Reproductive and gynaecological health 2018

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Reproductive and Gynaecological Health

Izzy and McFly drummer Harry Judd discuss their IVF journey PHOTO: LAURA BETH PHOTOGRAPHY WWW.LAURABETHPHOTOGRAPHY.CO.UK

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IN THIS ISSUE

A 360 look at ovarian cancer And what young women must know.

Izzy and Harry Judd Extended edition of the struggles they face.

Adam Balan Chair, British Fertility Society on 40 years after the world’s first IVF baby.

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ONLINE

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Gynaecological health should not be taboo

“While we hear so much about gender equality in the UK and worldwide, there are many issues affecting the health of women and girls which still remain “off-limits”.

T

his stigma often causes women to ignore concerns about their health, while the fear of embarrassment can leave them suffering in silence. We must do more to address this and break down taboos surrounding gynaecological health.

“As a group of doctors, we care for 51 per cent of the population and have unique access to women across their life course. Many of those interactions are not about ill health but helping them to do normal things like have safe sex, prevent pregnancy, become pregnant and have a healthy menopause and post-menopausal life. To make the most impact, we must move away from being a disease intervention service and instead promote the importance of preventative measures to improve Follow us

survival rates so we must continue to raise awareness about the disease, its symptoms and ways to prevent it.

the health of all women at every age and stage of their lives.

One in four women don’t take up their screening invitation “It is disheartening to see that gynaecological health remains a taboo subject among the public, despite more than 21,000 women being diagnosed with one of the five forms of gynaecological cancer each year in the UK. Cervical cancer, which leads to the death of two women a day, is a largely preventable disease, yet screening rates are at their lowest level in two decades*.

Evidence shows that routine screening – which can detect pre-cancer abnormalities – prevents up to 75 per cent of cervical cancers, however, one in four women don’t take up their screening invitation.

Early detection is vital to increasing

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Later maternal age and weight can increase risk of miscarriage

Professor Lesley Regan President, Royal College of Obstetricians and Gynaecologists (RCOG)

“Cervical cancer leads to the death of two women a day.”

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“The 21st century has brought with it the largest ever group of adolescents in history and we urgently need to ensure that they can take control of their own fertility. To do this successfully, we need to place women and their families at the centre of their care, educating them and empowering them to make informed choices about their health. Currently, around 15 per cent of couples experience infertility; that’s around 3.5 million people in the UK. Unfortunately, by the time a woman decides to have a baby or is already pregnant, she may not realise the impact maternal age @MediaplanetUK

and weight can have on her ability to conceive or have a healthy pregnancy.

We know that female fertility starts to decline gradually from the late 20s and more rapidly from the mid-30s onwards. As well as potentially taking longer to get pregnant, later maternity and being overweight can involve a greater risk of miscarriage, a more complicated labour, and higher rates of medical intervention at the birth.

As healthcare professionals, our role is to advise both men and women about the implications that maternal age and weight can have for fertility, pregnancy and birth, to enable couples to make informed decisions about when to plan a family.” *Latest figures by NHS Digital for the NHS Cervical Screening Programme 2016-17 show that there has been a decrease in attendance rates from 75.7 per cent in 2011 to 72 per cent in 2017 for women aged 25-64 in England.

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Skipping school because of menstruation

Women and girls living in poverty often struggle to afford proper menstrual care products. Now NGOs have started to work with menstrual cups to fight period poverty.

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What is a menstrual cup?

Most menstrual cups are made from medical-grade silicone, can be reused for up to 10 years, and provide up to 12 hours of comfortable, leak-free protection.

The cup is a small, bell-shaped device that sits about half an inch inside the vagina where it collects, rather than absorbs, menstrual fluid. This allows the vagina’s pH balance to stay intact, therefore being a healthy option to conventional

menstrual products.

The longevity of a menstrual cup makes it an economical and sustainable solution. It has been around since the 1930s, but only recently entered the mainstream market of menstrual care products.

Especially for women and girls living in poverty, this product can be a life-changing solution.

A sustainable solution Menstrual cups remove the financial burden of having to buy monthly supplies and they do not create waste compared to disposable products. Apart from being sold commercially, social enterprises and NGOs have started to work with menstrual cups as a sustainable solution for girls and women living in poverty. Ruby

Leanka Sayer Community Manager

“It allows menstruators to stay safe and healthy.”

Cup, for instance, runs a Buy One Give One Programme to support NGOs in East Africa with menstrual cups. Girls have reported improved self-esteem and concentration in school. They feel confident and are able to participate in class and other activities with their friends instead of staying home to avoid staining their school uniform.

The cup also removes the need to use unsafe solutions such as old rags, newspaper or tissue that pose serious health risks and are often associated with shame. It allows menstruators to stay safe and healthy, and does not sacrifice their ability to participate in work, school or daily activities.

Experienced menstrual cup users will tell you that it takes some time and requires a bit of practise to get used

to, but you can also expect that any menstrual cup user will be very happy to offer you tips and advice. Many women report that their relationship with their body and period experience improves when using a menstrual cup and are eager to share their stories.

It’s, of course, important to acknowledge that every menstruator’s anatomy is different and there is no one-product-fits-all solution, but it’s safe to say that menstrual cups have numerous potential benefits for people and the planet.

Menstrual cups may be life-changing for women and girls living in poverty, but all women can benefit from switching to a cup.

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Women with ovarian cancer are paired with a clinical nurse specialist (CNS). How can the CNS help?

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‘It made me feel like I was an anomaly’ – how I dealt with an ovarian cancer diagnosis

By Linda Whitney At 21, Lisa Arthurs was studying in Hawaii when she was diagnosed with ovarian cancer.

“It flipped my world upside down.

As a young person, you don’t see it coming, so it’s a big shock. As soon as the doctor said, “It’s cancer,” I didn’t hear anything else. My mum – my rock – was with me and she was asking the questions.

They removed the tumour three days later but didn’t tell me that they failed to get all the tissue. I had follow ups for a few months, then went home to Canada.

Part of the tumour remained

Natalie Percival Matron, The Royal Marsden Hospital

“The CNS is an advocate for the patient, and supports her and her family through diagnosis and treatment,” says Natalie Percival, Matron at The Royal Marsden Hospital and President of the National Forum of Gynaecological Oncology Nurses.

Support covers more than medical issues. The CNS can offer access to psychological care and even financial advice, as patients commonly worry about paying their bills.

Psychological support extends beyond diagnosis. Percival says: “Often, patients do not ask for psychological help until treatment ends, when many look back and the full impact hits.”

A CNS can help with difficult conversations “Each patient needs a personalised, flexible treatment plan. Some may need advice about side-effects, others about telling their three-year-old that they have cancer,” says Percival.

The CNS is a permanent member of the patient’s care team, and can be consulted by phone and in person. “National patient surveys show that timely information and help from a CNS improves patient satisfaction,” says Percival.

“The CNS aims to ensure the patient’s quality of life is the best it can be, on and off treatment. Patients help design their own pathway, and can access help including relaxation, massage and art therapy.”

Help for younger women “Younger women often worry about how to do the school run, so I can help schedule appointments around that. The woman’s life is already turned upside down so we try to minimise that,” says Percival.

The CNS can also help women who suspect they have the BRCA gene mutations that put them at higher risk of ovarian cancer. “We can refer patients for testing and offer support. Patients thinking, ‘If I have it, what does it mean for me and my children?’ can call and ask the CNS.” Read more on healthawareness.co.uk

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Once home, some of the symptoms returned. Sitting on the sofa, I could feel the pressure of the seat through my body and into my tummy. I found out that the Hawaii operation hadn’t removed all of the tumour. I was livid. I had surgery two weeks later, this time successfully.

Six months later, I moved to the UK to train in physiotherapy.

I’ve had excellent care here, but the emotional toll of follow-up appointments is huge. I was offered psychological help on the NHS. I couldn’t bring myself to go, but I wish I had.

Ovarian cancer rarely seen in someone so young Lisa Arthurs Ambassador, Target Ovarian Cancer

“It flipped my world upside down.”

When I was first diagnosed, my consultants had never seen ovarian cancer in someone so young. It made me feel like I was an anomaly and there wasn’t a lot of support for me, but when I came to London and found Target Ovarian Cancer I felt there were resources to help me. Having information and support at your fingertips is huge.

Five years after my second operation, I go most days without even thinking about cancer, which is great - it used to get me down. I don’t want to think about it right now and that’s okay.

Why young women must know about ovarian cancer

By Linda Whitney Better treatment options for women with ovarian cancer, combined with increasing awareness of symptoms, especially among the under 60s, could prolong more patient’s lives.

Early diagnosis could mean the difference between life and death for women with ovarian cancer.

Caught at stage one, 90 per cent of women are alive five years later, but at stage four, that statistic drops to just five per cent.

“Almost 60 per cent of cases are diagnosed at stage three, so we must increase awareness among women and doctors,” says Dr Susana Banerjee, Consultant Medical Oncologist and Research Lead at The Royal Marsden NHS Foundation Trust, London.

Early symptoms can be vague.

“Symptoms of bloating, persistently feeling ‘full’, and constipation may not seem urgent, so women delay visits to the GP. There some are misdiagnosed cases too, especially if they are under 60,” she says.

Around 7,000 cases are diagnosed in the UK annually, mainly in over-60s,

but around 1,000 are in younger women. Women with BRCA gene mutations, such as actress, Angeline Jolie, are at increased risk of ovarian cancer as well as breast cancer.

PARP inhibitors extend the time it takes cancer to worsen Dr Susana Banerjee MBBS MA FRCP PhD Consultant Medical Oncologist and Research Lead at The Royal Marsden NHS Foundation Trust, London

“Almost 60 per cent of cases are diagnosed at stage three.”

Treatment has come a long way in the last decade. New drugs called PARP inhibitors, prevent PARP, a protein which repairs cell damage, from working in cancer cells, so they die. PARPs are taken orally after chemotherapy has shrunk the cancer, and extend the time before cancer worsens.

In women with the BRCA gene mutations, there was an 82 per cent improvement in the time it took for the cancer to worsen.

There were minor extensions in women without the mutations.

“More women diagnosed with advanced ovarian cancer are living relatively normally five years later,” says Banerjee. “More awareness, especially among younger women, combined with the present rate of progress in treatment, will make that more common.”

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Preserving fertility through egg freezing findings could drive discussions among patients and prescribers to explore either IVF treatment and/or oocyte-freezing and among legislators and payers for the funding of these procedures.

The LIFE survey results are currently under review by a group of experts in the field of fertility treatment and sociology and will be published in a peer reviewed journal before the end of 2018.

As fertility rates in Europe drop, public acceptance for egg-freezing practices and IVF treatment is highly positive

In September 2016, an online questionnaire distributed to 8,682 individuals throughout six EU countries was conducted with the goal of assessing the perception of in-vitro fertilization (IVF) and fertility preservation using oocyte-freezing among European men and women.

The survey, which was called LIFE (Listening in: IVF and Fertility in Europe), indicated wide acceptance of IVF and oocyte-freezing for both lifestyle and medical reasons.

Oocyte cryopreservation for fertility preservation is generally available to women diagnosed with cancer or other medical conditions that could affect fertility and to those that choose to delay family planning for lifestyle reasons.

LIFE survey, conducted in UK, France, Germany, Italy, Spain and Sweden, has assessed the public attitudes and opinions toward IVF and oocyte-freezing, together with the beliefs surrounding the treatment, it’s success, the need for public funding and the use of IVF among different lifestyles.

Among the 6,110 respondents (70 per cent of the total) 61 per cent demonstrated support for IVF in single woman and 64 per cent for same sex couples. Interestingly, 84 per cent of the respondents showed support for oocyte freezing for medical reasons and 60 per cent for lifestyle decisions. With different views on how IVF and oocyte preservation should be funded (if publicly or privately) the survey provides a view on the general acceptance of IVF and cryopreservation among Europeans. The

Source: B.C.J.M. Fauser, R. Levy-Toledano; Public perception of In-Vitro Fertilization (IVF) and fertility preservation : assessed by the Listening IVF and Fertility in Europe (LIFE) survey; Abstracts of the 33rd Annual Meeting of ESHRE, Geneva, Switzerland 2 to 5 July 2017 Note: The survey has been supported by Teva Women’s Health (today Theramex)

About oocyte cryopreservation (egg freezing) Oocyte cryopreservation – also known as eggfreezing – is a process for preventing future infertility. Egg-freezing is aimed at two particular groups of women: those diagnosed with cancer who have not yet begun chemotherapy, or with any other medical condition for which treatment may alter future fertility; and those who would like to preserve their future ability to have children, either because they do not yet have a partner, or for other personal or medical reasons (egg-freezing for preserving future fertility not related to medical treatment that could alter fertility, is also known as “social freezing”).

Chemotherapy and radiotherapy are toxic for oocytes, leaving few, if any, viable eggs.

Egg-freezing offers women with cancer the chance to preserve their eggs so that they can have children in the future. Additionally, women with a family history of early menopause may have an interest in fertility preservation. With egg-freezing, they will have a frozen store of eggs, in case their eggs are depleted at an early age.

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IVF gave this young couple hope and a second chance A couple’s IVF journey can be long, lonely, and frustrating at times, but without it Izzy and McFly drummer, Harry Judd, wouldn’t have their beautiful baby Lola.

When did you first consider IVF? Harry and I got married in 2012 and naturally the next step was to talk about starting a family. Ever since I can remember all I wanted was to be a mum, I never really considered that it might not be an option for me. After I was diagnosed with Polycystic Ovarian Syndrome, it became clear that the process wasn’t going to be straight forward.

After months of medical intervention I was totally deflated. I accepted that I needed a helping hand so we made the decision to go ahead with IVF.

Can you describe the emotional journey you went through?

During the years of waiting I

experienced so many emotions, from fear to frustration, desperation to anger and guilt to loneliness.

I had an overwhelming feeling of sadness and sense of responsibility to give myself and Harry a family.

It seemed like everyone around me was pregnant and I felt isolated.

Can you describe the IVF process After our first IVF appointment, I felt overwhelmed with information.

IVF isn’t talked about enough and as a result it can feel frightening.

On egg transfer day I realised just how amazing it was and how lucky I felt to have experienced it. We were able to look at the screen where our embryo was being projected in front of us; it looked like a beautiful moon.

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dreamed of conceiving, but it was every bit as romantic.

You then fell pregnant with your beautiful Lola. What advice would you give to women and couples going through IVF?

Izzy We were devastated to suffer a miscarriage after our first round of IVF. It took a long time to grieve before finding the strength to go through another round. I was unbelievably fortunate to become pregnant after a frozen embryo transfer which resulted in the birth of our little girl, Lola.

If I could give any advice, I would say don’t be frightened. This is what

Izzy Judd Spokesperson, Wellbeing of Women

“That’s why I support Wellbeing of Women, along with championing women’s health, the charity is investing in new and improved practices in IVF to ensure more couples, like us, have a successful pregnancy.”

inspired me to write Dare to Dream and share our story in the hope it would be a comfort and companion to others. IVF is amazing and magical; always believe amazing things will happen.

Harry My advice would be to remain positive and be supportive, I went to all the appointments with Izzy and helped with her medications.

It was all-consuming, so do fun things to take your minds off it. I was unsure about IVF initially, I was worried that if it didn’t work, we’d have nowhere else to turn. I couldn’t bear the thought of seeing Izzy in that situation. Izzy’s attitude was amazing and it helped the experience to be exciting, instead

of terrifying and negative.

How did you feel, as a husband and father to be, going through this procedure?

I wanted to support Izzy but I also wanted to take her mind off everything that was happening, and give her a different focus. I tried to give rational advice and encourage her to step back and look at things more objectively.

You might think IVF would be clinical, but in a way it’s romantic.

Izzy and I shared such a magical experience together. We wouldn’t change it for the world, because now we have Lola.

Read the extended edition on healthawareness.co.uk

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