Frequently asked questions

No. Many high-risk pregnancies end in a normal vaginal delivery. The mode of birth is decided on the specific condition, how the baby is growing and how labour progresses, and it is discussed with you well before your due date.

It depends on the condition. Some women need a visit every four weeks in early pregnancy; others need weekly or twice-weekly checks in the third trimester. Your written plan sets out the schedule.

Some medicines are safe, some need a dose change and a few must be switched. Do not stop anything on your own - bring all your prescriptions to the first visit so each one can be reviewed.

Yes, in many cases. When the first twin is head-down and there are no other complications, vaginal birth is a reasonable option, with the team prepared to assist the second baby.

You need more iron, folic acid, calcium and protein, but not double the calories. You will get a diet plan suited to a twin pregnancy at your early visits.

Yes, for some tests. Chromosomal tests in particular are done for both partners when they are indicated.

For most couples there is no medical need to wait more than one normal cycle, but it is sensible to complete the key tests and start any treatment before the next conception.

Ideally between 6 and 8 weeks of pregnancy, or as soon as you have a positive test if you have a medical condition or a previous complication.

For most women, yes. It is given by an anaesthetist once labour is established. Side effects and the rare complications are explained beforehand so you can decide.

Women with a healthy single pregnancy, the baby head-down at term, and labour progressing normally. Suitability is checked again when you arrive in labour.

For women being monitored at home, fasting sugar below 95 mg/dL, 1 hour after a meal below 140 mg/dL, or 2 hours after a meal below 120 mg/dL are the usual targets. For diagnosis, the thresholds depend on the test used - for example, 140 mg/dL at 2 hours on the DIPSI test.

Uncontrolled high sugar can lead to a large baby, a difficult birth, and low sugar or breathing problems in the newborn. With good control and regular growth scans, most babies of mothers with GDM are born healthy.

Yes. Insulin does not cross the placenta in meaningful amounts and has been used in pregnancy for decades. Needing insulin does not mean you have failed at diet - some women simply need it to reach target.

Yes, in moderate portions. Whole fruits such as apple, guava, pear or orange are better than juices, and are ideally eaten as a snack rather than straight after a large meal. Mango, chikoo and grapes raise sugar more quickly, so keep portions small.

In most women it does, often within days. A repeat glucose test 6–12 weeks after birth is needed to confirm this, and yearly checks afterwards are advised because the chance of type 2 diabetes later in life is higher.

Not necessarily. Many women with gestational diabetes have a normal vaginal delivery. A caesarean is considered mainly when the baby is estimated to be very large or for other obstetric reasons.

A reading below 140/90 mmHg is generally considered acceptable in pregnancy, and most healthy women run around 110–120/70–80. A single high reading should be repeated after resting; consistent readings of 140/90 or more need medical review.

Often there are none, which is why routine BP and urine checks matter. Warning symptoms include a persistent headache, blurred vision or flashing lights, pain under the ribs on the right side, vomiting, and sudden swelling of the face, hands or feet.

Low-dose aspirin improves blood flow in the developing placenta. When started before 16 weeks in women at higher risk, it reduces the chance of early pre-eclampsia. It should only be taken on medical advice.

Labetalol, nifedipine and methyldopa have been used in pregnancy for many years and are considered safe. Leaving high BP untreated carries far more risk to mother and baby than these medicines do.

Often, yes. Induction of labour aiming for a vaginal birth is reasonable in many women. A caesarean is chosen when the condition is severe and delivery is needed quickly, or for other obstetric reasons.

The chance of recurrence is raised, roughly one in six overall and higher if it was early or severe. Starting aspirin early and having a monitoring plan from the first trimester helps in the next pregnancy.

Yes, in most cases. As the uterus grows, the placenta usually ends up well away from the cervix by the third trimester. That is why a repeat scan at around 32 weeks is arranged before any decisions about delivery are made.

If the placenta still covers the cervix late in pregnancy, a caesarean is needed. If it is low-lying but more than 20 mm from the cervix at the final scan, a vaginal birth can often be considered.

Strict bed rest is not routinely advised, as it raises the risk of blood clots without clear benefit. Avoid heavy work and intercourse, stay close to the hospital, and come in promptly if you bleed. Some women with repeated bleeding are admitted for observation.

It is a condition where the placenta grows into the wall of the uterus and does not come away after birth, which can cause heavy bleeding. It is serious, but when it is recognised before delivery and the operation is planned with the right team, outcomes are much better.

Often a hysterectomy at the time of caesarean is the safest way to control bleeding in accreta spectrum. In selected cases conservative options may be possible. The likely approach, and what it means for future pregnancies, is discussed with you in detail beforehand.

Desk work and short local travel are usually fine in the second trimester if you have had no bleeding. In the third trimester, avoid long journeys and places far from a hospital, and do not travel alone. If you have bled at any stage, discuss work and travel at your next visit before making plans.

Yes. With aspirin and heparin and careful monitoring, most women with obstetric APLA go on to have a live baby. Treatment reduces the risks substantially, though close watching for pre-eclampsia and growth problems remains important.

Yes. Low molecular weight heparin does not cross the placenta and is considered safe for the baby. Bruising at the injection site is common and harmless.

For most women with obstetric APLA, heparin is started as soon as pregnancy is confirmed, usually alongside aspirin which may already have begun before conception. The exact timing depends on your history and is set out in your plan.

Lupus can flare in pregnancy or after birth, but the risk is much lower when the disease has been inactive for six months before conception and hydroxychloroquine is continued.

Yes. Heparin, warfarin (after delivery) and hydroxychloroquine are all compatible with breastfeeding. Other lupus medicines are reviewed individually.

Usually, yes, with careful timing. A preventive dose of heparin is generally stopped about 12 hours, and a treatment dose about 24 hours, before an epidural or spinal anaesthetic. For this reason you will be told to stop injections when labour starts or the night before a planned delivery.

As a rough guide, babies weigh about 300 g at 20 weeks, 1 kg at 28 weeks, 1.8 kg at 32 weeks, 2.6 kg at 36 weeks and around 3 kg at 39–40 weeks. What matters more than a single number is the centile and whether growth continues on follow-up scans.

A balanced diet with enough protein, and treating anaemia, support healthy growth, but in growth restriction due to the placenta, extra food alone does not make the baby grow faster. Stopping tobacco in any form does make a real difference.

No. Many babies below the 10th centile are healthy and simply small. Normal Doppler studies and steady growth on repeat scans are reassuring.

If the cause was placental, starting low-dose aspirin before 16 weeks reduces the risk of early placental problems in women at higher risk. Treating conditions like APLA and BP, and stopping tobacco, also help.

There is no fixed number to count. Get to know your baby’s usual pattern from about 24 weeks, and if movements slow down, stop or change, contact the hospital the same day rather than waiting until the next morning.

Not always. Many small babies born at or near term go to the mother’s side and only need extra checks on sugar, temperature and feeding. Babies born early or with significant growth restriction are more likely to need neonatal care, and this is planned with the neonatal team before the delivery.

Between 16 and 24 weeks, a cervical length above 25 mm on transvaginal scan is generally considered normal, and most women measure 30–40 mm. A measurement of 25 mm or less before 24 weeks is considered short.

The stitch is placed under spinal anaesthesia, so you do not feel the procedure. Mild cramping and light spotting for a day or two afterwards are common. Removal at 36–37 weeks is done without anaesthesia in most women and feels similar to an internal examination.

Strict bed rest is not recommended, as it does not prevent preterm birth and raises the risk of blood clots. Avoid heavy lifting and intercourse as advised, and keep follow-up scans.

In women with a short cervix, nightly vaginal progesterone reduces the chance of preterm birth. It is less clearly helpful in other situations, so it is prescribed when there is a specific reason.

Yes. Once the stitch is removed at about 36–37 weeks, most women go into labour naturally and many have a vaginal birth.

Many women can. If you have had one previous lower-segment caesarean and this pregnancy is uncomplicated, a planned VBAC is a reasonable option, with around 60–80% of women achieving a vaginal birth.

An interval of at least 18 months between the previous delivery and the next birth is generally preferred, as shorter gaps are associated with a higher risk of the scar giving way in labour.

Staying active, keeping weight gain and sugar within the advised range, attending antenatal classes and waiting for labour to start naturally where safe all help. Coming in once labour is established, rather than very early, also tends to help.

Yes. An epidural is compatible with VBAC and does not hide the signs of uterine rupture in a way that makes VBAC unsafe. It is given by an anaesthetist once labour is established.

Induction is possible but raises the risk of scar rupture, especially with prostaglandins. A balloon catheter or breaking the waters may be used instead. The options and risks are discussed before any decision.

A repeat caesarean is advised after a classical uterine incision or previous rupture, with placenta praevia, and is often preferred when there are other complications. Some women also simply prefer a planned caesarean after counselling, which is a valid choice.

Pregnancy after 35 carries a somewhat higher chance of chromosomal conditions, diabetes, high BP and placenta problems, so it is often managed with extra screening. Most women over 35 have healthy pregnancies and babies.

Most IVF babies are entirely healthy. Large studies show only a small increase in some risks, partly related to the reasons for infertility rather than IVF itself. The anomaly scan and routine screening are the same as for any pregnancy.

Age alone is not a reason to have an invasive test. The NT scan with blood screening, with or without NIPT, gives a personalised result. CVS or amniocentesis is offered if screening shows a higher chance or if you prefer a definite answer.

No. IVF on its own is not a reason for a caesarean. The mode of delivery is decided on the same grounds as any pregnancy - the baby’s position, placenta, your health and how labour progresses.

Progesterone support is usually continued until about 10–12 weeks, when the placenta takes over hormone production. The exact timing depends on your IVF protocol and is agreed with you and your fertility specialist.

Natural conception after 40 is possible, but fertility falls and the chance of miscarriage rises with age. Women over 35 who have been trying for six months without success are advised to seek a fertility review. Once pregnant, the care plan is the same whichever way the pregnancy began.

In the first trimester, a TSH up to about 2.5–4.0 mIU/L is generally acceptable, depending on the laboratory’s pregnancy-specific range. Values are interpreted together with free T4 and thyroid antibodies, and targets for women already on thyroxine are usually kept towards the lower end.

Untreated overt hypothyroidism is linked with miscarriage, preterm birth and effects on the baby’s brain development. When it is treated and TSH is kept within the target range, these risks fall to those of other pregnancies.

A haemoglobin of 11 g/dL or more is considered normal in pregnancy. Between 10 and 10.9 is mild anaemia, 7 to 9.9 moderate, and below 7 severe.

Modern intravenous iron preparations are considered safe in the second and third trimesters and raise haemoglobin faster than tablets. They are given in hospital as a short infusion with monitoring.

Iron commonly causes constipation, dark stools or nausea. Taking the tablet with a small snack, plenty of water and fibre, or switching to a different preparation usually helps. If you still cannot tolerate tablets, IV iron is an option.

No. Iron and calcium reduce the absorption of thyroxine. Take thyroxine first thing on an empty stomach, and keep at least four hours before taking iron or calcium.

Diagnostic ultrasound has been used in pregnancy for decades and is considered safe when performed for a medical reason by trained operators, using the lowest exposure needed to get the information.

Early scans are sometimes clearer with a moderately full bladder. For scans after the first trimester it is usually not needed. The team will tell you when you book.

No scan can detect every condition. A good anomaly scan picks up most major structural problems, but some only become visible later in pregnancy and some are not visible on ultrasound at all.

Most women describe a brief pressure or cramp, similar to an injection. It takes a few minutes and you can usually go home the same day after a short rest.

Current evidence puts the additional risk from an experienced operator at well under 1 in 100. Your individual risk is discussed at counselling.

Avoid strenuous work and heavy lifting for a day or two. Report fluid leakage, bleeding, fever or strong cramping straight away.

The normal range depends on the size of the baby, because the NT grows slightly as the baby grows between 11 and 14 weeks. As a general guide, most babies measure under 3 mm, and a value of 3.5 mm or more is above the 99th centile. The number is never read in isolation - it is combined with your age and blood test to give your individual chance.

The scan can be done any time from 11 weeks to 13 weeks 6 days. Around 12 to 13 weeks is often a convenient time, because the baby is large enough for a good look at the early anatomy while still well inside the window.

It estimates the chance of Down syndrome rather than diagnosing it. Combined with the blood test, it identifies most affected pregnancies. A definite answer needs a diagnostic test such as CVS or amniocentesis.

A moderately full bladder can help in early pregnancy, but a very full bladder is uncomfortable and not necessary. The team will tell you what to do when you book.

No. NIPT is a more sensitive blood screen for the common trisomies, but it does not check the baby’s anatomy, the heart, the placenta or pre-eclampsia risk. Many couples have both, and the NT scan remains useful whichever blood test you choose.

Usually 20 to 30 minutes. If the baby is lying in an awkward position you may be asked to walk around for a while and come back, so allow a little extra time.

A level I scan is a basic check of the baby’s heartbeat, size, position, placenta and fluid. A level II anomaly scan adds a systematic, organ-by-organ assessment of the baby’s structure. The level II scan is the one recommended for every pregnancy at 18–22 weeks.

Between 18 and 22 weeks, with around 19 to 20 weeks often giving a good balance of clear views and time for any follow-up tests.

Yes. TIFFA stands for targeted imaging for fetal anomalies, and it is another name for the detailed mid-pregnancy anomaly scan.

Not reliably. Some babies with Down syndrome show markers or heart differences, but many look entirely normal on scan. Chromosomal conditions are more reliably screened for with the NT scan, combined screening or NIPT, and diagnosed with CVS or amniocentesis.

The anomaly scan is done mainly in 2D, which is how organs are measured and assessed. 3D imaging is useful for specific questions, such as looking closely at the face, spine or limbs, and is added when it helps answer a clinical question.

Bring your earlier scan reports, NT and blood screening results, and any medicine prescriptions. A full bladder is not usually needed.

Usually between 18 and 24 weeks, when the heart is large enough to see in detail. In high-risk pregnancies, an early heart scan from about 13 to 16 weeks can be done, followed by a full echo later.

Yes. The anomaly scan includes standard heart views as part of a whole-body check. A fetal echo is a dedicated, longer examination of the heart alone, with more views and detailed Doppler of blood flow and rhythm.

Larger holes, such as many ventricular septal defects and atrioventricular septal defects, can usually be seen. Very small holes may not be visible, and a hole between the upper chambers (an ASD) cannot be judged before birth because that opening is normally present in every baby.

Yes. It is an ultrasound scan through the abdomen, using the same technology as other pregnancy scans, with no radiation and no needle.

Most irregular beats in the womb are extra beats that are harmless and settle on their own. A fetal echo identifies the type of rhythm, and the small number of babies who need treatment are monitored closely and managed with the paediatric cardiology team.

In a healthy pregnancy, blood keeps flowing forward through the umbilical artery throughout the heartbeat, and the resistance (the pulsatility index) falls steadily as pregnancy advances. Results are compared with charts for the exact week. Raised resistance, or flow that stops or reverses between heartbeats, means the baby needs closer monitoring.

Scan weight estimates are usually within about 10 to 15% of the actual birth weight. That is why the trend over several scans matters more than any single estimate.

Sometimes the dates are slightly out, sometimes the baby is constitutionally small like its parents, and sometimes the placenta is not supplying enough nutrients and oxygen. Doppler and repeat measurements help tell these apart.

Measurements are not usually repeated more often than every two weeks, because smaller gaps make real growth hard to judge. Doppler, however, may be checked more often - even several times a week - when the placenta is under strain.

A balanced diet matters, but eating extra does not usually correct growth restriction caused by the placenta. Stopping smoking, controlling blood pressure and sugar, and attending planned scans are what make a difference.

Do not wait for your next scan. Contact the hospital the same day if your baby’s movements reduce or change in pattern, especially in the third trimester.

In published studies, NIPT detects about 99 in every 100 pregnancies with Down syndrome, with a false-positive rate of around 1 in 1,000. Because it is still a screening test, a higher-chance result must be confirmed by CVS or amniocentesis.

From 10 weeks of pregnancy onwards. Many couples combine it with the 11–14 week NT scan, which checks the baby’s early anatomy at the same time.

For the common trisomies, NIPT has a higher detection rate and fewer false-positive results than the double marker (combined) test. The combined test, however, comes with the NT scan and can include pre-eclampsia screening. Your options are discussed at counselling.

Yes, NIPT can be used in IVF pregnancies, and for twins it is available with some limitations in accuracy. It is less reliable after a vanishing twin, which is discussed before testing.

It means the laboratory could not give a reliable result, usually because too little placental DNA was present in the sample. It happens in a small proportion of tests, more often with higher body weight or very early testing. The options are a repeat sample or other screening.

No. Under the PCPNDT Act the sex of the baby is not tested for or disclosed, and NIPT reports issued for pregnancies in India do not include it.

It is a blood transfusion given to the baby while still in the womb, through a fine needle guided by ultrasound into the umbilical cord or a vein in the baby’s liver. It is used to treat fetal anaemia.

It varies. Anaemia from parvovirus often needs only one or two transfusions, because the baby recovers once the infection passes. Anaemia from Rh antibodies usually needs repeated transfusions every two to three weeks until delivery.

It is a scan that measures how fast blood flows in an artery in the baby’s brain. Faster flow suggests the baby may be anaemic. It lets doctors monitor the baby without a needle and decide when a transfusion is needed.

It is an established treatment, and for a baby with severe anaemia the benefits clearly outweigh the risks. It does carry a small risk of complications, including pregnancy loss, which is explained to you before the procedure.

Babies treated for Rh disease may need phototherapy for jaundice and, sometimes, a top-up transfusion in the first weeks after birth. The neonatal team is involved in planning before delivery.

It usually affects later pregnancies, after the mother has been exposed to Rh-positive blood. Anti-D injections during pregnancy and after birth greatly reduce the chance of antibodies forming.

Most are. Very large fibroids, previous extensive surgery or certain medical conditions may make open surgery the safer choice - this is assessed before the decision is made.

Myomectomy preserves the uterus and many women conceive afterwards. Depending on how deep the fibroids were, a gap before trying and a planned caesarean may be advised.

PCOS is a long-term condition, but its symptoms - irregular periods, weight gain, acne and difficulty conceiving - respond well to lifestyle change and targeted treatment.

Generally every three years from age 25, or every five years with HPV co-testing from age 30, unless your doctor advises otherwise.

PCOS is a long-term tendency rather than an infection or growth that can be removed, so there is no one-time cure. However, the symptoms can be controlled very well. Many women have regular cycles once their weight and insulin resistance improve, and symptoms often settle further with age.

In everyday use in India, PCOD and PCOS refer to the same condition. Medical guidelines use the term PCOS (polycystic ovary syndrome), because it affects hormones and metabolism, not just the ovaries.

Yes. Most women with PCOS conceive, either naturally or with help to ovulate. Letrozole tablets with scan monitoring work for many women; for others, injections, ovarian drilling or IVF may be needed. Optimising weight and sugar before pregnancy also lowers the risk of complications.

No. The pill is one option for regulating periods and treating acne or hair growth, and it can be stopped whenever you wish to conceive or try another approach. Some women manage well with lifestyle change alone or with periodic progesterone tablets to bring on a bleed.

Weight loss does not change the underlying tendency, but in women who are overweight, losing 5–10% of body weight often brings back regular ovulation, improves skin and lowers diabetes risk. Women with PCOS at a healthy weight need a different plan, focused on cycles and symptoms.

Long gaps between periods can, over years, raise the risk of the womb lining becoming abnormal. Making sure you have a regular bleed - naturally, with the pill or with progesterone - protects against this. Bleeding between periods or a very long gap should be checked.

Yes, in many cases. Fibroids that cause no symptoms often need only monitoring, and heavy bleeding can frequently be controlled with tablets or a hormonal IUD. Surgery is considered when symptoms persist despite medicines, when a fibroid affects fertility, or when it is large and growing.

Fibroids are benign, and it is extremely rare for a cancer called leiomyosarcoma to arise in the uterus. Rapid growth after menopause or unusual scan features are investigated further, but for most women this is not a realistic concern.

There is no single cut-off size. A 2 cm fibroid inside the cavity can cause heavy bleeding and affect fertility, while a 6 cm fibroid on the outer surface may cause no symptoms at all. The decision rests on symptoms, location and your plans for pregnancy.

Myomectomy removes the existing fibroids but not the tendency to form new ones, so some women develop new fibroids over the years. Many never need further treatment. Hysterectomy is the only treatment that removes the possibility entirely.

Yes. Fibroids depend on oestrogen and usually shrink after menopause, and symptoms often ease. Women close to menopause with manageable symptoms may choose to wait for this.

Most women go home within one or two days, return to desk work in about two weeks and resume full activity in four to six weeks, depending on the size and number of fibroids removed.

Yes. Functional cysts, which are the commonest type before menopause, usually disappear within one to three menstrual cycles without any treatment. A repeat scan after six to twelve weeks confirms this. Dermoid cysts, endometriomas and cystadenomas do not resolve on their own.

Size is only one factor. Simple cysts under 5 cm in women before menopause usually need nothing. Cysts larger than about 7 cm, those that persist or grow, those with complex features, and those causing pain are usually considered for removal.

Most functional cysts do not. Endometriomas are linked with endometriosis, which can affect fertility, and surgery on any cyst should preserve as much healthy ovary as possible. If you are planning a pregnancy, this is discussed before any operation.

Torsion is when an ovary, usually enlarged by a cyst, twists on its blood supply. It causes sudden, severe one-sided pain, often with nausea and vomiting, and needs emergency surgery to untwist and save the ovary.

No medicine dissolves an existing cyst. The contraceptive pill can prevent new functional cysts forming in women who get them repeatedly, and hormonal treatment can help endometriosis symptoms, but established dermoid cysts and cystadenomas need surgery if treatment is required.

Most women go home within a day, walk around the same evening and return to desk work in one to two weeks. Heavy lifting and strenuous exercise should be avoided for about four weeks.

Most women stay in hospital for one to two days and are encouraged to walk from the first day. Light household activity is fine after the first week, desk work usually resumes after two to three weeks, and full recovery, including lifting and exercise, takes about six weeks.

Not if your ovaries are kept. Your periods will stop because the uterus is removed, but the ovaries continue to produce hormones until natural menopause. If both ovaries are removed before menopause, menopause starts straight away and hormone replacement is usually discussed.

For most women who are suitable, laparoscopic surgery means less pain, a shorter stay and a faster recovery than an abdominal operation. Very large uteruses, extensive previous surgery or certain medical conditions may make open surgery the safer choice, and this is assessed individually.

Hysterectomy itself does not cause weight gain. Some women put on weight during the weeks of reduced activity while recovering, which can be prevented by gradually returning to walking and normal diet.

Yes. Once the vaginal vault has healed, usually after six weeks, intercourse can resume. Many women find their sex life improves once pain or heavy bleeding is no longer a problem.

If the cervix was removed for a benign reason and you had normal screening beforehand, routine Pap smears are usually no longer needed. If the cervix was kept, or there was a history of abnormal smears, screening continues.

Most women describe cramping similar to period pain during a diagnostic hysteroscopy, lasting a few minutes. Pain relief is given beforehand and local anaesthetic can be used. Operative hysteroscopy is done under anaesthesia, so you will not feel the procedure.

Most women go home the same day and return to normal activities within one to two days. Mild cramps and light bleeding or spotting for a few days are common. Avoid intercourse, tampons and swimming until the bleeding stops, usually about a week.

When there is a problem in the cavity, such as a septum, polyp, adhesions or a submucosal fibroid, correcting it can improve the chances of implantation and reduce miscarriage risk. Routine hysteroscopy in women with a normal scan has not been shown to improve IVF results.

Hysteroscopy looks inside the uterus through the cervix, with no cuts. Laparoscopy looks at the outside of the uterus, tubes and ovaries through small cuts in the abdomen. The two are sometimes combined, for example in infertility evaluation.

After a diagnostic hysteroscopy or polyp removal, you can usually try in the next cycle. After septum division or adhesiolysis, a short gap of one to two cycles is often advised, sometimes with a check of the cavity first.

Not always. A short diagnostic hysteroscopy is often done with pain relief alone or with local anaesthetic. Operative procedures, such as removing a fibroid or dividing a septum, are usually done under a short general or spinal anaesthetic.

Studies show that Indian women reach menopause on average in their late forties, typically between 45 and 50, though anything between 45 and 55 is considered normal. Menopause before 40 is premature and should be evaluated.

For most healthy women who start HRT before 60 or within ten years of menopause, the benefits outweigh the risks. HRT is not suitable for everyone, for example women with a history of breast cancer or certain clotting disorders. Your individual risks are assessed before treatment.

Hot flushes and night sweats last on average around seven years, and some women have them for longer. Vaginal symptoms tend to persist or worsen without treatment, but respond well to local therapy.

Usually not. In women over 45, menopause is diagnosed from symptoms and the pattern of periods. Blood tests such as FSH are mainly useful for women under 45, or when the picture is unclear.

Yes, pregnancy is still possible while periods continue, even irregularly. Contraception is advised until two years after the last period if you are under 50, or one year after the last period if you are over 50.

Keeping cool, layered clothing, regular exercise, weight loss if needed and avoiding triggers can help. Some prescription non-hormonal medicines reduce flushes, and CBT techniques have good evidence for reducing their impact.

Ideally three months before you start trying, and at least one month before, continuing until twelve weeks of pregnancy. Most women need 400 micrograms daily; some need 5 mg, which your doctor will advise.

Usually blood group, haemoglobin, thalassaemia screening, thyroid function, blood sugar, rubella immunity and screening for hepatitis B, HIV and syphilis. A Pap smear is done if it is due. Extra tests may be needed depending on your medical history.

Pregnancy should be avoided for one month after the MMR (measles, mumps and rubella) vaccine. This is why rubella immunity is checked before, rather than during, pregnancy.

Often, yes. If you are a thalassaemia carrier, your partner should be tested. His general health, medicines, smoking and alcohol also affect sperm quality, and a semen analysis is advised if conception does not happen within the expected time.

About eight in ten couples conceive within a year of regular unprotected intercourse. If you are under 35 and have been trying for a year, or 35 and over and trying for six months, an evaluation is recommended - sooner if periods are irregular.

Many medicines are safe, some need a dose change and a few must be switched before conception. Do not stop anything on your own - a pre-conception visit is the right time to review each prescription.

No. A Copper-T does not affect long-term fertility. Once it is removed, the ability to conceive returns to what it would have been without it, often in the very next cycle.

A Copper-T cannot travel to the heart, stomach or other organs. Very rarely, in about one in a thousand insertions, it can pass through the wall of the uterus into the pelvis, usually at the time of insertion; it is then removed by laparoscopy.

Most women feel cramping like period pain for a few minutes during insertion. Taking a pain-relief tablet beforehand helps, and the cramping usually eases within hours.

It is very unlikely - fewer than one in a hundred women become pregnant in a year. If it does happen, see your doctor promptly, because there is a higher chance that the pregnancy is outside the uterus (ectopic).

Both are highly effective. The Copper-T has no hormones but can make periods heavier; the hormonal IUD usually makes periods much lighter and is also used to treat heavy bleeding. The choice depends on your periods, health and preferences.

It depends on the device. The commonly used Cu-T 380A is effective for ten years and the Cu 375 for five years. It can be removed at any time before that, and a new one can be inserted in the same visit if you wish.