Endometriosis affects around 1 in 10 women. Tissue similar to the womb lining grows outside the uterus — on ovaries, fallopian tubes, bowel, and bladder. It responds to hormones each cycle, causing inflammation, scarring, and often severe pain.

Symptoms: Painful periods (dysmenorrhoea), pain during sex (dyspareunia), pelvic pain throughout the cycle, painful bowel movements or urination during a period, fatigue, and difficulty conceiving.

Treatment: Hormonal suppression (combined pill, progestogen-only pill, Mirena IUS, GnRH analogues — e.g. Prostap), laparoscopic surgery (excision or ablation of deposits), pain management (NSAIDs, co-codamol). There is no cure — treatment manages symptoms.

PCOS affects 1 in 10 women and is the most common hormonal condition in women of reproductive age. Diagnosis requires 2 of 3 criteria (Rotterdam): irregular/absent periods, raised androgens (clinical or biochemical), polycystic ovaries on ultrasound.

Features: Irregular or absent periods, acne, excess hair growth (hirsutism), thinning scalp hair, weight gain, difficulty conceiving. Long-term risks include type 2 diabetes and endometrial cancer (due to unopposed oestrogen from irregular cycles). Management: Combined pill (regulates cycle, reduces androgens), metformin (insulin resistance), lifestyle (weight loss restores ovulation in many), clomifene or letrozole for fertility.

Defined as blood loss ≥80mL per cycle, or bleeding that significantly impacts quality of life. Common causes: fibroids, adenomyosis, PCOS, endometrial polyps, or no identifiable cause (dysfunctional uterine bleeding).

Treatment options (NICE CG44): First-line — Mirena IUS (most effective medical treatment). Also: tranexamic acid (reduces loss by ~50%), NSAIDs, combined pill, norethisterone. Surgical options: endometrial ablation, myomectomy (for fibroids), hysterectomy.

PMS affects up to 40% of women — physical and emotional symptoms in the luteal phase (days 14–28) that resolve with menstruation. PMDD (Premenstrual Dysphoric Disorder) is a severe form causing disabling mood symptoms. Management: SSRIs (continuous or luteal-phase dosing — first-line for PMDD), combined pill (Yasmin/Eloine — drospirenone-containing), CBT. Referral to specialist PMS clinic if severe.

The NHS Cervical Screening Programme uses HPV primary screening. A sample of cells is taken from the cervix (smear). If high-risk HPV is detected, the sample is checked for abnormal cells. If HPV is not found, no further action is needed until the next routine screen.

HPV not detected: Routine recall at next screening interval — no further action.
HPV detected, no abnormal cells: Repeat smear in 12 months.
HPV detected + abnormal cells (CIN1/2/3): Referred for colposcopy.

CIN grading: CIN1 — mild changes, often clear spontaneously (watchful waiting). CIN2 — moderate changes, usually treated. CIN3 — severe changes (pre-cancer), always treated. CIN is NOT cancer — it means cells that could potentially develop into cancer if left untreated.

Colposcopy is a closer examination of the cervix using a magnifying instrument. A biopsy may be taken. Treatment for CIN2/3: LLETZ (Large Loop Excision of the Transformation Zone) — removes abnormal tissue under local anaesthetic, takes ~15 minutes. LLETZ is both diagnostic and curative in most cases. Follow-up smear at 6 months post-treatment, then annual for up to 10 years depending on result.

The NHS HPV vaccine (Gardasil 9) is offered to all Year 8 pupils (aged 12–13). It protects against HPV types 16, 18 (cause ~70% of cervical cancers), 31, 33, 45, 52, 58, and types 6 & 11 (genital warts). Vaccination does not replace screening — vaccinated women must still attend cervical screening.

NHS breast screening is offered every 3 years to women aged 50–71. Mammograms detect cancers too small to feel. Around 1 in 25 women screened are recalled for further assessment — most of these do NOT have cancer. Recall for further imaging (ultrasound, magnification views, biopsy) is not a diagnosis.

Women at higher risk (family history, BRCA gene) may be offered annual mammograms and/or MRI from age 30–40, arranged via a Familial Breast Cancer clinic.

BRCA1 and BRCA2 are tumour suppressor genes. Pathogenic variants significantly increase lifetime risk: BRCA1 — ~72% lifetime risk of breast cancer, ~44% ovarian cancer. BRCA2 — ~69% breast cancer, ~17% ovarian cancer (also increases male breast and prostate cancer risk).

Management options: Increased surveillance (annual MRI/mammogram), chemoprevention (tamoxifen or raloxifene), risk-reducing mastectomy (~90% risk reduction), risk-reducing salpingo-oophorectomy (also reduces ovarian cancer risk). Genetic counselling is offered before and after testing.

Breast cancer is the most common cancer in the UK — around 1 in 7 women will be diagnosed. Most (80%) are oestrogen-receptor positive (ER+) and respond to hormonal treatment (tamoxifen, aromatase inhibitors). Survival has improved dramatically — 85% survive 10+ years. HER2-positive and triple-negative cancers require targeted treatments (trastuzumab/Herceptin, chemotherapy).

Check breasts monthly — look and feel for: a new lump or thickening (especially if only on one side), change in size, shape, or outline, skin changes (dimpling, puckering, redness), nipple changes (inversion, discharge, rash), or pain in one area. Report anything new to your GP promptly — don't wait for your next screening appointment.

Non-cancerous growths within the muscle of the uterus. Found in up to 70% of women by age 50, though most cause no symptoms. More common in Black women (who also tend to present at a younger age with more severe symptoms).

Symptoms: Heavy/prolonged periods, pelvic pain or pressure, urinary frequency, bloating, fertility problems (depending on location). Treatment: Watchful waiting (if asymptomatic), Mirena IUS, ulipristal acetate (Esmya — note MHRA restrictions), uterine artery embolisation (UAE), myomectomy (removes fibroids, preserves uterus), hysterectomy.

The endometrial tissue (womb lining) grows into the muscle wall of the uterus. Causes a bulky, tender uterus. Symptoms mirror endometriosis: heavy painful periods, pelvic pain throughout the cycle. Often coexists with endometriosis. Definitive diagnosis is histological (from hysterectomy), though MRI is highly suggestive. Management: Hormonal suppression (Mirena IUS most effective), GnRH analogues, or ultimately hysterectomy.

Most ovarian cysts are functional (related to the normal ovulation cycle) and resolve spontaneously within 1–3 months. Persistent, large, or complex cysts require further assessment.

Risk of malignancy index (RMI) guides management. Benign-appearing cysts <5cm in premenopausal women: repeat ultrasound in 3 months. Suspicious features (solid areas, septations, bilateral, ascites): urgent 2-week wait gynaecology referral. Emergency: Sudden severe abdominal pain may indicate ovarian torsion — go to A&E immediately.

Affects up to 1 in 3 women. Includes: stress urinary incontinence (leaking on coughing/sneezing/exercise), urgency incontinence (overactive bladder), pelvic organ prolapse (bladder, uterus, or bowel descending into the vaginal canal). Treatment: Pelvic floor physiotherapy (first-line for most), bladder training, pessaries (for prolapse), surgical repair. Pelvic floor exercises (Kegels) are effective if done correctly — a physiotherapist can assess and teach proper technique.

AMH (Anti-Müllerian Hormone): Indicates ovarian reserve (the pool of remaining eggs). Can be measured at any point in the cycle. Low AMH suggests diminished reserve — relevant for IVF planning. Does not predict ability to conceive naturally.

Day 21 progesterone: Confirms ovulation has occurred (level >30 nmol/L is considered ovulatory in a 28-day cycle — adjust for cycle length).

HSG (Hysterosalpingography): X-ray with dye to check the uterine cavity and fallopian tubes for blockages. Performed as an outpatient procedure. Some women find it painful — take ibuprofen beforehand.

In-Vitro Fertilisation (IVF) involves: ovarian stimulation (gonadotrophin injections, ~10–14 days), egg collection (under sedation), fertilisation in the laboratory, embryo culture (3–5 days), and embryo transfer (fresh or frozen). NHS funding criteria vary by CCB/ICB — typically offered to women under 40 after 2 years of trying, up to 3 cycles.

Success rates (HFEA 2022): Under 35 — ~32% live birth rate per embryo transfer. 35–37 — ~25%. 38–39 — ~19%. 40–42 — ~11%. 43–44 — ~5%.

Start folic acid 400mcg daily at least 3 months before trying to conceive (5mg daily if previous NTD, on antiepileptics, diabetic, or BMI >30). Stop smoking and limit alcohol. Review all medications with your GP — some are teratogenic (methotrexate, warfarin, ACE inhibitors, valproate). Achieve a healthy BMI (19–30) if possible — obesity significantly reduces fertility and increases pregnancy complications. Ensure rubella immunity is confirmed before conception.

1. Ovarian stimulation (10–14 days): Daily self-injections of gonadotrophin hormones stimulate the ovaries to produce multiple follicles. Regular monitoring scans and blood tests track progress. The dose may be adjusted as you respond.

2. Egg collection: Done under sedation or light general anaesthetic. A fine needle guided by ultrasound passes through the vaginal wall to aspirate follicles. Takes 20–30 minutes. Cramping and spotting are normal afterwards. Rest is advised for the remainder of the day.

3. Fertilisation: Eggs and sperm are combined in the laboratory (IVF) or a single sperm is injected directly into each egg (ICSI). The lab will call the next day with a fertilisation report. Not all eggs will fertilise — this is normal.

4. Embryo development: Embryos are cultured for 3–6 days. Many clinics culture to blastocyst stage (day 5–6) as this allows better embryo selection. Not all fertilised eggs will reach blastocyst — further attrition at every stage is expected and normal.

5. Embryo transfer: One (or occasionally two) embryos are placed in the uterus via a thin catheter — similar to a smear test. No anaesthetic needed. Remaining suitable embryos are frozen (vitrified) for future use.

6. The two-week wait: The hardest part for most people. Progesterone support (pessaries, injections, or gel) is taken to support implantation. A pregnancy test is taken 9–14 days after transfer. This period can be intensely anxious — this is a completely normal response to an incredibly high-stakes wait.

IVF: Eggs and sperm are placed together in a dish and fertilisation happens naturally. Used when sperm quality is sufficient and there are no fertilisation failure concerns. ICSI: A single sperm is selected and injected directly into each egg using a micro-needle. Used for male factor infertility, previous fertilisation failure, low egg yield, or frozen/surgically retrieved sperm. ICSI does not improve pregnancy rates over IVF when sperm quality is normal — it is not automatically "better."

NICE guidelines recommend up to 3 full cycles of IVF on the NHS for women under 40 who have been trying to conceive for 2 years (or 12 failed IUI cycles). Women aged 40–42 may be offered 1 cycle if certain criteria are met. In practice, NHS funding varies enormously by ICB (Integrated Care Board) — some areas fund 3 cycles, others fund 1 or none.

A frozen embryo transfer (FET) using embryos created during a funded cycle is usually also funded. Check your local ICB policy or ask your GP for a referral to a fertility clinic for a funding assessment. Fertility Network UK (fertilitynetworkuk.org) provides up-to-date local funding information.

OHSS occurs when the ovaries over-respond to stimulation — fluid leaks from blood vessels into the abdomen. Mild OHSS (bloating, mild discomfort) is common and self-limiting. Severe OHSS (breathing difficulty, severe abdominal pain, reduced urination, rapid weight gain) is rare but serious — seek urgent medical attention.

Risk factors: PCOS, previous OHSS, young age, low AMH (paradoxically — very high response possible), large number of follicles. In high-risk women, clinics may freeze all embryos (freeze-all cycle) and transfer in a later natural or medicated FET cycle — this completely prevents severe OHSS.

A negative IVF result is a genuine bereavement — not an overreaction. The grief is real, the loss is real, and the physical and hormonal crash after a failed cycle is real. There is no right way to feel. You do not need to "stay positive" or "stay strong." Allow yourself to grieve.

Miscarriage after IVF is not more common than natural conception — the rates are similar. But it can feel more devastating when so much effort, money, and hope went into getting there. The Miscarriage Association (miscarriageassociation.org.uk, 01924 200799) offers support specifically for loss after fertility treatment.

Support resources: Fertility Network UK (fertilitynetworkuk.org) — patient charity, forums, local groups. Infertility Network UK helpline: 0800 008 7464. The Fertility Counsellors Register (BICA) can help find a specialist fertility counsellor. Many clinics offer counselling as part of treatment — you are entitled to ask for it.

Embryos can be stored for up to 55 years under UK law (extended from 10 years in 2022 — HFEA amendment). Annual storage fees apply — typically £200–£400/year at private clinics. NHS clinics may cover storage costs during the funded treatment period.

Important: You will be asked to renew consent annually. If you do not renew, the clinic must contact you before taking any action. Keep your contact details up to date with your storage clinic. If your relationship status changes (separation, divorce), both partners' consent may be required to use the embryos — discuss this with your clinic in advance.

Combined screening (11–14 weeks): NT ultrasound + blood tests (PAPP-A, free beta-hCG) — calculates risk of trisomy 21 (Down's), 18 (Edwards'), and 13 (Patau's). A high-risk result (typically >1:150) is offered diagnostic testing.

NIPT (Non-Invasive Prenatal Testing): Analyses cell-free foetal DNA in maternal blood. Highly accurate (>99% sensitivity for T21) but is a screening test, not diagnostic. Available via NHS (England 2023) following high-risk combined screening result, or privately.

Diagnostic tests: Amniocentesis (16+ weeks) or CVS (chorionic villus sampling, 11–14 weeks) — give definitive chromosomal diagnosis but carry ~0.5–1% miscarriage risk.

Pre-eclampsia: High blood pressure + proteinuria after 20 weeks. Symptoms: severe headache, visual disturbances, epigastric pain, sudden oedema. Can progress to eclampsia (seizures) — medical emergency. Women at high risk are offered aspirin 150mg daily from 12 weeks.

Gestational diabetes (GDM): Glucose intolerance first identified in pregnancy. Diagnosed by OGTT (oral glucose tolerance test) at 24–28 weeks if risk factors present. Increases risk of macrosomia, shoulder dystocia, stillbirth. Managed with diet, metformin, or insulin. Usually resolves after birth — but increases lifetime T2DM risk.

Obstetric cholestasis: Liver condition causing intense itching (especially palms/soles) without rash. Raised bile acids — increases risk of stillbirth. Managed with ursodeoxycholic acid; elective delivery usually offered at 37 weeks.

Epidural: Most effective pain relief — local anaesthetic infused into the epidural space. Requires anaesthetist. May slow labour and increase instrumental delivery rate. Gas & air (Entonox): 50% nitrous oxide/oxygen — takes the edge off, no effect on baby, but can cause nausea/dizziness. Diamorphine/pethidine: IM opioid — may cause nausea and can affect baby's breathing if given close to delivery (reversed with naloxone). TENS: Electrical stimulation — works best in early labour. Warm water/pool: Effective for pain and relaxation in established labour.

Around 1 in 4 confirmed pregnancies end in miscarriage — the majority in the first 12 weeks. Most are caused by chromosomal abnormalities in the embryo and are not caused by anything the parent did. After 3 or more miscarriages (recurrent miscarriage), NHS investigation is offered.

Management options: Expectant (wait for natural passage), medical (misoprostol pessaries), surgical (ERPC — evacuation of retained products of conception, under general anaesthetic). All are equally safe — choice depends on gestational age, medical history, and personal preference.

Medical emergency if ruptured. The fertilised egg implants outside the uterus — usually in a fallopian tube. Symptoms: one-sided pelvic pain, vaginal bleeding, shoulder tip pain (if internal bleeding). Ruptured ectopic causes collapse — call 999. Treatment: methotrexate injection (if unruptured, hCG <3000, no fetal heartbeat), salpingostomy or salpingectomy (surgical, laparoscopic). One previous ectopic increases risk of recurrence to ~10%.

Defined as loss of a baby at or after 24 weeks gestation. Around 1 in 250 pregnancies in the UK. Causes include placental problems, infections, fetal abnormalities, and umbilical cord complications — in many cases, no cause is found. Reducing movement should always be reported promptly — never wait until the next day. Bereavement support is available via SANDS (stillbirth and neonatal death charity) — 0808 164 3332.

Menopause is confirmed after 12 consecutive months without a menstrual period. The average age in the UK is 51. Perimenopause (the transition) typically begins 4–8 years before the last period. Over 30 symptoms have been identified — including vasomotor symptoms (hot flushes, night sweats), psychological symptoms (anxiety, low mood, brain fog), and genitourinary symptoms (vaginal dryness, UTIs).

Premature Ovarian Insufficiency (POI): Menopause before age 40 — affects ~1% of women. Requires HRT until at least the average age of menopause (51) to protect bone density and cardiovascular health, regardless of symptoms.

Oestrogen protects bone density. After menopause, bone loss accelerates — women can lose up to 20% of bone density in the 5–7 years after menopause. Osteoporosis (T-score ≤ −2.5 on DEXA) significantly increases fracture risk.

Prevention: HRT (most effective in early menopause), weight-bearing exercise, calcium (1000mg/day from diet), vitamin D (400–800IU/day). Treatment: Bisphosphonates (alendronate 70mg weekly — first-line), denosumab, raloxifene, romosozumab. DEXA scan offered to high-risk women — use FRAX tool to estimate 10-year fracture risk.

GSM (formerly called vaginal atrophy) affects up to 50% of postmenopausal women and does not improve without treatment — unlike vasomotor symptoms, which may ease over time. Symptoms: vaginal dryness, soreness, painful sex, recurrent UTIs, urinary urgency. Treatment: Vaginal oestrogen (pessaries, cream, ring — e.g. Vagifem, Estriol cream, Vagirux ring) is safe even for most women who cannot take systemic HRT, including many breast cancer survivors. Can be used long-term.

The risks of HRT were significantly overstated by the 2002 WHI study (which used oral conjugated equine oestrogen + medroxyprogesterone acetate). Current evidence (NICE NG23, BMS guidance) shows that body-identical HRT (transdermal oestradiol + micronised progesterone/Utrogestan) carries no increased risk of VTE and a significantly lower (possibly neutral) breast cancer risk compared to older synthetic progestogens.

Transdermal oestrogen (patches, gel, spray) does not increase clot (DVT/PE) risk — unlike oral oestrogen. This is important for women with a history of VTE or at elevated cardiovascular risk.

Sequential (cyclical) HRT: Oestrogen daily + progestogen for 12–14 days/month — causes a monthly withdrawal bleed. Used in perimenopause / within 1 year of last period.

Continuous combined HRT: Oestrogen + progestogen daily — no bleed. Used once confirmed postmenopausal (12+ months since last period). Initial irregular spotting may occur for 3–6 months.

Testosterone: Licensed for women with low libido not responding to HRT. Applied as a small daily amount to the inner thigh or abdomen. Levels should be monitored to remain within the female physiological range.

Absolute contraindications include: oestrogen-sensitive cancers (e.g. ER+ breast cancer — specialist advice needed, vaginal oestrogen may still be appropriate), unexplained vaginal bleeding, active liver disease, untreated endometrial hyperplasia, and pregnancy. HRT is not a contraceptive — contraception is needed until 2 years after the last period if under 50, or 1 year if over 50.

A chronic inflammatory skin condition affecting the vulva (and sometimes anus). Causes white, thinned, fragile skin with itching, soreness, fissuring, and — if untreated — architectural changes (loss of labia minora, burying of the clitoris). Can occur at any age but most common post-menopause and in girls before puberty.

Diagnosis: Clinical (by specialist), confirmed by biopsy if uncertain. Treatment: Ultra-potent topical steroid (clobetasol propionate 0.05%) — applied as directed (typically daily for 4 weeks, then tapering). This is a long-term condition requiring ongoing management — not a cure, but symptoms are well-controlled with regular treatment. Annual review to check for VIN (pre-cancerous changes).

Important: Untreated LS carries a small (~4%) lifetime risk of vulval squamous cell carcinoma. Report any persistent ulcers, lumps, or new lesions promptly.

Vulvodynia is chronic vulval pain lasting 3+ months with no identifiable cause. Vestibulodynia (vulvar vestibulitis) is pain specifically at the vaginal opening (vestibule) triggered by touch or pressure. Both are real, recognised conditions — not "in the mind" — and affect up to 8% of women.

Management: Pelvic floor physiotherapy (most effective — addresses muscle hypertonicity), topical lidocaine (short-term), low-dose tricyclic antidepressants or gabapentin (neuropathic pain), CBT, psychosexual therapy. A multidisciplinary approach gives the best outcomes. Avoid soap and scented products — use emollient wash (Dermol, Cetraben) and unperfumed moisturiser.

Recurrent vulvovaginal candidiasis (thrush): 4+ episodes per year. Confirmed by swab culture before starting prophylactic treatment — not all itching is thrush. Prophylaxis: oral fluconazole 150mg weekly for 6 months (BASHH guideline). Identify and address triggers: antibiotics, tight synthetic clothing, diabetes, immunosuppression.

Bacterial vaginosis (BV): Most common cause of vaginal discharge in women of reproductive age — caused by imbalance of vaginal flora (not an STI). Characteristic fishy odour, thin grey-white discharge, high vaginal pH. Treatment: metronidazole 400mg BD for 5 days, or metronidazole 2g single dose. Recurrent BV: intravaginal lactic acid gel (Balance Activ), intravaginal boric acid (unlicensed), prophylactic metronidazole gel twice weekly.

Involuntary spasm of the pelvic floor muscles making penetration painful or impossible. Can be lifelong (primary) or develop after a period of pain-free sex (secondary — often following LS, vulvodynia, trauma, or childbirth). Highly treatable: graded vaginal trainers (dilators) combined with pelvic floor physiotherapy and psychosexual therapy. Success rates are high with a supported programme — this is not a permanent condition.

STI testing is free on the NHS and confidential. You can attend a GUM (genitourinary medicine) clinic without a GP referral. Many areas also offer free home test kits by post — order via SH:24 or your local sexual health service. Annual testing is recommended for anyone who is sexually active with more than one partner, and after any unprotected sex with a new partner.

Standard screen includes: Chlamydia, gonorrhoea (throat, genital, anal), syphilis, HIV, hepatitis B and C. Herpes is not routinely screened — diagnosis is usually clinical or by swab of an active lesion.

Modern antiretroviral therapy (ART) suppresses HIV to undetectable levels in the blood. Someone with an undetectable viral load (<200 copies/mL) cannot transmit HIV sexually — this is proven by major clinical trials (PARTNER, PARTNER2, Opposites Attract). Life expectancy on effective ART is comparable to the general population.

For clinicians: Standard infection control precautions apply for all patients regardless of HIV status. Disclosure of HIV status is the patient's choice — it does not change routine care for most procedures. HIV is not a contraindication to surgery, immunotherapy, or most treatments.

Affects around 1 in 8 adults in the UK — most don't know they have it. HSV-1 (typically oral) and HSV-2 both cause genital herpes. After the primary episode, the virus lies dormant and may reactivate. Recurrences become less frequent over time for most people.

Treatment: Aciclovir or valaciclovir reduce severity and duration of outbreaks. Daily suppressive therapy (valaciclovir 500mg daily) reduces frequency by ~70–80% and reduces transmission risk. Herpes is very common and manageable — it does not affect long-term health for most people.

Chlamydia — most common STI in the UK. Often asymptomatic. If untreated, can cause pelvic inflammatory disease (PID), fallopian tube scarring, and fertility problems. Treat with doxycycline 100mg BD for 7 days (first-line) — single dose azithromycin no longer recommended (BASHH 2023). Gonorrhoea — increasing antibiotic resistance means treatment must be guided by culture sensitivity. Current first-line: ceftriaxone 1g IM single dose. Test-of-cure 2 weeks post-treatment is essential.

UTIs are the most common bacterial infection in women — around 50% of women will have at least one in their lifetime. Women are more susceptible due to a shorter urethra. Common symptoms: burning on urination, frequency, urgency, cloudy or smelly urine, pelvic discomfort. Fever, loin pain, and rigors suggest kidney involvement (pyelonephritis) — seek urgent medical attention.

Recurrent UTIs (3+ per year): A urine culture (not just a dipstick) should be sent to identify the organism and sensitivity before each treatment course. NICE NG112 supports self-start antibiotics for women who can reliably identify their symptoms. Low-dose prophylaxis (nitrofurantoin or trimethoprim at night) or post-coital single dose is effective. Vaginal oestrogen significantly reduces recurrence in postmenopausal women — often overlooked.

OAB affects around 1 in 6 adults — defined as urgency (sudden compelling urge to urinate) with or without urge incontinence. Not the same as stress incontinence (leaking on coughing/exercise). Many women have mixed incontinence (both types).

Management: First-line — bladder training (increasing intervals between voids), pelvic floor physiotherapy, fluid management (reduce caffeine, alcohol, carbonated drinks). Second-line — anticholinergics (solifenacin, tolterodine) or beta-3 agonist (mirabegron — fewer dry mouth side effects). Third-line — botulinum toxin bladder injection (under cystoscopy), sacral nerve stimulation.

A chronic condition causing bladder pain, pressure, and urgency without infection. Often misdiagnosed as recurrent UTIs — if cultures keep coming back negative but symptoms persist, IC should be considered. Affects women far more than men. Diagnosis is by exclusion (cystoscopy, urine culture, symptom history). Management: dietary triggers (caffeine, citrus, alcohol, spicy food), pentosan polysulfate sodium (Elmiron), bladder installations, pain management, physiotherapy. The Interstitial Cystitis Association (ichelp.org) is a useful resource.

Visible blood in urine (frank haematuria) should always be investigated urgently — refer via 2-week wait pathway to rule out bladder cancer, kidney cancer, or other serious causes. Non-visible haematuria (dipstick positive, no symptoms) in women under 40 is usually benign (menstruation, vigorous exercise) but persistent cases in those over 40 warrant investigation. Do not assume recurrent UTI without a urine culture — persistent symptoms with negative cultures need further assessment.

Mirena IUS (hormonal coil): >99% effective, lasts 5–8 years (licensed 5 years for contraception, 8 years off-label for perimenopausal women using it as the progestogen component of HRT). Reduces or stops periods. Best medical treatment for heavy periods. Insertion takes ~5 minutes — can be uncomfortable. Fertility returns immediately on removal.

Copper IUD: >99% effective, lasts 5–10 years (10-year device also licensed as emergency contraception if fitted within 5 days of unprotected sex). Completely hormone-free. May worsen periods, especially in the first 3–6 months. Fertility returns immediately on removal.

Implant (Nexplanon): >99% effective, lasts 3 years. Small rod inserted under the skin of the upper arm under local anaesthetic. Most common side effect: irregular bleeding (unpredictable, can be frequent). Fertility returns quickly after removal.

The COCP is safe for the vast majority of women under 35 who don't smoke. It is absolutely contraindicated in: migraine with aura (increases stroke risk), personal history of VTE (DVT/PE), current or past breast cancer, liver disease, uncontrolled hypertension, and in smokers over 35.

VTE risk: Third- and fourth-generation pills (drospirenone — Yasmin/Eloine; gestodene; desogestrel) carry a higher VTE risk than second-generation (levonorgestrel — Microgynon, Rigevidon). All COCPs increase VTE risk 3–4× compared to non-users — but absolute risk remains very low in healthy women. Progestogen-only methods do not increase VTE risk.

Contraception is needed until 2 years after the last period if under 50, and 1 year after the last period if over 50. HRT is NOT a contraceptive — women on HRT still need contraception if they could conceive. The Mirena IUS can serve double duty: it provides the progestogen component of HRT whilst also acting as contraception. The combined pill can mask menopausal symptoms and mask the last period — making it harder to know when menopause has occurred; switching to progestogen-only methods at 50 is often advised.

Levonorgestrel (Levonelle): Up to 72 hours — effective if taken promptly (most effective within 12 hours). Available free from GP, sexual health clinic, or pharmacy. Ulipristal acetate (ellaOne): Up to 120 hours (5 days) — more effective than levonorgestrel, especially taken later. Available from GP or pharmacy (prescription required on NHS). Copper IUD: Most effective emergency contraception (>99%) — can be fitted up to 5 days after unprotected sex or 5 days after earliest likely ovulation. Also provides ongoing contraception for up to 10 years.

Hypothyroidism (underactive thyroid) affects around 2% of the UK population — the vast majority women. The most common cause is Hashimoto's thyroiditis, an autoimmune condition where the immune system attacks the thyroid gland. Symptoms develop gradually: fatigue, weight gain, feeling cold, constipation, dry skin, hair thinning, low mood, brain fog, heavy periods.

Diagnosis: TSH is the primary screening test. A raised TSH (above ~4.5 mIU/L) with low or low-normal Free T4 confirms hypothyroidism. TSH alone can be normal in the early stages of Hashimoto's — TPO antibodies confirm autoimmune cause. Treatment: Levothyroxine (T4) — taken on an empty stomach, 30–60 minutes before food. Target TSH is 0.5–2.5 mIU/L for most people on treatment (NICE guidance).

Persistent symptoms despite normal TSH: A significant minority of people on levothyroxine continue to have symptoms despite a "normal" TSH. Options include: optimising TSH to the lower end of the range, trialling combination T4+T3 therapy (liothyronine — available on NHS in some areas), or switching to NDT (natural desiccated thyroid — less commonly prescribed). This remains a debated area — specialist referral is recommended if symptoms persist.

Hyperthyroidism (overactive thyroid) causes: weight loss despite good appetite, palpitations, tremor, anxiety, heat intolerance, sweating, diarrhoea, and irregular periods. Graves' disease (autoimmune) is the most common cause — may also cause eye disease (Graves' ophthalmopathy) and skin changes.

Treatment options: Antithyroid drugs (carbimazole — first-line in the UK; PTU in pregnancy first trimester), radioiodine (RAI — most commonly leads to hypothyroidism, then lifelong levothyroxine), or thyroidectomy. Beta-blockers (propranolol) control palpitations and tremor while awaiting response to treatment. Many patients achieve remission on antithyroid drugs alone after 12–18 months.

Thyroid function changes significantly in pregnancy — TSH targets are lower (under 2.5 mIU/L in the first trimester). Women on levothyroxine often need a dose increase of 25–50mcg as soon as pregnancy is confirmed. Uncontrolled hypothyroidism in pregnancy increases risk of miscarriage, premature birth, and neurodevelopmental problems in the baby.

Important: If you are on levothyroxine and become pregnant, contact your GP immediately to have your dose reviewed. TSH should be checked every 4–6 weeks in the first half of pregnancy. Post-partum thyroiditis (temporary thyroid inflammation after childbirth) affects ~5–10% of women — causing a transient hyperthyroid phase followed by hypothyroidism before usually recovering.

Take on an empty stomach, 30–60 minutes before breakfast (or at bedtime, at least 4 hours after the last meal). Do not take with: calcium supplements, iron tablets, antacids, or dairy — all reduce absorption significantly. Take at least 4 hours apart from these. Consistency matters — take it at the same time every day. If you miss a dose, take it when you remember (same day) or double up the next day if you forget entirely. Do not split tablets unless prescribed — brand consistency can matter for some patients (do not switch between brands without GP advice).

BPH is a non-cancerous enlargement of the prostate that commonly affects men over 50. It causes lower urinary tract symptoms (LUTS) by squeezing the urethra. BPH does not increase the risk of prostate cancer.

Treatment options: Lifestyle changes (limit evening fluids, caffeine, alcohol), alpha-blockers (tamsulosin, doxazosin — relax prostate muscle), 5-ARIs (finasteride, dutasteride — shrink prostate), or TURP (transurethral resection of the prostate) surgery for severe cases.

Inflammation of the prostate. Acute bacterial prostatitis is a medical emergency (fever, severe pelvic pain, difficulty urinating) — treat with antibiotics (ciprofloxacin 28 days). Chronic prostatitis/CPPS (Chronic Pelvic Pain Syndrome) is more common and may have no bacterial cause.

Symptoms: Pelvic/perineal pain, painful ejaculation, urinary frequency, flu-like illness (acute). Management of CPPS: Alpha-blockers, physiotherapy (pelvic floor), pain management, antibiotics only if bacterial infection confirmed.

The most common cancer in men in the UK — around 1 in 8 men will be diagnosed. Most prostate cancers grow slowly and may never cause problems; some are aggressive. Diagnosis is via PSA blood test, MRI, and biopsy.

Risk factors: Age (rare under 50), Black ethnicity (2–3× higher risk), family history (father/brother with prostate cancer doubles risk), BRCA2 gene mutation.

Treatment options: Active surveillance (low-risk), radical prostatectomy (robotic or open), external beam radiotherapy, brachytherapy, hormone therapy (ADT — reduces testosterone), chemotherapy (docetaxel for advanced disease), focal therapy (HIFU, cryotherapy).

PSA is age-related. A PSA of 3.0 ng/mL is more concerning in a 45-year-old than a 75-year-old. PSA velocity (rate of rise over time) is also important. PSA can be elevated by: BPH, prostatitis, UTI, vigorous exercise, ejaculation in the 48 hrs before test, and urological procedures.

Two main types: Seminoma (slower growing, responds well to radiotherapy) and Non-seminomatous germ cell tumours (NSGCT) (faster growing, treated with chemotherapy — BEP regimen). Most present as a painless lump or swelling. Emergency if sudden severe pain — may indicate torsion.

Tumour markers: AFP (alpha-fetoprotein), beta-hCG, LDH — measured before and after orchidectomy to guide staging and monitor for recurrence.

SURGICAL EMERGENCY. The testicle twists on its blood supply — causes sudden, severe, one-sided scrotal pain, often with nausea/vomiting. Call 999 or go to A&E immediately. Surgical de-torsion must occur within 6 hours to save the testicle. Risk is highest in adolescents but can occur at any age.

Enlarged veins within the scrotum (like varicose veins). Affects ~15% of men and ~40% of men being investigated for infertility. Often described as a "bag of worms" sensation. Most varicoceles are left-sided. Treatment (embolisation or surgery) is considered if causing pain or affecting fertility.

Best done after a warm bath or shower when the scrotal skin is relaxed. Use both hands — gently roll each testicle between thumb and fingers. Feel for: hard lumps on the front or side, changes in size, shape, or consistency, a feeling of heaviness. The epididymis (soft, rope-like tube at the back) is normal — do not confuse with a lump. See your GP promptly if you find anything unusual.

ED affects up to half of men between 40–70 to some degree. It is often a cardiovascular warning sign — the penile arteries are small and show endothelial dysfunction earlier than coronary arteries. New or worsening ED warrants cardiovascular risk assessment.

Causes: Vascular (most common), diabetes (neuropathy and vascular), hypertension, hyperlipidaemia, obesity, smoking, alcohol, medications (beta-blockers, SSRIs, antipsychotics, 5-ARIs), anxiety/depression, relationship issues, post-prostatectomy nerve damage.

PDE5 inhibitors (first-line): Sildenafil (Viagra) — taken 30–60 min before sex, lasts 4–6 hrs. Tadalafil (Cialis) — daily low-dose (5mg) or on-demand (10–20mg), lasts up to 36 hrs. Caution: contraindicated with nitrates (risk of severe hypotension).

Male factor infertility accounts for around 50% of all infertility cases. Semen analysis is the key investigation: normal parameters — volume ≥1.5mL, concentration ≥16 million/mL, total motility ≥42%, morphology ≥4% (Kruger strict criteria).

Optimising fertility: Avoid smoking, limit alcohol, maintain healthy BMI, avoid cycling shorts and hot baths (heat reduces sperm production), avoid anabolic steroids (suppress sperm production — can cause permanent azoospermia).

Sometimes called the "male menopause" (andropause), LOH is a clinical and biochemical syndrome associated with ageing. Unlike menopause, it is gradual. Diagnosis requires two morning testosterone levels below the normal range (NHS labs: typically <10.4 nmol/L) plus symptoms.

TRT monitoring: Once started, levels should be checked at 3 months, then 6-monthly. Monitor: testosterone (target mid-normal range), PSA, haematocrit (TRT raises red cell mass — stop if haematocrit >54%), liver function, blood pressure.

Illicit anabolic steroid use causes severe suppression of the HPG axis (hypothalamic-pituitary-gonadal). This leads to: testicular atrophy, azoospermia (can be permanent), gynaecomastia, cardiovascular damage (cardiomyopathy, dyslipidaemia), liver toxicity (oral steroids), and acne. Recovery of natural testosterone production after cessation may take 1–2 years or may not occur. Tell your doctor if you have used these substances.

Benign breast tissue enlargement in men. Common causes: puberty (physiological), obesity (aromatisation of oestrogen from fat tissue), medications (spironolactone, cimetidine, some antipsychotics, opioids, cannabis, anabolic steroids), liver disease, hypogonadism. Needs investigation if painful, rapidly growing, or unilateral (to exclude breast cancer — rare in men but possible). Treated by addressing the cause; surgical reduction for persistent cases.

An AAA is a dangerous bulge in the aorta (the main blood vessel from the heart). Men are offered a one-off ultrasound scan at age 65 — the UK AAA Screening Programme. If a AAA is found, the frequency of monitoring depends on size:

The Faecal Immunochemical Test (FIT) detects tiny traces of blood in the stool — an early sign of bowel cancer or polyps. In England, it is offered every 2 years from age 50–74 (postal kit). A positive result means blood was detected — it does NOT mean cancer, but you will be referred for a colonoscopy. Around 2 in 100 FIT tests are positive; of these, only a small number have cancer.

A 20–30 minute appointment offered every 5 years to adults aged 40–74 without a pre-existing cardiovascular condition. It checks blood pressure, cholesterol, blood glucose (or HbA1c), BMI, and calculates your 10-year cardiovascular risk using QRISK3. Men are at higher CVD risk than women at equivalent ages — on average, men have their first heart attack 7–10 years younger than women.

Men are less likely to recognise symptoms of depression and anxiety, less likely to seek help, and more likely to use harmful coping strategies (alcohol, substance use, social withdrawal). Men often present with "masked depression" — irritability, anger, risk-taking behaviour, or physical complaints rather than sadness.

Warning signs to watch for: Loss of interest in things you used to enjoy, withdrawing from friends and family, increased alcohol or drug use, feeling a burden to others, reckless behaviour, talking about death or hopelessness. These are medical symptoms — not weakness.

NHS Talking Therapies (IAPT): Self-refer online at nhs.uk for CBT, counselling, and other psychological therapies. No GP referral needed in most areas. Waiting times vary.

Charities: CALM (Campaign Against Living Miserably) — helpline 0800 58 58 58 (5pm–midnight daily). Mind — mind.org.uk. Movember Foundation — men's health charity. Andy's Man Club — peer support groups for men.

In a crisis: Samaritans — 116 123 (free, 24/7). NHS 111 — option 2 for mental health crisis. A&E for immediate risk to life. Crisis Resolution & Home Treatment teams (via CMHT). Text SHOUT to 85258 (free, 24/7 text-based support). 999 if in immediate danger.

Scar tissue (plaque) forms inside the penis, causing it to curve during erections. Affects around 1 in 10 men — most commonly between 40–70. It is not a sexually transmitted condition and is not caused by anything the man has done. The acute phase (first 6–18 months) may involve pain; the chronic phase is usually painless but the curvature persists.

Treatment: Mild cases may not need treatment. Collagenase injections (Xiapex) can break down scar tissue. Penile traction therapy may help. Surgical options (plication, grafting, penile implant) are considered for severe or stable disease that affects function. Discuss with a urologist.

Phimosis: The foreskin is too tight to retract. In adults it can cause pain during sex, difficulty urinating, or recurrent infections. First-line treatment is a topical steroid cream (betamethasone) applied daily for 4–8 weeks — this works in around 70–80% of cases. Circumcision or preputioplasty if cream fails.

Balanitis xerotica obliterans (BXO / lichen sclerosus): A chronic inflammatory skin condition causing white, thickened patches on the foreskin and glans. Can cause severe phimosis. Treated with high-potency steroids; circumcision is often recommended to prevent progression.

Rare in the UK (~700 cases/year). Risk factors include HPV infection, phimosis, smoking, and poor hygiene. Presents as a lump, sore, or discoloured area that does not heal. If you notice any unexplained change on the penis, see your GP promptly — caught early, penile cancer is very treatable.

A hernia occurs when an internal part of the body pushes through a weakness in the surrounding muscle or tissue wall. The most common type in men is an inguinal hernia — bowel or fatty tissue pushes through the inguinal canal in the groin. It usually appears as a lump that may disappear when you lie down and returns when you cough or strain.

Symptoms: A visible bulge in the groin or scrotum, aching or dragging sensation, discomfort when bending, coughing, or lifting, or no symptoms at all.

Not all hernias need immediate surgery. Watchful waiting is appropriate for men with no or mild symptoms. Surgery is recommended if the hernia is enlarging, causing pain, or affecting daily life. Two main approaches: open surgery (single incision, often under local anaesthetic) or laparoscopic (keyhole) (faster recovery, better for bilateral hernias).

Mesh repair is standard — mesh reinforces the weak area and significantly reduces recurrence rates (from ~10% to ~1–2%). Mesh complications (chronic pain, infection, migration) are uncommon but should be discussed with your surgeon.

• The hernia suddenly becomes hard, tender, or cannot be pushed back in — possible strangulation
• Severe, worsening pain in the groin or abdomen
• Nausea, vomiting, or signs of bowel obstruction
• Redness or discolouration over the lump

A strangulated hernia cuts off blood supply to the trapped tissue — it is a surgical emergency. Call 999 or go to A&E immediately.

Gout is caused by hyperuricaemia — too much uric acid in the blood. When levels are high, uric acid crystallises and deposits in joints, causing the sudden, intense inflammation of a gout attack. The big toe is affected in around 50% of first attacks (a pattern called podagra).

Causes of raised uric acid: Diet (red meat, offal, shellfish, beer, spirits, fructose-sweetened drinks), dehydration, diuretics (thiazides, furosemide), aspirin, renal impairment, obesity, hypertension, and genetics.

Start treatment within 24 hours of the attack — the sooner you treat, the quicker it resolves. Rest and elevate the affected joint. Keep well hydrated. NSAIDs (naproxen 500mg twice daily or indomethacin) are first-line if tolerated. Colchicine (500mcg 2–4 times daily) is an effective alternative — particularly if NSAIDs are contraindicated. Prednisolone (short course) if both are unsuitable (e.g. CKD).

Do NOT start or stop allopurinol during an acute attack — this can prolong or worsen it. Wait until the attack has fully settled for 2–4 weeks, then begin or adjust ULT.

Urate-lowering therapy is recommended if you have 2+ attacks per year, tophi, uric acid kidney stones, or renal impairment. Allopurinol is first-line — start low (100mg daily), increase every 4 weeks until uric acid target <360 µmol/L is reached (or <300 if tophi). Cover with colchicine (500mcg twice daily) for the first 3–6 months when starting ULT to prevent flares. Allopurinol dose must be reduced in renal impairment.

• Stay well hydrated — aim for 2–3 litres of water per day
• Reduce red meat, offal, and shellfish
• Avoid beer and spirits (wine in moderation is lower risk)
• Cut down on fructose-sweetened drinks (fruit juice, fizzy drinks)
• Low-fat dairy (milk, yoghurt) has a uricosuric effect — may help lower uric acid
• Lose weight gradually — rapid weight loss can trigger attacks
• Cherries and cherry extract have modest evidence for reducing flares

Visible haematuria (blood you can see) in any adult over 45 is treated as suspected cancer until proven otherwise — NICE guidelines require an urgent 2-week-wait urology referral. Even non-visible haematuria (found on a dipstick, with no UTI) warrants investigation in anyone over 60 or with risk factors.

Common causes (in order of likelihood): UTI (most common), kidney stones, BPH, bladder cancer, kidney cancer, prostate cancer, glomerulonephritis (kidney inflammation), anticoagulation drugs (warfarin, apixaban, rivaroxaban), vigorous exercise.

1. Urine dipstick & MSU — confirm blood and exclude infection
2. Blood tests — renal function (eGFR, creatinine), PSA (if prostate suspected)
3. Urine cytology — checks for abnormal (cancer) cells shed in urine
4. Ultrasound of kidneys and bladder — looks for masses, stones, hydronephrosis
5. CT urogram (CT KUB) — detailed imaging of the whole urinary tract
6. Flexible cystoscopy — camera examination of the bladder under local anaesthetic; outpatient procedure; takes ~10 minutes

• You are passing blood clots and cannot urinate (urinary retention)
• The bleeding is very heavy or not stopping
• You have severe loin or abdominal pain alongside the blood
• You feel faint, have a high fever, or are generally very unwell

UTIs are much less common in men than women due to the longer urethra. When a man develops a UTI, it is usually assumed to be complicated (involving the upper urinary tract or prostate) until proven otherwise. A urine culture should always be sent. Common causes in men include: urethral stricture, BPH (poor bladder emptying), kidney stones, catheterisation, and prostatitis.

Treatment: A longer course of antibiotics (7–14 days) is typically recommended for men compared to women. Recurrent UTIs in men warrant investigation — ultrasound, flow rate measurement, cystoscopy, and PSA testing may all be indicated. Trimethoprim and nitrofurantoin are common first-line options (depending on culture result).

LUTS affects around 30% of men over 65. Symptoms include: frequency, urgency, nocturia (waking at night), weak stream, incomplete emptying, hesitancy, and post-void dribbling. In most men, BPH (benign prostatic hyperplasia) is the cause — the enlarged prostate compresses the urethra.

Management: Lifestyle changes (reduce evening fluids, caffeine, alcohol), bladder training, alpha-blockers (tamsulosin, doxazosin — relax smooth muscle), 5-ARIs (finasteride, dutasteride — shrink prostate over months), combination therapy for moderate-severe LUTS, or TURP surgery for severe cases. The International Prostate Symptom Score (IPSS) questionnaire is a useful self-assessment tool.

OAB in men is often linked to BPH but can occur independently. Defined as urgency (sudden strong urge to urinate), usually with frequency and nocturia, with or without urge incontinence. First-line management: bladder training, pelvic floor exercises, reduce caffeine and alcohol. Medication: anticholinergics (solifenacin, tolterodine) or beta-3 agonist mirabegron. Botulinum toxin bladder injection or sacral nerve stimulation for refractory cases.

Kidney stones (nephrolithiasis) affect around 1 in 10 people at some point in their lives — more common in men. Renal colic (severe loin-to-groin pain, often with nausea and vomiting) is a medical emergency if associated with fever or if the stone is causing obstruction.

Recurrent stones: Drink at least 2–3 litres of fluid daily. Urine should be pale yellow. Dietary advice depends on stone type (calcium oxalate stones — reduce oxalate foods; uric acid stones — reduce red meat, alcohol, purine-rich foods). 24-hour urine collection can identify metabolic risk factors. Thiazide diuretics or allopurinol may be prescribed for recurrent stone formers.

Urinary incontinence after radical prostatectomy is very common — affecting up to 60% of men immediately post-surgery. Most recover within 6–12 months. Pelvic floor exercises (Kegel exercises) should be started before surgery and continued after. Physiotherapy referral is strongly recommended. For persistent incontinence beyond 12 months: specialist continence review, urodynamics, and consideration of male sling surgery or artificial urinary sphincter (AUS) implantation.