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Endometriosis

What is Endometriosis?

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Endometriosis is a condition when endometrial tissues (inner lining of the womb) are found outside the womb. These endometrial tissues can be located in the pelvis, ovaries, fallopian tube, bladder, bowel, vagina and other areas of the body. It is a common disease that affects 1 in 10 women during their reproductive years.  Cause of endometriosis The exact cause of endometriosis is unknown, but it is likely to have a genetic component activated by hormonal factors and the immune system. The disease is rare in African-Caribbean but more common in Asian women which suggest a genetic involvement. Symptoms of endometriosis  During the menstrual cycle, the inner lining of the womb thickens to receive a fertilised egg. If the egg is not fertilised, pregnancy does not happen and the inner lining of the womb breaks down as a period (menstrual blood). The endometrial-like tissue located outside the womb also responds to the hormonal changes during the menstrual cycle and thickens. The blood from the thickened tissue, however, cannot leave the body as a period because it is trapped outside the womb. Endometriosis may not cause any symptoms in some women while other women can be severely affected. The symptoms will be related to the area in the body the endometriosis is located. They are usually associated with pain due to the inflammation and scarring caused by the process. The most common symptoms include: Painful or heavy periods Pain in the lower back and pelvis (usually associated with menstrual cycles) Pain during sexual intercourse Bleeding between periods Fertility problems (damage ovaries or fallopian tubes) Diagnosis of endometriosis Endometriosis can be difficult to diagnosis. This is because the symptoms vary from women to women and they can be similar to other common conditions such as pelvic inflammatory disease. In addition, a definitive diagnosis can only be given by laparoscopy which is an invasive procedure with a small risk of major complications. During laparoscopy, a thin camera is inserted into the tummy to allow the direct visualisation of the uterus, fallopian tubes, ovaries, and other pelvic organs. A pelvic ultrasound scan may be used to check the womb, fallopian tubes, the ovaries and to detect cysts associated with endometriosis. A normal scan, however, does not exclude the diagnosis, especially when the endometriosis is located superficially in the pelvis. Delays of 4 to 10 years can occur between first reporting symptoms and confirming the diagnosis. Treatment of endometriosis  At the moment, there is no cure for endometriosis. The treatments available aim to relief the symptoms, increase the chances of becoming pregnant and improve the quality of life for women living with the condition. The options include: Pain control – pain can be controlled with anti-inflammatory medications like ibuprofen. They work more effectively if taken the day before the expected period giving sometime to decrease the inflammation caused by the endometriosis. In more severe situations, stronger pain killers can be given and a referral to a specialist pain team can be done if pain is not well controlled. Hormonal treatment – hormone may be given to reduce or stop ovulation. This will decrease oestrogen production and shrink the endometriosis. The choice of hormonal treatment depends on whether the patient wishes to become pregnant or not, as some of them are contraceptive while other are not contraceptive. There are four types of hormonal treatments which include: the contraceptive pill, progestogens, antiprogestogens and Gonadotrophin Releasing Hormone. Surgical treatment – surgery can remove areas of endometriosis to improve pain and fertility. The procedure is usually done during the laparoscopy diagnosis. In severe cases, however, the surgeons will discuss the laparoscopy findings with patient before offering a surgical treatment. Although surgery improves pain and fertility of women, the endometriosis can sometimes reoccur.                                                                  Conclusion Endometriosis is a common condition that affects women during their reproductive years. The treatment should be personalised accordingly with the severity of the symptoms and the importance of future fertility. Endometriosis is a complex and variable disease that still challenges modern science. The growing recognition that and early diagnosis can slow down the disease and limit long term consequences offers current support to women. Hopefully, more specific treatment will be developed in the future. N.B. The article contains views based on latest guidance. It should not be used as individual advice which should be obtained from your doctor.

Polycystic Ovary Syndrome, Women's Health

Understanding polycystic ovary syndrome

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Polycystic ovary syndrome (PCOS) is the name given to a group of symptoms caused by a hormonal imbalance in the ovaries. This is a very common condition affecting more than 10% of women in their reproductive age. The hormonal variance can cause period problems, fertility issues, weight gain and excess hair growth. What causes PCOS? The exact cause of PCOS is not yet know although it is related to family history, obesity and hormonal imbalance including insulin resistance. Insulin is a hormone that controls sugar levels in the body. If the cells in the body become resistant to the effect of normal levels of insulin, more insulin is then produced to keep the blood sugar normal. This increase in insulin contributes to an increase in production of other hormones like testosterone. In addition, obesity also increases the amount of insulin produced by the body. What are the symptoms of PCOS? The symptoms of PCOS usually become apparent in the late teens or early 20s. They can change over time and can vary from woman to woman. The symptoms are caused by an excess level of insulin and testosterone including: Irregular periods or no periods at all Difficulties getting pregnant due to reduced fertility Excess hair growth on face, stomach and back (hirsutism) Loss or thinning of scalp hair (alopecia) Acne prone skin which may persist beyond the normal teenager years Weight gain and increased risk of type 2 diabetes Emotional problems (anxiety, depression, poor body image) How to diagnose PCOS? The diagnosis of PCOS is made when two out of the following 3 criteria are present: Irregular or infrequent periods – this indicates that ovulation is not happening monthly Symptoms and/or blood tests that show excess testosterone levels. e.g. acne, increase in facial or body hair or blood test with high androgen levels. Ultrasound scan demonstrating polycystic ovaries Blood tests are useful to rule out other hormonal conditions in case of doubt about diagnosis. An ultrasound scan can be used as one of the two criteria to make the diagnosis if multiple cysts is observed in the ovaries. However, it is possible to have PCOS without multiple cysts in the ovaries. What are the treatments for PCOS? Lifestyle changes is the best way to improve PCOC symptoms and to manage long-term health. There is no cure for PCOS but there are a number of medicines available to treat the symptoms caused by the disease. For instance: Irregular periods can be managed with contraceptive pill Fertility can be managed with clomiphene citrate, metformin, letrozole or IVF under a fertility clinic team Acne can be managed with contraceptive pills or Isotretinoin Depression can be managed with counselling support and medication if required. Medication alone has not been shown to be any better than eating well, staying physically active and preventing weight gain.   Long term health issue related to PCOS? PCOS causes an increased risk in developing long-term health problems usually related to insulin resistance and to being overweight rather than to the PCOS itself. Possible long-term problems of polycystic ovary syndrome include: Obesity High blood pressure and cardiovascular disease High cholesterol levels Developing type 2 diabetes Endometrial cancer However, these risks can be reduced with a healthy balanced diet, exercising regularly and weight reduction. To conclude Polycystic ovary syndrome (PCOS) is a name given to a condition which affects the way a woman’s ovaries work. There is an excess of testosterone levels which can contribute to acne prone skin, increase hair growth on face, weight gain and irregular periods.There is no cure for PCOS available at the moment but symptoms can be managed with lifestyle changes. Hormone medication usually helps to correct PCOS symptoms if becoming pregnant is not the focus.

Menstrual Period, Women's Health

Heavy Periods: causes and treatment

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Excessive menstrual bleeding, known as heavy periods, is a common symptom amongst females in the UK and worldwide. It can have physical, emotional, social, and financial impact on a woman, but it is not necessarily a sign that anything is wrong. In some cases, no treatment is required, and with the right intervention, a woman can regain their quality of life. How much is a heavy period?  The perception of heavy menstrual bleeding is subjective. Most women knowwhat normal bleeding is for them during their period. They can tell when it changes and become lighter, heavier or irregular. Therefore, it is not usually necessary to measure blood loss. A heavy period is a blood loss of 80ml or more per month. This means that, a period is likely to be considered heavy if: You need to change your sanitary pad or tampon every 1 to 2 hours. You need to use 2 types of sanitary product together (e.g.both a tampons and a sanitary pad at the same time). You pass blood clots. You bleed through to your clothes or bedding. Your period lasts for more than seven days. You feel tired and drained just after your period. You avoid physical activities or take time off work because of your periods  What causes heavy periods? The majority of reasons why someone may suffer from heavy menstrual bleeding are due to dysfunctional uterine bleeding. The womb, ovaries and blood tests are at a normal value. Heavy periods are more common when a woman has recently started her periods or if she is approaching menopause. Other less common causes includes:  Conditions that affect the uterus, ovaries, or hormones, such as fibroids (benign growth of the womb), endometriosis (growth of endometrial tissue in sites other than uterine cavity), polycystic ovary syndrome (cyst in the ovaries causing hormonal changes), hypothyroidism and pelvic inflammation.  Some medications such as chemotherapy, anti-clotting medication, and a copper coil (non-hormonal intrauterine device (IUD)). How to investigate heavy periods? The initial investigation will be done using blood tests to check for conditions such as anaemia (low iron), thyroid problems, and clotting dysfunction. An ultrasound scan may be requested to look for any structural cause of the symptoms. This can detect fibroids, polyps, ovarian cysts, and other changes in the uterine linin.  An endometrial biopsy can be done if the ultrasound scan shows that the lining of the womb is thicker than normal. This is done by inserting a thin tube into the vagina to obtain the sample.  A hysteroscopy can be performed to look inside the womb with a camera. This procedure involves passing a narrow telescope via the vagina. An endometrial biopsy (a small sample) can also be taken during this procedure. What are the treatment options for heavy periods?  The treatment will be case specific and will depend on the cause of the bleeding. The aim of any treatment will be to reduce the amount of blood loss. Treatment options that may be considered are oral during the periods, continuously during the month and the hormonal intrauterine device(IUD). For instance, Tranexamic acid and anti-inflammatory tablets can be used during the period to decrease bleeding. The combined contraceptive pills and the progesterone only contraceptive pills are examples of medication to take regularly during the month. The Mirena Coil is a hormonal device used intrauterine and it is the most effective treatment for heavy bleeding, reducing blood loss up to 70-100% by 12 months.  A surgical procedure may be advised depending on whether a cause for the bleeding has been found. For example, a surgical removal of a large symptomatic fibroid may resolve the problem. A hysterectomy (removal of the uterus) is generally one of the last options. This is 100% effective in stopping excessive bleeding, however, this is a large surgical procedure, and the risks and benefits must be weighted. To conclude Heavy bleeding is one of the most common reasons that a woman consults her doctor for advice in the UK. It usually presents as losing a lot of blood during a woman’s period or a period lasting for longer than 7 days. This can be natural for that particular woman or caused by womb abnormality or a hormone imbalance. The treatment includes medications to decrease bleeding or surgical procedure.   Speak to your doctor if you have symptoms of heavy periods.  

Welcome

Welcome!

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Welcome to my website! Here you will find reliable information about Women’s Health, especially about symptoms and treatments for Perimenopause and Menopause, such important phases, but unfortunately, often misdiagnosed by some health professionals. Due to the challenges of our daily lives, we know how difficult it is to prioritise our physical and mental health. Nothing is better than having specialised professional support to help us on this journey. Therefore, I’m offering my support to help you achieve your goals for a healthier and more fulfilled life. Establishing this direct connection with you is an honour, and I hope to help you through the information provided on this website and professional contacts. But, first of all, I’d like to introduce myself and tell you a little more about my story as a doctor, mother and, above all, as a woman. Personal challenges I’m Dr Alba Pereira, and I currently work as a Menopause Specialist and General Practitioner for the NHS (National Health Service) in London, UK. I moved to England 20 years ago, leaving Brazil, where I studied Medicine, Residency as General Surgeon, and started my specialisation in Plastic Surgery. Around this time, I decided to come to London to live with my fiancè. I left my job, my financial independence, my English was very basic, and I was seven months pregnant. The frustration of not understanding the healthcare system associated with the language barrier was enormous. I remember taking my newborn daughter to receive her first vaccination with the GP nurse (General Practitioner), and I couldn’t understand any instructions. The feeling of powerlessness, exclusion, and not belonging to that society was enormous and negatively affected me, as my basic needs were unmet. I wasn’t happy in general. My marriage wasn’t going well, and I had no money or family support to help me with my daughter. So I decided to reorganise my life, and the first step was to improve my communication by improving my English and trying to understand my environment. It wasn’t easy, but it was possible. Today, I work as a General Practioner (GP), a Family Doctor, at Imperial College in Central London. I am passionate about diversity, social inclusion and women’s health and will gladly share information about it.  Regarding new info for this blog, we can start by discussing in general about NHS. I am open to suggestions on medical topics, answering questions about how the NHS works or giving health and wellness tips.  What is NHS? The NHS (National Health Service) is the publicly funded healthcare system in England and one of the four National Health Service systems in the United Kingdom. It is the second largest single-payer healthcare system in the world, after the Brazilian Unified Health System. It’s a complex system that has continuously changed since its inception. These changes are happening at an accelerated pace lately because of the ageing population, the emergence of expensive medicines, Brexit and due to the pandemic caused by Covid-19. All parts of the NHS are being overhauled, making it difficult for employees to understand the new rules. Requiring the patient to understand these steps automatically would be unrealistic for a healthcare professional. Even the native English patient needs to be guided through the system. When a patient requests clarification of doubts or questions about the options offered by the NHS, he is not showing weakness but rather maturity. These clarifications will provide security for making informed decisions. But for that, the patient has to be open to understanding a system different from the model he was used to. This system could be better and is in urgent need of reform. On the other hand, the NHS is a public health system that offers quality care on a non-profit basis to people of all social classes, a system that survives in a capitalist world bombarded by a highly developed pharmaceutical industry. I’m sure that our journey on this website will be enriching, especially for me, an immigrant who went through difficulties in the same way as most readers. Educating yourself about the environment we are living in, including the health system, will open the way to a healthier life with better quality of life in every sense. I look forward to suggestions for the following blog topics and will try to include how the NHS works according to the chosen topic.  Thank you so much for your attention and engagement. Dr Alba Pereira

NHS

How to continue your medical treatment in the UK?

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If you have recently moved to the UK but are still under medical treatment, it is essential to continue your regular medications, especially if you suffer from chronic illnesses. Once you arrive in the UK, you must register with the NHS (National Health Service). It’s the most effective way to get your routine prescriptions, monitor your illness and keep your medical records up to date in the country. The NHS refers to government-funded health and medical services that everyone in the UK can use without being asked to pay the full-service cost.  These services include: Visiting a doctor or a nurse at a doctor’s office. Get help and treatment at a hospital if you are sick or injured. Consult a midwife if you are pregnant. Get urgent help from healthcare professionals working in ambulance services if you have severe or life-threatening injuries or health problems, including being transported to the hospital.  NHS registration The General Practitioner (GP) will be the first point of contact for almost all NHS patients. If you plan to live in England, register with a local General Practice (GP) clinic when you arrive. The service is free and open to everyone, and you don’t need to have an identity document, proof of address or proof of your immigration status. It is advisable to register at a GP practice close to your home. Google “find a gp nhs.uk”, open the website and fill in the box with your postcode/zip code. The website will list several clinics you can register for (visit or ask your neighbours for recommendations before registering). GPs are specialists in family medicine, preventive care, education in health and treatment of people with chronic and complex illnesses. GPs can write your prescriptions and refer you to other NHS services. Disease monitoring After registering with a GP you will come for your first appointment and inform your GP about your pre-existing conditions. Monitoring your illness will be just as crucial as having previous medications issued. Our body constantly changes, and moving to another climate can worsen some diseases. It’s common in respiratory, allergic and immunological pathologies and requires changing medications (eg asthma, psoriasis). Health professionals in the UK work with protocols. We can be flexible, considering the patient’s best interest, but we cannot prescribe a drug not licensed in this country (e.g. some cancer drugs). In this case, we will offer another medication and monitor the its effectiveness. Furthermore, some diagnoses in the UK automatically trigger other programs designed to prevent complications caused by the disease. For example, all diabetic patients should aim for reasonable blood sugar control and have an annual diabetes review. The frequency of sugar control consultations depends on each case’s severity. But the annual program is for everyone and includes a review of cholesterol, high blood pressure, eye problems and peripheral nerve damage. Medications may change based on the results of these tests.

HPV

How to prevent cervical cancer

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Worldwide, an estimated 604,127 women were diagnosed with cervical cancer in 2020, according to data from cancer.net. Cervical cancer incidence rates dropped by more than 50% between the mid-1970s and mid-2000s due, in part, to increased use of tests, which can detect cervical changes before they become cancerous. Cervical cancer can be found in any part of the cervix. Almost all cervical cancers result from an infection caused by certain types of human papillomavirus (HPV). Cervical cancer usually grows very slowly. The severity depends on its size, whether it has spread, and your overall health. Demystifying cervical cancer The preventive exam of the cervix (Pap smear) is one of the best ways to protect against cervical cancer. The test checks the health of the cervix (the opening between the vagina and uterus). The NHS cervical cancer prevention program has reduced the number of deaths from cervical cancer by up to 70% since its introduction more than three decades ago, according to data from Cancer Research UK. Who is eligible for the cervical screening test? Screening is available to women and people with a cervix aged between 25 and 64 in the UK. All eligible patients registered with a family physician will automatically receive an invitation by mail. Transgender men do not receive the automatic invitation if registered with the family doctor as a male, but they are encouraged to take the test. Signs & Symptoms It’s essential to monitor the signs and symptoms your body presents. The cause could be a medical condition other than cancer, so seeking medical attention is necessary if signs and symptoms persist. Any of the following could be symptoms or signs of cervical cancer: The sooner precancerous cells or cervical cancer are found and treated, the better the chance cancer can be prevented or cured. What happens during your consultation? A nurse usually does the Pap smear. The full consultation takes approximately 10 minutes. You will need to undress, in privacy, from the waist down. You will be given a disposable paper to place over yourself during the test. The nurse will ask you to lie on a bed, usually with your knees bent and apart and your feet together. They will gently place a small tube (speculum) into your vagina. A small amount of lubricant can be used. The nurse will open the speculum so they can see your cervix. She will use a soft brush to collect a small sample of cells from your cervix. The speculum will be removed, and you can get dressed. You may have some bleeding afterwards, which is entirely normal. Results For more info, keep reading our blog post: HPV and Cervical Cancer.

HPV

HPV and Cervical Cancer

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Human papillomavirus (HPV) is the name of a widespread group of viruses. Most people get some form of HPV in their lifetime through direct skin-to-skin contact in the genital area (not just penetrative sex). In most cases, our body will fight off HPV without causing problems. However, some types of HPV can cause cancer. The discovery that cervical cancer is caused by HPV in more than 99% of cases facilitated the early detection of cervical cancer. Currently, the sample cells removed from the cervix are tested for HPV instead of looking for abnormal cells, as in the past. What do your results mean? Negative result for HPV: Most people would not show the virus on the test. That means your risk of getting cervical cancer is very low. You do not need further testing and will be invited to repeat the preventive test every 3 to 5 years. Positive result for HPV: If HPV is found in your sample, the same instance will be examined under a microscope to see if HPV caused abnormal cell changes. If HPV is found, but there are no abnormal cells: you will be invited to repeat the preventive test annually. It will check that your immune system has cleared the virus. If HPV is found and there are abnormal cells at any time during the test preventive or during the annual review, you will be directed to make a Colposcopy. Colposcopy is a more detailed medical examination because it uses an instrument to enlarge the cervix. The doctor will let you know the severity of the abnormal cells and discuss some treatments that can be done during the Colposcopy. Treatment can use freezing, burning, laser, or removal techniques. HPV vaccination Since 2008, girls between 12 and 13 have been vaccinated against HPV. The vaccine is most effective in young people and is now offered to boys as well. The vaccine protects against the four most common types of HPV that are known to cause cervical cancer. The vaccine does not protect against all types of HPV, meaning that girls who have received the HPV vaccine still need to be screened starting at age 25. Conclusion Pap smears and HPV vaccination are highly effective in preventing cervical cancer. However, the most recent figures suggest that only 70.2% of those eligible are up to date with screening and 76.7% are vaccinated. The main barrier for women to be proactive in cervical health care is the embarrassment caused by speculum examination. NHS England is currently testing speculum-free sampling approaches and vaginal self-sampling to decrease discomfort during the exam. In the meantime, we must continue to talk about cervical cancer risks. Overcoming the embarrassment and stigma associated with this clinical trial will be critical to improving women’s health and lives.

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