What I can help with

A prolapse happens when the supports of the womb, bladder or bowel weaken, and one or more of them bulge into the vagina. You may feel a lump, heaviness or a dragging feeling that is worse at the end of the day. It can also change how your bladder and bowel work, and it can affect sex.

A prolapse is not dangerous, and how much it bothers you matters more than how it looks on examination. The choices include doing nothing, physiotherapy, a vaginal pessary and surgery.

Pregnancy and birth put great strain on the pelvic floor. Some problems settle in the first months. Others do not, and they deserve proper attention.

• Leaking urine, wind or stool after birth
• Pain from a tear or an episiotomy, or pain during sex
• Recovery after a third or fourth degree tear (also called OASI)
• A feeling of heaviness or a bulge
• Advice on the safest way to give birth next time after a previous tear

This is the centre of my NHS work, where I lead the service for women with these problems.

• Heavy periods, painful periods or periods that are not regular
• Bleeding between periods or after sex
• Bleeding after the menopause, which should always be checked
• Fibroids, which are growths in the muscle of the womb that are not cancer
• Polyps of the womb lining or the cervix

An assessment usually includes an examination and an ultrasound scan. Sometimes a look inside the womb with a fine camera, called a hysteroscopy, is advised.

Hot flushes, poor sleep, low mood, joint aches, vaginal dryness and bladder symptoms can all be part of the menopause and the years before it. Good treatment starts with a careful talk about your symptoms, your health and what matters to you.

I can advise on hormone replacement therapy (HRT), on treatments that do not use hormones, and on vaginal oestrogen for dryness and bladder symptoms.

Endometriosis is a condition where tissue like the womb lining grows in other places. It can cause painful periods, pain during sex and pain in the pelvis that does not go away. Pelvic pain can also have other causes, and often more than one.

I offer assessment, scans, medical treatment and, where it will help, keyhole surgery to find and treat endometriosis. Women with severe or complex disease are best cared for in a specialist endometriosis centre, and I will arrange that referral when it is the right step.