Perimenopausal

Once you reach a certain age, it is tempting to see everything as a sign that you are perimenopausal. But what are the signs you should really be looking out for?

Changes to your menstrual cycle

It might seem obvious, but changes to the frequency or duration of your period is often the first sign that something is afoot.

Some women find their periods get much heavier as they approach the menopause, others get lighter. Some get their period every two or three weeks, some will go months without bleeding at all, then bleed non-stop for a fortnight.

Really, any change at all in your menstrual cycle is a sign that something is going on inside. However, these things can also be a symptom of other gynaecological conditions. So it is important to consult with a doctor, who will be able to confirm whether the changes you are seeing are due to perimenopause or something else.

Hot flushes

Aside from changes to your period, hot flushes are probably the most widely known symptom of perimenopause.

A hot flush is often described as a sudden overwhelming feeling of heat that seems to come from nowhere. They are usually short in duration, and for some women they occur infrequently and don’t cause much of a problem. Others might have several hot flushes a day and find them inconvenient and embarrassing.

There are a few things that are thought to increase the frequency of hot flushes, including:

  • spicy food
  • caffeine
  • alcohol
  • smoking

Insomnia

Perimenopausal women often have difficulty sleeping. They either struggle to get to sleep at the beginning of the night, or wake up during the night.

Over a prolonged period this lack of sleep can have a cumulative effect, impacting on your mood during the day. It can exacerbate another symptom of perimenopause…

Mood swings

Every woman knows that anything which affects your hormones is also going to have an effect on your mood. Perimenopause is no different.

Many women report feeling very low in mood or experiencing increased anxiety during the perimenopause period. Others find that their mood will change dramatically for seemingly no reason.

If you are experiencing mood changes, it is important to be kind to yourself and keep a watch on your mood. If at any point you feel the mood swings are getting out of hand, or you feel like you are becoming depressed, get in touch with a doctor, who should be able to help.

Recurrent UTIs

A lesser-known symptom of perimenopause, urinary tract infections can be very unpleasant and painful. They are thought to occur more during menopause as your oestrogen levels drop dramatically, increasing muscular pressure around your urethra.

Symptoms of UTIs include:

  • A burning sensation when urinating
  • Needing to urinate more frequently or with more urgency
  • Blood in your urine
  • Cloudy urine
  • A high temperature

If you are experiencing any of the above symptoms, it might be worth investigating whether you are perimenopausal.

Here at SureScan, we provide a full menopause healthcheck to help your path through the menopause run that much smoother. For more information, please contact us.

Covid and fertility

There is no doubt that for many of us the Covid-19 vaccine rollout is wonderful news. Bringing us that much closer to a time when we can get together again with friends and family. But there are people who do have some concerns.

Fertility matters

When you are trying for a baby, it is natural to be extra careful about what you are putting into your body. In recent weeks, there have been some rumours spreading on social media that the Covid-19 vaccine could affect fertility. Some posts have even gone so far as to suggest that the jab could cause recipients to become infertile.

Here at SureScan, fertility treatment forms a large part of our service. We take a great interest in anything that could have an impact on fertility. With that in mind, we decided to investigate these claims a little further. So, could the Covid jab really affect fertility?

‘No evidence’

The rumours surrounding the Covid vaccine and infertility have not just affected members of the general public. Even healthcare workers have been put off having the jab.

In January, the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists (RCOG) issued a joint statement to dispel these rumours. They confirmed that there is ‘no evidence to suggest that Covid-19 vaccines will affect fertility’.

And whilst it’s true that a lack of evidence does not mean it’s an impossibility, Dr Edward Morris, president of the RCOG, went on to reassure the public that there is ‘no biologically plausible mechanism by which current vaccines would cause any impact on women’s fertility’.

Covid-19 and fertility

Not only will having the jab not affect your chances of having a baby, there is a growing body of evidence to show that the pandemic is impacting the efficacy of fertility treatment. So it could be argued that the sooner we roll the vaccine out, the sooner couples can begin to get the help they need to conceive.

Fertility treatment in the UK stopped altogether between March and May 2020, and has been operating on a reduced service since. A recent study from Aberdeen University shows that these delays is having a disproportionate impact on women aged 40 plus.

The study looked at the impact of delays in the onset of fertility treatment of six months or twelve months. Women in five age categories, from under 30 to 40-42, were affected in some way. However, the biggest impact was seen in the 40-42 category. Here there was estimated to be an 11.8% reduction in live births after a six-month delay, and a 22.4% reduction if the treatment was delayed by a year.

The authors of the study have said that they hope the results will inform a phased reintroduction of IVF in the NHS. And women aged 40 plus would get priority.

For more information about fertility treatment, please contact us on 0121 308 7774.

Fertility check

There are many different reasons for seeking a fertility check. It may be that you have been trying for a baby and are worried that it is taking too long. Or perhaps you just want reassurance about your fertility status for future reference.

In this post, we will be looking at what a fertility check is. As well as when is the right time to have one, depending on your reasons for doing so.

What is a fertility check?

Here at SureScan, a fertility check for women gives you a complete overview of your fertility health, including:

  • A 30-minute consultation with a consultant gynaecologist, to discuss any concerns you have, as well as lifestyle factors that affect your fertility
  • Examination of the abdomen and pelvis
  • Blood tests to check hormone levels and test thyroid function
  • Ultrasound scans to perform an antral follicle count and examine pelvic anatomy

When is the best time to seek a fertility check?

That depends on your reasons for doing so. If you are not planning a family yet, but would like to know more about your fertility in order to plan for the future, then this can be performed at any age. However, if you are considering egg freezing, we would recommend having a fertility check between the ages of 30 and 42. Egg production does tend to decline fairly rapidly post 40.

What if you are trying for a baby?

If you are trying to start a family, it can often be tempting to seek help straight away. The period between each ovulation can seem very long, and it might feel like you have been trying for a long time without success.

You can of course seek a fertility check at the start of the process, to put your mind at rest. Fertility experts generally recommend trying to conceive naturally for at least a year before seeking help. That time can be reduced to six months if you are over the age of 35.

What other reasons are there for having a fertility check?

A fertility health check is not only useful for checking your ovarian reserves. It can also help to diagnose any health problems around the reproductive organs, such as ovarian cysts, pelvic inflammatory disease, or endometriosis.

If indicated, the check can also include a cervical smear, or screening for polycystic ovary syndrome (PCOS).

Is the check only available for women?

No, we can also provide semen analysis for your partner, if required.

Here at SureScan, we aim to provide a complete service, ensuring that we are able to diagnose any fertility problems, whether they be physical or emotional. To find out more about this service, or to book an appointment, please contact us.

Birthing Partners

Pregnant women will welcome new guidance from NHS England, released in December. There is a change in the COVID-19 restrictions that have prevented birthing partners from attending any pre-natal appointments.

What are the current restrictions?

Since March, depending on the NHS trust, partners have been unable to accompany expectant mothers to maternity appointments. This includes scans, blood tests and early labour, as part of an effort to prevent the spread of COVID.

Many women have received news of miscarriage or foetal abnormality without a partner there to support them. In some NHS trusts, partners are not allowed to attend labour until the cervix is 4-5cm dilated. This has resulted in them missing the birth entirely.

Even in cases where the partner has been present for the labour, they are asked to leave as soon as the baby is born, which many new mothers report to be a very traumatic experience.

What is the new guidance for maternity care?

The new guidance issued by NHS England states that partners should now be allowed to be present for all maternal care. From antenatal appointments right through to labour and the postnatal period.

Before this happens, hospitals will need to have carried out thorough risk assessments to ensure that wards are COVID-secure.

This new guidance comes after months of tireless campaigning from various maternity support groups. They claim many mothers have been left traumatised after receiving devastating news or birthing alone.

How quickly will this guidance be implemented?

Whilst the guidance has been issued to all NHS trusts, it is unlikely to be actioned immediately. Steps to protect staff and patients from contracting COVID could take a while to put in place.

According to the new guidance, these steps include:

  • Conducting risk assessments throughout the hospital’s entire maternity service to find out where the presence of partners may increase the risk of COVID transmission
  • Reconfiguring space to make it more COVID-secure
  • Using rapid testing to prevent COVID from being carried onto wards

It is likely that some hospitals will say they are unable to put all these measures into place and so cannot implement the new guidelines.

What does this mean for me?

Are you pregnant, or hoping to become pregnant soon? It is advisable to check with your NHS trust if or when this new guidance is likely to become a reality for you.

If you are one of the lucky ones, you and your partner will need to be extra vigilant for signs of COVID. Also be prepared for appointments to take longer than usual. Rapid testing will need to be carried out and other precautions put in place beforehand.

While there may be some caveats, this new guidance will come as a relief to many expectant mothers in the UK and is welcomed by many maternity care providers.

HRT for IBS

The menopause has an impact on almost every aspect of your body, or so it can seem. Many of us may eagerly anticipate the end of menstruation. But the actual process of menopause can be both drawn-out and painful.

Many women report an increase in the symptoms of irritable bowel syndrome (IBS) during the perimenopause phase. This includes those who had not previously experienced bowel problems.

Could hormone replacement therapy during the menopause provide some relief for these women? Especially those who suffer from worsening symptoms of IBS?

Hormones and the menopause

Whilst many scientific studies have found a correlative link between menopause and worsening IBS, a firm reason for this link has yet to be found.

Research into the effects of menstruation on inflammatory bowel disease (IBD) has suggested that hormonal fluctuations can affect symptoms. This would explain why women often experience an increase in abdominal pain and bowel movements around the time of their period.

During the menopause, hormonal fluctuations are ever present, so it seems likely that this could be a reason for worsening IBS.

HRT and inflammatory bowel disease

One 2008 study, published in the American Journal of Gastroenterology, took a retrospective look at medical records of 65 postmenopausal women. All the women had inflammatory bowel disease – 45 with Crohn’s disease and 25 with ulcerative colitis.

For each woman, disease activity in the five years before the menopause was compared with the five years after menopause had finished. 20 of the women had been using hormone replacement therapy (HRT) during the postmenopausal period.

The study found that those women using HRT were 82% less likely to have active IBD symptoms post menopause.

However, studies into irritable bowel syndrome (IBS) and HRT use have shown a potential increase in symptoms associated with the hormone therapy. Researchers from the 2008 study acknowledged that a larger trial was needed to confirm their findings.

What to do if you suffer from IBS and are approaching the menopause

If you suffer from IBS or IBD and think you might be perimenopausal, your best first step is to speak to your doctor about how the menopause might affect your condition.

The jury is currently out on whether HRT use could help or hinder bowel conditions. A doctor is unlikely to prescribe hormone therapy as a tool for treating IBS. However they will almost certainly take your condition into account when considering HRT.

Anecdotal evidence suggests that some women do experience relief from the symptoms of IBS or IBD when undergoing hormone replacement therapy during the menopause. But as with any treatment, no two patients will have exactly the same experience.

Cervical screening

This week is Cervical Cancer Prevention Week, and this year cervical screening is as important as ever. SureScan Women’s Health Clinic is joining others to support #SmearforSmear, this year’s social media campaign led by Jo’s Cervical Cancer Trust.

We want to remind women that we are here for you with information and support, particularly at this difficult time. Although the Coronavirus has made it difficult for many to attend medical appointments in the normal way, our cervical smears are still going ahead.

We know that it can be a daunting thought, but smear tests are still the best protection against Cervical Cancer.

Why should I have a smear test?

A Cervical Screening can provide much needed reassurance, particularly if you are experiencing symptoms such as vaginal bleeding, vaginal discharge or discomfort during sex.

Early detection and treatment can help prevent the majority of cervical cancers from developing. However, lots of people are unsure if they can or should go for a cervical smear appointment.

The government guidance says that you are allowed to go for a medical appointment, even within the current restrictions across the UK. However, there are a number of reasons why you should not have a cervical smear, which include;

  • If you are on your period
  • Experiencing vaginal bleeding
  • You have had an IUD inserted or removed within the past 3 months
  • If you have had a smear test within the past 12 weeks
  • You are pregnant or think you may be
  • You have given birth, miscarried or had a termination within the past 3 months

Do I need an HPV Test?

Sometimes, an abnormal smear test can be the result of a very common sexually transmitted disease called Human Papillomavirus or HPV. Estimates show that about 14 million new HPV infections occur every year.

Most people who have HPV never experience any problems, and many cases go away without treatment. But some strains of the virus can cause problems such as genital warts or cancer.

If you would like to speak to a specialist in confidence about HPV or cervical cancer or would like to arrange a cervical screening, phone us on 07835 736627 or email us info@​surescan-womenshealth.co.uk .

NIPT

When you are pregnant, it is only natural to have some concerns about the health of your unborn child.

The nuchal fold test, available on the NHS at the time of your 12-week scan is a non-invasive option. This gives some idea of your risk factor for genetic abnormalities. However, it is not always completely accurate. This can lead to expectant mothers having the more invasive amniocentesis procedure unnecessarily.

However, there is now another option to find out whether your baby is at risk of any chromosomal problems. Non-invasive prenatal testing, or NIPT.

What is NIPT and how does it differ from the nuchal fold test?

The screening test currently available on the NHS is a combined blood test and nuchal fold measurement. This test measures the level of fluid at the back of the baby’s neck. It uses this measurement together with a maternal blood test to determine the risk factor for certain chromosomal abnormalities.

NIPT is a relatively new screening test. It works on the basis that a small amount of foetal DNA will cross the placenta and enter the mother’s bloodstream. A sample is taken of the mother’s blood, which is then tested using state-of-the-art DNA analysis technology. This can pinpoint your baby’s risk of a number of genetic disorders, with an accuracy of 97-99%.

NIPT can also be performed earlier in the pregnancy – from around ten weeks. And there is no upper limit on when the testing can be carried out.

What conditions can NIPT test for?

As with the NHS screening programme, there are three main conditions that NIPT can test for:

  • Down’s syndrome (Trisomy 21 – the most common genetic disorder)
  • Edward’s syndrome (Trisomy 18)
  • Patau’s syndrome (Trisomy 13)

The most common abnormality, Down’s syndrome, can be detected with over 99% accuracy using NIPT.

Does NIPT preclude the need for amniocentesis?

Although NIPT is a very accurate tool for assessing your baby’s risk factor for these conditions, it is not a diagnostic tool. If your baby is found to be at high risk, you will still need to undergo amniocentesis to be absolutely certain.

However, because NIPT is so accurate, it hugely reduces the chances of the mother having to undergo the amniocentesis procedure. This is good news as the amniocentesis test is a much more invasive procedure that can carry complications.

Is NIPT available on the NHS?

NIPT is currently available on the NHS for those mothers considered to be at high risk. For those mothers not considered to fall into this category, but who would like a bit of extra reassurance, the test is available privately here at Surescan.

For more information about NIPT, or any of our other antenatal services, such as early pregnancy scans, please contact us.

Long Covid

There’s no escaping it – COVID-19 has never been far from anyone’s mind over the past year. You may have been avoiding the news or social media in a bid to stay sane. The virus has unquestionably had an impact on the way we all live our lives.

In recent months, the subject of ‘long COVID’ has become more prevalent. More and more people report experiencing symptoms long after the illness should have subsided.

Symptoms of long COVID include fatigue, fever and headaches, which tend to come and go. You might feel fine for a couple of weeks, then wake up one morning feeling like you’re coming down with it all over again.

However, for some women with long COVID, another worrying symptom is starting to emerge. Many are reporting disruption in their menstrual cycles.

Long COVID and menstruation

Medical News Today spoke to six women experiencing long COVID. All of whom thought that the virus had had an impact on their periods.

Two of the women interviewed reported missing several periods in the months after they initially contracted the virus. Others said they had experienced clotting.

One woman said she was so alarmed by the sight of one clot that she took a photograph and sent it to her GP. The doctor reassured her that such clots were entirely normal. “But I know it isn’t normal for me”, the woman told MNT.

The emotional impact

There’s no denying that a woman’s menstrual cycle has a huge impact on her emotional wellbeing. Even those of us who don’t suffer particularly from PMS will notice a change in our mood around the time of our period. Long COVID sufferers have reported that this has increased since they became ill.

One woman told MNT: “I feel like I have PMS all the time. COVID has also made me more sensitive emotionally and I am aware of emotional ups and downs that I’m having now that I didn’t have before.”

Symptoms syncing with the cycle

Some of the women also feel that their long COVID symptoms tend to flare up around the time of their period:

“In the days leading up to my period, my eczema would worsen, my breathing would start to get more difficult. My POTS [post orthostatic tachycardia syndrome] would act up. I would get a migraine. My fingertips would have sharp pains. My joints would start hurting and my right leg would start tingling”, said one.

Not much is known medically about the reasons for long COVID, or the long-term impact it has on your health. It seems certain that in 2021 we will find out more. In the meantime, if you are concerned that the virus could be having an effect on your cycle, it is worth speaking to a medical practitioner.

Pregnancy scan

Getting pregnant can be a long and often painful process. When you finally get that positive pregnancy test result, it’s fair to say the journey is only just beginning.

Every pregnant woman in the UK is entitled to two ultrasound scans during her pregnancy, one at 12 weeks gestation, and another at 20 weeks. If there are perceived complications, such as concerns about the baby’s size, or a low-lying placenta, you may also be offered further scans later on in the pregnancy.

For many women, however, 12 weeks is a long time to wait to be sure that everything is OK with their unborn child. An early pregnancy scan can provide reassurance.

Why reassurance is important in pregnancy

Here at Surescan, many of the pregnant women we see for early pregnancy scans have been on a long journey.

Often they have undergone fertility treatment, sometimes lasting several years. This pregnancy is such a hard-won prize that they are in need of extra reassurance that it really is happening.

Some have experienced miscarriage in the past and are terrified of once again turning up for the 12-week scan to hear bad news.

Others may just want to know that the foetus is healthy before imparting the news to family and friends. In fact, according to madeformums.com an estimated 24% of pregnant women have opted to have an early pregnancy scan prior to the standard 12-week ultrasound.

For all these pregnant women, having an ultrasound early on in pregnancy to check the strength of the foetal heartbeat can help put their minds at rest. And after all, a stress-free pregnancy is a healthy pregnancy.

What happens at an early pregnancy scan?

An early pregnancy scan is very similar to the 12-week scan in terms of the way it is carried out.

Just like the later scans, you will be asked to lie on a bed and remove the clothing from your abdominal area. The ultrasound technician will then rub gel onto the area, before passing the ultrasound handpiece over your abdomen. The ultrasound image will appear on a screen.

There are some differences in terms of what you can see in an early pregnancy scan. The reason for the standard 12 week scan is that by this time the foetus has usually reached a stage of development that allows us to assess whether things are progressing in a normal, healthy way.

What can you see at an early pregnancy scan?

That all depends on how early the scan is. An ultrasound scan as described above can be carried out from about six weeks. But the heartbeat gets stronger over time, so seven weeks or later is usually recommended.

Prior to the six week mark a scan is only really recommended if ectopic pregnancy is suspected.

At eight weeks, as well as the heartbeat, you might be able to make out the baby’s head and body.

By about nine weeks the baby should be nearly fully formed and you may be able to discern the limbs. At ten weeks you may even see them moving.

If you would like to find out more about early pregnancy scans, please call us on 07835 736627.

Fertility Treatment

There is a strong, but often overlooked, link between employment and fertility treatment. These days, many women choose to sacrifice their most fertile years in order to get ahead on the career ladder. And often, women delay starting a family until their early forties.

The sad truth is, however, that while plenty of women are lucky enough to be able to conceive without help after 40, female fertility does drop off sharply after the age of 35. This means that more and more women in the workplace are having to seek fertility treatment. But many are reluctant to speak to their employer about it.

A conspiracy of silence?

A large proportion of female employees undergo some form of fertility treatment. In fact, around one in six couples, which equates to a lot of working women. But many employers are often left in the dark about the subject.

According to Fertility Network UK, 50% of women undergoing treatment opted not to tell their boss. So why are women so reluctant to speak to the people they work for about their fertility issues?

Privacy matters

One major reason for keeping it secret, is that infertility is an intensely private matter. We might discuss this with our nearest and dearest, but it’s certainly not fodder for office gossip.

Treatment for infertility can have a major impact on your work though, so keeping your boss informed seems sensible, even if you don’t want the whole office to know.

Employer support

The problem is that whilst most businesses now have packages and benefits to cover maternity leave and pregnancy, very little support is available to those undergoing fertility treatment.

Unfortunately however, the fact is that appointments for IVF treatment or fertility tests can often be more time consuming and require more recovery time than pregnancy check ups.

There’s also the emotional rollercoaster to consider. Whilst pregnancy has a huge impact on women both physically and psychologically, the emotional toll of repeated rounds of fertility treatment should not be underestimated.

Why should employers support women through fertility treatment?

It might not seem like there’s much benefit to the employer in helping a woman through all of this, but in fact the advantages to the company can be major. If you know one of your employees is undergoing fertility treatment, you can work with her to plan ahead.

Some women prefer to take on a less taxing role during this process, perhaps dropping their hours to allow for appointments and recovery. Others might decide to push through and distract themselves with greater challenges now, with the aim of slowing down a bit during and after pregnancy.

If employers work with their employees at times like this, then the company gets to retain talent that might otherwise drift away from a lack of support.

If you are, or are considering undergoing fertility treatment, but are unsure of your company’s policy on the matter, it might be worth setting up a confidential meeting with HR to find out what your options are.