To help you be informed and empowered, here are five things your gynaecologist wants you to know. I hope this helps you feel confident to take charge of your reproductive and sexual health – with a trusted gynaecologist by your side!
As a Brisbane gynaecologist and obstetrician, I am passionate about providing comprehensive care to all women, from the age of adolescence through to motherhood, menopause and beyond. Like many gynaecologists, however, I am often frustrated by the lack of information in the public sphere around menstruation, fertility and sexual health.
The taboos that still exist around these women’s health topics prevents women from seeking early intervention, and therefore effectively managing or resolving their symptoms. To remove shame or embarrassment around these perfectly natural processes, education is vital. Here are a few things every woman needs to know.
1. When it comes to periods, a ‘normal’ cycle varies considerably
There is no such thing as a standard period. Period. Due to a number of factors (genes, age, lifestyle, health), women’s menstrual cycles are very variable. Generally speaking, however, a ‘normal’ cycle is considered to be 21 to 35 days, with 28 days being the average. (To get this number, count from the first day of one period to the day before your next period.) The duration of a menstrual bleed also varies between women, from a few days to a week.
While some women could virtually set a clock by these numbers, for others it’s more of a guessing game. Unpredictable cycles are sometimes idiopathic, meaning there is no real cause; however, other causes include Polycystic Ovary Syndrome (PCOS), stress, weight, over-exercising and thyroid and pituitary dysfunction. Age is a factor, with irregular periods being common during adolescence and again during perimenopause. It can also take a few months after coming off hormonal birth control for your regular cycle to return.
While an irregular cycle isn’t necessarily a cause for concern, it’s important to be in tune with your body. Learning what’s ‘normal’ for you is the key to noticing any changes that might need investigating and seeking the guidance of your gynaecologist or GP.
2. Periods can be uncomfortable, but they shouldn’t be debilitating
Many women will experience a degree of discomfort or pain during their period. Period pain, or dysmenorrhoea, is caused by the natural process of shedding the lining of your uterus. The amount of discomfort this causes will differ between women. While period pain is common among girls starting to menstruate and tends to improve with age, it can persist until menopause in some women. In some cases, birth control may be prescribed to manage particularly painful and heavy periods.
It’s important to understand that, while period pain is normal, it should never be debilitating. If pain relief such as anti-inflammatories or other simple pain relief does little to help and you find yourself out of action for a few days each month, it’s time to see your gynaecologist. There may be an underlying cause for your pain, such as endometriosis.
Endometriosis occurs when the normal lining of the uterus (that we shed with a period) is present outside of the uterus within the pelvis. It is an unusual and not-uncommon disease with around 10% of women affected. It is unusual in that some women can have severe endometriosis and not know they have it, whilst some can have a little endo and be debilitated by it.
If left unchecked, endometriosis can affect your ability to function due to worsening pain, and your future fertility. So it’s important to seek timely medical advice if you’re experience heavy, painful periods.
3. The bleed you get on the pill is NOT your period
In a natural menstrual cycle, the follicles (or sacs) which contain the eggs/oocytes release oestrogen to prepare the lining of the uterus. With ovulation, when the egg is released from the ovary, the sac that releases the egg undergoes a process called luteinisation and produces progesterone. This helps to stabilise the lining of the uterus and support a pregnancy until the placenta takes over towards the end of the first trimester. If there is no pregnancy, the corpus luteum stops producing progesterone, and it is this drop in progesterone that causes a period.
However, we can also induce a withdrawal bleed by giving synthetic progesterone for some time and then withdrawing it. This is the case with the contraceptive pill. The pill contains progesterone (plus or minus oestrogen). Once again, it is the absence of progesterone in the non-active sugar pills that causes a ‘period’. As there is no ovulation on the pill, this is not a true period but rather a progesterone withdrawal bleed.
It’s important to realise this and know that what you experience on hormonal birth control is not the same as your natural cycle.
4. We want you to be honest about sex
Gynaecologists are not easily embarrassed. We’ve heard and seen it all, so please be upfront. We can ascertain a lot during a physical examination, but if you’re not honest with us about your sexual history and symptoms, making the correct diagnosis and treatment plan is more difficult.
For instance, if you are experiencing pain during intercourse (dyspareunia), that’s something you should share. There are a variety of factors that painful sex can result from, including ovarian cysts, endometriosis, vaginal infections such as thrush, sexually transmitted infections (STIs), vaginismus (involuntary contraction of vaginal muscles), psychological factors, menopause and pelvic inflammatory disease (PID).
Similarly, please tell your gynaecologist if you experience bleeding during or after intercourse. This could be caused by PID or an STI. It could point to something as simple (and easily addressed) as insufficient lubrication, or something more serious such as cervical pathology. It is therefore important you talk to your doctor to rule out any sinister causes.
5. It’s never too early to start thinking about your fertility
Did you know that, as women, we are born with all the eggs we will ever have? In other words, the maximum number of oocytes we have occurs when we are within our mother’s womb. This number diminishes over our lifetime, with a marked drop after the age of 35 and steep decline post-40.
As well as assessing your sexual health, your gynaecologist can test your ovarian reserve. This refers to the number and quality of eggs you have remaining. Even at a young age, everyone’s fertility differs. It’s always better to be informed and make decisions early if you think you might one day want to start a family.
To speak to a trusted and experienced Brisbane gynaecologist, please call us on 1300 833 560.