This page includes information about women’s pelvic health and links to other services that may be involved in care.
What is endometriosis? It is a condition where tissue similar to the lining of the womb is found in the pelvis, around the womb, ovaries and fallopian tubes. It can affect 1 in 10 women and can be hereditary. It can be a long-term condition and will usually affect women in the reproductive years. There is no known cause but is dependent on hormones, meaning that symptoms may be worse around the time of menstruation.
Symptoms – this includes pelvic pain and painful irregular periods. It can cause pain during sex and can lead to fertility problems. Some women have pain related to bowels or bladder, pain in the tops of legs or lower back, whilst others may not experience any symptoms.
Referral – If any symptoms occur, your first port of call should be your GP or Practice Nurse. They will take a history of your symptoms, with your consent, may perform a pelvic examination, may organise a transvaginal ultrasound scan (TVUSS) and referral to general gynaecology may be required.
Diagnosis – A transvaginal ultrasound scan (TVUSS) may detect endometriosis, in which case appropriate treatment can be discussed with either your GP or gynaecologist. If the TVUSS proves inconclusive and symptoms continue, you may be referred to have a gynaecological procedure, called a laparoscopy, as a day case. In some cases, this can be undertaken at a Powys Hospital. If this is not possible, you may be referred to a neighbouring Health Board for the same procedure.
Treatment – This can be pain relief, physiotherapy and in some cases referral to pain management specialists may be required. Hormone treatment may be offered and, in some cases, surgical treatment to remove endometriosis disease may be required.
Support and follow up – This is offered by Powys Teaching Health Board Endometriosis/Women’s Health Clinical Nurse Specialist and Gynaecology clinics, Women’s Health Physiotherapists, Continence Nurse Specialists, through GP’s and Practice Nurses. Initial contact to the Endometriosis/Women’s Health Clinical Nurse Specialist can be made by emailing firstname.lastname@example.org
For further information and support, refer to Endometriosis UK www.endometriosis-uk.org
National Institute for Health and Care Excellence (NICE) – Endometriosis: Diagnosis and Management: www.nice.org.uk/guidance/ng73
Royal College of Obstetricians and Gynaecologists (RCOG) https://www.rcog.org.uk/en/patients/patient-leaflets/endometriosis/
Fertility Network UK http://fertilitynetworkuk.org/uk
What is the menopause? The menopause occurs when eggs stop being released from your ovaries or if ovaries are removed. The amount of oestrogen hormone falls and periods stop. The average age for women to have their menopause is 51 years. However, menopause can start earlier for some women.
Symptoms – hot flushes, night sweats, vaginal dryness, low mood and anxiety, joint and muscle pains, loss of libido. Symptoms will vary for most women and some may be severe whilst others may not experience any symptoms.
Diagnosis – Diagnosis is usually made based on symptoms, on the absence of periods for one year after the age of 50 years or two years under the age of 50 years. Your GP or nurse may request hormone level blood tests but as hormone levels fluctuate a lot, this is usually only advisable in women under 45 years of age.
Treatment – Lifestyle changes, such as exercise and dietary changes, can help symptoms. As can reducing alcohol and caffeine and smoking cessation.
Some women find non-prescribed treatment help reduce symptoms. This can include herbal medication, alternative or complementary therapy – although the effects of these treatments are not well researched or known.
Cognitive behaviour therapy is sometimes offered for low mood or hot flushes.
Options for prescribed treatment include non-hormonal medication to reduce hot flushes, intrauterine devices containing hormones and/or HRT which is the most common form of prescribed treatment for menopausal symptoms.
Support and follow up – This is offered through GP’s, Practice Nurses, Gynaecologists, Powys Teaching Health Board Endometriosis/Women’s Health Clinical Nurse Specialist, Sexual Health Team, Women’s Health Physiotherapists, Continence Nurse Specialists.
Royal College of Obstetricians and Gynaecologists (RCOG) https://www.rcog.org.uk/en/patients/patient-leaflets/treatment-symptoms-menopause/
National Institute for Health and Care Excellence (NICE) https://www.nice.org.uk/guidance/NG23
British Menopause Society (BMS) https://thebms.org.uk/
Menopause Matters https://www.menopausematters.co.uk/downloads.php
What are periods?
A period is part of the menstrual cycle when a woman bleeds from her womb, though her vagina for a few days and. For girls, it is a sign that she is getting close to the end of puberty. Everyone is different but mostly this will happen around age 12 but anytime between age 10 and 15 years old is normal.
If a girl has sex, she could get pregnant as soon as periods start.
Why do periods happen?
Periods happen due to hormonal changes which cause the lining of the womb to build up in order for a fertilized egg to attach and develop into a baby. If an egg isn’t fertilized, the lining breaks down and causes a bleed – a period.
How often does a woman have a period?
Periods usually happen once a month but in the early years, they can be irregular but should settle within 2-3 years. The bleed lasts around 5 days but this could be shorter or longer for some girls and women.
Periods don’t happen during pregnancy and stop when a woman becomes menopausal, when aged 45 to 55 years old.
Some girls and women have painful periods and/or experience pre-menstrual tension, where they experience emotional and physical symptoms around the time that their period is due. These symptoms may only last a couple of days and could include moodiness, sadness, anxiety, bloating and cramps and acne.
How much blood and what problems to look out for?
The amount of blood loss is usually only around a teaspoon full of blood for the whole period. Some girls and women loose more which can be problematic. If a pad or tampon needs to be changed within an hour, if pain relief doesn’t help with cramps, lasts for more than one week, bleeding in between periods or they don’t regulate after 2 years of starting periods, then it is advisable to see a GP.
Which products to use?
Pads, tampons or menstrual cups are all available and finding a product which is suitable is part of understanding periods.
Most girls use pads when they first start having periods.
Some girls and women use tampons as they can be more convenient than pads for playing sport, exercising and whilst at school or work.
Some women use a small silicone cup which is inserted into the vagina to collect blood. This is called a menstrual cup and stays inside the vagina until it it removed and emptied.
Support and more information
More information can be found on
Bloody Brilliant, Mislif Fi, is a resource set up by the Women’s Health Implementation Group and is a resource for young girls to help them understand about and break the taboo around periods.
The team at the Pain and Fatigue Management Service provide help to people who want to live life more fully but are hindered in doing so by persistent pain or chronic fatigue including post-viral fatigue syndromes such as Post-COVID Syndrome.
Programmes have been run by the Health Board since 1994 and the multidisciplinary team have a wealth of experience of working with people for whom their health problems effect the physical, psychological and social aspects of their lives.
The service runs from a variety of locations throughout Powys. Currently, due to the COVID-19 outbreak services are primarily available via video conferencing and telephone although we do offer face to face appointments where appropriate and required. For accessing video conferencing our digital support team can be booked directly by service users, via clinicians and administrative services to support easy access to appointments.
People who access the Pelvic health service can be referred to the Pain and Fatigue Management Service by a clinician in the service or by a General Practitioner.
To find out more about the service please click on the link below -
Pain and Fatigue Management Service - https://pthb.nhs.wales/services/painandfatiguemanagement/