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Nuffield Health: helping you through all life’s stages

Your body is amazing. No other working machine in our lives receives so little attention but runs for years and years. Mrs Caroline Overton, a Consultant Gynaecologist at Nuffield Health Bristol Hospital, offers some simple women’s health tips that will help you keep your body in good working condition, whatever your age.

Health in your 20s & 30s

Periods & fertility

Not all women have a 28-day period cycle. A period cycle of between 25 and 35 days is normal, and tells you that you are ovulating. Women often count the days that they are not bleeding, but the length of the cycle is counted from the first day of the period to the first day of the next. Ovulation occurs 14 days before the period arrives, so for a 25-day cycle, ovulation occurs on day 11 with the fertile days 9-11. For a 35-day cycle, ovulation occurs on day 21 with fertile days 19-21. Keep a record of your period dates to know what your pattern is.

Hormones & PMT

It is normal to have cyclical changes in the body in response to hormones produced by your ovaries. Estrogen is produced in the first half of the month, and oestrogen and progesterone in the second half of the month. Progesterone is the “moody hormone” and you may recognise feeling “pre-menstrual” with breast tenderness and moodiness. Generally these symptoms are manageable, but for some women they can be extreme. The simplest treatment is to recognise what is happening and to make allowances, or try vitamin B6 or evening primrose oil. If the changes are affecting you, your work, family or relationships then see your doctor for help.

Ovulation & PCOS

The term polycystic ovary syndrome (PCOS) may suggest that the ovaries are enlarged and full of abnormal cysts. However, the medical name for the egg sac is follicular cyst and here PCOS means “many egg ovaries”. The majority of women with PCOS are able to have children without difficulty. However, some women have irregular periods with long gaps between the periods, together with symptoms of greasy skin and hair, acne, sometimes unwanted hair on the face or body and loss of head hair. Treatment is available whether you just want control of the symptoms or whether you want to regulate your periods because you are planning on starting a family.

Cervical smears

It is normal for you to be offered your first smear at the age of 25 and then every three years. The test can be uncomfortable, but lasts less than a minute.

The smear test checks that the cells look healthy and tests for Human Papilloma Virus (HPV). You come into contact with HPV through sexual intercourse. There are about 100 different types of HPV, but some HPV types called “high risk HPV” are more commonly linked with cell changes. It doesn’t mean that they are high risk to you or your partner. If one of these HPV types is detected, you will be offered an annual smear until you develop immunity and the HPV disappears. Symptoms of cervical cancer are irregular bleeding or discharge, so don’t put off going for that check-up.


It’s really important for women to recognize what are normal periods. If your periods are so painful that you need to attend Accident & Emergency, take time off work, have a bed day, or plan your life around them, then your periods are not normal. You might have endometriosis or adenomyosis. periods are not normal. You might have endometriosis or adenomyosis.

Other symptoms of endometriosis are pain going to the toilet, especially around the time of your period, and pain during intercourse. The majority of women with endometriosis and adenomyosis conceive without problems. There is no cure, but treatment is available from painkillers, hormones or surgery.

Ovarian cysts

Ovarian cysts are common. The majority of ovarian cysts relate to ovulation, are innocuous, and come and go. If the cyst has dispersed on a repeat scan, this will have been related to ovulation. A persistent haemorrhagic cyst can be a sign of endometriosis. Other common types of cysts are dermoid cysts which can contain hair and even teeth. Small cysts might require no treatment, but larger than 5cm, we normally recommend surgical removal by keyhole or laparoscopic surgery.


At least one in four women develop one or more fibroids during their lifetime. They can vary in size from the size of a pea to larger than a melon. The biggest fibroid I’ve ever removed weighed a stone! They are most common in women aged 30-50 and can sometimes run in families. They don’t require any treatment if they are small and don’t give any symptoms.

Large fibroids can cause abnormal bleeding, pressure on the bladder and/or bowel, bloating and difficulty getting pregnant. Fibroids can be removed surgically and there are new drug treatments available.

Health in your 40s

In your 40s, it is normal for your periods to get closer together, and this can be a problem if your periods are very heavy. It can feel that you are having hardly any break between periods and women can present with tiredness and symptoms of anaemia.

Symptoms of the perimenopause can start in your 40s even before periods stop. It’s the time when the ovaries gradually begin to make less oestrogen, and can start in your 30s or even earlier. The result can feel like a hormonal and emotional rollercoaster. Anxiety and depression can be major features of the perimenopause. Taking some very gentle bio-identical oestrogen can help smooth the hormonal lows.

The menopause

The menopause is the date of your last ever period (meno = period, and pause = stop). For most women, the end of periods is a relief and it is the symptoms of low estrogen or perimenopause that they need help with.

Should I take HRT?

No woman plans to go on HRT. Most women can manage the hot flushes, but when they are every 15 minutes with obvious sweating, when the night sweats wake you up every hour at night, it becomes very difficult to function. Fatigue, depression, anxiety and worse premenstrual syndrome can all be symptoms of the perimenopause. anxiety and worse premenstrual syndrome can all be symptoms of the perimenopause.

The hormonal and emotional rollercoaster of the perimenopause can be helped with bio-identical oestrogens and progesterone. A bit of a buzz word, as these are synthesized like all drugs, but they are identical in structure and function to the oestrogen and progesterone produced by the ovaries. On coming off the HRT, the symptoms will return, but since bio-identical hormones are available as a gel or patch, it is easier to slowly reduce the dose.

So if HRT is such a help, why don’t women stay on HRT forever?

The answer is that Women’s Health Initiative and Million Women study discovered an association between HRT and breast cancer. The longer you take HRT, the greater the risk. Taking HRT for five years after the age of 50 to help with perimenopause transition carries only an extra risk of breast cancer. If a thousand women age 50 opt to take HRT for five years, then six extra women would develop breast cancer over the five years.

Sex drive

Sex drive in the perimenopause can decline and sometimes dramatically. In combination with HRT, topical testosterone gel can help. If vaginal dryness and discomfort on intercourse is a problem (and it can be even if you are on HRT), then vaginal oestrogen pessaries or cream can help replenish the vagina.

Health in your 50s and 60s

Breast screening with mammograms is offered from the age of 55. Cervical smears are offered every five years (rather than three years).

Look out for symptoms of ovarian cancer.It’s important that women know the symptoms to look out for, because these can be subtle. Ovarian cancer generally presents with enlarging ovaries, and pressure from the ovaries can result in:
• Bloated tummy
• Always feeling full
• Tummy pain
• Reduced appetite
• Increased girth
• Needing to wee more

These are also symptoms of a benign enlarging ovarian cyst or fibroid. An ultrasound scan can tell the difference and a blood test for CA125 is useful to screen for ovarian cancer.

Bleeding after the menopause requires an urgent check-up

Once your periods have stopped, it is abnormal to have any bleeding and you should tell your doctor if you notice any. This is called a red flag symptom of possible cancer and you would be referred urgently for a check-up. It is important to remember that although a check-up is important, the majority of women do not have cancer.

Pelvic floor and bladder

Pelvic floor and bladderBy the time you are 60, it is normal to get up once a night to pass urine, twice a night after age 70.

It is important to try to maintain a healthy weight in to your 50s and 60s and beyond. Extra weight places a strain on your pelvic floor, which when combined with the hormone changes of the perimenopause could mean you may notice symptoms of urinary leaking or a bulge from the vagina (prolapse). Urinary stress incontinence is leaking of urine when moving, coughing or sneezing. Urinary urge incontinence is that feeling of not being able to get to the loo quick enough, sometimes called latchkey incontinence. Neither are dangerous, but require a check-up and treatment is available.

Like all working machines, your body needs a bit of looking after, but with good care and a few simple checks, there is no reason that you can’t keep it in tip top condition for many years.

Nuffield Health Bristol Hospital, The Chesterfield is a centre of excellence for orthopaedic surgery. To learn more, or to book a consultation with one of our surgeons please call 0117 405 8978 or visit nuffieldhealth.com for more information.

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