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Period health and symptom management

If you or someone close is experiencing heavy, painful or irregular periods, we can help.

How do you know if your periods are normal?

Well, it's really difficult because we're all different and we all experience different periods.

But I'm joined today by Dr.Sam Wild who's the Bupa clinical lead for women's health and we're gonna share with you a few tips around what you should be looking out for to identify that maybe something isn't quite right.

So Sam, let's start off.

What should period blood look and smell like?

So you might notice, to start, at the start of a period, your period blood is a light pink colour.

That's as the blood mixes with the cervical mucus that's there.

So pink is normal.

Bright red next is when the blood is at its fastest, it's leaving the body quite quickly, so usually at the start to the middle of the period and then this can go a darker red, brown and even look quite black.

And that's a sign that the blood's taken a little bit longer to come out of the body as the flow has slowed down a little bit and it's come in to contact with air and oxygen and that's what makes the colour change.

So all of those colours are completely normal.

Orange, yellow colours, grey colour, that can be a sign of infection.

So if you notice anything like that, then you should be speaking to your doctor.

Blood smells a bit metallic.

You know that if you've ever cut yourself as well.

But if there's a really offensive odour to it, particularly if you've got any itching or soreness as well, then I would definitely recommend that you see a GP as again, it might be a sign of infection or something else that's going on.

What about periods and heaviness and flow?

How heavy is too heavy?

So there's lots of different things that you can look out for here.

So if you're changing your pad or your tampon more frequently than every one to two hours, then that can be a sign that your period is quite heavy.

If you're needing to use two products together.

So if you're using a tampon and a pad or two pads, again, that could be a sign.

If at night you're flooding through into your bedding or you're leaking into your clothes during the day, again that's another sign.

If you're passing big blood clots.

So it's normal to pass some small clots, but if clots are bigger than the size of say a 10 pence piece, that's also something that I would, you know, recommend that you go and speak to your doctor about.

Okay, and then there's something around quality of life, isn't it?

If it's stopping you from going to work, going to school, doing the things that you normally would want to do.

Exactly, if you are feeling really tired with it, if you're feeling short of breath as well, that could be a sign that you're anaemic.

So yeah, again, in those situations, go and speak to your GP.

And what sort of conditions might cause very heavy bleeding?

So a very common one is fibroids.

So these are benign growths of the uterus, of the womb, which can cause heavy bleeding.

Endometriosis is very common too.

Polycystic ovarian syndrome.

And then there's other conditions, such as an underactive thyroid, and plenty of other things that the GP will be trying to exclude.

Okay.

What about period pain?

Period pain to some extent is normal.

Most of us experience it, but when is it too much?

So yeah, as you said, period pain, normal.

The uterus is contracting to make the lining leave the body, which is what we see as a period.

Again, if it's stopping you doing your normal daily activities, if you are losing time off school, off work, that is not normal.

So very simple really.

If it's really stopping in your tracks, go and see your doctor.

And people can try things like paracetamol, ibuprofen, which tend to be helpful for most people, don't they?

But if you've tried that and it's making you miserable.

Stomach massage too, exercise, those sorts of things can all help.

But if it isn't enough, then do go and seek some help.

And finally, what about how our menstrual cycle affects our emotions?

Is it normal to be up and down and all over the place?

It absolutely is.

And that's because our hormones are changing throughout the month.

So in the first half of our cycle as oestrogen levels rise, that's when we feel at our best, we feel our most energetic.

And then in the second half of the cycle, as the progesterone levels rise, that's when we can feel sort of quite slowed down, can feel quite low as well.

And that usually continues into the first bit of your period too.

So it is absolutely normal, what we call premenstrual symptoms.

But again, if you're finding that it's affecting your life and you're not able to continue as normal, then you must seek some advice.

Yeah 'cause there are things that your GP can do to advise you and support you to alleviate some of these symptoms, aren't there?

There are.

There's lots of medications that can be tried.

So definitely worthwhile going to have a chat with them.

Thanks, Sam.

So you've indicated there are four key areas that people can look out for things not being quite right.

So the look and the smell of the blood, how heavy the period is, how much pain, and also how it impacts mood.

I think the final thing to say is that you know your body better than anyone else.

So if something's changed or you're not happy, get it checked out by your GP.

How do you know if your periods are normal?

Well, it's really difficult because we're all different and we all experience different periods.

So Sam, let's start off.

What should period blood look and smell like?

So you might notice, to start, at the start of a period, your period blood is a light pink colour.

That's as the blood mixes with the cervical mucus that's there.

So pink is normal.

So all of those colours are completely normal.

Orange, yellow colours, grey colour, that can be a sign of infection.

So if you notice anything like that, then you should be speaking to your doctor.

Blood smells a bit metallic.

You know that if you've ever cut yourself as well.

What about periods and heaviness and flow?

How heavy is too heavy?

So there's lots of different things that you can look out for here.

So if you're changing your pad or your tampon more frequently than every one to two hours, then that can be a sign that your period is quite heavy.

If you're needing to use two products together.

So if you're using a tampon and a pad or two pads, again, that could be a sign.

If at night you're flooding through into your bedding or you're leaking into your clothes during the day, again that's another sign.

If you're passing big blood clots.

Okay, and then there's something around quality of life, isn't it?

If it's stopping you from going to work, going to school, doing the things that you normally would want to do.

Exactly, if you are feeling really tired with it, if you're feeling short of breath as well, that could be a sign that you're anaemic.

So yeah, again, in those situations, go and speak to your GP.

And what sort of conditions might cause very heavy bleeding?

So a very common one is fibroids.

So these are benign growths of the uterus, of the womb, which can cause heavy bleeding.

Endometriosis is very common too.

Polycystic ovarian syndrome.

And then there's other conditions, such as an underactive thyroid, and plenty of other things that the GP will be trying to exclude.

Okay.

What about period pain?

Period pain to some extent is normal.

Most of us experience it, but when is it too much?

So yeah, as you said, period pain, normal.

The uterus is contracting to make the lining leave the body, which is what we see as a period.

Again, if it's stopping you doing your normal daily activities, if you are losing time off school, off work, that is not normal.

So very simple really.

If it's really stopping in your tracks, go and see your doctor.

And people can try things like paracetamol, ibuprofen, which tend to be helpful for most people, don't they?

But if you've tried that and it's making you miserable.

Stomach massage too, exercise, those sorts of things can all help.

But if it isn't enough, then do go and seek some help.

And finally, what about how our menstrual cycle affects our emotions?

Is it normal to be up and down and all over the place?

It absolutely is.

And that's because our hormones are changing throughout the month.

So in the first half of our cycle as oestrogen levels rise, that's when we feel at our best, we feel our most energetic.

And then in the second half of the cycle, as the progesterone levels rise, that's when we can feel sort of quite slowed down, can feel quite low as well.

And that usually continues into the first bit of your period too.

So it is absolutely normal, what we call premenstrual symptoms.

But again, if you're finding that it's affecting your life and you're not able to continue as normal, then you must seek some advice.

Yeah 'cause there are things that your GP can do to advise you and support you to alleviate some of these symptoms, aren't there?

There are.

There's lots of medications that can be tried.

So definitely worthwhile going to have a chat with them.

Thanks, Sam.

So you've indicated there are four key areas that people can look out for things not being quite right.

So the look and the smell of the blood, how heavy the period is, how much pain, and also how it impacts mood.

I think the final thing to say is that you know your body better than anyone else.

So if something's changed or you're not happy, get it checked out by your GP.

Periods and menstrual health: your questions answered

Transcript

Who are you?

Hi, my name is Dr. Samantha Wild. I'm the Women's Health Lead for Bupa Clinics.

In this conversation,

please feel free to ask me anything you'd like about your periods.

Should I use a tampon?

So it's completely up to you if you want to use a tampon or not.

Some women prefer it because it's less messy because it's very

discreet. It goes inside the vagina.

But some women don't like the idea of putting something inside,

so they'd rather use a pad instead.

What is endometriosis?

Endometriosis is a condition when the cells that are normally found line in the

uterus that cause a period each month are found elsewhere in the body.

And just like they would with the menstrual cycle they shed each month,

but as there is no way for them to leave the body,

they can cause local inflammation and scarring.

So these cells are commonly found around the ovaries,

the ligaments between the ovaries and the rectum along the fallopian tube.

And they can also be found within the bowel, the bladder, and the lungs,

and they can all cause symptoms wherever they may be.

Can my period make me feel more anxious?

Your period can definitely make you feel more anxious as just before you have

your period. The progesterone levels rising will increase your cortisol,

your stress hormone. Also,

we may dread what's going to happen at that time of the month not want to feel

in pain, not want to feel tired, and lack of energy,

and not want to feel bloated.

So it's understandable that you may dread that time of the month coming.

Why do I feel so rubbish during my period?

You might feel rubbish during your period because of what is happening to your

hormones. Our oestrogen and progesterone levels are lowest at this time,

which affects our mood.

You might also feel a bit bloated and you might have period cramps,

which can make you feel uncomfortable and in pain and you might feel that your

self-esteem is lower at this time and feel more self-conscious about your body.

You might also get a breakout of spots.

It's not unusual to find this at the time of the month,

so it's not unusual that you would feel pretty low at this time.

Do periods smell?

So periods might smell slightly and this is due to the blood,

and also it can be a bit metalicy due to the bacteria within that,

but it shouldn't be offensive.

If you find that your period is stronger smelling, or if it's fishy,

then you ought to get checked out, as that may be a sign of infection. Also,

sometimes women unfortunately leave a tampon behind and this can cause a

horrible odour. In these cases you normally know about it,

it does smell quite rotten. So in these cases,

do remove the tampon as soon as possible or get assistance to do so if you're

unable to yourself.

How can I be more comfortable on my periods?

There's lots of ways to make your periods more comfortable. So firstly,

I would just listen to your body and do what it's asking you to do.

If you feel you need to relax a bit more and be a bit more quiet at that time of

the month, then do that. Equally, if you feel you can exercise,

then that can be really beneficial to help reduce pain and release some

endorphins.

Even some gentle exercise like yoga or Tai Chi can be really beneficial.

Try and eat healthily - that's really important,

and don't drink too much alcohol as that can affect your mood even more.

Try and wear loose fitting clothes if you feel bloated and if you feel that

tighter clothes are restricting you,

and make sure that you get enough sleep at night as well as this can really

help. Try and reduce stress as much as you can,

as you might not feel as able to deal with it this time of the month than at

other times of the month.

At what age do periods normally start?

Your periods usually start between the ages of 10 and 16,

but for some it may be slightly earlier or for some it may be slightly later and

still be completely normal.

If you haven't started your periods by the age of 16,

we usually advise that you see your gp,

but everybody usually starts at the time that's right for them.

And this is thought to be related to genetic and environmental factors.

When will I stop having periods?

So you stop having periods normally when you reach the menopause,

and this is when your ovaries are no longer producing estrogen and so you stop ovulating

and you are no longer able to have children. For most,

this will happen naturally between the ages of 45 and 55,

and the average age in the UK is about 51, but for some,

it may happen for other reasons,

such as surgery or due to certain medications or things like chemotherapy

or radiotherapy. Before your periods stop

You usually know that it's coming because you start to suffer with some of those

symptoms due to low oestrogen,

and these can include hot flushes and night sweats, mood changes,

brain fog, headaches, abdominal pains.

There's a variety of different symptoms that some women may experience,

and it's unique to everybody.

What is the point of a period?

The point of a period is to get rid of the unwanted endometrial lining,

so the lining of the womb of the uterus each month that is no longer needed to

support a pregnancy.

This builds up throughout our menstrual cycle so that if an egg is fertilized,

it can implant and carry on to grow. But if we don't get pregnant,

and if the egg isn't fertilized,

then this can be shed at it as it is not needed.

Are pads or tampons better for me?

It's up to the individual to decide if pads or tampons better suit them.

A lot of women prefer using a tampon because they find it's more discreet.

It goes inside their vagina to soak up the blood.

And so they can use wear tight fitting clothes without worrying that a pad may

be seen and they can get on with their normal daily activities.

And they can also swim and exercise comfortably with them. However,

some women may feel a bit squeamish about using tampons,

putting something inside, and so they would rather use a pad.

So it's completely up to you.

Are there different types of tampons?

There are different types of tampons and I would divide it up into three.

So there are tampons that have a paper applicator.

There are tampons that have a plastic applicator, which is often more rounded,

and there are ones that don't have an applicator at all where you use your

finger to insert it. They also come in different absorbances as well.

Some are made for sort of lighter periods.

Others are made for heavier periods or for overnight.

So sometimes you may need to take a bit of time finding what is right for you,

which one you feel more comfortable using.

Does using tampons hurt?

Using a tampon shouldn't hurt.

We advise that you make sure that you're very relaxed before you put it in.

Get into a comfortable position following the instructions in the box carefully,

and then insert the tampon if you can feel it inside at that point,

it may be that you haven't inserted it properly,

so we do advise that you remove it again straight away.

Sometimes it might be that you are using too high an absorbency and so the

tampon is getting quite dry. So in those cases,

I would drop down the absorbency level that you're using and try again.

Why do I seem to poo more on my period?

So it's normal to feel that you might need to open your bowels more whilst

you're on your period.

Due to the effects of our hormones just before our period,

when our hormone levels are increasing,

before they decrease the progesterone levels,

increasing can have a constipation effect. Then when we reach our period,

these progesterone levels have dropped and so we might need to open our bowels

more. And also we release prostaglandins at the time of our period.

These help our uterus, our womb to contract and help expel that period blood,

and it can also have an effect contracting the bowel too.

Does using a hot water bottle actually help?

Using a hot water bottle can really help with period pains,

and this is due to two reasons.

So the first is that using the heat can help the muscle wall of the uterus

relax. And when this contracts to get rid of the period blood,

this is what causes pain. So by relaxing it, that can help.

We also know that the heat locally apply to the skin can affect our heat

receptors,

and this will sort of mimic or mask any pain that's coming from the pain

receptors so you won't feel that.

Does a tampon take a woman's virginity?

Using a tampon for the first time does not take away a woman's virginity.

Only having sexual intercourse can do that. It may stretch or tear the hymen,

but that does not mean that you've lost your virginity.

Is period blood the same as my normal blood?

Period blood is not the same as your normal blood.

So period blood consists of the lining womb,

which is what we shed each month when we have a period and that has been inside

the womb waiting for an egg to be implanted. So if we haven't got pregnant,

then we don't need that anymore.

It also consists of cervical mucus and vaginal secretion,

so it's definitely not the same as the blood that's circulating around the rest

of our body.

I haven't had a period for a few months. Is this normal?

If you haven't had a period for a few months, first of all,

I would consider whether you are pregnant.

If you've had unprotected sexual intercourse,

you should definitely do a pregnancy test.

Then consider if there's any other reasons why you may not have had a period.

You may be a bit stressed, you may have suffered from some illness recently.

You might be on certain medications that can affect your period too.

If you're feeling well and none of those things apply to you,

then it's probably absolutely fine and it's just one of those things,

and we'd say up to three months. That can be completely normal.

If after three to six months you haven't had any periods,

then I would advise then that you're going to see your GP.

And of course if you do feel unwell.

Can I still have sex during my period?

You can have sex during your period and it's very important that you still

consider contraception and protection against sexually transmitted infections

during this time.

You ought to warn your partner first because obviously it might be a bit messy,

but actually the endorphins that are released during having sex may help you

with any pains that you're experiencing during your period.

What is the correct way to use a tampon?

The correct way to use a tampon is always to read very carefully first

the instructions within the box.

We would always advise good hygiene and then try and relax

Before you put the tampon in

you'll read in the box and you'll see the instructions on how you should be sat

when you're doing it.

So some people find sitting on the toilet helps or squatting or putting one leg

up onto the toilet, and then just follow the instructions to insert it.

You shouldn't feel any discomfort once it's in. If you do,

then you need to take it out and put it back in again.

Do all periods last exactly one week?

So most periods will not last one week. Everybody is different.

So they can range from three to eight days, and the average is about five days.

My bleeding seems really heavy, what should I do?

We'd always advise that you see your GP if you feel that your bleeding is

unusually heavy. However,

sometimes periods can seem heavier than they actually are,

so we only should lose about three tablespoons of blood during the average

period, although it can seem a lot more than that.

So what we'd say is look out for any big blood clots.

So more than two and a half centimeters or the size of a 10p coin is considered

to be large.

If you are changing your sanitary protection more than hourly, then again,

that can be a sign that your periods are heavier than they should be,

or if you're leaking through your clothes or into your bedding at all.

Other signs may be that you're feeling very fatigued or you might be feeling

short of breath,

or if you feel that your period is just generally affecting your activities of

daily living.

Do males have a period?

If you were born with male sexual organs,

then you won't have a period because you need to have a womb and ovaries to

enable you to have a period. If however,

you were born with female sexual organs,

but now identify as a male or non-binary, then you may still menstruate.

So menstruation is not just a female condition.

What are the symptoms of endometriosis?

The common symptom of endometriosis is pelvic pain,

and this pain usually starts before the period and continues throughout the

period as well.

And some women may find that they need to take strong painkillers to try and

ease this. It can also be associated with fatigue and heavy periods too.

Some women may also suffer problems with their fertility,

and this is because the scarring can occur around the ovaries and the fallopian

tubes.

And some women may find that they have problems with constipation or diarrhoea

and feeling sick as well because of the pain and maybe because of the resulting

impact on their fertility too.

It's not unusual to feel quite depressed when you do suffer with endometriosis.

For about 10% of women, they may also suffer with other problems,

so the endometrial cells can grow inside the bladder and the bowel,

and you might find that you are passing blood in your urine or your stool at the

time of the month.

And you can also get endometrial cell within the lungs as well,

so you can find that you cough up blood.

Is endometriosis a serious problem?

Endometriosis can be a serious problem because it can cause a lot of symptoms

For a woman, she may be in a lot of pain. She may get quite depressed with that.

She may suffer with problems with her fertility too,

and it can have a huge impact on her home life and her working life,

and it can affect the UK economy with up to 8.2 billion pounds a year

in lost days at work and healthcare costs.

I might have endometriosis, should I see a doctor?

You definitely should see a doctor if you think you have endometriosis,

as you may need to have some help with the pain that you may be experiencing.

Or it might be that you are having problems with getting pregnant and that is

something that you wish to discuss with the doctor as well.

We know that about 10% of women may suffer with endometriosis,

but many of these women are not diagnosed and it can sometimes take up to 10

years to get a diagnosis,

and endometriosis can actually cost the UK economy 8.2 billion

pounds a year in the problems that it creates.

What are the risks associated with endometriosis?

Endometriosis can cause chronic pelvic pain due to the scar tissue that forms

each month, and this can attach to internal organs.

These attachments are called adhesions, and these can also distort the bowel,

so that can cause a lot of pain and discomfort.

You are also more likely to develop ovarian cysts if you have endometriosis,

which again can be very painful. And there's also the fertility issue,

so we're not entirely sure why this happens,

but up to 50% of women may suffer with problems with their fertility.

It might be that the endometrial tissue is growing over the ovaries and their

fallopian tubes,

but even people that suffer with mild endometriosis may have problems with their

fertility too.

What treatment is available for endometriosis?

For someone needing treatment for endometriosis. Firstly,

I would suggest that they get some support and counselling,

and this may be from their GP or it may be from a charity such as Endometriosis

UK, who can provide invaluable support. Next,

we'd need to talk about whether any pain relief is needed

and this may be in the form of painkillers or anti-inflammatories,

or it may be the doctor needs to prescribe something stronger.

Then to actually treat the endometriosis, we can use hormonal treatments,

and this can dampen down the patches of endometriosis,

and so this may be in the form of tablets or sometimes it can be given as

injections as well.

If a woman is trying to get pregnant or if their hormonal treatments haven't

worked, then sometimes we'll use invasive surgery,

so surgery that will go in keyhole initially and burn away areas

of the endometriosis.

And this can increase your fertility after this has been done,

as it will get rid of all the endometriosis tissue for you.

If they can't do this by keyhole,

they may need to do it through a more open incision,

which we call a laparotomy. And finally,

if none of these treatments work,

then some women may need to have a hysterectomy. This is the last resort,

but this is when the womb and the ovaries and the fallopian tubes are all

removed to remove any areas of endometriosis that are still there.

Can endometriosis cause ovarian cancer?

1.3% of the general population will develop ovarian cancer compared to

just less than 2% of those who suffer with endometriosis.

So this is not statistically significant.

So most women with endometriosis will not develop ovarian cancer.

For those that do,

they are more likely to get diagnosed early and so they have a longer

life expectancy.

We'd always advise someone with endometriosis to look out for any abnormal

signs, and if they feel that they're feeling anything different to normal,

then they should consult with their GP.

Are periods different in different cultures?

So everybody's periods are different. There has been research into this area,

but very little has been found.

What we do know is that your weight may play a part as may your diet,

and certain genes that can run in families and cause particular illnesses may

affect your periods too.

What does differ is the way that different cultures also approach periods so

that you can find that it's very much still a taboo subject in certain

ethnic groups and is not very much spoken about.

What does PCOS do to my period?

PCOS will make your period irregular.

So it's not unusual for women to have less than eight periods a year or not at

all.

How is PCOS treated?

PCOS can't be cured, but it can be treated.

We'd start by advising that someone follows a healthy, balanced diet,

and if they have weight to lose,

then to try to lose it as this will help with any excess insulin that's within

the body and this can help with some of the symptoms. Next,

if they've got excess hair that they need removing,

we would talk about ways that they can safely do this.

And if they're suffering with acne, bad skin,

then there are medications that we can prescribe to help with this too. Next,

it depends on what the woman is trying to achieve at that time in her life.

So if she isn't trying to get pregnant,

we may give her medication to help her establish a regular menstrual cycle.

And if she is trying to get pregnant,

there may be medications that we give her to try and help her to ovulate.

And also there is surgery that we can offer which is done laparoscopically,

so via a keyhole telescope into the abdomen.

And what we do is we burn away areas of the ovaries that may be producing excess

hormones. And this, again, can help establish a regular menstrual cycle.

How do I know if I have endometriosis?

There are several symptoms that might make you suspect that you have

endometriosis. In which case I'd recommend that you see a GP.

These can include pelvic pain,

pain that is particularly worse before your period and during your period. Pain

that you experience with intercourse or having a smear test.

You may feel that your periods have become a lot heavier or you may feel

particularly fatigued with no energy.

Some women also suffer with constipation or diarrhoea or vomiting or can

find that it affects their mental health as well.

Up to about 10% of women will also suffer with more unusual symptoms,

and this can include bleeding from the bowel,

so you see blood in your stool during the time of your period or bleeding from

the bladder, in which case you'd see blood in your urine.

Some women also cough up blood. If you feel that you have got these symptoms,

I'd recommend that you kept a diary for about three months,

so you could take this to show your GP and they may then use this to help

diagnose you.

They're likely to examine you and they may trial you with some treatment.

Some GPs will refer you to the hospital to see a consultant for a more

definitive diagnosis,

which is made by putting a camera into the belly button normally, under general

anesthetic and having a look inside the abdomen.

What is the main cause of PCOS?

Unfortunately, we don't know what causes PCOS, but it can run in families.

We know that it is associated with abnormal hormone production,

and women often suffer with excess levels of insulin and their bodies are often

resistant to this. This excess insulin can produce higher levels of testosterone,

which is the male hormone,

and this affects the body to cause a lot of the symptoms that we see.

What are the signs or symptoms of PCOS?

Symptoms of PCOS include irregular periods,

so women may find that they have eight or fewer periods a year,

or they may completely stop. They may also find it difficult to get pregnant.

A lot of women struggle with their weight and find that they are overweight and

it's difficult to lose it again.

They may find that they have hair in unwanted places,

or may find that the hair on top of their head thins.

They may also suffer with acne,

and it's not unsurprising that due to these symptoms,

they may suffer with depression and lower self-esteem and lower self-confidence.

Does having PCOS stop me from having periods?

PCOS usually results in eight or fewer periods a year, but for some women,

they may stop completely. These usually return with effective treatment.

What is PCOS?

PCOS stands for polycystic ovarian syndrome and is a disorder of the ovaries.

Normally each month,

an ovary will release an egg and they will take it in turns to do so.

This egg will develop in what we call a follicle,

which is a fluid filled sack within the ovary, and many follicles will develop,

but only one egg will fully develop and be released.

When you have polycystic ovarian syndrome,

you have about 12 of these follicles or more,

and the egg never completely matures so you don't release an egg so you don't

ovulate each month, and your periods can be very irregular with it.

And this is also associated with other conditions.

You can have too much of certain hormones,

and so you might find that you have excess hair where you shouldn't have hair.

You might find that you don't have a full thick head of hair,

and you might find that you suffer with acne and problems with weight gain and

being able to lose weight again.

What happens if endometriosis is left untreated?

If endometriosis is left untreated, some symptoms may improve,

but this is unlikely. In most cases,

symptoms will stay the same or they will worsen.

So you run the risk of developing chronic pelvic pain due to all the scar tissue

that is forming inside,

and this can affect your fertility and any chronic debilitating condition

may have a negative impact on your mental health.

What age does PCOS usually start?

PCOS usually starts when a girl has gone through puberty.

So in the teenage years or in early twenties.

How long should a period last?

So a period usually lasts between three and eight days,

but the average is about five days.

I feel uncomfortable going out on my period. What should I do?

So it's understandable to feel conscious when you go out on your period.

At the time of the month, you might feel a bit more bloated,

you might be a bit spotty, you might be in pain as well.

So try and think about things that can make life easier.

So avoid tight fitting clothes if you are feeling a bit bloated,

think about what sanity protection you might be using.

Some people find that pads are bulky,

so they may prefer to use a tampon instead,

look after your skin the best that you can.

Drink plenty of fluids - that can help reduce bloating too,

and try and eat healthily. And at the end of the day,

if you don't feel like going out, then don't go out.

Stay at home and relax instead.

It can sometimes be a good time just to unwind a little bit.

Is it normal to clot during my period?

It is normal to clot during your period usually for the first few days when

you're at your heaviest and it's not unusual to see lots of small clots,

particularly if you've been laid down for a while and the blood's had chance to

accumulate in the womb. However,

if the clots are big and we'd say normally bigger than two and a half

centimeters and think of a 10p size coin,

then that's when you should see your doctor,

and particularly if you are changing your sanitary protection every hour as

well, or if you're flooding and leaking through your clothes.

What should my period look like?

Everybody's period is different and it changes in colour and consistency

throughout the month, but usually at the beginning of your period,

you may find it's a darker red in colour. That's when it's at it's heaviest,

and the blood may clot.

Then as you go on through the week and the blood gets free of flowing,

it can turn a brighter red or a pinkish color,

and then usually towards the end of your period when it's older blood,

it turns the brown or even a black colour.

If it's grey or if it's greenish in colour, that may be a sign of infection.

So if you do think you're at risk of infection or if there's a particular odour

with it, or if it's particularly painful,

then I would advise that you see a GP then.

Why do we call it menstruation?

Menstruation or menes comes from the Latin word menses,

which means month as our periods tend to happen every month.

Why do we even have periods?

So we have periods each month.

It's the body's way of shedding the lining of the uterus and the lining of the

uterus or our womb is what builds up in anticipation of a pregnancy.

So if we don't get pregnant, if the egg isn't fertilized,

then the body gets rid of this lining ready for the next cycle when the possible

pregnancy may occur.

Is PCOS common?

PCOS is very common. It's thought to affect 1 in 10 women,

although many won't realize that they have it.

Up to 50% of women won't suffer with any symptoms.

Is PMS even real?

PMS is definitely real.

We know that up to 80% of women will suffer PMS each month,

and this is due to your hormones fluctuating. So at this time of the month,

you may find that you suffer with headaches, fatigue,

bloating, bad skin. Your stomach may be upset as well.

You may suffer with sore breasts,

and all of this is completely normal as our oestrogen levels are dropping.

Can I get pregnant on my period?

You can get pregnant on your period, although it is very unlikely,

but you need to remember that sperm can stay alive inside the body for up to

seven days. So if you ovulate very quickly after you've had your period,

if you have a short ovulation cycle,

then there is always going to be that risk there.

Should I wear a sanitary product all day?

So some sanitary protection can be used for longer than others,

so period pads can be used for about four to eight hours as can

tampons or menstrual cups.

And the reason that we advise this is because we don't want to increase your

risk of getting any infection or irritation from using them,

but period pants can be used for a much longer period of time,

so usually up to about 10 to 12 hours.

We advise that you wash those and change them when they start to be feel a bit

heavy and a bit full, but they can be very useful for using overnight.

How often should I change my sanitary pad?

You should change your sanitary pad every four to eight hours.

This is just to prevent any unpleasant odours from building up and prevent any

irritation if the pad is becoming a bit damp.

What is a period?

A period is made up of the lining of the womb that is shed each month if a

pregnancy hasn't occurred,

and also contains cervical secretions and vaginal secretions too.

Do period pants work?

Period pants definitely work and a lot of women prefer using them now because

they're eco-friendly and they're reusable,

so you can save on those expensive costs of sanitary protection each month.

They tend to be very absorbent.

They also very good at eliminating odours as well,

and they can be used for a longer period of time than you can with normal

tampons or pads. So they can be used for sort of up to 10 to 12 hours.

So they're very good to be used overnight as well.

Can I wax or shave when I'm on my period?

So, yes, you can wax or shave when you're on your period,

but you just need to remember that your pain receptors are heightened during

this time so it may feel a little bit more uncomfortable than normal,

so you might want to schedule that waxing appointment for after your period.

Also, remember, you might feel a little bit more embarrassed at this time,

so if you do go and get waxed, you may prefer to use a tampon.

What shouldn't I do when I am on my period?

There's nothing you shouldn't do when you're on your period,

but there may be some things that you would feel better not doing when you're on

your period.

So if you find that heavy exercise or intense exercise is a bit too much for you

because you're feeling tired,

then I would advise avoiding that and maybe just do some lower impact exercise

instead.

We would advise not to drink too much coffee when you're on your period and not

to eat too many sort of processed foods or sugary foods,

even though you might feel you're craving them as they can make you feel more

bloated and just feel generally worse throughout that time.

Don't drink too much alcohol because even though you might feel that that can

help relax you, it can lower your mood as well.

So just do things that you feel make you feel a bit more comfortable.

Tight fitting clothes may not be good idea at that time of the month as well but

you know what's best for you.

What causes developing periods later then usual?

So we don't really know why some girls develop their periods later than others.

This is all down to environmental and genetic factors.

But we do know that our weight can play a part.

Our diet can play a part, but for most girls,

we would expect them to have started their periods by the age of 16.

So if they haven't, by then, we would advise that they see a GP.

Should I have unprotected sex during my period?

So we wouldn't advise that you had unprotected sex whilst you're on your period.

One, because there's always a chance that you can get pregnant.

Sperm can survive in the body for up to seven days after your period.

So there's always a chance that you may ovulate early and get pregnant.

And also, there's always the risk of sexually transmitted infections,

which you're susceptible to throughout your menstrual cycle.

How do I know if my period is too heavy?

You'd know if your period was too heavy, if it just didn't feel right,

basically.

So if it's very different to how it's been before. We say that if

you are losing clots bigger than a two and a half centimeters or a 10p

size, then that isn't right.

If you're changing your tampons or your pads more than every hour,

then also that's something to consider talking to your GP about.

If you find that you are flooding through your clothes or leaking into the bed

at night, then that can be a sign too,

if you're feeling very fatigued with it or you're feeling short of breath,

and particularly if you're having to change your normal activities of daily

living, so if you're not able to go into work or into school, then again,

that is a sign that your period may not be quite right.

Should I go to bed without a pad?

You can go to bed without a pad at night,

but you just need to consider that you might therefore leak into the bed linen.

We know that it might seem that your period stops at night,

but this is often just because you're lying down so the blood isn't being shed

from the uterus and the vagina because you're not stood up against gravity.

As soon as you cough or move, or if you do stand, that blood may come away.

So I'd advise you really to either use a pad or you might prefer to use some

period pants, but definitely use some sort of sanitary protection overnight.

Can being on my period affect my mental health?

Being on your period can definitely affect your mental health.

So in the time leading up to our period, what we term our luteal phase,

our oestrogen levels are dropping and this can affect our happy hormones,

our serotonin levels and our progesterone levels rise,

which affects our stress hormones, our cortisol levels,

and then they drop as well. So by the time you reach your period,

you can actually feel quite low and also understandably as you come on your

period, if you're not looking forward to suffering with menstrual cramps and the

bloating and the headaches and all those other horrible symptoms that you can

get around the time of the month,

it's not unusual to feel pretty rubbish around that time.

Does smoking impact how I feel during my period?

Smoking definitely impacts how you feel during your period.

We know that smoking is linked with higher levels of premenstrual syndrome,

so women who smoke are one and a half times more likely to suffer with this,

and it can also increase your pain from your period cramps as it causes the

blood vessels to contract in the uterus.

Does every woman have a period?

So not every woman will start their period.

So it is important if you haven't started your periods by the age of 16 to go

and see a doctor.

We do know that certain genetic factors can play a part, certain illnesses

and medications can too.

So it's always worth getting checked out if you haven't started your period by

then.

Who supplies sustainable period products?

There are several companies providing these products,

but Bupa currently does not have a particular affiliation with any of them.

Are health conditions related to heavy periods?

There's lots of different health conditions related to heavy periods,

and I find it useful to divide it into those that affect the whole body and

those that just affect the reproductive organs.

So conditions that affect the whole body are things like thyroid disease,

polycystic ovaries, clotting disorders, genetic disorders,

and some medications can also affect it.

Things that affect the reproductive systems may include fibroids and polyps.

So these are non-cancerous growth that can cause heavier bleeding

endometriosis, which is another condition and cancers,

of course, we always have to think those about an interuterine device,

which we use for contraception that can also make your periods heavier.

Is menstrual cycle tracking important?

Menstrual cycle tracking can be really useful for us to understand why we feel

the way that we do at different times of our cycle,

and to use that to help us with our daily life. So for example,

just before our period when our hormones are all over the place and our

oestrogen and progesterone levels have started to drop,

we may feel at our worst. We usually have little energy

then where we find confined that our mood is quite low as well.

There's sometimes that tendency to want to hibernate.

So knowing when that time of the month might be,

you might want to avoid that for certain activities. Equally,

just after we've had our period, we usually feel at our strongest.

We might feel very motivated

then, we might have lots of brain clarity at that time,

feel that our endurance levels are a lot higher,

so you can also maximize that to your benefit at this time.

Can I have a bath on my period?

You absolutely can have a bath on your period.

There's no reason why you shouldn't,

and it's very important to keep our hygiene levels up at this time.

What are your top tips for making me feel better on my period?

So I've got some great tips to help you make you feel better during your period.

Firstly, I would always say to exercise if you feel up to it.

Even just a little bit of gentle exercise can help release those endorphins and

make you feel brighter and also gets the blood flowing to the womb so you may not

feel those period cramps so badly. Try and eat healthily.

I know there's always a tendency to want to reach for those sugary snacks but if

you can have a healthy, balanced diet, then we do know that this helps.

Drink plenty of fluids as that can help reduce bloating. Also,

wear loose fitting clothes if you are feeling bloated,

as this will feel less restrictive to you as well.

Don't drink too much alcohol as although you might feel the need to reach for

some more alcohol during this time. Actually,

it is a depressant so it can make you feel worse.

Try and get as much sleep as you can,

as well as this will really help and try and avoid any stresses that you can

too.

Is it ok to swim when I'm on my period?

It is okay to swim whilst you're on your period,

but you might want to consider what sanitary protection that you use.

So we'd advise that you use a tampon or a menstrual cup as this goes inside the

vagina and will collect the blood inside.

You can't use a pad as this will absorb water from outside the body,

so won't help you and therefore you may have an accident or a leak.

Some people feel that maybe their period stops whilst they're in water.

This is just due to the water pressure. It isn't actually stopping,

and once you come out of the water,

then due to gravity and the water pressure going,

this blood is going to come away,

so you do need to consider that and make sure that you use adequate sanitary

protection at this time.

Does my period stop when I am sleeping?

Your period doesn't stop when you're sleeping,

although it sometimes may seem like it does.

What is happening is that it's pooling inside your womb or your uterus because

you're lying down. If you move or if you cough or when you stand up,

that blood is then going to come away,

so we do advise that you use sanitary protection overnight.

Do people lose weight during their period?

Most people find that they gain weight during their period,

and it's not unusual to gain a couple of pounds,

and this can be for a number of reasons.

It might be that you are comfort eating,

so you are reaching for those carbohydrates and the sugary snacks.

It might be that you're not exercising as much as normal,

or it might be that you're retaining fluid and you're feeling a bit bloated,

but some people do lose weight,

and this might be because they're feeling a bit down so they don't want to eat.

Or it might be that the period cramps and the pain are also putting them off

their food.

Why do periods hurt?

Periods hurt for a couple of reasons: each month as we shed the lining of our

uterus, our womb contracts to help us do so, and we have prostaglandins,

which are hormones building up inside the body to help us to do that.

So you can feel the cramping pains as the uterus is expelling the unwanted

lining out. Also, as this happens,

blood vessels can constrict and that means that the blood flow and the oxygen is

not getting to the tissues,

and so the tissues release some chemicals in response to that,

and these cause pain.

Why is it called a period?

Period comes from the Latin or Greek term, periodus, which means recurring cycle.

Can I donate period blood?

You can't donate period blood as it's not the same as the rest of the blood

that's flowing through our body.

Your period blood is made up of the lining of the womb, cervical mucus,

and vaginal secretions.

There has been thought so that we might be able to use some of the cells found

within period blood to help eradicate other illnesses,

so they are doing a lot of research into this at the moment.

Should I eat more when I'm on my period?

We definitely wouldn't advise that you eat more whilst you're on your period,

and it's a good time to make sure that you follow a healthy, balanced diet.

Although it might seem that it's a good idea to reach for those carbohydrates,

sugary snacks because you want to comfort eat. Actually,

they won't do you any favours.

So we would say just carry on eating as healthy as you normally would and just

try and exercise too.

Can I see an egg in my period?

You won't be able to see an egg within your period because it's microscopic,

so that means it's not visible to the naked eye. Also,

your egg is released when you ovulate,

which is normally a couple of weeks before you'll see your period.

So it will have long been absorbed by the time your period comes.

What is a menstrual cycle tracker?

So a menstrual cycle tracker just gives you the means to keep an eye on what's

happening each month. So this is recording how you feel each day,

what symptoms you've got, whether you are seeing any period at this time,

and it just enables you to be at tune with your body and what's happening.

And this can be very useful to track whether something isn't quite right and to

be able to share that with your GP.

It can also be useful for women trying to help with their fertility and to see

when they ovulate as well.

How can my partner support me during my period?

Only you know really what you want to get from your partner.

Some suggestions might be giving you some space if you feel that you want to be

left alone, but equally giving you some cuddles

If you feel that you need more love at that time,

you could ask them to get you more drinks because it's so important to stay well

hydrated.

You could ask them to go shopping for some healthy food and to cook for you.

You could ask them to exercise with you. You could ask them to rub your tummy.

Massage can really help relieve period pains,

or it might be that you want them to run you a hot bath or pour you a hot water

bottle as again, we know that heat can help relieve pains,

but you know what's going to be best for you.

Why do I dread my period so much?

It's understandable to dread your period if you think about it,

nobody really wants to be in pain. Nobody wants to feel bloated. But also,

our hormones affect how we feel too.

So just before our period comes and our oestrogen levels are low and our

progesterone levels are low,

this affects our stress and our happy hormones as well.

So it raises our stress hormones and it lowers our happy hormones.

So it is completely understandable to dread it.

And we would say just look after yourself.

Do anything that you can to try and make the experience as easy as possible.

Why is talking about periods such a taboo?

That is a great question, and surely now it is beyond time to challenge this.

I think it relates back historically to cultural taboos and the secrecy

surrounding it, and gender inequity as well.

We also know that a third of women still feel embarrassed to talk about their

periods, so we need to encourage them to have open and honest conversations

and just to normalise it.

Why does my period affect my mood?

Our period affects our mood because of our hormones changing throughout the

cycle. So just before we start our period, our hormone levels are at the lowest.

Our oestrogen and progesterone levels are very low,

and this affects our happy hormones, our serotonin,

and so we can feel quite rubbish at this time. Also,

as we go through our period and we might experience feelings of pain or bloated

headaches, bad skin, it's understandable that we might not feel at our best.

Does exercising help during my period?

Exercise really helps during your period and I can't recommend it enough.

It may be though that you don't want to do such high impact or high strength

exercise at this time as you may be feeling a bit weaker and in pain and tired

as well. But exercise helps release endorphins,

which can make us feel better and can also help with blood flow to the uterus so

you don't feel those period cramps quite so badly.

How can a period affect someone's mood?

It is understandable that your period may affect your mood as your hormones are

fluctuating before you have your period. So first of all,

your progesterone rises and that can release cortisol,

which is our stress hormone, and then it drops dramatically,

and that can give you a low mood by itself.

And our estrogen levels are also dropping, and that affects our serotonin,

which is our happy hormone. Also, when you have your period,

you may get symptoms of headache. You might feel bloated,

you might get bad skin, you might get sore breasts.

So all of these things in the cells are going to make you feel pretty rough.

So it's understandable really,

that at this time you might feel quite low.

What are your top tips for companies to support their employees during their period?

I have lots of tips for companies to be able to support their employees.

First of all,

I would say it's really important just to normalise the conversation and get

some open discussion going within the workplace,

but also remember that some women may not want to do this and may want to be

more discreet.

You can have a policy that you can refer to and that everyone else can refer to

as well, and it might be an idea to think about some flexible working,

allowing women to start working later in the day if they've had a bad night,

or even to have days off if needed, and also to be able to work from home.

Some companies may also consider providing free sanitary products within the

workplace too.

Can I get depressed because of my periods?

Due to the changes in hormones around your periods,

this can make you feel quite low in mood and can make you feel depressed as

well.

And also because of some of the symptoms that you may experience whilst you're

on your period. If you have existing mental health issues, then again,

these can get worse at the time of your periods because of the hormones

changing.

What are some useful questions to ask about my period?

I would ask yourself the following questions about your period. So first of all,

have a think. Is it happening regularly?

It should be happening roughly every 28 days,

although this can vary between about 21 and 35 days.

And how long are you bleeding for? So the average is about five days,

but most people will fall between three and eight days. Also,

ask yourself how heavy your period is. Is it causing you problems?

So if you are losing a lot of clots,

if they're bigger than two and a half centimeters, which is a 10p size,

then that's not normal.

And if you are needing to change your sanitary protection every hour as well,

then this isn't quite normal. Also,

if you feel that you are leaking a lot and you're flooding or if you're feeling

particularly tired with it, or if you're getting short of breath.

I would also make a note whether you are bleeding in between your periods as

this should be checked out, if you are.

If you're getting a lot of other symptoms in the lead up towards your period as

well, which affecting your activities of daily living.

If your mood is so unbearable that you can't cope again, this is not normal,

so you ought to contact your gp.

Menopause support and symptom management

From the perimenopause to post menopause, we offer support wherever you are in your life.

Menopause can bring many challenges and it can have both physical and emotional impacts, but it can also be a time of opportunity, strength, and empowerment.

Today I'm joined by Bupa's, Clinical Lead for Women's Health, Dr.

Sam Wild, who's gonna share with us some ideas for self care and lifestyle changes that women can take to really help support them through this period in their lives.

So, Sam, to start us off, what are the lifestyle changes that women can make?

So there's plenty that women can make.

Let's start with sleep.

So important to have between six and eight hours of sleep at night and even if you're not asleep, just to get that rest in bed and to keep that up at weekends as well.

It's important to keep to the same bedtime and the wake up time.

Next up, diet.

So important to have a Mediterranean-type diet.

We know that that's very healthy for our hearts and our risk of heart disease increases after the menopause.

And also to ensure that you're getting enough nutrients as well, so we can start to get thinning of the bones as we approach the perimenopause, the menopause and post menopause.

So we need to get enough calcium in our diets aiming for two to three portions of calcium-rich foods a day, as well as dairy products, that includes things like green leafy vegetables as well.

And if you're unsure what other products contain calcium, then you can have a look online for a calcium calculator.

And ensure that you get enough vitamin D.

So take a 10 microgram supplement a day of vitamin D, again, helps to keep the bones nice and strong.

Is there anything that you should be reducing or not having in the diet?

Not so much alcohol, that will aggravate hot flushes and night sweats and affect your sleep quality.

Don't smoke and try to avoid too much caffeine if you feel that you are sensitive to that.

What about exercise?

What's the best type of exercise, if there is one?

So really important to give your heart a good workout.

So some aerobic exercise and also some weight bearing exercise to help keep your bones nice and strong and some resistance exercise using weight or your own body weight, which will help to keep your muscle strength too.

What about mood swings and low mood anxiety?

These are really common around the time of menopause.

What can people do to help themselves with those symptoms?

It's really important to speak to your loved ones and your friends and your colleagues about how you're feeling and try and get some support from them.

Again, trying to practise mindfulness can really help.

Meditation, exercise, is brilliant to help calm you down too.

Cognitive behavioural therapy is a very useful type of therapy for this particular issue too.

And I always advise women that it will give you really useful tools for evermore really and to help with family and friends as well.

So definitely worth exploring that as a treatment.

A lot of women suffer in silence, don't they?

But that irritability, it's your loved ones who will feel the brunt of that.

So I always think let them help you, let them in, let them know what you're experiencing.

'cause you are really all in it together.

Absolutely, yeah.

What about memory and brain fog?

That's a really common symptom that a lot of people struggle with.

It is, and I see countless women that come into my surgery complaining and worrying that they're maybe starting to suffer with dementia.

And I reassure them that this is normal and often that on its own is enough.

But women have often found their own ways to manage things.

So list making is is really common.

Again, trying to speak to people around them and explain what's going on.

Maybe using technology as well.

So there's lots of different ways that they can get around this.

And HRT if they choose to take that will help too.

HRT also helps with hot flushes and night sweats, but are there things other than HRT that can also help with that?

Yeah, so again, having your healthy diet, avoiding those things that may aggravate it.

Exercising will help.

Some people choose to try herbal remedies.

Now there's no good evidence that these work, but also there's no good evidence that they don't work either.

They've just not been tested.

So I always advise women to speak to their GP first to make sure it's not going to interfere with any other medications that they're taking.

But then to give it a try, not to spend a fortune on it, but give it a go.

And if it works, then brilliant.

And there are some other prescribed medicines that can be.

It's quite confusing, but sometimes antidepressants, whilst they don't necessarily help for the low mood associated with menopause, can help with the night sweats and hot flushes.

So for women that can't have HRT or who choose not to have HRT, they may be prescribed antidepressants in these circumstances.

And the final thing I want to ask about is vaginal dryness, 'cause that's a really common symptom, isn't it?

It really is.

And we'd really encourage women to come forward because we know that about 70% are likely to be suffering with this, and yet only 7% receive treatment.

So there's a few things you can do before you see your GP.

You can buy vaginal moisturisers and lubricants over the counter and they can be used together.

So a vaginal moisturiser you'd apply every few days, just like you moisturise your face, you apply the moisturiser and the lubricants you use when you are having sex.

And there's two different types of lubricants.

There's oil based and there's water based.

If you're using condoms, you must avoid the oil ones because it can damage the integrity of those.

But we can find.

You know, find it helps if a partner, one partner uses the oil based one, one partner uses the water based one, a term that we call slide and glide, which I absolutely love, but people find that works really well.

You can also get vaginal oestrogen.

So you are applying the oestrogen exactly to where it's needed and that can come in different forms.

And again, you can get that over the counter if you fit certain criteria or your GP can prescribe it for you.

And it is different to the other forms of HRT, isn't it?

Just the vaginal oestrogen is safer and some people who can't use patches or take tablets can use that, is that right?

Absolutely.

So for example, women that have breast cancer, they may be able to use topical oestrogen depending on what other treatment they're on.

So something they need to discuss with their specialist but yeah, it might be absolutely fine for them to use it.

Thanks Sam.

We know that HRT is a really helpful treatment, but it's great to know that there are all these things that women can do, whether they're taking HRT or not.

Yeah, and it's absolutely imperative that they do.

We always recommend that they do this, as you say, whether they're taking HRT or not.

Menopause can bring many challenges and it can have both physical and emotional impacts, but it can also be a time of opportunity, strength, and empowerment.

Today I'm joined by Bupa's, Clinical Lead for Women's Health, Dr.

Sam Wild, who's gonna share with us some ideas for self care and lifestyle changes that women can take to really help support them through this period in their lives.

So, Sam, to start us off, what are the lifestyle changes that women can make?

So there's plenty that women can make.

Let's start with sleep.

So important to have between six and eight hours of sleep at night and even if you're not asleep, just to get that rest in bed and to keep that up at weekends as well.

It's important to keep to the same bedtime and the wake up time.

Next up, diet.

So important to have a Mediterranean-type diet.

We know that that's very healthy for our hearts and our risk of heart disease increases after the menopause.

And also to ensure that you're getting enough nutrients as well, so we can start to get thinning of the bones as we approach the perimenopause, the menopause and post menopause.

So we need to get enough calcium in our diets aiming for two to three portions of calcium-rich foods a day, as well as dairy products, that includes things like green leafy vegetables as well.

And if you're unsure what other products contain calcium, then you can have a look online for a calcium calculator.

And ensure that you get enough vitamin D.

So take a 10 microgram supplement a day of vitamin D, again, helps to keep the bones nice and strong.

Is there anything that you should be reducing or not having in the diet?

Not so much alcohol, that will aggravate hot flushes and night sweats and affect your sleep quality.

Don't smoke and try to avoid too much caffeine if you feel that you are sensitive to that.

What about exercise?

What's the best type of exercise, if there is one?

So really important to give your heart a good workout.

What about mood swings and low mood anxiety?

These are really common around the time of menopause.

What can people do to help themselves with those symptoms?

It's really important to speak to your loved ones and your friends and your colleagues about how you're feeling and try and get some support from them.

Again, trying to practise mindfulness can really help.

Meditation, exercise, is brilliant to help calm you down too.

Cognitive behavioural therapy is a very useful type of therapy for this particular issue too.

And I always advise women that it will give you really useful tools for evermore really and to help with family and friends as well.

So definitely worth exploring that as a treatment.

A lot of women suffer in silence, don't they?

But that irritability, it's your loved ones who will feel the brunt of that.

So I always think let them help you, let them in, let them know what you're experiencing.

'cause you are really all in it together.

Absolutely, yeah.

What about memory and brain fog?

That's a really common symptom that a lot of people struggle with.

It is, and I see countless women that come into my surgery complaining and worrying that they're maybe starting to suffer with dementia.

And I reassure them that this is normal and often that on its own is enough.

But women have often found their own ways to manage things.

So list making is is really common.

Again, trying to speak to people around them and explain what's going on.

Maybe using technology as well.

So there's lots of different ways that they can get around this.

And HRT if they choose to take that will help too.

HRT also helps with hot flushes and night sweats, but are there things other than HRT that can also help with that?

Yeah, so again, having your healthy diet, avoiding those things that may aggravate it.

Exercising will help.

Some people choose to try herbal remedies.

Now there's no good evidence that these work, but also there's no good evidence that they don't work either.

They've just not been tested.

So I always advise women to speak to their GP first to make sure it's not going to interfere with any other medications that they're taking.

But then to give it a try, not to spend a fortune on it, but give it a go.

And if it works, then brilliant.

And there are some other prescribed medicines that can be.

It's quite confusing, but sometimes antidepressants, whilst they don't necessarily help for the low mood associated with menopause, can help with the night sweats and hot flushes.

So for women that can't have HRT or who choose not to have HRT, they may be prescribed antidepressants in these circumstances.

And the final thing I want to ask about is vaginal dryness, 'cause that's a really common symptom, isn't it?

It really is.

And we'd really encourage women to come forward because we know that about 70% are likely to be suffering with this, and yet only 7% receive treatment.

So there's a few things you can do before you see your GP.

You can buy vaginal moisturisers and lubricants over the counter and they can be used together.

So a vaginal moisturiser you'd apply every few days, just like you moisturise your face, you apply the moisturiser and the lubricants you use when you are having sex.

And there's two different types of lubricants.

There's oil based and there's water based.

If you're using condoms, you must avoid the oil ones because it can damage the integrity of those.

But we can find.

You can also get vaginal oestrogen.

So you are applying the oestrogen exactly to where it's needed and that can come in different forms.

And again, you can get that over the counter if you fit certain criteria or your GP can prescribe it for you.

And it is different to the other forms of HRT, isn't it?

Just the vaginal oestrogen is safer and some people who can't use patches or take tablets can use that, is that right?

Absolutely.

So for example, women that have breast cancer, they may be able to use topical oestrogen depending on what other treatment they're on.

So something they need to discuss with their specialist but yeah, it might be absolutely fine for them to use it.

Thanks Sam.

We know that HRT is a really helpful treatment, but it's great to know that there are all these things that women can do, whether they're taking HRT or not.

Yeah, and it's absolutely imperative that they do.

We always recommend that they do this, as you say, whether they're taking HRT or not.

Endometriosis support and symptom management

If you think you might have endometriosis, have just been diagnosed, or want to support someone, we’ve got facts and advice for you.

Endometriosis matters, it matters to millions of people and their families. It can be extremely painful and affect your quality of life or you could have no symptoms at all.

For many, it is a hidden mystery illness. That is why we have spoken to an endometriosis expert to get you the answers you need.

Endometriosis is a condition whereby cells that are very similar to the lining of the womb called endometrium are found outside of the womb.

We think it affects about one point five million women in the U.K., so approximately 10 percent of the adult female population.

We tend to think of five sets of symptoms. So the first is, do they have very, very painful periods? And I do not mean periods where the pain will be resolved by one or two paracetamol.

The next symptom is do they have pain with intercourse? Typically, this is pain deep within the pelvis, it is at the time of intercourse but it can also be afterwards and it can last from a few hours to up to two or three days.

Does she have pain when she is opening her bowels? This typically is related to the time of the month when they are having a period, but it can also occur leading up to the periods and it can occur around ovulation or even at random between periods.

Are they having pain when they are passing urine? So are they going more frequently? Do they feel like they have got a urinary tract infection even though when they go to the GP's, a dipstick analysis of the urine shows that there is nothing in there; and finally, do they have pelvic pain throughout the month? Do they have pain not when they are on their periods, not when they are going to the toilet, not when they are having intercourse but just throughout the month.

Do they have pelvic pain, do they have bloating, do they have profound fatigue?

As you can imagine, all of these things collectively can have a huge impact, so they can affect their ability to hold down a normal work pattern.

The impact of endometriosis on personal relationships can be extremely profound and this can relate to a number of things.

First and foremost, patients often find it either extremely difficult or impossible to have an intimate relationship with their partner, it is inevitably going to have a negative impact on somebody's mental health and up to 80 plus percent of patients will describe that.

I think it is fairly well established now that it takes around, on average eight years from the onset of symptoms to actually achieving a diagnosis, which from a medical perspective is a huge period of time. Why does it take so long? Well, the symptoms that a patient can exhibit are very, very variable between patients.

Very, very rarely do you get two patients who are just the same and it is important to remember that when you are dealing with endometriosis.

So in order to achieve a diagnosis of endometriosis the gold standard is something called a laparoscopy.

So this is keyhole surgery and it involves the patients coming to hospital either as a day case, sometimes overnight.

They are put to sleep under general anaesthetic and then a small incision is made in the umbilicus or the navel or belly button and that allows the Gynaecologist to look everywhere from the diaphragm down to the pelvic floor and really check to see if there is any endometriosis present.

So as you can imagine, if a patient turns up at the General Practitioner's office, it can be really very difficult for a GP to say, well you have got endometriosis and this is how we are going to manage it.

We are frequently asked, are there any treatments available for endometriosis and the answer is yes, definitely.

I would say that the gold standard treatment is surgical for those patients who are able to undergo surgery and ideally should involve excision or removal of the endometriosis.

If a patient is not able to undergo surgery or is not willing to or can not do or wants to defer it for a period of time there are some medications that can help with the symptoms but it is really important to realise that they do not actually get rid of the underlying condition. So we would typically start with the really simple analgesia regiments such as Ibuprofen or Brufen, Naproxen in combination with Paracetamol.

Now patients may find that that is helpful, they may find that actually it really does not do anything but just take the edge off at the most. So then you are looking at the stronger drugs, so the Codeine based drugs such as Co-Codamol.

The second branch of medicine that could be used to sometimes control the symptoms is hormonal control, so this would involve typically using the combined oral contraceptive pill in a continuous fashion.

How can we make the lives of patients with endometriosis better? Well, I think first of all, we need to be able to talk about it.

Yes, it is a gynaecological condition and yes a lot of people still find it embarrassing or difficult to talk about gynaecological issues.

However, the more we talk about it, the more we get used to it, the more people will understand it, they will accept it and this will help in the management of the diagnosis of endometriosis.

By talking about endometriosis, we can help it feel a little less hidden. Explore more about endometriosis on our Women's Health Hub at bupa.co.uk/womens-health. Because endometriosis matters.