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.
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.
If you would like to sponsor Mr Pisal, please click here.
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
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. If you would like to donate, please click here.
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
Today is Walk to Work Day. If you can, why not take this opportunity to put on some trainers and try your commute on foot. It might take a bit longer but chances are you’ll feel better for it. Walking more regularly is great for our mental and physical health, and of course much better for the environment. We asked our fitness ambassador Ellie Baker some quick questions about the benefits of walking and how we should be doing it.
Is walking a good form of exercise?
Walking is a good form of exercise, it is extremely accessible and people of all ages can do it.
What are the benefits for our physical and emotional health?
The physical benefits of walking are that it improves: fitness, cardiac health, builds stamina, reduces risk of diabetes, cancer, dementia, weight loss, vitamin D, improves circulation, posture, helps you sleep better and builds strong bones.
The mental benefits of walking are it alleviates depression, improves mood, releases feel good endorphins, reduces stress, reduces anxiety.
How many steps do most people walk a day?
The average person takes between 3,000-4,000 steps per day.
How many steps should we be walking a day?
Ideally people should walk around 10,000 steps per day.
What is a good speed to walk at?
A brisk walking pace is 3.0 miles per hour / 5 kilometres per hour which is the 12 minutes per 1 kilometre.
Is duration or speed more important in terms of fitness benefits; what else should we consider, e.g. heart rate?
When it comes to fitness benefits when walking you will get more the faster you walk, however if you’re unable to walk very fast it would be better to walk for a longer duration of time. 30-60 minutes is good to aim for. I wouldn’t consider heart rate when it comes to walking but I would go on how I feel.
On No Smoking Day 2019, Consultant Gynaecologist Narendra Pisal looks at the effect of smoking on women’s health, outlining overall risk levels for gynaecological cancer and the problems associated with smoking during pregnancy and the menopause.
What is the link between smoking and gynaecological cancers?
There is a strong link between smoking and cervical, vaginal as well as vulval cancers. These cancers are caused by Human Papilloma Virus (HPV) infection and smoking is known to affect immune response to HPV. As a result, smokers are less likely to shake off this infection.
Smoking paralyses ‘cells of Langerhans’ which are responsible for carrying the ‘HPV antigen’ to the immune system which then leads to ‘antibody’ formation. As these cells are paralysed, smokers are not able to mount an immune response to Human Papilloma Virus and are more likely to have persistent infection and hence higher risk of cancer.
Some types of ovarian cancers are also more common in smokers (e.g. Mucinous ovarian cancers). The exact mechanism of how this risk increases is not known.
How much more are you likely to develop these cancers if you smoke?
According to IARC (International Agency for Research on Cancer), 21% of cervical cancer cases in the UK are caused by smoking. Risk of developing the commonest type of cervical cancer (Squamous Cell Carcinoma) is 46% higher in current smokers when compared with women who have never smoked.
Will your risk decrease after stopping smoking?
Cervical cancer is not associated with past smoking, so stopping smoking is known to reduce the risk of developing cancer. This is because the effect of tobacco on the immune system is reversed after quitting smoking.
What are the dangers of smoking while pregnant?
Smoking when pregnant is associated with increase in the risk of miscarriage, ectopic pregnancy, small baby (growth restriction), still birth, premature labour and abrution of the placenta. Smoking can also affect the newborn child by increasing risk of asthma, chest infection, cot death and poor performance at school. All in all, it is best to quit smoking as soon as possible when you are planning a pregnancy. Stopping smoking will reverse all the above risks.
Can smoking affect menopause symptoms?
It is known that smoking can affect ovarian reserve and function and can lead to early menopause. Smokers are also likely to have lower oestrogen levels. Smokers also have more menopausal symptoms such as hot flushes and poor quality of sleep. Women who smoke often don’t know that they are prone to earlier menopause and more severe menopausal symptoms. It is important to get this message out so that women have another incentive to give up smoking.
If you’re looking to quit smoking, NHS Smokefree can help. If you have any questions or concerns, feel free to contact us on 0207 10 11 700.
In celebration of Pancake Day, we asked Nutritional Therapist Laura Southern for a delicious and nutritious pancake recipe that you can easily whip up at home.
Using wholemeal or spelt flour increases the fibre content of these pancakes which can support blood sugar balance – vital for anyone with hormone dysregulation. The addition of ground almonds increases the essential fat and protein content, also both necessary for hormone production and balance. Including fresh blueberries can help support the liver which is key to metabolise old circulating hormones.
Here’s the recipe:
Ingredients
Method
Enjoy!
Consultant Gynaecologist Narendra Pisal shares some information on the topic of ovarian cysts, discussing types, symptoms and treatment.
Ovarian cysts are fluid-filled cysts commonly seen within ovaries. The cysts can vary in size and range from a few millimetres to tens of centimetres. They are very common and probably most women have them at some stage of their life.
There are three common types of ovarian cysts:
Functional ovarian cysts: These cysts are also known as follicular cysts and are common in young women. Function of ovaries is to produce eggs every month and it is not uncommon for these eggs to be retained and enlarge in size. These cysts are often self-limiting and can be monitored. Usually, these cysts will resolve spontaneously without any treatment.
Benign ovarian cysts: These cysts are not cancerous but do not resolve spontaneously. Tumour marker (CA125) levels are often normal and surgery can be performed as a key-hole (laparoscopic) procedure. Dermoid cyst or Chocolate cysts (Endometriosis) are common benign ovarian cysts.
Malignant ovarian cysts (ovarian cancer): These cysts are often seen in older women and the tumour marker (CA125) level may be raised. Even though ovarian cancer may be suspected on tests, it is confirmed after removal and histological analysis. Treatment is often (but not always) by open surgery. In some cases of advanced ovarian cancer, further treatment may be required after surgery in the form of chemotherapy.
Many ovarian cysts are asymptomatic but some may produce symptoms such as abdominal pain, fullness of abdomen, lump and occasionally sharp pain. Sharp pain that comes on acutely can be a sign of complications such as torsion, bleeding or rupture. Cancerous ovarian cysts in early stages may not produce any symptoms at all or the symptoms may be vague or appear unrelated. In addition to above symptoms, abdominal distension, indigestion, dyspepsia or altered bowel habits may be associated with malignant ovarian cysts. New onset of pelvic pain after the age of 50 is also a significant symptom. These symptoms often imitate irritable bowel syndrome (IBS) and you should see your GP urgently if you are older than 50 and have these symptoms.
What tests may be needed to make a diagnosis?
An ultrasound scan (vaginal or abdominal) is used to make a diagnosis. An MRI scan may be advised to obtain further information about the nature of an ovarian cyst. CA125 blood test (also known as the tumour marker test) may be performed. This test is often raised in cancerous cysts but may also be raised in other benign conditions such as endometriosis, fibroids, infection, during monthly periods and after surgery.
How is an ovarian cyst generally treated?
Not all ovarian cysts need removal. Functional (follicular) cysts often will resolve spontaneously. Surgery may be needed if the cysts are persistent or if there are symptoms. If there is a suspicion of cancer, urgent surgery is indicated to make a diagnosis and also as treatment.
Most of the ovarian cysts can be removed as a key-hole (laparoscopic) procedure. Three or four small (5-10mm) incisions are made on the tummy wall. Camera and special surgical instruments are then inserted to remove the cyst and healthy ovarian tissue is conserved. The cyst is then put in a plastic bag, decompressed and removed without spilling anything inside the tummy. Key-hole surgery avoids the need for a big incision and has the advantage of reduced hospital stay and quick recovery and return to normal life.
The ovary containing the cyst does not need to be removed unless the cyst is suspected to be cancerous or too large.
Are some women more susceptible?
We don’t know exactly why but some women appear to have a tendency to develop recurrent ovarian cysts, often simple or functional cysts. It may not be always possible to prevent these ovarian cysts, but going on the contraceptive pill can help by preventing development of an ovarian follicle and cysts. We know that some genetic conditions such as presence of BRCA1&2 and family history can increase the risk of ovarian cancer. Screening with ultrasound scan and CA125 can help with early detection in these women with increased risk.
Do ovarian cysts affect fertility?
A large ovarian cyst can stop that ovary from functioning properly. Some ovarian cysts are caused by endometriosis which can be associated with reduced chance of getting pregnant. Most of the times however an ovarian cyst will not interefere with chance of ovulation and fertility.
Consultant Gynaecologist Narendra Pisal outlines the condition adenomyosis, explaining its symptoms, the impact it has on women’s lives, and the ways it can be diagnosed and treated:
Adenomyosis is a common but under-recognised condition characterised by an enlarged uterus due to infiltration of the uterine lining into the muscle wall. During menstruation, this adenomyotic tissue also swells up and bleeds within the uterine wall, which can cause severe period pain, cramps and heavy periods. The condition is often diagnosed on an ultrasound or MRI scan where an enlarged uterus is seen with one wall of the uterus thicker than the other.
Typical symptoms of adenomyosis are heavy and painful periods. Sometimes the uterus is so enlarged that a lump can be felt in the lower abdomen and can also cause pressure on the bladder and bowel causing urinary frequency and constipation. Having said that, a lot of women do not have any symptoms at all.
Many women live with this condition without ever having a diagnosis made. A lot of women with adenomyosis have such bad periods that they have to put their life on hold for that time of the month. It affects their work and quality of life significantly. It can lead to anaemia due to heavy bleeding and lead to extreme tiredness and also affect performance at work and sports.
Treating adenomyosis
Adenomyosis can be a difficult condition to treat. Supportive treatment is often the first line of management with medication to make the periods less painful (painkillers and antispasmodic medication such as Mefenamic Acid) and to reduce the bleeding (Tranexamic Acid). Sometimes taking the minipill or the contraceptive pill back to back can also stop the periods and hence help with the symptoms. Mirena intrauterine device is also helpful in reducing the symptoms significantly. The condition also improves during and after pregnancy and after menopause.
Uterine artery embolisation (UAE) is a treatment usually reserved for fibroids but is also very effective for treating adenomyosis. The uterine blood supply is blocked by an interventional procedure carried out through the groin blood vessels. Hysterectomy is often reserved for extreme cases where the symptoms are resistant to other forms of treatment and the family is complete.
Diagnosing adenomyosis
This condition is difficult to diagnose as the symptoms are common and affect a lot of women. A large proportion of women have heavy and painful periods and accept the symptoms as ‘normal for me’. Women don’t often know how heavy or painful their periods are supposed to be. When they do seek medical attention, often the doctors would start medical treatment to control symptoms and a scan may not be carried out or may not actually pick up the condition.
There are many other causes of heavy and painful periods such as fibroids and endometriosis which are more commonly known. In fact, both fibroids and endometriosis often coexist with adenomyosis. Adenomyosis is also known as ‘internal’ endometriosis as the uterine lining grows inside the uterine wall where as it grows outside the uterus with endometriosis.
More doctors and women are now aware of this condition and increasing availability of ultrasound scans will lead to higher detection rate. This is good news indeed as early diagnosis will help in prompt treatment and improving the quality of life for these women.
If you are concerned about adenomyosis or heavy periods please visit your GP or contact London Gynaecology on 0207 101 1700.
We are delighted to announce that Miss Heather Evans is joining the London Gynaecology team. An experienced consultant gynaecologist, Miss Evans qualified in 2002 at The Royal Free Hospital, where she is currently the lead for colposcopy and gynaecological cancer. Miss Evans is provides a range of gynaecological services including colposcopy and abnormal smear management, management of heavy periods, post-menopausal bleeding and hysteroscopy.
If you would like to book an appointment with Miss Evans, please call 0207 10 11 700 or email [email protected].
