Dr Sarah Brewer talks to iVillagers openly about their gynaecological and reproductive health concerns
Conceiving after a loop incision
Treatments for conception with PCOS
Live discussions on the Sexual Health and Contraception message board
Bleeding after the Pill
Q: When I came off the Pill, I had an agonising withdrawal bleed. It was so sore - I 've never had anything like it. I also found discharge on my towel - it was about three inches long and one inch wide. I am worried, embarrassed and scared to go to docs. andre82
A: There are several possibilities. It may have been a plug of mucus that normally plugs the cervix and which comes away - sometimes at ovulation or sometimes during menstruation. It may have been a blood clot, which can get quite large if blood has stayed in the upper vagina for a while, or it could be an early miscarriage. It is difficult to say, but as you're concerned, it is important to see your GP for a full check-up to help put your mind at rest. It's also important to check that your cervical smear is up to date.
Period cramps all month long
Q: For the past four months I have been getting period cramps for the whole month. It's not every day, but occurs often enough to bother me. I also have a feeling like something moving inside my tummy, but I don't think I could be pregnant - although I was having unprotected sex with my boyfriend six months ago. I've also had quite a few bouts of thrush and cystitis and I need the toilet quite often, especially during the night. iv_twinkles
A: A few women do have periods during pregnancy, so it is important to have a pregnancy check-up. As you were having unprotected sex, another possibility is that you have pelvic inflammatory disease due to chlamydia. Your best bet is to visit a genito-urinary medicine clinic for a full check-up as soon as possible (phone your local hospital for details). The clinic will test your urine to exclude infection and the presence of glucose, too, as well as sorting out any lingering thrush or cystitis problems. If the tests for chlamydia are clear, your doctor will probably want to refer you to a gynaecologist to exclude endometriosis, which can cause abdominal pain.
Post-coital bleeding
Q: Sometimes after sex I get a pale bleed, without any pain. I'm 44 years old and was wondering if this is anything to do with the menopause? I'm worried about it and don't really want to see my GP yet. nerak69
A: Do see your doctor, as post-coital bleeding should always be investigated. In many cases, no obvious cause is found, but it is sometimes a sign of a cervical polyp, a cervical erosion (more properly known as an ectropion), which may need to be cauterised, or an infection or inflammation (for example, chlamydia). It's also important to ensure your cervical smear is up to date, and to have an internal examination to assess the size of the womb and ovaries. If you don't want to see your GP, you can ask for a full screen at your local genito-urinary medicine clinic.
Back to main question page
Are these pains IBS?
Q: I've been suffering from lower abdominal pain and pains right inside my vagina (sometimes when I urinate but mainly throughout the day). My doctor has put me on anti-spasm pills for the abdominal pains, which seem to be working, but I still get the odd one now and again. Now my stomach seems to feel generally unsettled all the time. Is it IBS? broody2003
A: Abdominal pains during periods can be due to excessive production of hormone-like chemicals (prostaglandins) in the womb wall, which can be helped with anti-inflammatory drugs such as mefenamic acid. Although IBS is a possibility, another potential cause could be endometriosis in which womb-lining cells are present in the pelvic cavity. These swell and bleed during a period, just as if they were in the womb, and can cause severe pain during menstruation, pain between periods, pain on making love, and can also make it difficult to conceive. As symptoms have been going on so long, do ask your GP if he or she will refer you to a gynaecologist for assessment and advice.
Conceiving after a loop incision
Q:I had a loop biopsy two weeks ago and was advised to avoid intercourse and bubble bath for four weeks to prevent infection. I should get biopsy results in another week or two. My husband and I were trying to conceive before this and the doctor at the hospital said it would be okay after the four weeks wait is up. In your experience have there been any problems conceiving following treatment? indys2004
A: As long as the procedure was straightforward, then you should be fine, so try not to worry. Very occasionally, if a large area has to be taken away, the cervix may need a stitch inserted during pregnancy to keep it tightly closed, but this is not that common. Most people have a perfectly normal pregnancy and delivery after the treatment.
Tests for polycystic ovarian syndrome (PCOS)
Q: Last month I was diagnosed with PCOS and I'm due to go for my review appointment. During my first appointment I was given two plastic wallets to take to my doctor for blood tests, and information about laparoscopy. They told me I could only have the blood tests and laparoscopy when my period arrives. As yet I haven't had a period for seven months. nuttytart343
A: Try not to worry as the blood tests will probably be done at the time of the clinic appointment - in some ways the fact that you haven't had a period is of diagnostic help in itself. Investigations to confirm the diagnosis of PCOS usually include blood tests to check hormone levels. With PCOS, these will show low progesterone and elevated free testosterone levels. Pelvic examination using transvaginal ultrasonography will show the size of the ovaries and whether or not multiple cysts are present.
Last year, a joint meeting of the European Society for Human Reproduction and the American Society of Reproductive Medicine suggested new guidelines for the diagnosis of PCOS. It was suggested that PCOS may be diagnosed when at least two of the following are present: lack of periods (oligomenorrhoea) and/or lack of ovulation (which you have); clinical or biochemical signs of raised androgen levels; and/or ultrasound findings of polycystic ovaries (which can be done in the clinic, too). It is still important to go along for your appointment.
Back to main question page
Treatments for conception with PCOS
Q:I came off the pill at end of January, at the request of my gynaecologist. I had a withdrawal bleed, which was controlled fairly well with tranexamic acid. However, since this I have not had a period at all. I have PCOS and I don't know whether to be concerned that I've not had a period yet. I have experienced sore enlarged breasts, abdominal twinges that aren't really period cramps, nausea and tiredness, though I don't know if this is just changes from coming off the pill. Pregnancy tests to date have been negative. cl-nemo01
A: Sometimes it can take several months for a normal menstrual cycle to return after stopping the Pill. If you have PCOS, this is the most likely reason why your periods have not returned, rather than having taken the Pill itself. If you do not want to conceive, then treatment is not necessary unless you have troubling symptoms. Absent or irregular periods are often treated with synthetic progesterone hormones or the oral contraceptive pill to produce a regular bleeding pattern (although recent evidence suggests the Pill may worsen insulin resistance and that oestrogens are better given as a patch rather than in tablet form). Excess hair (hirsutism) and/or acne are treated with an androgen blocker (for example, cyproterone acetate found in a brand of Pill called Dianette).
Researchers have also found that PCOS responds to treatment with the anti-diabetes drug, metformin, which improves insulin resistance so that more glucose is taken up into muscle cells. Metformin helps to reduce weight gain, lowers androgen levels and improves cycle irregularities. When used together with clomiphene, metformin may improve ovulation rates and chances of pregnancy in women with PCOS - certainly in those of normal weight. Women with PCOS who aren't obese tend to respond better to treatment with metformin than those who are very overweight.
If you wish to conceive, then treatment with the fertility drug, clomiphene, is effective in triggering ovulation in four out of five women with PCOS but does increase the chance of a multiple pregnancy, most commonly with twins. Stronger fertility drugs such as gonadotrophins will help up to 95 per cent of women ovulate, but significantly increase the risk of multiple pregnancy (14 per cent to 36 per cent). If drug treatment does not work, a laser beam may be used to literally drill holes in the surface of the ovaries using keyhole (laparoscopic) surgery. It is as effective in improving fertility as clomiphene and gonadotrophins although why it works is unknown.
Lose any excess weight - even modest weight losses of around six kg (one stone) can correct hormone abnormalities, reduce unwanted hair and improve your chances of conceiving. Take regular exercise and, if you smoke, do your utmost to stop, as smoking reduces ovarian function.
Back to main question page