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Gynaecological Q&A with Mr Mortimer

10 October 2018

We sat down with our Consultant Gynaecologist and Obstetrician Mr Alex Mortimer, to dispel some common myths and answer questions on all things gynaecological - from cervical smears, stress incontinence and contraception, to heavy periods, fertility and menopause.

Do I still need to have a smear if I had the HPV vaccine?

Yes. The HPV vaccine protects you against Human Papilloma Virus 16 and 18 (HPV 16/18), and this therefore reduces your chance of cervical cancer. It is still important, however, to attend for your smears every three years from age 25 to 49, and every five years from age 50 to 64 as not all cervical cancers are caused by HPV 16/18.

My periods are so heavy that I can't leave the house when things are at their worst. What treatments are available?

Non-hormonal tablets such as Tranexamic acid can help reduce the amount of bleeding. Hormonal options include combined or progestogen-only contraceptive tablets, the Mirena hormone coil, Progestogen injections or implants. There are some injections that mimic a menopause and 'switch off' your periods temporarily. Surgical options include endometrial ablation and hysterectomy.

Do I need any tests if my periods are heavy?

While the definition of heavy periods used to be 80ml, a woman is the best judge of how heavy her periods are. Sometimes, it is necessary to arrange an ultrasound scan, or arrange a hysteroscopy (camera into the womb) and take an endometrial biopsy to determine the cause and if any further treatment is necessary.

Do I still need smears after a hysterectomy?

This depends on a couple of things. Firstly, you should be told whether or not your cervix was removed during the hysterectomy. If this was a vaginal hysterectomy then your cervix was almost certainly removed. A subtotal hysterectomy means the cervix was not removed. Secondly, some women need to have something we call a 'vault smear' after hysterectomy - your doctor would write to you if this was the case.

Why can't I hold onto my urine?

Some women have an overactive bladder which means they have an intense sensation to pass urine and sometimes this leads to an accident (incontinence). While some women can find this embarrassing, there are many treatments such as bladder retraining, pelvic floor exercises, leading to medications and some surgical procedures.

Every time I run after my child, or go to my exercise class, I have an accident. What can I do?

This sounds like stress incontinence and pelvic floor exercises are an effective treatment. It can be helpful to see a specialist physiotherapist to ensure that you are doing them effectively. It can sometimes help to lose weight if you are overweight and stopping smoking is important. Avoid constipation. Sometimes a minimally invasive operation may help your symptoms - minimally invasive operations.

I think I have a prolapse. Do I need an operation?

Not necessarily! Prolapse can be uncomfortable or lead to bladder or bowel symptoms, but it can sometimes cause no bother at all, and in that case you can leave it alone. It is helpful to maintain a healthy diet and weight and avoid smoking. Pelvic floor exercises can help too. If you do not wish to have an operation then then there are some non-surgical alternatives to surgery that are still effective and safe.

I don't want any more children - what are my options?

Options can be split into hormonal and non-hormonal. There are pills, tablets, injections, implants, and the Mirena intrauterine system. The Mirena can help heavy periods, painful periods, endometriosis, premenstrual syndrome and it can protect the lining of the women who have Polycystic Ovary Syndrome. It can also be part of Hormone Replacement Therapy (HRT). Further to hormonal methods, the copper coil lasts 10 years and sterilisation is a keyhole operation which is a permanent option.

I'm developing menopausal symptoms but I'm worried about breast cancer - what are the alternatives to HRT?

There is indeed a small increase in the risk of breast cancer whilst taking HRT. Some women seek complementary therapies for menopausal symptoms such as Evening Primrose Oil. The 'flushes' or vasomotor symptoms can be treated by drugs such as Clonidine, and certain antidepressants such as Venlafaxine.

We've been trying for a baby for a while - is it time we had fertility investigations?

Some couples take some time to conceive. Over 80% of couples conceive after one year of trying and over 90% after two years of trying. However, it is reasonable to ask for help or advice if, for example, your periods are further apart than every five weeks, or if a man has had testicular problems or surgery. Getting pregnant can sometimes be difficult but your GP or a gynaecologist can be helpful in answering your questions and make the necessary investigations.

If you’d like more information on women's health, or would like to book an appointment with Mr Mortimer, call 0191 418 8687.

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