Five experts, five tips: How to maintain good reproductive health

Dr Aisling Loy

Genito-urinary medicine consultant at St James’s Hospital and Himerus Health

Young people don’t often link their sexual behaviour to their future fertility but two of the most common sexually transmitted infections (STIs) – Chlamydia and Gonorrhoea – are associated with sub-fertility in women and occasionally in men.

Genital herpes is another common STI and although incurable, it can be managed in pregnancy with medication to significantly reduce any risk to the baby at birth. Telling your obstetrician about any past infections is therefore important.

The most common misconception regarding STIs is that “you would know if you had one” but most STIs are asymptomatic. Testing and treatment for STIs are very straightforward. Many GPs offer it, as well as public and private sexual health clinics such as the GUIDE clinic at St James’s hospital or Himerus Health.

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The way to reduce risk is to use barrier protection, such as condoms. Regular testing if you are changing sexual partners is important. If you are establishing a long-term monogamous sexual partnership, get tested together before throwing away the condoms.

Dr Hugh Donal O’Connor

Obstetrician and gynaecologist who co-runs the new public clinic for endometriosis at the Coombe Women’s Hospital, Dublin

Endometriosis affects about one in 10 adult women. It results in tissue similar to that in the lining of the uterus (womb) growing outside the uterus on the bowel, bladder or ovaries. It causes painful periods or pain during sexual intercourse and can make it difficult to conceive.

Endometriosis can be suppressed with hormonal medication such as the intrauterine coil or the contraceptive pill. It can be removed with keyhole surgery but usually requires long-term medical management and surveillance.

Ovarian cysts, the majority of which are benign, are another common issue which usually resolve themselves without intervention. A cyst may be asymptomatic or else present with pain on one side of the pelvis. Ovarian cysts can be confirmed or ruled out with an ultrasound scan. Cysts which persist can be removed with keyhole surgery.

Polycystic Ovary Syndrome (PCOS) is another common problem which results in light and infrequent periods, often without ovulation taking place. An ultrasound will reveal lots of small cysts and blood tests may show excessive testosterone activity. Oestrogen-blocking drugs are prescribed to woman with PCOS who want to become pregnant.

Dr Catherine Riordan

Fertility specialist at the Bray Women’s Health Centre

The most important factor in fertility is age. The quality of women’s eggs falls significantly from the age of 35 onwards and the quality of male sperm declines from the age of 40 onwards. This can mean that older couples will take longer to conceive and there are increased chances of miscarriage or having a baby with a genetic abnormality.

Keeping a healthy diet, weight and exercising regularly increases the chance of conception, a healthy pregnancy and a healthy newborn baby. Smoking, excess alcohol and recreational drugs can reduce sperm quality. Anabolic steroids and testosterone can stop sperm production. No supplement can compensate for a poor lifestyle and there is little evidence to support the use of expensive fertility supplements.

Women trying to conceive should take a folic acid supplement and be aware that it can take up to 18 months for fertility to return after the contraception injection, Depo Provera. Conception can occur immediately or within a couple of months after stopping any other form of contraception.

If a woman is under 35, unless the couple has a specific medical worry, there is no need to have any investigations done until they have been trying to conceive for about 12 months without success. Those over 35 might seek advice if they don’t conceive after six months of trying. When couples fail to conceive easily, the woman often shoulders the “blame” but in 50 per cent of cases the problem lies at least partly on the male side.

Dr Shay Dezayi

Gynaecologist at the Menopause Hub and Beaumont Hospital

The menopause marks the end of a woman’s reproductive years, at about age 51. When ovulation ceases, oestrogen, progesterone and testosterone decline. After 12 consecutive months without periods, a woman is post-menopausal.

The peri-menopausal years (from mid-forties onwards) are when the physical, psychological and genito-urinary symptoms begin.

Classical physical symptoms include hot flushes and night sweats, but some women also experience weight gain, insomnia, headaches, heart palpitations and musculoskeletal aches.

Psychological issues may include anxiety, depression, mood swings, irritability, and poor focus. The genito-urinary problems typically include vaginal dryness, painful sex and loss of libido, with worsening of any previous urinary incontinence. Four in five women have symptoms during the menopause and these can be severe for one in four of these.

Maintaining a healthy weight, eating nutritional food and exercising daily all help. Giving up smoking and limiting alcohol consumption will also benefit. Some women opt for hormone replacement therapy in consultation with their doctor, and/or referral to specialists may be needed if symptoms continue.

Post menopausal women are at greater risk of heart disease and osteoporosis.

Sheilah Broderick

Clinical nurse specialist in Gynaecological Oncology

Cancers that develop in a woman’s reproductive system are known as gynaecological cancers. These cancers can have devastating impacts on a woman’s sexual well-being, her ability to conceive, her body image, her relationships and work life.

Cancer of the uterus (womb), ovaries, cervix (neck of the womb), vulva, vagina and fallopian tubes account for about 1,300 new cancer diagnoses in Ireland each year. Treatments include surgery, chemotherapy, radiotherapy, endocrine (hormone) therapy, targeted therapies and immune-therapies.

Awareness of the signs and symptoms is important as treatments are most effective when cancer is detected at an early stage.

Women should talk to their GP if they have any of the following symptoms; post-menopausal bleeding, abnormal vaginal bleeding before the menopause such as unusually heavy or irregular periods, bleeding between periods, vaginal spotting or unusual discharge, bleeding after sex. Unexplained weight loss, constant tiredness and/or persistent abdominal pain/bloating or increase in size of the abdomen, loss of appetite and feeling full quickly, change in bowel or bladder habit and persistent lump/ itch, pain or skin discolouration of the vulval skin can also be symptoms of a gynaecological cancer. The human papillomavirus (HPV), hereditary predisposition to womb or ovarian cancer (eg BRCA 1/BRCA2, Lynch syndrome), obesity, hormone replacement therapy, smoking, diabetes, endometriosis, immune-suppression can increase the risk of some gynaecological cancers.

A healthy diet, quitting smoking, exercising regularly, engaging in the HPV screening programme run by Cervical Check and ensuring teenage girls and boys avail of the HPV vaccine offered in secondary school are all ways to reduce the risk of getting a gynaecological cancer.

Five experts, five tips
- GPs
- Heart health
- Musculoskeletal
- Digestion
- Respiratory health
- Urological health
- Reproductive health