Aims. To display internal structures using sound waves.

Indications. Investigating, examining and measuring internal structures in the pelvis, for example looking for ovarian cysts and tumours, abnormalities of the uterus, ectopic pregnancy, measuring the gestation (age) of an early pregnancy, assessing the anatomy and well-being of a foetus, localising the placenta, imaging structures for investigations and procedures such as foetal blood sampling, etc., and many more.

Method. A probe, a bit like a microphone, is attached, via a cord, to a machine with a screen, a bit like a television screen. The probe sends pulses of tiny sound waves (that you can’t hear). These pass through different layers of the body at different rates. The machine somehow manages to interpret the ‘echoes’ it receives from the various layers the sound waves hit. This way, a picture can be built up of the layers, and an image is formed.

To get a good picture of what is in the pelvis, a ‘window’ of water helps. We are fortunate that our bladders sit in front of our pelvic organs, as a full bladder serves this function very well. This is why women having a pelvic ultrasound will be asked to come along with a full bladder, and not to empty it until the scan is done.

The probe is moved around on the skin of the lower abdomen, and a special gel is used to make contact between the probe and the skin, to get a better picture. If the picture is not as clear as it needs to be, sometimes a special probe is used. This probe is inserted into the vagina. The images are generally clearer, because the waves do not have to pass through so much extra tissue. Scans ordered by a gynaecologist will often be performed in this way.

The pictures and measurements obtained in the scanning procedure then need to be interpreted by an expert ultrasonologist.

Complications. Apart from the discomfort of having a full bladder for a while, this is really a pretty safe procedure. There is no radiation, as there is in x-rays, and there are no known long-term side-effects from ultrasound.

*248\52\4*

The term ‘change of life’ has been used for generations to describe the various changes women experience around menopause. In many ways it is a suitable description, because it implies a major adjustment, and for many women menopause involves dramatic changes on many levels. It is also vague, and nonspecific. This is appropriate too, because different women may experience

different feelings and physical changes; it is not like chicken pox, when most people who have will describe the same symptoms.

Doctors have a specific definition of menopause. It is the last ever menstrual period a woman has. So in fact you don’t know you’ve had it till it’s gone. The average age at which this occurs is 51. Periods tent tobe erratic towards the end of reproductive years, a woman may have two or three a year before they eventually disappear. Some woman experience regular periods until an abrupt stop. The periods are deemed to have stopped if there have been none for six consecutive months. Peri-menopausal symptoms (peri- means around), the most common being hot flushes, may be experienced for many years either side of the last period. The time in which the symptoms are experienced is called the climacteric.

The reason for all these changes is that the ovaries slow down production of the sex hormones, namely oestrogen, progesterone and testosterone. It does not mean that there are no hormones produced after menopause, just that they are in much lower concentrations, and in different forms. The body is able to convert one type of hormone to another. In some women this conversion creates enough oestrogen-like hormone to prevent oestrogen deficiency symptoms. This may explain why some women have fewer noticeable symptoms than others.

Towards menopause the ovaries have also slackened off a little in their egg-producing duties. Not as many follicles start off, and the ones that do start may not make it to ovulation as reliably, so natural fertility starts to wane (it actually hits its peak in the twenties). By the forties fertility is significantly lower, but it is not recommended for couples to rely on this as a method of contraception. Many ’surprises’ are toddling around now as you read this.

As the hormone levels drop they dip below the threshold level required to build up a lining in the uterus. There is therefore nothing to shed, and so no period.

*216\52\4*

The doctor will tell you what is going to happen during the operation, and answer any questions you may have. It’s important that you are clear about what vasectomy will mean for you,

and what to expect If you are in a relationship, it is good if your partner can come with you to this appointment as well, but it is not essential.

If you are able to have the operation, and you want to go ahead with it, you will sign a consent form and make a booking for the vasectomy at the end of this visit. You will be given instructions on how to prepare for the operation before you leave.

If you are having the operation at the doctor’s surgery or at a clinic you will probably be asked to shave the pubic hair around the base of your penis and your scrotum just before you go to the clinic to have the operation. If the surgery is planned under local anaesthetic you will be at the surgery or clinic for about one to two hours altogether. This includes preparation and recovery time as well as the operation itself which usually takes about 30 minutes. If the operation is to be done in hospital under general anaesthetic you should expect to be in hospital most of the day.

The operation is simple and straightforward. When the operation is done under local anaesthetic you will be given an injection into die scrotum and then into each vas. This may sting a little, but most men don’t mind it too much. Some doctors give a sedative as well. When the area is numb, the doctor makes a small opening on the midline of the scrotum, carefully picks up one vas at a time, cuts them and seals the ends. Some doctors make two little openings, one for each vas, and some doctors remove a small portion of each vas before sealing the ends. Remember the area is numb so although some men say they feel a sort of tugging feeling, it does not usually hurt. The opening in the scrotum is closed with a stitch or just with a small bandaid strip.

*104\132\4*

How do you use the Temperature method?

You have to take your temperature every day to find out when you ovulate so you can work out your safe time. You must take your temperature every morning as soon as you wake up, before you get out of bed. It also has to be taken before you eat, drink or smoke.

This is called your basal body temperature (bbt). Your basal body temperature is your temperature when your body is completely at rest.

You can take your temperature with the thermometer in your mouth or in your vagina, but you will need to decide on one or the other and do that for the whole cycle. Be aware that your temperature can go up for a number of reasons, like illness for example. It should be safe to have sex once you have had three days, one after the other, where the readings are higher than on any of the six days before them.

Take your temperature every day from the first day of a period, and record the temperature on a chart or graph. You will see that for a number of days your temperature will stay just about the same, then one day you should notice that the temperature has gone up a bit If it is still up on the following day, and then the day after that (three days), and it is higher on each of those three days than on any of the six days before it went up, that means you have ovulated. It also means your fertile time is now over and it is safe to have unprotected sex.

You will notice that this method only gives you a safe period in the second half of the cycle after you have ovulated and isn’t able to give you any idea of your fertile times early in the cycle. This means if you use this method correctly and have a 28 day cycle there are probably only 11 days a month when this method says you are safe from pregnancy.

*72\132\4*

A. If you really don’t want to be pregnant it does matter. Even though you have not become pregnant so far, you could get pregnant any time that you are late taking the pill if you have sex around that time. Perhaps you could choose another time of day to take your pill when you are most likely to remember it.

If you are often late taking your pills or you miss a pill at least once every month you are at a much higher risk of getting pregnant It would be best to consider changing to another method of contraception that will be more reliable for you.

Q. I only missed one minipill and now my period is overdue.

Should I have a pregnancy test, or am I worrying too much? A. Even though you only missed one pill it is possible you could be pregnant if you have had sex since you missed the pill.

Irregular periods are very common on the minipill even if you’re not pregnant but it’s probably better to know for certain if there’s any chance at all. A urine pregnancy test is simple and accurate.

Q. If I got pregnant when I missed one of my minipills, but I didn’t know I was pregnant so I kept taking the pills, would that affect the baby?

A. There is no evidence that the minipill has any bad effects on an unborn baby.

Q. Do I need to have regular check ups if I take the minipill?

A. You should check your own breasts every month after your period. If you don’t know how to do it, ask your doctor or a nurse to show you, or ask for a pamphlet on how to do it.

It’s a good idea to have your blood pressure taken, and your breasts checked for lumps when you go for a new prescription for the minipill. You should also have a Pap test every two years, or more often sometimes, if you have had an abnormal Pap test in the past.

*40\132\4*