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Health Screening (Back to top)
Mr Braithwaite recommends that women have an annual check-up to prevent them developing illnesses such as cervical cancer or ovarian cancer. An annual check-up will typically consist of:
- A consultation during which you would discuss your medical history and any worries or concerns.
- A blood pressure check.
- A cervical smear test to check for cervical cancer. He recommends this is done each year.
- A transvaginal scan. This scan is painless and is very important as it allows him to see the fallopian tubes, ovaries and uterus. He is able to check that everything appears normal and to check for ovarian cysts and ovarian cancer, polyps and endometriosis. Mr Braithwaite is one of the few gynaecologists to do this. Often you would need to make an appointment to see a consultant Radiologist to do this scan.
- It can also include other tests such as swabs and blood tests. This could be to check for sexually transmitted diseases, a cancer marker test (CA125), cholesterol, haemoglobin, hormone levels, liver function and thyroid profile, amongst others. These can be done during the consultation if you wish.
- We can also take a urine test and check for chlamydia, thrush and other sexually transmitted diseases if needed.
Costs
- Consultation
- £ 150
- Transvaginal Scan
- £ 150
- Smear Test
- £ 68
- TOTAL
- £ 368
Many patients wish to discuss their contraception and check that they are using the best method for them. Mr Braithwaite can advise on this and prescribe the chosen method. He is a great supporter of the Mirena coil and can insert one of these during the check-up if this is deemed to be the best way forward.
Mr Braithwaite recommends that all women over the age of 40 have a mammogram every 18 months. Women aged between 30 and 40 should consider having a breast ultrasound scan, particularly if they have a family history of breast cancer, in which case screening should take place annually. We follow the advice of Dr Nick Perry, who runs the Breast Institute at the Princess Grace Hospital, where we arrange for our patients to have a breast ultrasound scan or mammogram. Mr Braithwaite considers this to be an essential part of a check-up for a woman.
Cervical Cancer (Back to top)
Cervical cancer is described as one of the silent cancers as it is very difficult to diagnose. Cervical cancer kills about 1 in 120 women every year in Britain. The well-established method of preventing this disease is through effective screening. Mr Braithwaite recommends that all women have a smear test once each year to check for cervical cancer. A smear test is very effective as it shows any sign of development of cervical cancer many years before it becomes a risk. If a smear test result shows any significant changes, Mr Braithwaite may recommend a colposcopy.
Colposcopy
Colposcopy is the name of the procedure that allows Mr Braithwaite to have a closer look at the cervix. This is not a painful procedure but it does require you to place your legs in the old-fashioned stirrups. This really is the worst aspect of this procedure. Mr Braithwaite will take a biopsy from the cervix that can be sent for analysis.
Mr Braithwaite’s practice is a BUPA-recognised Colposcopy Centre. This means he can offer this service very easily in our clinic environment.
If Mr Braithwaite decides that treatment is necessary then he will arrange for you to have a LLETZ (Large Loop Excision of the Transformation Zone) procedure at the Portland Hospital. Again this is a very simple procedure which is done as a day case. This all sounds rather daunting but following this advice ensures that you will not develop cervical cancer.
Vaccine to prevent cervical cancer (Cervarix)
A vaccine has been made available to help protect women against cervical cancer. It is called the Cervarix vaccine (Gardasil is a very similar vaccine but is developed by a different company) and is licensed for use across Europe. The vaccine is being offered by the NHS to all teenage girls in the UK. This is a very good idea and we will hopefully see a significant decline in the development of cervical cancer as a result of this policy.
Mr Braithwaite can administer this vaccine and it is given as 3 injections over a 6 month period.
About 90% of sexually active women can expect to have a human papillomavirus (HPV) infection at some point in their lives. HPV can cause changes to occur to a woman’s cervix, which if left untreated, can develop into cervical cancer. It is important to emphasise that the vast majority of HPV cases do not develop into cervical cancer.
Women can protect themselves against HPV by avoiding unprotected sex and avoiding smoking. Women are advised to have annual smear tests.
The vaccine protects against cervical cancer caused by 4 strains of HPV. These are strains 6, 11, 16 and 18. If a woman has been exposed to any of these strains prior to having the vaccine, there will be no protection against that strain. However it will still be effective against the other strains. In trials there were no patients who had been exposed to all 4 strains i.e. it is very rare for someone not to benefit from the vaccine. It also protects against genital warts.
Fertility (Back to top)
Mr Braithwaite offers a number of services to assist couples that are finding it difficult to get pregnant. On average he would expect 75% of all couples trying to conceive to achieve this within a year. Any delay is often frustrating, particularly for people who are trying for a baby in their late 30s and are worried about their clock ticking away.
The first step is to have a check-up to ensure everything looks healthy. Mr Braithwaite can do this by performing a transvaginal scan of the uterus, ovaries and fallopian tubes. Assuming all is well then Mr Braithwaite will advise on ovulation
and the best time to have sex.
and the best time to have sex.
A relatively new test that can be helpful is the anti-mullerian hormone, which is a blood test that measures a woman’s fertility. Find out more about anti-mullerian hormone below. This can be helpful if you are planning to leave having a baby for a couple of years and need to know that this is not going to jeopardise your chances of getting pregnant in the long term.
If you want to get pregnant now, and have been trying unsuccessfully for some time, the next step is known as ‘follicle tracking’. This is really very impressive and reassuring. Mr Braithwaite will do a transvaginal scan between days 10 and 13 of your cycle. This allows him to see the egg that you are due to pop during this cycle. He can also measure the lining of the uterus. With this information he can work out exactly when you are going to ovulate and advise you accordingly.
You may wish to arrange for your partner to have a sperm analysis to ensure everything is healthy from his side. We can organise this at the Andrology Solutions Centre, with whom we have a very close working relationship. They are fully
accredited by the HFEA, which is crucial in the area of fertility. Mr Braithwaite also offers artificial insemination to aid fertility, which we can also organise for you at the Andrology Solutions Centre. Mr Braithwaite will perform the procedure for you at the Centre. Rest assured this procedure is very straightforward, quick, and not at all painful.
accredited by the HFEA, which is crucial in the area of fertility. Mr Braithwaite also offers artificial insemination to aid fertility, which we can also organise for you at the Andrology Solutions Centre. Mr Braithwaite will perform the procedure for you at the Centre. Rest assured this procedure is very straightforward, quick, and not at all painful.
Finally, if there are reasons to pursue IVF as an option then Mr Braithwaite can provide advice and guidance on how to approach this and which clinics to consider.
Anti-Mullerian Hormone Test (AMH)
Mr Braithwaite is able to offer a fertility test that allows a woman in her 30s or 40s to predict her fertility levels. You may have read articles in the press describing this as the ‘Plan Ahead’ test. The test can count the number of eggs in a woman’s ovaries and compare this with others of the same age, thereby predicting the ovarian reserve for the next two years.
The result may help women decide whether, or how long, they can delay trying to conceive and is helpful for the increasing number of women delaying motherhood as they pursue their careers. Fertility starts to decline after 35 so this test can provide early warning of the onset of the menopause. The test is marketed as the most accurate hormone-based ovarian test publicly available, enabling women to make informed decisions about whether to start trying for a baby sooner or later.
It is important to remember that there are often other factors affecting fertility such as male fertility, endometriosis and blocked tubes, but the AMH test does give a good indication of one of the key factors.
There are of course other options available to women who want to enhance fertility and improve their chances of pregnancy. Follicle Tracking can accurately predict when an egg “pops” from an ovary so that artificial insemination can be performed.
Menopause (Back to top)
Menopause is the permanent end of periods and is only diagnosed with certainty when a woman has not had a period for 12 months. The average age of the menopause in the UK is 51 years although for some it is earlier and for others, later. A variety of changes may be evident in the run up to the menopause. For example, your periods may become irregular and you may develop drier skin, headaches, hot flushes or sweats, vaginal dryness or soreness, changes in the way the bladder works, sleep disturbance and memory issues. Most women cope well with the physical and psychological changes of the menopause but for some the impact is profound.
Period Problems (Back to top)
In the UK the average age for a girl to have her first period is 13 years. The majority of women will bleed for approximately 5 days every 28 days. Periods may start early (precocious puberty), may not start (primary amenorrhoea), may stop for
no reason (secondary amenorrhoea), may occur too often (polymenorrhoea), may be associated with too much bleeding (menorrhagia) or may be very irregular.
no reason (secondary amenorrhoea), may occur too often (polymenorrhoea), may be associated with too much bleeding (menorrhagia) or may be very irregular.
There are many reasons why problems could occur including lifestyle issues (stress and weight change), other illnesses (thyroid and kidney problems for example) as well as gynaecological problems (fibroids or ovarian cysts). The investigation
of period problems often includes a careful examination, pelvic ultrasound and blood tests.
of period problems often includes a careful examination, pelvic ultrasound and blood tests.
Painful Periods
The medical term for painful periods is ‘dysmenorrhoea’. Period pain, experienced just prior to and during menstruation, can be extremely uncomfortable and frustrating as it can affect your confidence to live your life as normal. Pain starts in the uterus but can spread to the lower back and legs. Painful periods are more common in teenage women and women in their 40′s. If period pain is severe in a woman in her 30′s there is often another issue that needs exploring. Common causes of painful periods in a woman aged 30+ are fibroids, endometriosis and pelvic inflammatory disease. These issues are likely to cause discomfort a few days before a period and the start of true period pain.
The most effective treatment for period pain is the use of good pain control. Mr Braithwaite would recommend that you use a combination of Paracetamol and heat treatment to control the pain before and during menstruation. A hot water bottle is not just an old wives tale but is a very useful way of managing pain. You can also buy products now that emulate this effect in a more practical way, such as heat patches from companies like Nurofen and Cura-Heat.
If you are worried that your period pain is related to an underlying condition then this needs to be explored. You will need to have a transvaginal scan to review your uterus and ovaries. Mr Braithwaite does one of these scans during your annual check-up so rest assured it is a routine and painless procedure. If the scan reveals an underlying issue such as fibroids, endometriosis or pelvic inflammatory disease, Mr Braithwaite can discuss effective treatment with you.
Pelvic Inflammatory Disease is treated with a course of antibiotics. The hormone coil is very effective at managing small to medium sized fibroids and endometriosis. Mr Braithwaite recommends the Mirena Coil and many of you will have heard him singing its praises. It is very effective at reducing your periods almost to the point of non-existence, as well as being a very good contraceptive.
If you would like to discuss any of these issues or just need some reassurance then please contact us with your concerns.
Heavy Periods
More than 1 in 5 women suffer from heavy periods. When your periods start to impact on how you feel or function, it may be time to consider whether you require treatment. Heavy periods may be because of a hormone imbalance, infection, fibroids, polyps, other illnesses or medication. Investigation of heavy periods usually involves an examination, blood tests and a pelvic ultrasound scan. Heavy periods may be treated by a variety of medications. The Mirena coil has had great success in this area.
Pelvic Pain (Back to top)
It is not uncommon to have discomfort in the pelvis at various stages of the menstrual cycle. Ovulation (release of the egg) may be associated with discomfort usually to one side or the other and may last a day or two. Some women have central
low discomfort immediately prior to or at the start of their period. This discomfort often resolves with simple pain killers and does not necessarily require any investigations. More severe pain may be as a result of gynaecological problems such as infection, ovarian cysts, endometriosis, adhesions, fibroids, bladder irritation or polyps and do require investigation. Following a detailed history and examination you will usually have a swab taken to rule out infection, a urine sample checked and a pelvic ultrasound. Rarely exploratory surgery (laparoscopy/ hysteroscopy) will be required. Treatment will be aimed at managing the cause.
low discomfort immediately prior to or at the start of their period. This discomfort often resolves with simple pain killers and does not necessarily require any investigations. More severe pain may be as a result of gynaecological problems such as infection, ovarian cysts, endometriosis, adhesions, fibroids, bladder irritation or polyps and do require investigation. Following a detailed history and examination you will usually have a swab taken to rule out infection, a urine sample checked and a pelvic ultrasound. Rarely exploratory surgery (laparoscopy/ hysteroscopy) will be required. Treatment will be aimed at managing the cause.
Ovarian Cysts
A cyst is a fluid-filled sac. It is entirely normal to find cysts on the ovary and most are as a result of a normal functioning ovary. Immediately before an egg is released it will be contained within a cyst measuring up to 2.5cms in
diameter. Again just before a period a cyst will usually be found on the ovary as it is this cyst that will produce hormones to support an early pregnancy should this occur. These ‘functional cysts’ are not of any concern.
diameter. Again just before a period a cyst will usually be found on the ovary as it is this cyst that will produce hormones to support an early pregnancy should this occur. These ‘functional cysts’ are not of any concern.
Occasionally these cysts will grow a little too big and may cause symptoms (pelvic pain or pain during intercourse). They often disappear without treatment, although if the symptoms are severe the cysts can be removed. Other types of cyst may develop on the ovaries which are not part of the normal functioning of the ovary. Such cysts include endometriomas, cystadenomas and dermoid cysts. Cysts may cause pressure or a sense of fullness in the tummy, pain, difficulty passing urine or irregular bleeding. A cyst may be evident on examination but will definitely be visible via pelvic ultrasound.
Fibroids
Fibroids are known as ‘leiomas’ and are benign (non-cancerous) growths in the muscle and connective tissue of the womb. They affect approximately 1 in 4 women. Whilst many women do not know they have them, fibroids can sometimes cause troublesome symptoms. They can cause heavy and painful periods, anaemia, pressure on the bladder or bowels, a sensation of a lump in the tummy or problems with pregnancy.
Whilst it may not be necessary to treat fibroids if they do not cause any problems, some women do require treatment. The type of treatment chosen will depend on the individual symptoms.
Polycystic Ovarian Syndrome (PCOS)
Approximately 1 in 5 women have polycystic ovaries. This is where the ovary is larger than usual and has at least 10 uniform small cysts around the edge (viewed on ultrasound). PCOS is a condition where the balance of hormones is affected causing problems such as greasy skin, acne, problematic hair growth in abnormal places (especially the face), hair loss on the scalp, irregular periods, problems with weight and problems in pregnancy. There may be longer term health concerns.
PCOS can be diagnosed on the basis of the symptoms together with a transvaginal scan or by blood test. The treatment options for PCOS depend on the individual’s specific symptoms.
Ovarian Cancer (Back to top)
Ovarian Cancer is the fourth most common cancer in British women and early detection is the key to successful treatment.
Approximately 7,000 cases of ovarian cancer are diagnosed each year in the UK. From those cases only 30% of women diagnosed survive beyond five years, compared to 70% for breast cancer. However, if the tumour is diagnosed early, treatment is much more successful. Diagnosis is often difficult as the wide-ranging symptoms of ovarian cancer can be similar to common ailments.
Detection is possible with a simple blood test known as the CA125 test. CA125 is a protein often found on the surface of ovarian cancer cells and in some normal tissues. This test can promptly mark out the ovarian cancer cells which otherwise cannot be readily detected in the early stages of development and Mr Braithwaite recommends this test to women over the age of 40.
Obstetrics (Back to top)
Jeffrey Braithwaite is one of the busiest Obstetricians working at the Portland Hospital. He delivers approximately 100 babies each year. His reputation has grown by word of mouth from one patient to another. His motto is ‘Healthy mother, healthy baby’.
Early pregnancy scan - In the 6th or 7th week of pregnancy it is possible to do a transvaginal scan to check that the pregnancy is progressing normally. Mr Braithwaite is able to perform these scans at 46 Wimpole Street. Please contact us on 020 7224 5292 or via email if you would like to book an appointment.
Obstetric Scanning
Mr Braithwaite recommends that his obstetric patients have 4 major scans during their pregnancy. These are the Nuchal scan at 12 weeks, the anomaly scan at 20 weeks and growth scans at 31 and 36 weeks.