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).

Click here to view the full article.

Nutrition and Menopause Symptoms

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

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

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

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

• Protein in plant-based protein sources like nuts, seeds, legumes, tofu, and pulses are recommended to supplement protein intake.
• Essential fats are crucial for cell and hormone sensitivity, aiding in blood sugar balance and combating insulin resistance, especially during menopause.
• Fibre is necessary to ensure an adequate fibre intake, include a variety of fruits, vegetables, and whole grains in your daily diet.
• Dark green leafy vegetables support the gut microbiome, crucial for nutrient absorption and excretory pathways – include a variety of green leafy options daily, such as those from the brassica family, different salad leaves, and fresh herbs.

Click here to view the full article.

Menopause and Testosterone Therapy

While it’s a common misconception that testosterone is exclusively a male hormone, women also produce testosterone from their ovaries and adrenal glands before entering menopause. Testosterone serves a pivotal role in various aspects of female health, including sexual function, muscle and bone strength, cardiovascular well-being, cognitive function, and energy levels. As women age, testosterone levels may gradually decrease, or a more abrupt decline can occur if a woman undergoes ovarian removal.

As part of your menopause consultation, testosterone can be discussed if you wish. There are a few different types of preparations that we might use, depending on your symptoms and preference.

A full assessment of your symptoms with your doctor is required prior to treatment, along with blood tests prior to starting testosterone treatment. Monitoring is then advised four-monthly.

Click here to book a menopause consultation.

Postpartum Hair Loss

Welcoming a new life into the world can be a magical experience, but the changes your body goes through afterward can sometimes be surprising. One common occurrence, often not discussed as openly as it should be, is postpartum hair loss. Let’s explore further.

What should I be expecting?

Between 6 to 12 weeks after giving birth, many women experience a noticeable increase in shedding hair. This reduction might make the hair feel thinner, especially around the crown and near the hairline. Moreover, the sudden change in hormones can also affect the texture, making it feel drier, more brittle, or lacking in its usual lustre. In some cases, the hairline might appear to recede temporarily due to the shedding of hair around the frontal area.

These changes, whilst understandably alarming for some, are typically temporary and usually resolve in 6-12 months.

Why Does Postpartum Hair Loss Happen?

Hormonal shifts following childbirth can affect the hair growth cycle. During pregnancy, soaring Oestrogen levels keep hairs growing, resulting in fuller, thicker hair. However, after childbirth, hormone levels normalize, and the hair follicles that were kept in the growth phase (anagen) start to enter the resting or shedding phase (telogen) all at once. It’s not necessarily an increase in hair loss but rather the catching up of the natural shedding process, and so it can seem scary at first.

Apart from hormonal changes, physical and emotional stress, nutritional deficiencies, your genetics and your general lifestyle also contribute to postpartum hair loss. To summarize, it’s often multi-factorial!

Tips for Coping with Postpartum Hair Loss

Wondering by about the best methods to optimize your hair’s health? Let’s deep dive.

1. Nutrition Matters: Re-vitalize your hair health by adding Zinc-rich foods like oysters and pumpkin seeds, Iron sources such as spinach and red meat, Vitamin D from sunlight or fish, and Vitamin B3 and B12 found in chicken, mushrooms, dairy, and fortified cereals. Incorporating protein such as in fish, along with healthy fats found naturally in avocados and olive oil will also support your hair follicles. This diverse range of nutrients supports overall hair vitality and growth.

2. Consider Supplements: Multi-vitamin supplements containing the above can complement your diet if you are lacking, and can help support your body during this time.

3. Manage Your Stress: Be kind to yourself and prioritize stress reduction and adequate sleep. Stress is a well-known cause of hair loss. Don’t be afraid to call on those around you for support – motherhood isn’t easy! These small tweaks can positively impact overall wellbeing, including hair health.

4. Care For Your Hair: Opt for volumizing shampoos or products – whilst they won’t stop shedding, they’re designed to add volume and thickness to your hair, giving it a fuller appearance. Try to avoid oilier or conditioning shampoos as these can flatten your volume! Be gentle on the scalp when brushing and washing, and avoid tight hairstyles that add extra strain to the scalp. Sometimes, trying out a new haircut might give you the lift you need – it might even help the new regrowth blend in more (plus the added benefit of less yanking from baby!).

When should I seek help?

Remember, postpartum hair loss typically resolves on its own within a year. However, if you notice excessive hair loss beyond this timeframe, or you’re concerned about your scalp health – or you just want some advice before then, seeking help from a healthcare professional can provide that reassurance and guidance.

Be particularly on the lookout for when loose strands of hair accidentally wrap around your baby’s fingers or toes, as they can be quite constricting! Thankfully it’s very rare, but it’s always safer to remove any loose hairs around your little one.

Where can I seek further support?

At London Gynaecology, you can consult with an experienced GP who can explore your concerns holistically, examine your scalp for any treatable skin conditions, and together you can create a treatment plan. Additionally, our specialized Nutritionist can offer personalized dietary advice to support your hair health.

It’s important to embrace patience and self-care during this phase of postpartum changes. We need to acknowledge and talk more about the physical changes that many women experience, and whilst hair loss can be concerning, it’s often a temporary phase in the tumultuous journey of motherhood. But remember, you are never alone, there will always be support if you seek it!

Written by: Dr. Alisha Esmail

Can HRT Be Used For Contraception?

A common question is whether hormone replacement therapy (HRT) can be used as a contraceptive. HRT is used as a treatment for the symptoms of the perimenopause and post menopause. It contains very low doses of hormones and as a result it cannot be used as a contraceptive. It is worth remembering that you can still get pregnant in the perimenopause, so it is important to discuss a method of contraception with your doctor.

If you are using HRT and depending on the type you are using, the progesterone only pill or the Mirena coil can be used safely.

Our New Harley Street Clinic Is Open

Step into a world of exceptional healthcare at our brand-new location in the heart of London ‘s medical district at 145 Harley Street, W1G 6BJ.  We are delighted to welcome all patients seeking excellent medical care in a luxurious setting.

Our state-of-the-art clinic, where advanced diagnostics and comprehensive services meet elegance, is equipped with cutting-edge medical diagnostic technology has been carefully designed to provide patients with the utmost comfort and convenience in a luxurious and relaxed setting.

Your journey to exceptional women’s health begins at 145 Harley Street.

What to Expect in a Private GP Appointment?

If you have never visited a private GP before, you may be unsure of what to expect.  Below outlines what a private GP consultation typically comprises of:

1. Medical history: We will begin by taking a detailed medical history, which includes information about any pre-existing medical conditions, allergies, medications, and previous surgeries.

2. Physical examination: We will carry out a thorough physical examination, which may include checking your observations, such as blood pressure, temperature, and pulse. We may also examine your ears, nose, and throat, listen to your heart and lungs, and check your reflexes.

3. Health concerns: You will have the opportunity to discuss any current health concerns or symptoms that you are experiencing. We will ask you questions to help determine the underlying cause of your symptoms.

4. Diagnosis and treatment plan: Based on your medical history, physical examination, and symptoms, we will diagnose your condition and develop a customised treatment plan. This may include prescribing medication, recommending lifestyle changes, or referring you to a specialist for further investigation or treatment.

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

6. Additional services: We offer additional services, such as health screenings, diagnostic tests, and vaccinations, which can be arranged during your consultation or at a later date.

Menopause and Anxiety

Does menopause cause anxiety?

Anxiety is a common perimenopause symptom and can often be one of the first symptoms that you might notice. For some women, this is the first time they have experienced anxiety whilst for others, they may have experienced it before, and their anxiety has worsened. Anxiety can manifest as a feeling of fear, panic, feeling overwhelmed or a general feeling of worry.  

Hormone fluctuations and our stress responses can make the anxiety worse, so it is important to take the time to look after yourself and manage your stress levels wherever possible. Yoga, mindfulness and relaxation therapies can help and there are various apps which can support you through some meditation practices.  

Hormone replacement therapy may be used if it is felt that hormone fluctuations are contributing to your anxiety. It is also worth noting that some anti-anxiety medications can be extremely helpful too.  

Cognitive behavioral therapy (CBT) can also be beneficial in the peri/menopause and is based around talking therapy. There is lots of evidence that it can be helpful in managing hot flushes too.  

A holistic approach is key.  

Everything you need to know about a Transvaginal Scan

Feeling anxious about an upcoming transvaginal scan appointment? 

Stylist Magazine writer Abbi Henderson recently underwent her first transvaginal scan.  Although the thought of the scan itself didn’t cause her much mental anguish (though, it very commonly can), She did have a lot of other, unanswered concerns. Did she need to do anything special – food and drink-wise – beforehand? What, exactly, would be picked up on the scan? And, were the treasure hunt successful, would she receive info on the whereabouts of the sneaky thread or even be able to have the IUD removed same-day? So she turned to our expert consultant gynaecologist Mrs Pradnya Pisal to provide the answers.

Can you give an outline of what actually happens at a transvaginal ultrasound? What’s the process from start to finish?

For an internal (vaginal) ultrasound scan, you will be advised to empty your bladder and then undress completely from the waist down. A hospital gown or sheet will be given to cover you. You will be asked to lie on your back on the ultrasound couch. A chaperone is always present for this scan. Your knees will be bent and your feet will be on movable feet rests. The knees will then be raised in a way that allows the scan to be performed easily. A thin elongated ultrasound probe is used for this procedure. It will be covered with a protective sheath and lubricating gel and then gently inserted into the vagina.

The ultrasound probe will need to be moved into different positions in order to visualize the uterus and ovaries clearly. Ultrasound scans are generally painless, although you may experience some discomfort as the probe is inserted into your body.

An ultrasound scan takes around 15-20 minutes. It will be carried out in the ultrasound department or in the consulting rooms of the clinic.

What is the ultrasound looking for? What info can it obtain (obviously, someone may be having one for many reasons but for those feeling anxious about it, can it locate cysts/endo tissue/cancers/irregularities/awkwardly positioned contraceptives, etc)?

An ultrasound scan is an investigation to create an image on a screen of the organ or body part being examined using sound waves. It is used to help in making a diagnosis so that appropriate treatment can be offered. It is carried out by medical doctors and specially trained health care professionals (sonographers). The scan is performed using an ultrasound probe that gives out high frequency ultrasound waves. These sound waves cannot be heard. The size and shape of the ultrasound probe depends on the part of the body being examined.

The internal (vaginal) ultrasound scan allows the probe to be placed inside the vagina so that it is closer to the pelvic organs being examined. This provides clearer pictures of the uterus, ovaries and abnormalities that may lie deep in the pelvis.

What happens after? Do patients receive results straight away or is there a wait? If there is a wait, is there anything that can be done for those with anxiety to make the wait less stressful for them?

The person performing the scan will usually inform you of the findings or arrange for you to see your doctor. If your scan is performed by a sonographer, if appropriate, they will tell you if any abnormality is detected.

You will be given a report immediately or the report will be emailed to you. For pregnancy scans, you will be given a copy of the images of your baby. Your consultant will explain the scan findings, make a diagnosis and then discuss further investigations and treatment options.

What if someone is allergic to latex?

If you’re having an internal (vaginal) scan and are allergic to latex, it’s important to let the sonographer or doctor carrying out the scan know this so they can use a latex-free probe cover.

 If someone has sexual trauma, how is that handled?

Please inform the clinic / person carrying out the scan of this. You can also ask to take a friend with you and request a female sonographer. You can also request a local anaesthetic gel to be used to make the scan less uncomfortable. If you think that you may not be able to go through a transvaginal scan, you can request a transabdominal scan (you will need a full bladder) or an MRI scan.

Why aren’t virgins allowed to have a transvaginal ultrasound?

A transvaginal scan involves insertion of a probe which can be uncomfortable and also not appropriate. Hence, a transabdominal scan is preferred.

Are there alternatives if someone absolutely doesn’t want to have a transvaginal ultrasound?

The three types of ultrasound scans commonly used in obstetrics and gynaecology are:
1. External abdominal ultrasound scan – the probe is moved over the skin
2. Internal (vaginal) ultrasound scan – the probe is inserted into the body (vagina)
3. HyCoSy or Aqua scan – this scan is performed to assess the uterine cavity and patency of fallopian tube

An external ultrasound scan is most often used to examine your unborn baby (after 10 weeks of pregnancy) or when an internal scan cannot be performed to examine the pelvic organs. A small handheld probe is placed on your skin and moved over the part of the body being examined. A lubricating gel is put on your skin to allow the probe to move smoothly. This also ensures there’s continuous contact between the probe and the skin. You shouldn’t feel anything other than the probe and gel on your skin (which is often cold). If you’re having a scan of your womb or pelvic area, you may have a full bladder that causes you a little discomfort.

In some cases, ultrasound scanning has no alternatives but an MRI or CT scan can be used instead or in addition to ultrasound scanning.

Anything else to know to make the experience less uncomfortable? Any specific questions to ask the gynae/info to disclose to them? Advice on what to wear/what to eat or drink before and after?

Before having some types of ultrasound scan, you may be asked to follow certain instructions to help improve the quality of the images produced. You may be advised to drink water and not go to the toilet until after the scan – this may be needed before a scan of your unborn baby or your pelvic area. You can eat as normal and you do not need to starve. There will be a toilet nearby to empty your bladder once the scan is complete. If you are using a tampon, this will need to be removed before a vaginal scan.

Patients can bring a friend or relative with if it makes them feel more comfortable.

Click here to view the full article.

Beverley Knight’s personal battle with fibroids

Did you know Beverly Knight suffered from fibroids and had to take a break from showbiz as she recovered?

Singer’s scary condition ‘I had no idea’!  Beverley Knight didn’t know what fibroid were when she was diagnosed. The NHS notes that fibroids are more common in women of African-Caribbean descent and a 2015 study highlighted that 80 per cent of Black women will suffer from fibroids, compared to 70 per cent of white women by age 50.

Beverley Knight is a recording artist and musical theatre actress. She is widely labelled as one of Britain’s greatest soul singers and is best known for her hit single “Greatest Day”. The singer endured a health scare and was forced to take time out.  Beverley Knight’s battle with mystery condition that affects 80 per cent of Black women.

The hitmaker, who now appears on TV each Saturday night on the judging panel of Starstruck, told Hello! at the time: “I have no idea why, I’m just glad that I got through it.” She added: “‘I’m a proud aunty and godmum, but having children of my own has never been part of the plan”.

Beverley Knight spoke candidly about her experience in 2017 to the Mirror recently.

Mr Narendra Pisal, consultant gynaecologist , says more awareness needs to be raised. “I don’t think there is much awareness of fibroids, even in the African-Caribbean community,” the expert, who has practised gynaecology in London for over 21 years, tells the Mirror. “I see women and they are often shocked. It does become a taboo, kept a secret, it is a private thing for a lot of women, they won’t talk about it. “The more awareness we increase, the better it will be.”

He has called for every woman at the age of 25 to have an ultrasound – which can pick up conditions like fibroids, endometriosis, and polycystic ovaries.

This is why fibroids can remain undetected, he says, until women start trying to have a baby and then go for a pregnancy scan, most commonly in their 30s. Click here to view the full article online.