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Updated 05 July 2013

GynaeDoc - top questions

Health24's GynaeDoc answers the most frequently asked questions about women's health.

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Q:  I stopped taking the Pill. I now have missed a period/or have had very long cycles. Could I be pregnant?

A:  Commonly, after stopping the oral contraceptive, there is a period of time which the body needs to adjust to its own cycle again. In this time, periods may be irregular or may not come at all. It often takes three months for the cycle to regularise. Most women do not fall pregnant in this time, though there are, of course, instances where pregnancy does occur. If you have a delayed period soon after stopping the Pill, it is probably a good idea to do a pregnancy test so as to know where you stand. Bear in mind, however, that it is more likely to be due to a readjustment of the hormones. If this persists beyond three months, a gynaecological check-up would be advisable.

Q:  When does ovulation occur and when is the best time to have intercourse in order to conceive?

A:  The length of the menstrual cycle (the time from the start of one period to the start of the next) varies from person to person. Anything from 21 - 35 days is normal. On average, most women have cycles of about 28 days. In this case, ovulation occurs on Day 14. If your cycle is not 28 days, the way to work out the time of ovulation is to subtract 14 days from your cycle length, i.e. for a 30 day cycle, ovulation should occur on Day 16 (30-14). The best time to have intercourse would be starting two days before the expected ovulation to two days after. Bear in mind that not all women ovulate at the expected time, so this is not an absolute rule. Unless you are having difficulty conceiving, regular intercourse about three times per week will catch the ovulation period.

Q:  What are the early symptoms of pregnancy and when is the earliest one can do a pregnancy test?

A:  The best symptom of pregnancy is missing a period. Before this happens, there are no symptoms as the hormonal changes have not really started yet. Common symptoms of early pregnancy are morning sickness, sore breasts, backache and dizziness. These can start from five weeks but, in many cases, only start later. Many women do not have any symptoms at all. The blood pregnancy test can be positive a day or two before the expected period. However, it is usually better to wait to see if your period comes, or you will be spending lots of money unnecessarily. The home pregnancy tests can be positive a day or two after missing a period. Once again, it is better to wait four to five days before testing, or you may have a false negative result because of testing too early .

Q:  How long should it take me to fall pregnant if I have never been on contraception and how long would it take after stopping contraception?

A: A normal healthy couple who have never been on contraception can take up to a year to conceive. The reason for this is that conception does not result from every episode of intercourse, even if it occurs at the time of ovulation. There are many reasons for this. For example, the sperm which reaches the egg first may not be able to fertilise it, the egg may fertilise but not implant, the fertilised egg may abort very early, often because of a genetic abnormality. If you have been on the Pill, after the three months adjustment time, your chances would be the same as that of someone who has never been on contraception. If you have used the injectable, it could take up to a year for your periods to return. From the time that you have regular periods again, it may still take up to a year to conceive, the same as any other couple on no contraception.

Q:  What are the symptoms of thrush, how can it be treated and how does one prevent recurrent thrush?

A:  The typical symptoms of thrush are itching of the vulva and a thick white discharge. Thrush can be treated with antifungal creams or pessaries, such as Canesten. Oral tablets such as Sporonox or Diflucan can also be used (not in pregnancy). Recurrences are common as the spores are very resistant to treatment. The following measures can help prevent recurrent thrush. Wear cotton rather than nylon underwear. Avoid tight jeans, g-strings or pantihose which cause sweating in this area. Ensure that your partner is also treated to prevent reinfecting each other. Boil all underwear and towels initially to get rid of the spores. The time around menstruation is particularly vulnerable, so it is useful to use the pessaries before menstruation for about three months after an attack. Yoghurt douches may also be of help. If there are frequent recurrences, this may indicate a problem with the immune system. Diabetes and HIV should then be excluded.

Q: Pregnancy and antibiotics

Please can you clear my confusion? I am using Melodene (+- 7 months now). (Had a baby 8 months ago) I have had regular periods on it since now. I was on antibiotics from 19 to 24 feb (for upper airway infection) and had my period just before, ending around 18/19 feb (cant remember 100%). My husband and I had a very sexual week while I was on the antibiotics and we did not even think about the effects on the melodene.

I started having very light spotting yesterday but turned to very light bleeding today (I have to use a thin pantyliner) and had a lot of cramps this morning. I did a HPT this morning which was negative, but it could be way too soon. If I am pregnant do I need to stop taking the melodene? If I am, I  wouldn't want anything to happen to the pregnancy, or could this be a miscarriage or perhaps just a period as all hormones might be in a mess from the antibiotics.

A: The bleeding is probably due to the antibiotics affecting the hormone levels. It is too soon to test for pregnancy but you are at risk for this. You can continue the Melodene and do a pregnancy test if you do not have a period when you reach the placebo pills. Remember to use extra precautions for another week.

Q: Herpes outbreak

I have a herpes outbreak every month with itching, discharge and burning – how do I deal with this?

A: To decrease the severity of an attack, you can use Acyclovir as soon as symptoms start. And take care with any partners.

Q: Sex after a miscarriage

I had a miscarriage on the 14th of Feb and would like to know how soon should we wait before I can engage in intercourse again, and how long should I wait before we try to conceive again. I had pains for two days before I lost my baby, how likely is it that this may happen again if I conceive, and is there anything I can do to prevent it from happening again? It was a first pregnancy.

A: You should wait till the bleeding has stopped before having sex. The usual recommendation is to wait at least 3 months before falling pregnant again. There is a greater than 85% chance of a successful pregnancy the next time.

Q: Mirena and spotting

I had the mirena inserted on the 20th of January 2010 and on the 31st of January I had my first menstruation with the mirena. It is now almost a month later and I still have my period. Some days I spot heavily, other days I spot lightly. Now I see that there is a clotty discharge which is a dark brown colour, and my spotting is also dark brown and then turns red. Please help – I'm not sure if this is normal, or if it is a side effect of the mirena, must i hang in there? Will it clear up eventually? I also feel quite bloated and have slight cramps in my lower abdomen on some days. Is this also normal? I would appreciate any info.

A: These are common side effects of the Mirena. The spotting unfortunately can go on for several months.

Q: Vaginal prolapse – complications

What are the possible complications from Vaginal Prolapse? I'm Diabetic &  don't want to undergo surgery.

A: Usually there are no major complications due to vaginal prolapse, other than discomfort and sometimes constipation.

Q:  Mirena and bad bleeding 

I've had the Mirena for 1yr & 6 months. I've noticed acne on my back, I have terrible lower back pain, I get my period every 2 weeks (heavy bleeding) and it lasts for 8 - 10 days. When my husband and I have intercourse I bleed. I was on Mercilon before I had my baby, which was an absolute breeze, but my Gynae does'nt want to put me back on the Birth Control pill, because we have a history of blood clots in the family.

A: You should see your gynae for a pap smear as bleeding after sex suggests a problem with the cervix. You should also be checked for problems with the uterus and ovaries. If these are all normal, then you should consider something other than the Mirena for contraception. The injectable would be one option.

(Joanne Hart, Health24, May 2012)

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