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

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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.

Prolapse is one of the commonest issues affecting women, especially if you have had vaginal deliveries. Thankfully many are asymptomatic and not all need treatment. From what you have mentioned, your prolapse is not bothering you therefore I would agree to leave it alone but that does not mean doing nothing. We all need to do pelvic floor exercises forever more, as tedious as they may be! With age, the prolapse is likely to worsen, especially around peri-menopause and following menopause. This does not mean you definitely need surgery, sometimes a more simple pessary may be enough.

We have many great urogynaecologists who would be happy to see you and assess the prolapse at anytime if you are concerned. The same applies to the 'skin tags' you mention, it is difficult to advise without seeing any lesion directly, but given you have had them for some time and one has recently fallen off, they are unlikely to be anything concerning.

I am sorry to hear you are experiencing this issue with sex and would recommend you see a women's health specialist physiotherapist who can assess your pelvic floor as sometimes the muscle may be hypertonic (over contracted) and you need to retrain them to relax. I am not sure if there may be any other issues that may need addressing but often psychosexual counselling is also helpful. This is not to say the pain in in your head, but they can explore any potential underlying causes and teach you breathing and relaxation techniques which can help.

Our periods often do change over time especially after we have had children or if we have significant changes in our weight, and is usually not concerning. a regular cycle is considered to be between 21-35 days, e.g. not always a 28 day cycle. A common reason for periods becoming more prolonged includes PCOS which we can do blood tests and a scan in our clinic to help diagnose and manage. A scan is also help to rule our any cysts which can cause discomfort and pain on one side compared to another. In terms of ovulation, we usually ovulated from alternate ovaries and some women are very sensitive and experience pain and can tell which side they have ovulated from. Medications such as the combined pill may help with ovulation pain and we would be happy to assess you if felt you wanted to be seen.

Irregular bleeding before your period may be something simple as fluctuations in your hormones given your age and potential peri-menopause. Having said that, there can be other causes such as a polyp (overgrowth of tissue similar to a skin tag within the lining of the womb, usually benign) and given the extent of the bleeding you have mentioned, a scan and potential biopsy may be needed or removing a polyp if identified, all of which we can easily assessed and arranged for you in one of our clinics. Please feel free to call us at 0207 101 1700 to book in a private consultation, if you would like to get this checked further

Pain during periods which also involves the bowls can be a sign of endometriosis or adenomyosis which are very similar in presentation and management is the same to a large extent. It is unusual that you seem to suffer from pain every thrid cycle and not every cycle but I do not feel that this is concerning. Mananging gynaecological conditions inevitably involves using hormonal treatment although sometimes surgery may also be needed. If you are keen to look into this further, we would be happy to see and assess you in one of our clinics where we can also perform an USS to see if there are any other causes for pain or features to suggest endometriosis or diagnose adenomyosis.

I would suggest other casues for hip and back pain are excluded first before attributing the pain to peri-menopause or menopause. Your GP should be able to do this and may need to arrange x-rays or refer you to bone speacialist doctors (orthopaedic doctors). Other things to consider are vitamin D levels and if you are not doing so already, to take the recommended dose of 25mcg daily. Once other causes have been ruled out, your HRT dose may need adjusting. We have many menopause and HRT specialists who would be happy to help you.

You are right in that not all cysts cause symptoms, indeed many of us will have cysts throughout out lifetime and not know about it! Cysts that are larger than 5cm are more likely to cause discomfort for pain, and especially severe acute pain if they twist or burst depending on the type of cyst it is. Other times smaller cysts can also be painful especially if they bleed into themselves (haemorrhagic cysts). It is great that your cyst has spontaneously resolved. Once your periods stop for at least a year you are then deemed to be menopausal and your ovaries stop working and shrivel up and usually become very difficult to see on scan. Occassionally we may find cysts in menopausal women which are usually incidental, as in your case, and as long as there are no concerning features and it is less than 3cm, there is not cause for concern and no further scans or follow up is needed. If you are ever concerned or are having symptoms, please do reach out to the clinic who would be happy to see you.

HRT is really helpful for most women but sometimes it takes time to figure out the right combination of HRT and for some women and this can take time. Starting HRT is such an individual and personal reason that it difficult to advise whether or not to stop without a full assessment. From what you have mentioned, if the lining of the womb is thickened for your type of HRT, I would strongly advise that you have a full assessment urgently as advised by the gynaecology team which should involve a biopsy. This is to ensure that there is no other cause for the bleeding other than the HRT. We are also able to do a biopsy and further assess you and your need for HRT at one of our clinics and we could also discuss other forms of progesterone that may help with the bleeding if you are planning to continue HRT.

Unfortunately, no form of contraception is 100% effective! Having said that, the coil is one of the more reliable forms of contraception with a low failure rate of less than 1% per year. If you were to get pregnant with a coil in place, there is a low risk (1 in 1000) of a pregnancy outside the womb (ectopic pregnancy). This is because the coil is most effective at preventing a pregnancy inside the womb. If you were to become pregnant with a coil, you would need to be seen to have a scan and then discuss the implications and potential risks to a pregnancy in the womb.

I am sorry to hear that you are having such difficulties but unfortunately this is not an uncommon issue that many women may face over time. Ovesse and similar are definitely helpful in increasing the lubrication of the vaginal and should help with smears and sex etc. If you find Ovesse or similar is helpful, you can continue to use is every night long-term. Other things to consider are an overactive pelvic floor and need for vaginal dilators - seeing a women's health physiotherapist would be a good idea.

Is there a heightened cancer risk leaving endo

@BaljinderLondonGynaecologySpecialist
Thank you for your reply, very helpful. I am going to look into that.

@BaljinderLondonGynaecologySpecialist

hello,

I am 49 and they found a large fibroid at an ultrasound last week. I also have a Rectocele for which i am waiting physio. I have to splint to go to the toilet, am getting uti’s and long periods. What do you think is the best approach here and what will the NHS suggest?

Hello
I'm nearly 40 and have always found sex a bit painful, like in my ovary area if the guy is a bit thrusty/large. I went to the dr before who said it was normal/do lower depth positions. It's not really got in the way of anything as it's still more pleasurable than painful but there is always a fairly significant accompanying pain if im underneath. I've tried to compare with friends but still cant tell if it's normal or not?

I have a 6x3x9mm isthmocele with 8mm residual myometrium. Am I likely to be able to carry a pregnancy without correcting it?

My mons pubis, if that's what the hairy bit below stomach is called, is sometimes so unbelievably itchy I need to scrape it with sharp implements (nails are all bitten). I can't see any spots or psoriasis style lesions - though there may be small bumps. No cream helps. What is it? What can I do?

Im 36 and have recently been diagnosed with hyperparathyroidsm, and am waiting on a surgery appointment to remove a mass in the thyroid. I'm on cinacalcet for high calcium in the meantime. So not sure if this is relevant but for the last few months I've been having excess periods. Since October Id say I have about 2 a month, however I only started properly tracking recently and have had my period on the 14th Feb, 26th Feb and 10th March.
Is this something that I need to get checked out or will it sort itself out when I have the surgery?

I have suffered from low level constipation for many years. I have recently lost 3 stone and now notice that my bowel movement seems to push into the wall of my vagina. Will my weight loss have contributed to my “lax” * vagina?

*As described by a gynaecologist when I asked if I had any sign of a prolapse

Thanks so much to everyone who shared a question with the London Gynaecology specialists, and to the experts for their answers so far. The experts are working on their final answers this week, so don't worry if your question hasn't been answered yet!

The winner of the prize draw is @MonaJo - congratulations!

Thank you, what a lovely surprise 😳

I always understood that labia minor atrophied after the menopause? I have the opposite problem as one (on the left) has grown and is now about half an inch longer. Should I be concerned? It is annoying as it can cause chafing when I wear trousers.
Thank you.

Not sure if it’s too late for an answer? I have been suffering from gynae issues since my late teens (very heavy periods, extremely painful ovulation and bleeding during ovulation). Over the years I’ve had several US scans and an D&C and was always told it’s just one of those things that some women experience.

During my late 30’s my periods became very heavy. I was referred to the local gynae department in 2011 and have been a patient ever since. Several hysteroscopies later and a myosure procedure didn’t help and I was still suffering from a thickened uterine lining and very heavy bleeding (ferritin of 3 for almost 10 years). So in 2022 I opted for a uterine ablation which stopped the heavy periods but within 6 months each period was agony and continues to be so even though I no longer bleed. I asked for a mri late 2023 which revealed deep endometriosis and diffuse adenomyosis. I was 50 and no one had ever suggested endo previously despite me telling them my sister has it.

Now under a endo gynae at the same hospital and awaiting a hysterectomy which I don’t really want as I’m terrified of surgery.

My question is that I am now 53 and still in perimenopause and have been for 8 years. I am still experiencing a cycle although no longer bleed due to the ablation but each ‘period’ is agony and I dread it coming. I would like to try hrt as I have so many debilitating peri symptoms but I’m scared the hormones will exacerbate the endo and adeno pain and will encourage ‘bleeding’ as I’ve read hrt can bring on a period. My gynae has zero interest in hrt or menopause and my GP isn’t helpful as she says my issues are complex. I can’t afford private treatment so no idea where to turn for advice.

Any advice would be most welcome.

Hi @CassandraWebb Myasthenia Gravis (MG) can worsen around the time of menstrual periods, often in the few days leading up to menstruation, and can persist into the first few days of the period. This is thought to be related to the natural fluctuations in hormone levels during your cycle, although the exact mechanism is not fully understood.

One option to address is to adjust your MG medication in the days before your period- your neurologist can advise whether this is appropriate for you and how to do this safely.

Another option is the combined contraceptive pill (the ‘combined pill’), which works by smoothing out the hormonal fluctuations that may be triggering your flares. The evidence for this is mixed, but some women find it helpful. It can be taken back-to-back, for example for 3 packs without the usual 7-day break, or continuously, which avoids the hormone drop that can coincide with symptom worsening.

The combined pill is not suitable for everyone. Your doctor will need to check that it is safe for you before prescribing it, taking into account factors such as your weight, smoking status, migraine history, and any personal or family history of blood clots.

You could also consider a Mirena coil, which has the benefit of making periods much lighter, or stopping them entirely. The hormone in the Mirena coil acts locally and thins the lining of the womb but may not stop ovulation so will not necessarily prevent the hormonal fluctuations that can trigger MG worsening. There is no direct evidence that it helps but it is an option you may want to explore further.

If you are unsure which option is right for you, a discussion with both your neurologist and a gynaecologist is a good idea.

Hi @whoTFismadelaine I’m sorry you’ve been suffering with your symptoms and had also had so many difficulties with smear tests. Having a retroverted uterus is a normal anatomical variation but can make examinations more difficult. It is also possible that your fibroids are contributing to the position of your womb, depending on the number, size and where they are located in your womb.

If your family is complete and your fibroids are large or pressing on your other organs, a hysterectomy could definitely be considered. However, I think it is worth checking if your pain, bloating and bladder issues are linked to your uterus and fibroids rather than something else such as your bowel or a condition like endometriosis, which can also cause these symptoms and is more common than people realise.
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If you haven’t had a recent pelvic scan, it would be worth having that done in the first instance and then making a plan with a gynaecologist about next steps.

Hi @StickChildNumberTwo Fibroids are benign (non-cancerous) muscular growths in the womb and are very common, affecting up to 70-80% of women at some point in their lifetime. They can vary in number, size and location, and symptoms vary widely- many women have no symptoms at all, while others experience heavy periods, pelvic pressure, bloating or back pain. They are hormone-dependent, which means they tend to shrink after the menopause, although they do not necessarily disappear completely.

When fibroids are not causing symptoms, treatment is not usually needed. I would recommend an ultrasound scan every 18 months or so to monitor your fibroid and check it is not growing significantly.

Regarding your spotting, whilst fibroids can occasionally cause irregular bleeding, spotting between periods is not always directly related to them and it is important not to assume that is the cause. Irregular spotting can have a number of other explanations, including hormonal changes, a cervical or uterine polyp, or changes to the lining of the womb that are worth excluding. For this reason, if the spotting continues or recurs, I would recommend seeing a gynaecologist for an examination, a swab, and possibly another scan. It is also worth making sure your cervical smears are up to date.