Going through the menopause is a fact of life for all women. For many fortunate women, the transition will be smooth; however, for others, the menopause will present a challenge of varying degrees. Menopausal symptoms include hot flushes, mood swings, a loss of libido, fatigue, night sweats and depression. Just as each woman experiences her own set of menopausal symptoms, some mild, some severe, each woman responds uniquely to the treatment prescribed – but there are many options for post-menopausal women.

‘I hear such conflicting stories about menopause treatments in the news…’

With menopause stories frequently in the headlines, be it questioning the effectiveness or safety of HRT, or suggesting that symptoms will be with you for a decade or more, it is no wonder that confusion and apprehension about treatments is rife. During your consultation with London-based female gynaecologist Miss Amanda Tozer, you will talk through your symptoms, your priorities and your concerns. Miss Tozer is a consultant gynaecologist with a particular interest in menopause; she will put these reports into context, explaining how – and, indeed, if – they are relevant to you.

What can be done to treat the menopause?

When you see Miss Amanda Tozer at her London menopause clinic, you will have the opportunity to discuss all treatment approaches, including lifestyle changes and alternative therapies. Alleviation of all symptoms is usually only possible with hormone replacement therapy (HRT).

There are associated risks which female gynaecologist Miss Tozer will discuss with you in depth; she will also conduct a physical examination and run any necessary tests to assess your health and suitability for HRT.

Miss Amanda Tozer has guided many post-menopausal women through this stage in their life, and understands how challenging and bewildering a time it can be. Offering them support and understanding and specialist, personalized care, she has enabled many women to manage their symptoms and make life that bit easier.

For couples with fertility problems, trying to start a family can be a very distressing time. The fact that one in seven couples need medical assistance of some sort may not be of direct comfort when you are suffering yet another disappointment, but it does mean that a great deal of research is being done into infertility, and there are experienced specialists ready to help you through the process. Your first step is to see your GP who will then recommend a specialist, such as female gynaecologist Miss Amanda Tozer, to investigate the cause.

What will happen at the initial fertility consultation?

Before undergoing any tests at Amanda Tozer’s London fertility clinic, you will first talk about your medical history. Miss Tozer will then conduct a physical examination and run several diagnostic tests. These may include: semen analysis; a pelvic ultrasound to check for abnormalities such as fibroids; tubal patency tests whereby the Fallopian tube is checked for any blockages that would obstruct the egg’s movement from ovary to uterus; hormone tests to check ovulation and for imbalances; and saline sonography. Saline sonography is a means of detecting uterine abnormalities and is conducted using a transvaginal catheter through which saline is injected; the saline distends the uterine cavity, allowing abnormalities to become visible on the ultrasound. The results of this test are available immediately.

Individualised care in fertility treatments

A highly experienced female gynaecologist, Miss Amanda Tozer has helped many couples who have had repeated setbacks in either getting pregnant or carrying a baby to term. At her London fertility clinic, couples receive specialist, attentive and personal care; Miss Tozer personally conducts the tests, she talks through each step of the process at length and encourages her patients to ask questions no matter how small – and she can always contacted via her personal phone.

Fibroids are benign growths in the womb and are extremely common: an estimated one in four women will have fibroids at some stage in their life. However, many women will not know they have fibroids as only one third of cases present symptoms; these can include heavy and prolonged periods, swelling, post coital bleeding and infertility. They vary both in size – from that of a small pea to a large grapefruit – and location, the most common of which is within the muscle tissue of the womb (intramural fibroids).

Surgery is not always necessary

Fibroids do not always cause symptoms or they may only be mild; if this is the case, you may not require any treatment. Furthermore, fibroids tend to shrink after the menopause and symptoms ease. There are also medication options to manage the symptoms.

Fibroids and fertility treatment

During your consultation at Miss Amanda Tozer’s London fertility clinic you will initially undergo an ultrasound scan; sometimes an MRI will be required to locate and establish the size of multiple fibroids. Miss Tozer, a female gynaecologist with many years’ experience of treating fibroids, will then discuss the results with you, explaining the implications, if any, regarding your fertility. If the fibroids lie in the muscle tissue (intramural) and are smaller than 5cm, it is unlikely that removal will be recommended.

However, larger intramural fibroids can be removed either in an open procedure or laparoscopically, depending on their location. If Miss Tozer identifies fibroids growing from the inner wall into the middle of the womb (sub mucosal fibroids) she will most likely recommend they be be resected before you embark on fertility treatment. Resection of sub mucosal fibroids entails a hysteroscopy, usually performed as a day case; in some cases, pre-op suppression of hormones will be required.

At the London Clinic, Miss Amanda Tozer’s patients can count on attentive and specialist care.

When a couple has successfully overcome the first stages of the IVF process, a failure at implantation can be devastating. For couples who have had repeated failures despite highly rated embryos, the chances of pregnancy may be improved by a process known as ‘endometrial scratching’. It has been shown in several randomised studies that this procedure of performing endometrial biopsies, usually during the luteal phase (after ovulation) of the menstrual cycle, can improve the rate of implantation, pregnancies and live births.

How does endometrial scratching work?

Endometrial scratching has been widely offered since 2003 but why it is effective is still not clearly known. The belief is that ‘injuries’ to the endometrium (the womb lining) stimulate the production of endometrial white blood cells, creating an inflammatory reaction that in turn enhances the uterus’s receptivity to implantation. Female gynaecologist Miss Amanda Tozer offers endometrial scratching at her London fertility clinic where it takes not more than 15 minutes. It can be uncomfortable and some women may find it painful; it is advisable to take analgesia such as ibuprofen an hour or two before the procedure – your doctor will advise you on this. It is also a good idea to bring a friend or your partner so they can escort you home afterwards.

How much does it cost?

If you are an existing patient of Miss Amanda Tozer, endometrial scratching will cost £100. The procedure is available to any patient, whether or not they are undertaking their IVF treatment with Miss Tozer; for these new patients, the price is £125. Miss Amanda Tozer is an experienced female gynaecologist who offers her London fertility patients expert and individualised support and guidance through this most difficult of challenges; she will talk you through the theories and practicalities of the procedure and its success rates, while ensuring you understand any associated risks or side effects.

Intracytoplasmic sperm injection (ICSI) is part of an in vitro fertilisation requiring only one sperm which is directly injected into the egg. As the sperm neither has to travel to the egg nor penetrate its outer layers, it can help many men with fertility problems conceive with their partners when other options are not open to them.

When will ICSI be recommended?

Your fertility consultant may suggest ICSI if fertilisation has failed in previous IVF cycles, or if the fertilisation rates have been poor with fewer than 25% of mature eggs being fertilised. It is also the preferred choice where the male sperm count is low, has a low number of normal forms or displays poor motility. ICSI is also an option if a man is unable to get an erection and/or ejaculate as the sperm can be taken from the epididymis or testicle under local anaesthetic using a fine needle.

What are the advantages and disadvantages of ICSI?

During a consultation with London female gynaecogist Miss Amanda Tozer, you will talk through all the pros and cons of ICSI. The primary advantage is that it gives some couples the best chance of conceiving a child where previously their only alternative might be a sperm donor. Another benefit is that sperm can be extracted if necessary; it is not at all uncommon for anxiety to prevent ejaculation on the day. In terms of disadvantages, the increased risks of multiple births and ectopic pregnancies are similar to those associated with standard IVF.

Another important consideration is the quality of the sperm: when a couple naturally conceive, only the strongest sperm make it through the egg’s outer layers.

At her London fertility clinic, Amanda Tozer will talk you through the associated risks and share the latest findings from on-going studies and advise you on pre-treatment screening for genetic problems.

Embarking on fertility treatment can be an incredibly nerve-wracking experience. Miss Amanda Tozer is an experienced female gynaecologist who has helped many couples achieve the family they so desire, guiding them through the process at her London fertility clinic with compassion and reassurance. She encourages couples to ask as many questions as they need in their consultations, and is always available by phone. In order to get the most out of your IVF consultation, it can be a good idea to think about what questions you would like answered in advance. Here are five that are frequently asked:

1. What does ovulation stimulation treatment involve?

Miss Tozer takes time to talk couples through the drug regime, ensuring they are comfortable with self-administering the injections, and explaining the side effects and why they are the most appropriate treatment.

2. Can our lifestyle help?

Is there anything you can both do in the lead up to treatment to improve the quality of both the eggs and sperm?

3. What level of monitoring will there be during the stimulation period?

You could ask about the frequency of clinic visits, and how flexible this is. At our London fertility clinic, we can be flexible about the time of day you have your screening appointments, fitting them around your schedule where possible.

4. Is egg collection painful?

How, where and using what form of sedation will this happen? Miss Tozer carries out the egg collection personally at the CRM London clinic in a procedure that takes just 25 minutes and is performed using intravenous sedation – you will be asleep throughout.

5. What are the potential side effects of IVF?

A consultation at Miss Amanda Tozer’s London clinic is an informative, reassuring and unhurried experience. It is important that any couple considering IVF understands all that it involves, both negative and positive, before being asked to make any decisions.

There is not a ‘cure’ or treatment for the menopause itself, but there are treatments for its symptoms, one of which is Hormone Replacement Therapy. HRT has provided effective relief for many women over years but the associated risks and side effects have attracted critics.

During a consultation at the London Clinic with female gynaecologist Amanda Tozer, you will have the opportunity to discuss the pros and cons of HRT, and to find out about the potential risks and side effects. Miss Tozer has helped many women manage their menopausal symptoms using HRT and is well placed to give you all the facts and advice you need in order to make an informed decision about your treatment.

What does HRT do?

Hormone Replacement Therapy contains an oestrogen hormone that replaces the oestrogen your post-menopausal ovaries have ceased to produce. Oestrogen on its own, however, would result in the building up of the womb lining, increasing a risk of cancer of the uterus. For this reason, HRT usually combines the oestrogen with a progestogen hormone that drastically reduces the risk of cancer. The different types of HRT contain a varying degree of each hormone; some women need to try a few combinations before finding the one that works for them.

What are the side effects of HRT?

Both oestrogen and progestogen produce different side effects with some crossover. Possible side effects include fluid retention, breast tenderness, leg cramps, headaches, indigestion, acne, backache, depression and nausea.

Before embarking on any course of treatment, London based gynaecologist Miss Tozer will explain the potential side effects – as well as how the worst of these may be relieved by a number of lifestyle changes. With her years of experience in treating the symptoms of the menopause, she can help you put the risks and side effects of HRT into a useful perspective.

For women who wish to delay having a child until their late thirties, be it for financial or social reasons, egg freezing is becoming an increasingly viable option.

How successful is egg freezing?

To improve the chances of the process being a successful one, a woman will ideally be under 35 years old when she freezes her eggs. While there are limited good studies that look at live birth rates from frozen eggs, what we do know is that approximately 90 per cent survive the process, and of those 70 per cent will fertilise, producing embryos.

The age of the woman at this stage remains an important factor as it does with any pregnancy: live birth rates from frozen eggs decline with age. In terms of potential risks, there are no increased risks in chromosomal abnormalities or development problems.

How does the process work?

Women attending female gynaecologist Miss Amanda Tozer’s London clinic will first have a pelvic ultrasound. This enables Miss Tozer not only to assess the accessibility of the ovaries, but also to check the antral follicle count, an indicator of remaining egg supply (the ovarian reserve).

The treatment of egg collection itself involves daily injections that stimulate the ovaries to produce more eggs; the level of stimulation will be adjusted according to your age and your ovarian reserve. Over the next fortnight, you will have two or three scans, before the eggs are collected on approximately days 14 to 16. Miss Tozer will perform the collection herself; the procedure takes around 30 minutes during which you will be sedated. You may experience mild bloating but this should settle within five days of the eggs being collected.

At Amanda Tozer’s London fertility clinic you will benefit from personal, one-to-one care with all aspects of the egg freezing process being explained, assessed and performed by Miss Tozer herself.

The good news is that awareness of female diseases such as breast and cervical cancer has increased, with more women being vigilant with their health. However, the reality is that most women’s lifestyles are too busy to accommodate much more than a cursory self-check and attendance of routine screening appointments. Whether a woman is in her reproductive or menopausal years, a check-up at a Well Woman clinic can be invaluable, either providing early diagnosis or indicators about required changes in lifestyle.

What will I be screened for at the Well Woman Clinic?

There are frequent developments in screening technology, and tests can detect early signs of female cancers – breast, uterine, ovarian and cervical – and non-cancerous illnesses including osteoporosis, heart disease and diabetes.

At female gynaecologist Miss Amanda Tozer’s London clinic, a full medical history will be taken before the following tests are run: full blood count, liver and renal function, fasting glucose and cholesterol levels, body mass index, blood pressure, urinalysis, breast examination and cervical smear.

Miss Tozer can also run hormone tests to check ovarian and pituitary function and conduct a gynaecological pelvic ultrasound to assess the pelvis for abnormalities such as endometrial polyps, uterine fibroids and ovarian and para-ovarian cysts. There is also the option of a CA125 test; rather than a diagnostic test, a CA125 can be used to monitor high-risk women with a family history of ovarian cancer.

Can you screen for osteoporosis?

Osteoporosis is relatively common, affecting around 3 million people in the UK to some degree. It usually, but not exclusively, affects post-menopausal women. Miss Amanda Tozer offers bone densitometry tests to women attending her London Well Woman Screening clinic. This test involves performing a scan of the hip and spine to assess bone density, detecting the presence of bone loss, be it mild or severe.

To find out more, call 020 7034 6240 or click here. Here’s a link to clinic times at Miss Tozer’s Well Woman Clinic.

Any kind of fertility problem can cause friction in a relationship so it is completely normal for couples presenting at a fertility clinic already to be under some strain. It has also been found that IVF fertility treatment itself is a stressor and is the factor most likely to cause anxiety as the process unfolds. The role of stress during IVF treatment on the outcome has been of considerable interest with variable findings – but any means of easing this will certainly be welcomed by all.

Why is it so stressful?

The situation itself is extremely difficult. With couples longing to conceive, it is natural to oscillate between optimism that this cycle could be the one and then conviction that it is never going to happen. When you introduce hormones from the IVF drugs to the mix, everything becomes more intense. Further exacerbating factors can include a large, impersonal fertility clinic where you have minimal contact with your consultant, see different people for each procedure and don’t feel able to ask questions for fear of them being too trivial.

What can be done to make it less so?

At the Amanda Tozer London fertility clinic, you can be confident of receiving personal one-to-one, attentive and sympathetic care. Female gynaecologist Miss Tozer believes that continuity of care is hugely important and to this end she sees all couples prior to treatment to discuss their options and goes through the injections in detail, ensuring they know how and why to administer the drugs. She personally performs the egg collection, embryo transfer and first early pregnancy scan. Miss Tozer assures her London IVF patients that she can be contacted on her personal telephone at any time during the process, no matter how small the concern. Feedback from previous fertility patients shows that this personal care has been tremendously reassuring throughout what can be a nerve-wracking process.