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:

 
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.

How to help relieve period pain at home

Dr Claire Phipps, GP and Advanced Menopause Specialist at London Gynaecology, spoke to GoodToKnow about several strategies designed to provide relief and soothe menstrual pain during your period.

Period cramps can be debilitating, but there are several effective home remedies to alleviate the discomfort. Here are some doctor-recommended strategies to help you feel better:

1. Apply Heat

Using a hot water bottle or a heating pad on your lower abdomen can significantly reduce menstrual pain. A warm bath can also provide soothing relief.

2. Stay Active

Engaging in regular exercise helps to reduce cramps. Activities like yoga and Pilates are particularly beneficial for gentle stretching and muscle relaxation.

3. Massage

Gently massaging your abdomen can ease muscle tension and reduce pain. Use essential oils like lavender or peppermint for added relief.

4. Watch Your Diet

Certain dietary adjustments can make a difference. Avoid sugar and dairy, which can exacerbate inflammation. Instead, focus on anti-inflammatory foods like berries, nuts, and leafy greens.

5. Hydrate and Sleep Well

Drinking plenty of water helps reduce bloating, which can make cramps worse. Ensure you get adequate sleep to help your body manage pain more effectively.

6. Increase Magnesium Intake

Magnesium-rich foods such as bananas, almonds, and spinach can help relax muscles and reduce cramping.

7. Try a TENs Machine

A Transcutaneous Electrical Nerve Stimulation (TENs) machine can provide pain relief by sending mild electrical pulses through the skin.

Incorporating these strategies into your routine can help manage and alleviate period cramps, making your menstrual cycle more bearable.

Cost of Uterine Artery Embolisation for Fibroids

We understand that many patients self-fund their medical treatment, making early visibility of the costs involved essential. At London Gynaecology, we offer self-pay packages to ensure patients can easily understand the costs associated with their treatment.

What is the Cost of Uterine Artery Embolisation for Fibroids?

The cost for uterine artery embolisation (UAE) for fibroids starts from £7,750.

What Does the Cost Include?

The charges for the uterine artery embolisation procedure for fibroids include:

• Hospital fees
• Surgical fees
• Anaesthetist
• Post-procedure follow-up consultation

Does the Cost of Uterine Artery Embolisation for Fibroids Vary?

The cost is dependent on the specific case. An accurate quotation will be provided following your consultation with an Interventional Radiologist. Please note that the charges on this page are correct at the time of writing. For our latest fees, please visit our Fees page.

Hot Flushes in Pregnancy

Dr Shikha Kapour, Consultant Obstetrician and Gynaecologist at London Gynaecology, spoke to GoodToKnow about hot flushes in pregnancy.

Why do you have hot flashes when pregnant? / What causes hot flashes in pregnancy?

Hot flushes are a symptom we normally associate with menopause. It is when you experience a sudden sensation of excessive heat, mainly the face, neck and chest. Excessive sweating can also accompany this phenomenon. It is also a symptom of pregnancy and is reported in over a third of cases during pregnancy and in the postpartum period (Thurston et al 2013).

Can you get hot flashes in early pregnancy?

One study examining the appearance of hot flushes throughout pregnancy found that as many as 18% of women developed hot flashes within the first 20 weeks. In total, 35% reported hot flashes at some point throughout their pregnancy, and 29% experienced them postpartum (1).

While they typically peak in the third trimester, hot flashes can appear at any point during the course of pregnancy. A study found that 10% of women reported hot flashes within the first postpartum month (2)

Are hot flashes normal during pregnancy?

Hot flashes can occur during pregnancy and are considered normal for many women. Hot flushes are a result of hormonal changes driven by your pregnancy. These changes lead to an increase in the blood supply to the skin and result in a rise in body temperature.

Should I worry about hot flashes during pregnancy?

Hot flashes can occur during pregnancy and are considered normal for many women but it is distressing you please discuss it with your doctor or midwife so they can rule out any other underlying medical issues.

What should I do if I experience a hot flash in pregnancy? What can I do to ease/soothe symptoms?

• Wear loose clothes made from natural fibres
• Keep well hydrated
• Ice packs / cold towels used at pulse points – temples / back of the neck
• Stay in the shade
• Keep your room cool – electric fan
• Take a refreshing shower
• Avoid triggers – spicy food / hot drinks

How do you deal with hot flashes at night during pregnancy?

Wear loose clothes made from natural fibres, dress in layers, use a sheet instead of a duvet, use a fan and have cold shower before bedtime.

When should you see a doctor about hot flashes in pregnancy?

Hot flushes are not harmful but you should inform your midwife of any symptoms that are bothering you. They will be able to reassure you. Your midwife will also be able to check that you are not having a fever which is a sign of an underlying infection and may need treatment.

1. Thurston RC, Luther JF, Wisniewski SR, Eng H, Wisner KL. Prospective evaluation of nighttime hot flashes during pregnancy and postpartum. Fertil Steril. 2013;100(6):1667-1672. doi:10.1016/j.fertnstert.2013.08.020

2. Gjerdingen D.K, Froberg D.G, Chaloner K.M, McGovern P.M. Changes in women’s physical health during the first postpartum year. Arch Fam Med. 1993; 2: 277-283

Fibroids in Pregnancy

Mr Narendra Pisal, consultant gynaecologist, contributed to Goodtoo article explaining the management of pregnancy with fibroids.

Can fibroids affect pregnancy? How?

Fortunately, fibroids do not usually interfere with chances of getting pregnant. Most of the fibroids are small and do not interfere with the cavity of the uterus or the fallopian tubes. Submucous fibroids (those which encroach on the uterine cavity) can sometimes affect the process of implantation. This can lead to sub-fertility and sometimes early pregnancy loss.

Fibroids in the upper corner of the uterus (cornual region) can occasionally obstruct fallopian tubes and can be a cause of tubal factor subfertility. Similarly, very large fibroids and an enlarged uterine cavity can be a cause of not getting pregnant.

So, in general, if the fibroids are small (smaller than 6cm) AND if the cavity is normal AND if the fallopian tubes are not affected, there is no cause to worry.

In what ways can fibroids impact you when pregnant?

Fibroids usually cause no problems with pregnancy but can sometimes be associated with risks during antenatal period, labour and post-partum.

Fibroids can increase the risk of early pregnancy loss and preterm birth especially if they are large or interfere with the uterine cavity (submucous fibroids).

Fibroids tend to increase in size with hormones and increased blood supply of pregnancy. This can lead to increased discomfort. Increase in size is also associated with ‘Red degeneration of Pregnancy’. This happens due to rapid increase in the size of fibroids where the central area of a fibroid does not get enough blood supply and undergoes ‘necrosis’. This is associated with pain and tenderness over the fibroid. Sometimes admission to the hospital and rest is required for pain relief, anti-inflammatory and supportive treatment.

Fibroids in the lower part of the uterus can lead to malposition such as transverse lie or breech presentation necessitating Caesarean Section. Caesarean Section can sometimes be difficult and complex due to location of the fibroids.

Post-delivery, fibroids can interfere with contraction of the uterus leading to post-partum haemorrhage and hence a hospital delivery is often recommended.

How big does a fibroid have to be to affect pregnancy?

There isn’t always a correlation between the size of fibroids and effect on pregnancy. If the fibroids are external to the uterus (growing outside), even large fibroids will have minimal effect on pregnancy. Whereas a small 2cm fibroid within the uterine cavity may interfere with chances of getting pregnant or even cause a miscarriage. So, location of fibroids carries more significance that just the size.

Can you have a safe, full-term pregnancy with fibroids?

Yes, in most cases, fibroids and pregnancy can co-exist without any problems and the pregnancy can progress as planned with good chance of a normal delivery.

How do you manage fibroids during pregnancy?

Fibroids are almost always managed conservatively in pregnancy. If you have fibroids, please let your obstetrician know, who will be able to keep an eye on the size of fibroids and any symptoms. Also, a scan in the third trimester is a good idea to see if the fibroids may interfere with the presentation and delivery. A hospital delivery is recommended as there is a higher chance of post-delivery bleeding in women with uterine fibroids.

Is there any treatment for fibroids that someone can have while pregnant? Is treatment necessary?

Fibroids are almost always left alone in pregnancy and no treatment is recommended apart from watchful supervision of an experienced obstetrician.

Are fibroids anything to worry about during pregnancy?

As discussed, pregnancy will usually progress without any problems in presence of fibroids. You should discuss your particular case with your obstetrician who will be able to guid you through your pregnancy journey and also delivery options.

Endometriosis in Pregnancy

Mr Hemant Vakharia, Consultant Gynaecologist and Advanced Laparoscopic Surgeon, contributed to GoodToKnow article explaining the impact of endometriosis on pregnancy and fertility.

How does endometriosis affect fertility?

Endometriosis is a condition where tissue similar to the lining inside the uterus (endometrium) grows outside the uterus, leading to various symptoms, including painful periods, pain with intercourse, heavy periods and in some people difficulty conceiving.

The prevalence of endometriosis in women of reproductive age in the UK is approximately 10%; in women with subfertility it increases to 25–50%.

When it comes to fertility, endometriosis can affect it in several ways:

• Inflammation and Scarring: The endometriotic tissue outside the uterus can cause inflammation (the body’s response to injury or infection) and scarring (fibrous tissue that replaces normal tissue after an injury). This can affect the ovaries, fallopian tubes, and the lining of the pelvic cavity, potentially hindering the movement of the egg and sperm and also causing adhesions (structures sticking together)
• Impaired Egg Quality: Endometriosis when affecting the ovaries directly can lead to the formation of cysts known as endometriomata. These cysts can negatively impact ovarian tissue, potentially affecting the quality and quantity of eggs.
• Blocked Fallopian Tubes: The scarring caused by endometriosis as described above can lead to the fallopian tubes becoming blocked, preventing the egg and sperm from meeting, which is essential for fertilisation. Up to 30% of women with endometriosis have tubal pathology (obstruction, adhesions or hydrosalpinx – (swollen fallopian tube)).
• Altered Pelvic Environment: Endometriosis can lead to changes in the hormonal environment necessary for ovulation (the release of an egg from the ovary), fertilization, and implantation of the embryo in the uterus.

Crucially not all individuals with endometriosis will experience difficulty conceiving as the impact of endometriosis on fertility can vary greatly from person to person.

What are the options for getting pregnant with endometriosis?

The chances and challenges of achieving pregnancy with endometriosis largely stem from how the condition affects the reproductive organs in an individual. As mentioned above, inflammation and scar tissue can distort the anatomy of the pelvis, making it harder for the sperm to reach the egg or for the fertilised egg to implant in the uterus. The quality of the eggs can also be compromised, and the environment within the uterus may become less conducive to implantation, further complicating the process of getting pregnant. These are all unique variable to an individual and therefore the chances of conceiving depend on individual circumstances.

Despite these challenges, there are several options for those looking to conceive with endometriosis:

I. Medical Treatment: Hormonal treatments can sometimes be used to manage the symptoms of endometriosis and reduce inflammation until the patient is ready to conceive. Medical therapies do not eradicate the endometriosis however and studies have shown no benefit in endometriosis related infertility

II. Surgery: Surgery to remove endometriosis tissue can alleviate pain and may improve fertility, particularly for those with mild to moderate endometriosis. This is typically done laparoscopically, a minimally invasive procedure that removes endometrial implants and scar tissue. The evidence for the benefit for surgery in severe disease is less clear and depends on individual circumstances

III. Assisted Reproductive Technologies (ART): Techniques such as in vitro fertilisation (IVF) can be helpful for those with endometriosis especially in those with blocked fallopian tubes. IVF involves fertilising an egg outside the body and then implanting the embryo into the uterus, bypassing many of the challenges endometriosis may pose to natural conception.

IV. Lifestyle Changes: Whilst not a direct treatment for difficulty conceiving, adopting certain lifestyle changes can support overall reproductive health. This includes maintaining a healthy weight, reducing stress, and stopping smoking.

Does everyone with endometriosis require infertility treatment? What does that entail?

The short answer is ‘No’. Not everyone with endometriosis will require fertility treatment and some patients may not realise they have endometriosis until it is picked up on imaging or during a surgical procedure.

Can you get pregnant naturally with endometriosis?

Absolutely! I have seen patients with severe endometriosis conceive naturally but again this depends on their individual circumstances.

Does endometriosis affect pregnancy? How?

Endometriosis can affect pregnancy in a number of ways. Studies have shown that endometriosis in pregnancy is associated with an increased risk of spontaneous miscarriage, pre-eclampsia, postpartum haemorrhage (bleeding after birth), caesarean section, placenta praevia, fetal growth restriction, prematurity and adverse neonatal outcomes.

Those with mild disease are considered less at risk and in general can expect a normal pregnancy and labour.

Those with serve disease are considered high-risk and require additional antenatal and intrapartum care.

How can I prepare my body for pregnancy with endometriosis?

There is no specific advice in this context but it is important to discuss your pregnancy with your midwife and be booked under consultant led care, especially in those with severe disease. Of course, general lifestyle measures such as maintaining a healthy weight, reducing stress, and stopping smoking apply as they do to all patients.

Can endometriosis cause ectopic pregnancy? Is there anything that can be done to help avoid this?

In patient with tubal disease (blocked fallopian tubes/swollen tubes) there is an increased risk of a tubal ectopic pregnancy. In some cases, to improve fertility outcomes, patients may be advised to have the affected tube clipped or removed to reduce this risk. If not, then there is nothing specific that can be done to avoid this, but patients are advised to have an early scan in pregnancy.

Can you give birth naturally with endometriosis?

Yes, in general there is no reason why you cannot deliver vaginally but there may be individual circumstances for specific patients where a specialist may recommend a vaginal birth.

Can you develop endometriosis after pregnancy?

Yes, Endometriosis can develop after pregnancy.

Click here to see the full article.

Tips to Manage Menopause Symptoms

Dr. Claire Phipps, GP and Advanced Menopause Specialist, Laura Southern, Nutritional Therapist, and Mr. Tomasz Lukaszewski, Senior Consultant in Reproductive Medicine, talk about the symptoms of menopause and their management and how you can manage them.

What Age Does Menopause Start?

The average age of menopause is 51 years, marking the day when you can retrospectively determine that you have been without a period for 12 consecutive months. Most women will have their last period between 47 and 53 years of age. This can vary depending on ethnicity and genetics. Perimenopause, the transition to your last period and beyond, can start in your early 40s, but no two women are the same.

What Causes Menopause?

Menopause occurs when your periods have stopped for 12 consecutive months, signaling the end of a woman’s reproductive stage. It is caused by the natural decline in the production of the hormones oestrogen and progesterone from the ovaries. As the number of eggs declines with age, so does the production of oestrogen, leading to menopause.

How is Menopause Diagnosed?

Women over the age of 45 with symptoms of perimenopause do not need blood tests to diagnose menopause. In younger women, doctors may carry out hormone blood tests and other profiles to confirm menopause, as it can occur earlier in some women. Accurate diagnosis ensures appropriate treatment.

Common Symptoms of Menopause and Their Management

Perimenopause is the transitional period leading up to menopause, characterized by various physical and emotional symptoms due to hormonal changes. Around 80% of women experience symptoms, with 25% experiencing significant symptoms. Common symptoms include:

• Irregular periods
• Hot flushes and night sweats
• Sleep disturbances
• Vaginal dryness
• Mood swings, anxiety, or depression
• Changes in libido
• Fatigue
• Weight gain
• Memory problems and difficulty concentrating
• Muscle and joint pains
• Dry eyes and dry skin

These symptoms result from the gradual decline in ovarian function and hormone production. An individualized approach, including lifestyle changes and treatment options like Hormone Replacement Therapy (HRT), is essential for managing symptoms. HRT is the gold standard treatment, while other treatments, such as antidepressants, herbal remedies, and cognitive behavioral therapy, are also available.

Lifestyle Changes to Manage Menopause Symptoms

Adopting healthy lifestyle changes can significantly alleviate menopause symptoms:

• Diet: Eat a balanced, varied diet to maintain a healthy weight and improve gut health. Include fermented foods if tolerable.
• Exercise: Engage in resistance training and aerobics to reduce joint stiffness, promote healthy bones and muscles, and enhance brain function.
• Stress Reduction: Practice relaxation techniques like yoga, massages, and breathing exercises to reduce anxiety and irritability.

Vaginal Dryness and Its Management

Vaginal dryness is common during menopause due to decreased oestrogen levels. Vaginal oestrogen treatments, available as creams, gels, or pessaries, can provide significant relief. These treatments can be used alongside HRT or on their own.

Managing Lack of Libido

Lack of libido can be a common symptom due to reduced testosterone levels. HRT often helps, and testosterone replacement might be considered for severe cases. Seek medical attention for unusual bleeding or discharge.

Hormone Replacement Therapy (HRT)

HRT replaces hormones that the ovaries no longer produce, minimizing menopause symptoms and improving quality of life. It helps prevent osteoporosis and cardiovascular issues. HRT involves either combined HRT (oestrogen and progestogen) or oestrogen-only HRT for women who have had a hysterectomy. It should be started after a careful assessment of risks and benefits.

Can Periods Restart After Menopause?

Once you have reached menopause (12 consecutive months without a period), you should not have any further periods. Report any bleeding to your doctor.

Can You Get Pregnant After Menopause?

Women who are perimenopausal are still fertile and should consider contraception. After menopause, fertility treatments like IVF with egg donation may be an option.

Best Supplements for Menopause

Supplements can support menopause management. Key supplements include:

• Bone Support: Vitamin D, calcium, and magnesium.
• Stress Support: B complex vitamins, magnesium, and ashwagandha.

Individual needs vary, so consult with a healthcare provider for personalized advice.

Can Magnesium Help with Menopause Symptoms?

Magnesium can reduce muscle cramps, support sleep, and alleviate anxiety. Magnesium glycinate or threonate is recommended for sleep and anxiety, while magnesium citrate supports digestion. Magnesium oxide

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 pms.org.uk 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:

• Pregnancy: If there’s a chance you could be pregnant, it’s a good idea to take a pregnancy test, even if you’re using contraception.
• Polycystic Ovary Syndrome (PCOS): This is a common condition where the ovaries contain many small cysts. It can lead to irregular ovulation, which might make your period late. A doctor might suggest a scan and some blood tests to diagnose this.
• Hormonal Imbalance: Issues with thyroid or pituitary gland hormones can delay your period. A doctor can check for these imbalances with tests.
• Eating Disorders: Conditions like anorexia can lower body fat significantly, which can affect how your ovaries work and lead to late or missed periods.
• Intense Exercise: Athletes, especially those in rigorous training, might miss periods due to low body fat levels.
• Approaching Menopause: As you get closer to menopause, your periods might become more irregular due to changes in ovulation.
• No Clear Reason: Sometimes, there’s no obvious reason for a late period. If you’re not pregnant, it’s usually okay to wait a bit longer before seeing a doctor. Keeping track of your periods and any other symptoms you notice can be helpful.
• Medications: Various medications can influence your menstrual cycle

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:

• Hormonal changes: Pregnancy initiates significant hormonal changes to support fetal development. After a miscarriage, it takes time for hormone levels, such as human chorionic gonadotropin (hCG), oestrogen, and progesterone, to return to their pre-pregnancy levels. These hormonal fluctuations can disrupt your menstrual cycle, leading to irregular periods.
• Uterine Healing: The process of miscarriage involves the shedding of the uterine lining and, in some cases, the expulsion of pregnancy tissue. Your uterus needs time to heal and rebuild its lining, which can affect the timing and nature of your first few periods after a miscarriage.
• Retained pregnancy tissue: In some cases, not all the pregnancy tissue is expelled during a miscarriage. Retained tissue can lead to irregular bleeding and may disrupt the normal menstrual cycle until it’s resolved. Medical intervention may be necessary to remove the remaining tissue.
• Emotional Stress: Experiencing a miscarriage can be emotionally traumatic. Stress can have a profound impact on your body, including the disruption of the hormones which regulates the menstrual cycle. This stress can contribute to irregular periods.
• Infection or Complications: If there were complications associated with the miscarriage, such as an infection, this could also affect menstrual regularity. Infections can cause inflammation and hormonal imbalances, further disrupting the menstrual cycle.

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:

• Prolactin: Breastfeeding increases the production of prolactin, a hormone responsible for milk production. Prolactin also has the effect of suppressing ovulation, which can lead to irregular or absent periods. The more frequently and exclusively a mother breastfeeds (including night feeds), the higher the levels of prolactin, and the more likely it is that her periods will be delayed or irregular.
• Ovulation Suppression: Because prolactin suppresses ovulation, the menstrual cycle, which is regulated by ovulation, can become irregular. Some breastfeeding mothers may not ovulate for weeks or even months after delivery, while others may begin ovulating before their first postpartum period which is why some couples get caught out and fall pregnant.
• Energy Demand: Breastfeeding demands extra energy from the mother’s body, which can sometimes affect the body’s readiness to resume regular menstrual cycles. The body may prioritize milk production over reproductive functions, leading to irregular periods.
• Individual Variation: Every woman’s body responds differently to the hormonal changes associated with breastfeeding. Some women may experience the return of regular periods soon after childbirth, even while breastfeeding, while others may not have a period until they significantly reduce breastfeeding or wean their child entirely.

What to do / how to treat irregular periods?

• If you begin to experience irregular periods it is a good idea to keep a diary and note down when the period occurs. This can be conveniently done using one of the many apps available.
• If periods become persistently irregular or if there are any ‘red flag’ symptoms such as prolonged bleeding, heavier flow, bleeding between periods or after sex, see your GP or gynaecologist urgently.
• If a period is slightly delayed or slightly early, that is no cause for concern unless it becomes a persistent pattern. Keep an eye on things and usually the cycle will return back to normal. A pregnancy test is recommended.

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).

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