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Is HRT the only answer to vaginal dryness?

There is much talk about what the menopause does to a woman’s body temperature and her moods. There is, understandably but rather misleadingly, much less time given to what changes she is likely to experience in her vagina. The sharp drop in the levels of the hormone oestrogen can cause devastation as it plays a key part in the health of the vulvo-vaginal tract, including by producing glycogen which encourages the helpful bacteria that keeps infections at bay. The decrease in oestrogen also affects the glands at the neck of the womb that produce essential fluids and mucus that keep the vaginal skin and tissues supple and moist.

How is vaginal dryness treated?

When this change causes symptoms such as pain during sexual intercourse, doctors term it atrophic vaginitis. About half of women display some related symptoms after the menopause – likely more but they have been too embarrassed to talk to their doctor about it, choosing instead to put up with discomfort. Some women are put off by the idea of HRT, having seen too many negative stories in the press. Female gynaecologist Miss Amanda Tozer has helped many women navigate their way through myriad menopausal symptoms, looking at each case on an individual basis, and prescribing a wide range of treatments, including HRT and alternative therapies. During a consultation at her London menopause clinic, Miss Tozer will ask you which symptoms you find most debilitating and that will inform the approach.

Is there a side-effect-free alternative to HRT?

Miss Tozer is pleased to be able to offer her London patients an innovative new treatment for vaginal atrophy: the MonaLisa Touch – a safe, painless and minimally invasive procedure that utilises laser therapy to rejuvenate the vulvo-vaginal tract. Its aim is to restore the premenopausal structures to enable the natural production of the all-important vaginal mucosa.

What should I look for in a fertility clinic?

Anyone who is struggling with infertility will tell you how stressful an experience it can be. Whether it feels like everyone around you is caressing a blooming bump or whether you’re dreading yet another physical examination, every aspect of getting pregnant can be an ordeal – so finding the right fertility clinic for you is important. Here are some points to consider.

1. What are their qualifications and success rates?

When embarking on IVF, most people find it reassuring to know that their fertility doctor is indeed a specialist who has a good track record of helping couples to achieve a family.

2. Who will perform each procedure?

There are several stages in the IVF journey, from consultation and diagnostic scans, to ovulation induction, egg collection and embryo transfer. Often in large clinics these will be performed by several different people, something some patients find impersonal, adding to their bewilderment at the whole process. Female gynaecologist Miss Amanda Tozer offers her London IVF patients one-to-one treatment with continuity of care, personally performing each step. Furthermore, understanding that couples going through fertility treatment benefit from being able to talk through concerns, Miss Tozer provides all her patients with her direct line and encourages them to call at any time.

3. What are the total costs?

No decision about medical care should be made on cost, but it is important that you know the full financial picture before embarking on treatment. Establish from the start that there will be no hidden extras.

4. What is the general atmosphere like?

Testimonials from past patients describe London-based Miss Amanda Tozer’s approach as compassionate, reassuring and personalised. Having confidence that you are in the right hands will help you through this emotionally difficult time.

Can an endometrial scratch improve my chances of pregnancy?

For couples undergoing IVF, having a cycle fail despite the transferred embryo being of good quality can sometimes be all the more distressing. They may question if it doesn’t work when all the signs are good, when will it? In some cases where there has been no discernable reason for the IVF to have failed, a procedure called endometrial scratching has had some encouraging results.

How does an endometrial scratch work?

The procedure involves superficially injuring the womb lining thereby initiating a ‘repair reaction’ where the production of endometrial white blood cells is stimulated. This improves the implantation conditions of the uterus. Research is still to be carried out to understand how and to what extent endometrial scratching is successful, but the belief is that growth factors, hormones and chemicals are released during the repair process. The new lining appears to be more welcoming to an implanted embryo. The scratching may also ‘switch on’ the genes responsible for preparing the endometrium for implantation, thereby increasing the chances of a successful pregnancy.

Female gynaecologist Miss Amanda Tozer who offers the service at her London fertility clinic will be glad to talk about whether you would be a good candidate for endometrial scratching and to answer any questions you have on the treatment.

An endometrial scratch sounds painful – is it?

Endometrial scratching may cause some minor discomfort, similar to that of a cervical smear, but should not be painful. The scratch itself is made with a plastic catheter. It may be an idea to take some paracetamol half an hour before the procedure, but no anaesthetic is required and takes just 15–20 minutes. London-based Miss Tozer will talk you through what to expect during and after the procedure, explaining that afterwards you may experience some mild cramping and you may prefer to take the day off work rather than return immediately.

Top 5 FAQs about fibroids

Many women who have fibroids experience no symptoms so carry on as usual, unaware of the condition. For others, the experience is very different. Female gynaecologist Miss Amanda Tozer sees many women with fibroids in her London clinic, each with their own set of symptoms – but many of the concerns are the same. Here are five of the most commonly asked questions:

1. What is a fibroid?

A fibroid is a muscular tumour that grows in the wall of the womb, sometimes within the wall (intramural fibroids) and sometimes into the uterine cavity (submucosal fibroids).

2. Are fibroids dangerous?

Cases of fibroids are overwhelmingly benign, with less than 1 in 1000 being cancerous. Furthermore, it is not thought that an existing fibroid can develop into a malignant tumour, nor that having fibroids increases your chances of developing other womb-related cancers. Depending on where they are located and to what size they grow, fibroids may exert pressure on other parts of the anatomy, particularly the rectum and bladder, causing discomfort and other related symptoms.

3. Why do fibroids happen?

The cause of fibroids is not certain and there are probably several contributing factors including genes and hormones. The likelihood of a woman having fibroids increases in her 40s. Fibroids are more likely to occur too in women of African-American heritage, those with a family history, and those who are obese.

4. How are fibroids treated?

The treatment options for fibroids will depend on your symptoms and the size and location of your fibroids. During your consultation at her London clinic, Miss Amanda Tozer will conduct a thorough examination and perform a pelvic ultrasound; she will then recommend a treatment plan for you.

5. Can fibroids affect pregnancy?

Most women with fibroids have a normal pregnancy but it is important that any doctor you see is aware of your fibroids as they can cause complications.