• Christina Hellmann

Common gynaecological issues

Last week I went to a very interesting lecture delivered by Tunbridge Wells based gynaecologist Philippa Moth who spoke about three of the main issues that women seek her help for. They are:

  • Heavy periods

  • Endometriosis

  • Menopausal symptoms

These symptoms are also something that affect many of my female patients so I wanted to share with you the main points of Philippa’s lecture in the hope that if you or someone you know suffers with any of these symptoms, you can use this information to either understand the condition more or find out something you didn’t know before. I also want to stress that if you also suffer any of these conditions and they are negatively affecting your life, you are not alone and it’s ok to seek help – it’s easy to feel embarrassed by problems with our ‘private parts’ but some conditions are surprisingly common and are easily treated. If in doubt, always see your GP and ask to be referred to a gynaecologist.

Heavy periods

What are heavy periods? This is difficult to quantify as different women will experience different levels of bleeding during their periods. The actual definition of a heavy period is:

‘Excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life’.

Heavy periods are very common with 1 in 20 women aged between 30-49 years consulting their GP every year. 12% of all referrals to gynaecology services are due to heavy periods. The symptoms of heavy periods include:

  • Flooding

  • Multiple changes of sanitary products throughout the day and night

  • Sleep disturbance

  • Missing work/being housebound

  • Clinical anaemia

Years ago, it was recommended that women who suffered with extremely heavy periods have a hysterectomy to resolve the problem. Nowadays there are many other options that women can try and hysterectomies are now considered a last resort option. Treatment of heavy periods include:

  • Treat the cause – e.g. endometriosis, polyps, fibroids etc. However, most of the time no specific cause can be found.

  • Oral medications e.g. the pill, tranexamic acid etc.

  • Mirena coil

  • Endometrial ablation – this is a day-case procedure in which radio frequencies are used to burn the lining of the endometrium. The procedure only takes a few minutes to do and is only needed once, however it is only recommended for women who don’t want to have any more children as burning the endometrium lining away makes falling pregnant much more difficult in the future.

  • Hysterectomy – the majority of hysterectomies are performed by keyhole surgery. In some cases, there is a choice to either leave or remove the ovaries and the cervix.


Endometriosis is a very common condition and affects 1 in 10 women. It is where tissue similar to the inner lining of the womb is found growing somewhere else – usually in the pelvis around the uterus, ovaries and fallopian tubes. Endometriosis used to be a condition thought to affect women randomly during their life. It is now thought that those affected by endometriosis are actually born with it and as they get older and develop periods, hormones will cause the endometriosis to grow. Endometriosis will affect women very differently with some women suffering with extreme symptoms and others not. The most common symptom of endometriosis is pelvic pain and this tends to be most severe in women in their 30-40s.

Severe endometriosis can lead to adhesions in the pelvis. This means that the endometrial tissue that grows outside of the womb can literally ‘glue’ other structures together. One of the more severe types of endometriosis is called rectovaginal endometriosis and as the name suggests, it affects both the rectum and vagina – causing the two to become attached to each other. This can lead to lower back pain, pain on opening bowels and painful sex. It is also more difficult to treat as it involves extremely careful surgery to try and detach the rectum and vagina from one another.

The main symptoms of endometriosis are:

  • Pelvic pain that worsens with periods

  • Pain during sex

  • Pain when opening bowels

  • Infertility

Treatment of endometriosis depends on how severe it is or how badly it affects quality of life. Some women can have severe endometriosis with very few symptoms whilst other women can have very little endometriosis and have very distressing symptoms. Therefore treatment is done on an individual basis looking at the patient’s lifestyle and how their endometriosis affects them.

Treatment options include:

  • Pain relieving medication

  • Hormone treatments e.g. the pill (as endometriosis is affected by the cyclical hormones of the menstrual cycle, using the pill is a great way to control these hormones and therefore can control the symptoms of endometriosis).

  • Surgery – the surgeon may attempt to excise (cut away) the endometriosis so that only healthy tissue is left behind. How severe the endometriosis is can determine how difficult the surgery is. If the patient is suffering an extreme endometriosis such as rectovaginal endometriosis, this will be much harder to cut away than someone who only has a little patch of endometriosis growing. If the endometriosis is too hard to cut away completely, a hysterectomy may be offered instead. There is an argument as to whether the endometriosis will return after it has been cut out. Theoretically, if it is 100% removed, it shouldn’t return. However, guaranteeing that 100% has been removed is difficult to determine in a lot of women and in these cases, symptoms may return in the future.


There are said to be seven witches of menopause:

  • Itchy

  • Bitchy

  • Sweaty

  • Sleepy

  • Bloated

  • Forgetful

  • Psycho

The menopause is often a challenging time for a woman. 80% of women going through the menopause will experience menopausal symptoms, the most common being night sweats. Having reached the state of ‘menopause’ officially means to go a whole year without periods. For many women, symptoms of menopause begin years before their actual periods stop. These are termed ‘peri-menopausal’ symptoms. The average age of menopause is 51 years old.

The more common symptoms of menopause are:

  • Hot flushes

  • Night sweats

  • Mood swings

  • Sleep disturbance

  • Problems with intercourse – dry vagina due to lack of oestrogen

  • Skin and hair changes

  • Erratic periods on the lead up to menopause

As hormones are changing, many women will also suffer:

  • Muscle and joint pain

  • Anxiety

  • Depression

All of these symptoms can be very challenging and can sometimes lead to issues at home with relationships or problems at work.

Hormone Replacement Therapy

There has been a lot of research based on whether HRT is actually that beneficial or whether it causes more problems long term. The role of HRT is to deal with the ‘witches’ of menopause and leads to symptomatic relief of menopausal symptoms.

The two main risks of HRT are:

  • Breast cancer

  • Clots in the leg and lung

There are two main types of HRT – oestrogen only HRT and combined HRT (a combination of both oestrogen and progesterone HRT). The risk of breast cancer depends on the type of HRT given. Women who have already had a hysterectomy will normally be prescribed oestrogen only HRT and this leads to no added risk of breast cancer at all. Women who still have a uterus will normally be prescribed combined HRT. With this HRT, there is a slight increase risk of breast cancer, however, this risk is lowered if the patient increases their exercise and reduces their alcohol intake.

The risk of clotting in the legs and lung is only a problem when taking HRT as a tablet/capsule. HRT can also be prescribed as patches or gels. Due to the slight risk of clotting with oral HRT and the risk of patches slipping off or becoming less sticky as they are worn, gels are becoming more popular amongst healthcare professionals when prescribing HRT.

Starting HRT is when developing these risks are highest so once the patient has started taking HRT, she should keep taking it rather than stop/starting repeatedly. At the moment, there are no current guidelines for how long a woman should be on HRT for. As everyone reacts differently, she should be assessed yearly according to her individual risks, lifestyle and genetics.


Philippa Moth says that very often her patients tell her that they’ve been suffering with a problem for years before they will do anything about it because they’re embarrassed or scared of what they will be told. More often than not, the problem is actually a very simple one and when given the right treatment, will greatly improve the condition and give her patients back the quality of life they deserve. I hope the information in this blog has been useful. Personally, I feel that it’s really important that we normalise talking about these sorts of things so please help me to spread the word by sharing this blog and if you or someone you know has symptoms that haven’t yet been checked, see your GP and ask for a referral to a gynaecologist.

For all the men out there, don’t worry, I haven’t forgotten you – one of the speakers at the same lecture is a urologist and spoke about men’s health too. I am currently in the process of getting my notes together and I will use them for my next blog. Stay tuned!