Painful Periods

Consultant Gynaecologist Narendra Pisal explains why some women get painful periods, how to ease the pain, and when to worry it’s something more serious.

Sometimes there isn’t a reason why some women have more painful periods than others, but often there is. And even if everything is normal, we can always do something to alleviate the pain. 

The most common reasons for painful periods are:

• Endometriosis: This is where the inner lining of the uterus is inside the abdomen causing painful periods (and sometimes also pain during sex)
• Fibroids: These are common benign (non-cancerous) lumps of the uterine muscle, which can cause painful and heavy periods.
• Adenomyosis: This is where the lining of the uterus is in the wall of the uterus and can cause of bruising during periods which is painful.
• Heavy periods with clots are often painful too.
• Hormonal imbalance is often the cause when there is no other physical explanation.

The best ways to alleviate painful periods are:  

• Always see your doctor to discuss your symptoms.
• Simple painkillers can help, but don’t underestimate the power of a hot water bottle.
• Prescription medications such as Tranexamic Acid (reduces the amount of bleeding) and Mefenamic Acid (great for relieving spasms) are very effective.
• Taking the combined contraceptive pill often can make the periods lighter and less painful.
• If these simple measures are not helpful, it is best to see a gynaecologist for an assessment and a pelvic ultrasound scan. 

There are a few signs that the pain could be more serious. These are:

• Intensity: If you need to take constant painkillers or cannot do your day to day activities, you need to seek medical attention.
• Associated symptoms: such as fainting, loose motions, painful motions, vomiting also indicate that you need to see a doctor.
• Taking time off work/school: If your periods are affecting the quality of life in a major way, it is important to take steps to alleviate the symptoms.
• Heaviness of periods: If the pain is associated with heavier periods with clots and flooding, that can indicate a physical problem such as uterine fibroids.
• Pain during sex: Deep pain during sex associated with painful periods can sometimes indicate a condition called Endometriosis.

If you are experiencing any of these symptoms or concerned about painful periods see your GP or gynaecologist or call us on 0207 10 11 700.

Your periods as you get older

Our periods are affected by many factors, from age and body mass index to contraception, pregnancies, breastfeeding and menopause; they change over time. Below, Consultant Gynaecologist Narendra Pisal explains how these things can have an impact on hormone balance, and in turn cause period issues as we move through different stages of our lives.

The teenage years 

The average woman starts her periods at around 11-14 years. It is normal to have irregular periods during the teenage years as the ovulation is still sporadic and unpredictable. It can take a few years (until the early 20s) for regular ovulation to establish and for periods to develop a particular pattern.

Twenties and thirties

This is a more stable period for the menstrual cycle and the periods are often regular and predictable.

If you’re on birth control, this can affect your periods. Read our blog for more information on periods and contraception here. 

A missed period or late period can occur because of several reasons or sometimes for no reason at all. The common causes are:

• Pregnancy: If there is any chance of pregnancy at all, please do a pregnancy test. You should do this even if you are using contraception.
• Polycystic ovaries: Polycystic ovaries are common and occur in around 22% of women. Some women with polycystic ovaries can also have anovulation (lack of ovulation) and this can lead to a late or missed period. A scan and blood tests may be necessary to make this diagnosis.
• Hormonal imbalance: Thyroid hormone problems or pituitary (a gland in the brain) hormone issues can cause delayed or absent periods. Your doctor will be able to check for this.
• Eating disorder: Anorexia can cause reduced body fat and can affect ovarian function leading to late or even absent periods.
• Extreme exercise: The same can happen with a lot exercise. Many of the Olympic athletes often miss their periods due to reduced body fat.
• Perimenopause or menopause: Cycles can often be delayed around the time of menopause. This is because of unpredictable ovulation and ovarian function.
• No cause: Sometimes, periods can be late due to no obvious reason. Stress or long distance travel or some medications can affect the cycle too. If pregnancy is ruled out, it is OK to wait for a few more weeks before seeing a doctor. Keep a record of your period dates and any other symptoms you may have.

Thirties and forties

If you’ve had a baby, your periods will change afterwards.

• Breastfeeding stops the periods for up to twelve months. One can still get pregnant while breastfeeding, so it is best to use some form of contraception.
• Periods often improve after delivery. The cervix is more open and hence the periods are less painful.
• It is not uncommon for conditions such as fibroids or polyps to develop and cause period problems. So heavy, prolonged or irregular periods should always prompt a doctor’s visit.

As you approach peri-menopause in the mid-forties, periods can become heavier and more frequent (or sometimes even more spaced out). Whilst cycle length can vary, bleeding between periods and prolonged or heavy periods should act as red flag symptoms.

Fifties and beyond

Menopause is the period in a woman’s life when menstruation ceases. In normal circumstances this usually occurs after the age of 45.

During this time ovarian function declines and periods become irregular, unpredictable and eventually stop. This decline in ovarian function means the decreased release of hormones oestrogen and progesterone and this change in hormone level causes menopause symptoms such as hot flushes, night sweats, mood swings, lack of libido and vaginal dryness.

Menopause is a retrospective diagnosis and is made 12 months after the last period. The symptoms above can point towards onset of menopause and can sometimes affect your life in a major way. It’s best to see your doctor to see if hormone replacement therapy may be a solution for you.

If you are concerned about any changes in your period it is best to seek medical advice with either your GP or gynaecologist.

Fibroids and Pregnancy

Fibroids are extremely common with approximately 50% of women having fibroids in their lifetime. Fibroids are benign (non-cancerous) growths within the uterine muscle and most fibroids are small and asymptomatic. Some women are concerned that their fibroids may interfere with their ability to conceive, have a healthy pregnancy and give birth. In this article Consultant Gynaecologist, Ms Flemming, answers those concerns and discusses what can be done to optimise pregnancy outcomes.

Can fibroids affect the chances of getting pregnant?

Fortunately, in most cases fibroids don’t usually interfere with chances of getting pregnant. Most fibroids are small therefore don’t interfere with the cavity of the uterus or the fallopian tubes.

However, there are a few cases where fibroids can interfere with conception and this is largely down to the location of the fibroid. Submucous fibroids (those which encroach on the uterine cavity) can sometimes affect the process of implantation. This can lead to sub-fertility and sometimes early pregnancy loss. Fibroids in the upper corner of the uterus (known as the cornual region) can occasionally obstruct fallopian tubes and can be a cause of tubal factor subfertility. Similarly very large fibroids and an enlarged uterine cavity can be a cause of not getting pregnant.

In summary, if the fibroids are small, the uterine cavity is normal and the fallopian tubes are open (patent) there is no cause to worry.

Can fibroids interfere with pregnancy?

Fibroids usually cause no problems with pregnancy but can sometimes be associated with risks during the antenatal period, labour and postpartum. Fibroids can increase the risk of early pregnancy loss and preterm birth, especially if they are large or interfere with the uterine cavity (submucous fibroids).

Fibroids can grow in pregnancy, this may be hormonally driven. This can lead to increased discomfort and can also be associated with ‘red degeneration’, this is where the rapid increase in the size of the central area of the fibroid does not get enough blood supply and undergoes necrosis (dying). This is associated with pain and tenderness over the fibroid. Sometimes admission to hospital and rest is requested for pain relief, anti-inflammatory and supportive treatment.

Can fibroids interfere with childbirth?

The effect of fibroids on childbirth largely depends on the fibroid size and location. Fibroids in the lower part of the uterus can lead to fetal malposition such as transverse (sideways) or breech position necessitating a Caesarean Section. C-Section can sometimes be difficult and complex due to the location of the fibroids.

Post-delivery, fibroids can interfere with contraction of the uterus leading to post-partum haemorrhage. However, most small fibroids do not cause a problem.

What can be done to optimise pregnancy outcome?

A consultation with a gynaecologist and an ultrasound scan is often required to make an assessment. If the fibroids are found to be large or within the uterine cavity, further assessment or intervention may be necessary. Fibroids may be associated with anaemia and correction of iron levels may be required before embarking on pregnancy.

Surgical removal of submucous fibroids is associated with an improved pregnancy outcome and there should be no increase in risk during future pregnancy or labour. However some surgical procedures may mean that natural labour is not safe, your surgeon will be able to advise you if an elective C-Section is required.

How long should you wait after surgery to try for a baby?

If you are thinking of conceiving post fibroid removal surgery, you should discuss with your surgeon who can advise when it is safe to start trying. In general, it is wise to wait for a year post a myomectomy procedure and 3 months after a hysteroscopic procedure.

If you have any further questions or would like to book an appointment with one of our consultant gynaecologists please give us a call on 0207 10 11 700. If you would like to read more about fibroids and the possible treatment options please head to our specialist London Fibroids website.

Charitable Giving to The Whittington Trust

Following Mr Pisal’s fantastic London Marathon 2018 effort in April we were able to present The Whittington NHS Trustwith a donation of £14,000. The money was raised through kind and generous donations from patients, friends and colleagues, with London Gynaecology also contributing £5,000. This donation will go towards new hysteroscopy equipment for the better diagnosis of endometrial cancer. Mr Pisal has practiced at The Whittington Hospital for 16 years and is proud to be the gynaecological cancer lead.

Mr Pisal and Emma Orman, COO London Gynaecology, visited The Whittington Hospital to present the Chief Executive, Siobhan Harrington, with the donation. She said “we are very grateful for you completing the marathon and all of your training and fundraising which will make a real different to so many of our patients.”

Mr Pisal and the rest of the team would like to thank all of the kind patients, friends and colleagues who donated to this fantastic cause.

At London Gynaecology we believe it’s important to give back and support many charities throughout the year, especially those who raise awareness for women’s health and support those affected by women’s health issues. If you would like to read more about our efforts, please head to our charity page.

Over £13,500 Raised for Charity

Consultant Gynaecologist Mr Pisal completed the 2018 London Marathon in an impressive 4 hours and 9 minutes. It was a spectacular day for both runners and supporters and humbling to see so many charities being supported.

Mr Pisal has raised a total of £13,752.50for The Whittington Hospital to purchase equipment to better diagnose endometrial cancer. We are overwhelmed with the support and kindness from all of those who donated to this incredible cause.

Fundraising is still open so if you would like to kindly donate please head here.

Launching with Pharmacierge

At London Gynaecology we strive to provide a first class service for our patients.  We recently launched Pharmacierge at our practice to extend our service right to the point of you getting your medicine. Pharmacierge are a seamless and efficient service which delivers your prescriptions straight to your door for a comparable cost to what you would pay in your local pharmacy for a private prescription.

Your prescription will be created for you in your appointment as usual, before it is sent to Pharmacierge. Pharmacierge will call you to arrange delivery and take payment. Your medicine is delivered to you the same day within London or the next day for the rest of the UK. All for a comparable cost of a private prescription and without a visit to your pharmacy.

We hope that Pharmacierge will enhance patients experience further as it will allow them to conveniently have their medicines delivered straight to them. For more information on Pharmacierge, please visit their website.

All About Fibroids

50% of women have fibroids by the age of 50.

Consultant Gynaecologist Mr Pisal spoke to Women’s Health about the signs, symptoms and risks of fibroids. Read the full article here.

Need to Book a Gynaecology Appointment?

We understand that having a medical concern may be worrying and booking an appointment with a private gynaecology clinic may be unfamiliar for many women. So as the first point of contact when a patient enquires, our administrator Aminah has put together some helpful points to think about ahead of making a call.

1. “What information should I have when making an appointment?”

When calling to make an appointment with one of our clinicians it is useful to have a couple of things to hand:

• Your referral letter from your GP (if you have one).
• Your availability.
• If you are an insured patient it is useful to have your insurance details including your membership number. Some insurance policies may not cover some procedures and tests. It is always advised to check with your insurer before making an appointment. They will be able to give you an authorisation code which indicates that they cover your appointment.
• If you are booking on behalf of someone else make sure you have the patients details to hand.
• Let us know if you have any access requirements or need a translator as this can be organised ahead of your appointment.

2. “What do I need to bring to my appointment?”

When you have your appointment with London Gynaecology there are a couple of things you might want to bring with you:

• Your referral letter with any previous scan reports and results that are relevant to the problem.
• You may bring your partner, a sibling or a friend to your appointment if for any reason you are worrying. All examinations are chaperoned and consultations can also be chaperoned by request.

3. “I am under 18, can I book an appointment at London Gynaecology?”

The minimum age for a patient to have an appointment varies by consultant:

• Mr Pisal or Miss Wilson minimum age is 16 years
• Miss Flemming minimum age is 14 years
• Mrs Pisal will see patients of any age

Any patient under 16 should make the practice aware when enquiring so we can contact the patient to understand more about their medical issue as it may be that the patient needs to be seen by another doctor. If you are under the age of 18 you must bring a parent or a guardian to your appointment. You must be over 18 to have an appointment at London Bridge.

4. “I can’t attend my appointment time anymore, what should I do?”

If you are unable to make your appointment it is best to let us know as early as possible so we can offer another patient the appointment. We can rearrange your appointment to a convenient time for you.

5. “How long do I have to wait for my appointment?”

We have 4 consultant gynaecologists at London Gynaecology so we are usually able to offer women an appointment within a few days and definitely within a week. If you require an urgent appointment we can usually see you the same day.

6. “I would like to read patient reviews, where should I look?”

If you are interested in reading about other patients’ experience with London Gynaecology, we have testimonials on our website. You can also find patient reviews on Google and on Doctify.

If you would like to book an appointment please don’t hesitate to call us on 0207 10 11 700.

Laparoscopic Surgery for the Removal of Fibroids

Fibroids are benign growths within the uterine muscle, and can be very debilitating. Often by the time we see patients they are very symptomatic with heavy periods causing anaemia or a large lump pressing on the bladder and other organs. Whilst benign, fibroids over 6cm can be removed in order to allow the patient to return to and enjoy a normal life.

However, for many patients the thought of open surgery is not very appealing, the large scar and a long recovery time can be off putting. In recent years, laparoscopic or keyhole surgery has provided a viable, and often preferable, option for many fibroid removal procedures.

Laparoscopic surgery is a procedure where 3 or 4 small incisions (5-15mm) are made on the abdomen. A device called a laparoscope (a narrow tube with a fitted camera) is inserted through an incision, to allow the surgeon to see the fibroids. A special device (morcellator) is used to cut the fibroid into smaller pieces which are extracted through the incision. Whilst it is a more complicated procedure, requiring specialist surgical skills and longer time in theatre, it also offers many benefits.

What are the benefits of laparoscopic removal of fibroids? 

• Shorter recovery time: The main benefit of laparoscopic surgery is tiny incisions, this means a much shorter recovery time; often patients will stay in hospital for 24 hours and are up and about within a few hours of their operation and can return to work within 2-4 weeks. In comparison, with an open procedure (open myomectomy) patients can expect stay in hospital for 3-5 days after surgery, and return to work within 6 weeks.
• Smaller scar:The reduced incision is cosmetically appealing and for patients who prefer to wear bikinis or who don’t want a “long” or “big” scar, laparoscopic surgery is a very attractive option.
• Lower risk of infection: Medically speaking, where possible, laparoscopic surgery is preferred as there is less risk of wound infection and also pelvic infection as tissue handling is minimal and is carried out by single use sterile instruments.
• Less risk of thromboembolism(blood clot to the legs or lung) as women tend to be mobile sooner which helps with better circulation.
• Better preservation of fertilityas there is less risk of adhesions and blockage of tubes.

When is a laparoscopic removal not possible?

There are instances where laparoscopic removal of fibroids simply isn’t possible. The size and location of fibroids will play a role in determining the procedure type, generally speaking fibroids smaller than 12cm can be removed laparoscopically but greater than this will depend on individual circumstances.

Age may also influence the possibility of having a laparoscopic removal. Patients over 50 years of age aren’t suitable for laparoscopic removal of fibroids due to higher risk of cancerous change within the fibroids.

Finding the right surgeon 

Laparoscopic surgical skills are specialist skills meaning that not every surgeon is able remove fibroids this way, so it may take more time to find an appropriate surgeon.

Finding the right surgeon is also important as trust plays an enormous role; in some circumstances the surgeon may not be able to decide whether a laparoscopic procedure is possible until the day of the surgery itself.  They may begin the surgery laparoscopically and move to an open procedure if it is required to complete the procedure successfully.

This would be discussed at length in the consultation before the procedure is booked so that the patient is comfortable and has had time to understand the situation and discuss the decisions she wishes the surgeon to make on the day.

Every year at London Gynaecology, we complete over 50 fibroid removal operations and over 90% are carried out by key-hole surgery.

Please visit our specialist website, London Fibroids, for more information, or call us on 0207 10 11 700.