There are a number of ways in which obesity is measured but the most commonly used system is that of the Body Mass Index (BMI). This is a calculation based on a combination of height and weight. A BMI of over 25 but under that of 30 is considered overweight and a measurement of 30 or over is considered obese. Morbid obesity is generally defined as a BMI of 40 or over. The healthy range is 18.5 to 25, with anything under 18.5 being considered unhealthy.
Here is a link so you can see where you are on the scale. Please be sure to enter your exact height and weight.

https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/

This is one of the best known forms of contraception. It consists of 2 hormones – oestrogen and progesterone – which are taken in the form of one pill orally every day for three weeks, followed by a one week “pill-free” interval. It is a very effective form of contraception if taken correctly. The pill should ideally be taken at the same time of the day. However you have up to 12 hours to remember to take it if you have forgotten. It works by stopping ovulation from occurring. It has few side effects and most young women can safely use it. It is not recommended in women over the age of 35 who are smokers or overweight.

There are several different brands available in Ireland. The most common brands available are Yasmin, Yasminelle, Yaz, Ovranette, Mercilon, Logynon, Microlite, Ovreena, Qlaira, Minulet, and Cilest.

This is an oral form of contraception which contains only progesterone. This is a slightly less effective form of contraception but is ideally suited for women who cannot take the combined pill for instance breast feeding mums,women who smoke over 35, or overweight women. It works by thickening cervical mucus and therefore making a more hostile environment for sperm to survive. It must be taken daily and it can be associated with breakthrough bleeding. Unlike the combined pill,you must take it within the same three hour period every day to ensure maximum contraceptive effect.The most common brands include Cerazette, Azalia. Desogestreland Noriday,

The contraceptive patch is a small sticky patch that releases hormones into your body through your skin to prevent pregnancy.
The patch releases a daily dose of hormones through the skin into the bloodstream to prevent pregnancy.
It contains the same hormones as the combined pill – oestrogen and progestogen – and works in the same way by preventing the release of an egg each month (ovulation).
It also thickens cervical mucus, which makes it more difficult for sperm to move through the cervix, and thins the womb lining so a fertilised egg is less likely to be able to implant itself.
Apply your first patch and wear it for 7 days. On day 8, change the patch to a new one. Change it like this every week for 3 weeks, and then have a patch-free week.
During your patch-free week you’ll get a withdrawal bleed, like a period, although this may not always happen.
After 7 patch-free days, apply a new patch and start the 4-week cycle again. Start your new cycle even if you’re still bleeding.
Where to put the patch
Stick the patch directly onto your skin. You can put it onto most areas of your body, as long as the skin is clean, dry and not very hairy. You shouldn’t stick the patch onto:

• sore or irritated skin
• an area where it may get rubbed off by tight clothing
• your breasts

It’s a good idea to change the position of each new patch to help reduce the chance of skin irritation.

Monthly NuvaRing is a small, flexible vaginal ring used to prevent pregnancy. And it’s easy to use. You insert and remove it yourself. Just put it in for 3 weeks, take it out, then put a new one in a week later. Once NuvaRing is in your vagina, it releases a continuous low dose of hormones. The exact position of NuvaRing inside the vagina is not critical for its function. It’s just as effective as the pill when used as directed, and you don’t have to think about taking it every day.
NuvaRing is not suitable for those who smoke cigarettes and are over 35 years old. Smoking increases your risk of serious heart and blood vessel problems from combination hormonal contraceptives (CHCs), including heart attack, blood clots, or stroke, which can be fatal. This risk increases with age and the number of cigarettes smoked.

For more information visit: https://www.nuvaring.com

High dose progesterone can be given as a three – monthly injection (Depo Provera) which is injected into your bum or arm. This is a very effective form of contraception. It is suitable for most women and is ideal if remembering to take pills is proving difficult.
The injectable contraception contains an artificial form of the progesterone hormone. Progestogen is slowly absorbed from the muscle into the blood over a course of 12 weeks.
It is:

• Over 99% effective when you use the method correctly every time
• Over 94% effective when you don’t always use the method correctly

It works by:

• stopping ovulation (an egg being released from your ovaries)
• thickening the mucus at the neck of the womb (uterus) so that it is difficult for sperm to enter the womb
• thinning the lining of the womb and this prevents a fertilised egg from settling (implanting) in the womb

Once this prescription is sent to your local pharmacy they’ll be able to administer the injection for you.

The Government has decided to provide a free contraception service for women and people aged 17 to 25 years inclusive. This new service will allow those eligible to receive a doctor’s appointment for free and receive free contraceptive medication.

As smartscripts is a private online doctor service we don’t get reimbursed for the doctor’s appointment so our fee of €20 still applies but all our prescriptions will allow you to receive free medication in the pharmacy.

ellaOne® is an oral emergency contraceptive pill (also known as the morning after pill) containing ulipristal acetate.
No other morning after pill is more effective than ellaOne®. If you have had unprotected sex, taking ellaOne® can prevent unplanned pregnancy. ellaOne® can be effective for up to 5 days (120 hours) after unprotected sex has taken place, but like all morning after pills it is more effective the sooner you take it.
ellaOne® is intended for use in the case of emergency it is not meant to be a replacement for a regular method of contraception.

Condom split? Missed pill? Caught in the moment? Whatever the reason, realising that you’ve had unprotected sex and could be at risk of pregnancy is never a fun moment. Don’t feel alone – plenty of people have been in this situation before.
To reduce the risk of unplanned pregnancy, it is wise to seek emergency contraception as soon as possible.

ellaOne® works by delaying ovulation so that any sperm in the female reproductive system cannot find an egg to fertilise, and so no pregnancy can occur.

When you have unprotected sex, sperm travel from the vagina, through the cervix and up the fallopian tubes where they wait for an egg. ellaOne® helps prevent or delay ovulation until all the sperm have died (5 days), so there is no egg for them to fertilise and no pregnancy can take place.

It is very important that you take ellaOne® as soon as possible after unprotected sex for it to be most effective.

If ovulation has already taken place, no morning after pill will be effective. It is very hard to know when you are ovulating as your cycle can change from month to month. By taking ellaOne® as soon as possible after unprotected sex, you reduce the risk of ovulating in that time.

The morning after pill only works by preventing ovulation, it can not cause an abortion and it will not have any effect in a case where an egg has already been fertilised.

No other morning after pill is more effective than ellaOne® .

In a clinical trial, ellaOne® has been shown to reduce the rate of pregnancy to just 9 in 1000 when taken within 24 hours of unprotected sex.

The Irish government introduced a free contraception service for women and people aged 17 to 26 years inclusive. This means you can access your primary GP for free and receive free medication in the pharmacy.

As smartscripts is a private online doctor service unfortunately we don’t get reimbursed so we still charge a €20 fee to complete our online consultation but the emergency contraception pill will be available free of charge in the pharmacy.

Our doctors can prescribe antibiotics, there are a number of treatments including nitrofurantoin and trimethoprim.

There is a small chance the bacterium may be resistant to the antibiotic the doctor prescribes, if this turns out to be the case please contact smartscripts as soon as possible.

Infections of the bladder(cystitis) or urethra (tube that carries urine out of the body)
are known as lower UTIs. These can cause:

• a need to urinate more often than usual
• pain or discomfort when peeing
• sudden urges to urinate
• feeling as though you’re unable to empty your bladder fully
• pain low down in your tummy
• urine that’s cloudy, foul smelling or feeling generally unwell, achy and tired

Most cases are thought to happen when bacteria in the bowel or on the skin get into the bladder via the urethra. The urethra is the tube that removes pee from the bladder and out of the body.It’s not always clear how this happens, but it can be caused by:

• having sex
• wiping your bottom after going to the toilet – particularly if you wipe from back to front
• inserting a tampon or urinary catheter (a tube that empties the bladder)
• using a diaphragm for contraception

Women may get cystitis more than men because their anus is closer to their urethra, which is much shorter. This means bacteria could get into the bladder more easily.

Norethisterone is a synthetic hormone which mimics the effect of the body’s naturally occurring hormone progesterone. It can have multiple uses such as treating breast cancer or endometriosis. However, it is often used as a tablet to delay periods. Norethisterone comes as a 5mg tablet and can be taken to delay periods for up to 17 days.
Norethisterone is NOT a method of contraception. It is therefore important that you should continue to use contraceptive methods if you do not want to become pregnant. Norethisterone should also not be taken if you are already taking the combined contraceptive pill. You can, however, take it while taking the mini pill.
Norethisterone is not suitable for pregnant or breastfeeding women.

If you are taking it to delay your period, there are a few things you should know. Firstly, it’s important that you can predict when your period is due. You should start taking it three days before you expect your period to start. One 5mg tablet is taken THREE times a day.

When you want your period to start, simply stop taking the medication. After stopping, your period should start 2-3 days later. You can take Norethisterone for up to 14 days in total, meaning that you can delay your period for around 17 days.

Side effects are very rare with Norethisterone if it is taken as directed. It is very important that you disclose all relevant information to our doctors by answering our questions truthfully; this will ensure that the medication is not given to someone for whom it is not appropriate.

smartscripts can provide prescriptions to help treat menopausal vaginal dryness, vaginal tablets Vagifem are prescribed to help treat vaginal dryness caused by menopausal hormonal changes.

When you start the menopause your ovaries produce less oestrogen. This causes your vaginal walls to get thinner and drier. Vagifem works by restoring oestrogen to your vaginal tissue, replenishing natural lubrication and relieving discomfort.

Vagifem starts to replace your natural oestrogen levels as soon as you start using it. It will take 8–12 weeks until you feel the full benefit of the treatment. You can stop using it once you feel better, but symptoms may return. You can use it long term if you need to. Common side effects you might experience when using Vagifem are vaginal irritation, new vaginal discharge, abdominal discomfort or bloating and headaches.

Vaginal dryness, sometimes called vaginal atrophy, is a common problem that many women may experience at some point in their life. Decreased levels of oestrogen in the body can cause changes in vaginal tissue and lead to reduced vaginal moisture and vaginal lubrication, causing vaginal dryness.

Those who experience vaginal dryness may experience symptoms such as burning, itching, frequent urination, urinary tract infections (UTIs), vaginal soreness, discomfort and irritation. These can be worsened during sex as it causes a lack of natural lubrication which results in discomfort and pain.

This can lead you to avoid sex or a drop in sexual desire.

It is predominately caused by hormonal changes which affect the vaginal wall causing vaginal atrophy. Most often the hormonal change is a result of menopause. Some research suggests that genitourinary symptoms, like vaginal dryness, affect up to 50% of women during menopause.

Other causes of vaginal dryness can include breastfeeding, taking contraceptive pills, antidepressants, hysterectomies and cancer treatments. These and other conditions can cause a disruption in your hormone levels. This disruption is what often results in vaginal dryness.

If you have other menopausal symptoms such as hot flushes, night sweats and mood changes, Hormone Replacement Therapy (HRT) patches or tablets may be beneficial for you.

Menopause is when the female hormones oestrogen and progesterone reduce in the female body causing a variety of possible unpleasant symptoms, including;

• Vaginal dryness
• Mood swings
• Hot flushes

Hormone Replacement Therapy treatments (HRT) are designed to replace these hormones, reducing the uncomfortable symptoms of menopause.
During menopause, a woman’s ovaries stop releasing an egg every month causing her to no longer have her monthly menstrual (period) cycle and will no longer be able to have any children.

This usually happens between the ages of 45 and 55. The average age in Ireland for a woman to reach menopause is 51.

Perimenopause is when you have symptoms before your periods have stopped completely. Symptoms can start 7 years before your periods stop.

Early menopause happens when your periods stop before the age of 45. It can happen by itself or as a side effect of some treatments.

Talk to your GP if you’re under 45 and your periods are infrequent or have stopped.

The reduction in oestrogen levels results in many of the characteristic symptoms of the menopause. Short-term symptoms that may continue for 2 to 5 years include hot flushes/flashes, night sweats, emotional disturbances (e.g., mood swings, irritability, depression, and anxiety), loss of libido (sex drive), insomnia/disturbed sleep, headaches, and tiredness.

Over the longer term, oestrogen deficiency results in skin and hair to become drier and thinner, including that of the vagina which makes intercourse painful. It also causes more frequent urinary infections and need to pass urine; urinary incontinence; bones to become thinner (osteoporosis); and an increased risk of heart and blood vessel disease. Low levels of progesterone are similar to those of oestrogen deficiency. They include infertility, dry skin, emotional disturbances, low libido, tiredness, headaches, and weight gain.

HRT is usually a combination of oestrogen and synthetic progesterone (progestin). The preparation and type of HRT suitable for any individual woman will depend on their preference and circumstance. All HRT provides an oestrogen dose into the bloodstream. However, oestrogen is usually given with progesterone to prevent an increase in the womb lining, which increases the risk of womb (endometrial) cancer.

HRT is available in many preparations such as tablets, skin patches, implants, sprays or in a specific vaginal preparation (vaginal creams, pessaries or rings). There are also different types of HRT, including oestrogen only HRT (for women without a uterus following hysterectomy), cyclical or sequential HRT (for women who still menstruate) or continuous combined HRT (for postmenopausal women).

The lowest effective oestrogen dose is usually taken at the start of treatment, and can be increased or the HRT type changed at a later date if ineffective. Long-term use (over 5 years) is generally not recommended. Stopping HRT after 2 to 5 years is appropriate once the menopausal symptoms have subsided. A gradual reduction in dose to prevent a recurrence of symptoms may be advised. Long-term symptoms of oestrogen deficiency such as vaginal dryness and osteoporosis may need continuing treatment with oestrogens or other therapies.

The most common side effects of HRT include fluid retention, bloating, breast tenderness and swelling, headaches, nausea and digestive disturbances, mood swings and depression. Weight gain may occur in women during the menopause, regardless of whether HRT is taken or not.

While HRT can reduce the risk of osteoporosis, and colon and rectal cancer, its use long term can increase the risk of breast and uterine (endometrial) cancer, stroke, and blood clots in blood vessels of the legs (deep vein thrombosis) and lungs (pulmonary embolism).

Useful links: https://www2.hse.ie/conditions/menopause/
https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/

Vaniqa cream is topical medicine that can be applied twice a day to help treat excessive facial hair growth. Its suitable for all women over the age of 19 and works by slowing down hair growth locally around the face and chin area. It cannot be used to treat excess hair in other areas.
Usually the cream will take a noticeable effect within 2 months and should be discontinued if no benefit is seen after 4 months. If the cream does work however, it is safe for continued use. Stopping treatment will usually cause the hair to grow back within 2 months.

The cream is NOT SUITABLE for women who are pregnant or breastfeeding.

Hirsutism is a condition that causes random unwanted and excessive hair growth in certain areas of the body. It’s a common condition that mainly affects women and is usually a symptom of another underlying condition.
Unwanted facial hair is often the most awkward symptom, causing low self-esteem, embarrassment and quite often distress. Up to 40% of women are affected by hirsutism at some stage in their life.

Causes
Hirsutism is a direct cause of either an excess of male hormones (androgens) in the body, or the body becoming more sensitive to the existing amount of endogenous androgen present. It’s not always clear what occurs to cause the symptoms but the two biggest causes are:

– PCOS (Polycystic Ovary Syndrome) – This is the most common cause in younger women. It is characterised by increased androgens in the body, developed fluid filled sacs in one ovary or both and irregular periods. PCOS patients often have difficulty in controlling their hormone levels, this includes androgens, thus causing increased, thicker and darker facial hair.

Post Menopause – Causes for hirsutism in post-menopausal women is unknown as sometimes androgen levels can be within range, yet a patient may still suffer from it. Some women tend to have greater facial hair growth as they get older regardless of menopause.

Less common causes include:

–Obesity –Cushings syndrome -Congenital adrenal hyperplasia –Acromegaly -Certain medicines such as certain HRT or IVF drugs -A tumour

Thrush is very easily treated with topical creams or internal pessaries. It is also possible to treat Thrush with an oral medication called Fluconazole and this is the easiest form of treatment. It is only necessary to take one capsule and the thrush symptoms will normally disappear within 10 days.

We can also prescribe pessaries like Gyno-Daktarin which contains a medicine called miconazole nitrate and is used for infections of the vagina and the skin around the vagina.

In about 5% of cases, thrush is caused by trichomonas (for which the treatment is Flagly).

The symptoms of vaginal thrush normally include an itching around the entrance to the vagina. Sometimes thrush will cause sexual intercourse to be painful and it may cause a stinging or burning sensation when urine is passed. Sometimes Thrush will cause discharge that is normally odourless. The discharge is usually thick and creamy (a bit like cottage cheese in texture) but it can be thin and watery in some cases.

More severe cases of vaginal thrush can include cracked skin around the entrance to the vagina. Severe cases can also include a red or swollen vagina. Ulceration of the vagina is unusual but it has been observed in cases of thrush. Where there is ulceration present, you should always get checked out by a doctor in a face to face environment as these ulcers can be caused by something other than thrush.

Thrush is caused by candida albicans. This is usually present in small amounts in the body but it is kept under control by the immune system. Occasionally there will be an overgrowth of the candida albicans and it will cause the symptoms outlined above.

Thrush can develop if you are feeling run down after an illness or if your immune system is impaired in some way. The use of antibiotics can also lead to thrush episodes as antibiotics can kill off the good bacteria that keep the levels of candida albicans under control.

An increased incidence of thrush during pregnancy has been observed. Thrush will not harm the baby but it should be treated with any of the cream or pessaries after consultation with your doctor or obstetrician. You cannot take the oral treatment (Fluconazole) while pregnant or breastfeeding.