A lump or pressure

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In order to allow a woman pass a baby through her pelvis, many of the pelvic contents are held up by ligaments, forming a type of hammock that stops the contents of your pelvis falling out. When a woman pushes her baby out through her pelvis, the ligaments are stretched and quite often damaged. Although they initially recover, the damage results in the pelvic contents prolapsing down, causing discomfort. The walls of the vagina can prolapse (near the bladder = cystocele, near the bowel = rectocele, high up at the top of the vagina = enterocele), and the uterus can prolapse down (uterovaginal prolapse).

Abnormal smear test

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Cells do not usually go from ‘Normal’ to ‘Cancer’; they go through pre-cancerous changes. We usually classify precancerous change as Mild, Moderate or Severe.

By examining the cells from your smear, we can spot precancerous cells, we can then treat them so you don’t develop cancer.

Diagram explaining the progression of precancerous cells to cancer

Precancerous cells in your cervix are caused by a virus, the human papilloma virus (HPV). There are over 100 variations of this virus but only about 10 are aggressive towards the cervix. We can now test to see if you have a high risk HPV. If you do not there are vaccines available which can prevent you from being affected by the most aggressive forms of the virus.

Frequent periods/bleeding

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Polymenorrhea (poly = many, menorrhea = bleeding) (Frequent Periods) or frequent irregular periods are typically due to problems with the way you produce hormones, or because there is a lump or bump in the pelvis (e.g. fibroids, polyps, ovarian cysts). If your periods or pain has changed it is important that you visit your doctor so that some simple tests can be carried out. These may include a high vaginal swab (to look for infection), a cervical smear test, an ultrasound scan.

You may need a hysteroscopy or laparoscopy to further investigate the possible causes of your problem.

Heavy periods

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Menorrhagia (meno = periods, agia ~ heavy) is the medical term used to describe heavy periods.Technically you have heavy periods if you bleed more than 80 mls each month. In reality if you notice that your periods become more heavy or painful, you will not be happy. If you become anaemic (low blood count) from heavy periods, you should seek medical attention, whatever the cause of your bleeding. Advancing age and having children are common causes of periods becoming heavier. There are also a number of pathological causes for menorrhagia, particularly when there is associated secondary dysmenorrhoea.

Infrequent periods/bleeding

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While many women are concerned regarding the heaviness, pain or closeness of one period to another, some women have infrequent or no periods. If you have reached the age of 16 and have never had a period (primary amenorrhea, a = without, menorhea = periods), you should discuss this with your doctor. While most women in this group will go on to have perfectly normal periods, it is wise to have someone check if there are any problems.

If you have periods which are infrequent (oligomenorrhea, oligo = few), or stop altogether (secondary amenorrhea), it is important to have some tests to see why this is so (of course the most common reason for not having a period is because you are pregnant). You normally have a period because you produce an egg, so logically the most common reason for not having regular periods is because you are not ovulating regularly. This can be caused or lead to problems with your weight, and can lead to excess hair and acne.

The majority of women who are not happy with the amount of hair on their face or body have no underlying problem. We all have hair on our body, some more than others. If you are a woman and you have male type hair growth (e.g. heavy hair growth under your chin) you may have an underlying problem (hirsutism). You should see your doctor for some tests. Acne is also a problem that is usually the effect of normal hormonal changes in your body. If your acne is affecting you, see your doctor who can help with various treatments. Sometimes further tests are required.

Where there is no underlying problem, the advice is to deal with the problem on a practical level e.g. electrolysis, acne creams, and personal hygiene. Some women suffer these problems when their ovaries do not function properly. They often have irregular periods, problems with weight gain in addition to problems with acne and unacceptable hair growth.

Menopausal

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You may be suffering from a number of symptoms associated with the menopause. Physically a woman may experience hot flushes, night sweats, loss of energy, and infrequent periods (sometimes the periods actually get heavier near the menopause). Other symptoms include insomnia, loss of concentration, decreased libido and vaginal dryness. Prolapse may become apparent around the time of the menopause as oestrogen levels drop. Each woman reacts to the menopause differently, from no symptoms at all to the unfortunate women who suffer virtually all the symptoms described above. This is why treatment must be tailored to the individual needs of the woman so as to ensure she has the optimum quality of life, rather than being drawn into polarised camps for and against the use of Hormone Replacement Therapy

My fertility

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For most people making a baby is easier than falling off a log. Most women get pregnant without even trying to do so. Nature makes sex pleasurable, particularly around the time a woman produces an egg, so as to encourage us to procreate and have babies. The vital ingredients for making a baby are the sperm from the man, the egg from the woman and sexual intercourse around the time the egg is produced, so the sperm and egg can meet.

Diagram of the female reproductive organs

The ovary and the egg

When a girl is born, her ovaries contain many thousands of eggs, which are not mature. When you are only a 30-week-old foetus, your eggs stop developing and start to die. By the time you are born you only have one million left, and by the time you reach puberty this number has fallen to approximately 400,000. At puberty, the ovaries are activated and hormones are produced. Each month, a number of eggs are stimulated and one is chosen to mature. Ovulation is when this egg is released from the ovary.

This is usually around 14 days after the start of the last period, but can vary depending on the length of the menstrual cycle.

The sperm and the testes

When a boy is born, his testicles have the ability to produce many billions of sperm. At puberty this process is activated and the testicles act as sperm factories. Sperm is stored in the epididymis. Sperm takes about three months to be created from start to finish. When the male is aroused, the man’s prostate gland blocks the exit of urine and allows sperm and all the secretions produced by the glands to be ejaculated from the penis at the time of orgasm.

When egg meets sperm

Sexual intercourse is the natural process that allows the egg and the sperm to get together. When the man ejaculates between 200 and 300 million sperm are left in the vagina. Some fall out, some are destroyed in the vagina, some act as minders for the sperm that pass into the womb and on to the fallopian tube. Here the sperm look out for a newly produced egg. Once one sperm makes it into the egg, it blocks out any other sperm entering. Conception has occurred. The embryo makes its way back up the tube and into the womb, where it implants and begins developing.

The uterus (womb)

The uterus is where a woman carries her pregnancy. The neck of the womb (the cervix) sits in the vagina, allowing the sperm access to the egg. It also dilates in labour to allow the baby out of the womb. The womb is made of fibre and muscle (the myometrium), with a lining (the endometrium) that can allow a pregnancy to develop. If a ripe lining (endometrium) does not receive a pregnancy, it must be shed (menstruation, period) so a new lining can be made for another try at getting pregnant. At the top of the uterus there are fallopian tubes, which allow the egg from the ovary to get to the sperm. See Your Body »

Cervix

Also known as the ‘neck of the womb’, your cervix is 3 to 4cm long. At one end it opens into the body of the womb (the uterus) and at the other end if opens into the vagina. The top half is muscular and stretchy, while the lower half contains a strong, tight band of fibrous tissue. The cervix produces secretions which vary according to the hormones produced in the menstraul cycle. See Your Body »

Fallopian tubes

The womb has two fallopian tubes that allow eggs to pass from the ovary up to the womb, and that allow sperm coming from the vagina to meet the egg. See Your Body »

Not wanting to get pregnant

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Sex is made pleasurable with the intention of encouraging pregnancy. Many people will have the desire to have sex at a time when they do not wish to conceive. They wish to control conception (contraception) to try and avoid pregnancy. For many the alternative (unwanted pregnancy, termination of pregnancy) is unacceptable. If you wish to use contraception you should seek the advice of your GP or a Family Planning Clinic. They will help you choose the one that is best for you and your partner.

Learn more about contraception on our Pregnancy Care site »

Painful periods

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Dysmenorrhoea (dys = pain, menorrhea = bleeding) is the medical term for painful periods.

Many women experience period pains or cramps on the first couple of days into the period. This is often called primary or spasmodic dysmenorrhoea, and is not usually linked to any problem with the womb (uterus). There may also be general discomfort associated with other premenstrual symptoms e.g. swollen breasts, abdomen, genitals, wrists and ankles. If the pain is worst before or after the heaviest days of the period, we often describe this as secondary dysmenorrhoea.

Pelvic pain

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There are lots of organs lying in the pelvis, which can cause you pain. The bowel is a muscular tube which has a continuous wave of contractions from top to bottom (peristalsis). The most common cause of pain is when the muscle in the bowel goes into spasm; while not serious the spasm can be severe and disabling, leading to concern. The bladder can also cause pain but there are usually other symptoms such as going to the toilet frequently or it is painful when passing urine. The ovaries can develop cysts which can cause pain and the uterus can not only lead to painful periods but can also cause pain secondary to problems such as fibroids or pelvic infection. Cancer in this area does not typically start with pain so this is an unlikely cause of pelvic pain.