The Questions You Should Be Asking Your Gynaecologist
Do I still need to have a cervical smear test?
“After the age of 50, smears are offered by the NHS every five years, and after the age of 65, you will receive a letter informing you whether you need further tests or not. If you have had regular negative smears during your lifetime, it is likely you will no longer be called for testing. This is because the human papilloma virus (HPV, which the smear test is designed to detect) is an infection you typically acquire when you are young and sexually active, and the infection takes ten to 20 years to cause cervical cancer. If you had the infection, it would have shown up in your smears before the age of 65. This means that a private smear test is not necessary.” – Dr Deborah Lee, GP at Dr Fox Online Pharmacy
What are the symptoms that would warrant getting HRT?
“Hormone replacement therapy (HRT) is an option for any woman who is perimenopausal or postmenopausal. In most cases, women decide to take it to help relieve symptoms such as hot flushes and night sweats. It is also helpful to improve sleep, calm anxiety and elevate mood. Women also often find taking HRT lessens joint pains, and improves their hair, skin and nails. HRT is thought to have specific health benefits if taken during 'the window of opportunity'. This means taking HRT around the age of 50-55 to control menopausal symptoms for five to ten years and stopping around the age of 60-65. When this happens, oestrogen replacement is believed to have a positive effect on the cardiovascular system, and also helps maintain and improve bone mineral density. If HRT is not taken during this time or started too late, the disease processes may already be under way, and it may be too late for HRT to confer any protection. Taking HRT is a personal decision and there are very few absolute contraindications to taking it. Even women who are not having menopausal symptoms may choose to take it, if they are at risk and would like to benefit from the protective effects of HRT on their heart and their bones.” – Deborah
If you don’t want HRT, what are your options?
“There are other options, but none will give the same degree of relief or additional health benefits. These include:
Clonidine: This is a tablet sometimes used to treat high blood pressure, which can also be used to treat hot flushes. It is introduced gradually, and then the dose slowly increased. However, at higher doses, around 50% of users complain of sleep disturbances.
Serotonin reuptake inhibitors (SSRIs): These can be successful at reducing the frequency and severity of hot flushes. Paroxetine is the most effective, followed by citalopram and fluoxetine. Venlafaxine is the preferred option for women who have had breast cancer and who are taking tamoxifen. Unfortunately, some women experience side effects including a dry mouth, nausea, problems with their appetite, constipation and lowered libido.
Gabapentin: This is a drug used to treat neuropathic pain. It can help reduce the frequency and severity of hot flushes and night sweats and aid sleep, but it can also cause daytime drowsiness.
CBT: One of the best alternatives to HRT is cognitive behavioural therapy (CBT). This is a type of talking therapy with a psychological approach. Women are taught a lot of the physiology of menopause, so they can understand what is happening to them, and are helped to develop coping strategies. In some studies, symptom relief following on from a course of CBT is similar to the use of HRT.” – Deborah
Why is it painful when I have sex?
“The hormonal changes that occur during the menopause and a reduction in oestrogen can cause the vagina to become thin and dry, which can create friction during sex, and the reduction of elasticity in the skin can make the vagina feel tight. Treatments that can help include HRT, including local HRT such as Vagifem vaginal pessaries, which contain a small dose of oestrogen, vaginal lubricators such as KY Jelly and vaginal laser therapy.” – Dr Zahra Ameen, consultant gynaecologist and obstetrician at the Cadogan Clinic
I am struggling with recurrent urinary infections – is this normal?
“If you are suffering with persistent urinary infections or cystitis-type symptoms, you could be struggling with vaginal atrophy, one of the key symptoms of the genitourinary syndrome of menopause (GSM). Like vaginal dryness, this is also caused by a lack of oestrogen in your genitourinary tract, and this causes symptoms in more than 50% of menopausal women. GSM is a chronic and progressive syndrome that is underdiagnosed and undertreated, and unfortunately symptoms do not settle over time as the tissues in the vulva and vagina continue to lose collagen and elastin. Some of the most common symptoms women report are a loss of lubrication as well as vaginal bleeding and discharge, stress incontinence, difficulty emptying the bladder, and a sensation of burning or irritation of the vulval area. If you recognise any of these symptoms, speak to your GP or a specialist gynaecologist.” – Zahra
How can I increase my libido?
“If you are struggling with a loss of sexual desire, you aren’t alone. Studies suggest this affects up to 86% of women at this stage in life. The most common complaints about lack of sexual desire include arousal difficulties, painful sex, inability to orgasm, and problems related to a negative body image. Many of these symptoms may be at least partially explained by the lack of oestrogen that occurs during and after the menopause. Replacing oestrogen with topical oestrogen, such as a pessary (Vagifem) or a cream (Ovestin) often leads to significant improvements in the quality and responsiveness of vaginal tissues. However, this is local treatment only and is not the same as taking substantive HRT products. If you are struggling with a low libido, speak to your doctor, who may be able to refer you to a specialist menopause clinic. Don’t underestimate the benefit of seeing a psychosexual medicine specialist – they are experts at helping couples with sexual difficulties. Many who have used their services have found this extremely helpful and wish they had gone sooner.” – Deborah
What level of urine leakage is normal?
“No urine leakage is normal, and women should not have to be incontinent. However, the issue is increasingly common with age. Stress incontinence – passing urine when you cough, laugh or sneeze – affects up to 45% of women over the age of 30, and urge incontinence – the continual feeling you need to pass urine – affects 9% of women aged 40-44 and 31% over 75s. Up to 30% of women with incontinence suffer from a mixed picture of stress and urge incontinence combined. The first step is to speak to your GP, who can carry out basic tests to work out which type of incontinence you are struggling with. If you have urinary symptoms, common conditions such as a urinary tract infection and diabetes need to be excluded. Stress incontinence is often related to pelvic floor prolapse, caused by childbirth. Physiotherapy with pelvic floor exercises can help, but if a significant prolapse is present, this requires surgery, in the form of a prolapse repair. Urge incontinence is more complex. It can be due to an overactive bladder and sometimes compounded by conditions such as interstitial cystitis. The treatment involves taking different types of medication to relax the bladder muscles. Investigations for incontinence include a cystoscopy – looking inside the bladder with a telescope – and urodynamic studies, which involve passing urine in front of a camera and measuring bladder pressure.” – Deborah
Does the menopause put you at risk of any other health conditions?
“It’s common knowledge that the complications of menopause include bone loss and an increased risk of osteoporosis, but it’s lesser known that after menopause, a woman’s risk of heart disease catches up with men. Women are protected from heart disease before menopause by their own oestrogen. Heart disease is the number one killer of women in the UK – it kills three times more women than breast cancer. There is evidence that taking HRT appropriately can help reduce the risk of heart disease. However, this needs to be started early in the menopausal period and taken for five to ten years.” – Deborah
As you age, are you still at risk of getting an STI?
“If you are having unprotected sex, you are still at risk of an STI, regardless of your age. In fact, between 2014 and 2018, rates of STIs increased by 23% in men and women over the age of 65. If you experience any unusual symptoms, head to your local sexual health clinic to get tested. The clue is in your sexual history – have you recently had sex with a new partner, a casual partner, or more than one partner? If so, these are all risk factors for getting an STI. Remember that many STIs have no symptoms, so you will not know if you are infected unless you get a test.” – Deborah
What are the gynae symptoms you should never ignore?
“Look out for bleeding after sex or any kind of bleeding post-menopause; abnormal discharge that is brown or pink-stained as well as unpleasant smelling discharge; a lump or swelling in the groin; or pain or soreness in the vulval area. Try to get into the habit of checking your vulva every three months, noting any skin changes, lumps or itchy areas – the easiest way to do this is with a mirror. If you notice anything suspicious, speak to your GP straight away for a referral for a gynaecological assessment. Also keep an eye out for symptoms of ovarian cancer, which can include persistent abdominal bloating, loss of appetite and nausea, unexplained weight loss, pelvic pain, changes in bowel habits and fatigue.” – Zahra
“If sex is painful, this is not normal and needs investigation. It can be due to an infection such as chlamydia, endometriosis, an ovarian cyst, fibroids or vaginismus. Pelvic pain should also never be ignored – if you feel any pain low down in the abdomen or pelvic region, see your GP. This could be due to pelvic inflammatory disease (PID) or an ovarian cyst.” – Deborah
Apart from gynae matters, what other tests should I be booking?
“The NHS invites all women between the ages of 47 and 73 to have a mammogram once every three years. After the age of 73, you can request a mammogram if you still want one. The aim of breast cancer screening is to detect breast cancer early before it has become advanced. You should also have a blood pressure check at least once every five years as well as a cholesterol test. One way of getting these done is to attend a free NHS health check, offered to all UK citizens aged between 40 and 74 at your GP surgery. Make an appointment with your GP without delay if this is overdue. If you are aged 60 to 74 and registered with a GP, you will also be sent a bowel cancer screening kit every two years. Bowel cancer is the fourth most common type of cancer and screening can help find it at an early stage, when it’s easier to treat.” – Deborah
Finally, is it worth seeing a gynaecologist privately?
“In countries like the USA, seeing a private gynaecologist is the norm, but that doesn’t mean you should also be seeing one regularly. Healthcare is structured in a very different way in the US. In the UK, the NHS provides excellent female health screening and there should be no need for you to pay to have these tests done privately. Moreover, most private healthcare companies don’t cover pre-existing medical conditions, or conditions linked to pregnancy and childbirth. Having said that, you should always be on the lookout for any new or unusual symptoms if you are over the age of 65 – report anything suspicious to your GP and they will likely make an onward NHS Consultant Gynaecology referral.” – Deborah
For more information visit DoctorFox.co.uk and CadoganClinic.com
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