Dr Bavna Sakurdeep

Wednesday: Iron Deficiency in Women — More Than Just Tiredness

If you feel constantly tired, dizzy, breathless, weak, cold, foggy, or notice hair shedding, don’t immediately blame yourself for being “lazy” or “stressed.”

It may be iron deficiency.

Women are especially at risk because of menstruation, heavy periods, pregnancy, low dietary iron intake, gut absorption issues, or blood loss.

Iron deficiency can exist with or without anaemia, and in women with heavy menstrual bleeding, it can affect energy, mood, concentration, physical performance, and overall quality of life. Clinical reviews show that heavy menstrual bleeding is strongly linked with iron deficiency and iron-deficiency anaemia.

Signs to look out for include:

Tiredness that doesn’t improve with rest, dizziness, headaches, shortness of breath on exertion, palpitations, pale skin, brittle nails, hair shedding, restless legs, poor concentration, and cravings for ice or non-food substances.

If you have heavy periods, recurrent fatigue, or symptoms suggestive of low iron, speak to your doctor about testing your full blood count and ferritin.

Your fatigue may not be weakness. Your body may be asking for support.

Tuesday: Heavy Periods — When Is It Too Much?

Many women live with heavy periods for years thinking, “This is normal for me.”

But heavy bleeding is not something you should simply tolerate.

Heavy menstrual bleeding can mean bleeding that soaks through pads or tampons quickly, periods lasting longer than usual, passing large clots, needing double protection, waking at night to change protection, or avoiding normal activities because of bleeding.

You should seek medical advice if you soak at least one pad or tampon every hour for more than two hours, have bleeding between periods, or have bleeding after menopause. These are important warning signs that should be checked.

Possible causes include fibroids, polyps, adenomyosis, endometriosis, hormonal imbalance, thyroid disease, bleeding disorders, contraception-related bleeding, or, less commonly, cancer.

Heavy periods can also lead to iron deficiency and iron-deficiency anaemia, which may cause tiredness, dizziness, shortness of breath, palpitations, poor concentration, and hair shedding. Iron deficiency and anaemia can significantly affect quality of life in women with heavy menstrual bleeding.

Common does not mean normal. If your period is controlling your life, please get checked.

Monday: Migraine Is Not “Just a Headache”

Migraine is one of the most common conditions affecting women, yet many women still feel they have to “push through it.”

But migraine is not simply a headache. It is a neurological condition that can cause throbbing pain, nausea, vomiting, sensitivity to light or sound, dizziness, fatigue, brain fog, and sometimes visual symptoms called aura.

Women are affected more often than men, and hormonal changes can play an important role. Attacks may become worse around periods, pregnancy changes, perimenopause, menopause, poor sleep, dehydration, skipped meals, stress, bright lights, or strong smells. NICE recognises migraine, including migraine with aura and menstrual-related migraine, as a clinical headache disorder requiring proper diagnosis and management.

Please seek medical advice if your headaches are frequent, worsening, affecting your daily life, or if you need painkillers often.

Seek urgent help for a sudden severe “thunderclap” headache, the worst headache of your life, headache with weakness, confusion, fainting, seizures, fever, neck stiffness, vision loss, or a headache that feels very different from your usual pattern.

Migraine is real. Your pain matters. You deserve proper care.

This week, I’ll be sharing a short series called:

Common but Not Normal: Women’s Health Week

Because many women quietly tolerate symptoms that affect their quality of life — headaches, heavy periods, fatigue, discharge, pelvic pain — thinking they are “just part of being a woman.”

But common does not always mean normal.

And getting checked does not mean you are overreacting.

It means you are listening to your body.

Understand your body. Protect your health. Feel empowered at every stage.

— Dr. Bavna Sakurdeep
Community Physician

Part 5 of Your Women's Health Series

🌸 10 Gynaecological Symptoms Women Should Never Ignore

As a community physician, one message I often repeat is this:

Please do not wait until symptoms become unbearable before seeking help.

Women are often incredibly good at enduring discomfort. We push through pain, bleeding, fatigue, bloating, discharge, and changes in our bodies because we are busy caring for everyone else.

But when it comes to women’s health, certain symptoms should never be brushed aside.

Most of the time, these symptoms may be due to treatable and non-cancerous conditions such as infections, hormonal changes, fibroids, polyps, endometriosis, ovarian cysts, or menopause-related changes.

But sometimes, they can be early warning signs of something more serious.

Early assessment can make all the difference.

1. Bleeding after menopause

Any va**nal bleeding, spotting, or brown discharge that occurs 12 months or more after your last menstrual period should be assessed.

It is not considered a normal part of ageing.

Most women with post-menopausal bleeding do not have cancer, but it can be an early sign of endometrial cancer, which is why prompt evaluation is important. ACOG notes that abnormal uterine bleeding can be an early sign of endometrial cancer.

2. Bleeding between periods

Occasional irregular bleeding can happen for many reasons, including hormonal changes, contraception, infections, polyps, fibroids, or stress.

But bleeding between periods should be discussed with a healthcare professional, especially if it is new, recurrent, heavy, or associated with pain.

Abnormal va**nal bleeding or discharge is listed by the CDC as a common symptom across several gynaecological cancers, except v***ar cancer.

3. Bleeding after s*x

Bleeding after in*******se should not be ignored.

It may be caused by cervical inflammation, infection, cervical polyps, va**nal dryness, or trauma.

But it can also be associated with cervical changes, including precancerous or cancerous changes, and should be properly examined.

4. Persistent pelvic pain or pressure

Pelvic pain that does not settle, keeps returning, or interferes with daily life deserves medical attention.

It may be linked to endometriosis, fibroids, ovarian cysts, pelvic inflammatory disease, urinary problems, bowel conditions, or, less commonly, gynaecological cancers.

The CDC lists pelvic pain or pressure as a symptom commonly associated with ovarian and uterine cancers.

5. Persistent bloating or increasing abdominal size

Bloating is common, especially around digestion or the menstrual cycle.

But bloating that is persistent, happens most days, or comes with an increase in abdominal size should be checked.

This is especially important if it is associated with feeling full quickly, loss of appetite, pelvic pain, or changes in bowel or bladder habits.

ACOG lists bloating, increased abdominal size, difficulty eating, feeling full quickly, pelvic or abdominal pain, and urinary urgency or frequency among symptoms that may occur with ovarian cancer.

6. Feeling full quickly or difficulty eating

If you suddenly feel full after eating only a small amount, or your appetite changes without explanation, do not ignore it.

This can be related to many digestive or metabolic conditions, but when persistent, it can also be one of the subtle symptoms associated with ovarian cancer. The CDC includes feeling full too quickly or difficulty eating among possible ovarian cancer symptoms.

7. Unusual va**nal discharge

A change in va**nal discharge can be due to common infections such as thrush, bacterial vaginosis, or s*xually transmitted infections.

However, discharge that is persistent, blood-stained, foul-smelling, watery, or associated with pelvic pain, itching, fever, or bleeding should be assessed.

Abnormal va**nal discharge is one of the symptoms highlighted by the CDC for gynaecological cancers.

8. Vulval itching, sores, lumps, or skin changes

Persistent itching, burning, pain, ulcers, lumps, thickened skin, colour changes, or non-healing sores around the v***a should not be dismissed.

Many causes are benign, such as infections, dermatitis, lichen sclerosus, or irritation.

But persistent v***al skin changes need proper examination, especially if they do not improve with usual treatment.

9. New urinary urgency, frequency, or constipation

Needing to pass urine more often, feeling urgency, or developing constipation can be due to many common causes.

But when these symptoms are new, persistent, or occur together with bloating or pelvic pressure, they should be reviewed.

The CDC notes that more frequent or urgent urination and constipation may occur in ovarian and va**nal cancers.

10. Pain during s*x

Pain during in*******se is not something women should simply tolerate.

It may be related to va**nal dryness, infections, endometriosis, pelvic inflammatory disease, fibroids, menopause-related changes, or emotional factors.

But persistent pain during s*x deserves compassionate medical assessment and proper treatment.

My message to women

Please remember this:

You know your body best.

If something feels unusual, persistent, new, or worrying, it is worth checking.

Seeking medical advice does not mean you are overreacting.

It means you are taking care of yourself.

Most gynaecological symptoms are not cancer. But early evaluation can detect problems sooner, provide reassurance, and allow treatment before complications develop.

As women, we often tell ourselves:

“I’ll wait and see.”
“It’s probably nothing.”
“I’m too busy right now.”

But your health is not something to postpone.

If you notice any of these symptoms, please speak to your doctor.

💚 Listen to your body.
💚 Do not ignore warning signs.
💚 Early assessment can save lives.

—

Dr. Bavna Sakurdeep
Community Physician

Evidence at a glance

Gynaecological cancers can present with symptoms such as abnormal va**nal bleeding or discharge, pelvic pain or pressure, bloating, difficulty eating, urinary urgency or frequency, and bowel habit changes.

For ovarian cancer specifically, symptoms may include bloating, pelvic or abdominal pain, feeling full quickly, difficulty eating, urinary symptoms, va**nal bleeding after menopause, and changes in bowel habits.

🌸 Part 4: Understanding Menopause — What’s Normal and What’s Not

Menopause is a natural stage in a woman’s life, but that does not mean women should suffer silently through it.

As a community physician, I often meet women who say:

“Doctor, I don’t feel like myself anymore.”
“I’m tired all the time.”
“I can’t sleep.”
“My mood has changed.”
“Is this just ageing?”

Many women go through perimenopause and menopause without fully understanding what is happening in their bodies. Some feel embarrassed to talk about it. Others are told to “just tolerate it.”

But menopause is not something women should have to navigate alone.

🌸 What is menopause?

Menopause is diagnosed when a woman has gone 12 consecutive months without a menstrual period, not due to pregnancy, medication, or another medical condition.

The years leading up to menopause are called perimenopause. This is when hormone levels, especially oestrogen and progesterone, begin to fluctuate.

This transition usually happens between the ages of 45 and 55, although it can occur earlier for some women. The World Health Organization describes menopause as a normal life stage, but also recognises that symptoms can affect quality of life and that women need access to reliable information and support.

🌸 Common symptoms of perimenopause and menopause

Every woman’s experience is different.

Some women have mild symptoms. Others find that symptoms affect their sleep, mood, relationships, work, confidence, and overall wellbeing.

Common symptoms include:

• Irregular periods during perimenopause
• Hot flushes and night sweats
• Poor sleep or waking at night
• Mood swings, anxiety, or low mood
• Brain fog and difficulty concentrating
• Tiredness and low energy
• Joint aches and muscle pains
• Vaginal dryness or discomfort during s*x
• Reduced libido
• Recurrent urinary symptoms
• Weight changes and changes in body composition
• Dry skin, hair thinning, or changes in skin texture

These symptoms are real. They are not “all in your head.”

🌸 What is normal?

It can be normal during perimenopause for periods to become:

• Irregular
• Lighter or heavier
• Closer together or further apart
• Less predictable

It can also be normal to experience hot flushes, sleep disturbance, mood changes, and va**nal dryness.

But “common” does not mean you must simply endure it.

If symptoms are affecting your quality of life, please speak to a doctor.

⚠️ What is not normal?

Some symptoms should always be checked.

Please seek medical advice if you experience:

• Very heavy bleeding
• Bleeding between periods
• Bleeding after s*x
• Bleeding after menopause
• Persistent pelvic pain
• Unexplained weight loss
• A new breast lump or ni**le discharge
• Severe mood changes or thoughts of self-harm
• Recurrent urinary symptoms
• Vaginal symptoms that affect intimacy, comfort, or daily life

Most of these symptoms have treatable causes. But they should not be ignored.

Bleeding after menopause, in particular, should always be assessed. If you have had no period for 12 months and then experience bleeding, spotting, or brown discharge, please see a doctor promptly. The NHS also advises seeking medical advice for bleeding after menopause or persistent irregular bleeding on HRT.

🌸 What can help?

There is no “one-size-fits-all” solution.

Management depends on your symptoms, medical history, age, risk factors, and personal preferences.

Helpful options may include:

• Lifestyle changes, including strength training, balanced nutrition, reduced alcohol, and stopping smoking
• Stress management and sleep support
• Vaginal moisturisers or lubricants
• Local va**nal oestrogen for va**nal and urinary symptoms, if suitable
• Menopausal hormone therapy, also known as HRT, for appropriate women
• Non-hormonal medications for symptoms such as hot flushes or mood changes
• Bone health assessment and prevention of osteoporosis
• Regular screening, including blood pressure, diabetes, cholesterol, breast screening, and cervical screening where appropriate

Hormone therapy can be highly effective for symptoms such as hot flushes and night sweats, and oestrogen therapy can help va**nal dryness and early menopausal bone loss, but it should always be discussed with a healthcare professional to weigh individual benefits and risks.

🌸 My message to women

Menopause is not the end of youth, beauty, energy, or purpose.

It is a transition.

A powerful one.

But it deserves care, attention, and support.

You do not need to accept poor sleep, constant exhaustion, low mood, painful intimacy, or feeling disconnected from your body as “just part of being a woman.”

Your health matters at every stage of life.

If you are struggling, speak to your doctor.

Ask questions.

Seek support.

Your body is changing — but you are still worthy of feeling well, strong, confident, and cared for.

💚 Menopause is natural. Suffering in silence should not be.

—

Dr. Bavna Sakurdeep
Community Physician

📚 Evidence at a glance

• Menopause is a natural life stage, but symptoms can affect quality of life and women need access to reliable information and care.
• Hormone therapy is considered one of the most effective treatments for hot flushes and night sweats, and can also help va**nal dryness and early menopausal bone loss.
• Bleeding after menopause should always be assessed by a healthcare professional.

Part 3 of Your Women's Health Series

🌸 Don't Ignore This Symptom: Understanding Post-Menopausal Bleeding

As a community physician, there are certain symptoms that immediately make me pause and think,

"This needs to be investigated."

One of those symptoms is post-menopausal bleeding.

Recently, a patient came to see me for her routine follow-up. Before we even began the consultation, she thanked me with all her heart for urgently referring her to a gynaecologist after she mentioned having post-menopausal bleeding.

She underwent surgery in time.

Knowing that early recognition and prompt referral likely prolonged her life and preserved her quality of life is one of those moments that reminds me why I chose medicine.

Her story is also a reminder for every woman reading this today:

Never ignore bleeding after menopause.

🌸 What is post-menopausal bleeding?

Post-menopausal bleeding is any va**nal bleeding, spotting, or brown discharge that occurs 12 months or more after your last menstrual period.

Even if it happens only once...
Even if it's only a few drops...

It should always be assessed by a healthcare professional.

Bleeding after menopause is never considered a normal part of ageing.

🌸 What causes it?

The reassuring news is that most women with post-menopausal bleeding do not have cancer.

There are several possible causes, including:

• Thinning of the lining of the uterus or va**na (atrophy), which is common after menopause due to lower oestrogen levels.

• Endometrial or cervical polyps.

• Hormone replacement therapy.

• Endometrial hyperplasia (thickening of the uterine lining).

• Cervical or uterine infections.

• Cancer of the uterus (endometrial cancer), cervix, or, more rarely, the va**na.

Although many of these conditions are benign, they all deserve proper evaluation.

🌸 Why is it important?

Post-menopausal bleeding is one of the earliest warning signs of endometrial cancer.

The statistics are powerful:

📊 Around 90% of women diagnosed with endometrial cancer experience post-menopausal bleeding as one of their first symptoms.

📊 Approximately 10% of women who present with post-menopausal bleeding are diagnosed with endometrial cancer.

That means:

Most women will not have cancer.

But because 1 in 10 may, every episode of bleeding should be investigated promptly.

🌸 What investigations might be needed?

Your doctor may recommend:

✔️ A pelvic examination

✔️ A transva**nal ultrasound to assess the thickness of the uterine lining

✔️ An endometrial biopsy (sampling the lining of the uterus)

✔️ A hysteroscopy, where a small camera is used to look inside the uterus if needed

These investigations help identify the cause of the bleeding and guide the most appropriate treatment.

🌸 My message to every woman

As women, we often dismiss symptoms because we're busy looking after everyone else.

We tell ourselves,

"It's probably nothing."

"It will stop."

"I'll deal with it later."

Please don't.

If you have gone through menopause and notice any va**nal bleeding, however light, don't wait.

See your doctor.

Most causes are not cancer, but if it is something serious, finding it early can make all the difference.

The patient who thanked me recently reminded me of a lesson I hope every woman remembers:

Listening to your body and seeking help early can save your life.

💚 Early action. Early diagnosis. Better outcomes.

—

Dr. Bavna Sakurdeep
Community Physician

📚 Evidence at a glance

🌿 Any va**nal bleeding occurring 12 months or more after the last menstrual period should be evaluated. (American College of Obstetricians and Gynecologists, ACOG)

🌿 More than 90% of women with endometrial cancer present with post-menopausal bleeding. (ACOG; Society of Gynecologic Oncology)

🌿 Approximately 10% of women with post-menopausal bleeding are diagnosed with endometrial cancer. (National Institute for Health and Care Excellence; ACOG)

🌿 When detected early, endometrial cancer has an excellent prognosis, with 5-year survival rates exceeding 90% for disease confined to the uterus. (American Cancer Society)

💚 Your Women's Health Series Part 2

A simple test that could save your life. 🌸

As a community physician, one of the most rewarding parts of my work is helping prevent disease before it happens.

One of the most powerful tools we have to protect women's health is something that takes only a few minutes to perform—a Pap smear.

Yet many women postpone it because they're busy, embarrassed, afraid it might be painful, or simply because they feel perfectly well.

The truth is that cervical cancer often develops silently. In its early stages, there may be no symptoms at all. By the time symptoms such as abnormal va**nal bleeding, bleeding after in*******se, pelvic pain, or unusual discharge appear, the disease may already be more advanced.

A Pap smear is not a test for cancer itself. It is a screening test that looks for abnormal changes in the cells of the cervix—changes that can be treated long before they develop into cancer.

The procedure is quick, simple, and usually takes less than five minutes. During the examination, a small sample of cells is gently collected from the cervix and sent to a laboratory for analysis. Although some women experience mild discomfort, it is generally not painful and can make a life-changing difference.

Why is it so important?

Almost all cases of cervical cancer (more than 95%) are caused by persistent infection with high-risk Human Papillomavirus (HPV).

Fortunately, these abnormal cervical cell changes usually develop slowly over several years, giving us an opportunity to detect and treat them before cancer develops.

Countries with organised cervical screening programmes have reduced cervical cancer incidence and deaths by up to 70–80%, making the Pap smear one of the greatest success stories in preventive medicine.

When cervical cancer is detected at an early stage, the 5-year survival rate exceeds 90%. This highlights the incredible value of regular screening.

Who should have a Pap smear?

Although recommendations may vary slightly between countries, in general:

• Women aged 21–29 years should have a Pap smear every 3 years.

• Women aged 30–65 years should continue regular screening. Depending on national guidelines, this may be:

A Pap smear every 3 years,
HPV testing every 5 years, or
HPV and Pap co-testing every 5 years.

Your doctor can advise you on the screening schedule that is most appropriate for you.

Before your appointment

To obtain the most accurate results:

✔️ Avoid s*xual in*******se for 24–48 hours before the test.

✔️ Avoid va**nal creams, medications, tampons, or douching for 24–48 hours beforehand.

✔️ If possible, avoid scheduling the test during your menstrual period.

My message to every woman

So often, we spend our lives caring for everyone else—our children, partners, parents, friends, and colleagues—while quietly placing our own health at the bottom of the list.

Please don't wait until you have symptoms.

A Pap smear is not something to fear.

It is an act of self-care.

It is an investment in your future.

If you're due for your screening, or if you've been postponing it for years, let today be your reminder to book that appointment.

Sometimes, the smallest test can make the biggest difference.

💚 Early detection saves lives.

—

Dr. Bavna Sakurdeep
Community Physician

📚 References (Evidence-Based)
World Health Organization (WHO): More than 95% of cervical cancers are caused by persistent high-risk HPV infection.
World Health Organization: Organised cervical screening programmes can reduce cervical cancer incidence and mortality by up to 70–80%.
American Cancer Society: The 5-year relative survival rate for localized cervical cancer exceeds 90%, highlighting the importance of early detection.

💚 Your Women's Health Series Part 1

💉 Prevent Cervical Cancer – Why the HPV Vaccine Matters

One vaccine. A lifetime of protection. 💚

As a community physician, one of the most powerful conversations I can have with parents isn't about treating disease—it's about preventing it.

One of the greatest advances in modern medicine is the Human Papillomavirus (HPV) vaccine. It is more than just another childhood vaccine; it is a vaccine that has the potential to prevent several types of cancer later in life.

As parents, we do everything we can to protect our children. We insist on seatbelts, helmets, healthy food, and routine childhood immunisations because we want them to grow into healthy adults.

The HPV vaccine is another way to protect them—not just today, but for decades to come.

What is HPV?

Human Papillomavirus (HPV) is the most common s*xually transmitted viral infection worldwide.

In fact, around 80% of s*xually active people will be infected with HPV at some point during their lifetime.

Most HPV infections clear naturally without causing problems. However, in some people, the infection persists and can cause abnormal cell changes that may eventually develop into cancer.

Which cancers can HPV cause?

Persistent infection with high-risk HPV types is responsible for more than 95% of cervical cancers.

It is also linked to several other cancers, including:

• Cancer of the a**s

• Cancer of the v***a

• Cancer of the va**na

• Pe**le cancer

• Certain cancers of the throat (oropharyngeal cancer)

HPV can also cause ge***al warts.

Why vaccinate children?

The HPV vaccine works best before exposure to the virus.

That is why it is recommended for girls and boys between 9 and 14 years of age, depending on national vaccination programmes.

Children in this age group develop a stronger immune response to the vaccine than older adolescents and adults.

The goal is simple:

Protect first. Prevent disease later.

Does it really work?

The answer is a resounding yes.

Since the introduction of HPV vaccination programmes around the world, researchers have observed:

✔️ Significant reductions in HPV infections.

✔️ Dramatic decreases in precancerous cervical lesions.

✔️ Falling rates of cervical cancer in young women in countries with high vaccination coverage.

Research shows that the HPV vaccine can prevent up to 90% of cervical cancers when combined with regular cervical screening.

This is one of the most remarkable success stories in cancer prevention.

Is it safe?

This is one of the questions I hear most often.

The HPV vaccine has been extensively studied for nearly two decades and hundreds of millions of doses have been administered worldwide.

Continuous safety monitoring by organisations such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) has consistently shown that the vaccine has an excellent safety profile.

Like any vaccine, mild side effects such as pain at the injection site, redness, swelling, or a low-grade fever may occur, but serious adverse events are very rare.

The benefits of preventing cancer far outweigh these temporary side effects.

A common misconception

One myth that still concerns some parents is that giving the HPV vaccine might encourage earlier s*xual activity.

Multiple high-quality studies have shown no evidence that HPV vaccination changes adolescents' s*xual behaviour.

This vaccine is not about s*xuality.

It is about cancer prevention.

My message to parents

As a physician, I don't see the HPV vaccine as simply another injection.

I see it as an opportunity.

An opportunity to prevent cancers that our children may otherwise face decades from now.

We often say that prevention is better than cure.

The HPV vaccine allows us to put that principle into action.

One decision you make today could protect your child for many years to come.

Sometimes, the greatest act of love is preventing a disease before it ever has the chance to begin.

💚 Protect. Prevent. Vaccinate.

—

Dr. Bavna Sakurdeep
Community Physician

📚 Evidence at a glance
🌍 More than 95% of cervical cancers are caused by persistent high-risk HPV infection. (World Health Organization)
💉 The HPV vaccine can prevent up to 90% of cervical cancers when administered before exposure to HPV and combined with regular screening. (National Cancer Institute; WHO)
👧 The vaccine is most effective when given at 9–14 years of age, before exposure to the virus. (WHO)
📉 Countries with high HPV vaccination coverage have reported substantial reductions in HPV infections, precancerous cervical lesions, and early cervical cancer rates. (WHO; The Lancet)

This Self-Care Sunday, let this be your gentle reminder:

You cannot pour endlessly from an empty cup.

Self-care is not laziness. It is not selfish. It is not something you need to earn after doing everything for everyone else.

It is how you protect your energy, your peace, your health, and your ability to show up fully in your life.

So today, slow down. Breathe. Move gently. Eat something nourishing. Rest without guilt. Choose peace where you can.

Your body and mind are always speaking to you. Take time to listen.

“Sometimes the most productive thing you can do is pause, breathe, and recharge your batteries.”