Gynaecology

PCOS (polycystic ovary syndrome)

One of the most common causes of irregular ovulation, affecting a significant proportion of women of reproductive age. It typically shows as irregular or absent periods, signs of raised androgens such as acne or excess hair growth, and a characteristic ovarian appearance on ultrasound.

PCOS is manageable. Weight reduction where BMI is raised, attention to insulin resistance, and ovulation induction where pregnancy is the goal are all effective. Many women with PCOS conceive with tablets alone. It also has implications beyond fertility — for diabetes risk and cardiovascular health — which are worth addressing in their own right.

Endometriosis

Tissue similar to the uterine lining growing outside the uterus, causing pain and sometimes affecting fertility. It is commonly under-diagnosed, and women frequently describe years of being told that severe period pain is normal. It is not.

Management depends on whether the priority is pain relief or conception, since the treatments differ. Hormonal management helps pain but prevents pregnancy; surgery may improve both; and in some situations proceeding to IVF is the more effective route.

Fibroids

Benign muscular growths in the uterus. Many cause no symptoms at all and need nothing done. Whether a fibroid affects fertility depends mostly on its position — those distorting the uterine cavity are the ones that matter most, while those on the outer surface often do not. Removal is considered on the basis of position, size and symptoms rather than presence alone.

Menstrual concerns

Heavy bleeding, painful periods, irregular cycles or bleeding between periods all deserve assessment. They are common, they are often treatable, and they sometimes point to something that also affects fertility.

Recurrent miscarriage

Two or more consecutive miscarriages warrant investigation. Testing looks at hormonal factors including thyroid function, uterine structure, clotting and immune factors, and chromosomal factors in both partners.

In around half of cases no cause is found, which is genuinely hard to be told. It is worth knowing that even without a identified cause, the prospects for a subsequent pregnancy remain reasonable for most couples.

Preconception care

If you are planning a pregnancy, a consultation beforehand is worthwhile — reviewing medicines that may not be safe in pregnancy, checking thyroid function and haemoglobin, confirming rubella immunity, starting folic acid, and addressing any existing condition before rather than during a pregnancy.