Expertise FAQs
All FAQs and more can be found on it's individual expertise listed page here
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Colposcopy & Abnormal Smear
What causes an abnormal smear?
Abnormal smears often represent a pre-cancerous abnormality on the cervix. These pre-cancerous abnormalities are caused by Human Papilloma Virus (HPV or Wart virus). This is a very common infection and 60-70% of women (and men) get it at some stage in life. Most (95%) women will shake it off through their immunity, but in some women it may linger on and cause abnormal smears. More information on HPV can be found by clicking here.
What is colposcopy?
Colposcopy is a simple outpatient clinic procedure to examine the cervix. As an experience, it is very similar to having a smear test performed. During colposcopy, the cervix is visualised using a speculum and is examined under magnification and bright light to look for signs of any abnormality.
Two dyes are applied to the cervix (acetic acid and iodine) which highlight the abnormality if present. From the colposcopy appearance, the abnormalities can also be graded as low grade (CIN1) and high-grade changes (CIN2-3).
Colposcopy examination is carried out by a specialist gynaecologist who is accredited by the British Society of Colposcopy and Cervical Pathology (BSCCP). A nurse will also be present and you will be given an option to see your cervix on the screen.
What happens during a colposcopy appointment?
During the consultation a detailed medical history will be obtained. You will also have an opportunity to ask the specialist any questions that you may have.
A nurse is always present during the colposcopy examination and will assist you. A speculum examination is performed to visualise the cervix and a colposcope is used to assess it under high magnification. Two solutions are used to highlight abnormal areas, if any. A biopsy may be obtained from these areas after application of local anaesthesia.
Why is a colposcopy performed?
A colposcopy is often performed following an abnormal smear. It allows the specialist to assess the cervix and grade any abnormalities if present.
Sometimes, a colposcopy is performed for assessment of certain symptoms such as bleeding after sex OR persistent vaginal discharge OR if your GP is concerned about the appearance of your cervix.
Does it hurt?
Colposcopy as an experience is very similar to having a smear test. There may be some discomfort involved with the insertion of a speculum, but you should not experience sharp pain. If you find smears uncomfortable, he/she will be able to use a smaller speculum or a numbing gel called Instillagel. If a biopsy is needed, it may also be carried out after the application of local anaesthetic.
What does the treatment involve?
The commonest form of treatment is LLETZ (Large Loop Excision of Transformation Zone). It is also known as LEEP (Loop Electrosurgical Excision Procedure, an American term). This is commonly carried out as an outpatient procedure under local anaesthesia. After numbing the cervix with local anaesthetic, a heated wire loop is used to remove the abnormal cells. It is a quick procedure that takes approximately 10 minutes. Similar to having a biopsy, some women report discomfort, but no sharp pain.
What will the colposcopy show?
The examination may show a normal cervix or low grade or high grade changes. Your specialist will explain the findings. Depending on your clinical circumstances, you may or may not need treatment.
How much does a colposcopy cost?
Our standard colposcopy package includes:
- A consultation with a consultant gynaecologist
- Full history taking
- Colposcopy procedure
- Explanation of results
- Detailed written report emailed or posted to you and your GP
- Direct access for any urgent health concerns
Fibroids
Uterine fibroids are benign lumps that grow in the uterus. Almost 50% of women will get uterine fibroids by the age of 50. These are benign (non-cancerous) lumps but can lead to symptoms that can affect the quality of your life.
What causes fibroids?
The exact cause of fibroids is not known, but they are more common in Afro-Caribbean women. Fibroids usually grow slowly and can sometimes reach impressive size even up to the size of a full term pregnancy!
Fibroids are oestrogen-dependent and therefore are uncommon before the age of 20 and tend to shrink after menopause.
What are the types of fibroids?
Fibroids can be classified as small (less than 4 cm), medium (4-8 cm) or large (greater than 8 cm). They are also classified depending on the location:
- Submucous fibroids: Fibroids that grow inwards within the uterine cavity, more likely to cause bleeding problems, also more amenable to Hysteroscopic Surgery.
- Intramural fibroids: Fibroids that grow within the wall of the uterus
- Subserous fibroids: Fibroids that grow outwards, more likely to cause pressure symptoms. Intramural and subserous fibroids are more amenable to laparoscopic surgery.
Can fibroids affect pregnancy?
Fortunately, fibroids do not usually interfere with chances of getting pregnant Most of the fibroids are small and do not interfere with the cavity of the uterus or the fallopian tubes. In general, if the fibroids are small (smaller than 6cm) AND if the cavity is normal AND if the fallopian tubes are patent (open), there is no cause to worry.
There is some evidence that Myomectomy is associated with improved pregnancy and fertility outcome. This is dependent on various factors such as previous history, location and size of fibroids.
Fibroids can sometimes be associated with risks during antenatal period, labour and post-partum.
Fibroids can increase the risk of early pregnancy loss and preterm birth especially if they are large or interfere with the uterine cavity (submucous fibroids).
Fibroids tend to increase in size with increased blood supply of pregnancy. This can lead to increased discomfort. Increase in size is also associated with ‘Red degeneration of Pregnancy’. This happens due to rapid increase in the size of fibroids where the central area of a fibroid does not get enough blood supply and undergoes ‘necrosis’. This is associated with pain and tenderness over the fibroid. Sometimes admission to the hospital and rest is required for pain relief, anti-inflammatory and supportive treatment.
Fibroids in the lower part of the uterus can lead to malposition such as transverse lie or breech presentation necessitating Caesarean Section. Caesarean Section can sometimes be difficult and complex due to location of the fibroids.
Post-delivery, fibroids can interfere with contraction of the uterus leading to post-partum haemorrhage.
The following tests can help ensure pregnancy will not be affected:
- Ultrasound scan can help in assessment of size, numbers and location of fibroids in relation to the uterine cavity and fallopian tubes.
- Hycosy (HYstero-Salpingo COntrast SonographY) scan is where a contrast in injected into the uterine cavity and visualised on scan coming out of the fallopian tubes. This helps in more accurate assessment of uterine cavity and tubal patency.
Do fibroids cause symptoms?
Fiboids are very common and most fibroids do not cause any symptoms. Some fibroids (approximately 40%) will cause some symptoms and these symptoms depend on location of fibroids, their size, changes within the fibroids and pregnancy status.
Submucous fibroids are often likely to cause bleeding problems while intramural and subserous fibroids tend to cause pressure symptoms. Fibroids tend to grow during pregnancy due to presence of oestrogen and consequently fibroids are more likely to cause symptoms during pregnancy.
Fibroids symptoms include:
Abnormal Uterine Bleeding: Fibroids (often submucous) can cause bleeding problems such as heavy periods (menorrhagia) or bleeding in between periods. Sometimes the bleeding is associated with heavy clots and spasmodic pain. Blood loss can also lead to iron deficiency and anaemia.
Pressure symptoms: Fibroids can press on the surrounding organs such as bladder and bowel. This can lead to urinary frequency and constipation. Occasionally, pressure on the bladder neck can lead to urinary retention. Large fibroids can cause pressure on pelvic blood vessels which can lead to swelling of legs, deep vein thrombosis and back pressure on kidneys.
Pain: Fibroids can cause heaviness and fullness in the pelvic area. Large fibroids can cause mass and pressure effects. Sometimes the fibroids can outgrow their own supply and can undergo central degeneration and become extremely painful. Some of the fibroids can cause dyspareunia (pain during sex) because of their position.
Infertility: Fibroids usually do not lead to fertility issues and most women with fibroids will achieve pregnancy without any difficulty. In fact, many of the fibroids are diagnosed on ultrasound scans performed during pregnancy. Submucous fibroids can obstruct the uterine cavity and prevent implantation very similar to an Intrauterine Device (IUD). Some fibroids can obstruct the fallopian tubes and cause difficulty in conceiving. There is some evidence that myomectomy can improve fertility rates by approximately 50%. Removal of fibroids larger than 6cm and submucous fibroids will improve fertility rates and risk of complication during pregnancy.
Pregnancy and Fibroids: Most women with fibroids will have straight-forward course in pregnancy. However, the fibroids tend to grow in size in pregnancy due to high levels of oestrogen. Occasionally, they will outgrow their own blood supply and become painful due to a condition called ‘red degenration’. Submucous fibroids can occasionally cause early pregnancy complications such as bleeding and pregnancy loss due to implantation on a fibroid and not enough blood supply. Later on in pregnancy, if the fibroids are low in the uterus, malpositions such as breech and transverse lie can occur or indeed slow progress in labour and a caesarean section may be necessary. Caesarean section sometimes can be complex if the fibroids are in the way. They can also interfere with uterine contractions and lead to excessive bleeding after delivery.
What tests are required for fibroids diagnosis
Ultrasound scan often is the best investigation. It can obviously make the diagnosis but can also tell us about numbers, size and location. It can also help with planning treatment.
For small fibroids, a transvaginal scan is more useful. For large fibroids, a transabdominal scan may be needed in addition.
MRI scan can sometimes be needed for more accurate description of size and location and for planning of surgery. MRI can be useful if there is suspicion of malignant transformation (Leiomyosarcoma). A CT scan may be needed if there is pressure on the kidneys causing dilatation.
Blood tests such as Haemoglobin levels and iron profile may be required to assess the degree of anaemia.
Hysteroscopy may be required if there are bleeding symptoms and presence of submucous fibroids. Hysteroscopy is camera inspection of the uterine cavity. This examination can be used not only for diagnosis of submucous fibroids, but they can also be treated through this approach. For more information on hysteroscopy click here.
Fibroid Treatments
Gynaecological Cancers
Gynaecological cancer is a term that refers to cancers that begin in a woman’s reproductive organs. These cancers can affect different parts of the reproductive system, and while they share some similarities, each type has distinct symptoms, risk factors, and treatment pathways.
Early diagnosis is key. Many gynaecological cancers are highly treatable when caught early, and recognising the signs, and acting on them, can make a significant difference to outcomes.
There are five main types of gynaecological cancer; cervical, ovarian, uterine (womb), vulval, and vaginal cancer. Cervical cancer is often linked to HPV and can be detected early through regular screening. Ovarian cancer can be harder to diagnose, with symptoms like bloating or pelvic pain, while uterine cancer is the most common type and often presents with postmenopausal bleeding. Vulval and vaginal cancers are rarer but may cause itching, pain, or skin changes. Each type has distinct symptoms, but all should be investigated promptly.
What causes gynaecological cancers?
Causes vary by type. Risk factors may include age, family history, certain genetic mutations (such as BRCA), HPV infection, obesity, hormone replacement therapy, and lifestyle factors. Often, no single cause is identified.
What are the early warning signs not to ignore?
Abnormal bleeding (especially after sex or between periods), postmenopausal bleeding, persistent bloating, pelvic pain, new discharge, or changes in vulvar skin should be assessed by a specialist promptly.
What does cancer staging mean?
Staging describes how far the cancer has spread. It helps determine treatment options and prognosis. Staging typically ranges from Stage 1 (localised) to Stage 4 (spread to distant organs)
Is gynaecological cancer treatable?
Yes. Many gynaecological cancers, especially when diagnosed early, are highly treatable. Treatment may involve surgery, chemotherapy, radiotherapy, or a combination of approaches tailored to your individual case.
Can gynaecological cancer be prevented?
While not all cases can be prevented, regular cervical screening (smear tests), HPV vaccination, maintaining a healthy weight, and recognising symptoms early can reduce risk or support early detection.
What is the HPV virus and how is it linked to cancer?
Human papillomavirus (HPV) is a common virus transmitted through skin-to-skin contact. Certain high-risk strains of HPV are the leading cause of cervical cancer and may also contribute to vaginal and vulval cancers.
I have symptoms that could be related to gynaecological cancer, what should I do?
If you are experiencing symptoms such as unusual vaginal bleeding (especially after menopause or between periods), persistent pelvic or abdominal pain, bloating, changes in discharge, or discomfort during sex, it’s important not to ignore them.
While these symptoms can often be caused by non-cancerous conditions, they should always be assessed by a specialist. Early evaluation means that if there is anything serious, it can be detected and treated promptly, and if not, you’ll have peace of mind.
You can book an appointment directly with one of our consultants without a referral. We offer daily clinics across London with rapid access to investigations such as ultrasound scans and diagnostic procedures. If further treatment is needed, we ensure a smooth and supportive onward care pathway with leading cancer centres
What does WID-Easy Test do?
The WID-easy test saves many patients from having to undergo invasive surgery to diagnose whether cancer is the cause of the bleeding. It assists in assessing the urgency of treatment and identifying the appropriate type of treatment needed. WID-easy helps you make informed decisions about your next steps in care, while helping you avoid unnecessary invasive procedures.
- Accurate – results have shown unnecessary follow-up procedures to be reduced by over 90% without missing cancers.
- Rapid – it has been designed for quick analysis, providing fast results within days.
- Simple – the cervical and vaginal swab sample collection is minimally invasive.
WID-easy can be used alongside other diagnostic procedures such as transvaginal ultrasounds however it should be conducted before applying lubricant and taking samples for tests like a PAP smear. It can also simplify diagnosis for women with fibroids or a high BMI.
You can book a consultation with any menopause GPs and ask if you qualify for a WID-Easy Test. Charges to consultation and the test will apply*. Book here
Menopause
Menopause is the natural point in life when a woman permanently stops having periods. It is diagnosed after 12 consecutive months without menstruation, usually occurring between ages 45 and 55. The average age in the UK is 51 but of course, no two women are the same. It marks the end of reproductive function and is associated with a decline in oestrogen levels.
Menopause is usually a gradual process this involves the following:
- Perimenopause: the period from the beginning of menopausal symptoms.
- Post-menopause: defined when there have been no periods for twelve months or immediately after surgical removal of the ovaries.
Perimenopause refers to the transitional years leading up to menopause. It is characterised by fluctuating hormone levels, irregular periods, and a range of physical and emotional symptoms. This stage can begin several years before menopause and varies widely between individuals.
Around 1 in 100 women become menopausal before the age of 40. This is known as premature ovarian insufficiency (POI), which can be caused by surgery, chemotherapy, radiotherapy, genetic, auto-immune or unknown reasons.
How do you diagnose menopause?
The diagnosis of menopause and the transitional process is dependent on the pattern of your periods and the symptoms experienced.
Measurements of hormone levels are not routinely done, but are most useful when early menopause or premature menopause is suspected, when fertility appears to be reduced or after hysterectomy with conservation of ovaries where there is no bleeding pattern to follow.
Common menopause symptoms and signs are:
- Irregular periods, absent periods, heavy bleeding
- Hot flushes
- Night sweats
- Tiredness
- Mood changes including low mood, anxiety, irritability
- Brain fog
- Low self esteem
- Decreased sex drive
- Poor sleep
- Bladder issues
- Vaginal problems including increase in infections
- Vaginal dryness and / or soreness
- Changes in skin and hair
- Joint pains
How can I improve symptoms of menopause?
Lifestyle: A healthy lifestyle can help reduce the symptoms of menopause and ensure healthy bones and heart. This can be done through the following:
- Balanced Diet
- Regular exercise
- Reduction in caffeine and alcohol
- No smoking
- Reduction of stress levels
Complementary/Alternative Therapies: There are a number of therapies to consider including acupuncture, herbal remedies, aromatherapy, reflexology and homeopathy. These are becoming popular especially for symptomatic relief but there is limited scientific research to support their effect and safety.
Psychological therapies: Cognitive behavioural therapy (CBT) develops practical ways of managing problems and provides new coping skills and useful strategies for a range of menopausal symptoms including anxiety, hot flushes, night sweats and fatigue.
What are the menopause symptoms?
Symptoms can vary by individual, and can include:
- Hot flushes and night sweats
- Sleep disturbances
- Mood changes and anxiety
- Vaginal dryness or discomfort
- Decreased libido
- Brain fog or forgetfulness
- Fatigue and joint pain
- Weight changes
How long do menopause symptoms last?
Symptoms may begin in perimenopause and last 4 to 8 years on average, although for some women they may resolve sooner or persist longer.
When should I seek help?
If menopause symptoms are disrupting your quality of life, sleep, relationships, or emotional wellbeing, it is advisable to seek support from a menopause specialist. Early intervention can significantly improve comfort and long-term health outcomes. We also advise individuals to have consultations to learn more about how they might be able to support their perimenopause early, even if your quality of life is not significantly impacted, as knowledge is power.
There are many different options to treat menopause symptoms, and you may be worried about using HRT or someone who has been told you cannot use HRT – please do not worry, there are options to be discussed and we can help you take control of your health, both now and future-proofing too.
Can menopause affect mental health?
Yes. Hormonal changes can contribute to low mood, anxiety, irritability, and poor concentration. Psychological symptoms are often the first symptoms to be felt. These symptoms are common and treatable. A supportive, individualised care plan can make a significant difference.
Why is weight gain common during menopause?
Oestrogen decline, reduced muscle mass, and metabolic changes can contribute to weight gain, particularly around the abdomen. Nutrition, resistance training, and tailored support can help mitigate these changes.
Can menopause affect sexual health?
Yes. Lower oestrogen can lead to vaginal dryness, discomfort during intercourse, and reduced libido. Treatments such as local oestrogen therapy and lubricants can be helpful. We can also guide you through the option of testosterone if needed.
Do I need contraception in perimenopause?
Contraception remains important during perimenopause, as pregnancy is still possible until menopause is confirmed. In a consultation, we will discuss your current contraceptive method, any changes in your cycle, and how these relate to both your contraceptive needs and menopause symptoms. We'll explore options that can offer both effective contraception and additional benefits, such as helping with heavy periods or providing hormone support, ensuring the approach is safe, suitable, and tailored to your individual health and lifestyle.
Menopause Treatments & HRT
Hormone Replacement Therapy (HRT) is a common treatment that replaces declining levels of oestrogen (and sometimes progesterone). For most women, HRT is a safe and effective way to manage symptoms and reduce risks of osteoporosis and cardiovascular disease. Risks and benefits should be reviewed individually. HRT is one option to treat menopause symptoms, however some women choose not to take this and these are some of the alternatives available. All of these can be discussed with our menopause specialist during your consultation.
- Lifestyle changes (diet, exercise, stress management)
- Cognitive behavioural therapy (CBT)
- Non-hormonal medications for hot flushes or mood including newer non-hormonal medications for hot flushes and night sweats.
- Vaginal moisturisers and lubricants
- Vaginal oestrogen treatments
The WID-Easy Test – An Innovative Test for Post Menopausal Bleeding
The WID-easy test (also called WID-qEC in research) helps doctors more accurately assess women who are peri-menopausal or post-menopausal and experiencing abnormal uterine bleeding.
Compared to a standard transvaginal ultrasound (TVUS), the WID-easy test can reduce unnecessary follow-up procedures, such as hysteroscopies, by over 90%, while still detecting the same number of cancers.
London Gynaecology offers the non-invasive test. If you are in the peri/post menopausal stage of life facing abnormal bleeding, book a consultation with our menopause GPs to discuss test options.
Fertility Check
Who is it for?
- Women or couples wanting to test their fertility potential.
- You should look into a Fertility Health Check at the age of 30, 35 and 40 years or if there is any delay in conceiving.
Starting a family should be a happy occasion, but for many couples it can be an anxious period of waiting. London Gynaecology’s fertility health check provides reassurance and guidance.
Our fertility check gives a good indication of your fertility levels and can provide guidance of reasons for unsuccessful conception or reassurance on how much time there is left to start a family.
Coils and Contraception
Choosing the right contraception is an important part of managing your reproductive health.
At London Gynaecology, we offer a full range of contraceptive options, including the hormonal and non-hormonal coil (IUD/IUS), and provide expert, personalised advice to help you make the choice that best suits your lifestyle and future plans. Whether you’re looking for long-acting contraception, want to switch methods, or are experiencing issues with your current option, our consultants are here to support you with evidence-based care in a discreet, comfortable environment.
Which contraceptive is right for me?
The best contraceptive method for you depends on your individual health, lifestyle, and future plans. We take the time to understand your medical history, menstrual patterns, preferences, and whether or not you're planning a pregnancy in the near future and discuss the most appropriate options. Your consultant will guide you through the benefits and potential side effects of each method, helping you make an informed decision that feels right for you.
What types of coil do you offer?
We offer both the hormonal coil (IUS), such as Mirena or Kyleena, and the non-hormonal copper coil (IUD). These are long-acting, reversible forms of contraception that are over 99% effective and can last between 5 and 10 years, depending on the type.
What is the difference between the hormonal and copper coil?
The hormonal coil releases a small amount of progestogen, which can lighten or stop periods and reduce cramps. The copper coil does not contain hormones and works by affecting sperm movement and egg fertilisation. It may make periods slightly heavier or more crampy.
How soon does the coil start working?
How soon does the coil start working?
The copper coil is effective immediately. The hormonal coil is effective straight away if fitted during the first 7 days of your cycle; otherwise, you may need to use additional contraception for 7 days.
How is a coil fitted, and is it painful?
A coil is fitted during a simple outpatient procedure that usually takes around 10–15 minutes. Some women experience mild cramping during or shortly after the procedure, but discomfort is usually short-lived. We take time to explain each step and offer pain relief if needed.
What other contraception options do you provide?
In addition to coils, we offer advice and prescriptions for the contraceptive pill, patch, implant, injection, and vaginal ring. We also offer contraceptive implant.
Can a coil help with heavy periods?
Yes. The hormonal coil (such as Mirena) is often used as a treatment for heavy menstrual bleeding and can significantly reduce bleeding over time — in some cases stopping periods altogether.
Contraceptive Packages
Coil Fitting
A simple solution to contraception, our package includes consultation, advice and fitting of the appropriate coil.
Who is it for?
- Our coil fitting service is for every woman considering having a coil fitted (IUD, IUS, IntraUterine Device) for contraceptive purposes.
- You should have a coil fitted as required. Most coils will need removing after 5 or 10 years depending on the type.
Coil Removal
Women with a coil need to have it removed every 5-10 years depending on the type of coil fitted.
Who is it for?
- Every woman with a coil needs it to be removed every 5-10 years depending on the type of coil fitted.
- Our coil removal service should be used as required. Most coils will need removing after 5 or 10 years depending on the type.
Contraceptive Implant Insertion
This package includes a consultation and expert insertion of the contraceptive implant, with clear guidance on what to expect.
The contraceptive implant is a small plastic rod that is inserted under the skin on the inner aspect of the upper arm. It contains the hormone progesterone and works by thickening cervical mucus and can stop ovulation. It is a very effective form of contraception (approximate 99% effective). The implant lasts for three years at which point it can be replaced if desired. Once removed fertility returns quickly.
It is a very effective form of contraception that does not require women to remember to take a pill. It is also very discreet but can be felt by the user under the skin of the upper arm. It can also be fitted at any point in the menstrual cycle or after birth or termination.
It is particularly suited for women who cannot for whatever reason use a contraceptive containing oestrogen, for example women with focal migraines or high blood pressure or who are overweight. It is also particularly suited for women who may find it difficult to remember to take a pill. It can also be used while breastfeeding.
Although most women have no side effects, some women can have side effects related to the progesterone such as fluid retention, breast tenderness or acne.
Some women find their periods change. In some women periods stop altogether, although the majority find this beneficial. Some women experience irregular bleeding.
The implant is fitted during an outpatient appointment by a consultant. Women will need an injection of local anaesthetic just under the skin that is on the inner aspect of the upper arm. The implant is then inserted but this should not be painful.
A bandage is normally placed around the upper arm for 24 hours. Some localised bruising or pain can occur but this usually settles after a few days.
Most side effects should they occur are short-lived and settle after a few months. Red flag symptoms are post-coital bleeding and persistent intermenstrual bleeding as well as pelvic pain, abdominal swelling/bloating & weight loss. Most settle within 6 months.
Very rarely, fitting can cause long-term local pain or discomfort.
The implant can be removed by a specialist at London Gynaecology or alternatively most NHS family planning clinics have a trained implant remover.
Removal can sometimes be difficult but is usually performed under local anaesthetic. Occasionally though a general anaesthetic is necessary especially if the implant is deep or cannot be located.
If you need to have a contraceptive implant removed, please read about our contraceptive implant removal service.
Paediatric Adolescent Gynaecology
If your daughter has any gynaecological disorders, it is important to seek professional care immediately. Chronic pain, abnormal bleeding, and contraceptive needs also qualify as reasons for seeking advise from a paediatric gynaecologist. One of the most common reasons adolescents see a gynaecologist is for help managing her periods. A girl’s menstrual cycle should not be so painful or heavy that it interferes with school or her extracurricular activities.
What is Paediatric and adolescent gynaecology?
It is a specialist area of medicine focused on diagnosing and managing gynaecological issues in children and teenagers, from birth to early adulthood. This includes concerns about periods, vaginal discharge, pelvic pain, and other developmental or hormonal issues.
What age group do you see?
We care for children and teenagers from age 13 to 18yrs and also through to adulthood.
What problems can you help with?
Common problem we can help with are:
- Irregular, Heavy and/or painful periods
- Irregular periods - frequent, delayed or missed periods
- Delayed or early puberty
- Vaginal discharge or irritation
- Genital skin problems: vulval itching, irritation or soreness
- Labial adhesions
- Facial and/or body acne
- Hair loss or excessive facial/body hair
- Ovarian cysts
- Premenstrual syndrome
- Concerns about anatomy or development
- Recurrent UTIs or vulvovaginitis
- Contraception
Will a parent or guardian be present during the consultation?
Yes. For all patients under 16, a parent or guardian must attend. For older teenagers, a parent or guardian needs to accompany the patient to the hospital. But they may not be present during the consultation depending on the young person’s preferences and if the doctor considers this appropriate.
Will an examination be needed?
Not always. Many issues can be discussed and diagnosed without a physical examination. If an examination is needed, it will be explained fully beforehand, and a chaperone will always be present. If not sexually active, an internal/vaginal assessment is not performed other than for swab tests, but this too is carried out with permission.
What happens during the first appointment?
The consultant will take a detailed medical history and discuss the concern in a sensitive and age-appropriate manner. If necessary, they may examine the child in presence of a chaperone and/or a parent or guardian . Investigations such as blood tests and/or ultrasound, will be arranged, if needed. All treatment options will be fully explained.
What if my daughter needs an ultrasound scan?
If an ultrasound scan is needed, we usually refer patients to The Gynaecology Ultrasound Centre on Harley Street. These scans are not performed on the day of the first appointment. Scans are usually performed externally on the lower tummy area and are not intended to cause pain or discomfort. Internal (transvaginal) scans may be performed in older sexually active teenagers. Further imaging such as an MRI may be required in some cases and this arranged at a later convenient date.
Which doctor will see my child?
Your child will be seen by Mrs Pradnya Pisal, a senior consultant gynaecologist with specialist expertise in paediatric and adolescent gynaecology. She is experienced in providing sensitive and age-appropriate care for children and teenagers who are at or over age 13yrs.
Where will my child be seen?
Appointments take place in The London Gynaecology Clinic at The Portland Hospital Site, 212 Great Portland Street W1W 5QN. The Portland Hospital is a Specialist private hospital facility for women and children located in Central London and offers safe, child-friendly facilities.
If my child needs a procedure, where will they be treated?
When procedures are needed, they are planned and performed in The main 205-209 Great Portland Street, W1W 5AH.
Heavy Periods (Menorrhagia)
The official term for heavy periods is menorrhagia, meaning an above average or prolonged level of bleeding in a menstrual cycle. Bleeding during an average period is supposed to be around 80ml (less than half a cup), but a lot of women experience more bleeding than this.
How do you differentiate between normal and heavy periods?
Definition of normal can be different for different people. However, you can call your periods heavy, if you are passing lots of clots or having to constantly use double protection, changing protection more frequently than every four hours or if your periods are making you anaemic.
How common are heavy periods?
Heavy periods are very common and nearly 50% of women suffer from heavy periods at some stage of their life.
What are the common causes?
- Uterine fibroids: Fibroids often present with heavy periods.
- Endometriosis: Endometriosis can cause heavy and painful periods.
- Polycystic ovaries: Periods can be less frequent but heavier.
- Perimenopausal changes: A few months / years before menopause, the periods can change pattern and become heavier.
- Endometrial hyperplasia and cancer: This can be a rare cause of menorrhagia.
- What tests are required?
- Blood tests: These are required to check your haemoglobin (to make sure that you are not anaemic) and thyroid function.
- Ultrasound scan: To check the uterus (womb) lining and to look for other causes as listed above.
- Endometrial biopsy: This may be indicated particularly in women over the age of 40.
- Hysteroscopy: This is camera examination of the uterus. This can be carried out under local or general anaesthesia.
What are the treatment options?
- Contraceptive Pill: This is appropriate if you also need effective contraception. The pill will often make the periods lighter.
- Tranexamic Acid: This medication is taken during periods, and will reduce the heaviness of periods.
- Mefenamic Acid: In addition to making periods lighter, this medication is also good for relieving spasmodic period pains.
- Mirena Coil: This popular intra-uterine device provides effective contraception, but also releases a small amount of progesterone hormone and often helps with heavy periods. In some women the periods completely stop, while in majority, periods become much lighter. Effective for five years.
- Endometrial ablation: Lining of the uterus can be treated with electrical, heat or microwave energy and will then be replaced by fibrotic tissue which does not bleed as much. Appropriate when family is complete.
- Treatment of cause: If fibroids are present, they can often be removed through key-hole approach (hysteroscopy or laparoscopy). Sometimes, an open operation may be required.
- Hysterectomy: This is now rarely needed to treat heavy periods, but if required is often performed as a key-hole procedure.
Ovarian Cysts
Ovarian cysts are fluid-filled cysts commonly seen within ovaries. The cysts can vary in size and range from a few millimetres to tens of centimetres. Many ovarian cysts are asymptomatic but some can produce symptoms such as pain.
How common are ovarian cysts?
Ovarian cysts are very common, particularly during the reproductive years. Most women will develop at least one ovarian cyst during their lifetime, often without any symptoms. Many cysts are harmless and resolve on their own without treatment.
What are the common types of ovarian cysts and what causes them?
There are three common types of ovarian cysts:
- Functional ovarian cysts: These cysts are also known as follicular cysts and are common in young women. Function of ovaries is to produce eggs every month and it is not uncommon for these eggs to be retained and enlarge in size. These cysts are often self-limiting and can be monitored. Usually, these cysts will resolve spontaneously without any treatment.
- Benign ovarian cysts: These cysts are not cancerous but do not resolve spontaneously. Tumour marker (CA125) levels are often normal and surgery can be performed as a key-hole (laparoscopic) procedure. Dermoid cyst or teratoma is a common benign ovarian cyst.
- Malignant ovarian cysts (ovarian cancer): These cysts are often seen in older women and the tumour marker (CA125) level may be raised. Even though ovarian cancer may be suspected on tests, it is confirmed after removal and histological analysis. Treatment is often (but not always) by open surgery. In some cases of advanced ovarian cancer, further treatment may be required after surgery in the form of chemotherapy.
What are the symptoms of ovarian cysts?
Many ovarian cysts do not cause any symptoms and are often found incidentally during routine scans. However, some may lead to:
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Lower abdominal or pelvic pain
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A feeling of fullness or bloating
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A noticeable lump or swelling
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Sudden, sharp pain – which may suggest a complication such as torsion, bleeding, or rupture
In rare cases, ovarian cysts may be cancerous. Early-stage ovarian cancer often causes no symptoms or only vague signs that may be mistaken for other conditions. In addition to the symptoms listed above, possible signs of a malignant ovarian cyst include:
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Persistent abdominal distension
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Indigestion or bloating
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Changes in bowel habits
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New onset of pelvic pain, particularly after the age of 50
These symptoms can mimic irritable bowel syndrome (IBS), which is why it’s important to see your GP promptly—especially if you are over 50 and develop these symptoms.
For more information regarding ovarian cancer symptoms please read the Early Recognition of Ovarian Cancer leaflet published by NICE.
How are ovarian cysts diagnosed?
Ovarian cysts are typically diagnosed using an ultrasound scan. In some cases, an MRI scan is recommended to provide more detailed information about the nature and characteristics of the cyst.
A blood test called CA125 (a tumour marker) may also be carried out. While elevated CA125 levels can be associated with ovarian cancer, they can also rise in several benign conditions such as endometriosis, fibroids, pelvic infections, during menstruation, or following surgery.
This test is often raised in cancerous cysts but may also be raised in other benign conditions such as endometriosis, fibroids, infection, during monthly periods and after surgery.
Do the ovarian cysts always need removal?
Not all ovarian cysts need removal. Functional (follicular) cysts often will resolve spontaneously. Surgery may be needed if the cysts are persistent or if there are symptoms (see above). If there is a suspicion of cancer, urgent surgery is indicated to make a diagnosis and also as treatment.
How are ovarian cysts treated?
Most of the ovarian cysts can be removed as a key-hole (laparoscopic procedure). Three or four small (5-10mm) incisions are made on the tummy wall. Camera and special surgical instruments are then inserted to remove the cyst and healthy ovarian tissue is conserved. The cyst is then put in a plastic bag, decompressed and removed with no spillage inside the tummy. Key-hole surgery avoids the need for a big cut and has the advantage of reduced hospital stay and quick recovery and return to normal life.
Will I lose my ovary?
The ovary containing the cyst does not need to be removed unless the cyst is suspected to be cancerous or too large. If the cyst is suspected to be cancerous, the ovary may be removed to avoid inadvertent rupture and spillage of contents. In other situations the ovary can almost always be conserved.
How can you prevent recurrent ovarian cysts?
It may not be always possible to prevent ovarian cysts, but going on the contraceptive pill may prevent cyst-formation to some degree.
Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a common hormonal condition and affects how the ovaries function. It can cause a range of symptoms including irregular periods, excess hair growth, acne, and difficulty with fertility.
PCOS affects approximately 7 in 100 women in the UK and is often diagnosed in late teens or early adulthood. While the exact cause is unknown, early diagnosis and a personalised management plan can help reduce the risk of long-term complications such as type 2 diabetes and heart disease.
What are the symptoms of PCOS?
- Irregular, infrequent periods or no periods at all
- Infertility (due to irregular or no ovulation)
- Excessive hair growth (hirsutism) on the face, chest or back
- Weight gain
- Hair loss from the head
- Oily skin or acne
Symptoms can vary widely from person to person, and not everyone with PCOS will experience all of these signs.
How do you diagnose PCOS?
Any two out the following three features would be diagnostic.
PCOS is diagnosed when at least two of the following three features are present:
- Ovaries have many (more than 12) tiny cysts: Ovarian cysts are small blister-like-lumps (about 5-8 mm) that form on the surface of the ovaries. Women produce an egg every month and these eggs, if not released, may be retained as small cysts. This is usually seen on an ultrasound scan. Polycystic appearance of ovaries is seen on ultrasound scan in 22% of women but only a few of these women will have the “syndrome”.
- Hormonal imbalance (Hyperandrogenism): Ovaries produce the “female” hormones, such as oestrogen and progesterone and also very small amount of the “male” hormone, testosterone. When the level of testosterone in the blood goes over a certain level, it can cause some of the common symptoms of PCOS like acne and unwanted hair growth.
- Failure to ovulate every month (anovulation) leading to infrequent or absent periods: Oligomenorhoea means less than six periods in a year and amenorrhoea means no periods at all.
A diagnosis is usually made based on clinical history, symptoms, hormone tests, and pelvic ultrasound findings.
Does PCOS affect fertility?
While around 60% of women with PCOS are able to conceive naturally, some may experience difficulties due to irregular or absent ovulation. Fortunately, many women respond well to simple treatments, often involving medication to stimulate ovulation, supported by regular ultrasound scans to monitor progress.
Can diet and nutrition help PCOS?
Yes, nutrition plays a key role in managing PCOS symptoms. Nutritional therapist Laura Southern explains, “A healthy eating plan can help manage and even alleviate some of the symptoms of PCOS. The right diet supports blood sugar and insulin regulation, improves cell sensitivity, and promotes hormone balance.”
Personalised nutritional guidance can make a significant difference in overall symptom control and long-term health.
For more information, visit our dedicated page on PCOS Nutrition.
What is the treatment for polycystic ovary syndrome?
- Stay slim through a combination of regular exercise and diet. Metformin, a drug used to treat very early diabetes, can also help with carbohydrate metabolism and losing weight.
- Treatment of PCOS depends on symptoms and whether you are trying for a family or not. The easiest way of controlling PCOS is to go on the combined pill (such as Yasmin or Zoely) which prevents recruitment of new egg-follicles and stops the problem from getting worse.
- Obviously the contraceptive pill is not an option if you are trying for a family. If you have been trying for longer than six to twelve months you may need ovulation induction tablets such as Clomiphene and serial scans.
- Treatment of unwanted hair can be either cosmetic or through medication.
- Lifestyle management: to reduce risk of cardiovascular disease and diabetes in later life.
PCOS Package
Provides a thorough investigation of possible polycystic ovarian syndrome, diagnosis and management plan.
What does a PCOS Package involve?
- A consultation with a consultant gynaecologist
- Clinical assessment including full medical history
- Blood test including:
- LH, FSH, DHEAs, HbA1C
- Thyroid function, prolactin, testosterone, oestradiol
- SHBG, 17-hydroxyprogesterone, lipid profile
- Comprehensive report to you and your GP
- Direct access for any urgent health concerns
The following can be added at an additional cost:
- Pelvic ultrasound scan
- Nutritional consultation, visit PCOS Nutrition
For more information on polycystic ovarian syndrome, please click here, or if you would like to download our PCOS patient information leaflet, click here.
PCOS Nutrition Package
Supportive nutritional strategies that work with your hormones from a Nutritional Therapist.
What does PCOS Nutrition package include?
- A 12 week package with 4 consultations
- 1×75 minute consultation with our Nutritional Therapist and 3×30 minute follow up consultations (virtual or in person)
- Self-completion of a detailed health questionnaire and a 3-day food diary prior to the first nutritional consultation
- In the first consultation your Nutritional Therapist will gather more information and ask you to expand on areas from the health questionnaire
- Identification of nutritional, diet and lifestyle factors that could be contributing to and/or underlying the symptoms and health conditions that you are experiencing
- Comprehensive report with a personalised and evidence-based nutrition and lifestyle programme, tailored towards your individual requirements
- Direct access for any urgent health concerns
- Option of assessment on ‘body composition scales’ to work out visceral fat, body fat percentage, muscle mass
- Follow up consultation to identify what has worked well from the previous plan, push the plan on further, and review symptoms. Supplement reviews if necessary
This list is by no means exhaustive. Our Nutritional Therapist will work alongside your consultant to personalise an achievable, nutrition programme to meet your individual needs. This may include dietary supplements, where appropriate.
The following can be added at an additional cost:
- Supplement recommendations
- Blood tests
- Functional tests if your Nutritional Therapist feels these could be beneficial, perhaps to assess if you’re deficient in any vitamins and minerals
Adenomyosis
Adenomyosis is a common but under-recognised condition characterised by an enlarged uterus due to infiltration of the uterine lining into the muscle wall. During menstruation, this adenomyotic tissue also swells up and bleeds within the uterine wall which can cause severe period pain, cramps and heavy periods.
There are many other causes of heavy and painful periods such as fibroids and endometriosis which are more commonly known. In fact, both fibroids and endometriosis often coexist with adenomyosis. Adenomyosis is also known as ‘internal’ endometriosis as the uterine lining grows inside the uterine wall where as it grows outside the uterus with endometriosis.
Adenomyosis
Adenomyosis is a common but under-recognised condition characterised by an enlarged uterus due to infiltration of the uterine lining into the muscle wall. During menstruation, this adenomyotic tissue also swells up and bleeds within the uterine wall which can cause severe period pain, cramps and heavy periods.
There are many other causes of heavy and painful periods such as fibroids and endometriosis which are more commonly known. In fact, both fibroids and endometriosis often coexist with adenomyosis. Adenomyosis is also known as ‘internal’ endometriosis as the uterine lining grows inside the uterine wall where as it grows outside the uterus with endometriosis.
How is adenomyosis diagnosed?
The condition is often diagnosed on an ultrasound or MRI scan where an enlarged uterus is seen with one wall of the uterus thicker than the other.
This condition is difficult to diagnose as the symptoms are common and affect a lot of women. A large proportion of women have heavy and painful periods and accept the symptoms as ‘normal for me’. Women don’t often know how heavy or painful their periods are supposed to be.
You can call your periods heavy, if you are passing lots of clots or having to constantly use double protection, changing protection more frequently than every four hours or if your periods are making you anaemic.
What are the symptoms of adenomyosis?
Typical symptoms of adenomyosis are heavy and painful periods. Sometimes the uterus is so enlarged that a lump can be felt in the lower abdomen and can also cause pressure on the bladder and bowel causing urinary frequency and constipation. Having said that, a lot of women do not have any symptoms at all.
How does the condition impact women’s lives?
Many women live with this condition without ever having a diagnosis made. A lot of women with adenomyosis have such bad periods that they have to put their life on hold for that time of the month. It affects their work and quality of life significantly. It can lead to anemia due to heavy bleeding and lead to extreme tiredness and also affect performance at work and sports.
What are the treatment options available?
Adenomyosis can be a difficult condition to treat. Supportive treatment is often the first line of management with medication to make the periods less painful (painkillers and antispasmodic medication such as Mefenamic Acid) and to reduce the bleeding (Tranexamic Acid). Sometimes taking the minipill or the contraceptive pill back to back can also stop the periods and hence help with the symptoms. Mirena intrauterine device is also helpful in reducing the symptoms significantly. The condition also improves during and after pregnancy and after menopause.
Uterine artery embolisation (UAE) is a treatment usually reserved for fibroids but is also very effective for treating adenomyosis. The uterine blood supply is blocked by an interventional procedure carried out through the groin blood vessels. Hysterectomy is often reserved for extreme cases where the symptoms are resistant to other forms of treatment and the family is complete.
Polyps
A polyp is like a skin tag; an overgrowth of cells. An endometrial polyp is where the cell overgrowth is located in the lining (endometrium) of the womb (uterus). A cervical polyp is an overgrowth that develops in the cervix and within the canal that connects the uterus to the vagina.
What causes polyps?
The exact cause is unknown but they tend to grow when there is more of the hormone oestrogen in the body.
Are polyps dangerous?
Polyps are generally non-cancerous (benign) growths although some can be cancerous or can eventually turn into cancer.
What are the symptoms of polyps?
Polyps often cause no symptoms and are found coincidentally during an ultrasound scan. However, if they do cause symptoms these could be irregular menstrual bleeding which may be unpredictable and variable in length and heaviness. There may be bleeding between periods or excessive heavy menstrual bleeding. After the menopause they may cause vaginal bleeding.
How are polyps diagnosed?
They can often be suggested by ultrasound scan but may require sonohysterography (an ultrasound scan where fluid is inserted into the uterus to give a better view of the lining of the womb) or direct visualisation during a hysteroscopy for confirmation.
Do polyps need to be removed?
Small polyps (<1cm) may be managed expectantly because they may spontaneously regress. Polyp removal should be considered in symptomatic women, postmenopausal women or women with fertility issues.
How are polyps removed?
A cervical polyp can be removed in the outpatient clinic and it is not painful. Women may experience mild discomfort similar to a period pain afterwards and should avoid intercourse for 24-48 hours.
Recurrent Thrush
Thrush is a common yeast infection that affects most women at some point in their life. Whilst most cases can be treated quickly.
Recurrent thrush is typically defined as four or more episodes of vulvovaginal candidiasis (VVC) in a year. It’s caused by the overgrowth of Candida, a yeast that normally lives harmlessly in the vagina. Recurrent thrush needs a different approach where the cause of the thrush is identified and treated.
What are the symptoms of thrush?
Common symptoms include:
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Itching, irritation or soreness around the vagina
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Thick white vaginal discharge (often described as ‘cottage cheese-like’)
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Pain or discomfort during sex or urination
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Redness or swelling around the vulva
What causes recurrent thrush?
Recurrent thrush can be triggered by:
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Antibiotic use (which disrupts natural vaginal bacteria)
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Hormonal changes (e.g. around your period or pregnancy)
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Diabetes (especially if poorly controlled)
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Wearing tight or synthetic underwear
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Sexual activity
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Using perfumed soaps or vaginal washes
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A weakened immune system
Sometimes, there is no obvious cause.
How is recurrent thrush diagnosed?
Diagnosis often includes taking a swab from the vagina to confirm the diagnosis.
Is recurrent thrush sexually transmitted?
Thrush is not considered a sexually transmitted infection (STI), but it can sometimes be triggered or passed on through sex. However, many women who are not sexually active also get thrush.
How is it treated?
Treatment options include:
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Antifungal medications: These may be taken as tablets (e.g. fluconazole) or as vaginal pessaries/creams (e.g. clotrimazole)
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Maintenance therapy: A longer course of low-dose antifungal treatment may be prescribed (e.g. weekly fluconazole for 6 months)
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Treating a partner may be considered if they have symptoms
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Addressing underlying factors such as blood sugar control or changing hygiene products
Should I see a specialist?
Yes, if:
- You’ve had multiple recurrences despite treatment
- Symptoms are not improving
- There's a suspicion of a non-Candida albicans infection (which may be resistant to common treatments)
Who is treatment for?
Women who have 4 or more episodes of thrush in a year
What does it involve?
- A consultation with a consultant gynaecologist
- Blood tests
- FBC, ferritin, vitamin D, HbA1C, glucose
- Pelvic examination including high vaginal swab test for microscopic culture and sensitivities for candida
- Prescription if required
- Comprehensive report to you and your GP
- Direct access for any urgent health concerns
The following tests can be added to a recurrent thrush package at an additional cost
- Nutritional consultation
- Follow up consultation
- Examination with vulvoscope