Polycystic Ovaries & Polycystic Ovarian Syndrome

There is a lot of information available out there about polycystic ovaries, and one important thing that I need to point out here is that an ultrasound finding of polycystic ovaries is not the same thing as having the metabolic disease called Polycystic Ovarian Syndrome. This is why if you have an ultrasound finding of a polycystic ovary you should not be alarmed, particularly if you have normal periods. It is not uncommon for polycystic ovaries to show up the scan of a patient who has periods and who will get pregnant. In fact it is thought that only a small proportion of the estimated 20% of middle class women who have polycystic ovaries will actually go on to have Polycystic Ovarian Syndrome.

Reasons for the Increase in Diagnosis Numbers

The number of women who are being (correctly) diagnosed with Polycystic Ovarian Syndrome (PCOS) appears to me to be on the increase. This is likely to be due to factors such as the obesity epidemic and also the change in the UK population dynamics. The UK population for example now includes more women from South Asia and the Middle East who are at risk of developing this disease. Many of these women have abnormal endocrine disease, may suffer from thyroid disease, and can have abnormal adrenal disease (Congenital Adrenal Hyperplasia). They can also have high levels of male hormones like Testosterone and Androstenedione. In these cases it is common to find a strong history of either early onset or late onset diabetes, and in these families the male members often have premature balding under the age of 30.

Overweight Risk

We now know that PCOS is associated with Diabetes, Metabolic Syndrome, and with infertility because PCOS patients do not ovulate and may need ovulation induction treatment. PCOS also increases the risk of miscarriage, and leaving the condition untreated is therefore very risky as far as your reproductive health is concerned. The situation could be most serious for women who are overweight because they run the risk of developing Diabetes and becoming infertile.

Symptoms & Physical Examination

The most noticeable symptom of the condition in the patient is irregular periods that can be very heavy and can be spaced by more than 6 weeks. When examining physical signs, indicators for this condition can also include increased facial and body hair (particularly on the abdomen and back), acne, male pattern baldness in the family, a history of a late puberty, and a black mark in the armpit known as Acanthosis Nigrans.

Taking Action

Getting an early diagnosis is the best way to safeguard your reproductive health and, as you may read in medical literature the combined oral contraceptive pill can protect the PCOS ovary, and can stop the disease from getting worse. It is really important therefore to see a Gynaecologist who has a specialist interest in this disease, and who also works with an interested Endocrinologist. I always like to exclude Diabetes because PCOS is related to Insulin Resistance, and this is the precursor to Diabetes. I carry out a formal Glucose Tolerance Test as part of my screening, and if my patient is screened positive, I ensure that they are seen by an Endocrinologist.

When it comes to treatment there are a number of things that can be done depending on the individual circumstances. These can include working with a Dermatologist to address the acne and hair loss (Dianette, sometimes a combined pill, and Cypropterone Acetate), use of the drug Metformin (particularly if you want to become pregnant), ovulation induction with Clomiphene (sometimes with Clomiphene – great for weight loss and improving ovarian function), ovarian drilling (a laprosopic keyhole treatment), and often dietary advice.

For more information visit my main website, or to arrange for an appointment call 0203 318 0263 or contact me online.

Outpatient Services

You may already have visited my website via the search engines (this Blog is part of that website although not linked via the menu) because you are searching for information about gynaecological services or obstetrics. You will see that I do list many of the main services on there with some detailed information. There are however many different outpatient services that I offer and I’d just like to give you an outline of some of the main ones here.

The Wellwoman Health Check is something I’ve written about in more detail on this Blog before but it is a very popular service which includes a full history examination, an assessment of an ultrasound scan, and the chance to discuss all of your health concerns. It also includes a Ca 125 test. This is a test to detect a protein called Ca 125 in the blood as the presence of a high level of this protein could be an indication of the presence of ovarian cancer cells. High levels of Ca 125 however can indicate conditions other than ovarian cancer such as endometriosis (where pieces of womb tissue are found outside the womb itself), fibroids (benign tumours in the womb), and of course pregnancy. All things considered the Wellwoman Health Check can be a great way to put your mind at ease about any health worries you may have, identify / detect possible threats to your health, examine and identify any symptoms you may be experiencing, explain smear results that you may have questions about, and get a clear snapshot of your health and wellbeing at this point.

Other outpatient services include Screening for thrombosis risk for contraception and hormone replacement therapy. HRT is something I’ve also written about earlier in this Blog and on my website, and this subject is something that I am asked regularly about. HRT advice is therefore an important outpatient service that I offer.

I also offer assessments for the treatment of premenstrual tension, urinary incontinence, and therapeutic management of polycystic ovarian disease and hirsutism (hairiness). I am also able to offer treatment of genital tract disorders such as bacterial vaginosis. Another outpatient service that I offer is the treatment for vaginal prolapse, both operative and non-surgical treatment treatments. Vaginal prolapse can have some very unpleasant symptoms and I am pleased to be able to offer help, advice and treatment options.

For more information about the different outpatient services visit my website, contact me online, or call 0203 318 0263.

A Thorough Health Check Designed For Women

For many women today it’s often the case that they lead very busy lives, and the only time they are really able to speak to a medical professional about any aspect of their health is when they visit their doctor or for example when they have their smear test. It is however unlikely that a woman will be able to talk over all of her medical concerns with her doctor within the time allocated for a normal appointment, and it may have been some time since her last smear test. It may also be the case that she has concerns or questions relating to that last smear test and these have left a nagging worry in the back of her mind.

As you read this you may have some health concerns of your own that you would like to opportunity to talk to a medical professional about, preferably to a specialist in women’s health. Perhaps for example you may have been experiencing very heavy periods, or you may have reason to believe that you are at risk of ovarian cancer or osteoporosis. It could also be the case that your quality of life is being affected in a very negative way by PMT and you would like to find a way to at least effectively deal with the symptoms.

For some women it’s a case of having health concerns such as pelvic pain, or they are concerned about other problems that they simply don’t want or feel able to talk about with a friend, their loved ones, or their GP e.g. a problem with your sexual health.

The Wellwoman Health Check

One service that seems to work particularly well for many different women is to have a health check with an experienced women’s health specialist that allows them to address all of their health concerns in one go. For example, I offer the Wellwoman Health Check. This is a private and thorough health check where, as well as well as covering all the important aspects of your general health, you can receive a comprehensive and reliable assessment of other areas of your health where you feel you may have cause for concern. This includes:

Assessing your risk of and answering any questions that you may have about ovarian cancer, osteoporosis, or sexual health concerns.

Offering a cervical smear and ovarian cancer screening, and answering your concerns and questions about smear results.

Addressing your concerns and answering your questions about heavy and painful periods, PMT, causes of pelvic pain, or pain during intercourse.

Covering any concerns and questions that you may have about HRT to enable you to make an informed choice.

If you are in the London area and you have would like more information about the Wellwoman Health Check, or you would like to make an appointment for one at a hospital near you please call 020 7390 8041.

New Rapid Treatment For Heavy Menstrual Bleeding

As any woman who has suffered / is suffering from heavy menstrual bleeding (menorrhagia) knows, as well as being very unpleasant and disruptive, it can also bring the worry and the real possibility of suffering iron-deficient anemia. In some cases where the bleeding has been very heavy and prolonged it can lead to other worrying symptoms of larger volume blood loss such as shortness of breath, fatigue and palpitations.

Many menorrhagia sufferers try to manage and control their symptoms as best they can with vitamin and iron supplements, or try one of the many different drug treatments available to reduce the bleeding e.g. nonsteroidal anti-inflammatories, oral contraceptives, Progestin, GnRH agonists, a Mirena coil, and Danazol. Some women may seek procedures like endometrial ablation, or even more serious steps such as Hysterectomy.

I offer my patients a rapid and highly effective third generation endometrial ablation treatment called NovaSure®. Endometrial ablation treatments work by affecting the uterine lining in a way that causes it to heal with a scarring that reduces or prevents bleeding. This new NovaSure®. treatment is fast, safe, doesn’t involve incisions, and many women report little or no pain. What is really impressive about this treatment is that it brings about a 97% reduction in heavy periods, and patients only need to be in hospital for 2 to 3 hours.

This treatment was only launched in the UK in 2005 and many women are unaware that it is available. It is particularly good for women whose heavy menstrual bleeding hasn’t really responded well to other medical pills or Mirena coil treatment. The NovaSure® treatment is best for women who have completed their family although it lightens or stops periods without hormonal side effects or the risks of hysterectomy. 75% of patients who have received the treatment do not have any periods at all after 5 years following this treatment. You can find details of the Novasure treatment here on my website.

The private NovaSure® treatment that I offer involves an initial consultation and an assessment with either ultrasound or outpatient hysteroscopy (examination of the uterus). To arrange for an appointment in a London hospital call 0203 318 0263 or contact me online.

Thinking About The Benefits of HRT

HRT is always a subject that attracts a lot of interest in the press and this is often because of new studies showing the different effects on health. The result of this over time has been that many women have simply avoided the treatment because they fear the side effects more than they fear the immediate symptoms.

For example the UK Women’s Health Initiative studies showed increased breast cancer and heart disease risk and a higher risk of breast cancer diagnosis with combined HRT. On the other hand a recently completed study by New York University, presented to the American Society for Reproductive Medicine in Baltimore showed that women who took HRT for up to 25 years were no more likely to develop breast cancer, heart disease or diabetes than women who were not taking HRT treatment. This study had involved comparing the health of 80 women who had been taking HRT for an average of 14 years to the health of women who had not.

Consider The Benefits

It is worth remembering of course that there are some very good reasons why approximately 1 million UK women are currently taking Hormone Replacement Therapy. The symptoms of menopause can be very unpleasant e.g. hot flushes, night sweats and headaches plus there are the longer term and serious post menopausal risks to think about such as depression, osteoporosis, cardiovascular disease and stroke.

It is worth remembering too when worrying about the risks associated with HRT that Drinking more than 3 units of alcohol a day, and being overweight increase the risk of developing breast cancer and heart disease compared to HRT.

HRT involves replacing the lost oestrogen in the body, thereby relieving the symptoms of menopause and guarding against many other potentially serious longer term conditions.

I believe that HRT has a very valuable role as an effective agent in treating some of the highly unpleasant symptoms of menopause, and premenstrual syndrome, protecting against bone loss, and in treating postnatal depression. Topical oestrogens also have a lower risk of causing thrombosis in the veins and pulmonary embolism. I feel that there are real benefits in using topical oestrogens in combination with a Mirena coil, which minimizes the exposure to progesterone.

Through my private London clinic I offer HRT counselling and advice to women on their breast cancer and heart disease risk. I am also able to carry out specific tests for inherited thrombosis risks which are common in Northern Europeans and Ashkenazi Jews.

If you would like more information about HRT visit my website here, or you would like to make an appointment for a consultation please call 020 7390 8041 or email me here.

Good Reasons For Cosmetic Genital Surgery

It’s often the case that if you’re not affected by a certain problem you can never fully understand all of the feelings you can experience or just how much, and in what ways the problem can really affect you. When it comes to the increased numbers of women seeking cosmetic vaginal surgery it would be all too easy to assume that it is somehow unnecessary or related to fashion or vanity. The truth is quite different.

The fact is that situations and motivations vary greatly among women, and there are in fact many different genital cosmetic procedures for women including labiaplasty, vaginoplasty (vaginal tightening) and pelvic floor reconstruction, perineal refashioning, and hymenoplasty.

It would be true to say that things like the Internet have contributed to fashions like genital shaving which has in turn made some women more conscious about the appearance of their genitals. This in itself though is not the only reason why a woman would seek labiaplasty surgery / labial reduction.

Women seek labial reduction surgery to improve their self esteem, or because they may be embarrassed or conscious about the appearance of their genitalia, particularly if there have been relationship issues.  It may be that they have always been unhappy the appearance of their genitals and this may have caused the emotional distress over many years. Some women may for example have experienced problems since puberty, or they may want to relieve the discomfort caused by clothing in that area. Some women have pigmented and uncomfortable labia, and this may be affecting their sex life and their relationships with partners. For other women involved in certain sports such as equestrian sports or gymnastics, discomfort or self consciousness may also be reasons why they are thinking about surgical options.

The reality is that the shape, size and appearance of labia vary widely within what is normal and in some cases I will have to say that a woman will not benefit from surgery because of this. It’s also not simply a case of me operating because a woman asks me to. I collaborate closely with a psychiatrist and a psychosexual therapist and I believe that a psychological and sensitive approach is essential, as is the need to rule out body dysmorphia, and self harm.

I have been carrying out labial surgery for 15 year and when I see a patient for a Consultation, I carry out a detailed assessment of the labia and advise the patient about whether they have enlarged labia. I will then go through the types of operations which I can carry out.

For more information see my website here, or to arrange an appointment call 0203 3180263.

No More Suffering in Silence – Getting Treatment For Perineal Trauma Injuries

The safe delivery of a healthy baby is the obvious goal for parents in childbirth. The health and wellbeing of the mother through pregnancy is also vital and this is monitored along with the baby’s with antenatal care. When it comes to delivery in natural childbirth however, even though baby is delivered safe and well and mum’s generally OK, we know from Royal College of Obstetricians and Gynaecologists figures that 85% of mums who have a vaginal birth suffer some degree of perineal trauma. For many women this will take the form of some relatively small amounts of tissue damage mainly caused by the stretching of tissue and muscle as the baby was delivered. For other women however the damage to perineal muscle, nerves and tissue can be more severe and can leave them with some very unpleasant symptoms. Unless the mother finds effective ways to manage these symptoms, or chooses an option such as corrective surgery the symptoms simply persist. Sometimes these symptoms can have a very negative effect on the quality of the sufferer’s life and their relationships with their partners.

The types of symptoms associated with trauma injuries to the mother in natural childbirth include:

  • Incontinence and other urinary symptoms
  • Recurrent UTI and interstitial cystitis
  • A lump or a dragging pain
  • Solid stool
  • Problems with straining or constipation
  • The need for perineal support during defecation
  • Feeling open and experiencing with no frictional benefit or intimacy with sexual intercourse.

Women often find it difficult to talk about some of these symptoms and the psychological, emotional and social problems that can follow. Many women in this situation can also worry that they are unable to satisfy their partner and this can lead to stress and relationship problems.

Corrective Surgery

There are several different surgical options to correct this kind of damage in many cases dramatically improve things.

Perineal Refashioning – Where episiotomy or the repair of a tear in the area between the vagina and the anus has caused disfiguring, a refashioning operation can improve the appearance of the perineum area. This can also help to restore a woman’s confidence and this in turn can help to improve her libido.

Vaginal Reconstruction – Natural childbirth can result in the loosening and loss of tone in vaginal muscle. This can cause lack of friction in intercourse which can affect sexual enjoyment and libido. Reconstructive surgery can bring back the internal shape and structure essentially bringing the vagina back to how it was prior to pregnancy. This can also be carried out at the same time as perineal refashioning.

Vaginal Tightening & Pelvic Floor Repair and Reconstruction – My method of vaginal tightening involves rebuilding the perineum i.e. the area where the muscles meet at the entrance to the vagina. This is the area where the muscles have been overstretched by the baby’s head during birth. The results of this surgery can improve yours and your partner’s full sexual enjoyment. This surgery can be carried out at the same time as labial surgery. You can find more information on my website here.

If you would like to book an appointment you can contact me online or call +44 (0)20 7390 8041.

The Importance of Great Antenatal Care

What happens at the very beginning of life is incredibly important because the health differences in our children start before birth. The quality of the antenatal care you receive can therefore be an important factor in shaping your child’s future, and making sure that it is more likely to be a healthy one.

Birth rates are rising. Inequalities in our society and geographical differences in antenatal care in the UK are just 2 factors that can increase the risks to the health of babies and their mothers. Our modern lives and culture mean that many women are having children later in life. This in itself can carry some extra risks for baby and mother, and can mean that getting the right type of monitoring, advice and care all the way through the pregnancy are especially important. Now more than ever it is widely understood and accepted that keeping a very close and experienced eye on the health of the foetus and the mother during pregnancy is proven way to improve the outcomes of maternal and perinatal morbidity and mortality for all pregnancies. So many parents-to-be are now willing to search for a private antenatal care package that can give them a high level of care at this vital development stage, plus the right level of care for the delivery and beyond.

I am an experienced Consultant Gynaecologist and Obstetrician who is passionate about natural childbirth. I ran a high risk obstetric practice in the NHS and I am an authority on high blood pressure in pregnancy (pre-eclampsia). My father Norman Morris, was the obstetrician who pioneered the development of a more humane approach to childbirth in the United Kingdom. It is this background and experience that has helped me put together truly comprehensive antenatal and delivery package that is designed to achieve the best possible outcome for mother and baby. Working alongside me on this are my Colleagues Gordon Cochrane DCR DMU who is an experienced expert in obstetric ultrasound, and Esther who is a skilled breast feeding midwife who also teaches baby massage and bonding techniques. Between us we are able to offer a package that holistic as well as comprehensive. This service is delivered through my private obstetric practice at The Portland Hospital in London.

The many different elements that make up this package include: a dating scan, monthly antenatal assessments (until 28 weeks), screening for Down’s syndrome. (11-13 weeks), an anomaly scan (20 weeks), a 4D UltraSound bonding scan, a growth scan (34 weeks), weekly antenatal appointments (from 34 weeks), and presence and supervision of normal delivery.

You can find more information about me, my team, and the obstetrics services that we offer by looking on at my website here. If you would like to book an appointment for the comprehensive antenatal and delivery package you can contact us online or call +44 (0)20 7390 8041.

What Do We Know About The Harmony Down’s Syndrome Test?

Down’s syndrome affects 1 in 1000 babies and is something that happens at the conception stage when the genetic material from the egg and sperm first join together. Screening in pregnancy is therefore commonplace but despite providing some idea of the likelihood of your baby having Down’s syndrome, screening doesn’t provide a definite answer. That is left to the kinds of diagnostic tests that are carried out only if the screening shows a higher chance of Down’s. Harmony is diagnostic test.

Risks & Accuracy

The Harmony Test is a relative newcomer to popular Down’s diagnostic tests. Prior to Harmony and still common antenatal diagnostic tests (although proving to be a lot less popular now that the safer Harmony Test is here) include:

CVS – Chronic Villus Sampling

CVS is a test that’s only really carried out if other screening, tests, family history may indicate that it could be appropriate, and the patient of course has the choice of whether to go ahead with it. CVS is generally carried out between 11 and 13 weeks. As well as detecting Down’s CVS can also detect some other genetic conditions.

The CVS test involves your obstetrician taking a sample of your placenta. The sample is taken by needle through the tummy and womb, or by forceps and a thin tube through the cervix (guided by ultrasound).

In essence the CVS is an invasive procedure because it requires cells to be taken from the placenta and therefore it does carry a 1% to 2% risk of miscarriage. There have also been some rare cases of infection.

Amniocentesis

Amniocentesis is offered where there it is believed that the baby is at significant risk of developing a serious condition. The test is usually offered between 15 and 20 weeks of pregnancy and although it has a lower miscarriage risk than CVS (about 1%), Amniocentesis is also an invasive procedure because a needle is used to extract some amniotic fluid for testing. This is the fluid that surrounds the foetus in the womb. Just as with CVS, the invasive nature of Amniocentesis also brings the very small risk of infection.

Why Could Harmony Be A Better Option For Down’s Testing?

Quite simply the Harmony Test is very accurate and extremely safe.

The Harmony Prenatal Test uses a simple blood test rather than an invasive procedure. It does not involve any disturbance of the womb or placenta, and it is this that dramatically reduces the risk of miscarriage. The Harmony Test can also correctly predict Down’s syndrome in more than 99% of cases because it can isolate ‘cell free’ Fetal DNA (the building bricks of chromosomes). This makes the Harmony Test very accurate.

This revolutionary test is predicted to reduce the need for invasive procedures by over 90%!

Safety and certainty are a powerful combination in Down’s testing, and this is the reason why Harmony has become so popular so quickly. You can find out more about the Harmony Prenatal Test on my website here.

How do I go about booking a test?

If you would like make an appointment with me for a Harmony Prenatal Test please call 0203 318 0263.

What Happens Next?

I will then organize an ultrasound on the day of the test to confirm the pregnancy is 10 weeks or more and also to assess for multiple pregnancy. This is because the test is not used in multiple pregnancies. You and your partner will then have a consultation with me to go through the test, and the blood sample is then taken. Your blood sample is then sent to a lab in the USA where the test itself is carried out. You can expect to receive the results within 2 weeks.