleeding much better than oral progesterone, which has to pass through the digestive system before reaching the uterus. That is why it is so often suggested for women on oestrogen. However, if you still prefer not to have one, there are other options, including adjusting your oral progesterone dose, using tranexamic acid during periods to reduce blood loss, removing any correctable causes found on scan or hysteroscopy, considering endometrial ablation (burning the lining of the womb) if suitable, or in severe cases hysterectomy. The first step is a full assessment so that treatment can be tailored to your needs and beliefs. I would strongly encourage a referral to a gynaecologist so you can finally get to the root of the bleeding and break the cycle of repeated anaemia.

Your daughter should not be dismissed, and heavy, painful periods at 17 fully deserve proper assessment. If she is still struggling despite tranexamic acid and two types of progesterone-only pills, the priority now is to investigate why her periods are so heavy. She needs blood tests to check iron levels, thyroid function and clotting factors, and she should have a pelvic ultrasound to see whether there are any structural causes such as a thickened lining or a small polyp. If she is medically allowed to take the combined pill (which I assume she may not be), that is often the most effective first option for teenagers with heavy, painful periods. If the combined pill is not suitable for her, a hormonal coil is a very good alternative. Many adolescents use it, and it can be inserted under sedation if she is nervous or has never been sexually active. She does not need to have had intercourse for it to be placed safely. The coil delivers progesterone directly to the womb lining, which usually makes periods much lighter and less painful, and in many young women bleeding becomes minimal. The other thing is to consider her diet and exercise and vitamin supplements that may help. If this were my own daughter and she could not take the combined pill, I would absolutely consider the hormonal coil for her. But the most important step now is to push for a proper gynaecology referral so that someone takes the time to find the underlying cause if there is one but if none is found then treating it to improve her quality of life.

It’s completely understandable that you feel shocked and I am sorry you were not warned that this can happen after a subtotal hysterectomy. When the cervix is left in place, there can sometimes be a small amount of endometrial tissue (lining of the womb) remaining at the top of it. This tissue can still respond to your natural hormones each month, which is why you are getting light, period-timed bleeding even though the main body of the uterus has been removed. This kind of cyclical bleeding is not dangerous, but it can be upsetting when you thought periods were over. For many women it does continue until menopause, because the tissue responds to the same monthly hormone fluctuations as before. The good news is that there are options if you want to stop it. Taking progesterone for part of the cycle or continuously can suppress the remaining tissue and prevent these bleeds. A doctor can also review whether any further treatment is needed, though additional surgery to remove the cervix is usually only considered if bleeding is heavy, persistent, causing real difficulty or there is a problem with your cervix and repeat surgery should not be taken lightly.

Bleeding for 90 percent of the time is not something you should simply be told to accept, and it is understandable that you feel dismissed. You have already had important investigations in the form of a hysteroscopy ruling out fibroids, polyps and endometrial cancer and this is reassuring. You should have full blood tests including thyroid function, prolactin, FSH/LH, androgens, haemoglobin and ferritin. Thyroid problems, hormonal imbalance and even mild iron deficiency can all make bleeding worse. Weight gain can also contribute, because fat cells produce extra oestrogen, which can overstimulate the womb lining and cause almost constant bleeding. PCOS can present with irregular or prolonged bleeding too, and if that’s a possibility, you should be assessed properly- supplements like myo-inositol can help stabilise cycles in women with PCOS.
Bleeding this much is absolutely not normal at 34, and it is reasonable to expect a treatment plan rather than being told to put up with it. Hormonal treatment is often the next step not because doctors want to fob you off, but because it is the most effective way to calm the lining and stop the bleeding. Even if you do not want the pill or the Mirena long term, trying one for a few months can be a useful way to reset the cycle and give your body a break. If you still do not want those options, the team should discuss alternatives such as tranexamic acid, cyclical progesterone or, in some cases, temporary ovarian suppression (but again this is hormonal). Endometriosis does not usually cause constant bleeding like this, which is likely why they have not focused on it as endometriosis is more linked to pain than flooding or near-continuous bleeding. But that does not mean your symptoms are being taken seriously enough. You are allowed to ask for a second opinion or a referral to a gynaecologist. You can say clearly that bleeding 90 percent of the time is affecting your quality of life, that initial investigations are normal, and that you would like to discuss other management options.

I'm 57 and since the menopause, I have difficulty inserting anything into my vagina. It seems as though my vaginal canal has shrunk width-wards and anything inserted causes awful soreness for a couple of days and I also experience slight bleeding.
I can't even face going for a smear, due to the pain I know I'll experience and lubrication doesn't seem to work anyway. My sex life is now nonexistent.
Would something like Ovesse help rectify this? What would you recommend please?

I have an autoimmune condition (Myasthenia) and it hugely flares around each time I get my period.
Is there anything I could do to help with that?

I have a retroverted womb and am going through perimenopause. I have to have a colposcopy for smear tests, which costs NHS and always takes a very long time due to the issues finding my cervix. I have fibroids which hurt if I walk too far and at night, back pains and bloating because my cervix is right by my bowel, which I feel causes issues with my bladder because it isn't meant to be there at that angle. Now my child rearing days are over, can I ask for an operation to take it out?

After some spotting I had a scan and a fibroid was found. The information I was given suggested it's not a problem and may well go away on its own. Is there anything I should be looking out for to check everything's OK?

I stopped my periods suddenly at 35. I was in hospital, very ill and underweight. The drs were not bothered. It ranged from you dont look pregnant, to my body was in shock. I went to an endocrinologist for thyroid issues she was pretty blasse and just went by the guidelines no period for a year before hrt. I was really suffering menopause now I look back so hot all the time, a male friend noticed me sweating. 5 years of this one light bleed every 9 months and she finally prescribed hrt the night sweats and constantly being too hot vanished. I was so naive, I was thinking I was sweating due to a new medication which was helping me, so I didnt question it, tell anyone. In your opinion would you have started hrt or done bloods earlier? TMI but I suffer badly with dryness now, and wonder if it had been picked up earlier it wouldnt be so bad. I don't see that dr anymore, we had differing opinions when she tried weaning me off thyroxine and I ended up in bed for hours in the daytime. Thank you I realize it is tricky what you say about colleagues, she may well be on here! On the advice of a helpful poster on the menopause board I switched to Utrogestan.

I was diagnosed with diffuse adenomyosis yesterday - the report says my uterus is globular and on seeing the imaging, looks like it's completed covered in polka dots on abdominal scan (which was incredibly painful with the pressure on the old section scar and looked like it was raining on tvs). I also feel like I am carrying around a football, have horrendous lower back pain and as if I am constantly menstruating - my last bleed lasted 3.5 weeks and I was flooding and clotting through superplus tampon, three pads, disposable period pants, fabric period pants and I still soaked through my clothes when I moved slightly at my desk. I also need a waterproof fitted sheet and use puppy pads to deal with overnight flooding..

Due to deeply unpleasant atrophy with itching, burning and concern over bone density due to long term steroid use for Psoriatic Arthritis on top of biologics, I am reluctant to stop sequential topical estrogen in addition to progesterone.

As the pain extends to my sacral spine and SI joints. I javeand splinting is often necessary despite taking magnesium, it is frankly intolerable.

Is it likely that a) I also have endometriosis around the pouch of Douglas, bowel and ligaments, b) need extensive exploration and c) would benefit from hysterectomy, bilateral salpingooophrecytome and further exploration. I have a gynae appointme in 4 weeks. I'm 53 and still both bleed randomly (despite a year without HRT, meaning the atrophy significantly worsened).

I have been complaining of section scar pain and sensations of intensely painful popping and pulling for 34 years but never been examined and generally told that it's impossible and all in my mind, I was also unable to conceive past the age of 25, but a recent MRI for the back pain did not mention any of this, focusing upon a small amount of narrowing in the disk space three vertebrae above the seat of my pain.

What is the likely appropriate process now it has finally been discovered and how do I advocate for the most effective treatment? And why was there never a physical examination and nothing observed at MRI despite excruciating pain that has been put down as chronic pain/all in my mind?

thank you - that's reassuring.

thank you - that's reassuring.

What age range do women go through menopause and what are the signs please?

Any type of bleeding that is not part of your regular cycle can certainly be concerning and you were right to speak to your GP about this. HPV is a really common infection, with up to 80% of people being affected by it at some point in their lifetime. Reassuringly, most infections will go away without any symptoms or treatment. Persistent HPV of certain types however can cause changes within the cervix which overtime can cause irregular bleeding either between periods or after sex, therefore if you were to experience persistent abnormal bleeding, you should always speak to a doctor and we are always happy to see you at the clinic here. Being seen would involve a vaginal examination which will include taking swabs and a smear if needed and occasionally an ultrasound scan to look for other causes for irregular bleeding. In your case, it is reassuring that the bleeding settled although it is difficult to categorically say why you had the irregular bleeding. It would be best to seek a second opinion, if you would like to. You can book a consultation with me to discuss further. https://www.london-gynaecology.com/team/baljinder-kaur-chohan/

Both endometriosis and adenomyosis are common and cause significant symptoms that can hugely affect women's day to day life. Endometriosis can cause painful periods and pain with sex as well as at other times, and ademomyosis causes heavy and painful periods. Fortuanately there is treatment for both which include medical and surgical treatment which we are able to provide a the clinic. Your consultant is right in that given the average age of menopause (when you periods stop) is 51, you are almost there and once your periods stop, your symptoms should also resolve if they are due to endometrosis or adneomyosis. Its is really your choice because whilst treatment is available, there can be potential side effects or risks involved so you need to decide if it is the right thing for you. We are always happy to speak to you further in clinic to help you decide. Our team is always ready to help, you can reach us at 0207 101 1700

Evidence shows that the risk of endometritis is higher with caesarean section compared to vaginal delivery but there can be many compounding reasons for this. For example, if you were in labour before the caesarean section, the risk is higher especially if you had a prolonged labour, or if there was meconium (poo from baby in the water around baby) or if you have had multiple vaginal examinations in labour. Prior to having a caesarean section, antibiotics are always administered to reduce the risk of any infection, however they cannot take away the risk completely but you could speak to your surgical team about your concerns and whether additional or different antibiotics may be needed prior to having another caesarean section. Whilst it is difficult to say specifically what the risk of endometritis occurring again following caesarean section, in my experience the chance of it happening again is low.

I am sorry to hear that you are having such difficulty with your symptoms and that you are having to wait so long for surgery, an issue which is all too common affecting many women.

As you know, fibroids can be in different positions within the womb and can therefore cause different issues. Having a large bulky womb can be uncomfortable in itself and cause pressure symptoms and difficulty with passing urine or pain with sex for example. Pain from fibroids can also occur if they grow fatser than their blood supply and then they can start to degenrate causing severe pain, but this typically occurs during pregnancy. When fibroids are within the lining of the womb (submucosal), they increase the surface area of the lining which means there is more lining that is shed when you bleed, therefore the periods are heavier. A mango sized fibroid within the lining of your womb would certainly be causing heavier bleeds! Heavier periods are definitely more painful, therefore by treating the heaviness, the pain should hopefully improve. In terms of treatment for fibroids, it really depends on where they are as to how they are removed which we would be happy to discuss further with you if you would like. It is also important, however to ensure there are no other causes for the bleeding and based on your age, sometimes further investigation is warranted in the shape of a biopsy (tissue form the lining of the womb), which we can do for you in clinic whilst you are awake as well as do another scan to assess the fibroids. Your pain should also be better managed, it is definitely not a matter of being "one of those things!".

If you would like to discuss options with me or any one of my colleagues at London Gynaecology, please reach out to our very capable team to discuss at 0207 101 1700.

I am sorry to hear that you still suffer from pelvic girgle pain (PGP) symptoms so long after your last child, but it is true that it can last for months or years in some women. Having a connective tissue disease, such as EDS, is certainly associated with pelvic floor disorders with a higher chance of developing PGP in pregnancy. Treatment is in the form of physical therapy ideally with a women's health pelvic floor specialist. The good news is that most women recover fully with treatment even after experiencing severe PGP symptoms for many years. It’s never too late to treat your pelvic pain!

Whilst we will all go through menopause, not everyone will suffer from menopausal symptoms and if they do, they affect everyone differently. Having said that, we know that up to three quarters of women may have symptoms, with a quarter describing really severe symptoms. It is always difficult to predict who will be affected and to what extent but if you do start to suffer, please reach out and we can see how we can help at the clinic. There is always help available!

I am sorry to hear you have suffered a blood clot as a result of the combined pill, but please be assured there are still plenty of treatment options available to you despite this. The main aim with PCOS is to ensure the lining of the womb remains thin, either by being shed regulalrly through having periods or using medication. Hormonally, the mini-pill (progesterone only) or mirena coil are viable options to keep the lining of the womb thin even with your history. Most women do not have a period with this option but the linining is thin which is different from PCOS. In terms of lifelong risks with PCOS inclduing the risk of developing diabetes, medication such as metformin can be used which can also regulate your periods and even help lose weight. I would be happy to see you in clinic and to discuss further and help.https://www.london-gynaecology.com/team/baljinder-kaur-chohan/

UTIs are really comon and whilst most are uneventful and clear up quickly with a course of antibiotics, they can sometimes be very troublesome. Having recurrent UTIs can be linked to several factors including perineal hygeine, diabetes, medication and even age. Sometime further investigatons may be needed so it is always a good idea to see a specialist to make sure everything is ok. You can book in with our urogynaecologist, Mittal Patel, who is experienced in treating recurrent UTIs

Irregular bleeding at your age is likely to signify peri-menopause which is a variable amount of time before your periods stop completely (menopause). Having said that, there can be other causes and given the extent of the bleeding you have mentioned, a scan and potential biopsy may be needed which we can easliy arrange for you in our clinic. Irreular bleeding can clearly adversely affect your day to day living, but there is definitely help available. It is important to speak to a practioner that listens, if you're comfortable with going private, you can book a consultation with me or my colleagues at London Gynaecology.

I am sorry that you feel you have been "written off" with your lichen sclerosis, but there is always help available. I often liken LS to eczema, it is always there and flares up intermittently and needs treatment using a potent topical steroid cream (Dermovate). LS can really adversely affect your day to day life and it is important any steroid cream is used correctly for the right period of time as it can also affect the vaginal skin and compound your problems. With LS the vagina may become really tight and painful when you have sex as you have described and I find the most helpful thing is to be seen by a women's health physiotherapist. Some women do need surgery so it is important to see a gynae specialist, Sapna Shah from our clinics would be a good gynae to book an appointment with at our clinics.Using plenty of lubrication is always important and sometimes vaginal oestrogen may aso be needed but again seeing a specialist first is always adviseable.

Your health is always a priority and you should not feel like you've been written off. I hope you get through this.