Our Consultant Gynaecologist & Gynaecological Oncologist, Mr Saurabh Phadnis, spoke to Stylist magazine for a Q&A feature answering the most Googled questions about thrush. To learn more about this common infection and to read the article, click here.
Many different medications can affect the menstrual cycle. In this article Consultant Gynaecologist Mr Pisal explains how medications can effect cycle regularity, period pain and stop periods altogether. However, it is always important to consider other causes of menstrual irregularities such as pregnancy or polyp. So if your symptoms are unexpected or troublesome, please see your GP or gynaecologist for an assessment.
Oral Contraceptive Pills:
The ‘pill’ usually has a positive effect on the menstrual cycle. It makes the cycle regular and periods less heavy and less painful. Hence, the pill is often used as a therapeutic intervention for conditions such as endometriosis, heavy or painful periods. Occasionally taking the contraceptive pill can lead to break-through-bleeding between periods.
Aspirin:
Aspirin in theory can increase the amount of bleeding during a period, but in practice this effect is minimal. It is also not particularly effective at reducing the period pain.
Ibuprofen:
Ibuprofen is excellent for reducing period-related pain and does not affect the amount of bleeding.
Antipsychotic and Anti-Depressant Medication:
This type of medication can sometimes lead to absent periods or infrequent periods with longer a menstrual cycle (35 days instead of 21 days for example).
Weight Loss Pill:
A sudden change in weight can also affect menstrual cycle. Diet pills are known to cause irregular periods. A body fat percentage less than 17% can also affect menstrual cycle and lead to a lack of periods (as in many Olympic athletes).
Chemotherapy:
Chemotherapy can lead to premature menopause and hence no periods. But sometimes the ovaries can recover and periods can resume normally. Your doctor will often recommend that you see a fertility specialist before starting chemotherapy if you wish to preserve your fertility.
Steroids:
Steroid medications such as prednisolone can affect periods and make them irregular, prolonged and sometimes heavier. This is usually after long-term use of steroids.
Other forms of Contraceptives:
Contraceptives other than the oral pill can also affect the menstrual cycle. The non-hormonal intrauterine devices (IUD, Copper-T) can lead to bleeding between periods. Whereas hormonal IUDs (Mirena or Jaydess) secrete a small amount of progesterone within the uterine cavity and will often lead to lighter and less painful periods. Sometimes the periods are completely blocked. Irregular bleeding in the first few months is also a common side effect. The injection pill, implant and minipill all contain progesterone and often lead to absence of periods. Irregular unpredictable bleeding is a known side-effect.
Make an appointment
Although different kinds of medication have been found to affect the menstrual cycle, if you are experiencing any symptoms or abnormalities which you are worried about, don’t hesitate to contact your GP or gynaecologist, or give us a call on 0207 10 11 700. At London Gynaecology, we have locations at The Portland Hospital and at our new opening in the City of London. To book a consultation please email our team on [email protected] or call the number above.
This week is Cervical Cancer Prevention Week and we sat down with Consultant Gynaecologist & Gynaecological Oncologist Mr Saurabh Phadnis who reveals the conditions and likely causes that could lead to an uncomfortable or painful smear.
Mr Phadnis shares tips on how this can be made more comfortable during your appointment if experiening any of the following conditions/causes:
You may benefit from vaginal oestrogen for 2 weeks prior to the appointment.
Ask for a smaller speculum or you could ask to insert the speculum yourself.
Try having the smear with your fists behind your lower back, adjust position on couch for comfort.
You can ask for some more lubricant.
To allay anxiety you can ask to be in charge of the exam with support provided by the clinician.
If you have any concerns or are worried about any symptoms, please always speak to your GP or gynaecologist.
Make an appointment:
We are continuing to see patients as normal during the third lockdown and offer routine cervical screening along with colposcopy procedures.
If you would like to book a consultation with Mr Saurabh Phadnis or any other member of the London Gynaecology team, please call 0207 10 11 700 or email [email protected]
This page was updated on 20th January 2021, in line with the latest government guidance.
Public Health England wants to inform women, currently pregnant or breastfeeding of the below guidance and advice in relation to Pfizer-BioNTech and Oxford University/AstraZeneca Vaccine against Covid-19.
The COVID-19 vaccines available in the UK have been shown to be effective and to have a good safety profile. The early COVID-19 vaccines do not contain organisms that can multiply in the body, so they cannot infect an unborn baby in the womb.
The vaccines have not yet been tested in pregnancy, so until more information is available, those who are pregnant should not routinely have this vaccine. Non-clinical evidence is required before any clinical studies in pregnancy can start, and before that, it is usual to not recommend routine vaccination during pregnancy.
Evidence from non-clinical studies of the Pfizer BioNTech vaccine has been received and reviewed by the Medicines and Healthcare products Regulatory Agency (MHRA). This evidence was also reviewed by World Health Organisation and the regulatory bodies in the USA, Canada and Europe and has raised no concerns about safety in pregnancy.
Non-clinical studies of the Astra-Zeneca COVID-19 vaccine have raised no concerns.
The Joint Committee on Vaccination and Immunisation (JCVI) has recognised that the potential benefits of vaccination are particularly important for some pregnant women. This includes those who are at very high risk of catching the infection or those with clinical conditions that put them at high risk of suffering serious complications from COVID-19.
In these circumstances, you should discuss vaccination with your doctor or nurse, and you may feel that it is better to go ahead and receive the protection from the vaccine.
There are no data on the safety of COVID-19 vaccines in breastfeeding or on the breastfed infant. Despite this, COVID-19 vaccines are not thought to be a risk to the breastfeeding infant, and the benefits of breast-feeding are well known. Because of this, the JCVI has recommended that the vaccine can be received whilst breastfeeding. This is in line with recommendations in the USA and from the World Health Organisation.
Here are the key points you should consider:
If you are pregnant but think you are at high risk, you should discuss having or completing vaccination with your doctor or nurse.
Although the vaccine has not been tested in pregnancy, you may decide that the known risks from COVID-19 are so clear that you wish to go ahead with vaccination. There is no advice to avoid pregnancy after COVID-19 vaccination.
If you are breastfeeding, you may decide to wait until you have finished breastfeeding and then have the vaccination.
If you have any email queries related to COVID vaccine and pregnancy, you can raise these to Public Health England here
Source: Public Health England.
Approximately 75-80% women (and men) get human papilloma virus at some stage in life. It usually produces no symptoms and many women will not even know that they have had the infection. However for some the diagnosis comes as a result of a routine smear test and this can raise many questions, not just for the patient but for out of concern for her partner too.
If you have been diagnosed with HPV, read the information below for considerations for you and your partner.
Do I need to tell my partner?
This is entirely your decision. Most men and women with HPV infection carry the infection without ever being aware of it. HPV infection does not need to be treated and in 95% cases, you would get rid of it through your immunity.
Pros of sharing the information: Honesty is often the best policy and sharing this information will raise awareness regarding HPV. Though the risk for men is significantly less than women, being aware is important. Low risk HPV can cause genital warts and high risk HPV may be asymptomatic but can lead to other lesions in the genital area as well as throat in men.
Cons of sharing the information: Currently, validated testing for men is neither needed nor available. Sharing the information may lead to anxiety as well as misunderstanding.
If either or both of you also have genital warts, you may need treatment for that and it is important to tell your partner and use barrier contraception.
What are the important things to consider when telling my partner?
You should explain what it means for you as your partner would be concerned about that. As you know, HPV infection is very common and 80% men and women get it at some stage in their life. You should stress on the fact that HPV infection is often transient and no treatment is necessary unless there are abnormal cells (this applies to women). Most men and women would get rid of it through their own immunity.
HPV infection can be transferred through sex but also through skin to skin genital contact as it can be present in the skin around as well. Using condoms therefore does not completely protect against HPV infection.
For men, no further action is necessary unless they have any obvious lesions on the external organs. It is not necessary to carry out any other tests or treatment.
Does it mean they/I have been unfaithful?
Not at all. HPV infection can sometimes remain dormant in the body for several years and it is extremely difficult to say when you acquired it or who from.
Does my partner need an HPV test?
This is not necessary.
If my partner has HPV, what does this mean for him; does HPV affect men similarly to women (ie cause warts / cancer etc)
Medically speaking, it is not necessary to decide if your partner has HPV or not. Currently, HPV testing is not recommended for men. HPV causing cancer is uncommon in men. Men who smoke and may have acquired HPV infection through oral sex may be at a slightly increased risk of throat cancer, but again no tests are needed unless they have symptoms such as change in voice, difficulty swallowing or persistent sore throat and cough.
If my partner doesn’t have HPV, how can I prevent passing it to him?
It is very likely that you both carry the same subtypes of the virus and will have already developed immunity. Hence there is no risk of reinfection for both of you. As mentioned above, there is no fool-proof way of preventing HPV transmission.
Can my partner re-infect me?
Currently, there is no evidence that you can be reinfected by the same subtype of HPV. So no additional precautions are needed.
I’m bisexual/gay, can I pass this to another woman through sexual contact?
Yes, this is possible through skin to skin contact.
Can men have HPV vaccination?
It is an option for all men up to the age of 21, but is recommended for men who have sex with men, transgendered people, or those who have a compromised immune system up to the age of 26 years.
Make an appointment
If you are concerned about HPV or would like a HPV test, call our clinic on 0207 10 11 700 or you can order a self-test kit here.
At London Gynaecology, we have locations at The Portland Hospital and at our new opening in the City of London. To book a consultation please email our team on [email protected] or call us on the number above.
Following the Prime Minister’s announcement of the national lockdown, we would like to inform patients that our clinic remains open. In line with government advice, we are continuing to see patients as normal for all gynaecological conditions and complaints.
We are delighted to share that Mr Pisal raised an incredible £11,668.13 for The Whittington Health NHS Trust that will be used to support the department of women’s health at the Trust.
This fantastic amount was raised by generous supporters, patients and colleagues and supported by London Gynaecology after Mr Pisal completed the first-ever virtual London Marathon back in October. Mr Pisal’s aim was to fundraise to support the women’s health services at the hospital at this ever-challenging time for the NHS.
Despite the poor weather conditions and non-stop rain on the day, Mr Pisal completed the marathon in an impressive time of 4 hours, 35 minutes and 19 seconds.
Mr Pisal is photographed from a safe distance with Siobhan Harrington, CEO of The Whittington Hospital on 17th December 2020, presenting the cheque to the Trust.
A colposcopy is a simple outpatient clinic procedure to examine the cervix and it is often performed following an abnormal smear. It allows the specialist to assess the cervix and grade any abnormalities if present.
During a colposcopy, the cervix is visualised using a speculum and is examined under magnification and bright light to look for signs of any abnormality.
Two dyes are applied to the cervix (acetic acid and iodine) which highlight the abnormality if present. From the colposcopy appearance, the abnormalities can also be graded as low grade (CIN1) and high grade changes (CIN2-3).
The colposcopy examination is carried out by a specialist gynaecologist who is accredited by the British Society of Colposcopy and Cervical Pathology (BSCCP).
Sometimes, a colposcopy is performed for assessment after having one of the below symptoms:
The examination itself usually takes around 5-7 minutes. You will be able to go home and back to work straight away.
The examination may show a normal cervix or low grade or high-grade changes. Your specialist will explain the findings. Depending on your clinical circumstances, you may or may not need treatment.
There is no need for cancelling a new colposcopy appointment or treatment appointment as a period will not interfere with the colposcopy assessment. However, if a smear is also required (as in a follow up colposcopy appointment), then it may be better to avoid it during a period.
It depends on the colposcopy findings and symptoms. All high grade pre-canacerous changes need treatment. Some low grade precancerous changes made need treatment depending on patient choice or if the changes have not regressed within 2 years. Often symptoms particularly vaginal bleeding after sexual intercourse may warrant treatment.
The commonest form of treatment is LLETZ (Large Loop Excision of Transformation Zone). It is also known as LEEP (Loop Electrosurgical Excision Procedure, an American term). This is commonly carried out as an outpatient clinic procedure under local anaesthesia. After numbing the cervix with local anaesthetic, a wire loop is used to remove the abnormal cells. It is a quick and easy procedure and there is some discomfort, but no sharp pain.
CIN is an acronym for Cervical Intra-epithelial Neoplasia. These are pre-cancerous changes within the cervical epithelium (lining cells of the neck of womb). There are three grades of CIN (CIN1,2&3) and even CIN3 starts 10 years before cervical cancer. CIN2 & CIN3 are high grade changes and need to be treated to prevent future risk of cervical cancer whereas CIN1 (low grade changes) will often resolve spontaneously.
There are various ways of treating CIN, but the common options are:
LLETZ (Large Loop Excision of Transformation Zone): Also known as LEEP (Loop Electrosurgical Excision Procedure, an American term). This information mainly relates to this procedure.
Cone Biopsy (Extended or deeper excision): Carried out by Laser, Knife or Needle.
Your specialist will discuss the colposcopy findings with you. The results will usually be ready within 10 days.
Yes, it is safe to go swimming after a colposcopy unless you have had a biopsy or treatment.
Make an appointment
At London Gynaecology, we offer a range of colposcopy packages which include a 30 minute consultation with a Consultant Gynaecologist as standard and direct access for any urgent health concerns.
If you would like to enquire about a colposcopy or learn more about any of our services please call 0207 10 11 700 or email our team on [email protected]
London Gynaecology is proud to be rated of 4.9/5 overall by patients across Trustpilot, Google and Doctify.
December 2020
As the UK has move into a Tier system following lockdown, we would like to inform patients that our clinic remains open. Our consultants will still be seeing patients at The Portland Hospital for face to face appointments with the most appropriate Covid-19 safety measures in place. Telephone consultations will also be available, where appropriate.
Mr Narendra Pisal, consultant gynaecologist at London Gynaecology, reveals what people can expect and what it is like to go through the menopause with health conditions such as endometriosis, polycystic ovary syndrome (PCOS), fibroids and after undergoing a hysterectomy.
Menopause may come as a relief for some women with endometriosis who suffer from painful and heavy periods during their reproductive lives. Stopping of periods may be a blessing, but other symptoms of menopause can still be overwhelming.
Polycystic Ovary Syndrome is now recognised as a metabolic disease with implications beyond the ovaries and fertility. Menopause with PCOS may be associated with weight gain, hypertension and Diabetes Mellitus. The underlying cause of PCOS is insulin resistance and a long-term lifestyle of exercise and nutritional change is needed to delay or prevent these conditions. Unopposed oestrogen with no progesterone due to lack of ovulation over the years will also increase the risk of endometrial stimulation and cancer of the lining of the womb. A careful assessment at 50 with an ongoing plan for later years is needed.
Fibroids are oestrogen-dependent benign tumours arising from the muscle layer of the womb. With decreasing levels of oestrogen, fibroids often shrink in size and the symptoms (see London-fibroids.com) will also improve after menopause.
Taking HRT in presence of fibroids can be complicated due to increased risk of growth and symptoms of fibroids. I would recommend careful monitoring with annual scans. If the fibroids start growing after menopause, it could be a sign of sarcomatous (malignant) change.
If ovaries are removed with hysterectomy, an abrupt surgical menopause may ensue with acute onset of troublesome menopausal symptoms. A prior discussion with your gynaecologist regarding HRT options would be helpful. If you are planning to have ovaries conserved, your gynaecologist still may suggest removal of fallopian tubes at the time of hysterectomy as it reduces the risk of ovarian cancer!
The average age of menopause is brought forward approximately by a year after hysterectomy.
If cervix is conserved (as in subtotal hysterectomy), you will need to continue having smears. Also, a combined (oestrogen and progesterone) HRT is indicated as some endometrium may be left behind at the top end of the cervix when a subtotal hysterectomy is performed. Whereas, if the cervix is removed (as in total hysterectomy), oestrogen only HRT is indicated.
Make an appointment
If you would like to book a consultation with Mr Narendra Pisal or any other member of the London Gynaecology team, please call 0207 10 11 700 or email [email protected]
