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Vaginal dryness is very common. Around 17% of women aged 18-50 and [more than half of post-menopausal women](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459457/) over the age of 51 experience vaginal dryness.

Lower oestrogen is a common trigger of vaginal dryness, and menopause, pregnancy, birth and breastfeeding can all impact oestrogen levels. But there are other causes too, including autoimmune diseases, certain lifestyle choices and medical or surgical treatments.

## What’s vaginal lubrication and why do we need it?

‘Vaginal secretion is created by glands in the cervix to maintain a moist, slightly acidic environment in the vagina,’ says Dr Elisabeth Rosen, a Livi doctor who specialises in gynaecology and obstetrics. 

This secretion helps maintain the right balance of bacteria and prevents infection by flushing out dead cells and unwanted bacteria to clean the vagina. 

‘The secretion changes throughout the menstrual cycle to help or prevent the movement of sperm and to protect the body and a potential pregnancy from infections,’ Dr Rosen says.

‘The lubrication you experience when you’re sexually aroused is different. It’s activated in the Bartholin’s glands right by the vaginal opening. This gland produces secretions all the time, but it’s also activated when you’re sexually aroused to protect the sensitive membrane in the vagina during penetration.’

## What are the symptoms of vaginal dryness?

The most common vaginal dryness symptoms include:

- Vaginal discomfort, tenderness and pain
- Pain during penetration
- Itching in and around the vagina

‘Reduced moisture in the vagina can also upset the balance of vaginal flora – the bacteria living inside the vagina – which can increase the risk of issues like [urinary tract infections](https://www.livi.co.uk/your-health/utis-your-questions-answered/), vaginitis and [bacterial vaginosis](https://www.livi.co.uk/medical-advice/womens-health/bacterial-vaginosis/),’ says Dr Rosen. 

## What causes vaginal dryness?

Vaginal dryness has a range of causes, but it’s often linked to the production of hormones like oestrogen and progesterone. The best treatment for dryness depends on what’s causing it, with several different causes:

### 1. Perimenopause and menopause

During [perimenopause](https://www.livi.co.uk/your-health/7-signs-of-perimenopause-a-doctors-guide/) and menopause, the body produces less oestrogen. This can cause the mucous membranes in the vagina – which are usually moist, elastic and pink – to become increasingly dry and pale. ‘Vaginal dryness during menopause is also called vaginal atrophy,’ explains Dr Rosen. ‘It affects more than 50% of all post-menopausal women.

‘This can cause stinging and itchiness, as well as pain during sex. It can also affect the urinary tract, making you pee more often or leading to recurrent UTIs.’

You might notice vaginal dryness alongside symptoms like irregular bleeding, hot flashes or a change in libido.

Many menopausal women benefit from [hormonal treatment](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)66519-1/fulltext).‘It’s very effective and safe for everyone, unless you’re undergoing treatment for breast cancer,’ says Dr Rosen.

### 2. Childbirth, breastfeeding and the early post-partum stage

‘This isn’t a cause for concern,’ explains Dr Rosen. ‘It’s perfectly natural and will pass. You might also experience missed periods or periods that haven’t returned as  a result of hormones preventing ovulation.

‘Using a water-based lubricant can be a good idea, and if that’s not enough, a doctor may prescribe local oestrogen to use temporarily.’

### 3. Hormonal contraception

‘Vaginal dryness is a common side effect of hormonal contraceptives,’ says Dr Rosen. ‘This is because the body’s production of oestrogen and progesterone, which control the production of vaginal secretion, is replaced by the synthetic hormones in hormonal contraception. 

‘As the synthetic hormones are not the same as the body’s natural hormones, they can’t fully recreate their functions. Most hormonal contraceptives contain quite a high concentration of hormones. 

‘They’re also constant over time, unlike the menstrual cycle’s natural fluctuation. For some people, that’s not a problem at all, but for others it can cause problems like vaginal dryness. Trying a different type of hormonal contraception can help.’

### 4. Antidepressants

The primary role of SSRIs (selective serotonin reuptake inhibitors), a widely used type of antidepressant, is to increase our levels of serotonin – a key hormone that stabilises our mood. 

‘But antidepressants also impact receptors for a neurotransmitter called acetylcholine,’ explains Dr Rosen. ‘This blocks certain involuntary muscle movements and bodily functions, which can lead to vaginal dryness.’ 

If you’re experiencing vaginal dryness, you can speak to a doctor about trying a different type of medication.

### 5. Hysterectomy

Both the cervix and the cells that produce vaginal secretions are often removed during a hysterectomy, and this can cause vaginal dryness.

‘If you’re experiencing these symptoms after having a hysterectomy, talk to a doctor,’ says Dr Rosen. ‘Local oestrogen can help tremendously.’

### 6. Chemotherapy

Additional symptoms: 
Menopause triggered by medicine, also known as iatrogenic menopause or medical menopause

‘Chemotherapy often affects the hormone production of the ovaries,’ says Dr Rosen. ‘This puts the body in a state of chemical menopause.’ 

Speak to a doctor about vaginal dryness symptoms. They may be able to offer solutions during your treatment.

### 7. Over-washing

‘Some people think that it’s necessary to flush out the vagina with water,’ says Dr Rosen. ‘But water has a dehydrating effect. The vagina is very clever and cleans itself – that’s exactly the purpose of the secretions and discharge. It’s completely normal as long as it’s not accompanied by pain, discomfort or a foul smell.

‘Simply wash the vulva gently with water – don’t use soap or other hygiene products.’ 

### 8. Sjögren’s syndrome

‘Sjögren’s syndrome is an autoimmune disease that causes chronic inflammation of the body’s secretion-producing glands, which leads to less secretion production. It can cause a dry mouth, eyes, skin and a dry cough. As a result it can also cause you to have a dry, itchy vagina,’ Dr Rosen explains.

Sjögren’s syndrome is relatively uncommon, affecting far more women than men, especially [from midlife.](https://www.uptodate.com/contents/diagnosis-and-classification-of-sjogrens-syndrome) 

### 9. Diabetes

‘High blood sugar levels can cause damage to the body’s small nerves and blood vessels,’ says Dr Rosen. ‘This can affect the glands in the cervix, resulting in dry mucous membranes.’ Other symptoms of diabetes include increased thirst, needing to pee more often, lack of energy and blurred vision. 

### 10. Not feeling aroused during sex

Sometimes, people experience dryness when they’re simply not aroused.

‘Use a water-based lubricant, or try more foreplay or other alternatives to penetration. I’d advise avoiding latex condoms as well,’ says Dr Rosen. ‘It’s also important to try to explore why you may not be feeling aroused, to avoid developing chronic vaginal pain.’

Read more on what might be the cause of a [low libido](https://www.livi.co.uk/your-health/8-causes-of-low-libido-a-doctors-guide/). 

### 11. Antihistamines

Antihistamines block your body’s histamine secretion to help relieve a runny nose or watery, itchy eyes. 

‘They can also affect the mucous membrane of the vagina, making it drier than normal,’ Dr Rosen explains.

## When should I speak to a doctor about vaginal dryness?

‘If you’re struggling with any of these symptoms and there isn’t an obvious, temporary cause, like breastfeeding, speak to a doctor,’ advises Dr Rosen.

Never ignore these symptoms:

- Pain during sex that doesn’t go away with increased arousal
- Recurring UTIs
- Recurring thrush or bacterial vaginosis
- Vaginal bleeding that’s unusual and abnormal for you

__This article has been medically approved by Dr Elisabeth Rosen.__


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‘Menopause has always been a disruptive time for women, but as is the case with so many other women’s health issues, it’s been disregarded and under-researched. Now it’s a recognised phenomenon,’ says Dr Elisabeth Rosén, a Livi doctor and gynaecology specialist.

Mental health difficulties during perimenopause and menopause are so widespread that some researchers have proposed a new term to describe them: ‘menopause distress’. The symptoms are described as significant and persistent, yet different enough to other depressive diagnoses to warrant their own label.

‘Around 70% of women experience some sort of mental health impact during menopause,’ says Dr Rosén. ‘But the good news is that these symptoms tend to go away when the body gets used to the new hormone levels.’ There’s also plenty you can do to look after yourself and get professional help.

## What are perimenopause and menopause, and how do I know they’re happening?

Entering menopause happens once you haven’t had a menstrual bleed in 12 months. The average age of menopause is 51. ‘Perimenopause is the time before and around menopause. It starts on average 4 years before menopause, but it can last longer than that,’ Dr Rosén explains.

Menopause happens as a result of a decline in ovarian function, which leads to a change in the production of the female sex hormones oestrogen and progesterone. 

‘The most obvious sign of perimenopause is changing periods – initially shorter and shorter cycles, followed by irregular and heavy bleeds,’ says Dr Rosén. Look out for these symptoms, which are often linked to reduced oestrogen levels:

- Sweating and hot flushes
- Tiredness and insomnia
- Vaginal dryness
- A [decreased libido](https://www.livi.co.uk/your-health/8-causes-of-low-libido-a-doctors-guide/)
- Psychological symptoms like irritability, low moods, a lack of motivation, aggression, difficulty concentrating and stress
- A relapse of previous psychological illness

## How do perimenopause and menopause impact our mental health?

The exact link between perimenopause and mental stress is yet to be established. ‘We do know that hormonal fluctuations and changing oestrogen levels can affect and interact with the neurotransmitters of the brain, which in turn impacts our mood,’ says Dr Rosén. 

There are two main ways that hormonal changes are thought to have a psychological effect:

### Reduced oestrogen 

Oestrogen affects your mood because of its impact on the levels of serotonin in your brain. ‘Serotonin is a hormone that stabilises your mood and promotes happiness and wellbeing,’ Dr Rosén explains. ‘When the levels of oestrogen go down, so do the levels of serotonin, which explains why you might feel closer to tears, a bit low or even depressed.

‘The oestrogen drop comes in phases, which can make the psychological problems more pronounced. When the body has acclimated to the new hormone levels, your mood tends to stabilise, only to suddenly worsen again the next time the oestrogen drops.’

### Reduced progesterone

The other female sex hormone, progesterone, has a calming effect. ‘Decreasing progesterone levels can lead to sleep issues, low moods, irritability and anxiety,’ says Dr Rosén.

On top of the impact of hormonal changes, many women find that the physical symptoms of menopause have a negative impact on their mood, too. ‘It’s tough to walk around worrying about sudden hot flushes, to not get the sleep you need, to be unable to enjoy sex to the same extent and to get used to a new weight, for instance,’ acknowledges Dr Rosén.

A growing body of research is now pointing to a potential link between vasomotor symptoms in particular – that’s night sweats and hot flushes – and changes in cognition and brain function in menopause. It’s possible that treatment of these physical symptoms could also relieve some of the cognitive difficulties.

## What mental health problems are most common in perimenopause and menopause?

Anxiety, mood swings and depressive symptoms are common problems during this time. ‘The difficulties can be quite pronounced and often seem to appear out of the blue, which can make them more difficult to deal with,’ says Dr Rosén.

Oestrogen doesn’t only impact serotonin levels, it can also affect our cognition. As a result, during perimenopause, it’s common for people to experience:

- Forgetfulness 
- Brain fog
- Brain fatigue
- Difficulty concentrating
- Frustration as a result of the above, which can then negatively impact our mood

You are 2-5 times more likely to experience depressive disorders during perimenopause than during the late premenopausal years. For some, emotional exhaustion can make everyday tasks difficult. 

‘Around 25% of people experience psychological problems they need professional help with, and many find the psychological changes during perimenopause more difficult to manage than the physical symptoms.’

## How might perimenopause and menopause impact our sleep?

‘Many perimenopausal women experience sleep problems, including those who have never had issues with sleep before,’ says Dr Rosén. ‘Changes to oestrogen and progesterone levels impact other hormones that are responsible for regulating your body temperature, which can cause intense night sweats. The hormone changes themselves, as well as anxiety, can also make it difficult to sleep, and it’s not unusual to wake up suddenly in a panic.’

However, these symptoms can often be treated and alleviated, which can not only improve sleep but also prevent mental illnesses that long-term insomnia can contribute to. 

## Are there any other risk factors for mental health issues during menopause?

Midlife is a time when many of us go through life-changing experiences and events. Life stressors and adversity can contribute to mental health difficulties, which is why psychotherapy or cognitive behavioural therapy (CBT) can help. In addition, people who have experienced depression previously are at higher risk during perimenopause.

## What should you do if you’re struggling with your mental health during menopause?

There are many things you can do to improve your chances of a positive menopause transition. Dr Rosén advises the following:

1. [Read up about perimenopause](https://www.livi.co.uk/your-health/7-signs-of-perimenopause-a-doctors-guide/) so that you’re able to identify symptoms and know what to expect.
2. Try to accept and manage the psychological difficulties – let yourself feel your emotions while also trying to find peace.
3. Identify situations that trigger negative emotions and try to avoid them.
4. Allow yourself to take things more slowly throughout this period of your life, as perimenopausal problems tend to be more difficult to manage if you’re stressed.
5. Exercise regularly. Research shows that physical activity has a positive effect on both physical and mental health during perimenopause. It also releases endorphins and other feel-good hormones.
6. Eat a well-balanced diet. 
7. Use techniques like meditation or yoga to help lower stress levels. 
8. Maintain a good sleep routine, keep the bedroom cool and keep extra bed sheets close by to improve your chances of a good night’s sleep.
9. Tell family and friends how you’re feeling – they can be a huge support during tough times.

## What if I feel like I need professional help?

If these habits don’t relieve your symptoms, reach out for professional help. Depressive symptoms are very common during perimenopause, and a doctor will be able to guide you through your options, including talk therapy, antidepressants, HRT or a combination. 

For many people, a mixed approach is best. While in many countries, HRT is currently only prescribed for night sweats and hot flushes, some recent studies suggest it might also help prevent depression in perimenopause. Options like family therapy can also be helpful. 

‘The physical consequences of reduced hormone levels can’t be reversed, even if HRT may postpone the reduction by a few years, while local oestrogen tends to help with vaginal dryness,’ says Dr Rosén. 

‘But psychological problems tend to ease off and eventually go away when the body has adapted to the new levels of oestrogen.’ 

__This article has been medically reviewed by Dr Elisabeth Rosén, a Livi doctor who specialises in gynaecology and obstetrics.__

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### Quick facts

- Vaginal discharge often varies at different times in your menstrual cycle
- If you see pink or brown thick discharge, not associated with a period of post-childbirth, then it’s best to speak to a doctor
- Using perfumed soap can disrupt the balance of beneficial bacteria which naturally cleanse the vaginal and keep it healthy

## What is vaginal discharge?

It’s normal to want to understand your body better - and ask why have I got vaginal discharge? Let’s start with what it’s there for. Vaginal discharge is a healthy fluid or mucus that keeps the vagina clean and moist, and provides a barrier to infection. 

Regular vaginals secretions are usually nothing to worry about and shouldn’t have a particularly strong or unpleasant odour.

## Is vaginal discharge healthy?

Having some vaginal discharge is normal, and healthy. This mucus is secreted to keep your vagina clean and moist, and it supports an eco-system of healthy bacteria which protect against infections, infertility and premature delivery in pregnancy.

The amount and texture of your vaginal discharge can vary depending on your age, whether or not you are sexually active or pregnant, and what birth control you use.

‘It’s also entirely normal for a woman’s discharge to change throughout the menstrual cycle,’ says Livi Lead GP Dr Rhianna McClymont. ‘It can go from being thick and sticky just after your period, to slippery, wet and clear, and then to creamy in colour towards the end of the cycle.

‘Along with this, a woman will have a natural odour from her vagina,’ she adds. ‘But if this vaginal discharge changes from your “normal”, or develops a new unpleasant smell, it could be a sign of an underlying problem.’

If you’re worried about thick discharge, any change in appearance, or you’re getting more discharge than usual, it’s important to talk to a GP. You can also visit a sexual health clinic to rule out any infection. 

Dr McClymont explains some of the most common changes, and what might be the cause.

## A white, thick discharge

This type of thick discharge is a classic sign of vaginal thrush, especially if it looks like cottage cheese. ‘Thrush is usually very itchy, but generally the discharge from it does not smell,’ says Dr McClymont.

Thrush is caused by a fungus called candida that many women carry without experiencing any problems. But if something disrupts the natural balance of bacteria in your vagina, it can cause an overgrowth of candida, and this can lead to the symptoms of thrush. Common triggers may include:

- Having sex
- Skin damage or irritation
- Hormone replacement therapy (HRT)
- Pregnancy
- Poorly controlled diabetes
- A weakened immune system

If you’ve had thrush before, and know the symptoms, it’s straightforward to treat with anti-fungal cream or pessaries, which are available from a pharmacy. But it’s important to see a doctor if:

- It’s the first time you have had symptoms
- Symptoms do not clear completely with treatment
- You are under 16 or over 60
- You are pregnant or breastfeeding
- You have weakened immunity due to something else, like diabetes, HIV or chemotherapy
- You experience symptoms more than twice in 6 months

## Green or yellow discharge with a fishy smell

An infection called trichomonas, or trichomoniasis as it is also known, may be the cause. ‘This yellow discharge may also be frothy in appearance and have an unpleasant, sometimes fishy, smell,’ Dr McClymont points out.

Other symptoms include pain when urinating or having sex; and soreness, itching or swelling around the vagina, which sometimes extends to itchiness on the inner thighs.

Trichomonas is caused by a minute parasite called trichomonas vaginalis, which can be spread by having sex without a condom and sharing sex toys that have not been washed or covered with a new condom before each use.

Symptoms develop within a month, but up to half of the people carrying the microscopic parasite have no signs of infection, so they do not realise they are spreading it.

Trichomonas is relatively rare — in the UK, for example, it affects 6,000 people a year compared to chlamydia, which affects 200,000. But it does require treatment with antibiotics, so it’s important to talk to a doctor or a sexual health clinic. Your current and recent sexual partners should also be told.

Trichomonas during pregnancy increases the risk of having a low birth-weight or premature baby, another reason to see a doctor if you have symptoms.

## Thick greeny-yellow discharge

Green-yellow discharge could be a symptom of gonorrhoea — the second most common STI in the UK after chlamydia. Other symptoms include pain when urinating and bleeding between periods, although half of women and 1 in 10 men with gonorrhoea have no symptoms.

A single antibiotic injection and single antibiotic tablet usually resolves symptoms within a few days. But most doctors and sexual health clinics recommend a follow-up test a week or two later to make sure the infection has cleared.

Treatment, and contacting recent sexual partners, is essential as untreated gonorrhoea can cause permanent blindness in newborn babies.

## A very smelly discharge

A particularly smelly discharge is often a sign of bacterial vaginosis (BV), particularly if it’s ‘fishy’ and more prominent after sex. ‘The vaginal discharge can be thin and watery, or have a greyish-white tinge,’ Dr McClymont says. It’s not usually associated with soreness or itching.

BV is caused by an imbalance of bacteria in the vagina. It’s the most common vaginal condition in women between the ages of 15 and 44 — although half experience no symptoms.

It’s usually easy to treat with antibiotics — in the form of tablets, gels or creams — but it can recur and might require treatment for up to 6 months. Having BV also increases your risk of getting chlamydia and other sexually transmitted infections (STIs).

## A pink or brown discharge

This can be a sign of bleeding, which is normal at the beginning and end of your period and after childbirth, when it is known as lochia.

But Dr McClymont says, ‘This should be discussed with a doctor if it occurs at other points in your cycle. Infections, particularly sexual infections such as chlamydia or gonorrhoea, can cause this, as well as conditions that affect the cervix or lining of the womb such as polyps or, in some cases, cancers.’

## Any unusual or excessive discharge

If it’s accompanied by pelvic pain or bleeding, any discharge that isn’t usual for you could be a sign of an STI such as chlamydia or gonorrhoea.

As chlamydia is quite common, and not everyone develops symptoms, some countries recommend that anyone under 25 who is sexually active should be tested once a year. Left untreated, chlamydia can lead to pelvic inflammatory disease (PID), infertility and reactive arthritis.

## How to prevent problems with vaginal discharge

If you’re sexually active and not in an exclusive relationship, using a condom will help prevent many problems.

It’s also a good idea to avoid products that supposedly promote vaginal hygiene or ‘freshness’, as they are not necessary and often do more harm than good.

‘Use water and an emollient instead of soap to wash and avoid vaginal douching — which involves cleaning the inside of the vagina with water,’ Dr McClymont advises. If you’re using lubricants, make sure they’re unperfumed.

## When to see a doctor

Dr McClymont suggests speaking to a doctor or sexual health clinic if you’re worried about any abnormal vaginal discharge, or any change from what you usually experience during the course of your cycle. And she stresses, ‘Any new bleeding or bloody discharge should be discussed with a doctor — particularly if it occurs after sex, after the menopause or in between your periods.’

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Whether you’re seeing yellow or brown discharge or there’s a smell that’s unusual, talking to a doctor can help you work out why it’s happening and find a solution. In the meantime, this guide to vaginal discharge colour, texture and smell can help 

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Dr Rhianna McClymont

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There are lots of reasons why women of all ages might experience abdominal pain. It’s extremely common and generally easy to manage if you know the cause.

‘Most lower abdominal pain in females isn’t a sign of a serious condition, but occasionally there can be something that needs investigating. If you do experience this type of pain, it’s helpful to familiarise yourself with the area of the tummy that hurts and how to manage the different types of pain,’ says Dr Rhianna McClymont, Lead GP at Livi.

The lower abdomen refers to the part of your tummy below the belly button. Pain in that area might also be referred to as pelvic pain.

## What causes central lower abdominal pain?

A woman’s lower abdomen has two main organs including the uterus (womb) and part of the bowel. Here are some of the potential causes of pain in this area.

### Period pain

Period pain is usually a crampy, dull or tight pain in the middle of the lower abdomen, sometimes spreading further into the lower back. It can be very uncomfortable, but many people find they can manage it with a hot water bottle and painkillers like paracetamol and ibuprofen.

### Urinary tract infection (UTI)

A UTI or [water infection](https://www.livi.co.uk/your-health/utis-your-questions-answered/) can also cause lower abdominal pain in women, as well as urinary symptoms like burning when you pee, or needing to go to the toilet very frequently or urgently.

Mild urinary tract infections like cystitis often clear up on their own if you drink plenty of fluids, but more persistent UTIs might need a short course of antibiotics, which a GP can prescribe. More severe UTIs can affect the kidneys, and might cause lower back pain on either or both sides, and make you feel generally unwell, sometimes with flu-like symptoms. 

It’s important to speak to a doctor as soon as possible if your symptoms are more severe or if you have recurring UTI symptoms.

### Pelvic inflammatory disease

Infections in the reproductive system can affect the uterus, fallopian tubes and ovaries. An untreated infection in the reproductive tract can become very serious and lead to long-term problems, so needs to be treated by a doctor. 

These kinds of infections are often caused by an underlying sexually transmitted infection (STI), so if you’re sexually active, make sure you have regular sexual health screening.

[Pain during sex](https://www.livi.co.uk/your-health/what-causes-painful-sex-and-pain-after-sex/), [spotting](https://www.livi.co.uk/your-health/whats-causing-my-spotting-in-between-periods/) or [discoloured](https://www.livi.co.uk/your-health/is-my-vaginal-discharge-healthy-a-doctors-guide/), smelly discharge can be other symptoms of an STI, or infection of the reproductive system. 

## What causes pain in the lower left abdomen?

‘Any of the causes of one-sided abdominal pain listed above, can just affect the left side, but there are some reasons that the pain might be only on the left – particularly because the bowel is closer to the end of the digestive system,’ says Dr Rhianna McClymont.

### Gas (flatulence)

A common cause for pain on your left side is [trapped or excessive wind and bloating](https://www.livi.co.uk/your-health/whats-causing-your-gas-and-flatulence/). Gas builds up in the digestive tract by swallowing air or as a by-product of gut bacteria breaking down foods. Having some gas is perfectly normal, but having a lot of wind could be a sign of an underlying health issue.

### Polyps or diverticular disease

Diverticular disease can affect the lower left side too, or can cause more generalised pain. Polyps are small wart-like lumps in the bowel, and diverticular disease is a condition where the bowel forms tiny pockets that become inflamed and painful. 

Diverticulitis and polyps can both cause diarrhoea and sometimes bleeding in the bowel. If you notice [[blood in your poo](https://www.livi.co.uk/your-health/10-things-your-poo-can-tell-you-about-your-health/), or if your poo looks black and tarry](https://www.livi.co.uk/your-health/10-things-your-poo-can-tell-you-about-your-health/), it’s important to speak to a doctor straight away.

## What causes pain in the lower right abdomen?

### Appendicitis 

The right lower abdomen contains the part of the bowel where the small intestine meets the large intestine. The appendix is a small part of the bowel which is found where the intestines join, and this can sometimes get inflamed, swollen, and infected. Appendicitis is a painful intestinal disorder that causes intense lower right abdominal pain – although the pain might also spread across the lower abdomen.

## Causes of general lower abdominal pain

### Muscular pain

Muscular pain can account for some cases of lower abdominal pain. A strained muscle from exercise or an injury can be very painful, affect one or both sides, or be more generalised across the lower abdomen. 

Sometimes it’s possible to work out how or when muscular pain started, and this makes it more manageable with regular painkillers and lots of rest.

### Pregnancy

Pregnancy causes major changes in a female’s body shape and places a huge amount of strain on the organs and muscles of the lower abdomen. As well as general discomfort in this area, women often experience pain from Braxton Hicks contractions during the later stages of pregnancy, as the muscles prepare for childbirth. 

You can always speak to a midwife or your local prenatal team for advice if you have any concerns about your health during pregnancy. There are some less common causes of lower abdominal pain in pregnancy that can be more serious. If you experience any severe, sudden or unexplained pain, or pain alongside unusual vaginal discharge or bleeding, go to your nearest A&E for urgent medical advice.

### Ectopic pregnancy

[Ectopic pregnancies](https://www.nhs.uk/conditions/ectopic-pregnancy/) affect around 11,000 people in the UK every year. Women affected can have problems with one ovary or fallopian tube that leads to lower abdominal pain either in one or both sides. This complication can also cause general or central lower abdominal pain, which is usually very severe. 

## When to see a doctor

‘Occasional lower abdominal pain isn’t unusual for women, and period pain is a particularly common cause. Most of the time, this type of pain can be easily managed at home with pain relief, hot water bottles, rest or gentle exercise depending on the cause,’ reassures Dr Rhianna McClymont, Lead GP at Livi.

‘Very severe, unexplained or unmanageable pain, with other concerning symptoms, should be checked by a doctor urgently.’ 
It isn’t always easy to identify the cause yourself, but if you do experience regular pain during your menstrual cycle or notice urinary or bowel problems, make a note of this if you do want to discuss your lower abdominal pain with a GP.


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Vaginal odour is something we can feel uncomfortable talking about. But getting to know your body can help you identify what’s ‘normal’ for you, and when to get medical help.

‘The vagina has a natural bacterial flora that’s there to keep a good balance,’ explains Dr Rosén. It’s because of this natural bacteria that the cervical mucus in the vagina always has a smell. You may also experience changes throughout your menstrual cycle as the pH balance in your vagina changes.

So, what does vaginal odour normally smell like? 

Dr Rosén says that it usually ranges from a slightly tangy or sour smell to a more metallic smell around or after your period. ‘Generally, if you’re feeling well and your vaginal odour or discharge isn’t unusual for you, there’s no reason to worry.’

## Here are 8 common causes of vaginal odour and when to talk to a doctor:

### 1. Bacterial vaginosis (BV)

__Vaginal odour: fishy__

Bacterial vaginosis is one of the most common causes of a smelly vagina, affecting 15% to 50% of women of reproductive age. ‘It’s a condition where there’s an imbalance in the vaginal flora,’ Dr Rosén explains. ‘The first symptom is often a fishy smell, which can progress to a frothy, grey or green-ish discharge. You may also feel itchy and swollen.’

There are a number of different treatment options if the symptoms of BV don’t clear up on their own. ‘A doctor can prescribe you a course of antiseptics or antibiotics,’ says Dr Rosén. Unfortunately, recurrence is not unusual after antibiotic treatment. Some studies have proven that the use of probiotics could be helpful, and Dr Rosén suggests changing contraception, especially if you’re using the coil.

She adds that your sexual partner may be the cause of your infection, so talking to them about their personal hygiene and using external or internal condoms for a while might be a good idea. If you find that this helps, your partner will likely need a [course of antibiotics](https://www.livi.co.uk/your-health/how-do-antibiotics-work-and-when-do-you-need-them-an-expert-q-and-a/), too.

‘If you’re having these symptoms, you should see a doctor to rule out any underlying conditions that may need treatment,’ Dr Rosén says. ‘That’s especially important if you’re pregnant, as there’s an increased risk for premature labour.’

### 2. Trichomoniasis

__Vaginal odour: pungent and fishy, similar to BV__

Trichomoniasis is the most common non-viral sexually transmitted infection (STI) in the world. ‘It’s a parasitic disease that typically doesn’t cause a lot of symptoms,’ says Dr Rosén. ‘Some people experience subtle symptoms like a yellowy-green [vaginal discharge](https://www.livi.co.uk/your-health/is-my-vaginal-discharge-healthy-a-doctors-guide/) with an unpleasant smell, and the vulva can be a little red and itchy. A course of antibiotics usually clears it up.’

### 3. Toxic shock syndrome (TSS)

__Vaginal odour: very unpleasant, but odour is generally a minor symptom__

Toxic shock syndrome has become a very rare illness – it was often caused by [high-absorbency tampons](https://www.ncbi.nlm.nih.gov/books/NBK459345/#:~:text=The%20incidence%20of%20TSS%20is,100%2C000%20in%20the%20United%20States.). ‘If this bacteria enters your system, you get very sick very quickly. You’ll get a high fever, [blood pressure changes](https://www.livi.co.uk/your-health/are-my-blood-pressure-levels-healthy-a-doctors-guide/) and possibly a rash and diarrhoea or vomiting, and you might feel faint,’ says Dr Rosén.

‘If you experience these symptoms, you should go straight to A&E. TSS cases are now very rare, though.’

### 4. A tampon you’ve forgotten to remove

__Vaginal odour: very unpleasant__

‘There have been instances of people seeking help for a bad vagina smell and finding it’s caused by a tampon that’s been left in for days, sometimes longer,’ says Dr Rosén.

‘If this happens, the smell will get worse quickly and be extremely obvious and offensive – so if you’re experiencing vaginal odour that escalates, it’s always best to check.’

### 5. Vaginal thrush

__Vaginal odour: yeasty__

Vaginal yeast infections like thrush are very common and typically cause itching, burning and changes to vaginal discharge, which can become lumpy and white, similar to curdled milk.
This discharge usually isn’t very smelly, though. ‘If your thrush symptoms are so pronounced that there’s a bad smell, you should see a doctor to rule out any underlying conditions,’ says Dr Rosén.

### 6. Hormonal changes

__Vaginal odour: individual__

Similar to the changing smells throughout your menstrual cycle, other hormonal changes can affect the smell of your cervical mucus. ‘During the menopause and in the post-menopausal years, the smell can change,’ says Dr Rosén.

Pregnancy changes the cervical mucus, too. ‘You may have more discharge, or sometimes it’s thicker or thinner, but it shouldn’t be smelly,’ Dr Rosén explains. ‘If you’re pregnant and have a foul-smelling discharge, you should speak to a doctor or midwife.’

### 7. UTIs and other urinary issues

__Vaginal odour: ammonia__

If you experience an ammonia-like vaginal odour, urine might be involved. This can happen if you have a [urinary tract infection (UTI).](https://www.livi.co.uk/your-health/utis-your-questions-answered/) ‘This is more likely if a UTI is left untreated and you might be leaking,’ explains Dr Rosén. ‘An infection that’s left untreated will also cause a fever, and the smell will be quite distinct and sickly.’

Occasionally, an ammonia-like smell can be a sign of an existing incontinence issue that you’re unaware of, says Dr Rosén. ‘These issues are very common. A doctor or gynaecologist can advise on treatment options.’

### 8. Gynaecological cancers

__Vaginal odour: metallic and sickly__

Very rarely, foul-smelling discharge can be a symptom of cervical or uterine cancer. Discharge and vaginal odour are unlikely to be the only or first symptoms, though.

‘You might have experienced bleeding during intercourse, or perhaps occasional spotting that becomes more regular. The smell will be a little metallic,’ says Dr Rosén. ‘The smell is very different from the fishy or rotten smells of BV or a forgotten tampon.’

If you experience unusual bleeding, you should always talk to a doctor.

## __Can STIs cause vaginal odour?__

‘STIs like chlamydia and gonorrhoea rarely change the smell of the cervical mucus but can cause other symptoms like pain when peeing,’ says Dr Rosén. ‘If you notice a smell, it might be that you’ve also got bacterial vaginosis. If in doubt, talk to a doctor for advice.’

## How do I get rid of the odour down there?

So, what vaginal smell treatments are available? Lots of people who are worried about vaginal odour want to know the right washing routine or best feminine wash for odour.

‘Like any part of the body that gets sweaty, the area around the vulva can get smelly,’ says Dr Rosén. But soaps can disturb the natural balance of the vaginal bacterial flora and possibly increase the risk of bacterial vaginosis. Douching – a method of washing out or rinsing the vagina – can do the same.  

Instead, the recommended way to wash down there is with nothing but water, and avoid perfumed sanitary pads or vaginal deodorants.

‘If you’re very dry as a result of [breastfeeding](https://www.livi.co.uk/your-health/breastfeeding-whats-happening-in-your-body/), vaginal atrophy (the thinning, drying and inflammation of the vaginal walls, often caused by lower oestrogen levels) or a recent infection, you can use vaginal moisturisers – but nothing with perfume.’

## When should I speak to a doctor about vaginal odour?

It’s important to recognise if the smell is abnormal for you.

Making simple lifestyle changes like using just water to wash down there and avoiding perfumed products is a good place to start. There are plenty of home remedies for vaginal odour too, like eating pineapple or drinking pineapple juice regularly, but these may not work for everyone.

But if the smell seems to be getting worse or you have other symptoms too, speak to a doctor.

__This article has been medically approved by Dr Elisabeth Rosén, a medical doctor at Livi who specialises in gynaecology and obstetrics.__

livi.co.uk >   article page > CTA

Speak to a GP if something’s up down there

Livi.co.uk > Your health > Why does my vagina smell? 8 causes of vaginal odour

Why does my vagina smell? 8 causes of vaginal odour

If your vagina smell is worse than usual, you may need to get treatment. From bacterial vaginosis to vaginal thrush, here are 8 causes of vaginal odour

Why does my vagina smell? 8 causes of vaginal odour and treatment | Livi UK

How often do you check your breasts? If it’s rarely or never, then you might be inadvertently putting your health at risk. Breast cancer is the most common cancer in women worldwide, representing 25.4% of all cancers in women. It’s also one of the most treatable and the earlier it's picked up, the better the outcome.

‘The earlier breast cancer is detected and treated, the better the prognosis,’ says Dr Elisabeth Rosen, medical doctor and women's health specialist at Livi. ‘That’s why it’s important to get into the habit of checking your breasts for lumps regularly.’

## When is the best time to check your breasts?

‘Knowing how your breasts should look and feel normally can help to alert you to any unusual changes that may be a symptom of breast cancer,’ says Dr Rosen. ‘Ideally, you should check your breasts once a month on the same day, a few days after your period.’ 

Like the rest of your body, your breasts react to hormonal changes during your menstrual cycle. Many women, for example, find their breasts naturally become swollen, tender and even lumpy in the week or so leading up to their period, so that’s not an optimal time to check them. 

If you’re postmenopausal, you should be checking your breasts for lumps on the same day every month.

## Am I eligible for breast screening?

The risk of breast cancer increases with age and most breast cancers are diagnosed after age 50. It’s important to have regular breast screening, called a mammogram, when you’re invited. The aim of mammograms is to detect breast cancers early, when they’re too small to see or feel. 

In the UK, women aged from 50 to 71 are invited for breast screening every 3 years. Anyone who has symptoms or a family history of breast cancer is also eligible to have a mammogram.

## How can I know what’s normal for me?

‘Look out for anything that’s different in how your breasts, armpits and nipples look and feel,’ says Dr Rosen. By checking regularly, you’ll become familiar with what’s normal for you regarding: 
- skin colour
- skin texture
- feel and shape of your breasts
- look, feel or shape of the nipples

## Most breast lumps aren’t cancer, right?

‘If you find a lump in your breast, you should always have it checked by a GP,’ says Dr Rosen. But a new symptom doesn’t automatically mean you have breast cancer. Around 9 in 10 breast lumps are benign. 

‘It could be that you’ve simply got a cyst, or a fibroadenoma, which is a non-cancerous, solid growth of fibrous or glandular tissue,’ says Dr Rosen.

Most cysts go away by themselves and are nothing to worry about. But if a cyst is large or causing discomfort, the fluid can be drawn off. Fibroadenomas may also disappear over time. In some cases, surgery (an excision biopsy) might be needed to remove it.

## What changes am I looking for?

Always consult a doctor if you notice any of the following changes:
- A new lump, bumpy area, swelling or thickening in one breast or armpit that’s different to the same area on the other side
- A change in the size, outline or shape of your breast
- A change in the look or feel of your skin, such as puckering or dimpling
- Nipple discharge (not milky, for example, if you’re breast-feeding)
- Bleeding from your nipple
- A rash or redness on or around the nipple area or a sore that doesn’t heal
- Any change in the position of the nipple – eg: becomes inverted, or is pointing differently
- Any new discomfort or pain in the breast (although pain is a rare symptom of breast cancer)

‘Checking your breasts for lumps monthly will help you to become aware of how they look and feel,’ says Dr Rosen. ‘It’s perfectly normal, for example, to have one breast that’s slightly bigger than the other. Most women have slightly asymmetrical breasts. What you’re looking for is anything that’s not normal for you. This means any changes and symptoms that weren’t there before.’  

## How to do a breast self-examination – a checklist

When you check your breasts, stand in front of the mirror with your shoulders straight and your arms on your hips. Observe the following:
- Are your breasts the same size and shape as usual?  
- Are there any visible distortions or swellings?
- Are there any changes in colour or texture to your breasts, armpits or nipples? For example, are there any areas that look red, inflamed, crusty, puckered or dimpled? Is there any soreness, rash or swelling? 
- Do you notice any indentations? This may be caused by a lump or tumour that’s pulling the skin inwards
- Has your nipple changed position; drawn inwards instead of protruding outwards?
- Check whether there’s any fluid or discharge coming out of your nipples eg: watery, yellow or bloody

Now raise your arms above your head. Notice how your breasts move while you do so. Are they moving in the same way as always? Breast cancer can make breasts less mobile. Keeping your hands above your head, look for any of the changes above.

Now check your breasts for how they feel. Standing or sitting, use your right hand to feel your left breast, and your left hand to feel your right breast. If you're less mobile, you can also lie down. Now:

- Keeping your index and middle fingers flat and together, using circular motions, feel your breast – from side to side, from the collarbone to the top of your abdomen and from your armpit to your cleavage. Begin at the nipple, moving towards the outer edge of the breast. Make sure you cover the whole breast. Next do the same of your armpit area.
- Do you feel any lumps, bumps or swellings? 
- Does skin feel different than usual?

## When to get help for a breast lump

‘If you find a breast lump or notice any other signs, always see your doctor as soon as possible,’ says Dr Rosen. ‘Try not to panic, as the vast majority of lumps are benign and there may be other reasons for them. Also, lumps that hurt are usually not cancerous but hormonal. Your GP will examine you and refer you to a breast cancer unit or clinic for further tests.’

## How will I be tested for breast cancer?

If you have symptoms, you may be referred for a mammogram. You may also need an ultrasound scan, which uses high frequency waves to create an image of part of the body.

If breast cancer is suspected, you will have a biopsy, which examines cells taken from your breast to see whether they are cancerous. A needle biopsy (where a sample of tissue is taken from a lump) is the most common type of biopsy. A biopsy can also be done by needle aspiration, where a sample of breast cells is removed using a small needle. 

If a diagnosis of breast cancer is confirmed, tests will be needed to confirm the stage and grade of the cancer, and the best method of treatment.

## What about gene testing for breast cancer?

Certain types of breast cancer may be genetic. For example, if you have BRCA1 or BRCA1 genes, this may raise your risk of developing breast cancer, and ovarian cancer.

If you’re concerned, for example, if breast cancer runs in your family, and you’re worried you may also develop it, talk to your GP about genetic testing. 

Not everyone is eligible and you would usually have to have good reasons to have this done. For example, if a relative has already been tested and shown to carry the BRCA1 or BRCA2. Testing is often inconclusive. You may also need to consider whether you really want to know, as a positive result may cause ongoing anxiety. 

Start with a discussion with your GP about your family history and they will help you decide on next steps.

__This article has been approved by women’s health specialist Dr Elisabeth Rosen.__


livi.co.uk >     article page >   CTA

See a GP about a breast lump

Livi.co.uk > Your health > Are you checking your breasts correctly? A doctor’s guide

Are you checking your breasts correctly? A doctor’s guide

Most breast lumps are harmless. But if they’re cancerous, then the earlier they are treated the better — so, make sure you’re checking your breasts regularly

How to Check your Breasts for Lumps - A Doctor's Guide

If you’re [planning to have a baby](https://www.livi.co.uk/your-health/10-health-tips-for-planning-a-pregnancy-a-doctors-advice/), are pregnant or about to give birth, it’s natural to feel a certain degree of anxiety. Studies suggest that around 80% of pregnant women experience worries and fears in relation to childbirth.

‘This can range from moderate anxiety to severe distress and common reasons include fear of pain, loss of control or that something may happen to the baby,’ says Dr Elisabeth Rosen, medical doctor at Livi who specialises in gynaecology and obstetrics. 

‘But at the more extreme end of the spectrum is tokophobia, a pathological fear of childbirth that causes severe anxiety. For many women, restrictions imposed by the pandemic have added to their fears. If you’re anxious, it’s important to know what help is available so that you can give birth in the best possible way.’

## What is tokophobia?
Tokophobia is a severe fear, or phobia, of childbirth, and for many women this also extends to pregnancy. It’s currently estimated that tokophobia could affect as many as 14% of women worldwide.  

‘Tokophobia causes severe anxiety at the thought of childbirth that usually also impacts a woman’s feelings about pregnancy,’ says Dr Rosen. 

There are two types of tokophobia. Primary tokophobia occurs in women who have never given birth before. Secondary tokophobia occurs in women who have previously had a traumatic experience of childbirth.

## What are the main signs of tokophobia?
Typical symptoms of a fear of childbirth may include:

- Excessive anxiety when thinking about or imagining childbirth
- Intense feelings of dread about childbirth
- [Panic attacks](https://www.livi.co.uk/medical-advice/mental-health/panic-disorder/) – these can include shortness of breath, a dry mouth, sweating, shaking, trembling, nausea, numbness, feeling dizzy, light-headed or faint, chest pains, and disassociation
- Flashbacks to a past traumatic experience of childbirth (in women with secondary tokophobia). This type of tokophobia is a risk factor for [post-traumatic stress disorder (PTSD)](https://www.livi.co.uk/medical-advice/mental-health/postnatal-depression/) in some women. 

## Is pregnancy anxiety different to tokophobia?
‘Most women will experience some type of anxiety while they’re pregnant,’ says Dr Rosen. ‘Typical worries may include anxiety about something happening to the baby. For example, is the baby developing as it should? What if it suffers damage or some other injury during childbirth? Will the baby be healthy? You may also feel anxious about experiencing difficulties with pregnancy or labour and worry that you might not get the right support and assistance. 

‘There may be other factors causing you to feel anxious, like how are you going to cope – financially, emotionally or practically. If it’s your first baby, there’s a sense of going into the unknown that can feel scary. For single mothers, there may be the added anxiety of having to cope with everything on your own.’

## What triggers tokophobia? 
Here are some of the causes that may trigger a severe fear of pregnancy and childbirth:

- Fear of pain
- A history of anxiety, [depression](https://www.livi.co.uk/medical-advice/mental-health/depression/) and other mood disorders, including PTSD
- A previous traumatic experience during childbirth
- A previous traumatic medical experience
- Previous traumatic events like sexual assault, rape, or a history of child abuse
- Hearing stories, reading about or witnessing negative experiences of childbirth
- A need to be in control
- A lack of support during pregnancy and birth, and lack of information

## What help is available if I’m not pregnant yet?
‘If you’re feeling excessively anxious and feel that anxiety is affecting you significantly, either physically or mentally, seek help from a psychologist or counsellor,’ says Dr Rihanna McClymont, Lead GP at Livi.  ‘Your doctor can refer you to the appropriate psychological service. If you suffer from tokophobia, it’s especially important to access the right help.’

## What are the best solutions for tokophobia? 
Treatment for tokophobia may involve a combination of therapy, medication, social support and lifestyle changes. Like other phobias, with the right help, tokophobia can be successfully treated and cured. ‘Having therapy before you get pregnant can help you work through your fears and teach you strategies to help you cope,’ Dr Rosen says. 

‘Cognitive behavioural therapy (CBT) can be helpful for tokophobia and pregnancy anxiety, as it can help you to identify, and learn how to change, the thought patterns contributing to your fears. CBT will also provide you with psychological techniques to reduce and manage your anxiety.’ 

## I’m already pregnant and scared of childbirth, what can I do?
‘If you’re pregnant and feeling fearful, it’s important to talk to your doctor, consultant obstetrician, or midwife as early as possible,’ says Dr Rosen. 

‘Your obstetric team should be aware of any specific fears and talk to you about the best treatment options and services and also discuss a birth plan for you.  

‘A clear birth plan will help you know what to expect and what plans are in place,’ says Dr Rosen. ‘For example, what happens if you go into early labour? What happens if there are any complications? What are the alternatives if you’re scared of needles? What are your options for having a caesarean section?  

‘But this is a major operation, and many women ask for it through fear. Yet often, after talking with their midwife or obstetrician, they change their mind and opt for a natural birth. But with tokophobia, it’s important to know that this option is available. Most women with secondary tokophobia will be offered an elective caesarean. You should always be referred for additional psychological and medical support if you have tokophobia.’

‘Feeling isolated can make anxiety or low mood symptoms worse, so it’s important to stay connected to family and friends as much as possible. If you feel you need additional support, always talk to your doctor. Also, seek help if you experience feelings of [sadness or depression after giving birth](https://www.livi.co.uk/medical-advice/mental-health/postnatal-depression/).’ 

## Can anxiety affect childbirth?
‘Feeling fearful or anxious is not good for a pregnant woman,’ Dr Rosen says. ‘It activates the sympathetic nervous system and your body goes into fight or flight mode, which is not conducive to having a good birth. When you’re anxious and stressed, your muscles tense up and oxytocin levels decrease, making childbirth more difficult.’  

‘There’s no need to put yourself through this, as with the right support, it’s possible to transform your pregnancy and childbirth into a much happier experience,’ Dr Rosen advises.

## Can a partner do anything to help?
‘It’s important to let your partner know how you feel,’ says Dr Rosen. ‘That way, they can better support you for example, by attending consultations with you, so they’re fully informed. Sometimes, a partner may be feeling anxious too, in which case they may benefit from a course of therapy themselves.’

__This article has been medically approved by Dr Elisabeth Rosen, medical doctor at Kry who specialises in gynaecology and obstetrics and Dr Rhianna McClymont, Livi Lead GP.__


See a GP about tokophobia

Livi.co.uk > Your health > Fear of childbirth and pregnancy (tokophobia) and how to cope

Pregnancy anxiety tokophobia 

Tokophobia is a fear of childbirth that can extend to a fear of pregnancy. Learn about tokophobia from a Livi women’s health specialist, including what help is available

Understanding the fear of childbirth and pregnancy | Livi UK

livi.co.uk > medical reviewer

IMG 20200730 224911 865-33- 1 .jpg

Tokophobia – how to cope with a fear of childbirth and pregnancy

Spotting in between your periods is common and usually not something to worry about. But what exactly is it?

‘Spotting is very light vaginal bleeding that happens outside of your regular periods,’ says Dr Rhianna McClymont. ‘You might only notice blood on your toilet roll or underwear, and it doesn’t usually require a tampon or pad for protection.’ 

## Is it spotting, or is it part of my menstrual cycle bleed?

‘A period bleed is your typical menstrual cycle bleed, which normally lasts about 5 days,’ says Dr McClymont. ‘Most people have a regular bleed approximately every 28 days, although some people naturally have a [more irregular cycle](https://www.livi.co.uk/your-health/what-causes-heavy-or-irregular-periods-a-doctors-guide/).

‘It’s common for a few days of this bleed to be a heavy flow of blood and a few days to be very light bleeding at the end of your period. Spotting, on the other hand, is bleeding in between your menstrual cycle bleeds.’

## So, what causes spotting? 

There are a number of reasons why you might experience spotting, and some of them aren’t necessarily a cause for concern. It’s always a good idea to talk to a doctor about spotting that’s new and unusual for you.

### 1. Starting a new hormonal contraception
‘Spotting isn’t uncommon when you start a new hormonal contraception,’ says Dr McClymont. ‘Usually, this spotting stops spontaneously after a few weeks or months.’ It’s also common to experience spotting if you miss a dose of the contraceptive pill. 

‘However, if you’re experiencing new spotting that’s developed after you’ve been using a contraceptive for a few months, when you haven’t previously had spotting, and when you haven’t missed any doses, you should speak to a doctor,’ adds Dr McClymont.

### 2. STIs
‘Sexually transmitted infections can cause spotting,’ says Dr McClymont. ‘There may be other accompanying symptoms such as vaginal discharge, pain while peeing or abdominal pain, too.’ 

### 3. Pregnancy
‘Spotting in pregnancy is also common,’ says Dr McClymont. ‘This usually happens during early pregnancy – around the time of implantation and during the first trimester. 

‘If the spotting develops into a heavier flow or is accompanied by [abdominal or pelvic pain](https://www.livi.co.uk/your-health/what-causes-lower-abdominal-pain-in-women/), you should talk to a doctor as this may be an indication of a miscarriage.’

### 4. Ovulation
Some of us experience spotting mid-cycle, around the time of ovulation. ‘This is usually very light spotting for a short time and can be identified if you’re tracking ovulation within your cycle,’ says Dr McClymont.

### 5. Fibroids and polyps
‘Both fibroids and polyps can cause spotting,’ says Dr McClymont. ‘This may be accompanied by heavier periods, or in some cases pelvic pain, but many people get no other symptoms.’

### 6. Problems with the cervix
If you ever experience spotting after having sex, be sure to speak with a doctor – it can be a sign that there’s a problem with the cervix. 

‘Often, changes with the cervix are completely benign. For example, an ectropion is when a growth of fragile cells that normally reside on the inside of the cervix move to the outside. These cells can bleed easily, particularly after sex,’ Dr McClymont explains. 

### 7. Gynaecological cancers
Gynaecological cancers affecting the cervix, vulva or lining of the womb can cause spotting, which is why you should always take spotting that’s unusual for you seriously. 

If you have:
- Spotting between your periods
- Spotting after sex
- Spotting after you’ve gone through the menopause
- New spotting after being stable on hormonal contraception or HRT for a while
- A non-healing rash or ulcer in your vulva or vagina
- Persistent vaginal itching or pain
- Anything else that concerns you in your genital region

...then it’s important to get this reviewed by a doctor.

## What if I’m nervous about discussing spotting with my GP? 

It’s natural to feel embarrassed or nervous about the thought of a genital exam, but there’s no need, Dr McClymont reassures. ‘Spotting is a common problem to discuss with a doctor,’ she says. ‘It’s important to remember that having an examination can help set your mind at rest and avoid long-term health problems.’

Dr McClymont also stresses the [importance of having a cervical screening ](https://www.livi.co.uk/your-health/what-happens-during-a-cervical-smear-test-how-to-prepare-and-what-to-expect/)test. ‘This will not be done as an investigation for spotting as it’s a screening test only, but it’s important to attend whenever you’re called to catch problems with the cervix early.’

__This article has been medically approved by Dr Rhianna McClymont, Lead GP at Livi.__


livi.co.uk   >     article page  >   CTA

See a GP about spotting

Livi.co.uk > Your health > What’s causing my spotting in between periods?

What’s causing my spotting in between periods?

What is spotting, what causes it and when might you talk to a doctor about it? Get expert advice from a Lead GP at Livi

 What causes spotting between periods? | Livi UK

Having a baby is one of the most wonderful moments in a person’s life. But it leads to physical and emotional body changes that can cause anxiety for new parents. 

‘Often, these changes are perfectly normal and are nothing to worry about,’ says Dr Elisabeth Rosen, a Livi specialist in women’s health. ‘But occasionally, you may need to seek further medical advice.’ 

Here’s our doctor’s guide on what to expect and what you can do at home to help — or, when to get a medical opinion.  

## 1. Lower back pain

A condition known as symphysiolysis (sometimes called symphysis pubis dysfunction) can cause pain in your lower back after having a baby. ‘Symptoms usually start around week 18 of the pregnancy and anyone can suffer from it,’ says Dr Elisabeth Rosen. ‘It’s thought to be connected to the loosening of the ligaments and joints between the lower back and pelvis thanks to hormonal changes while pregnant.’ 

### Self-help
If you’re suffering with severe pain in your lower back after having a baby, talk to your doctor. If you have general back pain after pregnancy, the NHS recommends:

- While feeding your baby, sit with your back well supported and straight. Put a small pillow or cushion behind your waist to support your lower back. Make sure your feet can reach the floor
- Kneel or squat (do not bend your back) to do tasks that are near the floor, like picking up toys or bathing your baby
- Change a nappy on a raised surface. You could kneel on the floor next to a sofa or bed. Never leave your baby unattended on a raised surface, in case they fall off

### When to talk to a doctor
‘If you need painkillers regularly for more than 2 weeks, see your GP,’ says Dr Rosen. ‘They may suggest alternative painkillers, a TENS machine [which uses mild electrical current to relieve pain], acupuncture or a back belt which you can buy or sometimes borrow from your delivery ward to help support the lower back.’

Read more about [lower back pain](https://www.livi.co.uk/your-health/what-can-help-my-lower-back-pain-a-doctors-tips/) and how you can help manage it.

## 2. Pelvic floor problems

Most women who give birth vaginally will suffer some form of damage to their pelvic floor area such as a mild or moderate tear. This can lead to pain, discomfort, dyspareunia, incontinence and [constipation](https://www.livi.co.uk/medical-advice/digestive-problems/constipation/) for a couple of weeks postpartum but should slowly resolve. 

### Self-help
‘Immediately after the birth you can apply an ice pad or cold compress to help the blood vessels constrict and reduce the pain,’ says Dr Rosen. ‘Pain killers can also help and make sure you start your pelvic floor exercises from as early as possible.’ 

### When to talk to a doctor
‘Usually the pain and discomfort will disappear in the first 2-6 weeks,’ says Dr Rosen. ‘Persisting problems should be taken up at your 6-week postpartum check-up. There, the midwife will be able to investigate your pelvic floor through a gynaecological examination and refer suspected persisting damage to your pelvic floor for further treatment’.  

## 3. Episiotomy stitches

It’s common for women who have a vaginal birth to have some kind of natural tear or episiotomy (a cut made by a health professional). These are normally stitched up within an hour of the birth and should heal within a month.

### Self-help
‘Shower each day rather than taking a bath for as long as you’re still bleeding as baths could let bacteria enter your uterus,’ says Dr Rosen. ‘Change your sanitary pads regularly and don’t have sex until you’ve stopped bleeding — usually around the 6-8 week mark. 

It’s useful to examine your wound and stitches regularly using a mirror, just to check for any changes. Don’t worry if the wound feels itchy or irritated. This is actually a good sign that the wound is healing. Massaging baby oil into the area often helps.’

### When to talk to a doctor
‘If you get a high temperature it could be a sign of infection, so see your midwife or a GP straight away,’ says Dr Rosen. ‘If the pain or swelling gets worse or there is a smelly discharge from the wound, also seek medical help.’ 

## 4. Bruising and infection after a C-section

Around 1.4 million C-sections are performed every year in Europe. ‘Like all major surgeries, a C-section risks infection through the cut as well as damage to the nerve and bruising is common,’ says Dr Rosen. ‘Most women will be able to take up light exercise within 2 weeks and normal exercise after 6 weeks but there may be decreased or a ‘tickling’ sensation as the nerves try to repair themselves.’ 

### Self-help
‘Keep the scar clean and examine it regularly for any changes,’ says Dr Rosen. ‘Many women try to “be strong” and continue with daily life but if you need painkillers, take them for at least the first 2 weeks after the birth. 

### When to talk to a doctor
‘If you develop a high temperature or the scar becomes warm, there is an increase in pain, swelling or redness or you see any kind of liquid — apart from blood — oozing out, consult your doctor as it might be a sign of infection,’ says Dr Rosen. ‘If your pain is increasing rather than slowly decreasing you should also seek help.’

## 5. Piles

Haemorrhoids or piles, are swollen veins in or around your bottom and are common both in pregnancy and after giving birth. Up to 35% of pregnant women are thought to suffer from them. ‘Piles normally start during pregnancy due to the increased pressure from the baby on the abdominal wall,’ says Dr Rosen. ‘Many women don’t realise they have them until they experience itching or they spot blood on the toilet paper but they are usually very treatable.’

### Self-help
Drink lots of fluid and eat plenty of fibre to keep your poo soft so you’re not straining. Keep your bottom dry and clean. Try to gently push the pile back inside the rectum using your finger. Use a haemorrhoid cream or suppository which you can buy from the pharmacist.

### When to talk to a doctor
‘Most of the time you can treat piles successfully at home but if you’re really suffering over a long period of time and painkillers are not helping, or you keep bleeding from the rectum, see your doctor,’ says Dr Rosen. 

## 6. Bleeding after birth (lochia)

It’s natural for women to bleed for around 2-6 weeks after giving birth either vaginally or via C-section. The bleeding is a mixture of mucous, blood and tissue shed after your birth as your womb lining is being replaced.

### Self-help
‘Shower every day, keep changing your sanitary pads and don’t have sex until the bleeding has completely stopped,’ Dr Rosen advises. 

### When to talk to a doctor
‘If you suddenly start to bleed more or see clots in the blood you should seek medical attention,’ says Dr Rosen. ‘Sometimes there may be pieces of placenta or membrane left inside and you might need medication to help the cervix dilate again or – in rare cases – you may need surgery. If you have a high temperature after birth, also see a doctor as this could be a sign of infection.’ 

## 7. Sore and swollen labia and vulva 

It’s natural for the vagina and the whole surrounding area to feel sore after giving birth vaginally, says Dr Rosen. 

### Self-help
‘You can use cold pads on the swelling as well as a local anaesthetic cream and take painkillers if you need them,’ says Dr Rosen. ‘I’d also suggest urinating in the shower to dilute the stinging sensation of the urine acid on this area.’ Follow the general advice above for pelvic floor problems too.

### When to talk to a doctor
‘If you continue to have pain while urinating after a week it might be a sign of a urinary tract infection,’ says Dr Rosen. ‘A GP will be able to confirm this easily with a test and prescribe antibiotics.’

## 8. Separated stomach muscles (Diastasis Recti)

Around 60% of women will suffer from separated stomach muscles, or diastasis recti, during pregnancy. It’s caused by the muscles that run down the middle of your stomach separating as the baby puts more pressure on the abdomen during pregnancy. The amount of separation varies from woman to woman but most of the time, the stomach reverts back around 8 weeks after the birth.

### Self-help
Gently exercise the stomach and core. Dr Rosen says, ‘Look for an app for new mums that provides exercises to help reduce the size of separation between the muscles.’ 

### When to talk to a doctor
‘If you still have separation of more than 2cm after 2 months or it’s giving you pain, seek medical advice,’ says Dr Rosen. ‘The GP may refer you to a physiotherapist and in rare cases you may need surgery.’

## 9. Hair and skin changes 

‘Hormonal changes during pregnancy can affect women in different ways and some report they have glowing skin while others say they have [acne](https://www.livi.co.uk/medical-advice/skin-conditions/acne/)’ says Dr Rosen. 

‘Some women report hair loss after giving birth but actually, this is down to their levels of oestrogen changing. While pregnant, the level of oestrogen is high which stops your hair falling out at the same rate as it would have if you weren’t pregnant. When that drops after birth, you shed the hair you would have normally shed that stayed in place thanks to your pregnancy.’ 

### Self-help
‘It’s vital to maintain a nutritious, healthy diet, get as much sleep as possible and perhaps take a multivitamin for new mums,’ says Dr Rosen. ‘Iron tablets may also help, although these can cause constipation so be wary.’

### When to talk to a doctor
If you’re losing your hair in just one place, rather than from all over the head, it’s a good idea to seek medical advice. Hair loss can be a sign of [hyperthyroidism (an overactive thyroid)](https://www.livi.co.uk/your-health/thyroid-symptoms-overactive-underactive/) but that is unusual in postpartum women as doctors keep a close eye on thyroid levels during pregnancy. 

## 10. Hormone changes

‘If you’re breastfeeding, you may have dryness in your vagina due to low oestrogen and it may be itchy or uncomfortable when you have sex,’ says Dr Rosen. ‘The onset of the baby blues is also down to hormone changes and tends to arrive around day 3 after giving birth.’ 

### Self-help
Vaginal dryness can be helped with lubricants which can be bought over the counter. ‘Being aware that the baby blues can kick in around day 3 is important for both you and your partner as awareness is half the battle,’ says Dr Rosen. ‘Usually these feelings disappear after a couple of weeks.’ 

### When to talk to a doctor
If you’re still feeling low after a couple of weeks you may be [experiencing postnatal depression](https://www.livi.co.uk/your-health/help-for-postnatal-depression/). ‘This is common and you shouldn’t be afraid of seeking medical help,’ says Dr Rosen. ‘You may need some kind of talking therapy such as CBT or we can prescribe antidepressants, even if you’re breastfeeding.’ 

__This article has been medically approved by Dr Elisabeth Rosen, Kry/Livi doctor and women’s health specialist.__


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Livi.co.uk > Your health > 10 post-baby body changes — advice from a women’s health specialist

10 post-baby body changes — advice from a women’s health specialist

 Your body will look and feel different after you’ve had a baby. Learn what to expect, with advice from a Livi doctor and women’s health specialist

 10 post-pregnancy body changes – a doctor’s guide | Livi UK

You know you need to keep your hamstrings, abdominals and biceps strong and toned. But just as you exercise your other muscles, it’s important to do regular pelvic floor exercises too. Although you can’t see your pelvic floor muscles, their strength plays a key role in your bladder and bowel function, your sex life and for women, your experience of childbirth and beyond. Here's what you need to know about strengthening a weak pelvic floor.

## Where exactly is my pelvic floor?

Your pelvic floor is made up of a group of muscles that lie across the base of your pelvis, stretching from the tailbone (coccyx, at the bottom of the spine) to the pubic bone at the front, and between the bones that you sit on. These muscles support and protect the pelvic organs (the bladder, bowel and uterus)  when you’re standing, walking, bending, or lifting. 

Together with the abdominal muscles, your pelvic floor is important for posture and to support your spine. Strong muscles prevent urine from leaking from the bladder. These muscles relax when you go for a pee or open your bowels, tightening again afterwards. Toned, healthy pelvic floor muscles can also help enhance sensation and enjoyment during sex. 

You can feel your pelvic floor muscles if you try and stop the flow of urine when you go to the toilet. Or, for women, pretend to tighten your vagina around a tampon.  

## What causes a weak pelvic floor?

Just like any muscle, your pelvic floor will naturally weaken over time. But there are many other reasons why your pelvic floor muscles may become weak, overstretched, too tight or torn. 

Some of the things that can weaken your pelvic floor include pregnancy and childbirth, especially if you had an episiotomy or tearing and the hormone changes associated with menopause. Chronic constipation, being overweight or overexercise may also play a part.

## What are the signs that I have a weak pelvic floor?

Some of the signs that it would be helpful to strengthen your pelvic floor include: 

- Leaking urine when you laugh, cough, sneeze, jump, run, walk, exercise or during sex
- A sudden and urgent need to pee or have a bowel movement, that may include leaking
- [Going to the toilet too often](https://www.livi.co.uk/your-health/urinary-frequency-constant-need-to-pee/) (more than 8 times a day)
- Regularly getting up at night to pee
- Decreased satisfaction during sexual intercourse or painful sex
- A feeling of heaviness, as if something was bearing down, in the pelvis or abdomen
- [Lower back pain](https://www.livi.co.uk/your-health/what-can-help-my-lower-back-pain-a-doctors-tips/)

## Is it normal to pee every 30 minutes?

It’s normal to empty your bladder 5-8 times a day, according to the NHS.  But, if you’re peeing more frequently, particularly if it’s every 30 minutes, this suggests there may be an underlying problem like a [urinary tract infection (UTI)](https://www.livi.co.uk/your-health/utis-your-questions-answered/) or overactive bladder syndrome. Or, it could be a sign of diabetes,  particularly if you also have other symptoms like feeling thirsty, tiredness, itching, blurred vision or cuts and wounds that are slow to heal. Talk to a doctor if you’re concerned.

## What if I pee when I laugh or sneeze?

If you leak urine when your bladder is put under sudden extra pressure, you may have stress incontinence. This may happen when you laugh, sneeze, cough or exercise. Normally when you laugh or sneeze, your pelvic floor muscles contract to prevent urine from leaking.  But when muscles are weak, they’re not strong enough to counteract the pressure. 

Stress incontinence affects around 40% of women and is more common after the age of 40 (1 in 5 have it to some degree).  The most common reason for stress incontinence in men is weak pelvic floor muscles due to treatment for[ prostate cancer](https://www.livi.co.uk/your-health/prostate-cancer-a-doctors-guide/). 

## Can having a stronger pelvic floor make a difference to my bladder?

Strengthening your pelvic floor muscles is helpful and effective for stress and urinary incontinence. It also helps keep your sex life healthy, increasing sensitivity, leading to stronger orgasms and helping to reduce the symptoms of e[rectile dysfunction in men](https://www.livi.co.uk/your-health/erection-problems-a-doctors-guide-to-getting-help/). 

## Can I prevent pelvic floor or bladder problems later in life?

It’s not always possible to prevent pelvic floor or bladder problems especially if, for example, you’ve sustained damage in childbirth. But leading a healthy lifestyle can help to keep your pelvic muscles healthy. Here are some changes you can make to help prevent leaks:

- Practise daily pelvic floor exercises and keep active
- Eat a healthy diet
- Drink plenty of water as it helps to eliminate waste through the bladder and bowels (constipation strains the pelvic muscles, making them weaker)
- Lose excess weight, to reduce pressure on the pelvic floor
- Stop smoking, as it can lead to coughing, which can stress pelvic floor muscles 
- Avoid lifting heavy objects. If you do lift anything, always tighten your pelvic floor muscles before and after the lift 
- Avoid high-impact exercise like jumping or running if you have weak pelvic floor muscles 
- Take your time and make sure you empty your bladder completely each time you go to the toilet
- If you’re about to cough or sneeze, tighten your pelvic floor muscles

## What are the best pelvic floor exercises?

Pelvic floor exercises are also known as Kegel’s exercises because they were originally developed by American gynaecologist Arthur Kegel, in the 1940s, as a non-surgical way to help women control urine leaks by strengthening weak pelvic floor muscles. They also work for men.

## 3 daily pelvic floor exercises

### __Exercise 1: Sit and squeeze__
- Sit comfortably and squeeze your pelvic floor muscles 10–15 times. Imagine you’re sitting on a marble and tighten your muscles as if lifting the marble
- Don’t hold your breath or tighten your stomach, bottom or thigh muscles. Instead, breathe deeply and slowly
- With practice, try holding each squeeze for a few seconds. Have a rest between each one for a second or two
- Do these pelvic floor exercises for a few minutes every day and gradually add extra squeezes each week 

### __Exercise 2: Lie and tighten__
- Lie on your back with feet flat on the floor and knees bent. Alternatively, sit in a chair with your hands on your thighs, bending forwards slightly
- Tighten your pelvic floor muscles, squeeze, lift and hold for the count of 5 or as long as you can that feels comfortable. It’s important not to overdo it when you first start to do the exercises. Over a few weeks, gradually increase the time you squeeze, lift and hold to 10 seconds
- Let go and slowly count to 5. Repeat the cycle 5 times
- Try to do the pelvic floor exercises 3 times a day. But, it’s fine if you can only manage once or twice a day to begin with. The main thing is to practise these exercises every day 

### __Exercise 3: Quick tone-up__
- Squeeze muscles and let go — repeat 10 times
- Practise this anytime, for example while you’re waiting for the kettle to boil or standing in a queue 

## Should I talk to a doctor?

Talk to a doctor if you start to experience urinary or faecal incontinence or if you suspect you might have pelvic organ prolapse. Your doctor will arrange for tests and examinations to determine the cause and severity of the problem and advise you on the best treatments. 

Depending on your symptoms, they may refer you to a specialist physiotherapist for pelvic muscle training as a first point of call. This can be very helpful, for example in managing stress incontinence. If you suffer from urinary incontinence and pelvic floor exercises don’t help, you may need more specialist treatment  such as bladder training, medication or surgery. 

Likewise, if you have pelvic organ prolapse, your doctor will discuss the best options for you. These may include hormone treatment, pessaries or surgery. 

## Weak pelvic floor in men

Pelvic floor dysfunction affects more women than men. But it can affect men too and lead to urinary and faecal incontinence, pelvic pain and sexual dysfunction such as erectile dysfunction, premature ejaculation and reduced penile sensation.  

Common causes of pelvic floor dysfunction in men include ageing, lack of exercise, surgery for prostate cancer and being overweight. Male pelvic floor function is involved in coordinating ejaculation and pelvic floor therapy has been shown to improve control (over ejaculation).  

Pelvic floor muscle exercises may also be beneficial as a relevant component for erectile dysfunction.  Always talk to a doctor if you have any concerns like pelvic pain, sexual dysfunction or pelvic floor weakness after surgery.

__This article has been medically approved by Dr Rhianna McClymont, Livi Lead GP.__


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Livi.co.uk > Your health > How to exercise weak pelvic floor muscles

How to exercise weak pelvic floor muscles

If your pelvic floor muscles are weakened it can cause issues with incontinence. Find out the symptoms and solutions from a Livi women’s health specialist

Pelvic floor exercises to strengthen a weak pelvic floor | Livi UK

We know that everyone’s journey to getting pregnant is different. Understanding how you can improve your health, fertility and chances of falling pregnant naturally is the best place to start. 

‘While there are some things out of your control when it comes to your fertility and falling pregnant, there’s lots you can do to improve your health at the beginning of your journey,’ says Dr Rhianna McClymont.

## Facts about fertility  

According to [figures from the NHS](https://www.nhs.uk/pregnancy/trying-for-a-baby/how-long-it-takes-to-get-pregnant/), if you’re under 40 and have regular sex without using contraception, there’s an 8 in 10 chance you’ll get pregnant within a year.

But we know that fertility declines with age, and more significantly [after the age of 35](https://www.livi.co.uk/your-health/having-a-baby-after-35-your-questions-answered/) – this is because of a decreasing number and quality of eggs. [Male fertility](https://www.livi.co.uk/your-health/male-fertility-9-lifestyle-factors-that-help/) also declines gradually with age.

Lots of people also experience fertility issues when trying for a baby, for a variety of reasons. The latest figures show that [1 in 7 couples have difficulty conceiving](https://www.tommys.org/pregnancy-information/planning-a-pregnancy/how-to-get-pregnant/how-long-does-it-take-get-pregnant) – approximately 3.5 million people in the UK. 

Although this can be distressing, there’s lots of help available – and it’s not uncommon for falling pregnant to take longer than you may expect.
‘It’s good to know that falling pregnant is a numbers game, to some extent. A young, healthy couple has around an 80% chance of conceiving within one year. And at least half of those that don’t conceive, likely will the following year,’ Dr McClymont reassures.

## Where’s the best place to start with boosting fertility?

### __1. Know your fertile days__
If you haven’t started to already, get to know your menstrual cycle by making a note of how long your cycle usually lasts. This will help you track the 6 ‘fertile days’ where conception is more likely to happen. 

These are the 5 days before ovulation happens and the day afterwards. 
Keeping an eye on your cycle’s length, regular pattern and cervical mucus changes helps you identify your fertile days. Remember that ovulation can vary from month to month, even if you have a regular cycle. 

For a more accurate idea of when you’re ovulating, you can buy over-the-counter ovulation kits to help find your fertile window. Like with most things, it’s always best to start with natural methods if you can.

### __2. Have lots of sex__
It may seem obvious, but one of the best ways to increase fertility is to have sex regularly (2-3 times a week). 

‘Sex every other day during the fertile window is recommended, and every 2-3 days throughout your cycle if you’re unsure when your fertile window is,’ says Dr Rhianna McClymont. 

Long periods of not having sex can reduce the number and quality of sperm, so try and make sex (a fun) part of your weekly routine. Although there are theories about which sexual position is better for conceiving, there’s no evidence to back this up.

### __3. Stay fit and active__
Exercising regularly gives you lots of important health benefits as well as boosting fertility. Although, it’s best to avoid excessive amounts of exercise or very strenuous workouts, as too much exercise can actually have negative effects on your ovulation.

### __4. Aim for a healthy BMI__
[A healthy BMI](https://www.livi.co.uk/your-health/5-simple-tips-for-a-healthy-bmi/) is between 18.5-25 – and so it’s best to be somewhere in the middle. Being overweight or obese can reduce your fertility as well as delay ovulation. Women with a BMI of more than 30 may take longer to conceive.  

Fertility is also affected if you’re underweight, as this can lead to problems with ovulation. 

If you’re worried about your weight, you can get support from a GP or dietician to help you get as healthy as possible when trying to get pregnant. 

### __5. Take a prenatal supplement__
Prenatal supplements are another recommended way to help improve your fertility. They also benefit early development of the embryo and reduce the chances of problems like spina bifida. These supplements mainly consist of folic acid (0.4 mg) – this is something women are recommended to take at least 12 weeks before pregnancy. 

Vitamin D is another recommended vitamin to take for fertility, and lots of prenatal supplements will include this too.

### __6. Stop smoking__
Smoking reduces your chances of falling pregnant naturally, and this includes e-cigarettes. Smoking affects both male and female fertility so we recommend that you and your partner stop smoking before trying for a baby. You can get lots of support and advice on quitting from a GP.  

### __7. Cut down alcohol and caffeine__
If you’re trying to get pregnant naturally, it’s always a good idea to limit the amount of alcohol and caffeine you’re drinking. Healthy limits for women are between 1-2 units of alcohol a week and 1-2 coffees a day. It’s even better to stop drinking alcohol completely.

### __8. Consider your contraception__
Many women can get pregnant immediately after stopping hormonal contraception, but for others it can take longer for their periods to regulate. 

‘If you’re using the combined contraceptive pill at the moment, and are planning ahead about trying for a baby, you may want to consider changing your contraception as it can take up to 3 months for regular periods to return,’ says Dr McClymont.

‘Similarly, if you’re using the contraceptive injection it can take a little while, sometimes up to a year for regular periods to return.’ 

### __9. Choose sperm-friendly lubricant__
Something that may seem a little less obvious to think about is your choice of lubricant, if you use one. Lots of lubricants contain spermicide which are designed to kill or slow down sperm and stop them from reaching an egg. Even lubricants that do not contain spermicide may significantly impede a sperm’s motility.

Look instead for a lubricant that mentions it’s ‘sperm-friendly’ on the packaging. 

### __10. Try not to worry__
Don’t panic if it doesn’t happen immediately. If you don’t fall pregnant straight away, it doesn’t mean there’s a problem. It’s considered perfectly normal for it to take up to a year to conceive a baby.

## What if I’m finding it difficult to get pregnant naturally?

Doctors usually advise to wait at least a year while having regular sex without contraception, before discussing fertility tests or treatment.

‘If you’ve been trying to conceive for a year and haven’t been successful then a GP can arrange tests for you which would normally include blood tests, a screen for sexual infections and sperm analysis for your partner,’ says Dr McClymont.

‘Depending on your medical history you may also be offered an ultrasound scan and referred to a fertility clinic for further treatment.’

## When to speak to a GP about fertility

- You’ve been trying for a baby for more than a year
- You’re aged 36 or over and want to try for a baby soon
- You take regular medication and want to get pregnant
- You have a long term medical condition like diabetes
- There’s a risk of passing on a medical condition like sickle cell disease
- You or your partner have a known or undiagnosed fertility issue like [endometriosis or polycystic ovary syndrome (PCOS)](https://www.livi.co.uk/your-health/severe-period-pain-endometriosis-or-pcos-how-can-you-tell-the-difference/), or a low sperm count
- You’re worried you or your partner may have an undiagnosed medical issue that’s affecting your ability to fall pregnant.


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Livi.co.uk > Your health > 10 health tips for planning a pregnancy – a doctor’s advice

10 health tips for planning a pregnancy – a doctor’s advice

 Expert advice from our Lead GP on boosting fertility to help with falling pregnant naturally

How to boost fertility naturally – a doctor’s guide | Livi UK

Rhianna-headshot

Lead GP, Livi

Thought your menstrual cycle was just about your period? In fact, your cycle is much more than just bleeding, and it can impact everything from your energy levels and mental health to your libido and skin. 

‘It’s a fascinating process that’s controlled by hormones communicating with the brain and other organs,’ says Dr Elisabeth Rosén. ‘The core purpose of your menstrual cycle is to achieve a pregnancy, but this impacts your entire body in different ways.’

## How long does a menstrual cycle last?

The average menstrual cycle is 28 days, but it can last anywhere between [21 and 45 days](https://www.ncbi.nlm.nih.gov/books/NBK470216/).  

![Your menstrual cycle explained](//images.ctfassets.net/h8qzhh7m9m8u/1P99JvlOCW30FoWl6TJlsz/a7f3ad57ace81e37014cff3d731f30cf/Menstraulcycle.jpg)

[Irregular menstrual cycles](https://www.livi.co.uk/your-health/what-causes-heavy-or-irregular-periods-a-doctors-guide/) are common too, especially if you’re experiencing mental or physical stress, or significant fluctuations in weight. ‘The body is clever – it won’t allow ovulation if it’s not ready for a pregnancy,’ says Dr Rosén.

But there are times when irregularities may suggest that something else is going on. ‘If your cycle is suddenly shorter than 21 days, it’s worth considering that it might not be a menstrual bleed but something else, which could suggest an infection in the uterus or changes to the cervix,’ Dr Rosén explains. 

‘Similarly, an ovarian cyst can affect the fine balance of all our hormones, and conditions like polycystic ovary syndrome (PCOS) can cause your cycle to last longer than 35 days. 

‘Later in life, irregular cycles are also the first sign of decreasing fertility and the start of [perimenopause](https://www.livi.co.uk/your-health/7-signs-of-perimenopause-a-doctors-guide/).’ 

## Which hormones control the menstrual cycle?

### Oestrogen
Oestrogen is a female sex hormone produced by follicles in the ovaries. The most important job of oestrogen is to regulate the menstrual cycle. It makes the lining of the uterus – the endometrium – thicker and more receptive to a fertilised egg. Oestrogen peaks just before ovulation.

### Progesterone
Progesterone is the other main female sex hormone. It’s produced by the corpus luteum – the leftover follicle after an egg has been released during ovulation. Its main job is to keep the endometrium in place and optimise it for implantation, and it peaks around day 21 of the menstrual cycle or about a week after ovulation

### FSH
FSH, or follicle-stimulating hormone, is produced in the pituitary gland in the brain. Its role is to get the egg follicles to mature, and it also plays a major role in kick-starting puberty. 

FSH rises during menstruation. It drops a couple of days before ovulation, when it’s important in the process of the body choosing only one egg for further maturation. It then rises again and helps facilitate ovulation before dropping to its lowest levels just before menstruation.

### LH
LH, or luteinising hormone, is also produced in the brain. Its job is to make ovulation happen and release the egg that’s the most mature. The production of LH is triggered when oestrogen levels peak, and it’s the spike in LH that makes ovulation happen. 

## The key phases of the menstrual cycle

### 1. Follicular phase

__When?__

From around the first day of your period until ovulation.

__What happens?__

‘The eggs in your ovaries are always there, trying to grow, but they’re only released for fertilisation when the hormonal balance is exactly right,’ says Dr Rosén. 

During this phase, the pituitary gland starts to produce FSH in response to the low levels of both oestrogen and progesterone. 

The FSH makes the follicles grow and produce oestrogen. The lining of your uterus grows thicker in preparation for a fertilised egg to get implanted, and eventually, when the oestrogen reaches a certain level, the FSH level drops. 

__How will it make me feel?__

__Potential migraines__ – ‘Oestrogen levels are low at the beginning of the follicular phase, so if you’re prone to hormonal migraines, this is when you’re likely to get them.’

__Increased libido__ – ‘Oestrogen tends to stimulate libido, so you may notice your sex drive increasing throughout the follicular phase,’ says Dr Rosén. This is your body’s way to try to get you pregnant, which is also why your vagina can feel fuller and your discharge more slippery. 

__Fuller breasts__ – Towards the end of the follicular phase, your breasts can feel fuller as well. 

![Follicular phase](//images.ctfassets.net/h8qzhh7m9m8u/45imWitDo6ggytBM8IzTBB/658df8e87c6ab8d29b3f06166cd49710/Follicular_phase.jpg)

### 2. Ovulation

__When?__

Ovulation occurs around day 14 in a 28-day cycle.

__What happens?__

At the end of the follicular phase, one egg – or in rare circumstances, one from each ovary – has won the growth competition and is ready for release. 

‘The mature egg produces so much oestrogen that it triggers the pituitary gland to release LH, which frees the egg,’ explains Dr Rosén. ‘It takes the egg around 24 hours to travel through the fallopian tube, where it must be fertilised for a pregnancy to happen.’ The egg survives for 24 hours, while sperm survive for up to 5 days.

__How will it make me feel?__

__Increased body temperature__ – ‘Your body temperature will rise by about half a degree Celsius just after you ovulate, because the sperm like it that way,’ says Dr Rosén. 

__Softer, more open cervix__– ‘The blood flow to the uterus will peak, and the cervix opens to welcome the sperm. You can have a feel – it’s usually quite hard and backwards-leaning, but just before and during ovulation it will be soft and open, and you’ll get that egg white-like discharge that helps to support the sperm.’

![Ovulation](//images.ctfassets.net/h8qzhh7m9m8u/1AKXjprMbeUWSmWlmH0S60/0355db8a4a632268eb2164df0394b77d/Ovulation.jpg)

### 3. Luteal phase

__When?__

The luteal phase of the menstrual cycle starts when the egg has been released during ovulation, so around 14 days before your period starts.

__What happens?__

The egg leaves behind its shell – the corpus luteum – which starts to produce progesterone to help the lining of the uterus mature. 

‘The body is waiting for a fertilised egg to move down through the fallopian tube and grow large enough to attach to the wall of the uterus, which takes a few days,’ says Dr Rosén. 

‘At around day 21, the corpus luteum can’t cope any more, and progesterone production starts to decrease. Eventually, progesterone and oestrogen levels are so low that the uterus lining breaks down, which is what becomes the period of bleeding.’

__How will it make me feel?__

__Premenstrual syndrome (PMS)__ – If you’re among the 80% of women who suffer from some sort of PMS,  this is the phase when you’re likely to experience it. ‘Progesterone has a calming effect, and its levels are low in this stage – so you might feel agitated, irritated and low,’ says Dr Rosén. 

__Hormonal acne__ – ‘Hormonal acne is usually worse during the luteal phase, again because of lack of progesterone.’

### 4. Menstruation

__When?__

The first day of your period is known as day 1 of your menstrual cycle, and this is also the first day of your follicular phase (see phase 1 above). The average cycle lasts 28 days, but this varies between different people.

__What happens?__

‘If you don’t get pregnant, you get your period as the lining of the uterus breaks down,’ says Dr Rosén. ‘During the luteal phase, when progesterone levels are high, the brain’s production of FSH and LH goes down to a minimum. When progesterone levels are low again, the cycle restarts and you go back to the follicular phase.’ 

__How will it make me feel?__

__Bleeding__ – Most people bleed for 3-5 days,  but this varies. 

__Potential cramping__ – Many experience mild cramping and discomfort during menstruation. If your pain is very severe, or you have an unusually heavy period or other worrying symptoms, there might be something else going on, so it’s best to talk to a doctor.

### 5. When am I most fertile?

‘During ovulation. The timing of this varies, but it’s usually 14 days before the first day of your period,’ says Dr Rosén. 

Getting to know your body throughout the menstrual cycle can be helpful, especially if you’re trying to conceive. ‘Pay attention to your vaginal discharge, have a feel of your cervix and notice if your breasts are starting to feel tender,’ Dr Rosén adds. ‘You’ll get to know the signs.’

![Menstruation](//images.ctfassets.net/h8qzhh7m9m8u/1HYsHbk9Y1lazvUjchJgh6/7c27ef46453ba60546e9823fc8363fe9/Menstruation.jpg)

### 6. How will my menstrual cycle change throughout my life?

__From your first period...__

The average age of getting your first period is just over 12 years, but this usually ranges from 9-15 years.  ‘It takes a while for your body to adjust and get the balance of all the hormones right, but after about a year, your periods should be regular,’ says Dr Rosén. 

__Through potential pregnancy and later life...__

With the exception of pregnancies and breastfeeding, and occasional skipped periods if you’re very stressed, your periods should continue regularly until you’re in your mid-40s. 

‘As we get older, the quality of our eggs declines, which is why the risk of miscarriage and chromosomal abnormalities increases. The corpus luteum also becomes less effective at producing progesterone, so your menstrual cycle might become shorter,’ says Dr Rosén. This is usually the very first sign of perimenopause.

__Ending with perimenopause and menopause...__

‘After a while, you start to run out of eggs, and you won’t have your cycle every month. Despite not ovulating, your ovaries will still produce oestrogen, causing your uterus lining to grow. But as you’re not ovulating, you’re not producing progesterone – and so eventually the lining becomes so heavy it just falls out. 

‘That’s why you can get very irregular but heavy, long-lasting bleeds until around the age of 51. After this time, if you haven’t had a period in a year, then you’re officially in menopause.’

![menstrual life line](//images.ctfassets.net/h8qzhh7m9m8u/2wso5QPqcJmY5XqYJn9CsP/7c070fcb3a9df99bdded641486256ab3/menstrual_life_line.jpg)

__This article has been medically approved by Dr Elisabeth Rosén, a medical doctor at Livi who specialises in gynaecology and obstetrics.__


livi.co.uk   >  article page >   CTA

Speak to a GP about your cycle

Livi.co.uk > Your health > Your menstrual cycle explained

Your menstrual cycle explained

Dr Elisabeth Rosén, a medical doctor at Livi who specialises in gynaecology, explains everything you need to know about the menstrual cycle

Your menstrual cycle explained | Menstrual cycle phases | Livi UK

Whether you’ve just been called up or you’re looking ahead to your next cervical smear appointment, it’s more important than ever not to miss this routine test.

There were an estimated [33,000 cases of cervical cancer in Europe in 2018](https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30122-5/fulltext),  with 15,000 people dying from the disease. The average age at diagnosis globally is 53, yet it’s the [third most common type of cancer affecting people under the age of 45](https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30482-6/fulltext).  

‘Each year in the UK alone, around 4,500 lives are saved by cervical screening – which shows the importance of having regular smear tests,’ says Dr McClymont.

## When do I need to go for a cervical smear test?

‘Any person with a cervix is invited for screening automatically when they reach the age of 25, and if the results are normal they’ll receive further invites every 3 years until the age of 49,’ Dr McClymont explains. 

‘Between the ages of 50 and 64, you’ll be invited every 5 years.’

You won’t usually need to have cervical screening if you’re pregnant – until at least 12 weeks after you’ve given birth. This is because pregnancy can make it harder to get clear results.

## What if I’m embarrassed by the thought of a smear test?

Despite the evidence that regular screening is so effective in detecting abnormal cell growth and the virus that causes cervical cell changes, human papillomavirus (HPV), many people avoid the tests due to embarrassment or anxiety. 

‘People who avoid smear tests often say awkwardness is the biggest reason for doing so,’ says Dr McClymont. ‘But it’s a short procedure, and your doctor or nurse has seen it all before – they’re just interested in testing your cervix. This is a simple test that could save your life, and there’s really no reason to be embarrassed.’ 

## What does the cervical smear test for?

‘The test looks for abnormalities in the cells of the cervix, as well as for HPV, which, if present, can cause abnormal cell growth,’ says Dr McClymont.

## Has the cervical screening process changed as a result of the pandemic? 

As a result of lockdowns, reallocation of staff and the prioritisation of other urgent care, [the pandemic has caused significant disruption to cervical smear screening programmes](https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21)00078-8/fulltext)  throughout Europe. So, it’s more important than ever to attend your cervical smear test when you’re called.

The test itself hasn’t changed as a result of the pandemic, says Dr McClymont, but you might find that processes at your local GP surgery have changed. ‘The nurse will wear a mask, and there may be fewer appointment slots available as it takes longer to thoroughly clean a clinical room between patients.’

## How can I prepare for a smear test if I’m anxious or nervous?

It’s not unusual to be a little anxious before a cervical smear test. Some people find that asking for a female nurse or doctor helps them feel more at ease, and relaxation breathing can help too. You can also ask the person performing the smear test to start with the smallest speculum. 

‘If you’re nervous about undressing, wearing a loose skirt is a good idea as you won’t need to fully remove it for the procedure,’ says Dr McClymont.

## What should I expect during the smear test itself? 

The nurse performing the smear test will explain to you exactly what will happen when you arrive and answer any questions you have before the test. 

- You’ll be invited to lay on an examination couch behind a screen and remove clothing from your lower half
- There will be a sheet or piece of clinical roll for you to cover your groin with, and you’re entitled to have a chaperone in the room with you if you’d prefer
- You should lie on your back with your feet together and knees apart. 
- The nurse will insert a lubricated plastic speculum into your vagina to enable good visualisation of your cervix
- A small “brush” is then used to remove some cells from the cervix, which are deposited in a small pot and sent to the laboratory for analysis
- The examination itself usually only takes a few minutes

## Can it ever be painful or uncomfortable?

‘A cervical smear is usually not a painful procedure, although some people report mild discomfort,’ says Dr McClymont, adding that it’s usually worse if you’re tense or anxious, as your pelvic floor muscles are more likely to tighten, making the procedure more difficult. 

‘If you’re very anxious, take some deep breaths and try to relax as much as possible.’

## Is it normal to bleed after the screening? 

‘A small amount of spotting after the procedure is quite common, but it should resolve very quickly,’ says Dr McClymont. ‘Wearing a pantyliner for a few hours is normally all that’s required.’

## What happens after the screening? 

After the test, the specimen is sent to a laboratory for analysis. It usually takes around 2 weeks for the results to come back.

‘If your results are normal, no further action is required, and you’ll be invited for another routine smear 3 or 5 years later, depending on your age,’ says Dr McClymont. ‘If abnormalities are found, however, you’ll usually be invited for a procedure called a colposcopy, to look at your cells in more detail.’

A colposcopy, Dr McClymont explains, is a procedure similar to a cervical smear, but it’s performed in hospital using a microscope and special dye to stain the cervix cells and make abnormalities easier to identify. ‘Having abnormalities in your cells usually doesn’t mean that you have cancer, but further tests or treatment are recommended to prevent cancer developing in future.’

## Do you need to have smear tests if you’re not sexually active?

People who have never been sexually active have a very low risk of cervical cell abnormalities – but not a zero risk. That’s why attending a screening is always advisable, regardless of your sexual history. ‘If you’ve never had sex, this may understandably make you nervous,’ says Dr McClymont. ‘It’s best to chat to a doctor or nurse about your individual circumstances.’


livi.co.uk >  article page >   CTA

Talk to a GP about your smear test

Livi.co.uk > Your health > What happens during a cervical smear test? How to prepare and what to expect

What happens during a cervical smear test? How to prepare and what to expect

Regular cervical smear tests save lives. Lead Livi GP Dr Rhianna McClymont explains what you can expect from your cervical smear test

What happens in a cervical smear test? How to prepare | Livi UK

Endometriosis and polycystic ovary syndrome (PCOS) are two conditions that affect millions of people around the world. PCOS affects around 8% to 13%  of women and people with uteruses globally, and endometriosis affects around 10%.  While they both can cause irregular bleeding and problems getting pregnant, there are some key symptom differences to be aware of.

Here, Dr Elisabeth Rosen, a medical doctor at Livi who specialises in gynaecology and obstetrics, gives her advice on how to tell if severe period pain and other symptoms are caused by PCOS or endometriosis, and when to talk to a doctor.

## What is PCOS and what are the key symptoms?

‘PCOS is a complex disorder that causes elevated levels of sex hormones,’ says Dr Rosen. ‘Polycystic ovaries contain fluid-filled cysts known as follicles, in which eggs develop but usually never mature enough to ovulate. This affects the menstrual cycle, leading to [irregular bleeding](https://www.livi.co.uk/your-health/what-causes-heavy-or-irregular-periods-a-doctors-guide/) and problems ovulating.

‘In the long term, living with PCOS can lead to a higher risk of type 2 diabetes, cardiovascular diseases and uterine cancer.’

The most common PCOS symptoms include:

- Irregular periods, long gaps between periods, or no periods
- Excessive hair growth on the face, chest and abdomen
- Weight gain
- [Acne](https://www.livi.co.uk/your-health/acne-types-and-their-treatments-help-to-clear-your-skin/)

## What is endometriosis and what are the key symptoms?

Endometriosis is an inflammatory condition in which cells similar to the ones in the lining of the womb are found elsewhere in the body, explains Dr Rosen. When these start to grow, they cause local inflammation and scarring. Endometriosis is most commonly found in the pelvis, but can be found in other parts of the body.

Not everyone who has endometriosis gets symptoms, and they can vary over time and between different people.

The most common endometriosis symptoms include:

- Severe period pain
- Heavy or irregular periods
- Pelvic or lower back pain, outside of menstruation
- Urinary tract problems, like blood in the urine or pain when emptying your bladder
- Pain during sex
- Pain while pooing
- Fatigue and lack of energy

## What’s the link between endometriosis, PCOS and infertility?

Both endometriosis and PCOS are linked to an increased risk of infertility. ‘As PCOS is a condition that causes problems with the release of eggs from the ovaries, it can make getting pregnant more difficult,’ says Dr Rosen.

More research is needed to determine why endometriosis affects fertility, but this may be caused by inflammation, scarring or deformation in the pelvic area.  People who have minimal or mild endometriosis usually have a better chance of becoming pregnant than those with more severe cases.

## How is PCOS diagnosed?

There’s no single definitive test to diagnose PCOS, which can make it harder to identify. A doctor will ask questions about your symptoms and experiences, explains Dr Rosen. They will refer you for a blood test to test your hormone levels and do an ultrasound to check for signs that your ovaries are polycystic.

## How is endometriosis diagnosed?

Endometriosis can take 6 to 7 years on average to diagnose.  Like PCOS, it’s usually a multi-stage process. Dr Rosen advises that a doctor will first ask about your symptoms, before referring you for further testing such as an ultrasound or laparoscopy – a form of keyhole surgery – to check for the presence of endometriosis lesions.

## Can you have both PCOS and endometriosis at the same time?

There are people who have been diagnosed with both conditions,  but Dr Rosen explains that while it’s possible, it’s not very common.

## When should I see a doctor about severe period pain?

Severe period pain is more closely linked to endometriosis than PCOS. ‘If you can manage the pain with paracetamol or ibuprofen a couple of days per month and it decreases over a couple of years (after your periods have just begun), there’s usually nothing to worry about.’

Dr Rosen emphasises that if you’re concerned, it’s better to speak to a doctor, especially if your menstrual pain affects your ability to go to work or school.

## How can I prepare to see a doctor about severe period pain – and increase my chance of a faster diagnosis?

Dr Rosen advises keeping track of your symptoms and menstrual cycle to help you spot patterns. You can use a cycle tracker app or a physical diary.

According to Dr Rosen, the more information you can give, the better. ‘Write any symptoms down that you feel may be associated with either your irregular bleeding (for suspected PCOS) or your severe period pain (for suspected endometriosis), including how long they last and when they occur,’ she says.

This also applies to painkillers. ‘Rather than just saying: “I take paracetamol,” it’s good to know how much, how often and for how many days,’ adds Dr Rosen.

## What can I do if I feel my pain isn’t being taken seriously?

Unfortunately, many women encounter difficulties getting diagnosed with endometriosis and PCOS, but being aware of this can help. 

If you don’t get a diagnosis immediately, you should keep pushing for answers, says Dr Rosen. ‘Even if it isn’t endometriosis or PCOS, a doctor will be able to carry out the necessary investigations to understand what’s causing your pain, irregular bleeding or other related symptoms.’

If you’re ever concerned about your period or period-related symptoms, book a meeting to discuss it with a doctor.

__This article has been medically approved by Dr Elisabeth Rosen, a medical doctor at Livi who specialises in gynaecology and obstetrics.__


livi.co.uk > Your health > Severe period pain, endometriosis or PCOS – how can you tell the difference?

Severe period pain, endometriosis or PCOS – how can you tell the difference?

Wondering whether your heavy periods or extreme period pain could be the sign of an underlying issue? Here’s what you need to know about two common, but often misunderstood, conditions

livi.co.uk > Your health >Severe period pain, endometriosis or PCOS – how can you tell the difference?

Differences between period pain, endometriosis & PCOS | Livi UK

More and more women are choosing to start a family later in life, and the average age of first-time mothers in Europe is now between 29 and 30.  Despite this, many women worry about the best age to have a baby and the implications of getting pregnant at an older age.

Dr Elisabeth Rosen acknowledges that it’s good to be aware of any risks, as well as ways to prevent them. But she also points out that focusing too much on potential problems only tends to make us worried.

‘There’s already a huge amount of anxiety and worry around pregnancy and birth. In reality, if you’re generally in good health, there’s a good chance that you’ll have a straight-forward pregnancy and a healthy baby,’ she says. ‘I also think it’s important to emphasise that no one ever feels entirely ready to become a parent!’

## What happens to the body and fertility with age?

‘The ovaries are formed at the embryonic stage, and we’re born with a predetermined number of eggs,’ Dr Rosen explains. ‘The eggs then rest until puberty, after which they’re used until they run out, simply speaking. The quality of the eggs deteriorates over time, but to what extent really varies from one individual to another. Some women get pregnant easily at 40 while others struggle when they’re only 30. But generally speaking, fertility decreases quite drastically around the age of 35.’

## What are the risks of having a baby after 35 or being a ‘geriatric mother’?

‘The risks of high blood pressure and diabetes increase with age, and pregnancy can increase that risk,’ says Dr Rosen. ‘There are also studies that show increased risk for preeclampsia, premature birth, a low birth weight, miscarriage, chromosomal abnormalities and stillbirth with age. A doctor or midwife will screen for high blood pressure and gestational diabetes, and in most cases, the conditions can be identified and successfully treated or controlled.

‘When weighing up your options, it’s worth considering these risks. It can also be worth knowing you’re more likely to need to use an egg donor for IVF to be successful when you’re older, which again increases the risk for high blood pressure and preeclampsia.’

When you go into labour, you might need a little more assistance since studies show that the risk of complications slightly increases with age, Dr Rosen explains. ‘Complications can include the risk of tearing, which increases slightly as a result of body tissues losing elasticity as we age. You’re also more likely to have to be induced, require a caesarean section or need other interventions.’

## I’m worried about miscarriage and chromosomal abnormalities – is this normal?

Many people feel anxious about the increased risk of both miscarriage and chromosomal abnormalities when trying to get pregnant. It can be reassuring to know that, while the risk of miscarriage increases after the age of 30, it starts out very small for mothers aged 25 to 29, at around 10%. 

‘The increased risk of miscarriage is a result of the lower quality of eggs,’ says Dr Rosen. ‘Chromosomal abnormalities are linked to this too. You’ll be offered screening tests to determine the risk of these and some of them are performed as routine.

‘It’s a good idea to think about what a potential high-risk result would mean to you before you have those tests. If you’re not sure what kinds of tests you’d like done, or if you’re struggling to process the results you get, a doctor will be able to support and advise you.’

## Are there any benefits to having children after 35? How do I know when I’m ready?

‘There’s been a shift in human behaviour across the western world, which is why more people are choosing to start a family later in life. We take gap years and study more, and many people meet their life partners at a later age. As a result, from a psychological perspective, life can be more stable when you have a child later on,’ says Dr Rosen. ‘Some studies suggest that these children do better. But if you’re waiting for everything to be perfect, you might never feel ready.

‘Fertility peaks around the age of 25, but there’s no best age to have a baby. From a fertility perspective, if you’ve met someone you want to have children with, it’s wise not to put it off. If you’re unsure, talk to a doctor about your options.’

## What can I do to increase my chance of having a baby after 35?

‘Stop smoking, cut down on alcohol, get some exercise and make sure you eat a well-balanced diet,’ says Dr Rosen. ‘A lot of caffeine will lower your chances of getting pregnant and can increase the risk of miscarriage, so cutting down is a good idea. That said, lectures about exactly what to do and what not to do can just increase your stress levels, which can negatively impact your chances of conception. Just look after yourself.’

If you’re hoping to get pregnant, it’s a good idea to take 400 micrograms of folic acid daily, from before conception and right through the first 12 weeks of pregnancy.  This is to help reduce the risk of any developmental issues in the early weeks.

If you’re overweight, losing weight can help increase your chances of conception and minimise risks once you do get pregnant, Dr Rosen explains. ‘Speaking to a doctor to check that you’re generally well can also be worthwhile. Get your thyroid function checked, as an imbalance can impact your chances of getting pregnant, and it’s something that can be easily treated.’

## What can I do if I’m struggling to conceive?

‘The help and treatments that a doctor will recommend to you will depend on the cause of your reduced fertility,’ says Dr Rosen, adding that everything from irregular ovulation and sperm quality to difficulty having penetrative sex can contribute to problems with conceiving.

Conditions like endometriosis and polycystic ovary syndrome (PCOS) are other common explanations, and eating disorders can play a role too.  ‘Sometimes helping the sperm get through to the uterus is enough, and other times we turn to IVF,’ says Dr Rosen. ‘Sometimes we need to boost the lining of the uterus to help it hold on to a fertilised egg.

‘In around 70% of infertility cases, we’re able to determine the underlying cause. There are a number of different factors that can affect the success of any treatment, but the huge majority of those who want to have a baby do so eventually.’

The different treatments available to you depend on where you live, so a doctor or gynaecologist will be able to talk you through your options.

## What should I do to support myself and my baby when I do get pregnant?

‘Exercise, eat well and keep taking folic acid – but don’t panic if you forget. Most people get everything they need from their diet,’ says Dr Rosen.

Many women worry about the impact of exercise, but research has shown that regular, moderate exercise is safe and can even reduce the risk of gestational diabetes. 

‘There are lists of things you shouldn’t do or eat, and it’s good to be aware of those, but it’s more important to focus on taking care of yourself,’ says Dr Rosen.

__This article has been medically approved by Dr Elisabeth Rosen, a medical doctor at Livi who specialises in gynaecology and obstetrics.__


livi.co.uk > Your health > Having a baby after 35: your questions answered

Having a baby after 35: your questions answered

Are you worried about what it means to get pregnant after 35? Dr Elisabeth Rosen, a Kry doctor who specialises in gynaecology and obstetrics, shares her advice on what to think about and how to know when you’re ready

livi.co.uk > Your health >Having a baby after 35: your questions answered

## Quick facts

- Pelvic pain is widespread, and chronic pain affects 1 in 6 women
- Women are less likely to report chest pain and more likely to dismiss heart disease symptoms than men
- Ovarian cancer is often diagnosed at a late stage, despite being one of the most common gynaecological cancers

If you’ve ever found yourself dismissing or brushing off a health symptom, you’re not alone. Lots of women feel embarrassed, anxious or scared of being judged when it comes to speaking up about certain health issues.

Many female conditions can also be harder to identify – like endometriosis, a debilitating condition that affects 10 percent of women in the reproductive age group worldwide  and takes an average of 7.5 years from the onset of symptoms to get a diagnosis. 

This likely stems from the historic gender inequality within the world of healthcare. ‘For years, women’s health has been under-prioritised, meaning it may take longer to get a diagnosis, and until recently clinical trials were mainly conducted on men,’ says Dr Elisabeth Rosen, a medical doctor at Livi who specialises in gynaecology and obstetrics.

‘It’s important to always put your health first as you only have one body and it’s supposed to last for a very long time. You should always speak to a doctor if you have an issue with anything that you don’t feel familiar with or are worried about.’

Here are some key women’s health symptoms that you shouldn’t ignore.

## 1.	Breast changes

Regularly examining your breasts is an important way to detect breast cancer. It’s now the world’s most commonly diagnosed cancer. 

‘It’s very important to check for changes in your breasts,’ says Dr Rosen. ‘Every woman should examine their breasts once a month at the same point in their menstrual cycle. It’s the most important life insurance a woman can give herself.’ 

A breast lump is the most recognisable  (and common ) [sign of breast cancer](https://www.livi.co.uk/your-health/are-you-checking-your-breasts-correctly-a-doctors-guide/). Reassuringly, most breast lumps are not cancerous.  Other breast changes to look out for include:

- The shape and size of your breasts
- A lump or swelling in your armpit
- Discharge from your nipples
- Thickening or dimpling of the skin
- An inverted nipple
- Red areas
- A rash

‘If you notice any changes, it’s worth getting them checked out by a doctor,’ advises Dr Rosen.

## 2.	Discomfort or pain in your chest

If you experience discomfort or pain in your chest, this may be an indicator of something more serious. If it suddenly occurs and doesn’t go away, it may even be a sign of a heart attack. 

‘The most common heart attack symptoms for women include chest pain or discomfort, shortness of breath, lethargy, and pain radiating in the arms, back, jaw and neck. You could also suffer from a sensation of heaviness and pressure on your chest,’ says Dr Rosen. ‘Get emergency help straight away if you feel any strange sensations in your chest.’

Despite coronary heart disease (CHD) being the single biggest killer of women worldwide,  women are less likely to report chest pain and more likely to dismiss symptoms. They’re also 50 percent more likely than men to be initially misdiagnosed when it comes to heart attacks. 

Dr Rosen points out that chest pain could also indicate a lung embolism, which affects more women than men and requires urgent medical assistance, as it can be life-threatening.

## 3.	Heavy or irregular bleeding

There are many factors that affect your menstrual cycle, including stress, weight loss and doing too much exercise.  But if your periods are heavier than normal and you have irregular bleeding, it’s a good idea to discuss this with a doctor.

‘With abnormal bleeding, it’s important to get it checked as there could be an underlying condition that needs to be treated. Apart from being an inconvenience, heavy bleeding can cause anaemia and can also be a sign of fibroids, polyps, or womb or cervical cancer,’ says Dr Rosen.

‘Irregular bleeding is usually related to your menstrual cycle not working properly. Polycystic ovary syndrome, sexually transmitted infections (STI), ovarian cysts, benign growths in the womb or the lining of the cervix, or cervical or womb cancer can all cause irregular bleeding.’

She also recommends seeing a GP straight away if you have postmenopausal bleeding, as this is abnormal.

## 4.	Bloating

Feeling bloated occasionally isn’t necessarily something to worry about, but it’s important to know that increased abdominal size is one of the main signs of ovarian cancer.  Unfortunately, ovarian cancer is often diagnosed at a late stage and there’s generally a low awareness of the risk factors and symptoms,  even though it’s one of the most common gynaecological cancers. 

‘Ovarian cancer is a harder condition to identify,’ says Dr Rosen. Other associated symptoms of ovarian cancer to look out for include:

- Lower abdominal pain
- Irregular bleeding
- Increased urinary urgency
- Lower back pain
- Loss of appetite
- Feeling full when eating
- Weight loss
- Changes in your bowel habits

Other common causes of bloating include irritable bowel syndrome (IBS), food intolerance and constipation. 

## 5.	A persistent low mood

[Depression](https://www.livi.co.uk/your-health/help-for-depression-7-daily-tools-to-improve-your-mood/) appears to be more prevalent in women.  The signs and symptoms to be aware of include a persistent low mood, irritability, low energy and difficulty concentrating and sleeping. 

‘Depression is a condition that needs to be treated, so it’s important to discuss it with a doctor. [Postnatal depression](https://www.livi.co.uk/your-health/help-for-postnatal-depression/) is an underdiagnosed condition and many women feel ashamed about getting help because the expectations placed on a new mother can be high,’ says Dr Rosen.

## 6.	Abnormal discharge

Vaginal discharge is something that most women experience, and it’s needed to keep the vagina moist and protect against infections.  According to Dr Rosen, healthy discharge doesn’t have a smell and is either clear or white. It’s also common to see changes in the amount and consistency throughout your menstrual cycle. 

‘If you’re experiencing discharge that is unusual for you, speak to a GP,’ says Dr Rosen. ‘Abnormal discharge could be a sign of an infection.’ Common infections like thrush can often be treated with over-the-counter medicine.  But abnormal discharge can also be a symptom of an STI, like gonorrhoea or chlamydia. If these STIs are left untreated, they can cause pelvic inflammatory disease (PID), which can lead to damage to the reproductive organs  and sometimes infertility. 

‘It’s important not to ignore symptoms because if infections are ruled out, abnormal discharge could be a sign of cervical cancer,’ says Dr Rosen.

## 7.	Pelvic pain

Pelvic pain is widespread and chronic pain affects 1 in 6 women.  ‘Common causes of pelvic pain include ovulation, endometriosis, [a urinary tract infection (UTI)](https://www.livi.co.uk/your-health/utis-your-questions-answered/) or PID. If you’re pregnant, pelvic pain can be caused by an ectopic miscarriage, miscarriage or premature labour. Other causes include ovarian cysts, IBS, constipation, appendicitis, inflammatory bowel diseases and ovarian cancer,’ says Dr Rosen. ‘If you have sudden, severe and long-term pelvic pain, seek an appointment with a GP.’

Learn more about what causes [abdominal pain in women](https://www.livi.co.uk/your-health/what-causes-lower-abdominal-pain-in-women/). 

## 8.	Pain during intercourse

Nearly 3 out of 4 women experience painful sex at some point in their lives.  ‘Pain during intercourse isn’t normal, but many women suffer from it from an early age and often don’t seek help due to embarrassment,’ says Dr Rosen. 

There are a variety of reasons why sex may be painful, including:

- Endometriosis
- Vaginal dryness
- Atrophic vaginitis (thinning and drying of the vaginal walls, which occurs most often after menopause)
- PID
- Ovarian cysts
- Fibroids
- Infections
- Vulvodynia (vulval pain)
- Vaginismus

‘Discuss it with a doctor and they’ll help determine the cause of your pain,’ advises Dr Rosen.

## 9.	An intense headache

The leading symptom of a migraine is an intense headache on one side of the head.  Women experience migraines 3 times as often as men.  According to Dr Rosen, it’s partly due to oestrogen levels changing, so many women will experience it at the same time in their menstrual cycle each month or during [perimenopause](https://www.livi.co.uk/your-health/7-signs-of-perimenopause-a-doctors-guide/). 

‘Additional symptoms of a migraine include nausea, visual disturbances and increased sensitivity to light. Sometimes you may also experience sweating, diarrhoea and poor concentration. In very severe cases, your nervous system can be affected – you may have problems speaking properly or you may become dizzy and lose consciousness. It’s important to seek help to rule out other conditions like a tumour,’ says Dr Rosen.

Discover what other [types of headaches](https://www.livi.co.uk/your-health/9-types-of-headache-and-what-you-can-do/) might mean.

## 10.	Ongoing fatigue

While it’s very common for people to feel tired, if you’re experiencing ongoing fatigue, your body may be trying to tell you something is wrong. Dr Rosen suggests that there could be many different reasons for your fatigue, including:

- Iron deficiency
- Lack of vitamin D
- Depression
- Heart disease
- Lack of quality sleep

‘[Fatigue ](https://www.livi.co.uk/your-health/whats-causing-your-tiredness/)is one of the main symptoms of an underactive thyroid (hypothyroidism), an autoimmune disease that mainly affects women. The condition has symptoms of tiredness, feeling cold, lack of concentration, depression, dry skin, brittle hair and nails, constipation, weight gain, a low heart rate and muscle pain and weakness. Speak to a GP if you’re experiencing these symptoms.’

Book a meeting to discuss any symptoms or issues that you’re worried about with a doctor.

__This article has been medically approved by Dr Elisabeth Rosen, a medical doctor at Livi who specialises in gynaecology and obstetrics.__


Livi.co.uk > Your health > 10 women’s health symptoms you should always talk to a doctor about

10 women’s health symptoms you should always talk to a doctor about

It may be tempting to dismiss health symptoms that seem minor, but there are some issues you shouldn’t ignore. Dr Elisabeth Rosen, a Livi doctor who specialises in gynaecology and obstetrics, shares her advice on the women’s health issues to be aware of

## Quick facts

- Heavy periods are a common cause of iron deficiency and anaemia
- Excessive dieting and exercise can cause irregular or absent periods, known as amenorrhea
- Irregular periods may be a sign an underlying condition so it’s best to talk to a doctor

Some women have heavy periods, while others have quite light periods, and as a general rule, every woman’s menstrual cycle and periods are individual. But sometimes heavy bleeding or problem periods are a symptom of something more serious. In fact, painful, irregular or heavy periods affect up to 14 percent of women in their childbearing years. 

## What is a period, anyway?

In simple terms, a period is your body’s way of saying you might be able to have a baby, but you have not conceived. Every month, the lining of the womb thickens in readiness for a fertilised egg, and if an embryo has not latched on to this lining, it’s shed as a period. 

This monthly cycle is driven by changes in levels of the hormones oestrogen and progesterone, so anything which affects these hormones can also affect periods.

Dr Rhianna McClymont explains how lifestyle and age can influence your menstrual cycle and when you should speak to a doctor about any concerns.

## Is it normal to miss a period?

‘It’s quite normal to get variations in periods when you first start menstruating,’ says Dr McClymont. ‘Also, as your periods are ending in the lead-up to [menopause](https://www.livi.co.uk/your-health/7-signs-of-perimenopause-a-doctors-guide/), changes both in cycle length and blood loss can continue for many months, or even years.’

Depending on a woman’s age, the most obvious reasons for periods to stop altogether are pregnancy and menopause. But other causes of irregular periods, or periods stopping completely, which is known as amenorrhea are:

- Sudden weight loss
- Being over- or underweight
- Doing too much exercise
- Stress 
- Some contraceptives, such as the progesterone-only pill or intrauterine system (IUS)

Sometimes an irregular period is a sign of something more serious, like polycystic ovary syndrome (PCOS) or a thyroid problem.  

## When is a period too heavy?

Heavy periods are common, and some women experience heavy periods with clots. Very heavy periods disrupt day-to-day life and can be physically and emotionally challenging. The definition of menorrhagia, as it is known, is losing 80ml — around 16 teaspoons, or more in each period, having periods that last longer than 7 days, or both.

Unless you use a menstrual cup, you may not be sure how much blood loss is too much. Other signs that your periods may be too heavy are:

- Having to change your sanitary products every couple of hours
- Having to empty your menstrual cup more often than recommended in order to prevent leaks
- Passing blood clots that are bigger than 2.5cm — around the size of a 10p coin
- Having to use more than one sanitary product at the same time
- Bleeding through to your clothes or bedding
- Having to get up in the night to change sanitary products, or empty your menstrual cup

Heavy periods are a common cause of iron deficiency too. In the UK, 1 in 4 women has iron levels below recommended levels  and the World Health Organization estimates that across Europe 22.6% of women of child-bearing age are anaemic.  Signs you may need to have your iron levels tested include tiredness, breathlessness and heart palpitations. 

Some medical problems can also cause heavy periods. ‘Conditions which affect the lining of the womb, like fibroids, endometriosis or polyps, can cause bleeds to be heavier,’ says Dr McClymont. Other potential causes are: 

- An underactive thyroid
- Clotting problems such as Von Willebrand disease
- Diabetes 
- Copper intrauterine devices (IUDs) 
- Anticoagulant medicines, like warfarin
- Herbal supplements, including ginseng, ginkgo and soya

If your periods are heavy, it’s a good idea to speak to your GP to rule out any underlying health problems and check you are not anaemic. Treatment options may include:

- A combined or progesterone-based oral contraceptive
- An IUS which releases progesterone
- A procedure to remove the lining of the womb
- Procedures to reduce or remove fibroids
- Hysterectomy

## Is it normal to bleed after sex?

Some, but not all women bleed after having penetrative sex for the first time. This is caused by breaking the hymen, a thin piece of skin which partially covers the vagina. However, this can easily happen before then as a result of using tampons, or horse riding and other sports.  

But if bleeding after sex happens regularly, speak to a GP. It could be a sign of:

- Pelvic inflammatory disease (PID)
- Chlamydia and other STIs
- Vaginal dryness, which is more common after menopause
- Cervical erosion
- Cancer of the cervix or vagina

## When should I see a doctor?

‘If you notice a change in your menstrual pattern from your “normal” then it is best to have a chat to a GP,’ Dr McClymont advises. ‘For instance, if you’ve always had fairly light bleeds but they have suddenly become heavier, and you’ve started passing clots, you should discuss this with a doctor.

‘Also, if you’ve started bleeding between your periods, bleeding after sex or have bleeding after you’ve gone through the menopause, you need to have a chat with your doctor.’

If you are still going through puberty and your periods have always been a little irregular there is nothing to worry about. But other times to see a doctor are: 

- You’re under 45 and your periods have suddenly become irregular
- Your periods are more frequent than every 21 days or come less often than every 35 days
- Periods last longer than 7 days
- There is a difference of at least 20 days between your shortest and longest cycles
- Your periods are erratic and you are trying to get pregnant


livi.co.uk > What causes heavy or irregular periods? A doctor's guide> button

livi.co.uk > Your health > What causes heavy or irregular periods? A doctor’s guide

What causes heavy or irregular periods? A doctor's guide

There are many reasons your period might change — from your hormones to the supplements you’re taking. Dr Rhianna McClymont, Livi’s Lead GP, shares her advice on period changes

livi.co.uk > Your health > What causes heavy or irregular periods? A doctor's guide

What causes heavy or irregular periods? A doctor’s guide

The weeks and months after giving birth can be a vulnerable time for new parents. If you think you may be suffering from postnatal depression, here’s how you can find help.

### Quick facts
- Depression among new mothers has almost tripled since the start of
the pandemic
- Up to a third of new fathers can experience depression, yet only 1 in 5
seeks help
- Support and therapy are available through your doctor

Having a baby can be one of the happiest times. But it can also be stressful — one that can bring feelings of confusion, loneliness and for many, depression.

‘Adjusting to motherhood can be a challenge under normal circumstances,’ says Dr Elisabeth Rosen, medical doctor at Livi.

‘But giving birth during a pandemic presents extra concerns — social distancing, changes in hospital procedures and worries about exposure to Covid-19, can make women feel even more susceptible to anxiety and depression.’

### You’re not alone

Postnatal depression is a common problem that affects 1 in 10 women in the UK, within a year of giving birth.

A new study shows that depression among expectant and new mothers has almost tripled since the start of the coronavirus pandemic – going from 15% to 41% of new mothers. It also showed moderate to high anxiety rose from 29% to 72% in pregnant women and new mothers.

### Postnatal depression or ‘baby blues’?

‘It‘s perfectly normal for many women to experience what‘s commonly known as the ‘baby blues‘ in the first week or so after giving birth,‘ says Linda Karlsson, Licensed Psychologist at Livi.

‘This can last anything from a few days to a week or so.‘ Typical symptoms include feeling emotional and bursting into tears for no apparent reason, feeling irritable or touchy, low mood, anxiety and restlessness.

‘If you’re still feeling low after 2 weeks, this may be a sign of postnatal depression. This can also affect fathers and partners.’

### Symptoms of postnatal depression

Postnatal depression can occur at any time in the first year after giving birth. ‘All women are different and not all women with postnatal depression get all the symptoms,’ says Karlsson. If you get any of the symptoms below, talk to a doctor or psychologist.

__Main symptoms include:__
- Persistent depression, sadness and low mood
- Lack of energy and feeling tired all the time
- Lack of enjoyment and interest in the wider world

__Other symptoms may also include:__
- Problems sleeping at night and feeling sleepy during the day
- Difficulty bonding with your baby
- Withdrawing from other people
- Lack of concentration and finding it hard to make decisions
- Disturbing thoughts, for example, about hurting your baby or suicide

### How your hormones can affect your mood after childbirth

‘We don’t know exactly why postnatal depression occurs,’ says Dr Rosen.
‘But one of the reasons (although there’s no conclusive evidence for this) may be the rapid drop in the hormones oestrogen and progesterone straight after you give birth.’

‘Low progesterone can cause anxiety, mood swings, irritability and depression,’ says Dr Rosen.

‘The drop in oestrogen can also trigger depression and anxiety. While the
increase in the calming, bonding hormone oxytocin (that [occurs during breastfeeding](https://www.livi.co.uk/your-health/breastfeeding-whats-happening-in-your-body/)) should help to compensate for this, it seems that in some women this doesn’t happen. Once you stop breastfeeding, hormones should gradually go back to normal.’

Be aware, though, that postnatal depression can be triggered by many other factors, and it differs from person to person.

### Breastfeeding and emotions

Some women who are breastfeeding experience abrupt dysphoria, or negative emotions like sadness, depression, anxiety and irritability just prior to the moment milk is released. This is a condition called Dysphoric Milk Ejection Reflex (D-MER).

These feelings are usually brief and pass in 30-90 seconds. While they can be distressing, it can be reassuring to know that these are not a sign of postnatal depression.

But if you‘re experiencing postnatal depression, D-MER will be harder to handle.

So it’s important to get help from a doctor or a psychologist.

### Who’s at risk of postnatal depression?

Some people will be more at risk of developing postnatal depression — these include:
- Women (and men) with a history of mental health issues, particularly
depression
- A history of mental health problems during pregnancy
- Having no close family or friends to support you
- A poor, troubled or abusive relationship with your partner
- A history of substance abuse
- Lack of sleep after the baby is born
- A stressful or traumatic labour
- Feeling overwhelmed and worried about being a parent
- Having experienced recent stressful events like a bereavement or
separation from your partner
- Experiencing the baby blues
- Financial worries

### Postnatal depression in men

It’s not just women who are at risk of developing postnatal depression – men can get it too.

Until recently, it was believed approximately 10% of new fathers experience postnatal depression. But a recent study suggests this figure might be as high as 27%. Yet fewer than 1 in 5 fathers who were depressed sought help, and a third had considered self-harm.

The study showed that while many women are screened for postnatal depression, the mental health of fathers is rarely assessed. What’s more, postnatal depression in men may show itself in different ways, like anger, irritability, working longer hours and drinking too much.

Read more about the signs of [depression in men](https://www.livi.co.uk/your-health/signs-of-depression-in-men/).

### Help for postnatal depression

‘To meet the criteria for postnatal depression, symptoms need to last for at least 2 weeks,’ says Dr Rosen. ‘It usually happens between 4 and 6 weeks after giving birth, but may be any time after pregnancy. ‘There is an expectation of women that they should feel super-happy after having a baby, but many women are hesitant to admit they don’t feel this way.

‘In fact, it’s common for new parents to feel depressed, confused, frustrated, tired and disillusioned — that’s nothing to feel ashamed of.‘Support and treatments are available, so speak to a doctor, who can help you to work out what are the best options for you.’

In the UK, many healthcare visitors have been trained to recognise postnatal depression and can help advise you on strategies that can help.
‘Whatever you do, don’t suffer in silence,’ says Dr Rosen. ‘If you think your partner is having problems, encourage them to get help too.’

### Postnatal depression self-help

__Talk to family and friends__. Tell them how you’re feeling and don’t be afraid to ask for help with things like looking after the baby, so you can catch up on sleep or have a night in with friends.

__Find local support__. If you don’t have anyone to turn to, for example, you’re a single mother with no friends or family close by, look for local support groups. A doctor should be able to help you find one in your area.

__Rest__. Try not to be a perfectionist. It doesn’t matter if your house doesn’t look immaculate, or if not all the chores are done. It’s more important that you catch up on sleep and rest when you can.

__Eat healthily__. Having a baby makes demands on the body. So eating a healthy diet and exercising regularly (or when you can) is crucial. If you haven’t the energy to go shopping or cook properly, ask friends and family to help out until you get back on your feet again.

### Expert help available

__Psychological therapies__. Your doctor can refer you for a course of therapy with a psychologist. Cognitive behavioural therapy (CBT) is shown to be effective in treating postnatal depression.

__Medication__. Antidepressants may be recommended in certain cases where
depression is severe and other treatments haven’t helped. Your doctor will
advise you on the safest options to take if you’re still breastfeeding.

If you have a history of mental health issues or depression, or a family history, talk to a doctor or mental health team if you’re thinking about having a baby.

Your doctor should arrange for you to be seen regularly in the first few weeks after giving birth.

__This article has been approved by Dr Elisabeth Rosen, medical doctor, Livi__


Livi.co.uk > article page > Help for postnatal depression > call out

Livi.co.uk > Your health > Help for postnatal depression

Help for postnatal depression

If you think you may be suffering from postnatal depression, here’s how you can find help

## Quick facts
- The average age of menopause is 50-52 for white and Asian women and around 2 years earlier for black women
- The average age for perimenopause in the UK — the transition period leading up to menopause — is 47.5, but symptoms can appear up to a decade before
- Around 13 million women experience perimenopause in the UK
- Lifestyle changes and, if needed, medical treatment can help

Hot flushes, night sweats, mood swings and sleep difficulties are some of the more common symptoms of the menopause — the date which marks a year since a woman’s last period.

But these symptoms, as well as many others, can be experienced for many years leading up to menopause, in a transition period known as perimenopause.

‘Although the menopause is clearly defined as a date 12 months from your last menstrual bleed, the perimenopause is less clearly defined and varies hugely from woman to woman,’ says women’s health specialist Dr Elisabeth Rosen.

‘The perimenopause indicates the first bodily changes that accompany the hormonal changes — a decrease primarily of oestrogen and progesterone — within a woman’s body as she ages. Some women will only experience these symptoms for a couple of years before their periods stop altogether, but some will have them for a decade.’

The average onset of perimenopause is 47.5 years, although these figures seem to vary by race and ethnicity and can be affected by your lifestyle and where you live.

Approximately 1% of women will experience early menopause before the age of 40. This can occur as a result of surgery or medical treatment, and sometimes it can run in families.

## The common first signs of perimenopause: Irregular periods, spotting or heavy bleeding

Hormonal fluctuations in perimenopause usually cause changes to a woman’s periods.

‘One of the first signs that most women notice of the perimenopause is that their periods become shorter than normal or they experience “spotting” or heavy bleeding,’ says Dr Rosen. ‘That’s linked to the decline in the hormone progesterone, which is produced by your ovaries. 

‘Progesterone helps the endometrium — the tissue inside the uterus — stick to the walls of the uterus, which helps take care of a pregnancy. When the levels of this hormone decrease, the endometrium can no longer stick to the walls of the uterus, which is why women may experience such erratic bleeding’.

‘There may also be heavy bleeding during women’s periods before menopause because the level of oestrogen becomes increased before declining. The production of oestrogen and progesterone continues to decline to extremely low levels, which is when you reach menopause.’ 

So, what are the symptoms of perimenopause, and what can help?

## Perimenopause symptoms

### 1.	Hot flushes
This is the classic symptom of the menopause and worldwide, between 50% and 85% of women older than 45 years of age will experience them. ‘We don’t really know what causes hot flushes (sometimes called “hot flashes”) but it’s related to the hormonal changes that come with the menopause,’ says Dr Rosen.

### 2.	Erratic periods
Some perimenopausal women notice their periods start changing up to a decade before their actual menopause. ‘You can take a hormonal contraceptive like an IUD or “the coil” to control the vaginal bleeding,’ says Dr Rosen. ‘It contains a synthetic version of progesterone so will help to keep the lining to the uterus sticking to the uterus wall. But, there’s nothing you can do to reduce the time your periods will be affected.’

### 3.	Mood swings
Several large studies have shown an increased risk of developing [depression](https://www.livi.co.uk/your-health/depression-spot-the-signs/) during perimenopause. ‘Taking general good care of yourself, getting 8 hours of sleep per night, eating good food and doing regular physical activity is the best treatment,’ says Dr Rosen. ‘Some women find the changes going on in their body quite hard to handle, so it’s good to be aware that these symptoms are caused by hormones and not by you or your surroundings. It’s not your husband, your job or you that’s causing you to feel like this, but your hormones.’

### 4.  Sleeplessness and fatigue
Perimenopausal women report more trouble sleeping as they enter the menopausal transition, and sleep has been reported to be worse during their period. ‘Doing physical exercise, sleep meditations and having regular bedtime habits can help,’ says Dr Rosen. ‘Medication is also available for insomnia, but it’s usually a last resort.’

### 5.	Decreased libido and vaginal dryness
‘Part of the problem with a low libido is that decreased levels of sex hormones can lead to vaginal dryness,’ says Dr Rosen. Your GP can prescribe a local oestrogen treatment gel or a pessary that can help with oestrogen levels. ‘Because these only treat the local area, they are safer to use than hormonal replacement therapy (HRT), which affects the whole body.’

### 6.	Urinary weakness
The urinary tract contains oestrogen, and as the level of that hormone decreases, women may experience urinary incontinence. ‘Local oestrogen gels or treatments can help alleviate the symptoms but it’s also about prevention, rather than cure,’ says Dr Rosen.

‘Women should remember to do their pelvic floor exercises regularly. But there’s only so much you can do yourself, particularly if you’ve given birth. Many women suffer from this for many years before seeking help because they are embarrassed. But it’s better to seek help from your doctor sooner rather than later as there is help available.’ 

### 7.	Night sweats
Breaking out in sweat during the night is a primary symptom that usually begins in the perimenopause. As with hot flushes, the exact cause is not known. ‘We know that physical exercise does help with night sweats and women should try to keep their bedroom cool and fresh,’ says Dr Rosen.

‘Cutting out alcohol or spicy food may also alleviate symptoms, but that varies from woman to woman. If that doesn’t help and the night sweats are making life difficult, medication may help, so [talk to a GP](https://www.livi.co.uk/).’

__This article has been reviewed by women’s health specialist Dr Elisabeth Rosen__


livi.co.uk > 7 signs of perimenopause — a doctor’s guide > button

Livi.co.uk > Your health > 7 signs of perimenopause — a doctor’s guide

7 signs of perimenopause — a doctor’s guide

Symptoms such as erratic periods and mood swings can make the years leading up to menopause a confusing time for women — but help is available  

Breastfeeding is a wonderful, natural process. But it’s not always as straightforward as you may see in the media.

‘There’s a common assumption that new mothers will automatically know what to do,’ says Dr Elisabeth Rosen, medical doctor at Livi. ‘But, even if you think you know what to expect, every woman’s experience is different.  

‘For some breastfeeding comes easily, but for the vast majority of new mothers, it can take a while to get used to and there may be a few stumbling blocks along the way. This is normal, and it’s important not to be hard on yourself at a time when you may be feeling more vulnerable than usual.’

## What happens to the body when breastfeeding?

‘The early production of milk (known as colostrum, see below) starts around week 16 of pregnancy,’ says Dr Rosen. ‘This is due to the increase of the hormone prolactin which stimulates milk production.

‘After you give birth, and immediately after the placenta comes out, oestrogen and progesterone levels drop and prolactin levels go up. This means you are ready to feed your baby straight away. Skin-to-skin contact further stimulates milk production and makes the baby want to feed. When the baby sucks your nipple, it sends nervous impulses to the brain, causing the release of more prolactin.

‘Suckling also releases the hormone oxytocin which stimulates the ‘milk ejection reflex’ where milk is pushed out of the breast through the nipple. Oxytocin induces feelings of calmness and relaxation and creates a powerful sense of bonding between mother and baby.’ Research shows that a suckling baby absorbs oxytocin from the mother’s milk.   

## A quick guide to infant feeding terms

### Colostrum
This is the fluid your breasts produce in the first few days after birth; a form of milk that’s highly nutritious. ‘Colostrum contains protein, vitamins, minerals and antibodies,’ says Dr Rosen. ‘Yet, it’s gentle enough for the baby’s delicate digestive system to handle. After a few days your breasts produce ‘mature’ milk.’

### Dysphoric Milk Ejection (D-MER)
D-MER is where women experience abrupt negative emotions such as sadness, depression, anxiety or irritability for a few minutes (or longer) just before milk release. ‘This is a relatively new diagnosis that used to be confused with postnatal depression,’ says Dr Rosen. ‘We’re not sure exactly why it happens’. If this is something you’re concerned about, talk to your doctor.

### Latching on
For a new baby to feed properly it needs to ‘latch on’ to the breast comfortably. Help your baby by:

- Always bringing your baby to your breast and letting them latch on themselves. Avoid leaning your breast into your baby’s mouth
- Making sure your baby can get a large mouthful of breast
- Placing your baby with their nose level with your nipple, letting their head tip back a little. This will encourage your baby to open its mouth wide and attach

### Engorgement
This is when your breasts get too full of milk, caused by increased blood flow and lymphatic fluid, and excessive milk production. This makes the breasts feel hard, tight and painful. This can happen in the first week or so while you’re still trying to get used to breastfeeding — or, any time while you’re breastfeeding. ‘Many women find breastfeeding painful to begin with and may also develop sore, painful, swollen breasts, inflammation (mastitis) or infections,’ says Dr Rosen. ‘Engorgement is common and your doctor can advise on what to do.’

### Foremilk and hindmilk
‘Focusing on the idea of foremilk and hindmilk is a bit of a myth,’ says Dr Rosen. ‘Foremilk refers to the watery, low calorie milk that comes out first when you start breastfeeding, and hindmilk to the higher calorie, more mature milk that follows. But this distinction can leave mothers concerned that changing breasts while breastfeeding could mean their baby doesn’t get enough hindmilk. But this is nothing to worry about. It’s the volume of milk taken in by the baby that matters and there’s no need to focus on the different milks, as the baby always gets what it needs.’ 

## It‘s normal to feel any of the following when breastfeeding...

### More tired
‘Breastfeeding takes up a lot of energy,’ says Dr Rosen. ‘You’re also going through an emotional storm and it can take time for your hormones to return to normal. This combination can leave new mothers feeling exhausted. Try to rest and sleep whenever you can.’

### More moody
It’s common to get ‘the baby blues’ a couple of days or so after giving birth, where you may experience low mood and feel slightly depressed. ‘The sudden hormonal changes that take place in the body after childbirth can make many women feel more moody,’ says Dr Rosen. ‘While you’re still breastfeeding, levels of oestrogen and progesterone remain low (to stop ovulation and prevent pregnancy) and this can cause anxiety, mood swings, irritability and depression. Although the calming benefits of oxytocin can help, not everyone reacts in the same way. Once you stop breastfeeding hormones gradually go back to normal. Talk to your doctor if you’re worried about how you feel.’

### Hungrier than usual
‘It’s normal to feel hungrier than usual as breastfeeding consumes so much energy,’ says Dr Rosen. Plus, being sleep-deprived can affect your levels of hunger and appetite hormones. If you’re wondering whether breastfeeding helps with post-baby weight, a systematic review of five studies found that after 12 months, breastfeeding mums lost between .6kg and 2kg more than mums who didn’t breastfeed.  If you’re exclusively breastfeeding, this will help you burn an extra 300 calories a day. 

__Reviewed by Dr Rhianna McClymont, Lead GP at Livi__


Livi.co.uk > Your health > Breastfeeding: What’s happening in your body?

Breastfeeding: What’s happening in your body?

Breastfeeding can be a confusing time for new mothers, and that’s okay. Here’s what’s actually going on....

Livi.co.uk > Your health >Breastfeeding: What’s happening in your body?

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Women’s health

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