Here at TMCK we believe that we should make ourselves as useful to you as we can and so we provide you with much of the information you will need.  We obviously cannot tell you everything you need to know in this way, but what follows is designed to deal with the most important aspects of this particular condition.

You can choose the care best for you provided by our renowned team of GPs, Consultant Gynaecologists, Ultrasound Scan Specialists, Psychiatrists, Psychologists, Counsellors and Nutritional Therapists.  If you are referred for a specialist opinion, you will be reassured to know that the Specialists at TMCK regularly review Patients' cases with the rest of the team.

Premenstrual Syndrome...What Is It?

PMS refers to a collection of symptoms that occur in the two weeks prior to a menstrual bleed.  Symptoms are usually physical as well as emotional and psychological, affecting the way you feel and behave.  Premenstrual Syndrome is also referred to as Premenstrual Tension, or PMT.  When Premenstrual Syndrome is severe, it is called Premenstrual Dysphoric Disorder (PMDD).

What Causes Premenstrual Syndrome?

PMS is a response to the changes in hormone levels that occur in the second half of the menstrual cycle.  Progesterone levels peak and then, just before a menstrual bleed, levels of progesterone and oestrogen both fall dramatically.

Your personal response to the changes in these hormone levels depends on your underlying health as well as what is happening in your life.  That is why your symptoms may alter from one month to another.

Activity in your ovaries, including hormone production, influences your entire body and your emotions.  At the same time, your ovaries are influenced by other hormone glands in your body, your nutrition and your levels of stress.  No single aspect of your body works in isolation and if the balance tips in the feedback system between your ovaries and the rest of your body, PMS may be worse.

How Is Premenstrual Syndrome Diagnosed?

There is no single diagnostic tool for Premenstrual Syndrome.  It is identified by noting symptoms that have been occurring for a number of months.  Your doctor may give you a calendar or chart to fill in.  Keeping a record of your symptoms is very useful.

It is important to exclude gynaecological conditions that may be linked to some of your symptoms, such as endometriosis, polycystic ovaries or fibroids.  Your doctor will ensure you receive a thorough diagnosis depending on your personal symptoms.

Who Is At Risk Of Premenstrual Syndrome?

It is very common for women of any age between puberty and menopause to have PMS, and for moods and behaviour to change significantly before a menstrual bleed.  It is thought that all women experience some symptoms in the run up to a period; most women notice it, but not all women find the symptoms interfere with their lives.

Susceptibility to PMS varies.  It may increase when a woman is lacking essential nutrients, is under stress, has underlying hormonal imbalance, is unwell, or doesn't have a balance of rest and exercise.  It may also be exaggerated if there is underlying depression.

What Are Premenstrual Syndrome Symptoms?

The range of recorded symptoms extends to over 100.  The most common are listed below.  Your specific symptoms may vary from month to month, and their intensity may alter.  If you have an underlying health condition, such as asthma, this may be exacerbated prior to your period.

Physical

• Headaches
• Backache and pelvic pain
• Digestive disturbances such as constipation, diarrhoea or nausea
• Bloating and stomach (abdominal) pain
• Breast tenderness
• Changes to skin such as acne and to hair such as lank and greasy
• Muscle pains
• Tiredness and lethargy
• Insomnia or broken sleep
• Weight gain

Emotional (Psychological)

• Mood swings
• Anxiety and worry
• Irritability
• Reduced ability to deal with challenges
• Restlessness and difficulty concentrating
• Forgetfulness
• Frustration and anger
• Feeling blue, depressed or tearful
• Low self-esteem

Behavioural

• Low confidence and feeling less sociable
• Altered coordination such as dropping things or tripping up
• Reduced desire for sex (low libido)
• Reduced flexibility and energy and less inclination to exercise
• Changes to appetite and food preferences

Can Premenstrual Syndrome Be Reduced?

The good news is that premenstrual syndrome can be reduced.  There is, however, no single 'cure' that suits all women.

We recommend you consider lifestyle and nutrition changes to introduce balance to your life and boost your underlying health.  This is because when you have the nutrients, exercise and rest you need, your body is more able to cope with fluctuations in hormones.  Many people believe that feeling happy and fulfilled and supported by friends and family also helps to boost health.  Your doctor and your team of specialists here at TMCK are here to help you work towards balance.

Medical treatments can be very effective and need to be discussed with your doctor so he or she can consider their benefits in your particular circumstances.

What Are The Medical Options For Treating Premenstrual Syndrome?

Your Doctor will take you through a range of options that may help reduce your symptoms.  They include...

Hormone Medication (HRT) is one of the main medical options used, helping to create a balance to reduce symptoms.

The Contraceptive Pill can help some women.  It can take time to find one that works.  Some of the side effects of the Pill can include symptoms similar to PMS such as bloating, mood swings, lethargy and breast discomfort.  Your doctor will discuss the options with you.

A Hormonal Intra-Uterine Device (Minera IUD) can be left in place for several years and often helps to reduce the flow of blood during menstruation, along with back and pelvic pain, and may reduce mood swings.  Like the Pill, though, it can have side effects - each woman has her own unique reaction.

Pain Relief NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as ibuprofen and aspirin can help to reduce pelvic pain, headache and backache, stomach cramps and breast pain.  They don't have a direct effect on emotions, although when physical symptoms improve your mood may lift at the same time.  Your doctor will provide a prescription based on your personal requirements.

SSRIs (Selective Serotonin Re-uptake Inhibitors).  These are a class of 'anti-depressant' that are sometimes prescribed when PMS is severe.  Your doctor will talk you through their benefits and potential side effects.

GnRh (Gonadatrophin Releasing Hormone Analogues).  These synthetic hormones are usually only considered when symptoms are very intense.  They force the body into an artificial, temporary menopause by stopping the release of oestrogen from your ovaries.  If this is an option for you, your doctor will discuss the pros and cons in detail and will be keen to monitor your response to the medication very closely.

What Lifestyle Changes Can Reduce Premenstrual Syndrome?

A healthy lifestyle will help to support the feedback system between your ovaries and the rest of your body, and help your body maintain equilibrium as your hormones change through the month.

The key elements are keeping stress levels low, and having a balance of exercise and rest, work and play.  Exercise may also help to alleviate some symptoms when they arise.

Can What I Eat Help Treat Premenstrual Syndrome?

Your nutrition, including what you eat and how your body is able to absorb the goodness from your food, can help your body cope with changes in hormone levels, and can affect the balance of hormones in your body.

Natural supplements and herbal preparations are widely used by women to combat PMS.  Before you make a choice about supplements it's important to know what you personally need and to have guidance about safe dosages.

A personal consultation with Nutritionist Dr Marilyn Glenville or one of her team will give you the opportunity to select the right supplements for you.  Dr Glenville is one of the UK's leading women's health nutritionists.  Her many books include Natural Solutions to PMS.  She will expertly guide you through a practical nutritional, supplemental and eating plan, combined with lifestyle advice, to suit you.

Premenstrual Syndrome + Depression

The emotional 'downs' of PMS are sometimes misdiagnosed as depression.  If you are concerned about depression, or you have a history of depression and/or have had treatment for it, your doctor will talk through this with you.  The team here at TMCK includes Psychiatrists, Psychologists, Psychotherapists and Counsellors who are available for further support.

Can Natural + Complementary Treatments Help To Reduce Premenstrual Syndrome?

Your doctor will give you advice about medical treatments based on your personal symptoms.  If you would like to follow other options, such as herbal medicine, it is important to continue having regular medical checks to assess your general health, cholesterol levels, bone health and breast health.  We recommend regular well woman checks with your GP or gynaecologist.

Here at TMCK we believe that we should make ourselves as useful to you as we can and so we provide you with much of the information you will need.  We obviously cannot tell you everything you need to know here in this Library, but what follows is designed to deal with the most important aspects of this particular condition.

Look after yourself and attending to your health now will bring many rewards.  Both for you and your baby.

Your health before you conceive has a huge impact on the likelihood of a successful pregnancy, your own comfort and wellbeing through pregnancy, and, perhaps most importantly, the healthy development of your baby.  It also has an influence on the birth and on your recovery and health in the postnatal period, as well as the likely success of breastfeeding.  So the benefits are far reaching.

PreConception care is useful for all women and couples planning pregnancy.  But, it is very important for women with an existing condition known to carry risk for pregnancy, such as diabetes, a known genetic condition, obesity or a family history of twins.  We are here to give guidance on the best course of preparation for you, and how to alter and manage any medication you are taking.

TMCK is also here to help you maximise your health before conception and avoid or identify and treat any issues that may cause a problem for you or your baby.  We believe the ideal is for a woman to have a clear picture of her health, and to be informed about measures that can enhance her and her baby's health, and to have support before, through and after pregnancy.

Do You Know?

• Good health for both you and your partner, prior to conception can increase your chances of pregnancy
• Your nutritional health and wellbeing before getting pregnant reduces the chances of complications during pregnancy
• Antenatal care in early pregnancy can reduce the occurrence of miscarriage
• Consistent medical and other antenatal support before and through pregnancy can reduce the risk of premature birth, and increase the likelihood of a problem-free, natural birth

PreConception Care...What Is It?

PreConception care will help you improve your health before you conceive a baby.  It is a combination of

• screens for infections and health conditions that could affect fertility and pregnancy
• personal health checks to assess your weight, blood pressure and hormone profile
• uterine health check, possibly including pelvic ultrasound scans
• optional sperm analysis for your partner
• nutritional and vitamin and mineral analysis, eg for vitamin D levels
• lifestyle advice

What Screens Are Important Before Pregnancy?

The tests you will need depend on your recent medical care and personal history.  We recommend you are up to date with these checks

• Breast health
• Cervical smear (pap smear).  Any abnormalities can be treated before you try to conceive
• Diabetes
• Hormone Analysis
• Infection Screen for bacterial vaginosis and similar
• Rubella Vaccination
• STD a full screen for sexually transmitted diseases including Hepatitis, Chlamydia and HIV
• Thyroid
• Weight + BMI assessment
• If you have a family history of genetically inherited conditions we recommend you talk to your Consultant before genetic counselling

Are Ultrasound Scans Part Of PreConception Care?

A PreConception consultation with Dr Horner allows you time to discuss your personal medical history, any previous pregnancies or pregnancy losses and any difficulties you have had with menstruation or fertility.  Ultrasound will give you useful information as you ensure you are in the best of health.

Monitoring Your Cycle

Ultrasound scans to monitor the menstrual cycle and observe the ovary after the release of an egg, in combination with hormone tests, is a useful assessment of fertility.  Many women find this extremely helpful as it allows them to time love making to coincide with the height of their fertility during the month.

Assessing Your Uterus

Close observation of the uterus, ovaries and fallopian tubes is useful to exclude any structural abnormalities, such as scar tissue (adhesions: fibrous bands that form between tissues and organs often as a result of injury during surgery) that can impede fertilisation or implantation; or cysts on the ovaries that may alter hormone balance to affect fertility.  If you have had previous problems getting pregnant, or an initial scan suggests there is structural problem, a more detailed test may be advised using HSG (hysterosalpingogram).  In this procedure, a fluid is introduced into the uterine cavity that allows much more detailed observation using ultrasound.

PreConception Lifestyle Advice

As well as medical checks and any treatment that is recommended for you, aiming for a healthy lifestyle is important as you improve your chances of a problem-free pregnancy.  There's a lot you can do and your doctor supported by the team of specialists here at TMCK can guide you.

If you smoke we strongly recommend you stop; smoking is one of the leading causes of prenatal death and is linked to premature birth and other problems for growing babies.

Your weight is significant; problems with foetal development in pregnancy are more likely when a woman is significantly under or overweight.  Weight can also affect hormone balance and fertility.

What you eat is the foundation of your health.  For detailed advice, including analysis of your vitamin and mineral levels, we recommend a nutritional consultation with Dr Marilyn Glenville.

Exercise is another key to good health - in the right balance.  Your doctor will talk to you about exercise levels and their impact on fertility and pregnancy.

Folic Acid And Other Supplements Can Help

Your doctor will help you plan a full programme of supplements, reflecting what you need to support both your and your baby's health, and any personal deficiencies you have that need to be remedied such as vitamin D.

• Folic Acid supplements before conception and in the first 12 weeks of pregnancy reduces the risk of neural tube defects such as spina bifida
• Calcium
• Vitamin D
• Vitamin C
• A general multivitamin and mineral supplement may be recommended, with care to avoid any excess of Vitamin A

Emotional Support

Amid all the planning and wishing for pregnancy, an important factor that may be missed is stress.  High levels of stress can have an impact on your hormone balance and your fertility; and extreme or prolonged stress in pregnancy has been shown to have links with distress in babies.  It you are feeling stressed you may wish to visit a Psychotherapist or other Counsellor here at TMCK.  If you suffer from depression or chronic anxiety, your doctor will talk about this in a personal consultation, preferably in conjunction with a Psychiatrist.

What If A Problem Is Found?

Firstly, don't worry.  Many conditions which impact on fertility or could have a negative impact on pregnancy can be treated and your doctor will talk you through your options.

What If You've Been Having Problems With Fertility?

Your PreConception care will take careful account.......  If you have been trying for a baby without success, this will be an important consideration as part of your PreConception care.  The fertility care team at TMCK is led by Dr Talha Shawaf.

If you have experienced previous pregnancy loss, the likelihood is that this will not impact your chances of a successful pregnancy in the future.  Diagnosing the reasons for miscarriage is not commonplace after a single pregnancy loss.  If you have experienced 3 or more miscarriages, however, Dr Horner is able to guide you through a process of investigation and support you as you try for a future pregnancy.  TMCK produces a separate information sheet on Recurrent Miscarriage.

Here at TMCK we believe that we should make ourselves as useful to you as we can and so we provide you with much of the information you will need.  We obviously cannot tell you everything you need to know here in this Library, but what follows is designed to deal with the most important aspects of this particular condition.

Your care will be led by Dr Etienne Horner, Consultant Gynaecologist specialising in the care of Premature Ovarian Failure.  He is joined at The Medical Chambers Kensington by specialists in Ultrasound Scans and by Psychologists and Psychotherapists.  The team also includes Nutritionists specialising in women's healthcare and female GPs.  So we can give you the personal attention and care that you need.

Premature Ovarian Failure...What Is It?

The average age for a woman's ovaries to stop producing eggs is 51.  This stage of life is called the menopause.  When egg production ends much earlier it is referred to as "premature ovarian failure".  POF is defined as the end of normal ovarian function before the age of 40.

Typically, POF entails the end of ovulation, but this is not always the case.  For some women with POF ovulation does occur, but very infrequently and irregularly.

When ovulation has stopped or significantly reduced the output of the hormones oestrogen and progesterone declines.  This alters your overall hormonal balance and can have widespread physical affects; it also influences your emotional state.

One of the most devastating effects of POF is the impact on fertility.  When ovulation has stopped, natural pregnancy is no longer possible.  When there is still intermittent ovulation, it is possible for a woman to get pregnancy but fertility is greatly reduced.

Other terms for POF include 'primary ovarian insufficiency' and 'hypergonadotrophic hypogonadism'.  You may have also heard of POF being referred to as 'premature menopause'.

What Are The Symptoms And Effects Of POF?

The first sign is the absence of menstrual periods or your periods becoming irregular and widely spaced.

The physical and emotional effects of POF are similar to menopause and pre-menopause symptoms.  You can find a lot more information on the menopause by clicking here.  The symptoms can include

• Hot flushes such as feeling, suddenly, incredibly hot, often accompanied by sweating usually at night
• Reduced sexual desire (reduction in libido)
• Reduced vaginal lubrication
• Headaches + migraines
• Weight gain + bloating
• Feeling blue and upset

The emotional impact of POF is often considerable.  This is the combined result of hormonal changes and your personal response to physical symptoms and the end of fertility.  Treatment to rebalance your hormones can help to alleviate feelings of depression and we often recommend further support from a Psychotherapist or Psychologist with experience in helping women through difficult life transitions.

Who Is At Risk Of POF?

The cause of POF is not always clear.  Between 1% and 4% of all women are affected.  Women who have a family history of POF are more at risk, so there may be a genetic link.  In some cases, ovarian follicles are absent.  In others, the follicles are present but are not active.

There are some conditions that are associated with a higher incidence of POF.  These include genetic conditions (eg Turner Syndrome, Fragile X Syndrome) and Autoimmune Disease (eg thyroid dysfunction, diabetes, arthritis). 

Ovarian failure may follow chemotherapy or Radiotherapy and is inevitable where the ovaries are removed (hysterectomy).  Lifestyle may also play a part, with smoking, excessive alcohol consumption and stress suggested by some healthcare experts.

How Is POF Diagnosed?

The first sign of POF is the absence of periods, or a change in menstrual patterns where bleeding is irregular.  Absence of menstruation may be due to other causes, so an accurate diagnosis is vital.

A blood test for follicle stimulating hormone (FSH stimulates the follicles to release eggs) and a measurement of anti mullerian hormone (AMH helps eggs mature) will provide information about the activity of your ovaries.  Ultrasound scans can also provide very detailed information about your ovarian function and allows close observation of ovarian follicles.

What Treatments Are There For POF?

Treatment for POF will reflect your personal diagnosis.

In the majority of cases, premature ovarian failure cannot be reversed.  The most important treatment is hormone replacement to raise oestrogen levels.  This helps to reduce menopause-type symptoms and lower the risks associated with low oestrogen production such as osteoporosis.  Your treatment will be carefully considered in the context of your personal health, medical history and ovarian function.

Caring for your emotional wellbeing is part of a wider treatment programme and you will be pleased to learn that TMCK is home to a number of excellent specialists including a Psychiatrist and a Psychotherapist.

How Does POF Affect Fertility?

The blanket statement that POF means an end to fertility is not try for every woman.  Some women with POF have very few or no ovarian follicles; others have many follicles but these are damaged or functioning abnormally.  Between 5 and 10% of women diagnosed with POF do go on to conceive naturally.

Dr Etienne Horner will discuss your unique situation with you and review your chances of conceiving.  One option is fertility treatment using egg donation.  We know that having fertility treatment is an emotional journey containing sometimes difficult decisions.  If you choose to have fertility treatment, our team at TMCK includes fertility specialist Dr Talha Shawaf.  The rest of the TMCK team is of course here to support you.

Here at TMCK we believe that we should make ourselves as useful to you as we can and so we provide you with much of the information you will need.  We obviously cannot tell you everything you need to know in this way, but what follows is designed to deal with the most important aspects of this particular condition. 

Each woman's journey through the menopause is unique. We're here to give you the advice and support you need to reduce your symptoms and boost your health and vitality as your body changes. Thanks to excellent medical care and a growing awareness of healthy living choices, the menopausal years need no longer be difficult - and many women celebrate a new lease of life with a sense of freedom and strength.

Our Consultant Gynaecologists, Dr Etienne Horner and Mr Claudine Domoney, take a special interest in the menopause.   Either can work with you to build a clear picture of your body's hormone balance and help you find the medical treatment and lifestyle changes that suit you best. The aim will be to reduce your menopause symptoms and make your transition as smooth as possible.

We also offer expert nutritional guidance, from Dr Marilyn Glenville and her Team, and very personal support from Psychotherapists and Psychologists. 

Menopause...What Is It?

The official definition of menopause is the natural end of menstruation and the end of a woman's reproductive years. The ovaries' production of the female hormones, oestrogen and progesterone, declines significantly.  The word menopause has its roots in the Greek pausis, meaning 'end', and men, meaning 'month'.

The true end of menstruation - your last period - only becomes evident in retrospect, when you have not had a period for 12 months. Periods may be irregular or widely spaced for some time before this.

The end of menstruation is not a sudden event: hormone output from the ovaries changes in the years leading up to menopause. This affects your whole body. Symptoms can continue for years before the menopause, the 'pre-menopause' years.

Peri-menopause is the term used to describe the years leading up the menopause, and one or two years beyond (peri means 'around').

When does the menopause happen?

The average age for menopause is around 51 but it can occur any time roughly 8 years either side of this, with premenopausal changes occurring for several years before the true end of menstruation. Most women begin to notice changes to their cycle, or their menstrual symptoms, in their mid-40s. Menopausal symptoms can occur earlier when ovulation ends before age 40.  This is Premature Ovarian Failure (POF) and you can find more information about this condition in our library.

What Are The Perimenopause And Menopause Symptoms?

Some women experience very few symptoms.  For others, symptoms may be mild and intermittent.  Others experience a range of severe symptoms.  They tend to include one or more of

Physical Symptoms

• Irregular periods
• Heavy vaginal blood loss
• Hot flushes best described as feeling, suddenly, incredibly hot, sometimes accompanied by sweating, typically at night
• Dry skin
• Reduced sexual desire (low libido)
• Reduced vaginal lubrication
• Increased susceptibility to vaginal and urinary tract infection
• Headaches  or migraines
• Breast tenderness
• Weight gain + bloating
• General aches
• Urinary incontinence

Emotional Symptoms

Mood changes are very common. They range from mild mood swings to periods of intensely strong feelings such as anger or irritability, or feelings of ineptitude and low self-esteem; some women liken it to depression or severe Premenstrual Tension/Premenstrual Syndrome

• Increased stress
• Forgetfulness
• Fatigue

The emotions of the perimenopause can be partially attributed to hormonal changes; but there is always a bigger picture. For some women the end of fertility needs to be mourned. The menopause may also coincide with significant life events such as children leaving home, or the loss of a parent. If menopausal changes leave you feeling less able to cope, medical treatment, as well as emotional support, may be extremely helpful.

Can I Avoid Menopause Symptoms?

The menopause is a natural stage of a woman's life.  To increase your chances of minimal symptoms, we recommend you visit your Doctor regularly for a Well Woman Check from the age of 45 onwards. This will help you keep your health on track and take measures that boost your wellbeing in the run up to your menopause, and may help reduce symptoms.

How Can Pre And Perimenopause Symptoms Be Reduced?

Your doctor will go through a range of options that are commonly used to reduce symptoms.

Hormone treatment is often recommended to reintroduce balance. There is a wide choice of products on the market, and a variety of applications including cream, pills, patches and implants. Your doctor will go through the options with you in detail and the choice will depend on your personal needs: finding the right approach is best done in consultation.

Can Nutrition Help Reduce Menopause Symptoms?

Your nutrition, including what you eat, and how your body is able to absorb the goodness from your food, can help your body cope with the changes in hormone levels. Your diet is important if you need to combat difficulties such as fatigue or weight gain, and it is also a powerful tool in offering some protection against osteoporosis (women are more susceptible to osteoporosis once oestrogen levels fall).

No two women have the same needs, so we do recommend you visit for tests including liver function tests, levels of Vitamin D, calcium and other minerals, omega fatty acids and cholesterol etc.

The ideal approach is to ensure your diet is nutritious and supports your hormonal balance for many years in the run up to the perimenopause period.

Dr Marilyn Glenville, one of the UK's leading women's health nutritionists, offers personal consultations at The Medical Chambers. Her many books include Natural Alternatives to HRT, and she will expertly guide you through a nutritional, supplemental and eating plan to suit you.

Natural And Complementary Treatments For The Menopause

Your doctor will give you advice about medical treatments based on your personal symptoms. If you would like to follow natural treatments such as herbal medicine, it is important to continue having regular medical checks to assess your general health, cholesterol levels, bone health and breast health.

When Menopause Comes Early...Surgical Onset Of Menopause And Premature Ovarian Failure

For a minority of women menopause occurs early. The reasons for altered hormonal output from the ovaries vary from an early end of ovulation (Premature Ovarian Failure or POF) to dysfunction or abnormal function of the ovaries and ovarian follicles.  You can find a more detailed explanation of POF elsewhere in this Library. 

A full hysterectomy, where the ovaries as well as the uterus are removed, causes the onset of menopause, since the ovaries are no longer present to produce hormones.

For early menopause, whatever the cause, hormonal medication is frequently advised. The impact of low oestrogen and progesterone levels on health - including increased risks of osteoporosis - is significant, and the medication helps to reduce this, as well as tackle symptoms. 

Post-Menopause...What Can I Expect?

In the post-menopausal years, women do feel different but how you personally feel depends on many factors. These include your body's response to change in hormone levels, what else is happening in your life such as the support you have, how fulfilled or stressed you feel, your diet and lifestyle, and any medication you take.

After the menopause, because your ovaries are producing less of the female hormones oestrogen and progesterone, this has an impact on your bone density, and as bone density declines you are at risk of developing osteoporosis. Your doctor will send you for a bone density scan to assess your bone health.

To reduce your susceptibility to bone loss, osteoporosis and hip fracture, it's important to take measures to protect your bones. Some hormonal treatments used to reduce menopausal symptoms may help to reduce bone density decline; in combination with exercise and sufficient intake of calcium and vitamin D. A personal consultation is important for you to find out what level of supplementation is useful for you. 

You're advised also to keep an eye on your cholesterol - because high levels are one of the highest causes of cardiovascular (heart) disease; and the risk of heart disease does increase with proportion to age. Your doctor will monitor your heart health and advise on treatment; our cardiovascular specialists at The Medical Chambers are available if you would like further advice or treatment.

We invite you for regular well woman checks once a year, with vaginal examination and a cervical smear. This will help you keep an eye on your liver and heart health, blood pressure and gynaecological health and discuss any concerns with your doctor.

Here at TMCK we believe that we should make ourselves as useful to you as we can and so we provide you with much of the information you will need.  We obviously cannot tell you everything you need to know here in this Library, but what follows is designed to deal with the most important aspects of this particular condition. 

Having three or more miscarriages is a difficult experience for couples; so first and foremost we are here to support you.  We will care for your physical health and we are here to listen to your concerns and give you advice and support.  There is not always an explanation for recurrent loss of pregnancy, but we will do all we can to identify a cause (or causes) and, if you wish to try for a baby again, to support you prior to conception and through your pregnancy.

Our expert physician specialising in recurrent miscarriage is Consultant Obstetrician & Gynaecologist Dr Etienne Horner.

Our team at The Medical Chambers Kensington also includes ultrasound specialist Bill Smith, whose advanced 3D and 4D ultrasound scans provide detailed views of the ovaries, uterus and pelvic organs, and allow close monitoring of ovarian function, the menstrual cycle and early pregnancy.

At TMCK you also have access to excellent psychologists and psychotherapists, and a female GP.  Many women appreciate the space to talk about their losses, as they grieve and integrate the experience into their lives. Emotional support from a therapist can be extremely helpful.

Beyond this, Dr Horner and the team at The Medical Chambers Kensington offer preconception care and counselling; supporting you as you prepare for a future pregnancy.

Recurrent Miscarriage...What Is It?

Miscarriage is the loss of a pregnancy before week 23. Roughly 1 in 5 women who get pregnant experience a miscarriage.

Recurrent Miscarriage is the loss of three of more pregnancies.  This is much less common; it affects around 1 in 100 women.

What Causes Miscarriage And Recurrent Miscarriage?

The cause of miscarriage is not always evident.  The most common reason for a single miscarriage is an abnormality with the developing embryo but there are many factors that influence pregnancy.

Recurrent miscarriage does not always have an identifiable cause.  Some of the possible causes include:

• Age the risk of miscarriage increases with age, rising from 1 in 5 at the age of 30 to 1 in 2 after the age of 42.
• Autoimmune Conditions linked to 10-15% of recurrent miscarriages cause the body to react against its own tissues.  It is not always a cause of miscarriage, but may be linked to it.  Other immune conditions such as ELE (Systemic Lupus Erythematosis) may be linked with miscarriage.
• Blood Clotting Abnormalities such as an increased tendency for excessive clotting (thrombophilia) are a common cause of recurrent miscarriage.  Your doctor will discuss possible medical treatment.
• Cervical Incompetence this is where the cervix is unable to remain closed as the pregnancy grows.  Surgical insertion of a 'stitch' or 'cerclage' helps to keep the cervix closed and can be removed when the pregnancy reaches full term.  
• Diabetes is occasionally linked with miscarriage, but when well managed it is not thought to increase the chance of miscarriage.
• Genetic Factors carried by one or both parents may affect development of the foetus. Genetic counselling [what is this?] is essential if you are affected by this.
• Polycystic Ovarian Syndrome, where the ovaries have multiple cysts, alters hormone output.  Medication is the usual approach to redress the balance and if cysts reduce successful pregnancy is more likely.
• Progesterone Deficiency following fertilisation results in inadequate support for the growth of the embryo. Hormone medication after conception may help to sustain a pregnancy.
• Thyroid conditions may affect fertility; medication needs to be prescribed on a case-by-case basis.
• Uterus Structure  Ultrasound is very useful in checking for any abnormalities.  Some abnormalities can be surgically corrected.   

What Can Help Increase The Chances Of A Successful Pregnancy In The Future?

The first step is to exclude or identify an underlying cause of previous miscarriage(s).  It may be that the cause can be treated. 

Unfortunately, even with treatment, there cannot be a 100% guarantee that a future pregnancy will continue to full term, as many factors come into play.  Your doctor will talk to you about your personal situation, the potential causes of your previous miscarriages, and possible treatments.

Preconception screening and care is important and you can find more information here in this Library.  A woman's general health, the uterine environment and the condition of eggs and sperm all play a part in conception, implantation, and pregnancy.

Care in the early stages of pregnancy, from conception through to week 12, is also important. Your doctor may recommend close monitoring with ultrasound scans and hormonal support, depending on your personal needs.

Miscarriage And IVF

There is no consensus about whether IVF increases the risk of miscarriage; it seems that the underlying cause of low fertility or pregnancy loss is often linked with miscarriage following IVF, rather than IVF itself.  As a preventative measure, where there is a genetic condition carried by one or both couples, IVF may be used in connection with screening to reduce the risk of the condition being passed on.

Emotional Support

Miscarriage at any time can cause a lot of distress.  Three or more miscarriages can be very hard to accept and live with.  The reaction varies enormously. Some women find it difficult to cope with the loss and sadness, and experience fatigue, insomnia, low energy and tearfulness.  Other women feel able to cope initially, and after some months experience grief. And there are others who are able to move on relatively quickly.  The range of emotions is similar among men; although the impact is typically greater for women.

If you would like personal support, please ask to meet with one of our psychotherapists, individually and as a couple.

Nutritional Guidance

Nutrition can help to provide your body with the nutrients you need as you recover from miscarriage, and during any investigation or treatment you are having.

A good diet will help to regulate your blood sugar, support hormone balance, and reduce problems of fatigue and low energy.  Dr Marilyn Glenville has many years' experience supporting women who have had miscarriages and is here to guide you.