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.

Hi @stopthemud I'm sorry you've had such a difficult time with this, it sounds like it has been a long and frustrating journey.

Thyroid conditions can significantly affect periods and hormone levels, so it is possible that this was also contributing to your symptoms alongside the perimenopause. These two things can overlap and be difficult to disentangle, which can unfortunately make diagnosis more complicated.

I'm glad to hear you are feeling better on HRT. In terms of your vaginal dryness, this is very common and actually tends to develop later than other menopausal symptoms, often becoming noticeable 3 to 5 years after the menopause. It affects up to 70% of menopausal women, so unfortunately it is something that can occur regardless of when HRT is started- I don't feel that an earlier start would necessarily have prevented it.

The good news is that vaginal symptoms respond well to treatment. Vaginal lubricants can be used during sex to reduce discomfort, while vaginal moisturisers, used regularly every few days, help maintain comfort day-to-day. If these are not sufficient, local vaginal oestrogen available as a cream, pessary or ring works directly on the vaginal tissue to restore it and is safe to use alongside your other HRT. It would be worth discussing these options with a gynaecologist, who can help you find the right combination for you.

Hi @NeverDropYourMooncup I'm sorry to hear how much you have been struggling. You have clearly experienced significant pain as well as very heavy bleeding, and the feeling of not being listened to over a long period of time must be exhausting, and it is completely understandable that you want clear answers and a plan.

Adenomyosis is a condition where cells similar to the lining of the womb grow within the muscle wall of the womb, causing it to enlarge and leading to symptoms such as heavy bleeding, pelvic pain and a feeling of heaviness or pressure, which may explain the sensation you describe of carrying a football. Endometriosis, when tissue similar to the lining of the womb grows in other places in the pelvis, can often coexist with adenomyosis and has many of the same symptoms including pelvic pain and painful periods. Ultrasound is the first-line investigation for diagnosis, although some cases are only identified on a pelvic MRI or during surgery.

Regarding your MRI, an MRI performed for back pain is focused on the spine and surrounding structures, and the pelvic organs are often not the primary focus of the scan. This means that adenomyosis or endometriosis could easily be missed, particularly if the images were not reviewed with gynaecological issues in mind. The absence of a physical examination is harder to explain, and it would be entirely reasonable to raise this at your next appointment and ask for one to be performed.

In terms of what happens next, as you are experiencing very heavy and irregular bleeding while on HRT, the priority would be to assess the lining of the womb. A hysteroscopy, a procedure using a thin camera to look inside the womb, would be the next step to take a biopsy and any polyps or thickening of the lining of the womb can often be treated at the same time.

In terms of treatment, we would usually try less invasive options before considering surgery. These include hormonal tablets, medication to reduce blood flow such as tranexamic acid, or a Mirena coil, which can be used in place of the progesterone component of your HRT and is often very effective at reducing heavy and irregular bleeding by thinning the lining of the womb. A hysterectomy, with or without removal of the ovaries, is sometimes the right answer when other treatments have not helped and given your diagnosis and history this is definitely a conversation worth having with a gynaecologist.
Given how heavily you have been bleeding, it would also be worth asking for blood tests including a full blood count and ferritin level to check whether you have become anaemic and whether you need iron supplementation.

Finally, the itching and burning you describe sounds like it may be genitourinary syndrome of menopause (GSM), which is very common but it is important to have an examination to rule out other vulval skin conditions, such as an infection, dermatitis, eczema or lichen sclerosis which would need different treatments.

Hi @hannahp1209 Menopause is a natural stage of life that happens when your hormone levels fall and your periods stop. The average age is 51 to 52, though it can happen anywhere between 45 and 55. It is officially diagnosed after 12 consecutive months without a period. The time leading up to this when you may already be noticing symptoms but your periods have not yet stopped, is called perimenopause, and this can begin several years before your last period.

Menopause is a very individual experience. Some women sail through it with minimal issues, while others find it significantly affects their daily life. Symptoms can include hot flushes, night sweats, irregular periods, vaginal dryness and a change in libido. Many women also notice psychological changes such as low mood, anxiety, brain fog or mood swings. Other common changes include difficulty sleeping, joint pain, headaches and weight gain.

Hormone Replacement Therapy (HRT) is the most effective treatment for menopausal symptoms and works by restoring the hormone levels that have fallen. It is available in different forms including tablets, patches, gels and sprays, and can make a significant difference to quality of life for many women. For women who prefer not to take hormones, or if HRT is not suitable, there are also non-hormonal options that can help with specific symptoms.
The decision about whether to take HRT and which type is right for you is a personal one, and will depend on your symptoms, preferences and medical history. If perimenopause or menopause is affecting your quality of life, it is worth seeing a gynaecologist who can talk you through all of your options and help you find the best approach for you.

Hi @PaperTyger There is a very small increased risk of ovarian cancer associated with endometriosis. In the general population, the lifetime risk of ovarian cancer is around 1.3%, and for women with endometriosis this rises to around 1.8%. While this is a real increase, it is important to keep it in perspective, the vast majority of women with endometriosis will never develop ovarian cancer, and your lifetime risk remains less than 2%. To put this in context, the lifetime risks of breast cancer, bowel cancer and lung cancer are all considerably higher. It is also reassuring to know that the types of ovarian cancer most commonly associated with endometriosis tend to be detected at an earlier stage and have a better outlook than other types.

This small increased risk needs to be weighed against the risks of surgery to remove all endometriosis, which is itself not without complications. For most women, it is best to be aware of the risk without being alarmed by it, and to ensure that they seek advice if they have any new or unusual symptoms such as persistent bloating, pelvic pain, feeling full quickly after eating, change in bowel habit or needing to urinate more frequently.

I would recommend that you discuss this further with a gynaecologist to help you decide on the most appropriate management plan for your individual situation, taking into account your symptoms, your wishes and longer-term risks.

Hi @page17 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.

Your difficulty going to the toilet is likely related to the rectocele, a prolapse of the back wall of the vagina and possibly also to the fibroid, depending on its size and position. Physiotherapy is usually the first step for pelvic floor prolapse and can make a real difference. If further treatment is needed, other options include a vaginal pessary, which supports the prolapse without surgery, or a surgical repair. If surgery is eventually recommended, a hysterectomy is sometimes considered at the same time, particularly if the fibroid is also causing significant symptoms.

It is very common for periods to change in the years leading up to the menopause, but if yours are becoming longer or heavier it is worth seeing your doctor. Your recent scan will have given some useful information, but if symptoms continue the next step would usually be a hysteroscopy, a simple procedure where a small camera is passed through the cervix to look at the lining of the womb and a biopsy can be taken or if there is a thickening or polyp, it may also be removed at the same time.

Recurrent UTIs can be linked to prolapse, or to genitourinary syndrome of menopause (GSM), where falling oestrogen levels cause changes to the bladder and vaginal tissue that make infections more likely. This is very treatable, so it is worth raising with your gynaecologist to make sure you are getting the right treatment for you.

Hi @MrsKateColumbo Painful sex is very common and often very treatable, so it is worth getting it assessed rather than simply putting up with it.
Some women experience discomfort at the entrance to the vagina or with penetration- this can be caused by pelvic floor spasms, vaginal dryness, hormonal changes, or vulval skin conditions. Others experience a deeper pain during sex, which can sometimes be related to the position, or to conditions within the pelvis such as endometriosis, adenomyosis, fibroids or ovarian cysts. Using lubricant can help make sex more comfortable. If your symptoms are ongoing, it is worth seeing your doctor for an examination. Depending on what is found, an ultrasound scan may also be recommended to rule out any underlying causes. The right treatment will depend on what is causing your symptoms, and there are options available for most of the common causes.

Hi @TerrazzoChips An isthmocele, or a caesarean scar defect, is a small pouch or indentation in the muscle of the womb at the site of a previous caesarean section scar. This is a common finding on ultrasound, seen in up to 50 to 60% of women who have had a caesarean, and in many cases it does not cause any symptoms at all.

In some women, an isthmocele can be associated with light bleeding or spotting after periods, pelvic discomfort, or occasionally difficulty conceiving. However, most small defects do not cause significant issues, and many women with an isthmocele go on to have completely normal pregnancies without any intervention.

Treatment is considered if symptoms are troublesome or if there are fertility concerns that can’t be explained by other factors. Based on what you have described, your isthmocele appears to be small, which is reassuring, so it is very likely that you can carry a pregnancy successfully. Current evidence suggests that smaller defects are much less likely to affect fertility or pregnancy outcomes.

If you do become pregnant, I would recommend arranging an early ultrasound scan at around 6 to 7 weeks. This is to confirm that the pregnancy has implanted in the correct place within the womb rather than within the scar itself.

Hi @rhabarbarmarmelade I’m sorry this has been so uncomfortable for you. There are a number of possible causes for itching in this area. A common reason is contact dermatitis, where the skin becomes irritated by products such as soaps, shower gels, perfumes, or laundry detergents. Skin conditions such as folliculitis, eczema or lichen sclerosus can also affect this area and cause itching. In some cases, infections may be responsible, including yeast infections (thrush), pubic lice, or scabies. Hormonal changes, particularly lower oestrogen levels around the menopause, can also lead to dryness and itching of the skin as well.

It would be best to arrange an appointment with your GP or gynaecologist so the area can be examined and the exact cause identified, as treatment will depend on this.

In the meantime, general vulval skin care measures can help reduce irritation. I would recommend washing with water only (or a gentle, non-perfumed emollient if needed), and avoiding soaps, scented products, and shaving until things have settled. Wearing loose, breathable cotton underwear and keeping the area as cool and dry as possible may also help.

Hi @Generallychill Hyperparathyroidism can affect hormone levels, and there is some evidence that elevated calcium and parathyroid hormone levels may influence the menstrual cycle, so it is possible that this is contributing to your irregular bleeding. However, six months of irregular bleeding needs to be assessed in its own right, and it would not be right to assume this is the only explanation without investigating further.

I would recommend seeing your GP or a gynaecologist who will be able to carry out an examination, check for infection with a swab, and ensure your cervical smears are up to date. An ultrasound scan of the pelvis would also be helpful to rule out common structural causes of irregular bleeding such as fibroids, polyps or thickening of the womb lining. In the meantime, continue to keep a record of your bleeding, noting the dates, duration and heaviness as this will be helpful information to bring to your appointment.

I'm 55 and have been on continuous HRT for nearly 8 months now. I have had no period/withdrawal bleed at all in that time, but today I started bleeding again. I also had some breast tenderness last week, which I haven't experienced for quite some time. Is this bleeding a cause for concern?

Best thing in 2024 take out the ffff coil you put in 6 months ago for no apparent fibroid. Best thing of 2024 was watching that coil go into the waste bin.

2026 ladies periods are regular. I’m older and more regular when they put the ‘ coil in’

So not all gynaecologists are correct.

Hi, I have been put into a medical induced menopause (3 monthly prostap) due to enlarged uterus and either hyperplasia or adenomyosis. Plan is for ablation once uterus has shrunk. Since I was given prostap 2 weeks ago, the fatigue is horrendous and also my hand grip has weakened and I have muscle fatigue and aches and pains. Is this normal? Thank you.

Hi @Untrustworthybottom What you describe is most consistent with a mild rectocele (a medical term), where the rectum pushes into the back wall of the vagina, often becoming noticeable during bowel movements.
Your weight loss is unlikely to have caused this, but it may have made an existing weakness more apparent due to less pelvic cushioning. The more significant factor is your long history of constipation. Chronic straining over time can weaken the tissue between the rectum and vagina, leading to this type of bulge.
The term 'lax vagina' is not a formal diagnosis and in my opinipon should never be used! It may refer to some reduction in pelvic floor support rather than a definite prolapse.
Management focuses on avoiding straining by improving bowel habits such as adequate fibre, hydration, and possibly stool softeners. Pelvic floor physiotherapy can also help strengthen support and prevent progression.
If symptoms worsen or you notice a persistent bulge or difficulty emptying your bowels, a repeat examination would be advisable.

Hi @Alleycat1 This does not sound like anything to worry about but it can be very annoying I agree. It is true that after the menopause, reduced oestrogen levels often lead to thinning and shrinkage of the vulval tissues, including the labia minora, as part of genitourinary syndrome of menopause. However, there is considerable natural variation, and asymmetry of the labia is very common.
An apparent increase in size of one labium, particularly on one side, is most often due to normal anatomical variation or a change in tissue elasticity with age, rather than anything abnormal. In many cases, it has always been slightly larger and has simply become more noticeable over time.
A true change should be assessed if it is clearly progressive or associated with a lump, thickening, colour change, ulceration, or bleeding. In the absence of these things it is very unlikely to be anything concerning.
The chafing you describe is a common practical issue. Measures such as wearing well-fitting, supportive underwear, avoiding tight seams, and using a simple barrier emollient can be helpful. If the discomfort remains troublesome, a minor surgical reduction can be considered (but this can sometimes make things worse and not often recommended), although this is usually only necessary in more significant cases.

Hi @MonsterMunchforbreakfast I’m very sorry you’ve had such a prolonged and difficult history. Your symptoms are entirely consistent with significant endometriosis and adenomyosis, and the severe cyclical pain you now experience after ablation is sadly a very recognised pattern. The ablation treats the uterine lining but not disease within the uterine muscle or outside it, so pain can persist even without bleeding.
At 53 and still perimenopausal, your ovaries are likely continuing to produce fluctuating hormones, which drive both conditions and explain the ongoing cyclical nature of your pain.
HRT is not automatically contraindicated, but it does need to be used carefully. Oestrogen can stimulate residual disease, so if used, it should be in a continuous combined form with adequate progestogen. It does not usually restart bleeding after ablation, but it may not control pain if your ovaries are still active.
Your concern about hysterectomy is entirely understandable. However, in this situation it is often the most definitive treatment. I have performed many hysterectomies for women with adenomyosis, and the majority feel significantly better afterwards, particularly in terms of pain and quality of life. If you are considering HRT longer term, having had a hysterectomy can also simplify how it is prescribed. The risks of surgery are generally low in experienced hands, and in your case the potential benefits are likely to outweigh them. I wish you the best of luck.

Hi @Tiredhotmess Bleeding after a period of no bleeding on continuous HRT does need to be taken seriously, but it is quite often due to benign causes.

In the first 6 months of continuous combined HRT, irregular or breakthrough bleeding can be normal as the lining of the womb adjusts. However, any new bleeding occurring after 6 months should be investigated. In the UK, this would usually involve a 'two-week wait referral' to exclude underlying problems via your GP.

The breast tenderness you noticed beforehand suggests some hormonal fluctuation, which can sometimes trigger a bleed even on a stable HRT regimen.

In most cases, the cause is not serious. Nonetheless, it is important to rule out other causes, including polyps, thickening of the lining, or more rarely endometrial cancer. Please do make a GP appointment.

Hi @Letloose2024 It sounds like you’ve had quite a journey and I’m really glad you’re now feeling well. What you describe shows an important point: not every gynaecological procedure like an IUD is always needed and the effects can be very different for each woman. Sometimes a coil is put in for symptoms that later settle on their own. It’s also true that periods can become more regular naturally. Your story shows that while guidelines are helpful, every woman is different and not every intervention is necessary.