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Endometriosis is a UTI – What is going wrong?

Mr Hemant Vakharia, consultant gynaecologist and advanced laparoscopic surgeon at London Gynaecology, worked on the Refinery29 article providing insight on the problem of misdiagnosing Endometriosis for a UTI.

Why are UTIs a common misdiagnosis when someone has endometriosis?

The bladder, uterus, ovaries and bowel are situated very close together in the pelvis and endometriosis symptoms can often be incorrectly attributed to these other structures. We commonly see patients who have been diagnosed with irritable bowel syndrome who ultimately are found to have endometriosis. Similarly, patients with endometriosis who suffer with lower abdominal pain are told they have a UTI. In addition, endometriotic deposits can affect the bladder and in some cases go all the way through the wall of the bladder. This can result in pain when passing urine or when the bladder is full and these can also be symptoms of a UTI. Some patients can also experience blood in their urine which can both be a sign of endometriosis or a UTI.

What should patients be doing to have their symptoms investigated further?

Patients who suffer with severe period pain, pain with intercourse, pain opening their bowels or passing urine should see their GP and asked to be referred to an endometriosis specialist. We know that endometriosis can be difficult to identify on scan and therefore assessment by an endometriosis specialist is really important to get a diagnosis. We also know that in some cases patients may be taken seriously so if their symptoms are persistent and severe it is important to ask for a referral to a specialist.

What’s the impact of having antibiotics when you don’t need them, as is often the treatment for UTIs?

Taking antibiotics in the absence of an infection can lead to antibiotic resistance developing which can mean in the future there may be more bacteria resistant to antibiotics. Additionally antibiotics can affect the good bacteria in your body leading to patients developing other problems like thrush or bowel symptoms.

We know women’s health issues often take longer to diagnose, is this just another example of a wider problem in the medical space?

In 2020 the All Party Parliamentary Group (APPG) published a report on their inquiry into endometriosis. It showed that average diagnosis times for endometriosis have not improved in over a decade – it still takes 8 years on average to get a diagnosis. Prior to getting a diagnosis and with symptoms:

58% visited their GP more than 10 times

43% visited doctors in hospital over 5 times

53% visited A&E;

I think there are a number of reasons which include the need for more education on the subject and the need to take patients seriously. Dismissing severe period pain as ‘normal’ should be consigned to the history books. Menstruation can also be a taboo subject in some cultures and patients may be reluctant to seek help.

Periods which are very painful that limit your quality of life should not be regarded as ‘normal’ and there are lots of things that can be done to help patients in this situation. Early referral and investigation is essential and educating patients, employers and the general public will help patients to have the confidence to seek help sooner. Additionally, increased awareness of endometriosis in primary care physicians through education will also lead to prompt specialist referral.


Click here to view the full article.

Premenstrual Dysphoric Disorder (PMDD)

Dr Claire Phipps, GP and advanced menopause specialist at London Gynaecology, helped with the Indy100 article on PMDD.

What do we know about PMDD?

PMDD stands for Premenstrual Dysphoric Disorder. PMDD is the most severe form of PMS and is characterised by severe psychological and physical symptoms. The feeling of anxiety and depression is more intense, and some women may even feel suicidal. Behavioural changes with PMDD may affect your work and relationship to a significant degree.

The underlying basis for premenstrual syndrome/PMDD and the mood related changes that are associated are to do with fluctuating levels of hormones. Some women are thought to be especially sensitive to these changing levels particularly in the luteal phase of the cycle (the two weeks prior to a period). These changes happen due to ovulation and the hormone changes that this brings about. With ovulation, the ovaries produce increasing levels of progesterone and oestrogen levels go down. This is thought to affect the serotonergic pathway in the brain leading to mood related symptoms.

Most women get some symptoms during the premenstrual two weeks phase. Around 20-30% of women will get significant PMS symptoms and the prevalence of PMDD is estimated to be 5-8% in menstruating women.

What are the common PMDD symptoms?

· Mood swings with feelings of extreme anxiety, sadness and increased irritability

· Depression with feeling of hopelessness

· Aggressive angry feelings

· Decreased performance in work and sports

· Lack of concentration and inability to perform to usual standards

· Poor quality of sleep

· Physical symptoms including abdominal cramps, headaches, breast tenderness and hot flushes

Why is PMDD so difficult to diagnose?

Many women notice these symptoms but may take some time, sometimes years, before making the association. It encompasses a spectrum of symptoms, which can make diagnosis and the connection with periods difficult.

Mood disorders, such as major depression and bipolar disease can also worsen during the premenstrual period and can mimic PMDD and make the diagnosis tricky.

PMDD was included in the DSM (The Diagnostic and statistical Manual of Mental Disorders) in 2013 and research published in 2017 found a genetic basis for the unusual sensitivity of people suffering from PMDD to oestrogen and progesterone. As you can see this is all quite recent and the lack of consensus and knowledge leads to problems with misdiagnosis.

How can someone get a formal diagnosis if concerned?

If you are worried about your symptoms it is imperative that you speak to a healthcare professional. Ask your GP surgery if there is someone who specialises in this area.

Crucial to aiding the diagnosis of PMDD is the logging of symptoms, ideally for 2-3 cycles. This can seem frustrating, especially when you are feeling bad, but it will help your diagnosis. Symptom questionnaires can be found at and the NAPS site (National Association for Premenstrual Syndromes) is a valuable resource.

What tends to be the treatment options for PMDD?

PMDD can be severe and can have a significant impact on a person’s quality of life. Recognising the symptoms and diagnosing the condition can help individuals and healthcare professionals work together to develop strategies to manage the effects of PMDD and therefore improve their quality of life.

Medications can help to address some of these symptoms, as can diet and lifestyle changes. Alongside this, recognising PMDD allows individuals to become more aware of their own physical and emotional patterns, helping them anticipate and prepare for the challenging times associated with the disorder.

When thinking about treatment for women suffering, it’s important to be aware of some of the most common risk factors for PMDD, these include:

· Stressful lifestyle

· History of depression and anxiety

· Obesity with BMI more than 30

· Smoking

· Age: Women between 20 to 35 years have stronger ovulation and have more symptoms

· Genetic risk factors

Doctors may suggest going on the contraceptive pill which evens out the hormonal levels by blocking ovulation. This is often useful in reducing PMDD symptoms. It is helpful to be aware of when the symptoms may start and to have a supportive family and colleagues.

Reducing stress through lifestyle changes is helpful and avoiding stressful situations at work and home. Mindfulness, yoga and meditation are also known to provide comfort. Avoiding caffeine, sugar, smoking and alcohol can also help. Getting 8 hours of sleep with regular exercise and balanced diet is very important. Managing physical symptoms through painkillers can also help the severity of psychological symptoms. Taking B-6 Pyridoxine vitamin and Evening Primrose Oil tablets (both available over the counter) during this two-week window can be helpful.

If the symptoms are affecting your well-being, quality of life, work or relationship, it is important to see your GP or a gynaecologist. PMDD symptoms occur up to two weeks before the period. Symptoms start with onset of ovulation and improve with menstruation. It is helpful to keep a menstrual diary of symptoms which will help your healthcare professional tailor treatment to suit your needs and assess the severity and cyclical nature of your symptoms and is an important part of the diagnosis.

Sometimes, interventions such as CBT (Cognitive Behavioural Therapy) may be helpful. For severe mood-related symptoms, your doctor may suggest SSRI (selective serotonin reuptake inhibitor) medication which also works as an anti-depressant.


Click here to view the full article.

Insights on Irregular Periods

Mr Hemant Vakharia, consultant gynaecologist and advanced laparoscopic surgeon at London Gynaecology, worked on the Mother&Baby article providing some insights on irregular periods.

What are the causes of irregular periods?

When it comes to menstrual cycles, every woman’s experience can be a bit different. It’s normal for the time between the start of one period and the next (we call this the cycle length) to vary from 21 to 42 days. Lots of things can influence your cycle, including your age, weight, birth control methods, whether you’ve been pregnant, if you’re breastfeeding, and if you’re approaching menopause. These factors can all affect your hormone levels, which might lead to changes in your period.

It’s pretty common for periods to be irregular, especially during your teenage years. This is because ovulation (when an egg is released from the ovary) isn’t happening on a regular schedule yet. It usually takes until your early 20s for things to settle down and for your periods to find a regular rhythm.

A late period is often no big deal and can happen for many reasons, like stress, traveling, slight hormone shifts, or sometimes for no clear reason at all. If your period is more than a week late, it’s considered ‘late,’ and here are some reasons why this might happen:

Can irregular periods happen after birth?

Typically, your period will come back around 6 to 8 weeks after you’ve had a baby. However, if you’re breastfeeding, the timing for your period to return can differ. For mothers who are breastfeeding exclusively, periods might not resume until they stop breastfeeding. But for some, periods may start again sooner. Because of this inconsistency, relying solely on exclusive breastfeeding as a method of birth control isn’t advisable.

What about irregular periods during perimenopause?

Claire Phipps, GP and menopause specialist at London Gynaecology: “The perimenopause is characterised by fluctuating levels of the reproductive hormones, particularly oestrogen and progesterone. These wild fluctuations disrupt the natural regulation of the menstrual cycle and can lead to irregular periods.”

“Overall irregular periods during the perimenopause are due to the decline in hormone production.”

Can irregular periods happen after miscarriage?

Irregular periods after a miscarriage can be caused by several factors as your body adjusts and recovers. Here’s a breakdown of some of the reasons:

It’s important to give your body time to recover after a miscarriage and to seek medical advice if you’re concerned about your menstrual cycle or if you experience symptoms like heavy bleeding, severe pain, fever, or foul-smelling discharge, as these could indicate an infection or other complications. Most women’s cycles return to their regular patterns within a few months after a miscarriage, but this can vary widely from person to person.

What happens with periods after stopping birth control?

When you stop taking the pill, most women will quickly go back to their usual menstrual cycle without any lasting impact on their ability to have children. However, a small number of women might experience a delay in ovulation and miss periods. This can happen because the pill works by suppressing the pituitary gland, and sometimes, it might take a bit for this suppression to lift even after stopping the pill.

If you notice missing periods after coming off the pill, it’s wise to consult with a doctor or gynaecologist. They can check for other reasons that might be causing this, like pregnancy or issues with other hormones. Even if you’ve been on the pill for many years, fertility typically returns quite soon for most women after they stop taking it.

Can irregular periods happen during breastfeeding?

Periods can be irregular during breastfeeding due to the body’s natural hormonal changes that support breastfeeding and influence menstrual cycles. Here’s why:

What to do / how to treat irregular periods?

Do irregular periods have an impact on fertility?

The exact impact irregular periods have on your ability to conceive will depend on the cause which your doctor will investigate. In general, if you are not ovulating you will not be able to conceive and your doctor will talk to you about this.

From a general perspective, a very high or very low BMI can affect the menstrual cycle. Women who are very slim (BMI less than 18) can also have problems with absent periods. This can be seen in women with an eating disorder or athletes with low body fat. A High BMI can be related to ovulation problems particularly in women with PCOS (Polycystic Ovary Syndrome). In this context, being overweight can mean more insulin resistance and can impact on ovulation.

Maintaining a healthy weight before pregnancy is strongly recommended, as being overweight when pregnant is not only uncomfortable but also associated with significant risk of developing gestational diabetes, pre-eclampsia (blood pressure disorder of pregnancy), increased risk of caesarean section as well as thromboembolism (blood clot).


Click here to view the full article.

Nutrition and Menopause Symptoms

Laura Southern, Nutritional Therapist from London Gynecology spoke to Yahoo in light of the new guidance announced by the Equality and Human Rights Commission for employers to clarify their legal responsibilities towards women in the workplace navigating menopausal and perimenopausal symptoms.

Are you interested in learning more about the role of food in managing Peri/Menopause symptoms?

In response, Laura shared valuable insights and recommendations regarding foods that can play a beneficial role in easing menopausal and perimenopausal symptoms. Given the substantial presence of over 3.5 million women aged 50 and above in the workforce, with 75% expected to undergo some level of symptoms and 25% experiencing severe ones, Laura’s expertise in nutrition during menopause aims to empower women with knowledge and awareness.

What types of food could be beneficial to consume during Menopause?

Click here to view the full article.

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:

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. Follow-up care: We may schedule follow-up appointments to monitor your progress and adjust your treatment plan, if necessary.

  6. 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.