There is much talk about what the menopause does to a woman’s body temperature and her moods. There is, understandably but rather misleadingly, much less time given to what changes she is likely to experience in her vagina. The sharp drop in the levels of the hormone oestrogen can cause devastation as it plays a key part in the health of the vulvo-vaginal tract, including by producing glycogen which encourages the helpful bacteria that keeps infections at bay. The decrease in oestrogen also affects the glands at the neck of the womb that produce essential fluids and mucus that keep the vaginal skin and tissues supple and moist.

How is vaginal dryness treated?

When this change causes symptoms such as pain during sexual intercourse, doctors term it atrophic vaginitis. About half of women display some related symptoms after the menopause – likely more but they have been too embarrassed to talk to their doctor about it, choosing instead to put up with discomfort. Some women are put off by the idea of HRT, having seen too many negative stories in the press. Female gynaecologist Miss Amanda Tozer has helped many women navigate their way through myriad menopausal symptoms, looking at each case on an individual basis, and prescribing a wide range of treatments, including HRT and alternative therapies. During a consultation at her London menopause clinic, Miss Tozer will ask you which symptoms you find most debilitating and that will inform the approach.

Is there a side-effect-free alternative to HRT?

Miss Tozer is pleased to be able to offer her London patients an innovative new treatment for vaginal atrophy: the MonaLisa Touch – a safe, painless and minimally invasive procedure that utilises laser therapy to rejuvenate the vulvo-vaginal tract. Its aim is to restore the premenopausal structures to enable the natural production of the all-important vaginal mucosa.

For couples undergoing IVF, having a cycle fail despite the transferred embryo being of good quality can sometimes be all the more distressing. They may question if it doesn’t work when all the signs are good, when will it? In some cases where there has been no discernable reason for the IVF to have failed, a procedure called endometrial scratching has had some encouraging results.

How does an endometrial scratch work?

The procedure involves superficially injuring the womb lining thereby initiating a ‘repair reaction’ where the production of endometrial white blood cells is stimulated. This improves the implantation conditions of the uterus. Research is still to be carried out to understand how and to what extent endometrial scratching is successful, but the belief is that growth factors, hormones and chemicals are released during the repair process. The new lining appears to be more welcoming to an implanted embryo. The scratching may also ‘switch on’ the genes responsible for preparing the endometrium for implantation, thereby increasing the chances of a successful pregnancy.

Female gynaecologist Miss Amanda Tozer who offers the service at her London fertility clinic will be glad to talk about whether you would be a good candidate for endometrial scratching and to answer any questions you have on the treatment.

An endometrial scratch sounds painful – is it?

Endometrial scratching may cause some minor discomfort, similar to that of a cervical smear, but should not be painful. The scratch itself is made with a plastic catheter. It may be an idea to take some paracetamol half an hour before the procedure, but no anaesthetic is required and takes just 15–20 minutes. London-based Miss Tozer will talk you through what to expect during and after the procedure, explaining that afterwards you may experience some mild cramping and you may prefer to take the day off work rather than return immediately.

It is no secret that IVF is a stressful process. With all that is stake, it is going to be. You then throw some hormonal drugs into the mix for good measure. For every eager-to-get-going woman who presents at Miss Amanda Tozer’s London fertility clinic, there will be another who is filled with apprehension and trepidation: how will the drugs affect her mood? Will she cope without her usual emotional strength? If this sounds familiar, here is some advice on taking the next step.

1. Do your fertility research.

While having a sense that an ordeal lies ahead is putting you off, knowing concrete facts can often help you through. Getting some clarity on what will happen when will enable you to plan ahead and to keep clear of stressors at particular times.

2. Keep communicating.

While the woman bears the brunt of the IVF treatment, it can put strain on both partners so it is important to keep talking. Enlist the support of family and friends, and many women find comfort from online forums where others are going through the same process. Remember that you are not alone.

3. Choose the right fertility care for you.

If you are feeling particularly nervous of IVF, you may find a large clinic too impersonal. At her London IVF clinic, female gynaecologist Amanda Tozer offers one-to-one care, guiding her couples through the entire process you’re undergoing fertility treatment. She personally performs each procedure and encourages her patients to call her personal line any time with questions or concerns.

4. Keep your eye on the prize.

It is an undeniable truth that a woman’s fertility decreases as she gets older, and the rate at which it does so accelerates after 35. While you must only embark on IVF if you feel it is the right step for you, if you are experiencing difficulty in conceiving, the sooner you seek help, the greater the chances of success.

Do you have much time in your life to think proactively about your health? Very few women do, but it is well worth factoring in some time to attend a Well Woman screening appointment.

1. Who is it for?

Well Woman screening is for all women, whether they are in their reproductive or postmenopausal years. There is a misconception that it is only really relevant for women in their later years but there are many feminine conditions that do not discriminate by age.

2. Is it not sufficient to make an appointment with my GP?

Your GP is certainly your first port of call if you have any concerns but the NHS cannot cover such a level of screening – nor will your GP have the specialist equipment to run all the tests (e.g. pelvic ultrasounds). During your Well Woman screening with London female gynaecologist Amanda Tozer, you will discuss your full medical history and any current concerns before undergoing a flexible package of tests. The consultation is an unhurried affair, and Miss Tozer will personally talk you through the results, advising on any necessary next steps, be they further treatment or simply lifestyle changes.

3. What tests will be run?

At Miss Tozer’s London clinic, she offers the full range of Well Woman screening tests including blood tests, full blood count, liver and renal function, BMI, blood pressure, fasting glucose and cholesterol levels, urinalysis, hormone tests, breast examination, thyroid function, bone densitometry and the CA125 tumour marker for ovarian cancer.

4. Do I want to know?

While some women will say that ignorance is bliss, others will argue that knowledge is power. Early detection of any condition – be it anaemia, diabetes, a hyperactive thyroid or cancer – means swifter, targeted action and a better chance of full recovery.

In films, books and general parlance, the two most frequently cited menopause symptoms are (often comical) hot flushes and a significant loss of libido. However, while many women do find their sex drive has taken a nose dive, there are many others who have not lost interest in intimacy, rather the act of sex has simply become painful. At Amanda Tozer’s London menopause clinic she is often asked this one question: ‘do I just have to say goodbye to my sex life?’

What changes does the vagina undergo during menopause?

The term for pelvic pain felt during or after sex is dyspareunia, and its symptoms can be very distressing and have a negative impact on self-esteem and on relationships. Dyspareunia that has developed with the menopause is likely to be a consequence of vaginal atrophy, itself a result of oestrogen levels plummeting. The vaginal wall requires oestrogen to keep it strong and resistant by increasing the blood supply and the levels of secretions to make it softer and able to stretch; when oestrogen levels fall, the vaginal tissues thin and lose their stretch and lubrication, both vital to pain-free sexual intercourse.

Can I enjoy pain-free sex after the menopause?

Female gynaecologist Amanda Tozer is pleased to be able to offer an innovative new treatment at her London clinic for women suffering from menopausal vaginal atrophy: the MonaLisa Touch. Clinical trials have shown that after just three sessions 63.53 per cent of patients reported an improvement in their symptoms of dyspareunia.

The MonaLisa Touch is a non-invasive laser treatment that gets to the root of vaginal atrophy, promoting and recovering pre-menopausal metabolic activity. New collagen, hyaluronic acid and other essential elements are synthesised, helping to regain a hydrated mucosa and, as a consequence, a proper trophic supply to the vaginal tissues – allowing them to function more as they did before the menopause threw your sex life into disarray.

The Mona Lisa treatment works very well in treating other menopausal symptoms such as recurrent thrush and vaginal dryness.