For most of us, knowledge of our hormones and gynaecology is basic at best: periods and how not to get pregnant. But that is it.
'I can't believe that in this country, the only time a woman gets to see a gynaecologist is if she's pregnant or has been suffering alone in silence and finally manages to get a referral. It's not considered routine practice to have a gynaecologist you see regularly,' says Dr Larisa Corda, fertility expert, obstetrician and gynaecologist. 'We need to start talking about this stuff, and from a younger age, so we feel comfortable talking about it.'
Both she and Dr Anita Mitra, who runs gynaegeek.com, are on a mission to get women informed and empowered. Here, 9 things they get asked most and the answers they give...
Does stress make PMS worse?
DR MITRA: Most likely, yes. Stress can not only make periods more painful but it can also make PMS worse. The main stress hormones are cortisol, adrenaline, noradrenaline and insulin – and they all interact with your female hormones. I call this the brain-vagina axis!
Stress can stop you ovulating, make your period come earlier or later, and make it heavier or lighter. Short bursts of stress aren’t bad for us, but when stress goes on and on, it can affect your cycle. Stress can also come from things such as overexercising, too much caffeine and yo-yo dieting. I often ask women, especially those trying to get pregnant, ‘Do you need to relax more?’ That could be via meditation, which is shown to be effective for stress. But if that’s not for you, then more downtime – such as walking without taking your phone with you or sitting in silence – could help.
I went to see my GP because I think I’m in the menopause, but she won’t give me HRT...
DR MITRA: I often hear of women thinking they have to put up with symptoms of the perimenopause. A lot of GPs are reluctant to prescribe HRT these days, and I think this is because of conflicting news stories about the drugs.
I’d say HRT is very safe and this is supported by decades of scientific evidence. If your GP isn’t up to speed on the different types of HRT, they can get advice from their local menopause team. And, if your GP isn’t prepared to prescribe HRT, you can ask to be referred to your local menopause clinic.
Should I invest in a fertility app?
DR CORDA: I’m a big fan of women developing more self awareness around their cycle and monitors, such as my Lotus, can help with that. There are apps available, too, such as Natural Cycles, but if you are trying to get pregnant, what I don’t advocate is becoming obsessed with the fertile window, as this can make sex become mechanical and regimented.
Instead, I advise sex three times a week or even more, with new studies suggesting that regular, even daily, sex from the start of your cycle can help improve sperm quality and regulate immunity, making conception more likely to happen.Sperm can survive for several days in the reproductive tract, so even if you have irregular ovulation, regular sex can ensure there is sperm around whenever it happens.
If, on the other hand, you’re using an app in place of contraception, you need to accept that there is a chance you might still get pregnant, as they are not as reliable as hormonal contraceptives. Check the statistics for your app. Also remember that these work best if you have a regular cycle, are very strict about monitoring yourself daily and use condoms or abstain on days you are fertile.
I don't understand why I get so hungry before my period
DR MITRA: Your hormones fluctuate all the time, sometimes on an hourly basis. As progesterone increases towards the end of your cycle, you may feel more hungry. Can you embrace this? If not, you’re criticising your body for doing what’s natural. Perhaps knowing this appetite increase is temporary might make it more tolerable?
I’ve been on the Pill for 20 years. I now want to get pregnant – will it stop me?
DR CORDA: If you’ve been taking the Pill purely as a means of contraception, studies have shown that though it may temporarily make you less fertile when you come off it, there is no long-term compromise to your fertility. Sometimes, however, it can take up to
a year for your periods to re-establish themselves fully.
Of course, you can start trying as soon as you stop taking the Pill. Make sure you’re eating well, though; we can see low levels of certain vitamins and minerals, such as iron and magnesium, in women who’ve been taking it.
You should consider a multivitamin supplement that includes folate as you’re trying to get pregnant. If you went on the Pill to treat polycystic ovary syndrome(PCOS), you may find your periods are irregular when you come off it, too, so it’s worth seeing a doctor sooner rather than later. The same would apply if you’ve been put on the Pill to control other conditions, such as endometriosis.
Why does my cycle mess with my sleep so much?
DR MITRA: Often, women will find their sleep is worse after ovulation and before their period, due to changes in core body temperature and progesterone levels. I recommend tracking your cycle to see how it affects your sleep.
You can use this information to change your lifestyle to promote sleep at key moments. One thing that can help is to keep your bedroom cool: around 18 degrees. It’s important to have a regular bedtime, too, rather than binge sleep at weekends.
It’s worth working on this, as lack of sleep is a stressor, raising cortisol levels, which in turn affects oestrogen and progesterone levels. There’s another hormone at play here, too: melatonin, the ‘sleep hormone’, which you produce in response to darkness. Being exposed to blue light from screens at night messes with melatonin, which in turn messes with your hormones. So keep off screens, ideally for at least 90 minutes before bed.
I’ve stopped taking the Pill and my discharge is sometimes really heavy – is this normal?
DR MITRA: So many women ask me this and, most of the time, I can say ‘yes’! Often, the question comes from women who’ve come off the Pill and aren’t used to ovulating. So when it happens, with its accompanying discharge – which is thin and stringy, like egg white – it takes them by surprise.
At other times of the month, your discharge will tend to be a bit dryer and yellower. But do see your GP if you are worried, or if there is discomfort, itching or an unusual smell. Don’t be tempted to use a vaginal wash, which can wash away healthy bacteria and can cause vaginal irritation.
My periods are really heavy, should I see my GP?
DR MITRA: I’d say a period is heavy when you can’t go to work or do things you enjoy, or if it interferes with your life. In that case, do see your doctor. There are various treatments available. Also see your GP if it’s become a lot heavier than normal – particularly around the perimenopause. It’s also worth seeing your GP if you have bleeding between periods, or after sex. It’s rarely a serious problem, but it’s important to get it checked out.
I'm trying to get pregnant, should I get my hormones checked?
DR CORDA: There are several hormones that influence your ability to get pregnant. The obvious ones are progesterone and oestrogen, made by the ovaries, but there are also follicle-stimulating hormone and luteinising hormone, made by the brain.
There are tests you can have, but it’s important to get them interpreted by a doctor, usually along with an ultrasound scan. Levels of thyroid hormones and vitamin D can impact fertility, too, as well as another hormone called prolactin.
If you are fit and healthy and under 35, you should try for a year before you see your GP. If you are over 35, then give it six months. But don’t wait for a year if you have a chronic health condition – for example, systemic lupus erythematosus(SLE) or diabetes – or if you have PCOS or endometriosis, a history of treatment for cervical cell changes, an STI diagnosis, if your mum or sister had a nearly menopause, or if you’ve had cancer.
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