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.

Visit a gynaecologist

Here in the UK, we’re not accustomed to making an appointment with a gynaecologist. Unlike our cousins across the Atlantic, who seem to have all the various specialists on speed dial. But we prefer to take all our problems to the GP and let them decide whether or not to refer it on.

GP practices are often overwhelmed. However, if you’re fairly sure of the area of expertise needed to deal with your problem, there’s no reason why you can’t bypass the GP altogether and go straight to a specialist.

If you’re suffering from problems related to menstruation, fertility, pregnancy or pelvic pain, then visiting a gynaecologist could be the best first step.

What is a gynaecologist?

Gynaecologists are doctors who have studied for at least seven years to specialise in women’s health, with a particular focus on the female reproductive system.

Some problems that a gynaecologist can treat include:

  • Infertility and fertility issues
  • Endometriosis
  • Polycystic ovary syndrome
  • Chronic pelvic pain
  • Menstruation problems
  • Issues related to the menopause
  • Pelvic inflammatory diseases
  • Urinary tract infections

Why should I visit a gynaecologist rather than my GP?

GP stands for General Practitioner, which means that they have a broad knowledge of many diseases and conditions. This enables them to diagnose the problem, and either treat it or refer to the relevant specialist.

If you are unsure whether your problem is gynaecological in nature, then the GP is always a good first port of call. Abdominal pain, for example, can be caused by irritable bowel syndrome, Crohn’s disease or even appendicitis.

In fact, whatever the nature of your problem, the GP is unlikely to turn you away. But if you are experiencing unusually heavy or painful periods, for example, or suspect that you may be perimenopausal, you may find that you get to the root of the issue faster if you go directly to a gynaecologist.

It can also be beneficial to visit a gynaecologist once a year for a check up, regardless of whether you are experiencing problematic symptoms down below.

What will happen when I visit a gynaecologist?

That depends on the nature of your visit. If you are having a routine check up, the gynaecologist is likely to talk you through your general health. This includes the regularity and heaviness of your periods, any associated pain etc. And this would be before performing a pelvic and vaginal examination.

If, however, your appointment is related to a particular issue, the gynaecologist will perform the necessary enquiries and examinations pertaining to that specific area.

A gynaecologist is qualified to not only diagnose but also treat many different conditions related to women’s health.

For more information, or to book an appointment, please contact us.

Menopause health

The menopause. It happens to us all sooner or later – some much sooner than others, unfortunately.

Because it’s such a natural part of life once you reach a certain age, it’s tempting to think that this is something you should get through on your own. After all, you didn’t feel the need to seek medical help when you started your periods, so why should you do so when they stop?

The menopause, however, is about much more than just stopping your periods. It marks a huge change in a woman’s body, and many of the symptoms associated with it can also be signs of something else. That is why a thorough health check can confirm that it is just the menopause you’re experiencing.

When should I go for a menopause health check?

There’s no right or wrong answer here – the menopause usually affects women between the ages of 45-55. But if you’re experiencing menopausal symptoms earlier, it could be that you are perimenopausal or even going through early menopause.

In fact, if you are having symptoms associated with the menopause before the age of 40, it is even more important that you seek medical advice.

Menopausal symptoms include, but are not limited to:

  • Lighter or heavier periods than usual
  • Irregular bleeding
  • Hot flushes
  • Mood swings
  • Depression
  • Weight gain
  • Vaginal dryness
  • Reduced sex drive
  • Fatigue
  • Insomnia

What happens at a menopause health check?

When you come for a menopause health check here at Surescan, you will receive a thorough consultation with a consultant gynaecologist. They will discuss all your symptoms with you, offer some lifestyle advice that could help to alleviate symptoms, and present you with all the information you need to make a decision on HRT (hormone replacement therapy) treatment.

We will also run some tests, including:

  • Blood pressure and BMI check
  • Abdominal and pelvic examination
  • Blood tests
  • Hormone profile if indicated
  • Vitamin D levels
  • Thyroid function tests

These tests are especially useful because there is a risk that if a woman is at menopausal age, symptoms get attributed to the menopause that are in fact caused by something more serious.

Both thyroid problems and vitamin D deficiency are relatively easy to treat but can be missed in women aged 40+ as the symptoms are strikingly similar to those experienced during the menopause.

If required, we can also include additional tests for ovarian and cervical cancer screening.

How often do I need a menopause health check?

We recommend that all peri and postmenopausal women undergo a full health check at least once a year. This should provide peace of mind with regard to your overall health and allow us to monitor the progress of any treatment.

For more information or to book a menopause health check, please call us on 0121 308 7774 or email info@surescan-womenshealth.co.uk.

Endometriosis Care

An All-Party-Political-Group (APPG) enquiry has published a report calling for an improvement in endometriosis diagnosis and care. This is welcome news for all women who have suffered whilst waiting for an endometriosis diagnosis.

With one in ten UK women affected by endometriosis, you might expect it to be top of the list of conditions to rule out when assessing a patient with pelvic pain. However, the APPG enquiry found that the average wait for an endometriosis diagnosis in the UK is eight years. And this has not improved in the past decade.

How did the enquiry work?

MPs from across the political parties came together to conduct the enquiry, which surveyed more than 10,000 women with endometriosis. It found that 53% of those surveyed had been to A&E with symptoms before being diagnosed. And 58% had visited their GP more than ten times before receiving a diagnosis.

A large majority also claimed their mental health had been affected. Around 90% said they would have liked some form of psychological support but were never offered it.

What is endometriosis?

Endometriosis is a condition where womb-like tissue grows outside of the womb, usually in the pelvic area. As with the womb lining itself, the tissue builds up and bleeds every month, but as it has no exit route from the body, it gets trapped, causing a lot of pain, swelling and scar tissue.

Some women experience no symptoms, and the problem is not uncovered until the pelvic area is scanned for another reason. But for many the condition causes debilitating problems. This includes chronic pain in the pelvis, painful sexual intercourse, difficulty in conceiving, and pain during bladder or bowel movements.

Why does endometriosis take so long to diagnose?

One major reason for the delay in endometriosis diagnosis is a lack of awareness about the condition, even among medical professionals.

The APPG enquiry has called for more training for medical professionals in the diagnosis and treatment of endometriosis. As well as investment in research into the causes and management of the condition.

It has also called for better menstrual education within schools, as lack of awareness is another factor in misdiagnosis.

Sir David Amess, MP, chair of the APPG, said:

“The report provides a stark picture of the reality of living with endometriosis, including the huge, life-long impact it may have on all aspects of life.

“It is not acceptable that endometriosis and it’s potentially debilitating and damaging symptoms are often ignored or not taken seriously. Neither should they be downplayed as linked to the menstrual cycle and periods.”

If you’re concerned about endometriosis or feel that you might be experiencing some of the symptoms, please contact us on 07835 736627 to book a confidential consultation with one of our women’s health specialists.

Fertility and Mental Health

If you have experienced fertility issues, it might not surprise you to hear that there is a link between infertility and mental health. Ninety percent of men and women struggling with fertility, surveyed by Fertility Network UK, felt depressed, and 42% even had suicidal thoughts. So perhaps it’s time to give more attention to the mental health of those battling fertility problems.

Fertility problems aren’t all about conception

Whilst the Fertility Network UK survey focused on couples trying to conceive, a separate study from Imperial College London looked at women who had experienced pregnancy loss in the form of miscarriage or ectopic pregnancy.

Of the 650 women studied, 29% suffered post-traumatic stress one month after losing their pregnancy, 24% had anxiety and 12% had depression. After nine months, those figures had fallen slightly to 18% experiencing post-traumatic stress, 17% moderate to severe anxiety, and 6% moderate to severe depression.

How can you protect your mental health throughout fertility treatment and pregnancy?

There’s no escaping the fact that pregnancy loss will affect you emotionally, and whilst you and your medical team will of course do everything to prevent that loss from happening, it is unfortunately a risk of every pregnancy.

However, by protecting your mental health throughout the conception process and pregnancy, you may be able to avoid suffering long-term damage.

Some of the best ways you can support your mental health during fertility treatment are to:

  • Keep talking – to yourself, in terms of acknowledging your pain, but also to your partner, and maybe to a counsellor. Being open about the emotions you are experiencing can help to prevent them from overwhelming you.
  • Find a support group – in these unusual times, an in-person support group might be difficult to find, but there are hundreds of groups online, full of people who will be going through very similar things to you.
  • Practise self care – whether that’s by allowing yourself the odd treat, by ensuring you get eight hours’ sleep a night, or by pushing yourself to go out for a jog every day – whatever makes you feel healthier, calmer and happier.

And the great news is that if you’re undergoing fertility treatment, then reducing your stress levels and looking after yourself can only improve your chances of conception.

If infertility is already impacting your mental health

Seek help now. Let your GP or fertility specialist know that you are struggling and they will be able to refer you for counselling or point you towards a support group.

Know that you are not alone, and that you will get through this. Talk things through with your partner, too, if you have one. Chances are, they are probably feeling much the same way as you, so talking things through together might help you both feel better.

Egg freezing rules

A UK ethics body, Nuffield Council on Bioethics, is claiming that the current ten-year limit on storing frozen eggs in the UK is arbitrary. And this is being used by some companies to pressurise women into making decisions about their fertility.

Why the ten-year limit?

The ten-year limit only applies to those women who have chosen to have their eggs frozen privately, for personal reasons. Eggs frozen by the NHS can be stored for up to 55 years. But the NHS will only fund egg freezing for medical reasons, such as for women about to undergo cancer treatment.

According to Nuffield, there are very few arguments against increasing the limit on “social” egg storing. The council claims that doing so would allow women to make a more informed decision about when to have a baby.

How does ‘social’ egg freezing work?

‘Social’ egg freezing really refers to the most common form of egg freezing. Women can freeze their eggs privately to allow them more time to think about starting a family.

Whilst this process gives women more freedom in terms of their careers and relationships, Nuffield claims that some less reputable fertility clinics have been using the ten-year limit to their advantage. Preying on anxious women with online advertising and alcohol-fueled marketing events.

And it’s not just fertility clinics taking advantage of social egg freezing. Some companies are offering their female employees egg freezing as part of an employment benefit package. Some see this as a way of providing more gender equality in the workplace. However, others claim it is putting pressure on women to delay motherhood in order to focus on their career.

How effective is egg freezing?

According to the Human Fertilisation and Embryology authority, about one in five IVF treatments using a patient’s own frozen eggs, results in a live birth. That’s compared to around one in four generally for IVF treatment.

However, it’s important to note that eggs harvested from women under 35 are much more likely to ‘take’ then those from women aged 35 and over. And this is the main concern of the ethics body. Clinics are using the ten-year limit to put pressure on women. To freeze their eggs, without providing them with all the facts.

What are the chances of the ten year rule being changed?

The government is currently assessing the ten-year rule, but there is no indication of when any change would come into effect.

If you are considering egg freezing for personal reasons, it is important to be fully informed of all the advantages and disadvantages of the process.

One option in the first instance might be to undergo a fertility MOT, or at least to have a full consultation with a fertility specialist. For more information, please contact us.

Pelvic Pain

Researchers from a group of top UK universities have conducted a study into the effectiveness of gabapentin in treating chronic pelvic pain. But they have found it to be no more effective than the placebo used in the control group.

Gabapentin is routinely used to treat pelvic pain, with 74% of GPs and 92% of gynaecologists saying that they would consider prescribing the drug for this purpose, according to one survey.

However, after publishing the results of the study, the researchers have recommended against prescribing gabapentin for pelvic pain.

How did the study work?

Researchers conducted a randomised clinical trial, involving 306 women who suffered from chronic pelvic pain with no known underlying cause.

Of those 306 women, 153 were given gabapentin to take for 16 weeks, while 153 were given a placebo. They were then asked to rate their pain on a weekly basis, using a scale of zero to ten.

Neither the women, nor the doctors prescribing the drugs, knew which drug they had been given.

At the end of the trial, researchers discovered that there was very little difference in reported pain levels between the two groups.

The group taking gabapentin did, however, report more side effects, including dizziness and mood swings, than the control group. This led the researchers to recommend against its use for this purpose.

What is chronic pelvic pain?

There are many reasons why women experience ongoing pelvic pain, with two of the most common being irritable bowel syndrome (IBS) and endometriosis. In some women, however, the underlying cause of the pain is never found.

If you are suffering from pelvic pain, it is important to see your GP and ask them to refer you to a specialist, to rule out any underlying condition.

But if endometriosis is the cause, it can be difficult to diagnose and is often overlooked. It is not unusual for a woman to suffer with the symptoms for up to ten years before receiving her diagnosis. So if you suspect you might have it, do try to be explicit with your doctor.

How can chronic pelvic pain be treated if gabapentin doesn’t work?

The most important first step in any pelvic pain treatment is to identify an underlying condition, if there is one, and treat that.

In around 24% of women worldwide, however, a cause for their pelvic pain is never found. These are the women who until now were prescribed gabapentin.

Professor Andrew Horne, lead researcher from the University of Edinburgh’s MRC Centre for Reproductive Health, said:

“We have been prescribing this drug for many years with little evidence of its effectiveness.

“As a result of our study, we can confidently conclude that gabapentin is not effective for chronic pelvic pain in women where no cause has been identified.

“More research is needed to explore if other therapies can help instead.”

Some possible treatment options suggested by the researchers included alternative drugs, as well as physiotherapy or even cognitive behavioural therapy. Some physicians believe there may be a psychological reason behind the pain.

If you are experiencing pelvic pain and would like to speak to a specialist in confidence, please call us on 07835 736627.