Vulva La Revolution

Welcome back to part two of Women's Health with Dr. Tamara Hunter of the WOOM Clinic. This episode, we're gonna focus a bit more on pain. You see, girl, a lot of girls come in with pain quite a lot. What are the symptoms that they're actually walking into you? How are they describing that?

You mean pelvic pain?

Yeah.

Yeah. Oh, that's such a Pandora's box.

Let's open it.

Yeah,

pain, pelvic pain. It's probably the most common presentation I have with adolescent girls anywhere between sort of 10, 11 years of age right up to young adult women.

10, 11, 12, that seems so young.

Yeah, yeah. And sometimes pelvic pain can be from the very first period, sometimes even before the actual period starts. Um, right through their very tumultuous teenage years, right through to their young adulthood. And there are so many possible differential diagnoses that you really have to consider. I think a theme that I often hear from mum, who often comes in with teenage girls, is um, and I had it today, um, I just felt not heard, I feel gas gaslit.

Yeah.

So I think it's really important to validate that even if there is nothing pathologically wrong, they have pain.

Yep. And their pain's real.

And and their pain's real and their quality of life is suffering.

Yeah.

And we want every teenage girl to reach her potential, you know, to have every opportunity to go where she wants to go in life. And if every month she has pelvic pain, that means she's going to the nurse, that means she's staying home from school, that means she's not participating in sport or drama or music, that's affecting her ability to relate to her friends, that's compromising her quality of life. So we have to address it.

So, in answer to your question, how do they present? Often it's complaining of painful periods. Yep. But more often than not, if that goes unchecked for months to years on end, it becomes pain at other times in the cycle, it becomes pain that wakes her at night time. It can be pain that radiates down her legs, around her back. Sometimes she starts to complain of IBS-like symptoms and bloating. Sometimes then there's pain with passing a bowel motion or even urinary urgency, pain with using tampons. And that's often how I see it play out, all depending on what else is happening in her life and also how long she's been trying to manage this with simple analgesia.

Yeah.

Uh on that note, a lot of girls of our generation were told, you know, take two panadol and get on with it.

Yeah.

Why is it so important for young women to trust in their own experiences of pain and advocate for themselves when something just doesn't feel right?

We know it takes on average seven years to diagnose endometriosis. And we know that there is increasingly uh endometriosis being diagnosed in adolescence. Is it that it's becoming more prevalent? No. I just think that we are now jumping on to the experience of pain in girls much earlier and offering diagnostic surgery much earlier.

Yeah.

So you want to rule out endometriosis or you want to identify it and treat it and then prevent it throughout the rest of her reproductive years. So put in place some sort of management strategy for her future reproductive health. So it is really important for us to jump on it much quicker than we have in the past. Even if there's not endometriosis present, because pain itself can become pathological, we call that neuropathic pain or a pain syndrome, if left unchecked, it's really hard to then manage

it. And it's a multidisciplinary team. So the way that I would describe it is imagine putting your hand on a hot stove, and you know what would normally happen. You'd take your hand away, and then your brain would go, ouch. So that's your body's way of saying, danger, danger, Will Robinson, take your hand away. It's that neural arc.

Yep.

Imagine having pain every month, month after month, and the nerves are so wired that they start to experience other things such as a bow motion, just a normal passing a poo, it hurts. Or your gut pushing food through, that becomes a painful experience. So all of a sudden, your nervous system starts to interpret normal physiological function as being painful. That's where the pathology is then in the nervous system, and we have to treat that, and you need to use medications specifically for neuropathic pain. But not only that, you've got your brain that's jumping in on this as well, and there's the danger Will Robinson. So all of a sudden, anxiety increases, sleep becomes disturbed, when you lack of sleep, you can't concentrate, you can't function well, which further implicates so you can see how all of a sudden a pain syndrome becomes this whole body experience, all because someone told you to take two panadols for your periods. When in really they should have been saying, hey, how about you we give you something that's actually going to either stop your periods or make them lighter, or have you skip them through the school term so you only have to have them during the holidays? All of these strategies help to manage long-term experience of pain.

Um, those

sound like amazing strategies, and I do want to talk about those strategies, but I want to go back to you talking about endometriosis and the seven years that it takes. If a girl is 13 years old and presenting with pain, that means she's 20 before someone either believes her with a diagnosis or what is endometriosis?

Yeah. Endometriosis is the growth of the similar tissue to the lining of the womb that you know that you shed.

Yep.

Except it's outside the uterus. So it's in the pelvis. So it's around the ovaries or around the bowel, on what we call the peritoneum, which is kind of like the glad wrap that lays over everything inside your tummy.

Okay.

We don't know how it gets there. We've been studying it for decades. One of the theories is that when you have a menstrual bleed, some of it goes back through the tubes. It's called retrograde menstruation, goes back through the tubes and then implants into the peritoneum and then and then grows there. Where the pain comes from is every time your lining bleeds, this stuff bleeds as well. And blood is irritating, and that's what causes pain and scarring.

Okay. And how do you diagnose that?

Surgery.

That's the only way to diagnose it.

That is the gold standard for diagnosis, is you need to take a sample. The only way you can take a sample is stick a camera in the belly button. We call that keyhole surgery. And take a sample of this tissue, send it off to the lab, and the lab goes, oh yeah, that's endometriosis. Some girls have it so bad that over years, years and years of periods every month, that these lesions have grown bigger and started to deeply infiltrate into the surrounding tissues, maybe around the bladder, maybe around the bowel. And so you can see that kind of disease on an ultrasound. But the vast majority of superficial disease you can't see, so you have to do a

laparoscopy.

And then what happens when you get diagnosed? How do you treat the pain?

Yeah, surgically. So most people who'll get laparoscopic diagnosis will have treatment at the same time. Yeah. And there are various treatment strategies. You can either cut these lesions out or you can diathermise them, burn them. But the big thing, and I think this is where only over the last few years are we starting to improve our care, is surgeons are doing the surgery and then sitting down with the patient and saying, This is a disease that's going to continue to come back every time you have a menstrual cycle. We need to prevent that to preserve your long-term pain, but also prevent infertility. And so putting them on some sort of long-term hormonal suppression like the pill, like a marina IUD, is going to protect them and their future reproductive health.

And what happens if you put them on the pill and the IUD? How does that counteract that period every month? Yeah.

So if we know how contraception works, it kind of has a little bit of estrogen and a little bit of progesterone in it that feeds back to the brain that says, oh, there's enough around, you don't need to ovulate. So it turns ovulation off. So therefore, you're not producing the big swings of estrogen that make this stuff grow. Remember, it makes the lining grow, so it makes this stuff grow as well. How a mirena works is a mirena is an IUD that contains progestogens. And we know progesterone or progestogens suppress these lesions.

Yeah, that's right.

So it stops them growing back.

Okay. And then there's no egg that that is released either, then if it stops all of that.

Yeah, which is a problem if someone's trying to conceive.

Yeah, of course. Of course. So you get off of you would stop taking the pill

And try and conceive, yeah.

Yep. And is there a problem conceiving if you've got endometriosis?

Some people can. So 40% of women who present with infertility are diagnosed with endometriosis.

Okay. So quite a bit.

Yeah. And weren't discovered way back when they could have been.

Of course. Adenomyosis

Now I my after I had kids, I had a C-section um horrific periods afterwards, and I was diagnosed with adenomyosis. I'd never even heard of it.

Yeah.

So what is it?

Yeah, well, look, it's probably been around forever. But it is the growth of the same lining tissue, but within the wall of the uterus. So within the muscle. So the uterus is a big muscle bag. And this stuff invaginates into the muscle. And again, every time the lining bleeds, this stuff bleeds as well. Causes pain, causes heavy periods. Again, we don't know why it goes there. Women who've had cesarean sections, it seems biologically plausible that maybe we're pushing some of those cells from the lining into the wall. So you do see an increased incidence in women who've had cesarean deliveries. However, what about the woman who's never had a cesarean?

Yeah.

We know that in that decade of life, 40 to 50 years of age, is the most prevalent time of adenomyosis diagnosis.

Really?

Many women present post-children in their late 30s with painful heavy periods. They get a scan. Oh, look, you've got adenomyosis. But we think that it's probably been over that decade that they've been growing it. The only reason we're so good now is because we've got ultrasound with such good resolution. Yeah, it's amazing. It's just an advance in our technologies for investigation. Yeah, but

you think this has been going on for decades.

Yep. Um you talked earlier about PCOS and how the name has changed a little bit. Um it's probably one of the most talked-about conditions that I have heard about in women's health um over the last you know decade or so. The WHO estimates that 70% of affected women with PCOS are undiagnosed and that it affects one in eight women in Australia. That's a massive amount. And again, what is it?

So the name has changed really recently, like within the last few months. And I'm gonna be a bit controversial here and say I'm I'm not really supportive of the name change.

Okay.

I never liked the first name because I think that it takes us off course as to what the disease process is. So firstly, let's talk about the old name, polycystic ovarian syndrome, PCOS. The name is it it indicates that it's a syndrome, which means a syndrome is a cluster of features. And so PCOS has often irregular periods. It might be that a girl has a period once every couple of months instead of once every month. And that might vary over time. She will often have either physical features of high levels of male hormones, so that might be bad acne or excess hair growth. And she will often have features of the metabolic syndrome as well. So often she might be a bit insulin resistant, might carry a little bit of extra weight. So weight loss is difficult. And then on an ultrasound, she'll have lots and lots and lots and lots of follicles or cysts on the ovaries.

Okay.

Where I think there is a lot of misunderstanding is a lot of girls will come and see me and go, Oh, I've got all these cysts on my ovaries, like they're bad. But in fact, they're just the follicles that contain ovaries that contain eggs. Like it's completely normal. In fact, the silver lining to having PCOS is that you are blessed with lots of eggs.

Okay.

You've got lots of follicles, so you've got lots of eggs. Okay. The menopause, interestingly, a bit off track, but the menopause in a woman with PCOS tends to be later.

Ah, that makes sense.

She's got more eggs. Yeah. So I think they wanted to change the name because of the polycystic thing. The fear of a lot of people come in and say, Oh, I've got really bad ovary pain, I must have PCOS. Pain is not a feature of PCOS at all. It's not part of the diagnostic criteria, it's not part of the syndrome at all. Can you develop cysts? Yes, anybody can develop cysts and have a bleed into a cyst which causes pain, but that's not particular to PCOS.

Okay.

So they thought they'd change the name. Because it intersects with metabolic syndrome, which is uh another syndrome, a cluster of features of insulin resistant and weight gain and high blood pressure and bad cholesterol. About 40% of women with PCOS will also have metabolic syndrome. They've kind of merged it all together. And that's why it's called polyendocrine metabolic ovarian syndrome.

It's quite a mouthful.

It's a mouthful, but it also detracts from the fact that this is a predominantly ovarian syndrome.

Yep. Not a metabolism.

Yeah, it's not a it's not a syndrome of metabolism. There are a lot of girls out there, often called lean PCOS, where they don't have the issues with high cholesterol and obesity and insulin resistance. They just don't have periods.

Oh, okay.

And you do a blood test, and oh look, your androgens are high and your LH, which is another one of those hormones, is elevated, which is very pathognomonic of polycystic ovarian syndrome. And you ask about their family history, oh yeah, I my mum had PCOS, and you know, my grandma, she had diabetes, and you can see that there is this genetic component through the families. So I don't love the new name. I'll go with it. Because who am I really to say? But but I do think that it's not gonna make it any easier to understand.

Yeah.

Is there a genetic link between your grandmother, your mother, and you and what what your um what your female reproduction looks like and behaves like?

Generally across the board?

Yeah.

Uh so we know women with endometriosis, they have a seven times increased incidence if there is a family member. Uh, we know women with PCOS often have a family history of PCOS or even diabetes in their family, particularly down the maternal line. So we know that there is both a nature and a nurture component to that disease as well. Often menopause will happen at about the same time as your family history. So if there is a woman who's going through menopause in the early 40s or even late 30s, if you ask a family history, often mum will have gone through menopause early as well. Because there's probably a genetic component to it. So, yeah, definitely there is, and that's why taking a family history is so important. Find out what mum did, what dad's mum did to see if you can see any links with your health.

Oh, yeah. I never even think of dad's mom.

Yeah.

Um doctors have spent decades telling women that they have PMS, um, and an overwhelming amount have got now PMDD, which I didn't also know about. So premenstrual dysphoric disorder. Yeah. So um, Oxford has done the most rigorous study to date in 2024 and estimated that 1.6 of the women, or 31 million worldwide, have had confirmed cases. Um how does PMDD differ from PMS?

So PMS premenstrual syndrome. So again, it's a syndrome, it's a cluster of features. So often there are physical changes, it might be something like breast tenderness or bloating, weight gain, um, and psychological features such as change in mood, change in appetite. These symptoms will occur in that week or two weeks from ovulation to the menses, to the beginning of the period. At day one, when that period happens, symptoms terminate. If mood and all of those things persist through the period, that's not PMS and it's not PMDD. So you have to you have to define the period of time. And the reason PMS happens is because you're getting the drop in or the change in the hormones, sort of the high oestrogen, high progesterone, and then it drops. And it's the change in hormones that leads to the PMS symptoms. And that's good. Everything normalises once the period starts. PMDD is actually a psychiatric diagnosis.

Okay.

It's defined in the DSM, which is the diagnostics statistical manual that psychiatrists utilise for criteria for different psychiatric conditions. The key difference is again, it'll be in that one to two weeks from ovulation up into the period. It terminates um within the first day of the menses. Yeah. But the key feature is extreme mood change to the point of suicide or suicidal ideation.

Oh, wow.

Yeah

it's quite severe.

Quite severe. Yeah. And um it is really important to get onto it. It is really important, again, no gaslighting. It is really important to identify and treat as soon as possible because there is that risk of suicide.

Yeah, which is terrifying. Um you talked about ovarian cysts and how it's not necessarily a bad thing. Um

fibroids seem different.

Completely different.

Completely different?

Yeah.

Um, how do they form?

Yeah. So fibroids are tumours of smooth muscle. So they are in the wall of the uterus. Yep. By virtue of being smooth muscle, that's what the uterus is, a muscle bag.

Yeah.

And these are little circular, think of them like marbles that form within the wall of the uterus. And they can form in lots of different positions. So they can form adjacent to the lining, they can span the thickness of the uterus, and sometimes they can even poke out on the surface of the uterus as well. And we have a certain classification system. They can grow really big. Um, I saw a woman just the other day whose fibroid was the same size as her uterus. So six centimetre fibroid, six centimetre uterus. So they can get really big. Again, the problem, much like adenomyosis, is that when the uterus is contracting to expel the blood, it can't contract against these hard tumours. And so women will often experience painful heavy bleeding. You'll do a scan and you'll see a uterus with lots of fibroids in it. There are ethnic differences. So African-American women, um, 80 plus percent of them will have fibroids.

That's a massive amount.

It's a massive amount, yeah. Um, whereas fibroids are not as common in an Asian population.

Yeah.

But they're super common. They can go hand in hand with adenomyosis. So a woman can have both. Interestingly, they're more commonly linked to fibroids than they are to endometriosis, even though adenomyosis. The same tissue as endo, so that messes with your head a little bit. But yeah, fibroids are they grow very slowly. They grow under the influence of hormones, particularly oestrogen. So they grow really quickly in pregnancy.

Oh yeah.

Um they're a problem.

They can grow in pregnancy alongside a baby in the uterus.

And sometimes they grow, uh, they outgrow their blood supply because they're growing so quickly that they start to break down on the inside. And so that can cause severe pain in a pregnancy.

Yeah, but how do you get rid of a fibroid?

You can't really. Yeah, you just you you well, surgery. So again, you tend not to see them or see women presenting with fibroids until they're in their sort of third or fourth decade.

Yep.

Uh, often when they've completed their family. So more often than not, we're having discussions around how about we just take the whole uterus out? Hysterectomy. Particularly if there's multiple fibroids. It they can cause issues with fertility. And so there's a pro and con discussion about whether or not you would try and do a big cut into the uterus to take out the fibroid and stitch the uterus back together. But I tend not to see them in women in their 20s and definitely not in their teens.

Um, and then if you had a fibroid, because they're estrogen-driven, right? Would being on the pill or having an IUD or some sort of contraception that releases estrogen, would that be a good idea?

Look, great question. I wish the answer to that was yeah. It helps, but we haven't seen it help. The only time fibroids really regress is during the menopause.

Okay.

When they're devoid of any further stimulation. But they never disappear.

Okay. That's good to know. Um,

two conditions that I had never heard of. Um, and I'm probably gonna butcher the names. Vulvodynia

Vulvodynia?

Vulvodynia, thank you, and vaginismus.

Vaginismus. You got one.

thank you.

And and you can have vulvo vagin vulvovaginitis, you can have vulvodynia and vaginismus. You you can have any combination of the two or three.

What are they?

Yeah, they're pain conditions. Pain more pain conditions. They're pain conditions, yeah. So vulvodynia is an exquisite pain in the vulva. And often a girl will present with it hurts to use tampons or it hurts to have sex. Um, the way that we diagnose it is with a cotton tip. So I will pop their legs up into stirrups, um, and I'll use a very gentle cotton tip, and I'll just map out around the vulva. And at some point, a girl will say, That really hurts. It's like electricity, it's burning, and yet I'm using a really soft cotton tip. So it's this out of um pain that is um not in association with the level of stimulation that they're receiving. Difficult to manage.

Yeah, okay. And now, um, is that a hormone-driven thing as well, or that's completely different? That's just anatomy.

Uh, it's not even necessarily anatomical. It is often more psychosocial overlay. Yeah. So they may have had uh sexual abuse, um, there may have been trauma as a young child, um, they may have had a difficult medical experience in the past.

Yep.

Um, there are lots of things that aren't really associated with the anatomy that cause vulvodynia.

But possibly trauma-related?

Yeah. In more often than not cases, if you delve deeper deep enough, you'll find trauma. and vaginismus, just to complete that. Vaginismus is not so much pain, although it is painful, but it's actually an involuntary contraction of the pelvic muscles. So that if you can imagine trying to insert a tampon or a penis going in the vagina against tight, tight muscles, it's going to be painful, isn't it?

Yeah, of course.

So the vaginismus is an involuntary contraction often in association with vulvodynia or pain.

Okay, so that you said they can both overlay.

Correct. So you can have a vaginismus that then leads to vulvodynia because it's been painful and then they develop this pain syndrome, or vice versa.

Yeah.

And so the best friend of someone with vulvodynia or and or vaginismus is actually a pelvic floor physio.

Really?

Yeah, amazing. They are just the best.

That's fantastic.

So they're women's physios that have trained in this area. Often the therapy is vaginal dilation, massage, relaxation techniques, understanding how the pelvic floor works.

Amazing.

Can achieve miracles.

Great.

Um, if a teenager goes to her GP with period pain, is dismissed or is told it's normal, what can she say so that she's heard appropriately?

Flippantly, I would say go out to the front desk and book in with someone else. But in that moment, I think it's really important for her to advocate for herself and say, Thank you for your opinion. However, I'm not coping, I would really uh appreciate it if you could institute some investigations. Or if this is not your area of expertise, please refer me to someone who is.

Very mature response.

Yeah. But it is difficult. You, you know, when you're sitting in a GP or any doctor's office, there's a power play that is in place there.

Yeah.

And it is very difficult for a young woman, but any woman, to say to a medical professional, I'm really sorry, but you're not listening to me. But I think you you have an opportunity to say, hey, let's, I know you're running late, I know there's 10 other people waiting out there, but I'm not coping. And if this is not your area of expertise, please send me to someone who whose area it is. Because some some GPs don't do women's health. Um, and you know, it's better just to not it's better for them just to be able to send you to someone who does.

This is gonna be controversial, and I'm not even sure they should be asking it, but do you think that women come up against this gaslighting more with male doctors than they do with female doctors?

Yeah, it is controversial, isn't it? Um, I wish I could say that with a case, but I've I've as commonly seen some women gaslight women.

Yeah.

I I don't necessarily think that it's a professional thing. It's often that there's other stuff going on.

Yeah.

You know, they might have a clinic of 60 patients to see, they might have a lost a patient with a a you know, a long history, had a bad outcome in a surgical experience. So I they might not like their job.

Yeah.

So often it's not really their profession, it's whatever else is going on for them.

Yeah, that's I think that's good to know.

Y eah.

what's the connection between chronic pelvic pain and mental health?

It's intimately related.

Yeah.

Hugely related. Any chronic pain, whether it's pelvic pain, whether it's shoulder pain, you put up with it for long enough, it's gonna get you down.

Yeah.

For sure.

It's gonna affect your quality of life.

Totally. Yeah, totally. You wake up in pain, you go to bed in pain. Like your quality of life is poor. And pain is never just here, go and take a couple of panadols and it'll be right. Pain is is complex and it is multidisciplinary. So there is this amazing guy. His name is Professor Lorimer Mosley. Cool name. He is a professor of pain and he has done research looking at the education of people around pain. And what he's found is if you teach people about how pain works in their body, you can actually reduce their experience of pain. So their visual analog score, which could be 10 out of 10 pain, can be reduced to five out of 10 just by teaching them how pain works in the body. Amazing.

Amazing.

Boom.

Education.

He's created all of these online resources for people to educate them around pain. So I would, I don't know, in your podcast

we'll put it in the show notes.

Yeah, put it in the show notes. Um, so when I see someone with pelvic pain, I give them those resources, I send them off to my pelvic floor physio, I talk to them about mindfulness, I give them some um relaxation apps that I've found really beneficial. Yes, we talk about how best to manage the pain medications. I also talk about medications specifically for neuropathic pain. And then I might talk about do we do surgery or do we put you on the pill? But all of and I talk to them about psychology and the importance of cognitive behavioural therapies, but I cannot manage someone's pain just by putting them on the pill or taking them to surgery. I have to get them to engage with all of this other stuff.

It's amazing because it makes like the take two panadol and like get on with it, like listening to you and all that you're doing for these young women who come in with pain. Like, that's amazing. And we have just been told for so long, yeah, like here's m mask it, you'll be fine.

Again, I think we're getting better.

Yeah.

And I think the endometriosis movement probably has helped this. There are now multidisciplinary medical centres around Perth, The Garden is the one of them, uh, where they have government funding to set up multidisciplinary services in one site.

It's amazing.

So I think we are getting better, but it's only because of advocacy.

Yep. Well, and doctors like you who are doing all those types of things for your patients.

We try.

Yeah. Good. So we've Questions from the Panel

got questions from some young girls for you.

Great.

How heavy is too heavy with my period? Give me something measurable because normal means nothing when I have nothing to compare it to.

That's so true. I, it's really hard for me to answer that question because everyone's norm is different. Yes. But if if you are struggling to get through your day, so if you're changing a pad every hour, if you're having to excuse yourself from class every hour to change a pad, if you are not participating in activities, dance, swimming, sports, music, drama, if you're avoiding those things because you've got your period, if you're taking time off school because it's too much for you, you're scared of the blood leaking out onto your uniform, um, you're going to the shop at the end of every week because you're having to replenish. That to me is too heavy. No one is going to measure their blood loss.

No.

But it's about experiencing clotting, it's about experiencing leaking, it's about experiencing having to lug your bed sheets down to the laundry once a month to, you know, all of those experiences to me is a period that is difficult to manage and therefore should be managed.

Clots are normal?

Clots are an indication of fast bleeding.

Okay. Is it the body trying to

Well, you're just bleeding off the blood. Yeah, exactly. So for me, a blood clot can be the size of a what a five cent coin? Or it can be the size of a 50 cent coin, or it can be the size of a palm.

Wow.

The bigger they are, the more of a problem we've got.

Yeah, that's good to know. Um, is it true that you can sync cycles with your friends?

No, that's rubbish. Mothers come in and see me all the time, oh yes, we've synced ourselves in the house. I'm like, really? I mean, there's probably, I don't know, 25% chance you're gonna get it right.

That's true. You only have so many days of the month, yeah. Um I get pain so bad I throw up from it. My mom says she was the same, so it's genetic. Is that true?

I don't think it's genetic, but it's again part of this body protection. So when some women have speculum examinations, some women have pap smears, um, some women have pain, there's this reaction, this reflex in the body called a vasovagal. And that is where you drop your blood pressure, therefore you stop putting brain your blood up to your brain, therefore you feel nauseous and often vomit and pass out, and you feel all sweaty as well. So vomiting is just a stress response to a degree of pain. Yeah. So it says to me, Oh, this is really painful, you're vomiting from this. Yeah.

Yeah. Um I told my doctor about my pain, um, and he told me that I'd grow out of it. What do I say next time? So he takes me seriously.

Again, I'd go out to the front desk and book in with someone else.

Yeah.

Um, quite seriously. I think pain is not not something that you grow out of. In fact, if anything, if it's left unchecked, it can get way worse. So if you are in that moment and you like that doctor and they've helped you, I think it's really important to advocate for yourself and just say, I appreciate I might grow out of it, but I'm trying to deal with it now. What can I do now?

Yeah. Is it normal to hurt? Not during my period, but randomly throughout the month.

Some girls experience ovulation. They actually feel ovulation and it can be a bit of a moment, one side or the other, left or right. Um sometimes when the corpus luteum, where you ovulate from, collapses, you can get some bleeding. That can also be painful. In fact, I've had many girls present to the emergency department with severe pain that lasts a few hours and then goes. And they're like, What was what the hell? What was that?

Yes, it's ovulation.

It's it's ovulation or it is a hemorrhagic cyst. Um, they are physiological things. Um, if it keeps happening, I'll often talk to them about maybe you might like to go on the pill and stop that Um, but you know, pelvic pain, it could be bowel, it could be bladder, it could even be musculoskeletal, um, because through the pelvis run the big less muscles to the legs, and so you might even get musculoskeletal um injuries that present as pelvic pain.

I have heard, I want to um possibly bust a myth with you that I have heard, um, and I'd like to know if it's true, I've heard that your ovary can reach around to the other side if your tube can reach to your ovary.

Yeah, yeah. So there's a really great study that was done, I can't even remember, it was published a while ago now, where a woman had lost one tube due to an ectopic pregnancy. So the tube was gone, but the ovary was still on that side, and then on the other side she had a tube and ovary. 30% of them fall pregnant with only the one tube. Even if they're ovulating from that other side. Yeah, so there are chemicals produced by the ovary and also by the tube that attract them to each other. It's called chemoattraction. So, yeah, it can happen.

That's why the female body is a credible.

Yep. That's why we're a better species.

I would agree. Okay,

we've got to go rapid fire. So your options are yes, no, or it's complicated. Feel free to um to extend on the it's complicated or on any of them. Um, if you're on a contraception that skips your period every month, that's completely fine.

Totally fine.

Normal to not have your period.

Normal to not have your period. The only reason a period was ever put in the contraceptive pill was to let girls know they're not pregnant.

Great. It's normal to feel genuinely anxious or low in the week before your period.

Yes, that can be normal, but if it's pathological, then that's not normal.

Yep. It's important to take a mirror to your vulva and see what your anatomy looks like.

Yes, do it.

Um, correct me if I'm wrong, you can get skin cancer or a melanoma in your vulva.

Yep.

Should your for your skincare check who who's checking that area for you to make sure that you don't have any

So general practitioners can specialise in skin.

Yep.

So if you're gonna get a proper skin check, go to go to a general practitioner. Um or go to a dermatologist. Um I see a dermatologist. Yeah, and my dermatologist makes me strip off. And we have a look at everything. But you're right, you're probably not gonna whip off your undies for your dermatologist unless you've noticed something.

Yeah.

So again, this is another reason why, you know, there are bits down there, and it's not just the lady bits, it's also the back passage as well you might want to have a look at.

Yeah, good. Um, irregular periods in teenagers are okay because your body is still working its hormones out.

For the first two years post to post the first period, you can have irregular cycles. After that, it should be regular.

And all the way up until you start perimenopause?

Yeah.

Yeah, right. Okay, good to know. Discharge is something to be worried or embarrassed about.

Depends how much. I think. I think if again, if it's affecting quality of life, go and speak to someone who knows and they can talk you through whether you need swabs done.

Yep.

Um, but yeah, if it's if it's troubling you, talk to someone about it.

Yeah, but discharge is normal for

it can be normal.

Yeah. You can miss a period due to stress or over-exercising.

Yes, you can.

It's okay to get a second medical opinion.

It's always okay.

PCOS means you'll have a hard time getting , getting pregnant.

Not always. Um, if you have a regular period, even though you've got PCOS or PMOS, you can still fall pregnant.

Endometriosis can only be confirmed through surgery.

Yes.

Pain during sex is something you just get used to over time.

No, sex should never be painful.

Good to know. If your mom had bad periods, you will too, and there's nothing you can do about it.

No, that's not true.

Good. Um, What Dr Tamara Hunter wants teens to know

and last question: if you could go back and tell your teenage self one thing about this topic, what would it be and how long did it take you to find it out?

We're very good at telling teenagers about contraception. We're not very good at talking to them about fertility. And it wasn't till I was 37, even though I'm an obstetrician gynaecologist, it was not till I was 37 that I really stopped to think about that ticking clock. So for me, it would be make sure you learn about the reproductive cycle and fertility as much as you learn about contraception.

Yeah. We're always taught how to prevent pregnancy, but we're not taught how to how to do it, how to get pregnant.

Yeah.

Will you come back and talk to us about fertility?

Of course.

Amazing. Thank you so much for being here. This was incredibly informative for me.

Good.

Um, and I know our audience is gonna love it. Thank you so much.

Fantastic, my pleasure.

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