• Dr Izzy Smith

Women's health Q and A with Dr Bronwyn

Summary of insta live with Dr Bronwyn;

Today I had a chat with obstetrician and gynaecologist Dr Bronwyn Hamilton from Mitcham Victoria. She is such a wealth of information and we covered so much in a short period of time, I decided to summarise the live into some separate categories! These are just bullet points but answer many of your questions and has also given me plenty of material for future posts.

Enjoy, Izzy xx

PCOS;

1. 10-20% of menstruating women will have PCOS. Each person’s symptoms and response to treatment may be different which is why seeing a specialist is important.

2. PCOS is a syndrome where you need to meet 2/3 criteria; >20 cysts on ovaries, signs of androgenism e.g. facial hair/acne, irregular or absent periods.

3. PCOS is often associated with carrying extra weight. However, some women with PCOS are quite lean and demonstrates that a personalised approach to management is important!

4. No specific diet but low GI and moderate carbohydrate intake is recommended, as is seeing a women’s health dietitian.

5. For people who are overweight, losing 5-10% of body weight often is enough to returns periods

6. PCOS is a syndrome that people can go in and out of in their life, often dependent on lifestyle factors such as weight and physical activity levels.

7. The pill, metformin and more natural supplements such as inositol, cinnamon and spearmint tea have evidence for managing symptoms of PCOS.

8. If women aren’t menstruating and aren’t on the pill, they are at risk of pre-cancerous endometrial hyperplasia and should take a 10-day course of progestin or the Oral contraceptive pill to cause a withdrawal bleed.

9. Being on the pill long-term could mask underlying PCOS. If you want to have children but not for a few years etc, it may still be beneficial to go off it for a short period of time to ensure you have a regular cycle.






Pap-smear/cervical screening-


1. Changed to looking for the virus rather than abnormal cells which has a better pick up rate (sensitivity).

2. Essentially anyone who has been sexually active has been exposed to HPV and it’s not like having an STI that you need to disclose to sexual partners.


3. If infected with high risk strains e.g. 16 and 18, you may need to go straight to colposcopy.

4. If your pap-smear was negative and you don’t need one for 5 years; mid-cycle bleeding, or bleeding or pain during or post intercourse are signs to talk to your doctor about the fact that you may need an earlier pap-smear/CST.


5. Cervical polyps are almost always benign and usually found incidentally.

Pregnancy and Covid-


1. Many/most women who have been pregnant with Covid have had mild cases or been asymptomatic which is reassuring.


2. Likely more of a concern if caught during 3rd trimester of pregnancy.


3. Covid is still very new and evidence on the impact of Covid and pregnancy is emerging but more is needed.

4. Covid isn’t going anywhere so people shouldn’t put off trying to fall pregnant due to Covid.

5. Prevention is better than the cure! Staying at home, avoiding crowded areas or hotspots and following hygiene practices will significantly decrease the chance of you catching Covid.



Fertility and pregnancy;


1. Unfortunately, fertility does ultimately start to decrease, especially after the age of 35, and considerably after the age of 40.

2. As a doctor (or anyone else), there is no perfect time in your career to have children. There are pros and cons to both e.g. registrar in public system you’d have guaranteed maternity paid leave whereas as a consultant in private it can be much harder to have time off and less paid maternity leave. Conversely registrar on calls, and exam life is immensely challenging, even without small children. Individual circumstances will be different and there will always be pros/cons either way.


3. Egg freezing is not a sure guarantee of fertility/children in the future, but it does provide another option, and if possible is best to freeze eggs by about 35.

4. It’s really unfair that men and women have different biological clocks and can’t take it in turns of being pregnant!

Periods;


1. Women get heavy periods in the years before menopause due to an imbalance of estrogen and progestin (too much estrogen). The Mirena can be excellent option to manage this.

2. It is perfectly safe to skip the withdrawal bleed when on the pill. There is no set time for how often you should have a withdrawal bleed but once every 6-12 months isn’t a bad idea.

3. Skipping the withdrawal bleed actually improves the efficacy of the pill as a contraception.

4. If you’ve got concerns about your cycle, concerning symptoms e.g. mid-cycle pain, severe cramping or other worries, seeing a GP with a specific interest in women’s health will be beneficial, or of course a specialist.



Running in pregnancy and contraception in runners/athletes;


1. Athletes at risk of REDS-s are advised against hormonal contraception such as the pill as it may mask REDS-s

2. Non-hormonal contraception methods are either barrier; condoms or diaphragm or copper IUD.


3. Alternatively, the Mirena does not always stop ovulation and may be suitable or alt being on the pill but going off every 6 months to monitor if normal ovulation returns.

4.The pill is not advised for bone health protections in REDs and an estrogen patch is recommended.


5. Exercise is great in pregnancy (decreases chance of pre-eclampsia, gestational diabetes, labour complications, pre/post-natal depression + more) but it’s important to listen to your body and keep the intensity moderate. If you’ve never been a runner, you shouldn’t take up running during pregnancy but runners can continue to run. If you have not been physically active but want to during your pregnancy, this is safe but needs to be done slowly and under medical advice.


6. Running in pregnancy is safe for the baby until full term/the entire pregnancy although physically most people will find at some point it will become uncomfortable.


7. Impact on pelvic floor and running in pregnancy is unclear. Some Women’s health physios advise that in later stages of pregnancy the baby’s head bouncing on the pelvic floor likely damages the pelvic floor and could increase the chance of complications down the track such as prolapse. On the other hand, some women run to full term (including some very famous runners who’ve done amazing marathon times) and don’t have any problems. More evidence is needed and if you’re a keen runner or athlete, seeing a pelvic floor physio at the start of your pregnancy is a great idea!



Stay tuned for next insta live with Dr Bronwyn and Dr Izzy!

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