March 2012

A recent BBC documentary examines the benefits of 20 second bursts of intense exercise.

Three exerpts are presented in video format - Videos - Intensive Exercise Benefits

Newsletter 23 - This will be the last newsletter with details sent through aWeber


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Metformin and PCOS

 In 1998, Metformin was introduced into the treatment of PCOS. PCOS is associated with insulin resistance and metformin is an insulin sensitizer. Initial studies looked entirely promising but larger studies have subsequently shown that it has little if any value. - see Updated Review


Family Planning and Age related reproductive risk

The development of reliable contraception from around the 1950s and increasing emphasis on career satisfaction and household economy have resulted in a significant move for women in 'developed' countries to delay their first pregnancy. Many of unaware of the potential problems associated with delaying motherhood. This is reviewed in Family Planning - Age Related

HRT and Breast Cancer

A recent review concluded "Healthy women have a low absolute risk of adverse events, whether they use hormone treatment during early menopause or not." Read the details....

Newsletter 22

I am frequently asked about how the menstrual cycle works: I hope the following video will help answer this question.


New Video - Reproductive Hormones (Oestrogen and Progesterone) and the Menstrual Cycle

An understanding of the female reproductive hormones is crucial when considering:

  1. Hormone Contraception.
  2. Reduced / Absent menstrualtion.
  3. Infertility.
  4. Premenstrual Syndrome.
  5. The Menopause and Hormone Replacement Therapy.

This new short video explains the basics of the mechanisms that control the cycle, and the changes that are occurring in the ovaries and uterus during the cycle.

Menopause and sexuality: key issues in premature menopause and beyond.

Woman's sexuality encompasses sexual identity, sexual function, and sexual relationships.  1101

It is modulated throughout life by life and reproduction-related events, health, relationships, and sociocultural variables.

The aging process and menopause are two potent contributors to female sexual dysfunction.

The earlier the menopause, the more severe and complex the impact on sexuality is.

The younger the woman, the less she realizes the different key goals of her life cycle (falling in love, having a satisfying sexual life, forming a stable couple, getting married, having a family) and the more pervasive the consequences on her sexual identity, sexual function, and sexual relationship can be.

Premature menopause is an amplified paradigm of the complex impact menopause can have on women's and couple's sexuality.

Graziottin A.
Center of Gynecology and Medical Sexology, H. San Raffaele Resnati, Milan, Italy.



Newsletter 21

Sperm, Eggs and Fertilisation

Our knowledge about physiology, the way the body functions is rapidly expanding. In a recent BBC documentary, released May 2011, we learn that fewer sperm than previously believed ever reach the fallopian tubes. When they arrive their, they are effectively sedated and only reivigorated when an egg is released.

Failed IVF - Assisted Hatching

IVF is usually a last resort for those with infertility. When IVF fails, assisted hatching becomes and option. As with all aspects of infertility treatment there is debate on the merits of assisted hatching.

A recent study confirms that this treatment may have a place.

Assisted Hatching was related to increased clinical pregnancy and multiple pregnancy rates in women with previous repeated failure or frozen-thawed embryos.1101

Assisted hatching is a laboratory technique developed in order to improve implantation of embryos generated by means of in vitro fertilization (IVF).

Assisted hatching involves the creation of modifications to the wall of the embryo to improve the probabilities of intra uterine implantation, by creating a small hole in the outer protective shell of the embryo (zona pellucida).

Assisted hatching is a good option for couples experiencing poor IVF outcomes or who have been diagnosed with a poor fertility prognosis.

Assisted hatching is a very delicate technique and can be performed only by a skilled micromanipulator or an embryologist. The embryo is held with a customized holding pipette and a very delicate, hollow needle is employed to expel an acidic solution against the outer shell or zona pellucida of the embryo. A small hole is produced in the shell by the acidic solution and the embryo is then washed and put back in the incubator. Shortly afterwards, the embryo transfer procedure is began. This procedure may be achieved chemically, mechanically, or with a laser.

assisted hatching   Assisted Hatching

Endometriosis Infertility Endometrial Polyps

Endometriosis is found in about 40% of women with infertility. A study from China has shown that about a third of these have endometrial polyps that can also be reducing the cance of pregnancy. Hysteroscopy +- polypectomy should be considered when endometriosis is noted in an an infertile woman.


Pictures of endometiosis and endometrial polyps.

Fertil Steril. 2011 May 14. [Epub ahead of print]
High prevalence of endometrial polyps in endometriosis-associated infertility.
Shen L, Wang Q, Huang W, Wang Q, Yuan Q, Huang Y, Lei H.
Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, People's Republic of China.

In a retrospective study, examination of 431 infertile women (158 cases with endometriosis and 273 without endometriosis) showed a significantly increased frequency of endometrial polyps in patients with endometriotic infertility and no significant differences among different stages and locations of endometriosis. Hysteroscopic polypectomy and removal of endometriotic foci significantly increased the chances of achieving a pregnancy compared with those without polyps.


Pelvic Pain and Hysterectomy

Chronic pelvice pain is a common problem affecting more than 10% of women. There are many causes which can be considered as gynaecological and non-gynaecological.

Many women with chronic pelvic pain come to hysterectomy. A recent review emphasised the need for careful evaluation before resorting to hysterectomy.1101:-

"Although hysterectomy is an accepted treatment for chronic pelvic pain, it has important limitations that need to be discussed with the patient before surgery. Women can expect improvement in pain levels and function from their preoperative baseline. However, studies show that in the absence of any obvious pathology, 21-40% of women having a hysterectomy for chronic pelvic pain may continue to experience pain after the surgery and 5% may have new onset of pain. Women may experience improvements in mental health, physical function, social function, and dyspareunia; however, sexual frequency is not likely to change. Comorbidities such as preoperative depression may lower the chances of pain resolution after hysterectomy. Approximately 14% of women report having results worse than expected and almost 26% may have a slower recovery than expected. To maximize the chances of pain resolution, all women with chronic pelvic pain should undergo a full evaluation of the urologic, gastroenterologic, neurologic, and musculoskeletal organ systems before surgery to exclude nonreproductive causes of pain."

Very Early Membrane Rupture in Pregnancy

At 20 to 23 weeks, survival is unfortunately poor (20% to 25%) and there is a high incidence of handicap in those who do live. PROM before 20 weeks gestation is associated with significant risk of infection and survival chance is negligible.

The outcome of 159 women with PROM before 24 weeks gestation in Salt Lake City has been reported.1101 More than half the women who delivered more than 12 hours after the membranes ruptured had a surviving child and nearly half had no major neonatal problems.

DHEAS Dehydroepiandrosterone sulfate and postmenopausal women.

DHEAS, mainly secreted by the adrenal gland, is the most abundant circulating steroid in humans. It acts as an inactive precursor, that is converted initially into DHEA and thereafter into active androgens and estrogens in peripheral target tissues.  

A remarkable feature of plasma DHEAS levels in humans is their great decrease with aging.

Researchers have postulated that this age-related decline of DHEAS levels may explain some of the degenerative changes associated with aging.

Administration of DHEA to laboratory animals has demonstrable beneficial effects such as prevention of diabetes mellitus, obesity, cancer, heart disease and positive immunomodulator effects.

Three mechanisms of action of DHEA(S) have been identified. DHEA and DHEAS are precursors of testosterone and estradiol.

 Randomised, placebo-controlled clinical trials which included healthy individuals aged 60 years and over treated with (near) physiological doses of DHEA (50-100 mg/day) have demonstrated very few positive results.

 Many elderly people in western countries take DHEA without medical supervision. In the US, DHEA is even classified as food supplement. At present there is no scientific evidence to recommend DHEA replacement in the elderly. Further studies are needed to form conclusions about the efficacy and the safety of DHEA replacement in elderly, and to better understand the mechanisms of action of DHEA at the molecular and cellular levels.

 A recent study of DHEAS supplements in healthy, postmenopausal women showed no benefit.1101



Women's Health

This is the personal website of David A Viniker MD FRCOG, retired Consultant Obstetrician and Gynaecologist - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

General and Personalised Questions


This website provides medical information of a general nature.

It would not be possible to provide answers to an individual patient over the internet.

A medical opinion for an individual patient requires the doctor

  • To take the full history (story).
  • Examination of the patient is usually required.
  • Investigations (tests) may be required.

There is a search box at the top of every page on the right of this website. If you type in your main problem, you will be offered a series of pages that may assist you.


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The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.

David Viniker retired from active clinical practice in 2012.
In 1999, he setup this website - - to provide detailed
information many of his patients requested. The website attracts thousands of visitors every day from around the world.
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