If you are embarrassed by urinary leakage when you sneeze, run or laugh (a condition known as stress incontinence), you will be reassured to know that it is very common and can often be easily resolved.  Other common symptoms include burning on passing urine or pain connected with a bladder infection.  Here, you can see Dr Judy McGonigal GP or our Consultant Urogynaecologist, Ms Claudine Domoney.  Physiotherapy is particularly helpful for improving pelvic floor control and minimising incontinence and vaginal laxity.  Some women respond well to hormone treatment.  Specialist care for vaginal prolapse is available if needed.

While a decline in bone density often comes after the menopause when hormone levels alter, women of any age are at risk.  Bone density and strength are also dependent on Vitamin D, calcium and magnesium among other minerals, and may be affected if there are deficiencies.  You may know that an alarming majority of the population in the UK are deficient in Vitamin D.

An assessment of your Vitamin D levels is useful, alongside the FRAX 'Fracture Risk Assessment Tool' to assess your risk of osteoporosis.  Referral for a DEXA bone density scan will be recommended if your risk factors for osteoporosis are high.

Your Doctor will advise you on the correct dose for Vitamin D supplements, as well as calcium and/or multi vitamin and mineral supplements, load-bearing exercises and the suitability of hormonal medication to reduce bone loss.  For further advice on tailoring your diet, we recommend a visit to one of our Nutritionists.

An abnormal cervical smear result will be described to you as cervical cell changes or CIN (cervical intraepithelial neoplasia).  The next stage of diagnosis and treatment depends on your personal results. 

CIN is not cancer.  It means there are changes to the cells which are precancerous and treatment is designed to reduce the risk of cancer developing.

CIN 1 is the diagnosis of mild cell changes.  An examination of the cervix using a magnifying and photographic instrument (colposcopy) allows your Gynaecologist to get a clearer assessment of the cervical cell changes and, at the same time, he/she can remove a small sample of tissue (biopsy), which will be analysed in the laboratory.  Treatment for CIN 1 is not always necessary.  It may be possible to remove abnormal cervical cells (if recommended) at the same time as the colposcopy or removal may be carried out later. 

CIN 2 or CIN 3 diagnosis means that it is essential to remove any abnormal cells.  Your Consultant will talk this through with you.

It is important to find the contraception method that's right for you and to talk with your Doctor about the advantages and disadvantages of each type in the context of your own health and lifestyle.  Your choices include:

• The Pill  The combined contraceptive pill, which is taken every day, contains oestrogen and progestogen hormones, and inhibits ovulation.  It gives a very high level of protection against pregnancy.  It is not suitable for everyone so you will need to talk through your personal needs with your Doctor.  There are many types of pill, each with different hormone doses and different effects, so it may take some time to find the right pill for you.
• Contraceptive Patch  This is similar to the combined pill, but works by placing a patch on your skin to deliver progesterone and oestrogen hormones into your body.  It needs to be renewed weekly.  It is suitable for women who do not want to take a pill every day and can be useful for those who frequently travel to different time zones, avoiding the need to take a pill at the same time every day.
• Vaginal Or Contraceptive Ring  This birth control method delivers the two hormones via a ring that you place into your vagina and leave in place for three weeks.  You then take it out, for a week, during which time you will experience blood loss, like a period.  When you talk to your GP she will give you an overview of the pros and cons and the possible side effects.
• Intra-Uterine Device (IUD) or Coil  This is a popular choice among women who do not want to use any hormones.  The device prevents implantation of a fertilised egg and can be left in place for up to 10 years.  Some women experience discomfort for a short period after insertion.  The coil can make periods heavier but does not interfere with your cycle.
• IntraUterine System (IUS + Mirena^™)  An IUS is inserted into your uterus, like an IUD or 'coil' but contains progestogen hormone.  This hormone alters the environment in the uterus giving a rate of protection against pregnancy of over 99%.  It can be left in place for 5 years and fertility returns to normal once it is removed.  Because the progestogen is delivered locally, in the womb rather than through the blood stream as with a contraceptive injection, pill or patch, few hormonal side effects are reported.  It is very effective at the end of a woman's reproductive years, as it tends to reduce blood flow, a welcome relief if periods have become heavier in the run up to the menopause.

A GP is often the first person a woman turns to for medical care or advice for anxiety, depression or stress, including panic attacks, insomnia, chronic fatigue and general unhappiness.  Dr Judy McGonigal is here to listen and to consider your mental health and your feelings in the context of your life stage and lifestyle and any physical health problems you have.  As a family health specialist, Judy will ensure that the two of you work in partnership to find the right measures to help you enjoy improved moods and mental wellbeing.  She will arrange referral to a specialist if you and she believe that this is the right option.  TMCK has an exceptional team of Mental Health Specialists who are here to offer emotional support for women; the team includes female Psychiatrists, Counsellors and Psychotherapists.

Fertility testing can be carried out through our GP or Consultant Gynaecologist, Dr Talha Shawaf, who will monitor your fertility with the support of Ultrasound Specialists.  Tests include

• Sperm tests (count and motility)
• Hormone assessment
• Monitoring your menstrual cycle
• Checking your egg reserves
• Checking your fallopian tubes

Fertility treatment is tailored to your needs, ranging from minimal support through monitoring to hormone medication and assisted reproductive care using In-Vitro Fertilisation (IVF) or other techniques.  We know that trying for a baby and having medical fertility care can be very stressful; Counsellors at TMCK are here to support you individually or as a couple.  Nutritional advice and support can also play a major part in addressing fertility issues, so you will be pleased to know that TMCK is home to one of the UK's leading experts in the field, Dr Marilyn Glenville.

Do you know that heart disease now kills more women than men?  Do you know that here in the UK it is responsible for more than a third of all deaths?  Dr Judy McGonigal GP can provide an initial assessment of your cardiovascular risk level and give you advice on lifestyle and diet to reduce your risk of heart disease.  Smoking, poor diet, lack of exercise, high blood pressure, high cholesterol, excess weight, diabetes and a history of CVD in your family all increase the risk.  So it is important to get your heart checked and we recommend these checks for all women over 40.  If you prove to be at risk, Dr Judy McGonigal can refer you to Dr Ferruccio De Lorenzo Consultant Physician in Cardiovascular Disease Prevention and Lipidologist.  Our Consultant Cardiologist, Dr Piers Clifford, is available should there be any concerns or further tests are needed. 

A vaccination against strains of Human Papilloma Virus (HPV) is available for teenage girls and older women.  We have chosen GardasilTM as it offers protection against four strains of HPV.  Strains 16 and 18 are high risk and known to be linked to cervical cell changes associated with cervical cancer; strains 6 and 11 are associated with over 95% of genital warts.  The vaccine is more than 99% effective against these four strains and immunity has been shown to last at least 6 years.  There is no vaccine, however, to cover all causes of cervical cancer, so it is important to continue visiting your GP or Gynaecologist for regular cervical smears.  Vaccination offers most protection if given before you become sexually active; however it still offers protection if given later.

Going through the menopause can be an unpredictable and challenging time.  Common perimenopause and menopause symptoms include irregular periods, difficulty sleeping, hot flushes, mood swings, dizziness and problems with sex, including vaginal dryness or reduced libido.  Treatment is a personal issue.  Lifestyle changes and Hormone Replacement Therapy (HRT) are both commonly used, along with natural alternatives to HRT.  Dr Judy McGonigal can help you weigh up the pros and cons of the various options and discover what is right for you.  You can also see Ms Claudine Domoney or Dr Etienne Horner, Consultant Gynaecologists, both of whom have a special interest in hormonal imbalances and the menopause.  Dr Marilyn Glenville, Nutritionist, offers specialist advice to deal with this issue.

After the birth of your baby, our GP or Gynaecologist will carry out your 6 week postnatal check, and give you breastfeeding advice and further support as your body adapts to life after birth.  Your Doctor is here if you have any concerns about postnatal bleeding, uterus health, pelvic floor control, postnatal incontinence or breast pain.  You will receive advice about your weight and we are here to help if you are feeling blue, having difficulties bonding with your baby or are concerned about postnatal depression.  Physiotherapy will also be useful if you have reduced pelvic floor control or you are experiencing urinary leakage (urinary stress incontinence).  For your baby our Paediatrician, Dr Annie Claudel, offers developmental assessments, health checks and immunisations.

We will support for you throughout your pregnancy.  Consultant Obstetrician, Dr Etienne Horner, offers a full pregnancy + delivery package.  Tests in pregnancy ensure that you and your baby are staying well and enable us to target treatment or recommend preventative measures if there are any causes for concern.  Dr Horner will provide advice and investigation if you have problems such as pelvic pain, morning sickness, back pain or raised blood pressure.  He is also supported by experts in ultrasound scans.   Common concerns or issues include

• Advice On Birth  Including vaginal birth following caesarean (VBAC) and preparation for caesarean birth.
• Bleeding In Early Pregnancy  Spotting in early pregnancy can occur without any risk to baby or mother, but any bleeding should be investigated and, if appropriate, an ultrasound scan carried out.
• Developmental Assessment With Ultrasound  Early pregnancy scanning using transvaginal ultrasound and the 12-13 week pregnancy scan to check development and detect markers for Downs Syndrome (nuchal scan).
• High Risk Pregnancy  You will need expert Obstetric care when pregnancy is not straightforward, such as being diabetic and pregnant, overweight and pregnant, congenital uterine abnormalities and pregnant and, of course, twins.
• Pelvic Pain In Pregnancy  Advice for reducing pelvic discomfort and an assessment to rule out any underlying problems.

Your health affects your chances of conception and a healthy pregnancy.  And it affects your baby's development in the womb.  A PreConception HealthCheck with our GP or a Gynaecologist includes screens for infection, blood analysis, hormone checks and a nutritional review.  Further support from our Ultrasound Specialists includes menstrual cycle monitoring and uterine scans, and you may value counselling or psychotherapy if you are worried or feel anxious.  A female PreConception HealthCheck can, if you wish, be complemented by a male check, involving male hormone analysis and a sperm test, which measures quantity and motility.

A visit to your GP for Sexually Transmitted Disease Tests (STDs) may put your mind at rest before you start a new relationship or after contact with a new sexual partner.  If you are asking "What tests should I have for STDs?" Dr Judy Clayton will guide you.  Tests can be carried out for Chlamydia, Herpes, HPV (strains of human papilloma virus linked to cervical cancer), Gonorrhoea, HIV and Hepatitis.  She will also offer advice if you are having difficulties with sex.  Common problems include vaginal dryness, vaginal pain, bleeding after intercourse, low libido and difficulty reaching orgasm.  Consultant Gynaecologist, Dr Etienne Horner, offers specialist care for low libido (Hypoactive Desire Disorder) and Ms Claudine Domoney offers similar specialist care for psychosexual issues. 

A personal approach for teenagers from our private GP, Dr Judy Clayton, who will give you medical advice, with tests if necessary, and a space to talk and understand more about your health as a young woman.  Judy offers medical checks and advice for adolescent girls, in complete confidence, on

• Puberty and teenagers' menstrual problems including PMS and period pains
• Sexual health advice with Sexually Transmitted Disease tests
• Contraception
• Weight problems + eating difficulties
• Fatigue, anxiety and depression including problems with school and emotional difficulties at home

When needed, Judy can refer you to trusted Specialists for further support.

We view weight loss as a positive journey towards improved health in the long term, to enhance the way you feel about yourself and reduce the risks of problems related to excess weight such as diabetes, heart disease, joint problems, hormonal imbalance, infertility and PCOS.  Your Doctor will listen to your concerns and assess your weight and Body Mass Index (BMI) measurements.  Cholesterol checks are also available.  If you are overweight, you will be guided as you choose a weight loss and cholesterol management programme that's right for you.  Judy is also here to guide you if you are worried about being underweight or need support for an eating difficulty; and we have a team of Nutritionists at TMCK specialising in Women's Health and weight control.

It is often challenging to change eating habits or to make changes when a weight issue is linked with emotional problems.  For further emotional or psychological help Dr Nagore Benito and Dr Lalitha De Silva, both Psychiatrists, practice at TMCK as well as Professor Julia Buckroyd, who specialises in the psychology of eating.  Dr Judy Clayton is also trained to deliver the PronoKal Weight Loss Programme.