What every woman. should know. about her body

Transcription

1 What every woman should know about her body

2 A woman s body: stats and facts Every year, around 16,000 women in the UK are diagnosed with a gynaecological cancer Millions of women experience period problems and many are too embarrassed to ask for help Severe PMS symptoms affect the lives of 1 in 20 women 10 per cent of women will have a hysterectomy by the time they re 60 While over 70 per cent of women experience some symptoms for a few years during menopause, most won t get all of them One in four pregnancies end in miscarriage in the UK, while around one in one hundred women suffer repeated miscarriages Always listen to your body and if you notice anything unusual speak to your doctor straight away. Waiting could cost you your life. How this guide can help you As a woman, your body has so many incredible things to do as you go through important stages of life such as puberty, pregnancy and the menopause. For many of us this journey is trouble-free, while for others it can be a tortuous ride. The fact is that over half of all women in the UK will experience a reproductive health problem during their lifetime. Many of them will choose to suffer in silence rather than visit a doctor because they are too embarrassed to explain the problem or too worried about what the outcome might be 1. Often they will endure months of pain and discomfort before they ask for medical help and by then drastic treatment may be the only solution. Yet, if they understood their bodies better, none of this would have to happen. Wellbeing of Women understands that every woman s body is unique and that it has its own way of telling you what it needs. We ve created this booklet to help you understand your body and what it s trying to say so that you can feel confident in getting the help you need sooner rather than later. your body is unique listen to your body 1 Wellbeing of Women Omnibus Research

3 Getting to know your body PITUITARY GLAND FALLOPIAN TUBE BLADDER OVARY UTERUS CERVIX Your vulva Your vulva is the external part of your genital area, and includes the mons pubis (the mound of fatty tissue overlying the pubic bone), the labia, clitoris and the vaginal and urethral openings (the urethra is the pipe that comes from the bladder). Many women experience discomfort or pain in this area at some time in their lives, which can interfere with your sex life and selfimage and cause a lot of distress. Your vagina Your vagina is the tube of skin that extends from the neck of your womb to the opening on the outside. The vagina receives the penis and semen during intercourse and also provides a passageway for menstrual blood to leave your body. It also plays an important part in the delivery of babies, as the lower part of the birth canal. RECTUM CLITORIS MONS PUBIS FALLOPIAN TUBES PUBIC BONE URETHRA VAGINA ANUS This is a side view of your reproductive organs (excluding the pituitary gland). Notice how these organs sit in relation to your bladder and rectum. LABIA MINORA LABIA MAJORA ANUS PREPUCE URETHRAL ORIFICE VAGINA CERVIX OVARIES UTERUS VAGINA OVARIES The female reproductive system is made up of seven organs, including the pituitary gland, which regulates the ovaries and various other glands. Your cervix Your cervix is the lower, narrow portion of the womb where it joins with the top end of your vagina. It is round in shape, sticks into the top of the vagina and it s possible to feel about half of it. 4 5

4 INFUNDIBULUM UTERINE TUBE FUNDUS UTERUS ENDOMETRIUM MYOMETRIUM FIMBRIAE OVARY CERVIX Your uterus Your uterus or womb is a muscular organ which is about the size and shape of a household light bulb in women who have never been pregnant. Its job is to house a fertilised egg while it develops. The main part of the uterus (which sits in the pelvic cavity) is called the body of the uterus, while the lower part is the cervix and the upper part is called the fundus. The fallopian tubes connect with the upper part of the womb. Your womb is made up of an inner layer known as the endometrium or lining of the womb. Once an egg is fertilized it burrows into the endometrium, where it will stay while it grows. Your uterus then expands during pregnancy to make room for the growing foetus. VAGINA PERIMETRIUM The part of the wall of the fertilized egg that has burrowed into the endometrium will develop into the afterbirth or placenta. If an egg isn t fertilised during your monthly cycle, the endometrial lining simply comes away as your period. The myometrium is the main part of your womb and is all muscle. It plays an important role during the birth, contracting rhythmically to push the baby through the birth canal (vagina) and out of the body. Your fallopian tubes Fallopian tubes are funnel-shaped passages next to the ovary that are about 10cm long. They have a number of finger-like projections known as fimbriae on the end nearest the ovary. When your ovary releases an egg it is caught by one of the fimbriae and transported along the fallopian tube. The egg is moved along your fallopian tube by the wafting action of cilia hairy projections on the surfaces of cells in the tube and the contractions made by the tube. It takes the egg about five days to reach your uterus and it is on this journey that fertilisation may happen if a sperm penetrates the egg and fuses with it. However, as an egg only lives for about 24 hours after ovulation, fertilisation usually occurs in the top third of the fallopian tube. Your ovaries Your ovaries are your main reproductive organs. You have two ovaries, each about the size and shape of an almond, and they have the crucial job of producing female hormones (oestrogens and progesterone) and eggs (ova). All your other reproductive organs are simply there to transport, nurture and otherwise meet the needs of an egg or developing foetus. Your ovaries are held in place by various ligaments that anchor them to the womb and the side wall of your pelvis. Inside each ovary are follicles, from which eggs develop. Once a follicle is mature, it ruptures and the developing egg is ejected from the ovary into the fallopian tubes. This is called ovulation. Ovulation usually occurs around the middle of the menstrual cycle, which is roughly every 28 days. The egg is released randomly from either your left or right ovary. 6 7

5 PITUITARY GLAND MEDULLA OBLONGATA PINEAL GLAND SPINAL CORD CEREBELLUM Common problems and what to do about them Here you ll find a list of some of the most common health problems that affect women, how to recognise them and what you can do to get yourself healthy again. Do bear in mind that just because you have a symptom it doesn t always mean you have a serious disease. What it does mean is that you need to visit your doctor quickly, to be on the safe side. Your pituitary gland This is a small gland at the base of your brain. It s in charge of releasing a variety of hormones that are vital for sexual reproduction. At the beginning of each menstrual cycle your pituitary gland produces follicle-simulating hormone (FSH) that encourages the growth of the follicles. After about six days one follicle will start to dominate the others and grow more quickly, whilst the others start to shrink. This follicle produces the principal female hormone oestrogen, which has effects on many tissues within the body and is very important to women s health. One thing oestrogen does is to cause the lining of your womb to thicken. Levels of oestrogen in the blood increase up to the time of ovulation (around day fourteen) while the follicle continues to grow. At this point, again in response to a second pituitary hormone (luteinizing hormone or LH), the follicle bursts (ovulation) and the egg is carried along the fallopian tube towards your uterus. The best way to avoid problems in the first place is to keep yourself as fit and healthy as possible, by doing things like eating a balanced diet, exercising regularly and managing stress. There is a lot of professional help out there for you too, so make sure you have regular cervical cancer smear tests, keep a record of any changes in your body and ask for medical help as soon you suspect something might be wrong. Itching and burning Irritation down below normally means you have a problem with your vulva. However, if it s accompanied by any other symptoms it could be something more serious. What causes it? Pain in your vulval region is usually due to infections of the vulva and vagina. It can also be the result of a gynaecological problem or environmental factors such as wearing tight or synthetic clothes. 8 9

6 10 Infections are the most common cause of vulval pain: Fungal infections can happen when things such as antibiotics, sexual intercourse or even menstrual periods alter the acidity of the sensitive area around your outer organs. This can cause an overgrowth of Candida, a fungus normally present in your vagina, and this condition is often called thrush. If the delicate skin of your vulva develops a candida infection it can cause pain or intense itching. Viral infections are often prompted by stress, ultra-violet light, emotional trauma, sexual intercourse or sometimes menstruation. The most common virus is HSV (herpes simplex virus). It s Type II of this virus that normally affects the vulva, although Type I (usually associated with cold sores) can affect it too. Shingles (also known as herpes zoster) happens when blisters form on the skin of your vulva. These blisters or vesicles usually appear on one side, burst, crust over and then heal without scarring. Bacterial infections affect the hair follicles or glands and cause small boils that produce mucus. The most commonly affected gland is your Bartholin s gland, which is situated just inside the lower part of your vagina. If it becomes infected it causes a painful swelling which can burst if not treated early. Wart virus infection or human papillomavirus (HPV) is caught through genital contact. If you get it, genital warts will appear at or around the base of your vagina, and they can take anything from three weeks to nine months to develop. These warts can be painful if they become very large or infected. Sub-clinical wart virus infection (which you can t see with the naked eye) can also cause pain, especially if you try to have intercourse or apply local pressure in any way. There are also gynaecological causes such as: Vulval cancer Pregnancy and childbirth Vulvodynia or vestibulitis (painful vulva) What can I do? Environmental causes include: Tight fitting clothing and synthetic materials If you re allergic to vaginal deodorant sprays or scented soaps Reactions to detergents used to wash clothes Poor genital hygiene (wiping from back to front) or excessive genital washing (scrubbing with soap) Most vulval problems will respond to simple measures such as avoiding soaps, bubble baths, perfume and soap substitutes like aqueaous cream. And you can wear loose fitting clothing and cotton underwear for a time. It s possible that you ve experienced soreness and irritation in the past, assumed they were caused by thrush and treated yourself. Although around 75 per cent of women experience at least one episode of thrush in their life, it doesn t always cause these symptoms. So if your symptoms don t respond to anti-thrush treatments or a change in clothing or hygiene, then do consult your doctor. In most cases you will be prescribed anti-fungal and mild steroid creams, antibiotics, laser treatment or chemicals like podophyllin for wart virus infections. If the pain persists then you will be referred to a specialist who will look at the area and may take a swab from your vulva or inside your vagina. Occasionally, a small sample may be taken, first by using a little local anaesthetic to numb the area and pinching off a small fragment of skin. This will be looked at under a microscope to try to find the cause of your discomfort. 11

7 Abnormal bleeding and discharges For most women, periods that cause mild discomfort or premenstrual irritability are a simple fact of life. However, some women will be affected by abnormal bleeding during their period and may suffer from: Heavy flow periods (menorrhagia) Long or frequent periods (polymenorrhoea) Infrequent periods (oligomenorrhoea) Dysfunctional uterine bleeding for most women with heavy periods no obvious cause can be found in the womb or in the production of hormones. This is known as dysfunctional uterine bleeding (DUB), a term often used by gynaecologists. Gynaecological cancer the most frequent symptom for most gynaecological cancers is abnormal bleeding during your usual menstrual cycle or if you bleed after menopause. Abnormal bleeding can also occur outside the menstrual cycle. If you notice you are bleeding between periods, after sexual intercourse or after the menopause it s wise to seek medical advice as soon as you can. Irregularities are not just about abnormal bleeding. If you notice a change or increase in your vaginal discharge there could be something wrong and you need to get this checked out. What causes it? You can experience abnormal bleeding for any of these reasons: Hormonal imbalance many things can upset the balance of your hormones such as stress, weight change, diet, exercise, chronic ill health, drugs and contraceptives. Benign diseases including polyps, fibroids, endometriosis, long-standing pelvic infection and intrauterine devices. Cancer of the lining of the endometrium (often called endometrial cancer) this is very rare in women before the menopause but can be found in younger women who suffer from polycystic ovarian syndrome. A change in your vaginal discharge will probably be caused by one of these infections: Trichomonas vaginalis (TV) this is a sexually transmitted infection (STI) and usually starts within a week of sexual contact. It causes large amounts of yellow or yellow/green frothy discharge and has a very characteristic fishy smell. It is easily treated with an antibiotic called Metronidazole (Flagyl). Bacterial vaginosis (BV) BV is the most common cause of vaginal discharge and affects around one-third of women. The discharge is off-white, creamy or watery and also has a fishy smell. It is caused by a change in the normal balance of bacteria in the vagina and is treated with metronidazole tablets or special vaginal creams. Candida, commonly known as thrush this causes a thick, whitish discharge, a bit like cottage cheese. It s associated with intense itching and painful intercourse and can be treated with a whole variety of tablets, creams or pessaries, many of them available from your local pharmacist. It is very important that your partner is treated at the same time, otherwise the infection will just be passed backwards and forwards between you

8 What can I do? You should consult your GP if you experience any of these symptoms, particularly if you are feeling pain as well. Your doctor will ask you a few questions about your health and symptoms before carrying out an external examination of your abdomen. If the symptoms are severe you will be referred to a gynaecologist who will examine your vagina to see if anything is wrong with the womb or if there is another associated disease. If no diagnosis can be found then you may have to have one or more of the following tests: Endometrial biopsy (sample of the lining of the womb) this will help rule out any problems with the endometrium and can be carried out in an outpatient department, without the need for anaesthetic Ultrasound examinations this painless procedure is usually done with a probe that is put in the vagina Telescopic examination a small camera is inserted through your vagina so the inside of your womb can be checked The treatments you re given will depend very much on the symptoms you are experiencing and the inconvenience or distress they are causing you. In most cases, simple lifestyle changes and drug therapy may be enough. Women affected by heavy periods may, depending on the cause, try a number of different treatments. The easiest is called tranexamic acid which can reduce your flow by as much as 50 per cent. These tablets are non-hormonal and you only take them when the bleeding is particularly troublesome. Hormonal preparations include the contraceptive pill, injections, implants and the intra-uterine hormonal system (Mirena). If these are unsuccessful then simple outpatient surgery may be considered. Years ago, if all else failed, the only option women had was to have a hysterectomy. These days, new developments have reduced the need for this major operation. Instead, a procedure called endometrial ablation removes the lining of your womb so that it can no longer grow. It is very successful but can only be used on women who have completed their family. Pain in the lower abdomen Most women experience pain or discomfort in the lower abdomen or pelvis at some time in their lives. Often it can appear suddenly and unexpectedly, or it may happen from time to time or continuously over a period of months or even years. What causes it? Pain brought on by ovulation Painful periods (dysmenorrhoea) Pain during pregnancy or miscarriage Ectopic pregnancy A twisted ovarian cyst Infection in the pelvis Endometriosis What can I do? Myofascial or trigger point pain, caused by torn fibres in the abdominal muscles Irritable bowel syndrome Cystitis Diverticulitis Crohn s disease Kidney or bladder stones When the pain is severe and appears suddenly, you should get urgent medical advice. If on the other hand the pain lasts a long time, you may not need to seek help urgently. However, it s important to go and get yourself checked out to make sure all is well and to prevent chronic pain affecting your quality of life. In either case it s a good idea to ask to see a gynaecologist who will be able to diagnose your condition. You may be treated with drugs, surgery and/or counselling to help clear up the underlying problem and relieve the pain you re in. Self-help groups can also play an important role

9 Going to the toilet frequently and leaking by accident If you need to go to the loo more frequently and you re not pregnant, chances are you have a problem with your bladder. The most common and probably most feared condition is incontinence. stress and urge incontinence What can I do? You should consult your GP for advice as soon as the symptoms become a problem as incontinence can usually be treated and cured, or at least considerably improved. What causes it? Stress incontinence anyone with this condition can leak urine during strenuous physical activities like coughing, laughing, sneezing and running. Stress incontinence is more common in women who ve had children where a damaged pelvic floor has led to bladder weakness. Urge incontinence if you have this condition you will pass urine very frequently throughout the day and often during the night. You ll need to get to the toilet in a rush and sometimes you ll start to pass urine before you get there. This is caused by an overactive bladder muscle or by urinary system problems and is most common among the elderly, although it can appear during the menopause too. Your doctor will ask for a urine sample, check it for infection, and perform a physical examination to see if you have a prolapse or enlarged uterus. A further examination may be required to check for inflammation, polyps or stones. The simplest treatment to strengthen your internal muscles is pelvic floor exercises. These are best taught by a physiotherapist or continence advisor, who can help you identify and strengthen your muscles. The exercises need to be continued on a long-term basis to have a lasting effect but up to 70 per cent of women benefit substantially with this treatment alone. In some cases surgery may be considered. Latest advances use supportive tapes, the best known being TVT (Tension-Free Vaginal Tape). Up to 85 per cent of women treated this way have reported being pleased with the result. pelvic floor exercises 16 17

10 Lumps Blood tests: full blood count, urea and electrolytes CA125 (this is a test if an ovarian cyst is suspected) Ultrasound scan X-ray Finding a lump in your abdomen can be frightening, but the majority of causes are easily treated. Any organ in the tummy can give rise to a lump and in many cases, once the cause has been identified, no further treatment is needed. What causes them? If you are referred to a gynaecologist they may consider an: Ultrasound scan (sometimes internal) Endometrial biopsy (sample of the lining of the womb) Hernias Very full bladder Chronic constipation Fatty lump (lipoma) Fibroids Pregnancy Ovarian cysts Endometrial or ovarian cancer MRI scan (special if it is difficult to see the important areas on an ultrasound scan) If your GP doesn t think the cause of your lump is gynaecological, you may be referred to another specialist, such as a gastroenterologist (bowel doctor), urologist or nephrologist (bladder and kidney doctor) or bowel surgeon. However, the doctor may be able to identify the cause so referring you on may not be necessary. indentification and treatment The treatment you receive is very much dependent on the cause of your condition but can either involve: follow-ups by a hospital doctor or GP to monitor the problem; medication; or surgery. What can I do? It s best to contact your GP who will refer you to a specialist gynaecologist if they think you may have a gynaecological problem. Your doctor may arrange some initial investigations, including: The information above was written by Peter Bowen-Simpkins, FRCOG, Medical Director at the London Women s Clinic

11 Glossary Contraceptive A device or drug that prevents pregnancy occurring. Crohn s disease A disease that affects the bowel, bringing symptoms such as diarrhoea with blood and mucus, accompanied by weight loss. It s not known what causes it. Cyst A fluid-filled swelling that can be benign or cancerous. Ovarian cysts may be very large. Cystitis Cystitis literally means inflammation of the bladder but is a term commonly used to describe an acute infection, irritation or damage to the bladder. Diverticular disease (Diverticulitis) Diverticulitis is a common disease of the bowel, in particular the large intestine. Ectopic pregnancy A pregnancy that doesn t form in the uterus where it should instead it implants itself outside the womb, usually in one of the two fallopian tubes. It can be dangerous and must be treated in hospital. Endometrial ablation An operation in which heat, electric current or laser destroys the lining of the womb. Endometrial biopsy Insertion of a thin tube into the womb to obtain a sample of the lining of the womb. Endometriosis A condition in which the endometrium or lining of the womb grows elsewhere in the body, usually the pelvis. Fibroid A benign (non-cancerous) lump in, or on the wall of, the womb. Hernia A condition in which an organ or body part, such as the intestine, protrudes through an opening in the body structure that normally contains it. Hysterectomy The removal of the uterus (womb), usually including the cervix. Hysteroscope A thin telescope used to inspect the womb lining. Hysteroscopy An investigation of the womb using a hysteroscope. Intrauterine devices These are flexible contraceptive devices with a plastic frame, around which copper wire or tiny copper sleeves are fixed. A trained doctor or nurse inserts the device into the uterus. Irritable bowel syndrome A combination of common bowel problems such as diarrhoea or constipation, accompanied by abdominal pain and, sometimes, psychological stress. Lymph node Any of the small bodies located along the lymphatic vessels, particularly at the neck, armpit, and groin that filter bacteria and foreign particles from lymph fluid. If infected, lymph nodes may become swollen with lymphocytes. Miscarriage The loss of a pregnancy before the baby is able to survive outside the mother s womb, usually before the pregnancy has reached 24 weeks. Menopause The stage when ovaries cease to produce hormones, which results in a woman s periods stopping. Menstruation The shedding of the lining of the uterus, usually once a month, often after the menstrual period. MRI scan A medical examination performed with a Magnetic Resonance scanner or an image obtained by examination with an MRI scanner. Oestrogens A group of female hormones, produced by the ovaries, including oestradiol. Ovarian cancer A cancer that begins in the ovaries. Pelvic floor The term pelvic floor refers to the group of muscles that form a sling or hammock across the opening of a woman s pelvis. Polyp A small benign (non-cancerous) swelling of the lining of an organ, such as the womb or gut. Polycystic Ovary Syndrome (PCOS) Polycystic ovary syndrome (PCOS) is a hormone imbalance that can cause irregular periods, unwanted hair growth, acne and obesity. Premenstrual Syndrome (PMS) A group of physical and psychological symptoms that start between two and fourteen days before menstruation and are relieved with, or soon after, the onset of menstruation. Mood changes and swings are the most prominent features. Progesterone A natural hormone secreted by the ovary that plays an important part in the control of periods. It is produced as a result of ovulation. Prolapse The descent of the female pelvic organs through the pelvic floor. The uterus and/or vaginal walls, having lost their supports in the pelvis, are allowed to drop when standing or straining. STI This is an abbreviation of Sexually Transmitted Infection. Thrush The common name for an infection caused by a yeast-like fungus known as Candida albicans. Ultrasound High frequency sound waves used to detect shapes and movements inside the uterus. Vulvodynia or vestibulitis Chronic pain of the vulva. What we re doing to help protect women s health Wellbeing of Women currently funds a wide range of research into all aspects of reproductive health and helps pay for the training of young doctors and nurses in this area too. Here are just a few of the projects we re working on to help improve women s health and wellbeing. Discovering new treatments for gynaecological cancer This year, Wellbeing of Women awarded 118,878 to researchers to carry out two years of ground-breaking research into gene therapy, using viruses like the common cold (adenovirus) to infect and kill cancerous tumors. To prevent the virus from being destroyed by the immune system, it is coated with polymer so that it works as a stealth virus. It can then enter the tumor undetected, where it replicates and destroys the cancer cells. The project is still in the early stages but has great potential. If the trials are successful, this innovative approach could form a third primary cancer treatment, alongside radiotherapy and chemotherapy, but without the associated side effects. Improving quality of life We ve enabled researchers to carry out a long-term study into the effect of childbirth on women s pelvic floor muscles. Since 1993 researchers have been following a group of women to discover how childbirth affects their pelvic floor. In 2000 they discovered that almost three-quarters of the women had developed a pelvic floor disorder (including incontinence and early signs of prolapse) after giving birth. New funding by Wellbeing of Women will enable them to look more closely at the impact of childbirth and other factors, such as caesarean section and forceps delivery, on a woman s pelvic floor muscles. This is the longest and largest ongoing study of pelvic floor dysfunction in the world and will lead to new methods of preventing pelvic floor disorders in women after childbirth

12 Preventing miscarriages Wellbeing of Women is currently funding research into the genetic causes of recurrent, unexplained miscarriage. Over the course of a year, 200 couples attending St Mary s Recurrent Miscarriage Clinic in London will be asked to provide blood samples for genetic analysis. For the first time, researchers will be able to see how combinations of paternal and maternal immune system genes can determine whether a pregnancy is likely to succeed. This could help identify which women are most at risk of recurrent miscarriage, and help with the development of new drug therapies for at-risk women in early pregnancy. Investing in tomorrow s experts Every year Wellbeing of Women help over ten medical and midwifery students with our Student Elective Bursaries to encourage them to pursue a career in women s health when they re qualified. The bursary enables students to travel abroad and experience working in reproductive and gynaecological healthcare as part of their university course. In 2006, Ajay Sanghvi was awarded 1,000 to contribute to and learn about healthcare provision in rural Tibet. He helped implement some basic healthcare programmes including hygiene and nutrition. He also managed to identify the top ten illnesses and the appropriate interventional resources required to deal with them. This is what he has to say about his experience: Can you give 20 to help us create better health for women? As you can imagine, the leading edge medical research and training we fund is very expensive. It costs over 100,000 to fund laboratory costs for three years. Unfortunately there are no short cuts. Each answer we discover throws up yet more questions. It costs time and money to answer them. Every year, due to lack of funds, Wellbeing of Women has to turn down three out of every ten grant applications, any one of which could provide a breakthrough. Our charity receives no Government funding we are entirely dependent on the generosity of people like you. With your help, Wellbeing of Women could support many more research projects. Success comes from the commitment and dedication of a team made up of scientists, doctors, Wellbeing of Women and you. So please, will you make a donation of 20 today and help us ensure that more women get the most out of life? Thank you. We really integrated ourselves into the Tibetan way of life and spent time with traditional Tibetan doctors to understand their practises. By understanding what the common complaints were and the medical needs of the community, we were able to pass on what we have learnt to the next year of students so they were better equipped and carry on the work we have done. Ajay Sanghvi 22 23

13 Discovering more to life We re passionate about women s wellbeing Wellbeing of Women is the only UK charity dedicated to solving the health problems that affect women by funding medical research and training into all aspects of reproductive health. Over the past 40 years we have invested over 27m to fund the very best in medical research and training, resulting in some remarkable progress. In fact, every woman living in the UK since 1964 will have benefited from advances in healthcare made possible by Wellbeing of Women. Half of all women in the UK still experience a reproductive health problem during their lifetime, be it trouble conceiving, intensely painful periods or gynaecological cancer. Wellbeing of Women is the only charity dedicated to changing this by funding medical research that will benefit these women and the professionals who diagnose and treat them. Wellbeing of Women is committed to transforming women s health. Yet, despite our best efforts, we still receive more research grant applications than we are able to fund. With your help, we could support more research projects and together discover solutions that will enable women to get more out of life. Thank you. While every effort is made to ensure accuracy, neither Wellbeing of Women nor the RCOG can be held responsible for the validity of clinical treatments or medical statements made. Wellbeing of Women 2007 Wellbeing of Women 27 Sussex Place Regent s Park London NW1 4SP Tel: Fax: [email protected] Royal College of Obstetricians and Gynaecologists Working in partnership with the Royal College of Obstetricians and Gynaecologists to improve women s health. Charity Registration No: