OFTEN you go to the GP in the hope of a straightforward diagnosis, and an effective solution.
Unfortunately, our bodies are clever and complicated, which means it’s not always possible to immediately pinpoint the cause of a problem.
Dr Zoe Williams answers some common questions sent in by readers
Your GP may need to take a full history and try multiple tests before getting to the bottom of things – but they will keep trying!
Here are some of the questions readers asked me this week…
Q: MY granddaughter is 18.
She has unwanted hair growth on her lower cheeks, chin, chest and tummy, which she gets waxed off every month, and she also has irregular periods.
She may have polycystic ovary syndrome, but was told she can’t have a scan until she’s had periods for eight years.
She is now on the combined pill to regulate her periods.
The nurse said it probably wouldn’t solve the hair issues, so she went back to the docs only to be told there is nothing they can do on the NHS as it’s cosmetic and to go down the private clinic route.
I’m absolutely appalled at this.
She is going to uni in September, this hair issue really bothers her and may affect her mental health.
Does she need a second opinion?
I’m sorry to hear this and yes, this could impact on your granddaughter’s confidence and quality of life, so should be taken seriously.
The medical term for the abnormal hair growth you describe is hirsutism.
Hirsutism is the growth of excess thick, coarse hair in male hormone sensitive areas in women (eg, face, chest, abdomen, lower back, upper arms and thighs).
Polycystic ovary syndrome is the most common cause and is highly likely if your granddaughter also has irregular periods.
If a blood test is positive for PCOS, a diagnosis of PCOS can be made.
A transvaginal ultrasound, to look at the ovaries, is not required in this case, and would not add any information that would alter the treatment and management plan.
It is true ultrasound should not be used for the diagnosis of PCOS in patients whose periods started less than eight years ago.
This is because it’s common for these people to have multiple follicles (polycystic) ovaries anyway, even if they don’t have PCOS.
Perhaps this wasn’t explained to your granddaughter.
In terms of what to do next, the combined contraceptive pill is the correct medical treatment for hirsutism and irregular periods.
But you’re right, this hormonal treatment may prevent hair growth from worsening, but likely won’t get rid of it.
It’s advisable to pair it with laser hair removal treatment — which is more likely to achieve permanent results than waxing.
It’s not available on the NHS, but if you search for deals on websites like Groupon, it can end up costing a similar price to going for professional waxing.
A tip from me is to opt for Soprano Ice laser, as this is relatively painless but effective.
Other things to consider include lifestyle changes.
In people who are also overweight or obese, weight loss has been shown to improve menstrual regularity, hirsutism and acne associated with PCOS.
There is a drug called metformin which is licensed for use in PCOS and has been shown to be effective for treating hirsutism in some.
It is more likely that this would be prescribed if your granddaughter is carrying excess body fat, as taking metformin can reduce weight, waist circumference and testosterone levels in overweight women with PCOS.
Finally, something else to explore once your granddaughter turns 19 is a prescription-only cream called eflornithine, which can be applied to the skin.
This is licensed for use for facial hirsutism in women aged 19 years and older.
However, like all medicines there is a risk of side-effects, and importantly, one of them is acne, which people with PCOS and teenagers are also quite likely to have.
Q: I HAVE a pain in my right leg.
It seems to come from my ankle during the day. When I go to bed at night it becomes extremely painful.
The vein protrudes and the ankle joint on the right hand side becomes puffy.
I get up, massage and exercise, and after about an hour it subsides. I go back to bed and it starts all over again in a few minutes.
My GP says it’s sciatica, the physio says it’s a strained ankle – nobody seems to know what it is.
Please help, I have had it for about six months.
A: It seems as though this problem is having a very significant impact on your quality of life and you have not yet achieved a clear cause, diagnosis or treatment plan for these symptoms.
While it is impossible for me to attempt to diagnose it without more detail, a full history, examination and likely investigations, I can advise on where you should seek help next.
The first port of call should be back to the GP, to start afresh and consider whether there could be an anatomical cause (injury or deformity of the joint), inflammatory cause (such as rheumatoid arthritis), a nerve cause (such as sciatica), a circulatory cause (poor circulation, DVT) or a systemic cause (some other illness which can cause pain).
I’m dogged by dizziness
Q: I SUFFER with bouts of acute dizziness when lying down and getting up from a horizontal position.
I believe this to be BPPV, which seems connected to an ear problem.
Could you tell me about this and whether there is anything I can do?
A: BPPV stands for benign paroxysmal positional vertigo and it’s a common cause of dizziness.
Benign means the cause of dizziness is not a threat to your health.
Paroxysmal that the dizziness comes in short bursts.
Positional means the dizziness is provoked by certain body or head positions, and vertigo is the medical name for the spinning sensation.
It’s more common in middle-aged and elderly people.
You are right, it originates from a part of the inner ear called the semicircular canals, where there is a collection of tiny crystals which can become dislodged from their correct position and cause BPPV.
Once the crystals are loose, putting your head into certain positions can cause the crystals to move, making your brain think you are moving even though you are not.
There is something you can do yourself to treat BPPV, called The Epley Manoeuvre.
It involves you turning your head in a series of movements to return the crystals to where they belong.
There are some great videos on YouTube from NHS Scotland. Search for “Epley NHS”.
If you don’t have any luck, book a double appointment with a GP and mention that it is for the Epley Manoeuvre.