Cervical Screening Awareness and Recommendations: How To Make Your Smear Test More Comfortable

It is extremely important to attend regular cervical screening appointments and to adopt other preventive care such as having the HPV vaccination – both help significantly with cancer prevention.

Cervical screenings – more commonly known as a smear test – can be a painful experience, and we understand that for many women and people with a cervix, the expected discomfort may be discouraging. Our consultants and nurses have helped support thousands of people through this process over the past two decades – here are some tips to make your cervical screening more comfortable:

1. Listen to music or watch TV: Nowadays with smartphones, watching a movie or listening to music or a podcast is easy to do in any location. Take your headphones and your phone and get prepared to zone out. And don’t worry, if you do forget your headphones ask the nurse if she minds you watching or listening anyway.

2. Equipment: Ask, if available, for the nurse to use a plastic speculum or a small speculum. Plastic is often warmer than metal and it’s clear so it’s easier for the nurse to see the cervix and a smaller speculum is more comfortable. They aren’t always available but don’t be afraid to ask.

3. Count from 1 to 100: Paula Radcliffe used to use this strategy towards the end of her marathon and many patients have found it useful. Often the smear is done well before you get to 50.

4. Paracetamol: Take a dose of paracetamol 30 minutes before your smear which will take some of the discomfort away.

5. Numbing gel: If all else fails, ask the nurse to use a small amount of numbing gel. Previously there was a concern that the gel would affect the smear cytology but with liquid based cytology which is used nowadays a small amount of gel will not interfere with the quality.

6. Vaginal oestrogen cream: If you have vaginal dryness symptoms linked to breast feeding or menopause ask for local vaginal oestrogen cream. This can make a smear test much more comfortable and is a very safe treatment. It can be stopped 2 days prior to the smear test. In addition to, or as an alternative to, local oestrogen, using a good pH-balanced vaginal moisturiser several times a week can be very beneficial such as YES vaginal moisturiser.

7. Practicing with a speculum: If you are concerned about the speculum, why not ask your practice nurse if you can try one out at home to get used to the sensation.

8. Communicate: If it feels uncomfortable or you feel worried at any point during your smear, ask the smear taker to stop. We can go at your pace.

9. Relax: Try taking slow and deep breaths which can help to relax your pelvic muscles. Find a technique that works for you – mindfully changing your breathing patterns can improve relaxation which in turn will help to make the appointment smoother and quicker.

10. Ask for specialist care: For anyone who has experience trauma or FGM often referral to a specialist service is best. Your healthcare provider will be able to arrange this for you. It is reasonable to ask for adjustments when you have a cervical screening although many are unaware that their tests can be slightly altered – as highlighted by The Eve Appeal.

In general, there remains a knowledge gap and lack of understanding around what a cervical screening is for and how it can help.

People with a cervix aged from 25 to 64 are offered the NHS cervical screening programme in England and routine screening is offered every 3 years up to the age of 49; every 5 years for those from 50 to 64 years old.

The NHS Cervical Screening Programme, England 2023-2024 annual report, published in November 2024 by NHS England, showed:

Only 63% of 5.12 million individuals invited to book an appointment were tested.
31.2% of 25 to 64-year-olds were not screened within the recommended time.
For the 2023-24 period, there was a 1.8% increase in referrals (approximately 250,000) to colposcopy considering all ages and referral reasons.

Even if you have been vaccinated against HPV or think that you have not seen or experienced any symptoms, it is still important to attend cervical screening appointments.

We encourage anyone whose test is overdue to book their appointment. If you have any questions or need further information, London Gynaecology can help.

Menopause and Testosterone Therapy

While it’s a common misconception that testosterone is exclusively a male hormone, women also produce testosterone from their ovaries and adrenal glands before entering menopause. Testosterone serves a pivotal role in various aspects of female health, including sexual function, muscle and bone strength, cardiovascular well-being, cognitive function, and energy levels. As women age, testosterone levels may gradually decrease, or a more abrupt decline can occur if a woman undergoes ovarian removal.

As part of your menopause consultation, testosterone can be discussed if you wish. There are a few different types of preparations that we might use, depending on your symptoms and preference.

A full assessment of your symptoms with your doctor is required prior to treatment, along with blood tests prior to starting testosterone treatment. Monitoring is then advised four-monthly.

Click here to book a menopause consultation.

Postpartum Hair Loss

Welcoming a new life into the world can be a magical experience, but the changes your body goes through afterward can sometimes be surprising. One common occurrence, often not discussed as openly as it should be, is postpartum hair loss. Let’s explore further.

What should I be expecting?

Between 6 to 12 weeks after giving birth, many women experience a noticeable increase in shedding hair. This reduction might make the hair feel thinner, especially around the crown and near the hairline. Moreover, the sudden change in hormones can also affect the texture, making it feel drier, more brittle, or lacking in its usual lustre. In some cases, the hairline might appear to recede temporarily due to the shedding of hair around the frontal area.

These changes, whilst understandably alarming for some, are typically temporary and usually resolve in 6-12 months.

Why Does Postpartum Hair Loss Happen?

Hormonal shifts following childbirth can affect the hair growth cycle. During pregnancy, soaring Oestrogen levels keep hairs growing, resulting in fuller, thicker hair. However, after childbirth, hormone levels normalize, and the hair follicles that were kept in the growth phase (anagen) start to enter the resting or shedding phase (telogen) all at once. It’s not necessarily an increase in hair loss but rather the catching up of the natural shedding process, and so it can seem scary at first.

Apart from hormonal changes, physical and emotional stress, nutritional deficiencies, your genetics and your general lifestyle also contribute to postpartum hair loss. To summarize, it’s often multi-factorial!

Tips for Coping with Postpartum Hair Loss

Wondering by about the best methods to optimize your hair’s health? Let’s deep dive.

1. Nutrition Matters: Re-vitalize your hair health by adding Zinc-rich foods like oysters and pumpkin seeds, Iron sources such as spinach and red meat, Vitamin D from sunlight or fish, and Vitamin B3 and B12 found in chicken, mushrooms, dairy, and fortified cereals. Incorporating protein such as in fish, along with healthy fats found naturally in avocados and olive oil will also support your hair follicles. This diverse range of nutrients supports overall hair vitality and growth.

2. Consider Supplements: Multi-vitamin supplements containing the above can complement your diet if you are lacking, and can help support your body during this time.

3. Manage Your Stress: Be kind to yourself and prioritize stress reduction and adequate sleep. Stress is a well-known cause of hair loss. Don’t be afraid to call on those around you for support – motherhood isn’t easy! These small tweaks can positively impact overall wellbeing, including hair health.

4. Care For Your Hair: Opt for volumizing shampoos or products – whilst they won’t stop shedding, they’re designed to add volume and thickness to your hair, giving it a fuller appearance. Try to avoid oilier or conditioning shampoos as these can flatten your volume! Be gentle on the scalp when brushing and washing, and avoid tight hairstyles that add extra strain to the scalp. Sometimes, trying out a new haircut might give you the lift you need – it might even help the new regrowth blend in more (plus the added benefit of less yanking from baby!).

When should I seek help?

Remember, postpartum hair loss typically resolves on its own within a year. However, if you notice excessive hair loss beyond this timeframe, or you’re concerned about your scalp health – or you just want some advice before then, seeking help from a healthcare professional can provide that reassurance and guidance.

Be particularly on the lookout for when loose strands of hair accidentally wrap around your baby’s fingers or toes, as they can be quite constricting! Thankfully it’s very rare, but it’s always safer to remove any loose hairs around your little one.

Where can I seek further support?

At London Gynaecology, you can consult with an experienced GP who can explore your concerns holistically, examine your scalp for any treatable skin conditions, and together you can create a treatment plan. Additionally, our specialized Nutritionist can offer personalized dietary advice to support your hair health.

It’s important to embrace patience and self-care during this phase of postpartum changes. We need to acknowledge and talk more about the physical changes that many women experience, and whilst hair loss can be concerning, it’s often a temporary phase in the tumultuous journey of motherhood. But remember, you are never alone, there will always be support if you seek it!

Written by: Dr. Alisha Esmail

Can HRT Be Used For Contraception?

A common question is whether hormone replacement therapy (HRT) can be used as a contraceptive. HRT is used as a treatment for the symptoms of the perimenopause and post menopause. It contains very low doses of hormones and as a result it cannot be used as a contraceptive. It is worth remembering that you can still get pregnant in the perimenopause, so it is important to discuss a method of contraception with your doctor.

If you are using HRT and depending on the type you are using, the progesterone only pill or the Mirena coil can be used safely.

Our New Harley Street Clinic Is Open

Step into a world of exceptional healthcare at our brand-new location in the heart of London ‘s medical district at 145 Harley Street, W1G 6BJ. We are delighted to welcome all patients seeking excellent medical care in a luxurious setting.

Our state-of-the-art clinic, where advanced diagnostics and comprehensive services meet elegance, is equipped with cutting-edge medical diagnostic technology has been carefully designed to provide patients with the utmost comfort and convenience in a luxurious and relaxed setting.

Your journey to exceptional women’s health begins at 145 Harley Street.

What to Expect in a Private GP Appointment?

If you have never visited a private GP before, you may be unsure of what to expect. Below outlines what a private GP consultation typically comprises of:

Medical history: We will begin by taking a detailed medical history, which includes information about any pre-existing medical conditions, allergies, medications, and previous surgeries.
Physical examination: We will carry out a thorough physical examination, which may include checking your observations, such as blood pressure, temperature, and pulse. We may also examine your ears, nose, and throat, listen to your heart and lungs, and check your reflexes.
Health concerns: You will have the opportunity to discuss any current health concerns or symptoms that you are experiencing. We will ask you questions to help determine the underlying cause of your symptoms.
Diagnosis and treatment plan: Based on your medical history, physical examination, and symptoms, we will diagnose your condition and develop a customised treatment plan. This may include prescribing medication, recommending lifestyle changes, or referring you to a specialist for further investigation or treatment.
Follow-up care: We may schedule follow-up appointments to monitor your progress and adjust your treatment plan, if necessary.
Additional services: We offer additional services, such as health screenings, diagnostic tests, and vaccinations, which can be arranged during your consultation or at a later date.

Menopause and Anxiety

Does menopause cause anxiety?

Anxiety is a common perimenopause symptom and can often be one of the first symptoms that you might notice. For some women, this is the first time they have experienced anxiety whilst for others, they may have experienced it before, and their anxiety has worsened. Anxiety can manifest as a feeling of fear, panic, feeling overwhelmed or a general feeling of worry.

Hormone fluctuations and our stress responses can make the anxiety worse, so it is important to take the time to look after yourself and manage your stress levels wherever possible. Yoga, mindfulness and relaxation therapies can help and there are various apps which can support you through some meditation practices.

Hormone replacement therapy may be used if it is felt that hormone fluctuations are contributing to your anxiety. It is also worth noting that some anti-anxiety medications can be extremely helpful too.

Cognitive behavioral therapy (CBT) can also be beneficial in the peri/menopause and is based around talking therapy. There is lots of evidence that it can be helpful in managing hot flushes too.

A holistic approach is key.

Menopause Symptoms

What menopause symptoms might I have?

No two women are the same when it comes to menopause symptoms. However, we do know that we have oestrogen receptors in every cell of our body so it is possible that the fluctuating levels of oestrogen can provoke a wide variety of menopause symptoms.

Not all women will experience all of these menopause symptoms, but common ones include:

Hot flushes
Night sweats
Insomnia
Low mood
Panic attacks or anxiety
Feeling tense or nervous
Heart beating quickly or strongly
Loss of feeling in hands and feet
Breathing difficulties
Vaginal dryness and itching with painful intercourse
Wanting to pass urine often
Hair loss
Formication (a feeling of insects crawling on your skin)
Crying spells
Loss of interest in most things
Irritability
Feeling dizzy or faint
Parts of the body feeling numb or tingling
Joint pains and muscle aches
Loss of interest in sex
Muscle and joint pains
Headaches including worsening migraines
Poor concentration
Feeling tired or lacking in energy
Urinary urgency
Hair and skin changes
Dry eyes/dry mouth
Weight gain

Menopause and Migraines

What are migraines?

Migraines are severe and recurrent headaches which can have a significant impact on a person’s quality of life. They are often accompanied by other symptoms such as visual disturbances, nausea and vomiting, sensitivity to light and sound, irritability, fatigue and malaise.

What how can menopause affect migraines?

From the early 40s, the menstrual cycle can become more erratic, with fluctuations in oestrogen levels, leading to more frequent migraines. As these fluctuations lessen in the run up to the menopause and beyond, some women may find that their migraine improves after the menopause.

What are the options for migraine treatment during menopause?

Here are 7 possible treatments for migraine sufferers during the menopause.

Hormone Replacement Therapy (HRT): Some menopausal women may benefit from HRT, which can help stabilise hormonal fluctuations and reduce the frequency and severity of migraines. If you have migraines with aura (changes to your vision) it is often advised to use oestrogen which is delivered through the skin, as there is no increased risk of blood clots when it is given this way. Your doctor will be able to discuss and individualised treatment approach with you.
Lifestyle Modifications: Lifestyle changes can play a crucial role in migraine management. This includes maintaining a regular sleep schedule, staying hydrated, managing stress, and avoiding trigger factors (for you) like certain foods, alcohol, and excessive caffeine.
Medications: Your healthcare provider may recommend migraine-specific medications, such as triptans, nonsteroidal anti-inflammatory drugs (NSAIDs), or preventive medications like beta-blockers, calcium channel blockers, or antiepileptic drugs. The choice of medication depends on the frequency and severity of your migraines and of course, your preference.
Complementary Therapies: Some women find relief through complementary therapies like acupuncture, chiropractic care, or herbal supplements. Be sure to consult with a healthcare professional before trying these approaches.
Dietary Changes: Maintaining a healthy diet and identifying and avoiding trigger foods can be helpful. Common migraine triggers include aged cheeses, processed meats, and foods with artificial additives. Alcohol again can be a trigger for some.
Exercise: Regular physical activity can help reduce the frequency and severity of migraines. However, it’s essential to find an exercise routine that suits your individual needs and doesn’t trigger migraines.
Tracking Migraines: Keeping a migraine diary can help identify patterns and triggers, which can inform your treatment plan.

Menopause: When to Stop Contraception

The decision of when to stop contraception during menopause can vary depending on your individual circumstances and preferences. Menopause is defined as the cessation of menstruation for 12 consecutive months and is technically one day in time. It is important to understand that pregnancy can still occur during the perimenopausal transition, as ovulation can be irregular.

If you are over 50 and your periods have naturally stopped for 12 months or more, you can usually stop contraception. This only applies if you are not using additional hormonal medication.
If you are under 50 you can stop using contraception if your periods have naturally stopped for 2 years. Again, this advice only applies if you are not taking additional hormones or using the Mirena coil.
At the age of 55 you can usually stop using contraception as natural conception at this time is very rare.

If you are using the combined contraceptive pill and you have withdrawal bleeds these are occurring because of these hormones rather than your own cycle. Because these methods give an ‘artificial bleed’, you are not able to tell where you are in the menopause transition or if your periods have naturally stopped.

Some women using the progesterone only pill, progesterone implant or hormone-containing coil may not have regular bleeds which can make it difficult to know when the menopause happens.

If this is the case, your doctor can carry out a blood test to check your follicle stimulating hormone (FSH) level. This blood test can be useful in helping you work out when to stop using contraception. Speak to a doctor to arrange this, and for advice on how to interpret the results. If you would like to discuss menopause or when to stop contraception with one of our menopause specialists, click here,