Physical Activity & Health

Physical Activity & Health

Physical activity has significant health benefits for hearts, bodies, and minds. Physical activity improves mood, overall well-being and sleep. Physical activity enhances thinking, learning and judgement skills. Moderate physical activity is important in maintaining healthy regular menstrual cycles and increasing fertility. Maintaining a healthy weight through exercise and moderate activity helps increase reproductive health and fertility.

Key Definitions

Moderate Exercise

Moderate intensity activities are those that get you moving fast enough or strenuously enough to burn off three to six times as much energy per minute as you do when you are sitting quietly. Moderate intensity activities may include, for example, brisk walking or riding a bike on level ground with no hills.

Vigorous Activity

Vigorous intensity activities are those that make you breathe hard and fast. If you’re working at this level, you will not be able to say more than a few words without pausing for breath. Vigorous intensity activities include, for example, jogging or running and swimming laps.

Muscle Strengthening

Muscle strengthening activities are those that make your muscles work harder than usual. This increases your muscles’ strength, size, power and endurance. The activities involve using your body weight or working against a resistance.

Women aged 18-64 years

  • Should do at least 150 to 300 minutes of moderate-intensity aerobic physical activity throughout the week;
  • Or at least 75 to 150 minutes of vigorous-intensity aerobic physical activity;
  • or an equivalent combination of moderate- and vigorous-intensity activity throughout the week;
  • Should also do muscle-strengthening activities at moderate or greater intensity that involve all major muscle groups on two or more days a week;
  • Should limit the amount of time spent being sedentary;
  • To strengthen pelvic floor muscles practice pelvic floor exercises such as Kegel exercises, heel slides, or toe taps 3 times a day;


Pregnant and postpartum women

All pregnant and postpartum women without contraindication should

  • Do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week;
  • Incorporate a variety of aerobic and muscle-strengthening activities;
  • Practice Kegel exercise to support pelvic organs; regular Kegel exercise during pregnancy and after you have given birth can help improve and maintain bladder and bowel control.



  • Listen to your body
  • Every activity counts
  • Any physical activity is better than no physical activity
  • Stay hydrated
  • Physical activity is important for all women throughout their lives



Nutrition is a complex topic and can be triggering for some of us depending on our background and history. We have information on calorie counting and beach body culture. We also have information on various diets such as ketone, paleo, and fasting. What we know is that our bodies have different nutritional needs and that one diet or way of eating does not fit for all. There is also a real lack of good research into female specific nutrition although thankfully this is changing. So here we will outline the baseline information that will help you make choices around nutrition that are healthy but with the disclaimer that this doesn’t replace speaking to a nutritionalist or dietician who is able to look at you as an individual.

What diet is the healthiest?

There are so many diets out there but time and time again the diet that comes out as being the healthiest for us, is one based on a Mediterranean diet. This means a diet that is rich in fruits, vegetables, pulses, legumes and good fats such as omega -3s from fish and olive oil. It is low on red meat and dairy but nothing is completely restricted.
But in the advent of companies such as Zoe, we can see that we all have unique ways of processing foods and that taking an individual view of our diet is important.
Certainly again another generalisation can be made that it is worth focusing on balance in our diet. That means taking in a balance of carbohydrates, protein and good fats.


What about nutrition across the menstrual cycle?

Our body will have different calories and nutritional needs across the cycle because of changes in hormone levels.

In the luteal phase, in that lead up to our period, there is an increase in our basal metabolic rate. This means we burn more calories with this varying between women but can be a change of up to 300 calories. Progestogen can increase appetite too leading to cravings at this time of the month for many women. We can manage this by reaching for long acting carbohydrates (think whole grains, fruits and vegetables) and good fats (think nuts, avocados and plant based oils) rather than high sugar foods which will often lead to energy crashes throughout the day.

15 to 18 % of women of child bearing age worldwide are iron deficient so another focus with what we are consuming has to be an increase in iron containing foods especially around the time of our period. Iron occurs naturally in our dark green vegetables, soy products, beans, nuts and seeds.

Magnesium supplementation has been shown to reduce premenstrual symptoms such as bloating and it has been found to be particularly helpful in combination with B6. Some of the other B vitamins have also been found to be helpful and these can be found naturally in foods such as seeds, nuts and spinach.

Calcium and vitamin D seem to also play a part in premenstrual symptoms with a higher level in our diet being associated with lower risk of symptoms. Natural sources of these come from our dairy products, non dairy milks, leafy vegetables and fish.

Some women seem to feel the benefit of soy based products at this time of the month but this does not seem to be true of all women and might be worth a try and see approach.

Diet and fertility

The first point here has to be that being pregnant is a big stressor on the body and it is great practice to focus on being as healthy as possible if you are trying to conceive. This means thinking about feeding your body in a nutritious way with a healthy, balanced diet at least 80% of the time. Fertility is a massive issue and nutrition is only one part of this with around 15% of couples experiencing infertility. This healthy, balanced diet will have more plant based sources of protein and unsaturated fats both found to help in fertility.

Every women who is trying to conceive should be taking a supplement of folic acid, to protect their baby from spinal cord defects, and also vitamin D.

Pregnancy, even more than our regular monthly cycle, is associated with anaemia or low iron and therefore thinking about eating a diet that is high in iron or supplementing is a good idea when trying to conceive. Good ways of ensuring we absorb the iron we are consuming is to think about also consuming vitamin C with your meals and avoiding drinking tea or coffee at mealtimes.

Iodine is worth considering as it is essential for fertility and can be lacking in our diet especially as more of us move to being vegetarian or vegan. We get iodine in our diet from dairy products and fish and it may be worth looking for fortified products if you don’t have these in your diet.


Nutrition and Pregnancy

It is worth looking at the above section on fertility to help start the conversation around nutrition during pregnancy as anything associated with fertility will also aid our body during pregnancy. Focusing on a healthy, balanced diet with particular focus on iron, omega -3 ( good fats), iodine and supplementation with folic acid and vitamin D would be the best advice.
There are certain foods that are not recommended when pregnant which can be found easily with a search online. My advice on how to remember the list is to think about how food is prepared. For the most part if food has been pasteurised or cooked then it is ok but if it is raw or under cooked it is best avoided if possible in pregnancy. Another thing to be cautious about is vitamin A which we find in liver and liver pates. The advice now is to avoid alcohol altogether and to limit amounts of caffeine.
If we are having to supplement with iron during pregnancy we can be at high risk of constipation. This is best managed by increasing fluid intake and also the amount of fibre in the diet. This again means whole grains, fruits and vegetables, beans and pulses. Keeping active will help with this. If it is very problematic and starting to cause pain and haemarrhoids from straining then please speak to your midwife or doctor about laxative prescriptions that are safe in pregnancy.

Postnatal nutrition

During the post natal phase our bodies are going through a lot of change. Hormone levels will be fluctuating out of any normal cycle and can be hard to predict. Whether you are breast or bottle feeding will have a difference both on these hormonal levels but also specific nutritional needs. But all women will be facing tiredness and physical and emotional changes so it is a good idea to plan for this phase and think about how to give your body the best nutrition possible to help cope with all that your body is doing.

The same healthy diet which we have been learning about, that supports us prenatally and perinatally will help us here too. Focusing on our macro nutrients of long acting carbohydrates, proteins with an emphasis on having some plant based sources, and good fats, is a great place to start. When we are tired we can often reach for more sugary or salty snacks which can lead to more mood and energy crashes. So try and plan for this (or ask supportive partners, families or friends to help) by stocking up on nourishing snacks that will give you sustained energy boosts. It is also worth cooking in bulk if possible and freezing so again it is easier to reach for a balanced meal rather than something that makes us feel more sluggish and drained.

If we are breast feeding our bodies need around a litre more fluid a day and also around an extra 500 calories a day. We require more protein (11g more), calcium (550mg more), omega 3 (200mg more), iodine and vitamin D. So lots of reasons to bring in lots of vegetables, beans, pulses, nuts and seeds to supplement our protein of choice.


Menopause and nutrition

Thankfully there is more and more information available to women in the perimenopause and beyond thanks mostly to the Davina effect and the various professionals who have stepped into the spotlight to highlight the importance of health in women.

Nutrition is one of the main pillars of how we can support our bodies through this transition. By now we know what makes up a nutritious diet but there are some particular areas we can focus on. The drop in oestrogen we have is blamed for the impact on our bone, heart and brain health along with the wide range of symptoms that women experience. So when we think about our diet we are working to support these systems as much as possible.

When we think about cardiovascular health then it can be good to reduce our intake of saturated fats and really think about increasing our good fats such as nuts, plant based oils and avocados. It is also worth cutting back on our red meat intake and salt and increasing our intake of oily fish or plant based fatty acids. Increasing our intake of oats, nuts and soy products have been shown to improve our lipid profile which in turn reduces our cardiovascular risk.

Increasing our intake of whole grains and eating the rainbow can improve the health of our gut and increase antioxidants in our system, the stuff that mops up toxins from our body caused by pollutants and stress.

Bone health can be improved by thinking about our intake of calcium and vitamin D. The best way to get vitamin D is through daylight but if you have dark skin or spend most of the day indoors then you are likely to be lacking your recommended amount. Many people have to supplement through the winter in the UK because they know that their levels drop and they can feel the impact on their whole body. Natural sources of calcium and vitamin D are dairy products and fortified non dairy equivalents such as oat milk and soy milk. Our flour in the UK is fortified as are some juices. Tinned fish, tofu and seeds are other sources and we can get some vitamin D from eggs, mushrooms and liver.

Protein intake is important at this phase of life too to help protect our muscular and nervous system which is so important. It can be helpful to think about getting protein at every meal and to go with what you enjoy. You will find you stay fuller for longer too which can help with weight management which can be a problem in the menopause.

Magnesium is a micronutrient getting more coverage recently, particularly with regards to our musculoskeletal system, and is something that we can be lacking in our diet. Sprinkling some mixed seeds on our oat based breakfast can be a really tasty way to increase our intake alongside nuts and even dark chocolate.



Hopefully this has given you some food for thought! Time and again no matter what phase of life we are in, the message is the same. A healthy, well balanced diet will be one that contains all the important food groups. When thinking carbohydrates, think about the longer acting types more than the short acting sugary ones. When thinking of protein try to make that plant based at least 2 or 3 times a week. When focusing on fats, think about cutting back on saturated fats and increasing those good fats like seeds, nuts, plant oils and avocados. Try and cut back on processed foods and to eat the rainbow. With all of that in mind it is hard to go wrong!



Menopause is the end of menstruation and fertility in women, and marks the end of the reproductive phase of a woman’s life.

Menopause is defined as the point a year after a woman’s last period. The perimenopause is a descriptive term for the period leading up to the menopause and afterwards when a woman will experience symptoms relating to the change in hormones in particular oestrogen, progestogen and testosterone.

It is a natural biological process that typically occurs in women between the ages of 45 and 55, although the age can vary greatly. During this time, the levels of the hormones estrogen and progesterone, which regulate the menstrual cycle, decrease significantly, leading to the end of menstrual periods. Some of the common symptoms of menopause include hot flashes, night sweats, mood swings, vaginal dryness, and sleep disturbances. But there are many other symptoms that women experience that are unique to the individual, with some women finding their life severely impacted and others not having any symptoms at all. These symptoms can start many years before the menopause and last for many years after.

The EKHO survey showed that 42% of women considered leaving their job because of the menopause. Newson Health Research and Education found that 99% of women felt that the perimenopause had affected their work. One in five women had passed on the chance to go for a promotion they would have otherwise considered, 19% reduced their hours and 12% resigned. Brain fog, tiredness, poor memory and concentration are cited as reasons. This has a massive impact on the remaining work force and leaves women feeling disempowered, unhappy and isolated. The good news is, that there seems to be a movement towards realising that this is treatable and that women don’t need to suffer in silence. Finally it feels like the world is ready to think about menopause properly.

Does treatment increase my risk of breast cancer ?

The Million Women Study was a large-scale, population-based study of the health of women in the United Kingdom. The study was launched in 1996 and enrolled over a million women between the ages of 50 and 64 to examine the relationship between lifestyle factors, such as diet and physical activity, and the risk of developing various health conditions.

One of the key findings of the Million Women Study was the relationship between hormone replacement therapy (HRT) and breast cancer risk. The study concluded that women who used HRT were at an increased risk of developing breast cancer, compared to women who did not use HRT. This finding had a significant impact on the medical community and the general public, leading to a reduction in the use of HRT.

The Million Women Study was a large-scale, population-based study of the health of women in the United Kingdom. The study was launched in 1996 and enrolled over a million women between the ages of 50 and 64 to examine the relationship between lifestyle factors, such as diet and physical activity, and the risk of developing various health conditions.

One of the key findings of the Million Women Study was the relationship between hormone replacement therapy (HRT) and breast cancer risk. The study concluded that women who used HRT were at an increased risk of developing breast cancer, compared to women who did not use HRT. This finding had a significant impact on the medical community and the general public, leading to a reduction in the use of HRT.


What Investigations do I need?

The National Institute for Health and Care Excellence (NICE) provides guidance on the investigation and management of symptoms in perimenopausal women. According to the NICE guidance, the following investigations may be appropriate for perimenopausal women:

Blood Tests

Blood tests to measure hormone levels, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol, can help confirm the diagnosis of perimenopause which is important when symptoms start earlier than the age of 45.

Bone Density Scan

Bone density scan (DXA scan): A bone density scan can be used to assess bone health and determine the risk of osteoporosis, which is a common condition in perimenopausal women and will be particularly helpful if there is a family history.


Women who are over the age of 50 or have a family history of breast cancer should have a mammogram as part of their routine screening for breast cancer.Pelvic ultrasound

Pelvic ultrasound

A pelvic ultrasound can be used to rule out any pelvic problems, such as fibroids or endometrial thickening, that may be causing symptoms in perimenopausal women such as very heavy and / or irregular bleeding.

It is important to note that the need for investigations will vary depending on individual circumstances and symptoms, and not all women will require all of the above tests. In fact the general advice is that a woman over the age of 45 experiencing perimenopausal symptoms does not require any blood tests at all. The NICE guidance recommends that women seek the advice of a healthcare provider to determine the most appropriate investigation plan.

What do we know helps with symptoms?



Lifestyle Factors

There are several lifestyle factors that have been shown to help with the symptoms of menopause and even if you choose to take medication these are worth prioritising. What we know is that the menopause also brings with it an increased risk of cardiovascular disease, diabetes, cancers and bone thinning and therefore optimising our health at this stage (and earlier) will help not just manage perimenopausal symptoms but also prevent these other disorders.
The top factors are:


Regular physical activity, can help with hot flashes, sleep disturbances, weight gain and mood swings.There is a lot of evidence for the benefit of resistance training in particular for bone health, balance and mobility being helpful in preventing falls and cardio workouts being good for our cardiovascular system, helping with blood pressure control and decreasing our risk of heart attacks and strokes. The key here is consistency and finding something you enjoy. All these physical benefits are in addition to the psychological benefits that come from being physically active.

Smoking and alcohol cessation or reduction

Quitting smoking and stopping or reducing alcohol can help reduce the frequency and severity of hot flashes. This is as well as improving cardiovascular risks.

Healthy Diet

Consuming a balanced diet that includes a variety of fruits, vegetables, whole grains, and lean proteins can help improve overall health and well-being during menopause. Increasing our “good” fats and omega 3s through eating oily fish, olive oil, avocados and some nuts can also be helpful in reducing inflammation in our body and improving brain function.

Weight Management

Maintaining a healthy weight through diet and exercise can help with hot flashes and reduce the risk of other health conditions associated with menopause. Being overweight has a higher risk of causing breast cancer than HRT so it is worth getting some professional help if you are struggling to do it alone.

Stress Management

Practicing stress-reducing activities, such as meditation, deep breathing, or massage, can help with anxiety, irritability, and insomnia. They have also been shown to improve our immune system and reduce blood pressure.

Vitamin D and calcium supplementation:

Vitamin D and calcium supplementation can help maintain bone health, which is important during and after menopause.

It is important to note that not all women will benefit from the same lifestyle factors and some may need to try a combination of strategies to manage their symptoms. It is always a good idea to speak with a healthcare provider to determine the best approach for individual needs and circumstances.

Hormone Replacement Therapy

There are certain people who should always be offered HRT including those who develop perimenopausal symptoms and who have had hysterectomies and oophorectomies under the age of 50. For these women it has always been clear that the benefits far outweigh any risk. But research is finding more and more that for the average woman hitting menopause around the age of 51 that the benefits also outweigh the risks.


What are the benefits?

The big benefits we have by sustaining oestrogen delivery to our body are on our bone health, with HRT associated with a 30% significant reduction in vertebral and non vertebral fractures, and also our cardiac health. HRT has been shown on a meta analysis of RCTs if started below 60 years of age or within 10 years of onset of menopause to give a significant reduction (>30%) of MI or cardiac deaths.


The benefit on our cognitive functioning has been shown by the prevalence of Altzheimers being less on HRT and the use of oestrogen reduces the risk of AD by 5% annually. In fact, even just 12 weeks of Oestrogen has been shown to increase verbal memory in healthy postmenopausal women. Oestrogen is also a serotonin agonist and several RCTs have shown it to improve anxiety and depressive symptoms in up to 80% of post menopausal women.

How is it taken?

Historically HRT was given as a tablet. This was mostly due to the lower cost of tablet form HRT. What we know now is that HRT that is delivered through our skin has a lower risk of causing blood clots or deep vein thrombosis, something that can be increased with all hormones including the contraceptive pill and HRT. HRT is available as patches, gels and sprays and it can be trial and error ( and frustratingly, supply) that will help an individual women to choose what suits them best.


Why do I need a separate prescription for Progestogen too?

It is important whatever form of HRT you are taking that you have progestogen alongside oestrogen. For some women that will be in the patch, but if you are using a gel or spray you will need to take separate progestogen. This is because oestrogen without the progestogen increases the thickness of the lining of the womb and can increase the risk of uterine cancer. This progestogen can be delivered as a pill, a vaginal pessary or through an intrauterine device like the Mirena coil. Some women are sensitive to progestogen and cannot tolerate taking it orally, other women find the progestogen helps them sleep. Your health care provider will be able to help you make a choice that works for you.


What is the difference between cyclical and continuous HRT?

You may have heard that HRT can be taken cyclically or continuously, but what does this mean? Cyclical HRT involves taking oestrogen through the month but with a break in the progestogen component which stimulates a bleed. This is similar to the natural menstrual cycle and mimics the patterns of oestrogen and progesterone in a woman’s body. Cyclical HRT is typically used to relieve symptoms of perimenopause and reduce the risk of endometrial cancer. It is offered when a woman is under the age of 51 and for up to a year after the menopause.

Continuous HRT, on the other hand, involves taking HRT every day without any breaks. This method provides a consistent level of hormones and is typically used to treat symptoms of menopause and prevent osteoporosis in women over the age of 51 or in those who have not had a bleed for a year. Continuous HRT may also be used to relieve symptoms of endometriosis or other conditions that affect the uterus. A woman with a heavy bleed that is impacting on their life may choose to go to a continuous way of taking the HRT earlier.

The choice between cyclical and continuous HRT depends on individual needs and circumstances, as well as the type of symptoms being treated. Women should discuss the options with their healthcare provider to determine the best approach for their individual needs.

How long should I take HRT for?

This is a very individual choice and will depend on a number of factors such as symptoms and how impactful they are, family history of risks such as heart disease, dementia , osteoporosis and cancers, and convenience of taking HRT and any side effects.

The duration of menopausal symptoms varies from woman to woman and can last anywhere from a few months to several years. The length of time that menopausal symptoms persist is influenced by various factors, including age, lifestyle, and overall health.

In general, the most common symptoms of menopause, such as hot flashes and night sweats, tend to last for 2 to 5 years. Some women may experience these symptoms for a shorter period of time, while others may experience them for several years or more.


What is vaginal oestrogen used for?

Vaginal or topical oestrogen can be very helpful for symptoms relating to changes in the skin around the vulva, anus and vagina caused by the drop in oestrogen around the menopause. These changes can be associated with an increased risk of urinary tract infection alongside sexual discomfort and pain and itching from dryness.

Topical oestrogen can be used on its own or alongside HRT and can be life changing for some women. Topical oestrogen does not come with an increased risk of breast cancer and therefore can be used safely in the small percentage of women who can not use HRT due to their genetic risk for breast cancer.


What about Testosterone?

Testosterone is a hormone that is primarily produced by the testes in men and the ovaries in women. During menopause, levels of testosterone in women can decline, leading to a range of symptoms, including decreased libido, fatigue, and muscle weakness. In some cases, testosterone replacement therapy (TRT) may be used in combination with other forms of hormone replacement therapy (HRT) to alleviate symptoms of menopause. Testosterone therapy can help increase energy levels, improve mood, and enhance sexual function in women who are experiencing a testosterone deficiency.

It is important to note that testosterone therapy is not a standard treatment for menopause and is not recommended for all women. Women who are considering testosterone therapy should discuss their symptoms and treatment options with a healthcare provider. The provider will consider factors such as the woman’s medical history, symptoms, and overall health to determine whether testosterone therapy is appropriate and safe. If testosterone therapy is prescribed, the woman will need to undergo regular monitoring to assess its effectiveness and monitor for any adverse effects.

What about contraception in the perimenopause?

Women can often forget about contraception when they hit perimenopause with the assumption that this means they are infertile. But for a lot of women perimenopause symptoms can start long before fertility has stopped.

The UK National Institute for Health and Care Excellence (NICE) provides guidance on contraception in the perimenopause.

The following are some of the recommendations provided by NICE:

Continue to use contraception

Women who are in the perimenopause and are sexually active should continue to use contraception until they reach the menopause. This is because a woman can still become pregnant during the perimenopause.

Use barrier methods with caution

Barrier methods, such as condoms or diaphragms, are less effective in protecting against pregnancy during the perimenopause, as hormonal changes can lead to an increased risk of vaginal dryness and irritation. But absolutely do continue to use barrier methods to protect against sexually transmitted infections.

Consider a long-acting contraceptive method

NICE recommends that women in the perimenopause consider using a long-acting contraceptive method, such as a hormonal implant or intrauterine device (IUD), to provide ongoing protection against pregnancy.

Hormonal methods

Hormonal contraceptives, such as the pill or the patch, can be used in the perimenopause, but women should be aware that hormonal changes can affect the effectiveness of these methods.

Assess Fertility

Women in the perimenopause can have their fertility assessed. This can be done through a blood test called FSH.

Combined Contraceptive pills

Combined Contraceptive pills should be stopped at the age of 50 and replaced with progestogen only contraception.

All Contraception

All contraception can be stopped at the age of 55 or if a woman has not had a period for 12 consecutive months over the age of 45 and is therefore considered to have reached menopause.

It is important for women in the perimenopause to have open and honest discussions with their healthcare provider about their contraceptive needs and to choose a method that is right for them. Regular follow-up and monitoring are also important to ensure that the chosen method remains effective and to address any side effects or concerns.

What about work and menopause?

As mentioned above, the EKHO survey found that 42% of women consider leaving their job because of symptoms relating to the menopause.

The workplace can play an important role in supporting women who are going through menopause. Here are some steps that a workplace can take to support women during this time:

Raise Awareness

Encourage open and honest discussion about menopause and the challenges that women may face. This can help to break down stigma and create a more supportive and understanding environment.

Accommodate physical needs

Ensure that the workplace has appropriate facilities, such as private rooms or cooling areas, for women to manage physical symptoms such as hot flashes.

Offer flexible working arrangements

Consider allowing women to work flexible hours or work from home if needed to accommodate physical or emotional symptoms related to menopause.

Encourage physical activity

Promote healthy habits and encourage physical activity, such as exercise or yoga, as a way to manage symptoms of menopause. Some companies provide this in house or online for all staff members.

Provide access to resources

Offer resources such as informational materials, workshops, or counseling services to help women learn about menopause and manage symptoms.

Provide support for stress management:

Offer support for stress management, such as mindfulness programs or counseling services, to help women cope with the emotional symptoms of menopause.

It is important for the workplace to take a supportive and proactive approach to menopause, as this can help to create a more inclusive and supportive environment for women during this time. Additionally, supporting women during menopause can help to increase productivity and reduce absenteeism, leading to positive outcomes for both the woman and the workplace.



Endometriosis is a chronic condition that affects the tissue lining the uterus (the endometrium). In endometriosis, this tissue grows outside of the uterus and can attach to the ovaries, fallopian tubes, and other organs in the pelvis.

Symptoms of endometriosis can include severe pain during menstrual periods, pain during sex, and difficulty getting pregnant. The exact cause of endometriosis is unknown, but it is thought to be related to a combination of hormonal and genetic factors.

Treatment of endometriosis typically involves medications to manage pain and hormones to reduce the growth of endometrial tissue. In some cases, surgery may be necessary to remove the endometrial tissue that has grown outside of the uterus.

It is important for women with endometriosis to work with their healthcare provider to manage their symptoms and maintain their overall health. This may include regular check-ups, maintaining a healthy lifestyle, and seeking support from friends, family, and support groups.

Endometriosis is often missed and is worth considering if you find you are having a lot of pain with your periods.

Polycystic ovarian syndrome (PCOS)

Polycystic ovarian syndrome (PCOS)

Polycystic ovarian syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age. It is characterized by a hormonal imbalance, which can cause a range of symptoms including irregular menstrual periods, excess hair growth, and difficulty getting pregnant.

PCOS is caused by a combination of genetic and environmental factors. It is often associated with insulin resistance, which can lead to high levels of androgens (male hormones) in the body. These high levels of androgens can lead to the development of cysts on the ovaries, which are small fluid-filled sacs that can cause irregular menstrual periods.
Treatment of PCOS typically involves a combination of medications and lifestyle changes. This may include oral contraceptives to regulate menstrual periods, metformin to manage insulin resistance, and weight loss to improve hormonal balance. In some cases, surgery may be necessary to remove the cysts on the ovaries.
It is important for women with PCOS to work with their healthcare provider to manage their symptoms and maintain their overall health. This may include regular check-ups, maintaining a healthy diet and exercise routine, and seeking support from friends, family, and support groups.

Bacterial Vaginosis

Bacterial Vaginosis

Bacterial vaginosis or BV is the commonest infection of the vagina and it is caused by an increase in gardnerella bacteria and a decrease in lactobacillus bacteria. This change in balance is associated with a change in the pH of the vagina to be more alkaline. It is not a sexually transmitted infection (STI) but is more common in sexually active women. It can cause a discharge that is often watery, grey or green and smells a little fishy. Sometimes it causes no symptoms at all. It doesn’t normally cause pain or itching but if untreated can cause irritation in the vaginal area. Sometimes for this reason it can be misdiagnosed as a urinary tract infection.

Why does it matter?

Having BV can often make women feel embarrassed. The smell can be more noticeable after sex but often more to the women herself than her partner. Women can pass it to female partners during sex and although it is not a STI it can make a woman more susceptible to catching STIs in particular Chlamydia. Having BV when she is pregnant increases a woman’s chance of miscarriage so it is important if you have a change in discharge during pregnancy that you get it checked out. You will be more prone to get this if you have an intrauterine device like a Mirena coil and untreated the infection can lead to a pelvic infection which can be serious.


How do we treat it?

The first thing is to recognise the symptoms and attend your GP, practice nurse, midwife if pregnant or gynaecologist (if you have one). They will take a swab and sometimes will use some litmus paper to check the pH of the vagina. They will prescribe either a gel or an oral antibiotic. Unfortunately BV can come back and be recurrent which can be frustrating and upsetting.


How do we prevent it?

Anything that changes the pH of the vagina will make this infection more common so it is important to avoid scented soaps, creams or sprays around the vagina. Avoid excessive washing and use a shower rather than a bath. Similar to thrush, BV is more likely to thrive when a woman wears tights or tight fitting trousers or if the area is wet, so it is a good idea to wear cotton underwear and ensure the area is dried properly after showering. Some lubricants can cause BV so again look for unscented and try changing the brand. Sometimes changing to a latex free condom can help. Faecal matter from the anal area can also cause infection in the vagina so it is important to always wipe from front to back after going to the toilet. It can be helpful to pass urine after sex to clean the area. Regularly changing tampons and pads is also good practice and will help keep your vagina healthy.

Sexually Transmitted Infections

Sexually Transmitted Infections

Any infection that is spread from one partner to another during sex will be termed a STI and the big message here is that they are very common and it doesn’t mean that someone has been promiscuous if they have one. Some STIs have no symptoms, especially in men, and they will often be completely unaware that they have passed on an infection. Women again can have no symptoms and it may be discovered when having tests for fertility issues or during pregnancy or when having urinary symptoms. So let’s lose the shame and guilt please on this topic and focus on being aware and getting appropriate help when we need it.

Why does it matter?

The problem with STIs is that there are some that can be causing damage without us being aware. Chlamydia which we will look at more closely below, if untreated can affect fertility. Syphilis and HIV again covered below both have long term health repercussions and most of them can cause problems in pregnancy or can be passed on to the baby during delivery.
So let’s talk about the most common STIs…


Chlamydia is the most common STI in the UK with women aged 20 to 24 most likely to be infected. It can be spread by vaginal, oral or anal fluid and can present with a vaginal discharge, pain after sex, discomfort in the lower abdomen or irregular bleeding, but for the majority of women will be symptom free. Left untreated chlamydia can damage a woman’s fallopian tubes leaving them susceptible to ectopic pregnancies and infertility. You can prevent Chlamydia by using condoms or dental dams every time you have sex. Having a regular sexual health screen if you are sexually active is also good practice to detect any STI early and prevent spread. Chlamydia is easily treated by a course of antibiotics which your own GP, Genito Urinary Medicine (GUM) clinic, or iCASH services can issue.

Genital Herpes

Genital Herpes is caused by the Herpes Simplex Virus and it is thought that around 23% of adults in the UK carry the virus that causes it. The virus is similar to the one that causes coldsores and can lie dormant for long periods of time and then present with sores around the genital and anal area. There is often accompanying pain and there can be an odd tingling sensation before the characteristic rash of small fluid filled spots appears. Many women are unaware they carry the virus which isn’t always picked up on STI testing if the spots aren’t present. Once again the best way to protect yourself is to use condoms and if you have any pain or spots on your genital area then it is worth getting tested. There is no way to clear your system of the virus but you can have medication on hand to use for outbreaks with some women using it rarely and others daily depending on how frequently you have outbreaks.


Gonorrhoea is another bacterial STI which is spread through sexual contact. 50% of women and 10% of men will have no symptoms but it can present with a discharge similar to BV, pain after sex or irregular or heavy bleeding. It can be prevented by using condoms and can be detected on swabs and treated by antibiotics.


Syphilis is again caused by a bacterial infection spread by sexual contact. It has seen a huge increase in diagnosis over the last 10 years mostly in young men. It will present with a painless sore in the genital area that will last for about 6 weeks. It is diagnosed by a blood test and treated with antibiotics. It is important to treat early as it can present years later with serious health problems.


HIV infection has also increased in the last 10 years. It is spread by sexual contact or blood contact and again it is thought that a large number of people are unaware that they are carrying the virus. It will present with viral symptoms and affect the immune system. It will be diagnosed by a blood test and there are now very effective medications that can treat the virus and stop it damaging the body.

How do we prevent these infections?

Using protection in the form of a condom is the best way to prevent a STI but sometimes we know that can go wrong. Condoms break or come off. Getting tested regularly is another good way to protect yourself.

There are lots of online options to self swab which will detect most of the common STIs but if you think you might have been in contact with Syphilis or HIV, or if you have an open sore that could be herpes or a wart then you need to attend a clinic to be tested. This could be your own GP or local GUM clinic or there are a number of private clinics that will also offer testing. As discussed these infections are common and not something to be embarrassed about. All of them are best caught early and treated.

Ovarian Cancer

Ovarian Cancer

Ovarian cancer is the 6th commonest cancer in women. The risk increases as we age. With the commonest age to be diagnosed being between 75 and 79 years.

The symptoms to watch for are a feeling of fullness and bloating, lower abdominal pain, and needing to pass urine more frequently. A lot of these symptoms are nonspecific so it is worth knowing what is normal for you and noticing if something changes. In particular over the age of 50.

If you have symptoms then you will often be given a blood test and an ultrasound scan to help make the diagnosis. If these are positive then you will normally then be referred to a specialist for further scans and biopsy.

Outcomes are better when ovarian cancer is picked up earlier so don’t put off seeing a doctor if you are worried.

5 to 15% of ovarian cancer is caused by an inherited faulty gene such as BRCA1 and BRCA2.

So what can we do to reduce our risks?

Be self aware

Notice when things change and seek help from a doctor.


Weight Management

Think about weight management. Having excess body fat has been linked to an increase in risk. Seek out help as once weight is increased it is hard to lose.


Stop Smoking

Smoking causes an increase risk not just for this cancer but many cancers. Seek out help as this is an addiction and is never easy to stop.


Understand the impact of hormones.

The combined contraceptive pill is seen as reducing our risk of ovarian cancer, as is having children and breast feeding. However there is a small increased risk with taking HRT after the age of 50 which is worth considering in the benefits and risks debate around HRT.

Cervical Cancer

Those in their 30s are most likely to be diagnosed with cervical cancer compared to other age groups. 9 women a day in the UK are diagnosed. It’s main cause is infection with Human Papilloma Virus (HPV) which is a common virus but thankfully is on the decline because of the vaccine that young girls are getting in school.
The symptoms that we need to watch out for are irregular bleeding or discharge, pain during or after sex and pelvic pain. But often there are no symptoms and the best way we can protect ourselves is by attending screening.

The screening service has changed in recent years with a move towards checking for HPV infection first and then looking at the cells on the smear test if a woman is HPV positive. If you are found to be HPV positive you will be recalled in a year. If you are negative the screening interval has increased to 5 years. This never takes away from your ability to be checked out if you are symptomatic and should mean that those of us who are at higher risk of cervical cancer because of our HPV status are seen more frequently.

If you are found to have abnormal cells on your smear you will be referred for colposcopy. This is when the specialist will have a closer look at your cervix and determine what treatment you need. The commonest treatment is a LLETZ (Large loop excision of the transformation zone) procedure which will be done at colposcopy and will take away the abnormal cells.

The outcomes from this procedure are very good with 95% of women having their cancer successfully treated.

As with every cancer the earlier it is diagnosed the better so make sure you attend your screening when called and check in with your doctor if you are symptomatic.

Uterine Cancer

Uterine cancer is the 4th commonest cancer in women in the UK with the highest incidence in women aged 75 to 79 years. Uterine cancer has been linked to higher deprivation and has the highest incidence in women in the Black ethnic group.
The main symptom to look out for is unusual bleeding. This might be post menopausal, it may be between periods or it may be in the form of an unusual bleed or discharge. There are lots of other reasons why women have unusual bleeding and 90% of uterine cancers are picked up early.

75% of uterine cancers occur in 40 to 75 year old women and the main risk factor that we can try to improve is our body weight. High body weight is associated with an increased risk which is thought to relate to higher levels of circulating oestrogen.

Other things that increase our oestrogen levels can also increase our risk. This means having caution with the use of HRT and why the oestrogen in HRT for most women needs to be given with progestogen which will help avoid the uterine lining becoming too thick. Women with diabetes and PCOS are also at a slightly higher risk again because of hormone imbalances. The combined contraceptive pill is seen as being protective as is having children.

Like a number of other cancers it is thought that being active and eating healthily reduces our risk although there is no scientific evidence for this, it may well help if it reduces our body fat and circulating oestrogen.

Having a family history increases our risk of uterine cancer with Lynch syndrome forming a small group of women who have a genetic tendency towards several different types of cancer including uterine and bowel cancers.

If you have symptoms then it is important you speak to a doctor. They will normally send you for an ultrasound scan to look at the thickness of the lining of the womb before referring you to a specialist to look more closely, which is called a hysteroscopy. Like all cancers the earlier they are detected the better. Uterine cancer has a great prognosis in the early stages with over 90% of women being treated successfully.

Breast Cancer

Breast Cancer

Breast cancer is the Big One that worries us as females. It’s the commonest newly diagnosed cancer in the UK representing a third of all cancers diagnosed in females. It is also the most commonly diagnosed cancer worldwide.

18% of breast cancers occur in women under the age of 50 (labelled as pre menopausal) and 82% in women over the age of 50 (post menopausal). The incidence has increased by 24% over the last 23 years and the rate has doubled in the last 50 years.

Incidence is rare in men but it does occur and that rate has remained stable in the last 20 years.

In the UK in women born after 1960 the lifetime risk of developing breast cancer is estimated at 1 in 7. In men the lifetime risk is 1 in 870.

The good news is that 86% of these cancers are being diagnosed early before they have spread and when they can be more easily treated. The survival rates for breast cancer are nearly the best of all cancers with only prostate cancer having better outcomes. Over 80% of women diagnosed are expected to survive at least 10 years. Mortality rates have dropped since the mid 1980s with 48% of breast cancer deaths occurring in women over the age of 75, and these numbers are expected to continue to improve.

It is still the 2nd commonest cause of death in women of any age and the 1st commonest cause of death in women aged 35 to 49 years of age.

15 to 20% of those with breast cancer will have a family history of breast cancer with the BRCA 1 and BRCA2 genes accounting for 4 to 6% of breast cancers in women and 11 to 12% in men.

So what can we do to reduce our risks?

Know your risks

There are certain things that we cannot change. Being a female and aging being two of these factors. Both of these increase our risk of developing breast cancer. Having a family history puts us at higher risk particularly if we have a first degree female relative who is under the age of 50 when they developed breast cancer. If we have our children over the age of 30 or don’t have children we are at higher risk. If we started our periods early (before 12) and start menopause late (after 55) we are at higher risk.


Be breast aware

Picking up breast cancer early is important when it comes to treatment options. Get familiar with how your breast tissue feels and how it changes with your cycle. Get anything unusual checked out with your doctor. That might be skin changes, lumps, pain or nipple discharge. Anything that is occurring in one breast in particular is worth noticing.


Attend screening when invited

The current screening programme in the UK is for women every 3 years between the ages of 50 and 71. This is in the form of a mammogram. Screening can be very anxiety provoking for some of us, but it is important to remind yourself that it is one of the ways we can keep ourselves well. There is support available if this is causing you concern.

Lifestyle changes

There are certain things we can do that will help reduce our risk of breast cancer. These are things that keep us healthy and protect us from other diseases too. Being active is one of the best things we can do to protect ourselves. We have a 14% lower risk of developing breast cancer if we are active. For every 2 hours a week a woman spends doing moderate to vigorous activity, the risk of breast cancer falls by 5%. It will also help us manage our weight which will also reduce our risk. Reducing alcohol intake also reduces our risk as every unit a week is associated with an increase in risk. No one diet has been found to be protective or harmful but eating a Mediterranean diet with whole foods, balance between all the food groups and rich in nutrients is good for us generally.




Most breast lumps scanned and examined are benign but that doesn’t take away the anxiety they come with. Be kind to yourself, take a friend or family member with you to appointments if you can or arrange a meet up afterwards. Don’t put off seeing your doctor if you are worried.

How to perform pelvic floor exercises

How to perform pelvic floor exercises

What is a pelvic floor and what does it do?

The pelvic floor is the area underneath the pelvis that is composed of layers of muscles and other tissue. These muscles are critical to daily functions and support the organs such as bladder and bowel (and uterus in women). The pelvic floor muscles are very important in controlling the release of urine, faeces, and flatus. When these muscles are weak and do not function properly, the bladder and bowel will lack full support. This may lead to bladder and bowel dysfunction.


What are the signs of weak pelvic floor muscles?

The common symptoms of a weak pelvic floor muscles are:

  • urinary incontinence,
  • unable to reach a toilet in time,
  • vaginal or anus flatulence when bending over,
  • vaginal numbness or decreased sensation,
  • tampons that dislodge or fall out,
  • reoccurring urinary tract infections, or thrush

The main symptoms of a pelvic floor dysfunction is loss of bladder control, and anal incontinence.


What causes a weak pelvic floor?

The pelvic floor muscles can be weakened by traumatic injuries to the pelvic area, pregnancy, childbirth, pelvic surgery, being overweight, advancing age, as well as chronic constipation.


How to strengthen the pelvic floor?

Pelvic floor exercises are designed to strengthen the muscles around bladder, bottom, and vagina. Training these muscles can help urinary incontinence, and may prevent the need for corrective surgery. These muscles can be activated anytime, and anywhere. However, for the best results, try incorporating specific exercises that are outlined below:

Finding the pelvic floor muscles

A good starting point with the pelvic floor muscles is to lie down, resting comfortably, or to sit in a supported position. Now, imagine you are squeezing your muscles to stop the flow of urine and the passing of wind. Focus on drawing these muscles inwardly tightly. This gives you an idea of the location and function of the pelvic floor muscles.


You can also quickly identify the pelvic floor muscles by trying to stop the flow of urine while emptying your bladder. If you can do it for a second or two, you are using the correct muscles.


(Do not do this repeatedly, or more than once a week. It can cause problems with emptying your bladder completely. It’s purely for identifying the muscles you’ll need to exercise.)

Kegel exercises

  1. Lie flat on your back with your knees bent. You can also perform this exercise sitting or standing.
  2. Breathe out gently, draw in your lower abdominal muscles, contract the muscles around the vagina for about 2-3 seconds and release.
  3. Maintain steady breathing throughout.
  4. Repeat the exercise 10 times, then rest for 10 seconds. Aim to do 2–3 sets.


  1. Lie flat on your back with your knees bent.
  2. Draw your pelvic floor up and lock in your core.
  3. Slowly lift one leg up to a tabletop position.
  4. Make sure you stay connected to your deep core.
  5. Slowly lower this leg to the starting position.
  6. Repeat the movement 10 times and alternate legs.

Heel slides

  1. Lie flat on your back with your knees bent.
  2. Draw your pelvic floor up, lock in your core, and slowly begin to slide your heel away from you.
  3. Make sure you stay connected to your deep core.
  4. Find the bottom position, hold it for about 5 seconds, and bring your heel back to starting position.
  5. Do 10 slides on each side and alternate legs.

Happy Baby Pose

  1. Lie flat on your back with your knees bent.
  2. Bring your knees toward your chest, keeping them at a 90-degree angle, with the soles of your feet facing up.
  3. Grab and hold the outside or inside of your feet.
  4. Spread your knees apart gently. Then, bring your feet up toward your armpits. Make sure your ankles are over your knees.
  5. Flex your heels and push your feet into your hands.
  6. Stay in this position for several breaths or gently rock from side to side.


Pelvic floor muscles are very important in assisting with essential bodily functions. Kegels, marches, heel slides, and happy baby pose are exercises that help strengthen these muscles.