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My name is Aisha ADI and I will be the moderator for today’s session um I will Begin by saying that um I’ll be introducing Dr Yara Muhammad in a second and before that I just want to make some things clear in terms of ground rules so please
Keep your mic muted during the time where Dr Yara will be giving her um inshallah and also if you would like to ask any questions you may do so if you want to ask the questions anonymously we do have um a link for that if not you can put so in the
Question box on the zoom and when Dr Yara finishes her lecture then we will have a Q&A conversation on the topic inshallah so for today I will be introducing ucing Dr Yara she will be giving her lecture for 35 minutes um if the time permits inshah
And as well as that then afterwards we will have the Q&A session inshallah any questions please put so in the chat so just to introduce Dr Yar Muhammad Dr Muhammad completed her undergraduate medical training at the University of Leicester um and qualified in 200 4 she completed her postgraduate specialty
Training in the Northwest and was appointed as a consultant at St Mary’s Hospital in 2016 Dr Muhammad is the lead for a complex OB obstetric surgery service and has a special interest in abnormally invasive placenti and the management of pregnant patients with complex surgical cories she has an interest in management
Of benign Gynecology she is also interested in improving migrant health and supporting victims of female genital mutilations which as we know is a huge problem today Dr Muhammad is currently the MS MCS lead for OB obric governance and we are so excited to have her here today to um share her knowledge
With us her expertise and as we know as the Emir said previously we do know that some people have easier periods and some people have more difficult periods and this is something that is affecting our community today so I just would like to give a really warm welcome to Dr Yara
Muhammad um to come on to do her lecture today Salam alikum Salam Alum to everyone thank you so much for this invite it’s a real pleasure actually to be joining you today uh can you hear me okay is everything yeah okay so I’ll just CH can everyone see the slides
Okay yeah okay so I thought this was a bit of a overlap or over over um wrap for menstrual pain and what’s normal for menstrual pain so some of it is a bit brief some of it I’ve tried to get into some conditions a little bit more um and
I’ve had a look at some of the questions that were sent so we’ll see how we get on from that on so firstly what happens with the menstrual cycle I find this is use useful to explain just because it helps people understand understand what their Cycles like and what treatments
There are for it so the lining of your womb is called the endometrium that’s there that’s the inside of the womb it builds up during your cycle at different stages menstruation usually happens the day one and then up to day five day six day seven depending on your
Cycle and then your lining of the womb will continue to build up during that buildup there are um vessels that start to form nutrients that come to the lining of the womb ovulation is when you release your egg and that happens between day 15 depending on the length
Of your cycle so this is an estimate on someone who has a 28 day cycle then your um lining of the room becomes a little bit more sensitive in receiving uh for uh a pregnancy if there’s a pregnancy that was was going to happen on that cycle if that doesn’t
Happen then you have something called an es schic phase where the arteries start to shrink and the lining inside the womb just sheds and then you go back to that cycle and it’s that kind of understanding of what happens at every stage helps you understand where you are and when you’re
Getting pain and and all of the other disorders that might occur secondary to it so what is the history of pain and sometimes people come to you and say I’m in pain and that’s it and so it’s really difficult to gauge what kind of pain and defining that pain helps us a lot
Understand what the cause of pain is your pelvic area has got so many other organs it’s got your arteries it’s got your nerve system it’s got your bowels has got your bladder so being in pain and saying I’m just in pain and not being able to understand understand the
Pain the history of the pain makes it really difficult to offer a good treatment so the first thing is how long and when did it start so some women like you said would have pain throughout their cycle so they always remember having pain they always remember having
Pain uh with their periods it started when they became um you know Adolescent and you know all of that through is never get better um that’s really important to understand that some woman will be okay and something will start the pain and it’s important to understand what that something
Is so when does it happen um and a woman always will not Define define when it happens properly so does it happen in the beginning of your cycle does it happen when your period happens does it happen with ovulation does it happen towards the end of your cycle is it
Completely unrelated to the cycle and that opens a little bit more of the cause of why you in pain what makes it better and and and often and often an answer that everyone says nothing and that if you think about it is not always going to be true because
There’s something that will if it doesn’t make the pain disappear will take the edge away so what else happens so are you bleeding in between your cycle uh are you bleeding um after intercourse are you bleeding uh halfway through your cycle is your period heavy um have you got
Pain when you open your bowels when you pass urine you got pain when you’re intimate and that’s all important into defining why why this pain is important what’s causing it is it related to you vomiting are you feeling unwell all of that just helps us understand why you
You why why there is a problem what the cause of the problem is so what else could it be and and and sometimes and and this is partly Medical but also patient related we just think pain pain has to be gyy but actually sometimes it might be something else unrelated but
Because it’s the same area it’s very difficult to Define so is it worse when you eat something is it worse uh when you’re stress is it worse because of your muscles or your postures or after you’ve had a child and all of that helps understand your history of your pain so what’s the
Story behind the pain so the first point of contacts always going to be your GP and that that it’s important to get all of that information to primary care because they have a lot that they can do to First help before you need further intervention so so what might the GP do
The GP might examine you so they need to have a feel and maybe do an internal examination uh screen for infections and I’ll go a bit more on the importance of infections uh may start you on pain colors and sometimes um you know we’re very um dismissive of pain colors we
Always we always dismissive that all that happened is I got pain colors but actually sometimes you need pain colors to help with the pain because that is the that helps with the symptom it might not help with the cause but it help may help with the symptoms so start you on hormonal
Treatment so a very common uh treatment that we offer women who have menstrual pain is uh the contraceptive pill because it regulates that and if you remember that first um image I showed regulates what hormones are given it regulates that lining of the womb and so
Might help uh with your pain and when your pain starts you may arrange a scan and that might be uh because of your history or because of something they found from an examination they might refer you to a gynecologist and again that might be something that comes from the history
And the conversation that you’ve had but it doesn’t take away from the treatment that they could offer you first so the the the pill and the painkillers are also effective treatments to help with pain so what causes pain so there’s a few things that cause pain one of them
Is scar tissue so women that have had previous surgery um may have a lot of scar tissue because of it and so the way your body heals means that you get pain around the area of the pelvis or the area of the SCAR or sometimes it might be surgery that’s unrelated so for
Example if you’ve had had an appendix removed or an appendix that burst removed and you’re in pain afterwards and that could just be Scar Tissue now the difficulty with scar tissue is if you form a scar then you always have a scar so even if you had another operation you’ll still have that
Scar so sometimes it is again managing the symptom rather than managing the cause um second one is an infection and there’s a lot of infections that may be causing pain a lot of women when they come are concerned about discharge and discharge may or may not be um a red flag for a
Condition sometimes discharge is normal it’s physiological because your cycle is changing your mucus might be changing but the discharge that we are concerned about related to infections might be um discharge that’s offensive that is noncyclical that has a color because that might indicate like an infection that’s sexually transmitted or an
Infection that’s moved around the tubes or the ovaries that might be giving you pain so the other conditions I’m just going to go a little bit deeper to so the first one is endometriosis an endometrosis affects a lot of women and what it is is a
Condition where the lining of the wom so over here implants into the other areas of of your pelvis um and so I’m just going to go a little bit on what’s what in a female organ because sometimes that helps explain and understand and and I’m sorry if uh this
Is a bit simple it’s not meant to offend anyone uh so this is a vagina your neck of the womb is here and that’s where your smear comes from and this is where we spoke about right at the beginning that’s the lining that will change according to where your cycle is that’s
Your tubes and that’s the ovaries and so in some women that’s that Patches from the lining of the womb and we don’t know why it happens we’ll implant on other areas and sometimes it will implant inside the muscle of that womb and that’s called adenomiosis and this tends to present
With cyclical pain pain with your period in some women they might say Well when ovulation happens I’m in pain and then I start pain again and it gets better with my period or it just builds up completely and I’m only pain free from my period to ovulation if you go back to
That first um image again so what can we do for them so endometrosis doesn’t show on scan and so a lot of a lot of women will come and say you know I’ve got pain but my scan is normal and that sometimes happens uh because it’s implanted tissue you only
See things like a cyst that might be in the ovary called endometrioma you might see uh some Scar Tissue but you don’t always see the Disease by scan uh there’s different ways of investigating it one investigation is an MRI scan your doctor might offer you
That but an MRI scan is good for picking up disease that is linked to other organs um where you’ve got signs or history that may suggest it so things like oh you know you’ve got when you have your period you have problems with your bow or bleeding through your bowels
That might be picked up by an MRI scan so an MRI scan is a useful tool but it doesn’t pick up all of the conditions the other thing is a minor surgery something called A laproscopy and A laproscopy is a minimal surgery so it’s a keyhole surgery through the belly
Button you go in h it’s a general anesthetic and you go in and see what what is where is the endometriosis where it’s affecting is it affecting anything outside the wom and the treatment would depend on on what you what the condition is and what has what is affected where
You are on your um menstrual life uh are you completed your family starting your family and you not considering your family and all of that comes together into the decision um and then towards the end I’ll go through treatments that are not surgical uh but I’ll wrap it up in the
End so that’s why I’m not done it now so ovarian cysts and uh many women will come really concerned about ovarian cysts in and polycystic ovaries and whether that’s causing pain now ovarian cyst and and polycystic ovaries are completely different conditions an ovarian cyst is a fluid
Filled sack around the ovary um and it’s a it’s a cyst it’s like a plastic bag if you have a plastic bag filled with water uh polycystic C is completely different it’s a metabolic problem an issue with the period and the hormones rather than the cyst and causes pain so
Polycystic ovaries does not always cause pain it causes maybe irregularities with the period but cysts may cause pain and so they’re two different things and and sometimes they can get confused with each other uh but I’ll go through variances because that might cause pain so a lot of women will have Cs and
Will get really anxious that they have cysts and they’ll want something doing but the majority of cysts especially if it’s just serus fluid actually disappear aone they’re very common within uh our uh young population they’re very coming within the menstrual cycle and actually cause no symptoms some women might not know they’re
There some cysts like if the cyst is caused by endometriosis or if it’s caused by another not liquidy kind of fluid might cause pain might cause pressure so woman would say well actually I feel a little bit like I’m heavy uh and that also depends on the
Size uh it might cause pain when passing urine if it’s pressing on the bladder um and it’s a chronic pain it’s not always pain that is acute so the most cysts as I said will resolve um but a small proportion of them might rupture or twist and that
Means that’s an emergency because you’ll get pain that doesn’t get better and if you have a cyst and you get an extreme pain then you should always seek medical help so the treatment like I said if they disappear and they”re causing you no trouble then we can leave them alone
Um we scan maybe a few months months uh and if a year nothing changes then you don’t need anything if you don’t want to have it removed D if they’re causing you symptoms again you might be offered surgery and surgery is to remove the cyst from the ovary but to keep the
Ovary behind and the ovary is what secretes all of the eggs uh and so sometimes we need to operate next to it and sometimes we could leave it alone finally fibroids fibroids are very common within our population uh they occur in about 2third of the population especially in women of
Afro Caribbean descent but usually you see it in in uh women who are around the age of 35 to 40 they’re not uh they’re not usually present within the younger population although they might they might be what they are they’re non-cancerous growth they appear inside the muscle of the womb there’s different
Types of them depending on where they decide to grow um and they’re like like a growth of muscle within the muscle they might sometimes cause heavy periods they might cause pressure symptoms so some women might have problems opening the bowels or feel a bit heavy complain oh I feel a bit like
I’m pregnant things like that the treatment depends largely on the location um and then depends on the symptoms it’s causing um and also again where you are in your uh menstrual life where what’s expectations what do you want to do about them um how much of an issue it causes and all of
That so what treatments are there for painkillers What treatments are there for conditions affecting gynecological hormons so like we said painkillers um second thing is hormonal treatment so that depends on again whether you feel you’ve completed your family or family is not not an issue for
You so if you have been investigated and your investigations are normal or you just need something to give you a break then the contraceptive pill is absolutely fine um it’s not only the contraceptive pill so it’s a long a long list of contraception so the combined pill has
Both hormones in it and you have a period with it but it stops the ovulation temporarily and so might help with that pain from that control point of view other contraception is called progesterone based contraception and they come as an implant they come as a pill that you don’t take a break from
They come as the impl um the rod and the coil and the way they work is they uh stop the lining of the womb from building up and if you go back to that first picture what it does is all of that lining of the womb comes out starts
To become small smaller and smaller and then you stop having a period because you’re not building it up how that works is it it stops because it stops the lining of the W from building up it stops from the periods from being painful and and and that’s the same for
All of the um progesterone only ones they’re the ones that your GP or your gynecologist might say why don’t you try this for three months why don’t you try the coil for three months it’s not the non hormone coil it’s the hormone coil that would help
Um the advantage of it is that it’s a quick treatment and it might work well for you the disadvantage of it is obviously if you’re trying for a to start a pregnancy it’s it’s not ideal because it will act to contraception uh but also with the progesterone only pill they might make
You spot outside your cycle for about six months to eight months and then it stops the period and it stops the period not uh permanently it stops the period uh temporarily now these work for or or hormonal treatments work really well for women who uh are not starting a family or
Don’t want to start a family or younger younger girls who start with a really bad period and just need a break from the period they work really well for women who suffer with endometriosis if they choose to have surgery then sometimes they reduce the coming back of the endometrial
Because you’re not building up that lining of the womb um the coil sometimes works well for uh women with also have heavy periods associated with the pain because it again it works inside the womb it works locally so it reduces the heaviness of the bleeding in the
Pain it might work with uh fibroids that are small uh and not inside the cavity of the womb uh because it stops that heaviness of the p period but it doesn’t take away the uh fibroid it just helps with the symptom um other hormonal treatment that
You might be offered uh is an injection and usually that’s for women that have either had surgery for endometriosis or are slightly uh older and just don’t want to have surgery where you can have an injection or a tablet that essentially stops the ovaries from working so gives you menopause
And so stops feeding the fibroid and that might help a stop the period but also shrink the fibroid slightly or uh help with the endometriosis not building up again so all of these are things that you can have to help to help manipulate your own hormones to help with the
Symptoms of either heavy period or a painful period or a bit of both they help from that point of view um if you choose like a hormone treatment that gives you menopause um then sometimes women don’t like the side effects of it because it gives you side effects like hot flushes uh feeling
Unwell and you can’t really use it for a very long time but you can always have hormone replacement with it so it’s something that can work on um helping to control the symptoms by not having a lot of surgery so it’s a temporary measure um someone also put in the question
About other things that are available for fibroids that are not surgery um the other option for fibroids and only works for fibroids is uh destroying the blood supply to the womb uh and that’s done by Radiology it’s not done by Gynecology what that does essentially is help shrink the fibroid because it doesn’t
Get the blood supply and that’s the final option that you can have for fibroids but it’s not for cysts and it’s not for endometriosis uh um but with that that you have to have completed your family so it’s better for women who have completed their family but don’t want to
Have surgery that’s an that’s the last option for them uh the final option is surgery so um a lot of these conditions we can do through Keyhole surgery depending on your history what operations you’ve had and where the conditions are so removing a small cyst can be done by Keyhole
Surgery uh removing endometriosis depending on how severe it is can be done by Keyhole surgery um and it’s a fairly safe operation it’s a minor operation but like anything any surgery has its risks uh but it’s to remove the condition is to remove the diseases to see whether removing the endometriosis
Makes your symptoms better removing the cyst makes your symptoms better um sometimes you can take fibroids out um and you can take fibroids out um depending on their size and their location either by Keyhole surgery or by an open procedure or by a minor operation uh that goes inside the
Womb and all of that might help with the symptoms um of of taking it out but they might come back in the future but that might help temporarily with the symptoms the final option is offering to remove the womb uh which is a major operation but also an operation that um
Helps with pain and heaviness of per period if the pain is associated with that and that’s a it’s a safe operation but again it’s got its risks associated with it so there’s a a wide range of um options that people have depending on also what you what you want what you
Feel you need what you where you are in your life and um sometimes uh you what you wanted 20 years ago is very different from what you want today so finally what can you do to help yourself and I think we also always forget a healthy person always uh
Affects the healthiness in them so keep a diary see what triggers it uh a lot of younger women now will have their own apps and will use their apps to um um track when they have moods and when their heaviness and that’s really useful actually it’s a benefit of this uh modern
Society sometimes changing your diet and I get a lot of um women that come and say oh if I is my fibroid because of me or is this and it isn’t but sometimes having a healthier diet H not only improves your uh own kind of health and
And your bowels may be a bit irritating as well but also will help you become healthier if you needed surgery uh exercise is really useful exercise really useful especially if your pain is causing you stress or is caused by stress so we sometimes forget that we are humans that are affected by
Other life events and so sometimes uh women will have problems within their marriage or within their family or within something traumatic that’s happened with them and suddenly they feel pain so helping yourself get better and healthier sometimes helps manage these pains and shouldn’t be dismissed you know it should be things that we
Encourage um sleeping better and helping yourself sleep better all helps you so all of that come together should help kind of if not help with the a mental aspect of having pains or heaviness can help you be healthier if you needed surgery or if you needed to go on the
Tablet or if you needed something um and so I’m very big Advocate I’m trying to be as healthy as possible for managing your treatments so that is me that’s my final slide I know I’ve whistled through things so I’m happy to go through things if people want me to go through a
Certain element of that presentation so I go back to Aisha I think Alum and thank you so much Dr Yara for you know going through all of the things as best as you know you could in the time um yeah that was really really beneficial and I think everyone can can
Say that they they gained a lot from that um I gained a lot from that myself I was just like making notes as you speaking um yeah so some questions that we’ve received um if anyone has any questions you are welcome to put them in
The chat from now on um and we will be asking Dr Muhammad these questions so please put the questions in the chat um send this to your friends so that your friends can also put it in the chat as well um so yeah one question that we have received
Is um so one question we have received is what causes delayed a delayed menstrual cycle so I saw I saw that question and I didn’t really understand what they meant by that question so is it a delay right at the beginning or is it a delay halfway through the cycle and
I couldn’t really I couldn’t really answer it because I didn’t know where it was where where they were going with it um so I think I think what we can say from that question is that better or sorry who who’s speaking oh um I think we could say some
People have delayed like their periods are maybe irregular or it can be delayed every month by different days I know that happens so there’s there’s a lot of factors that goes into our menstruation uh some women might just have a naturally longer cycle and that’s normal for them uh some women
Might have a period That’s not regular that’s linked to the way they release their hormones and if you if I can just trying to see if I can go back to my first slide that always helps me explain to patients uh bear with me now I’m going to show my it uh skills
Can you see the presentation again yeah okay so just go back to do it in a silly way just one minute so so if you go back to this slide oh one second it’s now doing the silly thing that it does to end the presentation we can still see doctor you
Can hold on if I end the show then it won’t um just show you because it helps it sometimes helps explain but it just when it does it as presentation it slides up through yeah okay so if you look at this this bit of the slide and and our
Menstruation it does depend so it does depend on where we release our hormones and what hormones we’re releasing at what stage of the cycle and so the the first hormone that comes through is the estrogen and that will build all of this up and if you can
See with with my pointer so this is is you start menstruating you release all of the estrogen up until you produce the egg and then you get another hormone called a progesterone which which either keeps the same because you’re uh you’ve Fallen pregnant or comes down and
There’s where you have your period now that cycle sometimes in some women will the release of their hormones will change either because that’s normal for them so they’re not releasing the right hormones sometimes it’s linked to uh things like polycystic ovaries or link to how they get that surge of the
Hormone how the hormone releases itself and that’s sometimes linked to U the their metab their own metab metabolism of that hormone and so instead of the hormone and this is what happens with polycystic ovaries for example uh instead of your hormone releasing at the same stage and kind of peaking up mid
Cycle when you ovulate you don’t get that Peak and that’s maybe because um the the breakdown is related to your own diet or your own if you’re overweight or if you’ve got a lot of stress and that sometimes causes people not to have their right cycle all the time so this
This and and I think another question was uh what H what’s a hormone imbalance but that kind of Surge and the cycle and how your periods are are sometimes related to which hormone you’re releasing in which part of your cycle and whether you get enough estrogen related in the beginning of this cycle
To tell you other bits of your body to release an egg and if you don’t have that because you’re you’re pre-diabetic for example or you don’t have a healthy lifestyle then sometimes that doesn’t happen doesn’t ovulate for some women it’s just normal for them it’s just the way their body is matab metabolizing
That hormones that they don’t produce the right hormones so your Cycles is not not exactly on that uh irregularity and sometimes they’ll have a cycle that comes every month two months um and sometimes it’s normal right at the beginning of your um of adolescence so you f you know you get
Getting your period and your body still doesn’t know which hormone to release and then you’re stopping your periods and again your hormones are are changing again and that might affected so there’s a lot of bit there’s a lot of things that might cause your menstrual cycle
Not to be uh not to be accurate all the time uh if it’s just a hormone with no other body problem then things like you know reducing your carb intake being healthy reducing your BMI sometimes just helps with that and sometimes other things in life which we forget about uh
You know stress unhappiness depression sometimes will change the way your hormones are released and so your periods might be prolonged or absent in some Wom to answer the question yeah thank you very much that was that was really um interesting and also um I liked what
You said about how there’s so many other factors in your life that can affect periods such as you know stress that we often Overlook I feel as women um and diet as well and exercise um I think we can Overlook how big of a difference that can make to our
Cycle so I think that’s a really important point to make absolutely absolutely I think I always tell people you just need to sometimes look at the other bits of your life yeah more like holistic view holistic view yeah as opposed to just like specifically there’s one reason as still why you’re getting this
Pain there might be so many other things so yeah um another question that we’ve got is um how many weeks after a surgical miscarriage do you get a period And when is it time to get worried so it depends uh your hormones from a pregnancy um
Whether you have had a pregnancy loss or termination or medical management or surgery sometimes will stay in your system for about six weeks so for some wom even after you’ve had the loss you will have six weeks before your periods start to regulate again and that’s normal um but sometimes if uh they
Advise women after they have a procedure to do a pregnancy test uh three weeks after just to make sure that that PR that you don’t have it because by then your pmon level should have come down because again that will stop your buildup from the ovulation so it depends
Uh on each woman to another usually by six weeks to three months you should be getting a period again if you don’t then you should go seek medical help Okay so around after 3 months time is where would be worried expect it for six weeks so if you’ve had if you’ve had a
Miscarriage um 3 weeks after you’ve had a procedure do a pregnancy test to make sure that that’s negative and if it’s not then you need to go to the emergency gy unit if you are negative then you should have after your procedure about six weeks start to get periods but up to
Three months is normal for some women okay thank you very much I hope that answers um the question’s question um also if you do not want to put your question in the chat to everyone you’re welcome to send it directly to myself um if you would feel more if
Anyone would feel more comfortable with that and then I can share it with Dr Muhammad um I’ve got another question similar to um previously um when we were speaking about PCO so I’ve got a question that says is early marriage beneficial to ladies with PCOS PCOS isn’t um isn’t a
Contraindication to marriage so I think any gynecological condition isn’t a label to not being able to get married and start a family and I think we get that a lot within our communities I feel really strongly about it so it’s not a contraindication there’s so many factors with INF fertility my interest isn’t
Fertility so not gone in but there’s so many factors into fertility polycystic ovaries is very common within our ethnic group because diabetes is very common within our ethnic group what polycystic ovaries is is essentially in in a nutshell is that you might not ovulate so that day 15
Ovulation might not occur all the time and that’s because you start with building up one estrogen but halfway through the pathway of releasing that right amount to tell your brain to secrete the second hormone that doesn’t happen and so it builds up a bit like a traffic drb and it starts
Producing other hormones uh which are which are testosterone because that’s a b product from it that’s why some women with polycystic ovaries will complain of abnormal hair will complain of things like that but essentially that condition is is related in some women not all women in some women uh to BMI to body
Weight to uh metab how you metabolize your estrogen how much carbs you have and and actually controlling that might help regulate your period and a lot of the work they a lot of the work that’s been done is reducing your uh body weight by about 10% might help regulate
The hormone now there is a group of women who um will have polycystic ovaries and have a normal BMI or have an under BMI um and and and there’s so much treatments that you could offer to help regulate their period to help um help them with fertility so it’s not a you
Know a lot of women link well I’ve got this it means I won’t have a baby I’ve got this it means there’s it doesn’t mean that there’s treatments that you could offer to help for some majority of women they might not need treatment so polycystic ovaries a lot of women fall
Pregnant with no problems endometriosis some woman all pregnant no problem but as usual there’s a subset of women that will need help and that or or couples that will need help because it might be male Factor as well and unfortunately there’s always going to be a group of
People that won’t get pregnant and and and I think it don’t label yourself and say well this is definitely not going to work for me because you you never know so yes I go go ahead and get married I think that’s really important to say um as the person said people with
PCOS are usually advised to marry early um and as doctor saying don’t you know limit yourself with the label and say let me just get married just in case because it affects people in different ways so I’ll tell you how that works that comment Works um so just to
Elaborate on that so a lot of people that have um you know health problems whether they gynecological or non gynecological are advised to have a a pregnancy earlier and the reason for that is if you so you’re born as an embryo with so many eggs that’s how
Women are different from men they don’t produce a different um men will always circulate so they they you know they can be of any age and they’ll still build up their seen although it might be a different quality the eggs you’re born with are the ones you live with until
You reach menopause and so if you have any condition any health condition the advice of getting married and having a family early is because of how much ovary Reserve you might have and so a woman uh you know in her in her early life will have a bit more than as she
Gets older and that’s where that comes from so the advice of yes you know starting a family early isn’t just because of this Condition it’s because your your your reserve and so your chances will get less and less as you get older and so the advice is you start
Early so that just explains that a bit more because I think it confuses people when someone says that yeah I think that makes sense um but I think it’s important to note that um some women might feel pressure to then get married earlier and then end up
In a marriage that maybe they wouldn’t want to be in just because they’ve been told to get married earlier yeah yeah and that will help your cycle because then you’ll be stressed you exact exactly and honestly everything is in the C of Allah some people are told that they can never have
Children and then they end up having children sometime later so none of these conditions equal you know none of these none none of your health conditions equal definite or you won’t get pregnant just sometimes you do need support um and and there’s only a small group of
People that people say to them actually it’s unhealthy to get pregnant because you have got this medical condition but that’s not all of us that’s only a small group of of women thank you very much um I’ve got another question saying um this very useful talk is it normal to
Vomit whilst on your period due to a lot of pain so that’s not normal always remember that your periods the so your Peri a normal period uh either from flow or pain should maybe make you a bit uncomfortable you know maybe you feel a little bit not right but if you’re
Having an extreme that it’s stopping you from um doing activities from daily living then it needs something doing whether that’s vomiting whether that’s extreme pain whether that’s flooding all of that is is not normal for a period some women if they get a lot of pain it
Might be a time for them to start uh seeking medical help because it might be that they uh have have have endometrosis or some women will have have it linked to like severe premenstrual tension and so sometimes that’s the time to have seek medical help it might be that you
Just start on the pill and see how you get better you might might not always need uh surgery or need something like that but definitely if it’s limiting you that you know you’re you’re um affecting your activities of daily living or you know some woman will say I don’t go to
Work or I have to think about you know changing my trousers and you know we all have to make considerations when when you’re on a period but if it’s changing the way you have to do things because you’re in a period That’s when you need to see medical help
Okay um I think uh just in terms of the like vomiting and growing up and being in that much pain sometimes difficult to realize that that’s not normal and sometimes some medical professionals will say that it’s normal or like they might not realize it’s not normal or say that it will
It’ll stop after a couple of years and then 10 years have gone by and that person is still in that much pain and unfortunately that happens a lot that’s you know and that was was quite pleased to do this talk um some some some sometimes people will have some
Conditions when they’re younger like their vomit or they’re in pain um and and sometimes people won’t accept things like why do why doesn’t this young girl just try the pill for a few months because that will help her because at that stage in your in your life you
Might just need something to take the edge of way but if you are still suffering or still continuing to suffer then sometimes you need investigations it might be that you come back with saying actually there’s nothing we can do there’s only this we can do but at least you’ve been investigated to make
Sure it’s nothing like you know like a Dem metriosis or something else um and so sometimes it is just having um treating the symptoms so treating the the problem uh the the problems it’s causing you sometimes you don’t need the treatment of the condition the whole way through
Because sometimes the condition can be just managed without needing it to be taken out and and vomiting is one of those sometimes it is something people might as they get older get better from but you still need something to support you with it you can’t have a a period
Especially for the young younger girls in school or in college or university you have to have something that helps you manage that symptom so what would you suggest for someone that is you know at that stage where they’re vomiting vomiting they’ve been told it’s normal Maybe by their GP
Uh I would try for for I’ll try the pill I would try the combined contraceptive pill um there’s a big fear from the combined contraceptive pill a lot of woman that you know scared of putting hormones in it um in them but it’s it’s it’s reversible so sometimes it might
Just help control that hormone level that you get each cycle sometimes with the combined pill you can take it for three months without a break to see how you get on and then you cycle it through and see if that helps your symptoms so although it might
Not treat the cause of the problem it might help control the symptom until you know you’re ready to stop the pill or ready to start a family and then it might get better or it might need investigations then so um what are there any side effects of taking the combined pill for prolonged
Periods of time so for prolong so the main the main thing with the the main thing with the pill is that it’s estrogen and progesterone um so because you’re taking hormones taking it for a very long time May slightly increase the chances of having a blood claw or breast cancer if
You’re taking it for a very long time but that’s actually on a background risk very very rare uh and so it doesn’t cause any long-term effects to fertility which is I think what a lot of people are worried about it’s completely reversible when you stop it and so even
If you’re taking it for a few years then it’s absolutely fine um some some of the fears that sometimes come from from women regardless of their backgrounds actually is they they go on the pill quite young and then 10 20 years or you know they get to 20 years and they say
Oh we want to start family want to come off it and then their symptoms come back and so in their heads they think oh this must be a side effect of the pill but it might be that the pill has really controlled your symptoms and now your
Symptoms have come back again um and so it’s not all related or if you had a problem initially that the pill controlled or masked and then that problem shows up again in a few years it might not be because of the pill it might be that the problem was always
There um I personally find it very useful in women and young women you know that are not planning to have you know a family soon just to help control their symptoms rather than go down the route of having a lot of operations a lot of surgeries at such a young
Age that’s really helpful thank you and I hope that helps the person that that question as well um another question I’ve got is is a 19 to 21 day cyle or normal for some women yes as long as it’s regular for some women yes okay so it would you say it’s more
About what’s regular for yourself yes as and that’s why keeping the diary is important because sometimes some some some woman come and say my period is completely irregular and actually the the period is regular it just a 35 week Cy 35 day cycle it’s still abnormal it’s still prolonged but it’s not something
That’s abnormal or always due to a problem it might just be normal for you or it might be just short for you you know might just be a normal thing for you a variant of the norm so then if for example if it was 28 before and
Then now it’s changed to 21 would you then say that then that should be something to think about investigate no not necessarily it just might be your ovulation is a different day so your your period will be at some stage and your ovulation it’s not always halfway
Through the cycle um it just depends on where you when you secrete that hormone and if your period is still regular that that’s normal okay thank you um so I’ve got another question um someone has said I’ve been told that I have a low ovarian reserve and I’m worried that I will not
Conceive so again like I said I don’t do fertility the low Varian Reserve is linked to what we were saying before so you’re born with number of eggs and your low variant Reserve looks at the hormone that’s left in that eggs so how much is left over the way the hormones
Communicate with each other in our body is they send the brain something called a negative feedback so when we have too little it sends a different hormone having a lower variant Reserve might mean that you need support uh conceiving and so it might be something that if
You’re trying for a pregnancy you seek medical help and fertility help quickly uh because it has implications it doesn’t have implications for your overall health but it has implications for your uh fertility so I definitely say if you’re being told that it might be that you need support for
Fertility okay thank you so they might have to go down um you know getting some maybe doing um tests and things like yeah so it be something if once they start planning for a pregnancy they might be you know they might need to be referred for uh like Reproductive
Medicine to see whether there’s anything they can do to stimulate and again it depends on the level of the reserve and how high how much they’ve got whether it’s something that they need they’ll be able to get pregnant on their own eggs or whether they need support doesn’t
Always mean that you won’t get pregnant naturally it just means that the reserve of those excess left over aren’t as good as they were and and and and so you need support with that sooner than someone who’s trying for pregnancy naturally okay thank you um another question that we received was how long
Can you take the combined pill without taking a break to manage heavy bleeding and pain and would the progesterone only pill be a better option that’s two questions yeah so you could take the pill as long as you need it to manage pain um so there’s no time limit for it
Per se the progesterone um so the progesterone depends again you can have it as well for you can have it instead of the combined pill you can have it U you can have the progesterone coil the marina coil instead of the combined fill uh they work they the only thing they do
The progesterone is it stops the period not temporarily not permanently just temporarily sorry um if the pill is working well for you then by all means stay on that if not and you feel that it’s not controlling the pain then you can go with the progesterone but there’s
No time limit to how long you can stay on the estrogen the only think that as you get older if you’re smoking if your uh BMI is over 35 the risks of having clots with the combined pill increases and so you might be advised to go on a different
Contraception but if if it works for you don’t don’t stop it unless it becomes something that you’re advised to try something else what would be the I guess difference in terms of the combined pill and Preston only pill so the combined pill uh kind of mimics the the cycle a
Little bit so you get estrogen and progesterone you get both hormones um and then you produce a you’ll have a withdrawal bleed in the end of it so you always have a period uh but it’s still you’re not ovulating it’s not your own kind of release the progesterone works
On that hormone that works on the diff the the end of that cycle that other bit so it causes the lining of the womb to be thin and it causes that to be continuous so it stays the same that one you have to take it all the time uh you
Can’t you don’t have a break from it because it works through a different mechanism um they there’s other forms of it and actually what we tend to use a lot more is the hormone based coil because that will sit in the in the womb and work locally and not give you that
Much absorption of the S side effects of the progesterone um the side effects for progesterone mainly is the bleeding that may be irregular so some women don’t like that because it disturbs their prayers um some women you might get a bit of s s breasts with them so it’s just a different
Pill when when you’re smoker or uh have a history of a blood cloth in the legs or the lungs you know uh or as you get older you are advised to do the progesterone only just because it reduces your own chance of having a blood clot so just the benefit of the
Different medication really does that answer that question yeah yes does answer the question um so would you say that if you’re younger it’s better to use the combin pill or does it just depend it does depend so if you’re younger and you want something that you still have a
Period with and the combined pill is working well for you then go with the combined pill if your older so usually over the age of 35 uh then and you’re going to keep up with taking the progesterone only pill then the progesterone only pill or the implant or
The coil work much better for that age group in saying that some women even the younger women would benefit from the implant or the implant on or the coil or the pill but with the progesterone only pill you need to take it at the same time and so it’s it’s about maintaining
That the combined pill you still need to take it in the same time but you’ve got a bit more of a window okay thank you um so got another question is it okay to refuse medication um for HTR to slow down menopause h r t like human replacement
Yeah I think yeah so it depends so yeah so um so HRT depends so HRT depends on what symptoms you’re getting um and it’s usually uh so it’s usually when your menopause starts if you have if so essentially what happens is the ovary switches off in menopause and so you’re not producing
Hormones anymore some women will get symptoms uh like hot sweat feeling unwell feeling irritable uh and so benefit from having that replacement if you have menopause earlier on so if you have it under the age of 50 then actually having HRT or having even the combined pill helps with
Giving you the hormone to maintain you other benefits of health so your bone health your heart health your uh motor Sy your you know your memory things like that if you get to an age to 50 in your periods have been fine otherwise and you don’t want HRT that’s absolutely fine uh
Because it’s only replacing the hormone that you’ve lost uh you would have lost anyway so just helping with the symptoms but you might still have the symptoms of menopause you might still need support from that point of view and so leading a healthy diet making sure you get the
Right vitamin D uh making sure you do kind of weight based exercise helps with your bone health and and that’s the importance it’s it’s the bones because as we’re living longer and we’re reaching menopause like say 50 52 53 and then you’re living till 70 or 80 your
Bone isn’t as strong it is and now it’s got 30 years and so if you have a fall you’re more likely to break it and that’s where HRT is useful but if you’re fine with the symptoms then you don’t need it that’s it’s absolutely fine thank you um I hope that answers
The question um in terms of endometriosis and getting a diagnosis from it you said something about you need to have the laproscopy to diagnose it so that makes it difficult for women to know if they have it or not without that um is there like another
Way to find out or is that the only way so with endometriosis it’s this it’s the symptoms that it causes that people are kind of you get a suspicion whether you have it or not sometimes when women are examined you can see whether they’ve got severe endometrio the scan doesn’t always show
It because it it’s implanting inside the other areas of your body and so the laproscopy is kind of the main way to be able to get that diagnosis because it looks inside it’s it’s an operation so you come in you’re asleep uh it’s Keyhole surgery through the belly button
And we have a look at inside what it is and and then see whether you’ve got signs of endometriosis or no signs of endometriosis and the laproscopy if it’s minor what sometimes major helps us take it out there’s no other kind of that that you can diagnose it by exclusion so
For example if you go in on the pill and your pains gets better it might be endometriosis that’s got better uh and that’s why I was saying in the beginning for younger women that have problems with their periods in pain sometimes going on the pill for a bit um avoids
Them having a lot of laparoscopies at such a young age because it might help their symptoms and and essentially that’s all you need to do um in women that have things that suggest that they have endometriosis affecting the bowel or the bladder an MRI is useful to identify if there’s anything
Infiltrating into it but it doesn’t give you that full diagnosis uh it just gives you whether there’s endometriosis that might be deep enough to affect other organs so essentially the laproscopy is your is your gold standard for treatment or or an you know a diagnosis of
Exclusion so if you used the pill and it got better and you suspected you had it before would then the GP say that then you you had it or you have it or would they suggest that so if it if you have so sometimes you might get pain from endometriosis or
You might just get pain that’s not related to endometriosis and it comes in stages uh people are sometimes fixated that if you take it out it’ll never come back but it does come back and it comes in stages so some wom might have it mild some people might have it severe if you
Go on the pill and it helps your symptoms your GP might say you’ve got symptoms that are suggestive of endometriosis so you possibly got endometriosis but it could possibly be other causes but if a lot of these um conditions if we can support them or we can treat them without needing surgery
Then having them doesn’t doesn’t isn’t a problem it’s one of those things that you might just have and as long as we help control control the symptoms and if the pill is doing that that’s absolutely fine some women are worried that there’s a delay diagnosis and so it might get
Worse and again that would depend on the symptoms and so some women might not get a lot of symptoms and have really bad uh disease and some women might have a little disease but a lot of symptoms and so if your symptoms are not resolving or not getting better with the GP then
Actually you do need further investigations regardless of the label that’s given to you by the GP does that answer a bit of your question I’m sure yes it does um when you say further investigation do you mean being referred for a gy yeah so being referred uh so if
You if if you go on the pill and and and it helps you then it’s fine you don’t always need a a a referral up until you know you’re trying for pregnancy and maybe you’re having problems or your pain reoccurs but if you are still getting a lot of symptoms and a lot
You’re still uncomfortable and you’ve tried you know the painkillers you’ve tried the pill and it’s not helped you then do need a referral to guy you do need further investigations okay and if um how would you be able to get a referral to gu so
Through the GP through the GP if you you know say that this is what you’re worried about and you’ve tried this and you’re still in pain then your GP will refer you through okay so would you have to that would you say you need to try the pill before you get referred or
Could you just be referred if you have so again again it depends on your symptoms if you have symptoms that you not managing then I would say try the peny because sometimes that because sometimes that’s what your gynecologist will will advise you with first line if
You find that actually um you know you don’t want the pill or you’re really concerned about it then you can get referred but the pill is a valid treatment and the pill will be offered to you by the gynecologist as well sometimes you won’t get offered the pill
Sometimes they offer you the marina coil or a progesterone only contraception because that also is treatment to hormonally control these conditions okay um and are there any if someone for example because I know a lot of women don’t want to go down the pill for hormonal treatment are
There any treatments that are non hormonal um or anything yeah painkillers so if you don’t want hormonal treatment because you’re trying pregnancy or you don’t want to have um you know the pill or you don’t want to take it then you just have to take painkillers
Um or then if you get referred you might you might need surgery to remove endometriosis or to do the laparoscopy but then with with a lot of these conditions they might come back even with the cysts if you have an ovarian cyst and we take it out it might
Come back in the future uh but if a lot of women are very weary of hormonal treatment and so it’s it’s always your decision and your kind of preference but if that happens then it will be getting referred for surgery or duration of surgery or pain relief if you want something
Else thank you that was really Thora um as I’ve said before if anyone has any more questions that they don’t feel comfortable sharing in the chat with everyone you’re welcome to send it directly to myself um I have another question which is about um um eggs I think so it says please
Advise on premature or wearing insufficiency and how to treat it I know you said that you you’re more on the period side but that’s just a question that we’ve been asked yeah so variant so a Vari efficiency sometimes um when the over so this is just a basic view uh so
It’s usually it’s again going back to what we were saying before about um not producing the right amount eggs and having a lower variant Reserve so it’s a different name for the same condition and again if you don’t have enough eggs then you might have you might go into menopause
Early there’s no kind of treatment for that unfortunately it’s the way we are made as women so we are made that we produced with this it’s like if you have a pot of gold and and your gold comes less and and and finishes it’s the same thing sometimes the treatment again is
Symptoms but there’s no there’s no unfortunately treatment that can bring back the eggs it’s it’s one of those conditions that HRT or hormone replacement that we discussed might help with the symptoms it’s the it’s the reserves that that are not there so essentially there there’s it’s just how you’ve
Been the way it’s just you’ve reached you’ve reached your menopause essentially before before you know before you should have before 50 and that’s because the reserves that are held within the ovary have have decreased and they’re not enough so the treatment is really to treat the symptoms that but that cause of the
Problem is is it reversible okay um so something like IVF wouldn’t be able to IVF depends on um a lot of factors sometimes depending on how much Reserve you’ve got um they’d be able to support you using your own eggs so if you’ve got some eggs that they can
Harvest and take and again this is not my field so I’m just giving a really Broad View sometimes they offer you to get donor eggs so have someone else donate their eggs and you get a pregnancy that way so it would depend on your reserves and how much you’ve got
You’ve got left over what what they can use for IVF okay thank you um we have another question which is pregnancy related um it says what does Dr Muhammad think of pregnancy over of 40 plus on any advice in in in age yes age so um 14 over the age of 40 your
Fertility is reduced um you obviously have a lot more risks associated with the pregnancy so you you know got more likely to get chromosomal problems you’re more likely to have a miscarriage uh you’re more likely to have other medical uh problems in the pregnancy so develop diabetes or high
Blood pressure um we do offer um if you choose to get pregnant over that age that we scan you quite frequently just to make sure baby’s growing because they placenta what feeds the baby doesn’t works as well as as you when you’re younger um we also offer kind of to
Deliver you at terms so usually if you get pregnant a bit younger then we could we could wait 10 days after your due date to make you go into to labor naturally so over the age of 40 your pregnancy it’s not completely kind of a no no but it’s a higher risk pregnancy
Especially if you’ve got other medical conditions because they might get worse in the pregnancy because you’re taking age a factor and whatever condition you have obviously our life has changed now and we do see a lot more women get pregnant over the age of you know some
Women won’t get pregnant till over the age of 35 and so there’s a lot of support but as you get older especially over 40 over 45 your risks of the pregnancy do increase thank you very much um that’s really helpful um so I’ve got a question
About periods um it says that is period pain genetic or hereditary there’s no evidence that it’s it’s genetic um we do get a lot of a lot of families that will say you know my mom had hysterectomy so many years ago and I’ve got the same problem so it
Might be but it’s not there’s no evidence for it either way so you don’t have a gene that carries you know heavy periods of endometriosis there’s no research supporting it um and so the short answer is I don’t know for sure um but there’s no evidence at the moment to say
So yeah because a lot of people do say that and it we have seen a lot of people that you know it starts with their Grandma their mom and then them and then yeah I guess some people it’s it just comes to them randomly I think quite a
Common thought that it can be hereditary it might be but just no there’s no evidence at the moment might be that you know years years from now people discover that it might be you know we just don’t have the evidence at the moment yeah okay thank you um so I’ve
Got a question that says can a menopausal woman get pregnant so the answer the answer is no because menopause essentially is the eggs that we produce that you born with have have finished and so women that are manop posal won’t get pregnant now the exception of that is if you have
Premature Varian failure or menopause early then some women might get the odd egg that releases and so for those women they might quite rarely get pregnant but essentially once you have a diagnosis of menopause then you’re not you’re not going to get pregnant because that’s the end of that reproductive cycle that’s
The that’s the end of your reproductive Health life and how would you get a diagnosis of menopause or how would you notice if so for your period stop essentially uh your period stop and it’s usually women that are older period stop they might get hot flushes because of the way their
Hormones are might get a bit Moody get a bit of dryness especially in the vagina um but usually the periods will stop and it’s once your periods stop for at least a year and a half to two years then that suggests your menopausal um the tests that we do looks
For those hormone levels to check whether you know some women the periods might stop because they’re not postmenopausal they’re not menopausal but their periods stop because of stress or because something else and their periods will restart but once you get a diagnosis and it’s confirmed by two separate blood tests that your
Menopausal then your menopausal um especially for women that are younger than 50 over the age of 50 if you’re periods stop and you get all the symptoms then we don’t routinely do blood test to check it okay thank you um and what I guess what other symptoms would you have apart from
Maybe less period if you’re under the age of 50 or even so under yeah under the age of so it’s the it’s the same symptoms regardless of where where when you get it the only thing is that at the age of 50 if your period stop then we
Don’t need to we don’t need to double check it sort of it’s the opposite so sort of like if you start bleeding at the age of 13 or 14 no one’s going to check whether your periods have started because that’s one we’d expected to have if your periods start to stop and don’t
You don’t get a period for over uh you know six months after your periods have started then you do need to be checked to check whether you’ve got early menopause or whether you’ve got another cause for your periods to stop unless you’re obviously pregnant or on the pill
That will stop your period if if you’re not taking anything then and you don’t have a period for over six months and you’re under that age you need to be screened for menopause okay thank you how would you know if because I know some people that have
PCOS they um can have a period once or twice a year um how would you know the difference then with for for policy stick overies for people who got policy de overies um the recommend so that if you’re if you have that condition your periods are irregular then the
Recommendations actually that you have a period at least four times a year um and that is because the buildup of that lining of the womb needs to be shed so because if you’ve got polycystic ovaries and you don’t have a period Then if that lining of the womb is being built up
With no right hormone supporting it then the risks of having an abnormality of the lining of the womb which may uh lead to kind of cancer if you’re older then it’s it’s quite high and so you should actually be taking and it might not be a true period that you
Get but you should be at least getting four periods a year if you are on a progesterone only contraception as a treatment for your polycystic OV so you’ve got the marina in or you’ve got progesterone only pill then that’s okay not to get a period because the lining
Of the womb is being it’s thinned out with the tablet but if you’re not on anything you should get at least four periods a day a year and if you don’t then you should get you should see your GP to get that sorted okay thank you um
Got a question that says any advice on vaginal dryness um it depends on vaginal dryness whether it’s related to menopause or in what context um to be honest um so Some Women Within menopause will get vaginal dryness and there’s um a lot of treatments that you can do within that
So one of them is there’s a lot of lubricants that you can get over the counter that are hormonal um but you could also get like HRT tablet that yourp can prescribe that will help with that if you’re getting vaginal dryness as part of uh issues
That you might have with kind of being intimate then that sometimes might be just the way your estrogen is and so you might need support with that or you might just need lubricants for for for for when you have a problem and so it’s a bit it’s very difficult to advice just
With that because it could it depends on the cause really more than than just have generals um well if the person that ask that question has any more context could you please directly message me and then I can elaborate on it later um but other
Than that I can move on to the next question um so does having a low egg Reserve mean that um there’s low chances of getting pregnant I think we kind of touched on that before yeah yeah yeah um yeah and I think the doctor said that you’ve got a
Certain amount of eggs from when you’re born basically and it decreases every month so it’s just every month um am I saying this right that there’s yeah so so if you have a low egg reserve it means that what you’re born with so you’re born with so many millions of
Eggs and if they they they they kind of decrease every month and if and if you have a low reserve it means that you don’t have enough eggs they leftover and and so that reduces your chances of getting pregnant and increases your chances of going into menopause early because
That’s the same thing that’s part of the same function the cause of it is that you’re egg reserving reduced um I’ve got another question that says says does prolapse affect the irregularities in maturation at the age of 40 the irregularities of maturation don’t understand what that means so Pro
Prolapse um I think it means I think they mean menstruation so not normally and not normally um so prolapse is usually related to and again I don’t do Euro but I’ll AB as much as I can um it’s related to to uh your ligaments so you after you have a baby you you’ve
Stretched your ligaments supporting the vagina so you might get a prolapse because of that it doesn’t relate to your menstrual uh cycle it’s not hormonal it is to do with the support mechanisms of the U of of the of the kind of the ligaments of the muscle uh
What you need to do to help with the prolapse the first thing and the simple things is your pelvic floor exercise your weight control and your exercise generally being able to be to to hook um control those muscles being able to help them to help with the symptoms and if
That doesn’t work you might need surgery for it but it’s not related to um your periods they’re two different they’re two different streams of work thank you for that um I’ve got another question that says does using a mobile phone affect menstrual pain cycle no no evidence on
That yeah your B your brain being able to work well other than that no it’s should not related it’s not related okay thank you because I know a lot of a lot of people can say that the phone the radiation or whatever it’s not related okay thank you very much
Um got a question here that says um just in terms of period pain how would you be able to um measure that your period pain is too much compared to normal I think it’s personal pain is personal we always forget that you know um we victimize wom
A little bit because you know say well she’s got pain threshold that’s this and that but pain is personal if you are troubled by it and if it’s something that’s disturbing you like I said you know some women won’t have won’t have a lot of disease but have a
Lot of pain then it’s it’s your own pain it’s your own Ownage of that pain um and so it’s a personal thing you there’s no measure for it there’s no measure on uh whether this pain is too much if it’s affecting you and it’s affecting your own activities of of daily living then
It’s p it’s pain for you um you know sometimes within our community say you know I’ve had worse pain than this and you know it’s not as bad as labor pain but if it’s painful for you and it’s affecting your own activities then it’s painful you don’t need validation for that
Pain thank you for that and I’ve read that like some people’s period pain is can be like very low compared to very low labor pain I don’t know if that’s true or not so it depends as and I mean it’s very difficult to say that because again even labor pain is different to
Different women um but some women will get you know some women are really really suffer with their periods where they can’t get out of the house because they’re in pain and and that’s painful but even if you know there if you feel that your pain is affecting you and
You’re struggling with it then that’s painful for you you don’t need you don’t need the validation of it being as bad as labor pain or toothache you know sometimes we compare it because we just need to understand but if it’s painful it’s painful yeah I think it’s really
Important to say that because sometimes some women that maybe don’t get pain might not understand or the pain doesn’t affect their daily life might not understand other women that have very painful periods um and then might compare and it just doesn’t really help anyone and I think it’s it’s important to to
Say that because how we perceive pain and where we find it painful might be different so you know some people might you know don’t care you know they got tummy pain they’re not bothered but if their finger hurts then that’s a big thing for them or if they got a headache
It’s a big thing for them so doesn’t always compare doesn’t always link to your perception yeah so would you say that if you’re not able to like leave the house if you feel that your pain is affecting your own activities of living if you’ve got to change your life because you’re
On a period that you change it significantly it’s not that you have to take a you know a pill or whatever you’re changing it significantly then that that is a problem and you should you know you see you you see a lot of women that say you know you know I have
To take I have to work from home on the days when I’m on my period or you know I’ll be in the office and I’ll be soaking through and that’s not normal your period shouldn’t be that you know shouldn’t affect you that much if you say well actually a bit uncomfortable
And I’ve got a bit of s through actually you know overall I’m okay then I mean if you if you compare it if you have a bad cold for example if you bit snuffly then you’re okay and you’re out and about then you’re okay you know you’re going
To get better but if you’re really sick and you haven’t been able to get out of your bed then you you you might you need treatment you might need to go to the hospital you know if you’re older for example and you know when Co happened
You know some people are okay but some people got really sick and passed away from it so it’s it depend it really just depend on on how it’s affecting you and your other health problems yeah um someone has said that um they get lower back pain on period and not pain on the
Abdomen um is that is that normal or what causes that yeah yeah so for some women they get they get pain around their back rather than abdominal pain and again if they’re managing that that’s their Norm for their pain they’re managing with pain colors and they’re okay they don’t need anything doing for
It but if it’s that severe that it’s affecting them it might be a signed for something else and they’ll need maybe to try the pill as first line see if it gets better or to speak to their GP for a referral um Sometimes some women will
Get a bit of s in the back but all but it’s because they have a problem with the back and they need to exercise the back rather than jump in to think well it’s definitely related to the period because of the change of how you release the hormone sometimes the ligaments
Might soften and so a back ache that is probably there but you haven’t really thought about might get worse because you’re on the period um so the person has just said in in response to what you just said um they asked is would retroverted be the
Cause for lower back pain so a retrovert so what so the what what retroverted uterus means is your you so your you imagine your kind of your pelvis or your tummy like a a round plate yeah so the uterus would either point frontwards or backwards and it’s a normal variant of
Of where of you of people yeah so it’s a normal variant it’s nothing so the majority of people that will Point um you know forwards called antivert for some women it might Point uh backwards but it’s normal for them it’s what they it’s where their uterus forms sometimes
The uterus kind of moves back and forth back and forth according to where it is um sometimes having a retroverted uterus which means it points backwards puts a bit more pressure on the back and that might be why you’re getting pain and some women might when they’re intimate
Find it a bit more painful in certain positions because of where the room is or if they’re doing a smear there’s no kind of quick fix for it it is just the way that you are at stages so it’s not something that’s wrong with you it’s just your own Anatomy it’s the
Variations of our body rather than a problem thank you for that um I’ve got another question saying is ablation a better option than the traditional hysterctomy and IND demetrial ablation yes so an endometrial ablation is basically burning off the lining of the wom what it does is it works on um so it
Works for PE women who have heavy periods it may or may not help with pain it’s a minor operation so it’s better from a traditional hysterectomy that it doesn’t need a major operation so it reduces the chances of having the risks of having a major operation um when it works for a woman
It works really well because it stops them from having a period sometimes you might still get pain when you’re due to have a period because um you’re still you know you’re still ovulating you’re still producing the egg you’re just not getting it flow the main thing with
Ablations is in some wom it causes scarring inside the wom and so in the future if they needed any procedures it might become a bit more difficult as they get older but it’s not something that’s major it’s just one of those things you need to be aware of with a
You need to be sure that you’ve completed your family and and I assume if you’re discussing a hysterectomy you have uh because your eggs are still producing but then you don’t have the inside of the womb where the pregnancy implants so you need to be on some sort of contraception long-term contraception
Or avoid getting pregnant because of the dangers it is so ablations are safe they’re they’re quick procedures they’re office procedures and they might avoid you having a major operation uh such as homy okay thank you um would the ablation then affect it says theor cell and CER cell of first degree see the
Question they sent it directly to me so it just says would it affect Rector seal yeah rect seal and S seal yeah no so that’s a that’s prolapse so it won’t it won’t it won’t relate to it um um so it depends if you’re trying to choose what
What treatment you have it depends kind of what treatment you’ve been offered from a prolabs point of view um the ablation will only work for the period the prolapse either can be managed conservatively or might need surgery it’s two different it’s two different things it won’t affect
It okay I think they we’re asking for heavy bleeds not for pain so the bleeding that’s causing chronic anemia yeah the heavy bleed and ablation will work if if they’re suitable to have an ablation the ablation will work for them uh the prolaps will need a different
Treatment um and so they might need surgery for that or exercises for that but the ablation will help will help with the anemia okay thank you um because I know as well heavy bleeding causing you know chronic anemia um is is also a big problem what would you suggest for that
So it depends on the cause of of a period and that’s really kind of lecture on its own so if the if you have no cause for your heavy period so they’ve investigated and there’s no other cause or you’ve got a fibroid that’s small um then an ablation is absolutely fine and
That will help kind of reduce your bleeding so that you you’re not anemic if you have a cause of it and and usually fibroids are a cause of anemia a cause of heavy periods then you might need treatment for the fibroids and again it depends on where the fibroid
Is if you wanted a treatment that doesn’t require you to have uh kind of a lot of intervention then the marina coil is really good and a lot of people advise it or a progesterone only pill because it reduces the amount of bleeding sometimes having some women can
Injections to give them early menopause but that’s not really for long-term use but it might help reduce the bleeding to build up from an anemia point of VI that answer some of that question words it’s a lot to discuss withs yeah yeah because I get what you mean about
It being a different a different topic so some of it is linked to each other but there’s a lot of other causes for it okay so there could be the issues that you have anemia not related to your period you mean so if your period is heavy so you might have other causes
That cause you to be anemic because it the way you build your blood is is how much iron you have so you might have a problem that makes you anemic all the time if you’re if you know that your period is heavy and you’re causing you
To have a low iron because of it then you’ve got options to treat that and that might be again things that are hormone or having an ablation or having surgery to take away the moon or to take out the fibroids or to take whatever you have so it’s different
Options depending on what’s causing you to be heavy okay and if it wouldn’t sorry on so yeah and again it like we say it always depends on where you are in your life to what treatment you have how healthy you are what other medical problems you will have and so sometimes
Um you know we compare and contrast or this one said this and that one said that but it does depend on a lot of factors um to what treatment is suitable for you so if you’ve not completed your family for example you can’t have an ablation you can’t have a hysterectomy
You have to go with the with the hormones to help you or non hormone to slow down the bleeding if you’re trying for a family so again it does depend on where you are on your life to What treatments you have and what what other Medical problems you’ve got as
Well um yeah I think that’s really important point to make because people can like find out um this worked for someone else but that person is about to go through menopause or this person is you know about to start their family or or 14 years old yeah so always always you know
Speaking to people is is good but sometimes you might not know what their other health problems are that impacts the decision to what treatment they have yes so I think the best thing then would be to just discuss with the GP and if after trying those things it doesn’t
Work then to ask for Gynecology yeah so number one discuss with the GP number two there’s a lot of really good information available online that is not um fake news coming from Google and WhatsApp there a lot of really good sources that I put of them on the slide
Like the endometriosis the NHS website there’s a lot of effort that’s gone into that so use that use that to guide you know we we sometimes don’t read enough about our conditions or we read the wrong um websites and build our own ideas and then speak to a medical
Profession knowledge about your own health is very important you know knowledge about what comes and there’s so much information that is good information so rely on those websites rather than a lot of websites that will feed a lot of frenzy um that is not required so yes by
All means that I think first line have a look have a read speak to GP and then ask a referral if you still need support yeah I think um advocating for yourself is really important um you know what you’ve just said about reading upon things that you know isn’t fake news um
Reputable websites and then being able to take that information to your GP um as opposed to some people notice a difference and then it’ll maybe take them a year to then go to the GP maybe they feel nervous about advocating for themselves they don’t have the
Information and I think a lot of people get put off sometimes because there’s a long waiting list but you you still get seen if you have a problem and the GPS can always initiate a lot of treatment as first line in the community before you need further
Treatment and and like I said you know we fear sometimes you know a lot of people oh they just put me in paracetamol and I say well paracetamol is a treatment for that but so yeah sometimes it is actually the treatment that you need and you don’t need
Anything else and so trying it there’s no problem with it trying the pill is no problem with it because that’s maybe what you need you don’t need anything else not everything needs a diagnosis and surgery and removal not everything needs that some do but not everything needs done sometimes just helping the
Symptoms is enough thank you for that I think that’s a really important point to make particularly in our community where we can be um kind of scared or nervous about going down the treatment route um so yeah um the person that spoke about the um ration um um said that mentioned
Adenomiosis which I know is a different thing that we’ve not mentioned and they said perhaps a zoom session on heavy beds might be good in the future yeah so adenomiosis is endometriosis in the muscle of the womb um and that’s a pain it sometimes causes pain which which gets worse with the
Period the ablation might not help with that the ablation will help with the heaviness of period but it’s a simpler treatment and it might be that she you just she might still need a hysterectomy in the future but you know she sometimes it just it’s a it’s a better stop than
To go for a major operation but just upshot with the ablation and that’s why I tell my patients that the ablation works really well for heavy periods but it may or may not help with adenomiosis and painful periods it might do but it might not okay thank you um and the last
Question that I’ve got um kind of a follow on for from that is is hormone testing a good idea for heavy bleeds and what would it show uh so hormone testing I’m assuming to check whether your menopausal or not whether you’ve got right aarian reserves so for heavy
Periods alone it doesn’t add that much to be honest it adds more for irregularity of the period or if your periods are stopping or if you have other symptoms that are suggested for menopause heavy periods usually need another set of Investigations they don’t just need hormonal treatment because it’s completely different pathway and
Again like what I said it’s all in the story of your of of your of your condition you know what makes it worse what’s associated with it which is important to see what investigations you need thank you so much for that um I think we can all agree that this has
Been a really really beneficial lecture from Dr Muhammad um I’ve learned a lot from it and as we’ve received so many questions um I think everyone has learned a lot from it as well mashallah um you’re very knowledgeable and you’ve been able to answer the questions in a
Really well-rounded way which has been really helpful as well so for that and I’m glad you guys have found it useful it’s really a pleasure to be here actually thank you so much it’s been very very useful um and to get a different perspective as well on sometimes we have have perspectives of
You know don’t use this don’t use that and to get from you know a reputable source that it’s okay to try um and then to go back to the drawing board if if it’s not working um so yeah um if we haven’t gotten to your question um please put it
Into the Google form that we sent out previously um and we can answer it another time inshallah um thank you oh someone’s asked about the website recommended um I think Dr Muhammad spoke about endometriosis the endometriosis UK website for endometriosis there is a really good resource in the NHS website
For fibroids um and I tend to I tend to use it for my patients actually direct them there yeah um and we also have um so the the Royal College of Obstetricians and gynecologist if you type rcog there’s a lot of patient information there that’s really good it goes through endometriosis it goes
Through PMS uh and it’s written quite well it is mainly written in English but there are resources that are translated brilliant thank you so much um so NHS website and endometriosis UK and the rcog the r website yeah brilliant thank you um so yeah we’re
Coming to the end of the lecture now um Dr Muhammad is there anything else that you’d want to add thank you so much um if we can all you know give a big thanks to Dr Muhammad for joining us today and walking us through something
That affects you know all of us and um my name is Aisha admi and um it’s been a pleasure to moderate um today’s lecture so I’m going to pass it on to um Amira to close yeah Salam alikum everyone thank you so much um Dr y Muhammad it has really been
An insightful session for us today and um you know we we say a big thank you Jaan for educating us and for spending this quality time with us I think it’s a rare opportunity actually um because you know you know how you know the the waiting list
NHS to be able to see a consultant but you’ve um volunteered to spend this poy time with us and I pray that may Allah accept it from you as a big you know um reward on the day of judgment and um I like to see this opportunity as well to
Thank Dr lameir for facilitating this connection because you know without I would not have met you so thank you very much and um we hope we can call you back again to talk about other you know issues affecting women I am pretty sure that everybody on this call will agree
That they are been you know educated and going away with you know um a lot of um useful information Zach M Kiran everybody for joining and um I hope you can leave feedback for us and let us know what other the topics would like us to deal
With in the nearest future thank you as well Aisha for moderating and um I sayum thank you so much for having me it’s it’s been useful for me as well thank you so much just before we go um we do have um uh our next networking session coming up
Um which I just want to share just before we go which is regaining self-esteem and self-confidence um the topic will be a joyful journey of well-being and resilience for women and this is going to be in person on Saturday the 10th of February inshallah so this will be in a
Couple of weeks time from 10:30 a.m. to 400 p.m. um and this will be at longside library um in Manchester in longside um this is a woman only event and you can register on event Bri um with early be discount lunch will be provided um it’s going to be a really
Really amazing session um and we’re going to have Zar Muhammad the Secretary General of Muslim Council of Britain as our one of our speakers um hafa Amin a therapeutic counselor as our guest speaker and kafi Abdus Salam um as our counselor slash guest speaker as well so
We would love to see a lot of you guys there um if you go on to event bright and search this out then you will be able to buy your tickets um ear bear discount is going soon so yeah thank you so much and we hope to see you there and thank you
So much Dr Muhammad for facilitating and you know sharing your knowledge with us and may Allah reward you and inshah we can see you another time am