Research by the Royal College of Obsetricians and Gynaecologists found a quarter (24 percent) of women feel unable to seek care because of embarrassment about their condition, and to make matters worse, many have been avoiding visiting their doctor because of the pandemic.
A recent study by gynaecological cancer research charity The Eve Appeal revealed 32 percent of women said they’d wait until after the pandemic to get advice about bleeding between periods.
In a bid to help women understand what gynaecological symptoms may be need checking, The Eve Appeal and Dr Anita Mitra, aka the Gynae Geek, have launched the new Be Gynae Aware campaign.
“There’s a huge lack of knowledge around gynaecological anatomy and symptoms – women are often woefully unaware of what’s going on inside their own pelvis and between their legs,” says The Eve Appeal chief executive, Athena Lamnisos. “If you don’t know your ‘normal’ in terms of bleeding, discharge, or what your vulva looks like, it’s really hard to spot when things aren’t normal and need to be checked by a medical professional.
“Worrying symptoms may not be cancer – but it’s always best to rule out the most concerning things as early as possible. Early diagnosis, and wherever possible, prevention, is so important.”
Dr Mitra adds: “We aren’t really taught a great deal about gynae health, so if something changes or doesn’t seem quite right, it can feel overwhelming. Thankfully in many cases the symptoms are nothing sinister, but it’s important for us to rule that out, and then address and alleviate them. Many patients say to me, ‘I wasn’t sure if I should bother someone about it’. As a general rule, I always say: ‘If it bothers you, bother someone about it’.”
Here, Mitra talks us through what’s on the Be Gynae Aware checklist…
1. Abnormal bleeding
“There’s no such thing as a ‘period’ after the menopause, and this should always be investigated, as should bleeding after sex and between periods,” advises Mitra, who says less sinister causes of abnormal bleeding may be polyps, cervical ectropion (cells growing outside the cervix), or atrophic changes (thinning, drying and inflammation of the vagina related to lack of oestrogen). In the worst case scenario, abnormal bleeding could be linked to cervical or endometrial cancer.
2. Pelvic/abdominal pain
This may need investigating if it’s different from your normal period pain. Mitra says: “Pelvic pain can be sporadic or associated with certain activities, such as sex or going to the toilet. It may happen at certain times in your menstrual cycle, so it’s worth keeping a note of this.”
Common causes could be ovulation, endometriosis, adenomyosis, fibroids, cysts, pelvic inflammatory disease, or infections. In the worst case scenario it could be linked to cervical, endometrial and ovarian cancer.
3. Menstrual cycle changes
Changes in your menstrual cycle may relate to its length, volume of blood, or cramps. Mitra says it’s worth consulting a doctor if your periods become much heavier or much more painful.
“Having to change your period product (eg. pad, tampon, cup, etc) every hour for several hours on end is a sign the bleeding’s very heavy, although there’s no real limit to what’s defined as ‘heavy’,” she explains. “Even if it’s not heavy enough that you need to change your pad that often but it’s affecting your life, I think it’s worth speaking to your doctor, and also if your periods are much shorter or much longer than normal, or become erratic.”
Common causes of menstrual changes may be polycystic ovarian syndrome, endometriosis, adenomyosis, polyps, or the menopause. In the worst case scenario, it could be linked to cervical or endometrial cancer.
4. Pain during sex
Mitra explains that pain during sex may be superficial – for instance, on the outside, making penetration painful or impossible, or deep on the inside during or after penetration. But either way, it may need investigating. Common less sinister causes could be endometriosis, fibroids, cysts, vaginismus, vulval skin conditions, or even constipation. Worst case scenario, it could be linked to cervical or ovarian cancer.
5. Change in discharge
Mitra says this may be a change in colour, blood-staining, itchiness, or the discharge may smell bad. “Again, it’s worth keeping a note if there are any connections to certain times in the menstrual cycle,” she advises. Changes in discharge are most commonly related to infections, but can also be linked to cervical cancer.
6. Skin changes/lumps on the vulva
The vulval skin can become very pale, pigmented (coloured) areas may arise, or it can become red or flaky, says Mitra, who warns women not to ignore such changes, or any lumps in the area. “Lumps or bumps may be felt, and these can bleed or have discharge coming from them,” she explains. Most commonly, such changes are linked to thrush, dermatitis, folliculitis, lichen sclerosus or atrophic changes. Rarely, they can be a sign of vulval cancer.
7. Itching pain/swelling of the vulva or vagina
Vulval itching can occur alongside or independent of skin changes, says Mitra, and may also be associated with a change in discharge. Common causes are thrush, infections or lichen sclerosus. More rarely, these symptoms may also be linked to vulval cancer.
8. Persistent bloating
This is when your abdomen is constantly bloated, and doesn’t seem to change according to the time of day, or have any relation to food. Mitra warns: “This can arise from big masses such as huge fibroids, cysts or tumours, but also if you have ovarian cancer because your abdomen can become full of fluid.”
9. Change in bowel/urine habits
Symptoms linked to the bowel and bladder aren’t always immediately thought to be connected to gynae health. However, Mitra explains: “Our bowel and bladder lie right next to the uterus and ovaries, so if there’s pressure from these things they can cause changes in the bladder or bowels, such as needing to pass urine more often than normal, incomplete emptying of your bladder so you feel like you need to go again right after you’ve already been, constipation or even diarrhoea.”
Common reasons for such changes may include urine infections, IBS, large fibroids or endometriosis, and in the worst case scenario they could be linked to ovarian cancer.