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The Contraceptive Implant

The contraceptive implant is more than 99% effective. Below, Consultant Gynaecologist Mr Ash Alam answers some questions for those considering the implant as a contraception, outlining what it is, how it works and why it can be a great choice for women.

What is the contraceptive implant and how does it work?

The contraceptive implant is a small plastic rod that is inserted under the skin on the inner aspect of the upper arm. It contains the hormone progesterone and works by thickening cervical mucus and can stop ovulation. It is a very effective form of contraception (approximate 99% effective). The implant lasts for three years at which point it can be replaced if desired. Once removed fertility returns quickly.

Why do women choose the contraceptive implant?

It is a very effective form of contraception that does not require women to remember to take a pill. It is also very discreet but can be felt by the user under the skin of the upper arm. It can also be fitted at any point in the menstrual cycle or after birth or termination.

Who can use the contraceptive implant?

It is particularly suited for women who cannot for whatever reason use a contraceptive containing oestrogen, for example women with focal migraines or high blood pressure or who are overweight. It is also particularly suited for women who may find it difficult to remember to take a pill. It can also be used while breastfeeding.

Are there any side effects?

Although most women have no side effects, some women can have side effects related to the progesterone such as fluid retention, breast tenderness or acne.

Some women find their periods change. In some women periods stop altogether, although the majority find this beneficial. Some women experience irregular bleeding.

How is the contraceptive implant fitted?

The implant is fitted during an outpatient appointment by a consultant. You will need an injection of local anaesthetic just under the skin that is on the inner aspect of the upper arm. The implant is then inserted but this should not be painful.

A bandage is normally placed around the upper arm for 24 hours. Some localised bruising or pain can occur but this usually settles after a few days.

Are there any risks associated with the contraceptive implant?

Most side effects should they occur are short-lived and settle after a few months. Red flag symptoms are post-coital bleeding and persistent intermenstrual bleeding as well as pelvic pain, abdominal swelling/bloating & weight loss. Most settle within 6 months. 

Very rarely, fitting can cause long-term local pain or discomfort.

Where can I get the implant removed?

The implant can be removed by a specialist at London Gynaecology or alternatively most NHS family planning clinics have a trained implant remover. 

Removal can sometimes be difficult but is usually performed under local anaesthetic. Occasionally though a general anaesthetic is necessary especially if the implant is deep or cannot be located.

Fertility, Pregnancy, IBD and Surgery

When it comes to Irritable Bowel Disease (IBD) and fertility/pregnancy,  possible complications lie in the medication more so than the disease itself. Although pregnancy will affect everyone differently, women with IBD who are pregnant are defined as ‘high risk’. Read what Consultant Gynaecologist Meg Wilson has to say on the topic in this piece by Trust Your Gut.

 

Bacterial Vaginosis

Bacterial vaginosis (BV, for short) can lead to vaginal odours, an itchy vagina, and excessive discharge. A survey from Canesten Intimate Health has found that 52% of women don’t have a clue what bacterial vaginosis is, despite it affecting around one in three. Consultant Gynaecologist Ash Alam has spoken to Women’s Health about BV; read the full article here.

 

Why Emptying Your Bladder After Sex Is Important

Consultant Gynaecologist Mr Narendra Pisal talks to Red Online about why it’s important to empty your bladder after sex. Read the article here

Maternity Fitness Clothes

Whether you prefer yoga, swimming, spinning, or just a run round the block, the health benefits linked to exercising while you are pregnant are innumerable. Our fitness ambassador Ellie Baker comments on the importance of exercising while pregnant in this article for The Evening Standard on the best clothing for fitness in pregnancy.

 

Mr Pisal’s Comrades Ultra Marathon Story

On Sunday, Consultant Gynaecologist Narendra Pisal ran the Comrades Ultra Marathon in South Africa in aid of The Eve Appeal and Jo’s Cervical Cancer Trust. So far, he has raised over £13,000 thanks to the incredibly grateful donations of family, friends, patients and colleagues.

Below, Mr Pisal recounts his full Comrades experience from start to finish, explaining his sources of motivation and how he kept going during the most difficult parts of the race:

Runners are often trying to find the next challenge. While driving to work one day, I was listening to Marathon Talk podcast presenter Tom Williams and his 73yr old dad Brian doing the Comrades this year and then was chatting the same day to Simpi, my surgical assistant whose brother in law was doing it for the 30th time this year! It was the same day the entries were opening up and I thought the serendipity of all that was pointing towards me doing this ultimate human race.

When I told Karen Weir (of runwithkaren), she was not phased. She had done Comrades in the infamous 2013 race and knew exactly what to do.

We started training with back to back long runs and I was astonished to get a 8min30sec PB (3:43) in Manchester Marathon in April which was only a training B-race. My foot kept hurting after that and I was sadly diagnosed with a stress fracture in cuboid bone of right foot. We were seven weeks from the start of Comrades. This was a devastating blow and I thought my challenge was over before it had started.

I was fortunate enough to get some very sensible orthopaedic advice from my mate and ace foot and ankle surgeon, Mr Pinak Ray. He said no impact, but ok to cross train. Karen chalked out a cross training plan for me which included rowing, spinning and use of a cross trainer. At this stage I still didn’t know if I was going to do it.

19th May was a Sunday when most other Comrades runners were starting their taper. I had missed a 4weeks chunk of running and started tentatively with a half marathon in Hackney (Thank you Julia Henderson). I ran that at a sensible pace chatting to Amara Hughes and was relatively pain-free in my foot (in runner speak it means ‘hurts like hell, but a morphine shot was not needed’). We then decided to go for it and Karen gave me double weekend workouts with long run-walks on Saturday followed by epic long walks on Sunday. Pradnya my wife would cycle around Regents Park (she is training for London-Surrey 100mile bike race) to accompany my walks at 5am! Simon Tanner joined me last Sunday and we had a great walk talking about life, work and politics!

Marta Solova who is an amazing sports massage therapist and Darran Marshalleck my personal trainer also kept me in reasonable shape when I was off my feet. I was so fortunate to be supported by these expert professionals in Karen, Marta and Darran. Couldn’t have done it without you guys! Your experience of working with injured athletes and still getting them race ready in time was so instrumental.

Meanwhile, Emma Orman and Florence were getting a campaign ready for using this as a platform for raising much needed money for cancer. We selected two charities that are doing amazing work in the field of women’s cancers (Jo’s Cervical Cancer Trust and Eve Appeal). The response from my friends, colleagues and patients was simple astounding. My private practice (London-Gynaecology.com) also decided to put in 5000£ and to date we have raised over 13000£. I am so amazed and indebted by the kindness and generosity of so many people. Really humbled. Thank you so much, it means a lot!

We arrived in Durban with hope rather than confidence. We knew that ‘DNF’ (did not finish) was a real possibility but we thought it was better than ‘DNS’ (did not start). I was constantly chatting to Rob and Mike who between them have done 12 Comrades and their experience, advice and detailed race strategy was enormously helpful on the race day. I also spoke at length to my son Rohit who has successfully completed two Ironmans in very challenging circumstances and he gave me some very useful tips about mental strength. He said sometimes in a race, you have to have a word with yourself and tell yourself why you are there and stop feeling sorry for yourself. It is always a choice and quitters don’t win. That advice was needed in the first 10k itself of this 87k ultramarathon where I had to have a very strong word with myself.

In South Africa, I met so many legends! I met the above-mentioned Tom and Brian Williams. Tom has been a legendary celebrity in my eyes as he along with Martin Yelling has done nearly 500 marathon talk podcasts and I have listened to them regularly over last 3-4 years. I met Bruce Fordyce who won the Comrades nine times in the 80s and I was fortunate enough to go on his bus tour of the route and benefit from his advice. I met Coach Parry whose Comrades podcasts I have been listening to and benefitted from his advice too. Finally I also met Jamie, co-founder of Runderwear, who is doing so much to make life easy for us long distance runners. I also met Isaac, Simpi’s iconic brother in law who was doing his 30th Comrades (triple green number).

On the race day, we got up at 3:15am, had a jungle-oats porridge at the hotel and walked 10 minutes to the start. The start of this race is spectacular and I was really pumped up after listening to Shosholoza, Chariots of fire and Cockerel followed by the gunshot. The race had started! I was in D-pen having qualified with a marathon time of 3:43 but was soon overtaken by EFGH runners as I was planning to start very conservatively.

The up run is famous for the hills. You have to climb more elevation than when you go up Ben Navis and the hills hit you right from the beginning. For some reason my (fractured) right foot went completely numb and I had to resort to walking in the first few km itself as I could not feel the foot landing and was afraid of falling. I then started getting shin pains and had to stop and massage those out. That was the first time I had to have a strong word with myself. I decided to go even slower than my planned pace and follow my plan C. This was to run at a pace just below the cut off pace. This was a dicey plan but I could not have sustained a faster pace.

In Comrades, there are six cut offs and you have to get to those points before a certain time. The time allowed is gun to gun 12 hours to finish this iconic 87km race with over 2000m of elevation. I made all the cut offs (obviously) but only by a few minutes and ended up giving palpitations to all my friends and family who were live-tracking me.

I decided (was forced) to walk all the hills and run all the flats and down-hills. This was again a risky strategy as the downhills come in the second half of the race and I had never run more than 42k even in training (I ended up missing all those long runs post-marathon). But I felt I had no other choice on the day. I had also suffered from flu in the week of the race and my strength must have taken a battering.

During the race, I was so excited to see Pradnya and Rohit five times! They carried a helium balloon with them and I could spot them from a long distance away. I talked to them, received my drinks and nutrition and also got much-needed motivation. One thing I got right in this race was nutrition and hydration and I could keep the cramps away (mostly). One time I was troubled by calf cramps, there was a spectator just there ready with a deep heat spray!

The atmosphere and spectator support throughout the 87k was nothing short of amazing. The whole population of South Africa appeared to be on the route of Comrades singing, shouting names, offering all sorts of food from boiled salted potatoes to barbecued meat to crisps and sandwiches. Water was provided in plastic sachets which meant I could drink from a corner but also use it as my personal hand-held shower! When I needed some Vaseline (don’t ask why), a lady took out one of the biggest tubs of Vaseline I have ever seen! There was coke, cream-soda and ice-cream! It was one long street party!! Thank you South Africa for making it so special.

Meanwhile, my running was going steady. I got into my rhythm and kept going. I was warned about the cats eyes but ended up tripping badly in the early part of the race. This was rather lucky as my aching muscles suddenly stopped hurting as the grazed knee and hands were hurting more!

My Garmin watch was amazing! I was tracking my average race-pace and keeping it as close to 8km/hr as possible. This gave me a 15sec/km cushion for the cut offs. This cushion was much needed in the latter part of the race. Thanks to a technician in the Garmin stand at the expo who had kindly switched off all nonessential functions such as heart rate monitor to vibrating alerts, the battery lasted the whole distance. It could have been a disaster otherwise.

About 15km from the finish-line I was woken up from my slumber when I was overtaken by the 12-hour bus. Buses are groups of runners following an experienced pacer who keeps them motivated and gets them to the finish line. Being overtaken by a bus at 12hr pace meant that I was going to be swept off at the next cut off on top of a nasty hill called Polly’s Short. That’s when I had to have another strong word with myself and get my act together. I made the cut off with just a few minutes to spare. Luckily it’s all downhill from there and I was so excited to see Pradnya and Rohit 2km from finish line. I hugged them and said ‘I have got this!’. I then had the luxury of high-fiving pretty much every spectator in the impressive stadium finish. I had tears in my eyes as I completed this ultimate human race 11:53 with just 7 minutes to spare. I didn’t think it was possible before the race and at so many times during the race. Your mind is stronger than your body and this was an example of my mind carrying my broken body over the finish line.

During the race, I was thinking of my cancer patients. The challenge they face is much much greater than mine. I ask them to focus on the next step and trust the process. Good nutrition, good hydration and positive mental attitude in addition to professional help and strong support from family, friends and colleagues is what you need. I had all of the above on the day and for that I am eternally grateful. This was one of the hardest but also one of the best days of my life.

Why Your Periods Might Be Irregular

Your menstrual cycle can provide clues about your general health. In this article for NetDoctor, Consultant Gynaecologist Narendra Pisal explains how issues with your reproductive system – like endometriosis and PCOS – can affect your periods.

 

Long Distance Running Tips

In light of Mr Pisal’s recent Ultra Marathon, we asked our fitness ambassador, Ellie Baker, for some tips on long distance running. 

The challenges of long distance running are both mental and physical.

On the mental side it’s about being able to keep your focus for the duration of the race. It won’t be easy and your mind might tell you it’s too much but you have to keep your mental strength and remind yourself of why you’re doing it!

On the physical side, your body will ache and your legs will feel heavy but you have to remind yourself you’ve done the training for it, you’ve felt this uncomfortable feeling before and to keep pushing though! 

 12 – 21 weeks depending on the level of the athlete (beginner- elite) 

1) Look after your feet. Blisters and other foot issues can bring your race to a stop.

2) Strengthen your quads. Most ultras take place on hilly terrain, which means your quads have to be strong to take the ups and downs of the hills.

3) Practice before the event. Test out your kit and equipment well in advance to ensure you’re comfortable with it and so you know what works for you and what doesn’t. This includes socks, leggings, technical shirts, gels and more.

4) Plan your recovery in advance. Once you have finished the race, it is important to fuel the body with carbs and protein within 20 minutes of crossing the finish line as that is the best time for your body to absorb nutrients that it will be crying out for after the race!

5) Refuel during training and while racing. While energy bars and gels can be beneficial for short ultras, longer events like Comrades should include snacks like jaffa cakes, sweets, bananas, rice pudding and potatoes, as they will fuel your body for longer.

Taper down well before the race and reduce mileage over the last few weeks. It’s recommended to reduce mileage to 75% of normal, then 50% and finally 25% during the last week. You want to go into it feeling fresh and not fatigued!

Break it down into sections, give yourself small milestones to reach as opposed to thinking about the whole distance of the marathon in one go. You’ll want to set yourself targets within the race so that it doesn’t seem so daunting.

A downside with altitude and endurance running is a drop in the oxygen content of your blood. Because of the reduced air pressure at higher altitudes, oxygen diffuses into your red blood cells more slowly. So because endurance races and runs are run at much slower speeds, this means the oxygen-deprivation of high altitude dominates, slowing you down slightly. Some people train in altitude chambers on treadmills to try and replicate the altitude and the feeling they will feel when competing at the Comrades Marathon.

Periods Can Be A Right Pain!

The Daily Mirror looks into natural ways to make your period less painful. London Gynaecology’s Consultant Gynaecologist Narendra Pisal speaks to the Mirror with his thoughts. To view the article click here

 

 

 

Mr Pisal Runs The Comrades Ultra Marathon

Giving back is at the core of what we do at London Gynaecology. We have a firm commitment to fundraising throughout the year, particularly for women’s health charities. With our first-hand perspective on the ways gynaecological conditions can affect women’s lives, we see huge value in raising money to help fund research, care and support.

London Gynaecology’s Consultant Gynaecologist Narendra Pisal is a keen runner with 12 marathons under his belt. Last year, he ran the London Marathon in aid of The Whittington Hospital NHS Trust raising over £14,000 for new equipment for better endometrial cancer diagnosis at the hospital.  This amazing achievement was only possible through kind donations from friends & colleagues, patients and London Gynaecology who also donated £5,000.

2019 will see Mr Pisal’s biggest challenge yet. On June 9th, he will run the Comrades Ultra Marathon in South Africa. Comrades is the world’s oldest and largest ultra-marathon, at a massive 87km long with 2000m of elevation gain, starting in Durban and finishing in Pietermaritzburg. All entrants have to finish in 12 hours.

Mr Pisal has chosen to run the Comrades Marathon for a cause very close to his heart; he will be raising money to support the charities Jo’s Cervical Cancer Trust and Eve Appeal.

Mr Pisal says: “I have chosen to support Jo’s Trust and Eve Appeal. I am passionate about women’s health but sadly as a gynaecologist I see many patients who have been affected by a gynaecological cancer. Every day in the UK, 58 women are diagnosed with a gynaecological cancer and 21 will die. There is still a lot of work to do in raising the awareness, discovering new treatments and ultimately supporting women and their families through these diseases. These two charities are doing great work to bring gynaecological cancers to the forefront, onto the agenda and support groundbreaking research.” 

As part of his training for Comrades, Mr Pisal has participated in other marathons and training events; earlier this year, he ran the Manchester Marathon, achieving a time of 3:43:11 – beating his previous PB by 8 minutes. We’re excited to keep you up to date with his progress on our social media in these last few crucial weeks of training.

As ever, Mr Pisal’s goal in completing this huge challenge is to raise as much money as possible for these fantastic gynaecological cancer charities.

At London Gynaecology we’re also extremely pleased to support Mr Pisal’s effort and will match the funds raised up to £5000.

If you want to keep up to date with Mr Pisal’s progress and journey or more information on women’s health, please follow us on:

Instagram:   @LondonGynaecology

Facebook:  London Gynaecology  

Twitter:  @LondonGynae

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