Why you need a good gynaecology guide
It is a fact that when it comes to talking about issues with our more intimate areas, some of us would rather pretend there was no problem at all. Our bodies change as we age and inevitably so do our bits. Get over it!
We asked a panel of experts to talk plainly about sex, about periods, the onset of menopause and what that means for you. Read our gynaecology guide to find answers to some of the most common gynaecological issues facing older women.
When sex is a pain
Sex should be a pleasure so obviously when it causes physical pain something is amiss. This is often caused by vaginal dryness which can affect women of all ages at some stage in their lives but is commonly a side effect of the menopause (although it can be a symptom of diabetes, certain medications, breast feeding, cancer treatments or even stress). Declining or fluctuating levels of the hormone oestrogen are often the problem and this typically affects vaginal lubrication making sex uncomfortable.
What can help: A survey by skincare brand nurture replenish found women who had experienced symptoms of the menopause noted significant changes to their skin, including increased intimate dryness (40%). Finding ways to hydrate from the inside as well as the outside will help. Rehydrating from the inside out is one way to do this. Taking a supplement like Healthspan Omega 7 Sea Buckthorn Oil, £16.95 could help – studies suggest this oil helps support the health of mucous membranes and increases vaginal lubrication.
But satisfying sex is also generally about emotional intimacy and comunication and if you are not getting what you want from your partner (in or out of bed) you are less likely to become aroused. But as sex expert Tracey Cox says, ‘Your partner isn’t a mind reader: be honest about what works for you and what doesn’t.’
Irritated vulvas
Who knew vulval disorders are some of the most common problems seen by gynaecologists? Common causes include infections like thrush and generally harmless skin conditions like lichen sclerosus (which typically causes itchy white patches around the vulva – or opening of the vagina).
These conditions are often triggered by irritants like soaps, perfumed products, spermicide or panty liners/sanitary towels and/or can be exacerbated by wearing tight restrictive clothing. Ulcers are also a fairly common vulval condition but can potentially be indicative of something more serious like Crohn’s disease or chancroid (a sexually transmitted disease).
What can help: Vulval disease that is dermatologically related can be treated with ‘emollient soap substitutes, using a barrier cream on the affected area like petroleum jelly and possibly a prescription steroid cream’, says Consultant Gynaecologist from The Medical Chambers Kensington and Luminosa London Tania Adib.
Try to avoid anything likely to inflame the condition – including perfumed bath and body products, perfumed toilet paper, restrictive or tight clothing or wearing your wet swimming costume for any length of time. Wear loose clothing and/or natural breathable fabrics (including your underwear) instead of manmade fibres to improve the condition and if vulval irritation is making sex uncomfortable use a vaginal lubricant/moisturiser daily to help.
Always schedule in a gynae examination at the earliest opportunity to catch any problem quickly and to rule out anything potentially serious like a pre-cancerous condition (the risk is very low but having lichen sclerosus does increase your risk of cancer of the vulva).
Bleeding problems
Heavy bleeding can, quite literally, be a pain. Your period is classified as ‘heavy’ if it lasts more than seven days or the bleeding is extensive (say, you are soaking a tampon or sanitary towel every hour or so) and gets in the way of your daily life. It can also potentially lead to anaemia leaving you feeling tired and washed out.
Irregular bleeding or bleeding between periods is pretty common in the first few months of starting hormonal contraception or at the start of the menopause. It can also happen after a period of excessive stress; sudden weight loss or can be a symptom of a medical condition like polycystic ovary syndrome (PCOS). Bleeding after sex and/or the menopause should always be checked out by a medical professional.
What can help: Tania says there are a number of ways of managing heavy bleeding by making lifestyle changes including getting enough sleep, taking regular exercise (yoga can be particularly helpful for also dealing with the stress associated with heavy periods) and eating iron-rich foods like red meat and taking an iron supplement to replace the iron you lose through blood loss (take these with orange juice as the vitamin C will help you absorb the iron better). She adds that there are a number of prescription only medications that can help like the hormonal contraceptive pill, an IUD or a Desmopressin nasal spray which releases a protein to help blood clots from breaking down to reduce the bleeding.
If your periods have always been irregular you don’t need to see a doctor but you should if this suddenly happens (especially if you’re under 45 and unlikely to be peri-menopausal) and/or you are trying to get pregnant. Treatments will depend on what is causing it but things that have been shown to help regulate your cycle include regular exercise – particularly yoga, maintaining a healthy weight and there is evidence that taking vitamin D supplements could help.
Pelvic pain
‘Pelvic pain is felt in the lower abdomen or pelvis,’ says Tania. ‘It can come on suddenly or gradually. If it persists for longer than six months it is classified as chronic pelvic pain.’ It can be caused by period pain, ovarian cysts, ovulation, endometriosis (a condition where small pieces of womb lining are found outside of the womb, causing pain) or pelvic inflammatory disease (a bacterial infection).
What can help: Tania Adib says talking over the problem coupled with a thorough examination should uncover the cause of your pelvic pain. ‘In addition blood tests, swabs and an ultrasound may be necessary. Treatment will vary widely depending on the cause.’
Things that you can do at home include the lifestyle changes recommended for PMS (above). Massaging essential oils like lavender onto the abdomen has been found to reduce painful menstrual cramps and period pain.
If you have endometriosis one of the things that has been shown to help relieve symptoms in one clinical trial is the spice turmeric, or specifically its active ingredient curcumin – which is thought to help suppress tissue migration of the uterus lining. A change in diet is also often suggested for endometriosis sufferers including an anti-inflammatory one.
A study has also found that women with endometriosis had significantly higher levels of the stress hormone cortisol – so anything that can help manage stress (think exercise, yoga, relaxation apps) should help. Medical nutritionist and author of CBD The Essential Guide to Health and Wellness (Simon &Schuster) Dr Sarah Brewer says research has shown women with endometriosis using CBD oil reported being able to reduce their endometriosis medication.
Pelvic inflammatory disease, if diagnosed at an early stage, is usually treated with a two week course of antibiotics. Try Healthspan CBD range, oils, capsules in different strengths available.
Discharge – what’s normal, what’s not?
It might not be the stuff of dinner party conversations but vaginal discharge is generally a healthy and entirely normal bodily fluid.
What exactly is it? Fluid made by glands in the cervix, vaginal opening and vaginal walls that carries away dead cells and bacteria to keep the vagina clean and healthy.
This discharge can be affected by stress, taking the contraceptive pill, your menstrual cycle and can change in colour or smell. A white discharge is usually normal unless it is thick and cottage-cheese like and you are also experiencing itching. This is usually sign of a yeast infection. A clear and watery discharge is unlikely to be cause for concern and if it is clear and stretchy this is normally a sign you are ovulating.
Brown or bloody discharge can occur at the end of your period but in rare cases it can be a sign of endometrial or cervical cancer. A yellowy or green discharge that also smells unpleasant is not normal and could be a sign of trichomoniasis (generally sexually transmitted).
What can help: You can’t prevent discharge but you can be aware of what is normal or not for you. Using panty liners might help if it is particularly heavy or excessive but avoid using them too often as they can cause more irritation (see Irritated Vulvas above). If you are concerned about your discharge do see your GP who will ask about your menstrual cycle, sexual activity and then might do a pelvic examination.
At home, avoid so-called ‘feminine hygiene’ wipes and similar products as they can exacerbate discharge by removing helpful bacteria. Wear breathable natural fibre underwear and practice safe sex.
A no sweat menopause
Menopause is the time when women stop having periods (normally this happens aged 45-55) and which typically causes symptoms like hot flushes, night sweats, brain fog, weight gain, tiredness, mood swings and irritability. Some women breeze through it with barely a symptom, for others it can be debilitating but for most of us it is somewhere in between and moderate symptoms can generally be managed with lifestyle changes and over the counter products.
What can help: Consultant gynaecologist Dr Anne Henderson who has spent nearly 35 years researching and helping women through menopause takes a holistic approach. She explains HRT can be ‘one arm’ of that holistic approach and is a fan of the newer body-identical hormones (a fully regulated form of HRT in which hormones are indistinguishable from those produced naturally in the body).
Not everyone needs or wants to take HRT and in her new book Natural Menopause (DK, £14.99) she is keen to point out good nutrition, exercise, herbal remedies and mental wellness practices can all improve menopausal symptoms – used on their own or in conjunction with HRT.
Alison Cullen, Nutritional Therapist for A.Vogel takes a similarly holistic approach and recommends laying off the stimulants like caffeine, alcohol and refined sugars and eating regularly ‘to avoid blood sugar dips and also to help maintain a healthy weight. A sage supplement – like A.Vogel’s Menoforce Sage Tablets, £14.25 – can help reduce flushes and sweats and magnesium can help with mood swings and tiredness.’
Tania Adib recommends Healthspan MenoSerene, £17.95 containing plant oestrogens and suggests you keep Physicool Rapid Cooling Mist, £12.99 to hand as ‘this really takes the sting out of a hot flush. At the first signs, spray it lightly over your chest and neck for an instantly cooling and calming effect.’
If you found The good gynaecology guide – expert women’s health tips helpful, you’ll find more women’s health tips and advice on our Health channel.
About the Author / Jane Collins
Jane Collins is a health and wellbeing journalist, author and editor with more than 25 years experience and a lifelong love of words.
