The first day back to the grind after a Bank Holiday is never the most fun. If you’re worried that you’re going to spend this week feeling constantly tired, then here are some fixes that might help you remedy that – without chugging back a triple shot flat white.
In this piece for Women’s Health, Consultant Gynaecologist Narendra Pisal comments on tiredness and Vitamin D deficiency; you can read it here.
London Gynaecology’s Consultant Gynaecologist Narendra Pisal is running South Africa’s Comrades Ultra Marathon on 9th June this year. He is running to raise funds for two charities very close to his heart –The Eve Appeal and Jo’s Cervical Cancer Trust. In this article, we offer a run-down on Jo’s Cervical Cancer Trust, including its origins and aims for the future of women’s health.
What is Jo’s Cervical Cancer Trust?
Jo’s Cervical Cancer Trust is the only UK charity dedicated to women, their families and friends affected by cervical cancer and cervical abnormalities. They provide high quality information and support, campaigning for excellent cervical cancer treatment and prevention – with the aim of seeing cervical cancer prevented and its impact reduced. Their vision is a future without cervical cancer.
How did it all begin?
Jo’s Trust was established in 1999 by James Maxwell, after his wife Jo passed away from cervical cancer at just 40 years of age. Jo felt her diagnosis was due to a combination of factors; her admission to having little knowledge about the causes and symptoms of cervical cancer, her reluctance to challenge medical advice, and the inadequate screening and medical advice she received. Jo’s hope was that every woman affected by this disease could get the support and information they needed in the future.
How are they making their vision to eradicate cervical cancer a reality?
Jo’s Trust commissioned research projecting cervical cancer incidence and mortality in England until 2040 factoring in changes to the vaccination and screening programmes and variations in uptake. By 2022, they want to see:
They plan to get there by:
Where might your money go?
Why we are supporting Jo’s Cervical Cancer Trust
Last year, over 3,200 women were given a life-changing diagnosis of cervical cancer, and 890 women sadly lost their lives to the disease. A further 220,000 women are told every year they have a cervical abnormality that may require treatment. Cervical cancer is one of the most common cancers in women under 35.
Largely, it can be prevented. Cervical screening protects against 75% of cervical cancers, and every year in the UK an estimated 5,000 lives are saved through the national cervical screening programme (also known as a smear test). Despite this, cervical screening attendance is falling and 1 in 4 women fail to attend their smear test.
Jo’s Trust are doing crucial work when it comes to both raising awareness and uptake of cervical screening, and dealing with cervical cancer itself after diagnosis.
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.”
On June 9th, London Gynaecology’s Consultant Gynaecologist Narendra Pisal will run the Comrades Ultra Marathon in South Africa, in aid of two charities very close to his heart –The Eve Appeal and Jo’s Cervical Cancer Trust. In this blog, we provide a run-down on The Eve Appeal, detailing its origins and goals for the future of women’s health as described on their website.
What is The Eve Appeal?
The Eve Appeal is the only UK national charity raising awareness about and funding research into the five gynaecological cancers – womb, ovarian, cervical, vulval and vaginal. Their groundbreaking research focuses on the development of methods of risk prediction, earlier detection and screening for these cancers. They also campaign consistently to raise awareness of women-only cancers. The Eve Appeal’s vision is a future where fewer women develop and more women survive gynaecological cancers.
How did it all begin?
The Eve Appeal was founded by Professor Ian Jacobs. A newly qualified doctor and trainee surgeon, he was so shocked by the low survival rates of those with advanced ovarian cancer that he began to search for a way of screening for the disease. Ovarian cancer has a high mortality rate because it tends to be diagnosed too late. When Peter Vagn-Jensen’s wife Lone was diagnosed with ovarian cancer in 1996, he joined forces with Jacobs. Although The Eve Appeal’s initial focus was ovarian cancer, the research they fund nowadays covers all five gynaecological cancers.
What are some of their current research programmes?
For more, see The Eve Appeal’s website.
Why we are supporting The Eve Appeal
Currently, the mortality rate from gynaecological cancers is 40%; The Eve Appeal are dedicated to changing this. Gynae cancer research is very underfunded, and although The Eve Appeal are a small charity their funding supports innovative projects where conventional funding is harder to come by. Their research is world-class and collaborative, conducted at sites from University College London and the University of Cambridge to the Harvard Medical School and the University of Southern California.
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.”
Consultant Gynaecologist Narendra Pisal defines molar pregnancy, explaining its symptoms, treatment and risk factors.
Molar pregnancy is a rare complication of pregnancy where the fetus and placenta do not develop normally and leads to a non-viable pregnancy. It occurs in around 1 in 600 to 1 in 1000 pregnancies. It is also known as Hydatidiform Mole or Gestational Trophoblastic Disease. Molar pregnancy can be partial or complete. Partial molar pregnancy is where there is a fetus with abnormal placentation where as in complete molar pregnancy, there is no fetus, just abnormal placental tissue.
Signs and symptoms
Many molar pregnancies are asymptomatic and are diagnosed during a routine early pregnancy ultrasound scan. The placenta is seen to be abnormal with or without a non-viable fetus on ultrasound scan. Sometimes, diagnosis is only made when tissue is sent for analysis after a miscarriage. Common symptoms include morning sickness, abdominal pain and vaginal bleeding. The uterus is also more enlarged than expected gestational age. Excessive morning sickness is caused by higher levels of pregnancy hormones (beta hCG). Abdominal pain is caused by rapidly expanding uterus and sometimes a cyst of pregnancy (luteal cyst of ovary). Vaginal bleeding can be a sign of miscarriage.
Causes and risk factors
Molar pregnancy is caused by faulty fertilisation process. Complete molar pregnancy occurs when an empty egg (no chromosomes) is fertilised by two sperms. Thus two paternal sets of chromosomes are seen in a complete mole. Partial mole occurs when a normal egg follicle is fertilised by two sperms thus leading to three sets of chromosomes (triploidy). The risk factors include extremes of ages (teenage mothers or women over 45 years of age), Asian ethnicity and previous history of molar pregnancy.
Treatment
Molar pregnancy is treated by surgical evacuation of pregnancy under ultrasound guidance. It is important to register all molar pregnancies with specialist centres in London, Sheffield or Dundee. In London, the centre is located in Charing Cross Hospital.
Monitoring of beta hCG (pregnancy hormone) levels for six months after surgical evacuation is important to ensure that it does not develop into persistent trophoblastic disease (also known as GTN or Gestational Trophoblastic Neoplasia). The specialist centres would usually do this by inviting women to send urine samples by post.
Sometimes a repeat ultrasound scan and repeat surgical evacuation may be needed if there is persistent pregnancy tissue. Very rarely, this tissue can have malignant potential or indeed become malignant and may need to be treated by chemotherapy.
Sex, contraception and pregnancy after molar pregnancy
It is important to avoid further conception for at least six months. Best contraception often is barrier contraception (condoms) as hormonal contraception and IUDs are relatively contraindicated. In future pregnancies, an early ultrasound scan and beta hCG levels are necessary as the risk is slightly higher (around 1 in 100). Beta hCG monitoring needs to continue for six months after delivery and is organised by the specialist centres.
Connection to abnormal (or cancerous) cells
In a small proportion of molar pregnancies, the pregnancy tissue can become persistent and sometimes cancerous. This type of cancer is called as Choriocarcinoma. This cancer is however very sensitive to chemotherapy and the prognosis is often very good. Monitoring of beta hCG levels is therefore critical for six months after a molar pregnancy.
On World Pre-eclampsia Day, Consultant Gynaecologist Pradnya Pisal offers an insight into this pregnancy complication.
Pre-eclampsia is a pregnancy complication where the mother develops high blood pressure, swelling and protein in the urine. It commonly occurs in the third trimester of pregnancy, more so around and after 34 weeks. It can also occur close to delivery and after delivery.
Some mothers will have no symptoms at all except for swelling of the lower legs, which can be a symptom of normal pregnancy. The high blood pressure can cause headaches, vision disturbances such as flashing lights, vomiting, upper abdominal pain. Some women will experience a reduction in the amount of urine they are passing and the swelling may not be limited just to the lower legs. Their urine will show significant amount of protein. In severe cases, mothers can become very unwell and have a seizure.
First-time pregnant mothers, older women and very young women, women who have pre-existing hypertension and diabetes and women who have medical conditions such as lupus are most at risk. Women who are overweight and who have family history of hypertension or have developed pre-eclampsia in previous pregnancies are also at risk. Women with twins can develop pre-eclampsia earlier in pregnancy and some women with a pregnancy abnormality called molar pregnancy will also develop this in the second trimester.
Babies of mothers with pre-eclampsia can be affected by growth restriction and may need earlier delivery or preterm delivery. When the condition develops in early pregnancy the baby is monitored with regular scans to check this. When delivery occurs early, the baby will have to be admitted to neonatal intensive care. There is a higher chance of these mothers needing induction of labour and increased chance of caesarean delivery.
Eating healthily, avoiding being overweight and controlling weight gain in pregnancy and after delivery are very important when it comes to avoiding pre-eclampsia. Women who are at high risk are prescribed low dose aspirin.
If women are experiencing symptoms of pre-eclampsia, they should urgently contact their midwife, see their GP or attend the maternity pregnancy assessment unit that is open usually during day time hours. Out of hours, they should contact the number for obstetric triage or the labour ward.
London Gynaecology’s nutritional therapist, Laura Southern, discusses whether veganism can be safe and healthy during pregnancy.
Whether a vegan diet is problematic in pregnancy depends on how good the vegan diet is. I give a nutritional consultation to all the pregnant women who are on London Gynaecology’s Early Pregnancy Package, and the vast majority of them can’t face their usual healthy food. They opt instead for starchy, processed and sweet foods. If a pregnant lady is feeling like this, and already omitting the animal food groups, then there is a chance of missing out on vital nutrients.
The benefits of a healthy vegan diet include blood sugar balance (so support for energy, mood and insulin levels), a wide variety of nutrients consumed, and lots of fibre to support digestion. Challenges are ensuring nutrient needs are met. Supplementation is essential, alongside regular blood checks to ensure iron levels are adequate.
A vegan diet can be low in three areas vital for a healthy pregnancy – protein, iron and omega 3.
Protein is essential in pregnancy because its used for growth and building. It is possible to get protein from a vegan diet from seeds, nuts, beans, legumes and soya products, however ‘complete’ protein, where all the essential amino acids are present in one food, is more easily found in animal products. The NHS doesn’t offer specific levels of protein for pregnant women to consume. There have been some studies, on both humans and animals, which show that a lack of protein in pregnancy can cause both muscle issues and chronic diseases in the offspring. Symptoms of low protein in pregnancy can include severe fluid retention, muscle weakness and frequent infections.
Iron is another nutrient essential in pregnancy. It’s used to make haemoglobin which transports oxygen around the blood for both baby and mum. Iron deficient anaemia is common in pregnancy making the mum feel lousy – symptoms include severe dizziness, fatigue and breathlessness. It is possible to gain iron from plant based foods such as green leafy veg, nuts, lentils and dried fruit, but this is the ‘non-heme’ sort, which is less easy to absorb than the ‘heme’ source found in meat.
Omega 3 is essential in pregnancy to provide a substance called DHA which is vital for the baby’s developing brain. Lack of DHA in the pregnant mother’s diet can cause the mother’s body to take it from stores to give to baby. Studies have shown a lack of DHA to be associated with postnatal depression. Plants such as seeds, seed oils, nuts, avocado and coconut are rich in omega 6, also essential, however it is harder to convert omega 6 to DHA. The most bioavailable source of omega 3 is from oily fish, such as salmon, mackerel and sardines.
Absorption of the nutrients from all these foods is dependent on the mother’s digestion, how much she’s eating, and variety. If nausea and sickness are occurring during pregnancy then this can negatively impact on what and how much the mother is eating and absorbing. Therefore including all food groups during pregnancy is helpful.
Animal products (of the right sort) are, in my opinion, vital in pregnancy, and though the quantity doesn’t need to be large, a pregnancy lacking in any animal produce might run some risks. A ‘flexitarian’ diet (mainly vegan, but with small amounts of animal produce, e.g. dairy, eggs, fish, sometimes included) can be a very healthy way of eating if done well. It includes all the food groups, but favours plants – high in nutrients, high in fibre and generally low in inflammatory forming foods. Eating like this usually supports both blood sugar, minimising the risk of gestational diabetes, and digestion due to the high vegetable and fibre content.
To book an appointment with Laura Southern, please call us on 0207 10 11 700.
8th May is World Ovarian Cancer Day, a day of solidarity and support for all those whose lives are affected by this difficult disease. Creating awareness of ovarian cancer and its symptoms is extremely important, because early diagnosis significantly increases the prognosis. Chances of surviving ovarian cancer for five years or more increase from 46% to more than 90% with early diagnosis.
Ovarian cancer is notorious for causing very minimal symptoms in the early stages, such as:
Because these symptoms are so non-specific being aware and alert to changes in the body is essential. See below for some frequently asked questions about ovarian cancer.
What is ovarian cancer? What is the risk I’ll get ovarian cancer?
Ovarian cancer starts in the ovaries and often causes very minimal symptoms in the early stages. It is known to progress quickly and hence early detection is important. Lifetime risk of getting ovarian cancer for women is around 1 in 50 (2%). Family history of ovarian cancer in one first degree relative would be associated with doubling of the risk (1 in 25 or 4%). BRCA 1&2 genes are associated with high risk of ovarian cancer (up to 50%).
How is ovarian cancer diagnosed?
An ultrasound scan and a blood test (CA125) can often give a provisional diagnosis, but the diagnosis is only confirmed after biopsy (usually after removal of any ovarian lesion). An MRI scan will often give more specific and detailed information before surgery. It also helps in planning the management.
Cervical smear test will NOT detect or rule out ovarian cancer! It is aimed at detecting cervical pre-cancerous changes and is nothing to do with ovaries.
What about screening?
CA125 and ultrasound scan have also been used for screening especially in women at higher risk of developing ovarian cancer. However, these tests can be both falsely positive and negative. Benign ovarian cysts are very common and CA125 is raised in many common conditions such as fibroids and endometriosis. Also, only 50% of stage 1 and 80% of all ovarian cancer will have raised CA125. Even if we do annual screening, there is a chance of developing disease in the interim.
What type of ovarian cancer, fallopian tube cancer, or peritoneal cancer do I have?
This information can often be obtained after an MRI scan or operation and biopsy (histology).
What are the treatment options for ovarian cancer?
Surgery to remove as much of the tumour and disease as possible is often the first option (though not always). If there is evidence or suspicion of spread outside the ovaries, additional chemotherapy may be recommended.
I’ve been diagnosed with ovarian cancer. What do I need to know?
Your doctor and CNS (Clinical Nurse Specialist) would be the first point of call as they would be able to provide information specific to your circumstances. Not all the information that you read online or in leaflets will apply to you and you must not draw any conclusions unless discussed with your team. You can get general information on websites such as www.ovacome.org.uk or www.cancerresearchuk.org or www.macmillan.org.uk.
What are the chances of beating ovarian cancer?
This often depends on your individual circumstances (such as age, medical condition, type and stage of ovarian cancer and response to treatment) and your doctor will be able to provide more specific information. It is important to ask questions (take somebody with you for consultations) and if there are no direct answers, you can always find out about best and worst possible scenarios.
What should I do to protect myself from ovarian cancer?
We recommend a “MOT@50” (well-woman check at 50years of age) which your GP can organise or we will be happy to arrange. Please visit www.london-gynaecology.com for more information.
Please see your GP urgently if you are concerned about ovarian cancer, and he/she will be able to arrange appropriate tests or referral on an urgent basis.
According to reports, Meghan Markle and Prince Harry are planning to raise their baby a vegan. Though the 37-year-old has never confirmed she’s a vegan herself, she reportedly follows a plant-based diet on weekdays. She is by no means the only person experimenting with a plant-based diet. There are now thought to be 540,000 vegans in Britain, up from 150,000 a decade ago, and many parents are choosing to raise their babies and children in the same way.
London Gynaecology’s nutritional therapist, Laura Southern, put together some tips for parents who are keen to raise their babies and children on a vegan diet for Yahoo!. Read them here.
In today’s busy life, it is quite possible to forget a tampon. Consultant Gynaecologist Narendra Pisal describes toxic shock syndrome, a rare but sometimes serious result of leaving tampons in for too long.
Toxic shock syndrome (TSS) is a name given to a serious condition of septicaemia (blood poisoning) caused by infection from a retained tampon. ‘Toxic shock syndrome’ classically was caused by retained tampons but it can also be caused by other retained foreign bodies, such as forgotten pessaries or swabs.
TSS occurs when bacteria release toxins, which cause a severe reaction in the body. The association with tampons is when they are retained in the vagina for long enough to allow high levels of bacteria to grow.
Symptoms tend to be a vaginal discharge which can become smelly and purulent, discomfort, lower abdominal pain and occasionally symptoms of severe infection such as raised temperature and feeling unwell.
The best ways to avoid TSS is to remember to take a tampon out and not put a new one unless the old one is out! Some women don’t like the retriever thread to be visible and the tampon can move upwards and be forgotten, but all tampons should be changed regularly (at least every 8 hours) to reduce the possibility of TSS.
On the whole however TSS is not very common, so don’t get too paranoid. The number of cases of TSS related to menstruation has decreased significantly over time from 9 in 100,000 women in 1980 to 1 in 100,000 women since 1986. This is explained by the withdrawal of highly absorbent tampons, which means women need to change them more frequently.
If you think you may be suffering from TSS please see your doctor or a gynaecologist as soon as possible. An examination will be necessary along with vaginal swabs to look for infection and remove the tampon. A course of antibiotics may also be prescribed if necessary.
A full recovery is usually made but it depends on how early the condition is detected. So if you start getting symptoms of discharge and smell which are not typical for you, you should see a doctor straightaway.
Panty liners, sanitary towels or moon cups would be safer than tampons in this respect, but tampons are often more comfortable and practical and chances of forgetting one are not very high. In summary, keep on using tampons, but do remember to take them out.
If you are concerned about TSS or have any questions, feel free to call us on 0207 10 11 700.
One in four women have an epidural during labour. They help to reduce the pain during child birth, but not everyone likes the idea. However, the latest research indicates that the risks associated with epidurals – such as nerve injury and infection – are far lower than previously thought. Consultant Gynaecologist Meg Wilson gives the lowdown on everything to do with on epidurals in this article for NetDoctor.
