Congratulations on your pregnancy! Navigating pregnancy whilst breastfeeding can certainly sound overwhelming when it comes to nutrition. However, there are many similar nutrients that you want to be focusing on when both pregnant and breastfeeding. The key nutrients needed to support both pregnancy and breastfeeding include iron, iodine, folate, omega 3 fatty acids, calcium and vitamin D.

Iron is essential in helping you to form red blood cells for both you and your baby. This will also help with keeping your energy levels up. Folate is important for reducing the risks of neural tube defects like spina bifida or anencephaly, particularly in the first 4 weeks of baby’s life. Your body also needs more iodine to support baby’s brain and nervous system development. You also want to ensure you’re prioritsing calcium and vitamin D to support the health of you and your baby’s bones. Then, omega 3 fatty acids are key for helping with baby’s brain, nerve and eye development. It’s important to know that in pregnancy, we don’t recommend taking omega 3 capsules as there is no regulation with the amount of mercury that these supplements can contain. That’s why it’s encouraged to try get these healthy fats from low mercury seafood such as tuna, sardines, salmon etc. You can also get omega 3’s from seeds such as chia, flaxseeds or walnuts.

Something else to note is that when you’re breastfeeding, your vegetable requirements also increases from 5 serves of veggies per day to 7.5 serves per day to help support your increased micronutrient requirements. For reference 1 serve is equal to 1/2 cup of cooked veggies or 1 cup of raw veggies. Whilst, this may seem like a lot of veggies it’s important to remember that your energy requirements also does increase in both pregnancy and breastfeeding. However, even with this increase in requirements, chances are you may still need to take a supplement to close any gaps in your nutrition, particularly if you’re struggling to eat due to nausea. Though, before doing so it’s important that you talk to your doctor, pharmacist or dietitian about this to ensure the supplements you choose align with your requirements.

The short answer to this is “I’m not sure!”

Period pain is mainly caused by the muscles of the uterus contracting. It’s hormone-like substances called prostaglandins that are responsible for causing the muscles to tighten or contract. The oral contraceptive pill is usually good at helping with period pain and lightening periods because it reduces the amount of prostaglandin produced by the glands that line the uterus. This is also why anti-inflammatory medications are often used for painful or heavy periods; they reduce the effect of prostaglandins.

It’s possible that even though you’re avoiding periods or withdrawal bleeds by taking your hormone pills continuously, there are still enough prostaglandins being produced to cause cramps. Another possibility is that the cramping is not related to your uterus and could be due to something else (for example, something bowel-related). Because it’s a bit uncertain, I recommend seeing your GP to discuss this further.

If you continue to take your pill consistently when travelling, your period (we call it a “withdrawal bleed” when you take the pill) shouldn’t be affected.

We count a combined pill as missed if you take it more than 24 hours late. When travelling to a different time zone, I recommend working out what time you normally take your pill in that new time zone and using that new time during your trip to avoid any confusion with missed or late pills. Adding a reminder to your phone can help with remembering to take your pill at this “new” time.

Missed or late pills can cause breakthrough bleeding and reduce the pill’s effectiveness at preventing pregnancy, so it’s important to take it on time. This is especially important for traditional progesterone only pills, which must be taken in the same three-hour window every day.

Here are useful resources from Family Planning NSW on what to do if you do miss the combined pill or the traditional mini-pill.

There are laboratory studies (such as this one) showing that some lubricants can negatively impact on sperm function. However, there are also studies showing that people who use lubricants (including lubricants known to affect sperm motility) are just as likely to become pregnant as those who never use lubricants, and that the use of lubricants doesn’t lengthen the time required to fall pregnant.

So there is a bit of a mismatch between lab-based and real-life studies. However, if you’ve having trouble conceiving, or if a male partner is already known to have issues with his sperm, it may be best to use a lubricant that has been shown to be safe for sperm. These are usually labelled as “fertility-friendly”. If you prefer something natural, mustard oil and canola oil are considered sperm-friendly.

Female orgasm may promote sperm transport; however, there is no evidence that it improves the chances of conceiving.

If you get brown discharge instead of a period (known as a “withdrawal bleed” when you’re taking the pill), that’s fine. It’s common for periods to get lighter or to stop altogether with the pill. This is not dangerous, and your periods will return to what’s normal for you when you stop the pill.

If the brown discharge is happening randomly, it might be worth trying a different pill to see if it’s better for regulating your period. It’s not uncommon to get some spotting or brown discharge in the lead up to the sugar pill week. Changing the pill you’re using can sometimes help with that.

If the brown discharge is a new issue, or occurs after sex, I recommend seeing your GP to exclude other potential causes, such as pregnancy (this is unlikely but something we like to check for anyway), infections or abnormalities affecting your cervix or uterus.

Periods can change throughout the reproductive years due to changes in our hormone levels. The periods from someone’s teenage years can be quite different from the periods one has after having children, or during the menopause transition. However, periods can also change for other reasons.

Darker periods with more clots (particularly if the clots are large) could be a sign that your periods have gotten heavier. Heavy menstrual bleeding can be caused by many things, such as fibroids, thyroid disorders and endometriosis.

If your periods have changed, I recommend seeing your GP to see if an underlying cause can be found and if necessary, treated. This is particularly important if you also have symptoms like bleeding between periods or bleeding after sex.

Investigations like a blood test and pelvic ultrasound may be ordered. Your GP may also recommend cervical screening, testing for infections and checking for iron deficiency, as this is a very common consequence of heavy periods.

Periods can change throughout the reproductive years due to changes in our hormone levels. The periods from someone’s teenage years can be quite different from the periods one has after having children, or during the menopause transition. However, periods can also change for other reasons.

Darker periods with more clots (particularly if the clots are large) could be a sign that your periods have gotten heavier. Heavy menstrual bleeding can be caused by many things, such as fibroids, thyroid disorders and endometriosis.

If your periods have changed, I recommend seeing your GP to see if an underlying cause can be found and if necessary, treated. This is particularly important if you also have symptoms like bleeding between periods or bleeding after sex.

Investigations like a blood test and pelvic ultrasound may be ordered. Your GP may also recommend cervical screening, testing for infections and checking for iron deficiency, as this is a very common consequence of heavy periods.

Over 85% of women having a vaginal birth will have some trauma to the perineum -- the area between the anus and vagina. Fortunately, most perineal tears aren’t severe and are unlikely to cause long-term issues. In fact, some first-degree tears don’t even require stitches.

If you look at more serious tears, in 2021 about 2.7% of all women in Australia who gave birth vaginally ended up with third or fourth-degree tears. These tears involve the anal sphincter and usually require surgical repair in an operating theatre.

Tears can happen spontaneously or because of medical interventions (for example, if a forceps or vacuum delivery is required). Factors that increase the risk of a tear include giving birth vaginally for the first time, if the baby’s shoulder gets stuck behind the pubic bone, and having a baby that is over 4kg.

So what can you do to help reduce the risk of a serious tear? Warm compresses and perineal massage have been shown to help. Your health care provider can also give more individualized advice depending on how your pregnancy is going, and the growth of your baby.

Even though bleeding in early pregnancy is common, affecting 20% to 40% of women, it’s understandably very stressful. Bleeding can be caused by normal pregnancy-related things, such as changes to the cervix which make it bleed more easily, or implantation. It can be due to things not related to pregnancy, such as cervical polyps or fibroids. However, it can also be a sign of pregnancy loss.

It’s hard to quantify how much bleeding in pregnancy can be “normal”. If the bleeding is heavier than a typical period, or contains tissue, it’s more suspicious for a miscarriage. However, some people can have heavy bleeding but still have a viable pregnancy. In fact, most pregnancies that have evidence of foetal cardiac activity and vaginal bleeding at 7 to 11 weeks are not lost.

I don’t think there is any way to eliminate stress in this situation. However, it can help to know what to do if you do get bleeding and what investigations to expect. It’s particularly important to seek help if you get bleeding before the location of the pregnancy has been confirmed, as bleeding can be a sign of an ectopic pregnancy, which can be life threatening.

When trying for a baby, it’s best to have intercourse about 24-48 hours before you ovulate (or release an egg). However, I usually recommend trying every two or three days in the week leading up to ovulation just to be safe. But when do you ovulate?

Everyone’s menstrual cycle is different, and you may even notice a little bit of variability in the length of your cycle depending on things like stress levels. Generally, though, if you have a 28-day cycle, ovulation happens about two weeks before your next period.

When trying for a baby, I recommend tracking your cycle in a calendar, or by using an app. This can help determine the length and regularity of your periods and help pinpoint when you’re ovulating. You may also be able to tell when you’re about to ovulate by changes to your vaginal discharge, or a small increase in your resting body temperature. Ovulation kits are available to check for the hormone that triggers ovulation, but these can get expensive if you’re using them regularly.

Endometriosis is very common, affecting about 1 in 10 women, and yes, it can affect fertility. It can also cause painful periods, pain during sex, pain when passing urine or opening your bowels, as well as pain in your abdomen, lower back, and pelvis.

So what is endometriosis exactly? It’s where the cells that usually line the inside of the uterus grow in other areas, usually in the pelvis around the ovaries or uterus. Many women with endometriosis don’t have any issues falling pregnant. However, 30-50% can have difficulty because of the changes to their anatomy and potential scarring, as well as the way endometriosis can impact on how your immune system functions.

If you do have issues falling pregnant, laparoscopy (keyhole surgery) or in vitro fertilisation (IVF) may be offered to help improve your chances.

Unfortunately, there is often a delay in having endometriosis diagnosed because the symptoms are so variable (some people have no symptoms whereas others have debilitating pain). If you have concerns you might have endometriosis, or if you know you have endometriosis and would like advice on pregnancy planning, I recommend seeing your GP or a fertility specialist.

Yes! Whilst there are multiple sensitive areas on the body that can lead to orgasm when stimulated, most women require some stimulation of the clitoris to achieve orgasm.

You can get indirect stimulation of the clitoris during penetrative intercourse. However, for some people this might not be enough to orgasm. This explains why some people can achieve orgasm with oral sex where this more direct clitoral stimulation, but not with penetrative intercourse. If you fall into this category, there isn’t anything wrong with you – this a just a normal variation of how we respond to stimulation.

When diagnosed with PCOS, there are a number of health habits you can incorporate to support hormonal balance. Insulin resistance is common amongst women with PCOS, therefore managing this is important to help reduce the over production of male hormones. Ways in which we can manage this include opting for low GI carbohydrates, only filling a quarter of your plate with wholegrain carbs, balancing your meals by ensuring each meal contains lean protein as well as non-starchy veggies and eating small regular meals throughout the day. This will help your body to better regulate your insulin levels by putting less pressure on your pancreas to produce insulin. Exercise also plays an important role in the management of your PCOS to help you look after your hormonal, metabolic, reproductive and mental health. You should be aiming to do a minimum of 150-minutes of moderate intensity exercise per week - incorporating both cardio and resistance style training. However, it’s important to find a type of exercise you find enjoyable for long term sustainability.

Think of labour like a workout. You first have the “warm up” - latent phase. During this stage you may or may not have already experienced your waters breaking (rupture of membranes), a bloody show (mucus mixed with blood) from the vagina and some mild period pain contractions. Every labour is different, so you may experience all or none of these signs during the latent phase. Your contractions here will be mild and felt in the lower abdomen, above your pubic bone, just like period pain. These contractions can be irregular and are working to thin your cervix from approximately 3cm thick, to paper thin. It will also start to dilate (open) your cervix. This is generally the longest part of your labour but is usually the least intense. Your body is “warming up” and beginning to prepare for your active labour.

Next is the active phase of your labour, this is when the workout begins. You will now be feeling contractions more frequently, every few minutes, with a break in between. Midwives will be monitoring your baby’s heart rate and checking your observation to ensure everyone is safe. The contractions will be dilating your cervix and it is important to rest and relax during the breaks between contractions. A rate of 1cm dilation per hour is normal for a first time Mum, with subsequent labour’s usually being quicker. Once your cervix reaches 10cm dilation, we are now into the second stage (pushing). Follow your body’s cues, breathe, try to relax and follow the guidance of your midwife and/or obstetrician. You will soon meet your baby.

I have my share of patients who have had negative experiences with hormonal contraception, particularly with side effects like irregular bleeding, mood changes and low libido. The good news is that there are non-hormonal alternatives; however, they vary a lot in terms of effectiveness.

The most reliable methods are the copper intrauterine device (IUD), tubal surgery and vasectomy. They are about 99.5% effective (meaning that in a year, the chance of falling pregnant is less than 1 in 100). The copper IUD lasts 5-10 years but can be removed any time. Its main downside is that can cause heavier periods.

Other less effective options include condoms, the diaphragm, fertility awareness and the pull-out method. Fertility awareness involves avoiding intercourse during the fertile phase of your menstrual cycle, and the pull-out method requires the penis to be withdrawn from the vagina before ejaculation.

Condoms are 98% effective when used properly and can protect against sexually transmitted infections. However, their effectiveness drops to 88% if used incorrectly.

There is no medical need to have a “period” when on the pill. However, if you take the hormone pills continuously, there is a risk of unpredictable bleeding due to the lining of the uterus being unstable. The sugar pills help with this by triggering a “withdrawal bleed”. However, you may not need a withdrawal bleed each month.

Ultimately, there is no limit on how long you can take the hormone pills – it just depends on how soon you get breakthrough bleeding. For this reason, some people choose to skip their periods for three or four months at a time. Others take the hormone pills as long as they can and just have a break when they get bleeding. Either approach is fine!

If you get four or more days of spotting when skipping periods, or if you get heavier period-like bleeding, stop the pill for four to seven days, then restart the hormone pills (even if the bleeding hasn’t stopped). You can’t do this more than once every four weeks though, or else the pill is less effective.

If you have difficulty skipping periods, you might benefit from trying a different pill – you can ask your GP about this.

About one in ten women experience painful intercourse. It can sometimes be hard to describe this pain, but we often categorise it as superficial (during penetration) or deep (with deep penetration).

A common cause for this issue is hormonal changes, such as during or after pregnancy, when breastfeeding or as part of the menopause transition. However, it can also be due to medical conditions like endometriosis, uterine fibroids, or infections. Whilst things like lubricants and vaginal moisturisers can sometimes help, there may be other treatments depending on the cause – this is where your GP or women’s health physiotherapist can help.

Some people also experience something called vaginismus. This is when the pelvic floor muscles in the lower part of the vagina unintentionally contract or spasm, making penetration painful and difficult. This is usually managed with physiotherapy and addressing other potentially contributing factors such as relationship issues or previous trauma.

You don’t have to put up with painful sex, particularly when it can affect relationships and quality of life. If you have persistent painful sex, please see your GP as there could be an underlying health issue. What’s more, there are good treatment options available.

I get this question a lot, particularly with some social media personalities spruiking the benefits they’ve had getting off birth control.

The reality is that the combined pill has been around long enough now that we know it’s safe for many people to take for a long time. In fact, some of the pill’s benefits – such as the reduced risk of uterine cancer – increase with longer use. So long as there aren’t any medical reasons that make the combined pill unsafe for you (such as certain types of migraines or high blood pressure), it can usually be continued until you turn 50.

Contraception options that just contain the one reproductive hormone are also safe for most people to take long term and can be continued after age 50. The exception to this is the hormonal injection. This temporarily reduces bone density (makes bones thinner) so we usually avoid using this as people approach menopause.

Ultimately, there is no need to have a “hormone holiday” from contraception if it’s working well for you, particularly if you’re getting other benefits from it, such as lighter or less painful periods. If you do have concerns though, I recommend seeing your GP.

When making this decision, think about what is important to you and your partner. What type of care are you interested in? An obstetrician who would provide your private care is a great option if you are wanting the same provider, who will get to know you and your pregnancy.

Public hospitals offer shared care, team midwifery and midwifery group practice, which is a service where you can see the same group of midwives throughout your pregnancy, birth and postpartum. These services are often associated with lower rates of birth intervention compared with private. They will then visit you at home, as the hospital stay is significantly shorter compared with private postpartum care.

Private hospitals often have a longer postnatal stay, therefore more time to practice feeding and caring for your baby before you go home.

What are your preferences for giving birth? Would you like to try for a birth with minimal intervention, or would you prefer a cesarean? This can determine the hospital system, as only private hospitals offer maternal choice cesareans. Make a list of things that are important to you, and chat with your GP about the hospitals in your area, which services they provide and how they align with your preferences for birth.

The number and quality of your eggs decrease with age. This means that if you’re younger when you freeze your eggs, the number of eggs that can be retrieved, and the chances of those eggs being able to result in a live birth, are greater. It’s important to remember, however, that freezing eggs is not a fool-proof back up plan. Whilst the technology is always improving, there is no guarantee that freezing eggs will result in a baby in the future.

Age related fertility issues tend to increase after you turn 35. Therefore, the best time to consider freezing your eggs is before this age. You can obviously still freeze your eggs after you turn 35, but you may not be able to freeze as many eggs (or you may need additional treatments if you want to freeze more eggs).

Egg freezing is unlikely to be successful after you turn 40, mainly because the chance of a successful pregnancy from eggs collected at this age are much lower.

Egg freezing can be costly and isn’t for everyone. However, if you’re not planning on having children until later in life, it’s worth chatting to your GP about.

It’s reassuring to note that based on studies, there is no strong evidence to suggest a link between nutritional deficiencies when on the oral contraceptive pill. Nevertheless, prioritising your nutrition is crucial, regardless of whether you're on the pill or not. Nutrients which are key for women of reproductive age are iron, vitamin B12, folate, calcium, vitamin C and vitamin A. To ensure you’re getting the right balance, it’s important you’re eating a wide range of foods including lean proteins, dairy, wholegrain carbs, fruits and veggies. If you’re unsure whether you’re getting this balance right, you can use the Australian guide to healthy eating to help guide you. If you’re still concerned about your nutritional status, it’s important to talk to your GP who can assess this via a blood test, as there are many factors that can impact your nutritional status on an individual level independent of the pill. This personalised approach can help you address any dietary gaps or health concerns effectively.

Periods are usually irregular when you’re not ovulating regularly – meaning your ovaries aren’t releasing an egg every month. This is common in the first two years after your periods start, and as you approach menopause.

People sometimes have one-off periods that might come late, particularly when stressed. Using hormonal contraception can also result in fewer or less regular periods. Unless there’s a chance of pregnancy, this usually isn’t anything to worry about.

However, if your periods are always irregular, or if months can pass without a period, I recommend seeing your GP to look for underlying medical conditions that could be causing this issue. Some causes include thyroid disorders and polycystic ovarian syndrome, but there are many others.

It’s also helpful to see your GP about irregular periods if you’re trying for a baby. Ideally, you want to time sex around the time you’re ovulating. However, this can be hard to work out if your periods aren’t regular. What’s more, you may benefit from certain treatments that can help trigger ovulation.

Age is the most important factor when it comes to female fertility, largely because egg quality and quantity decrease with age. This is important because the average age women have their first baby has been increasing in Australia and many other countries.

Age related fertility problems increase after you turn 35, with a significant rise after age 40. “Advanced maternal age” (being over 35 when you give birth) is also associated with a higher risk of pregnancy complications.

Male fertility also drops with age, with sperm quality decreasing from age 40 and increasing male age being associated with reduced chance of pregnancy and increased time to fall pregnant.

This doesn’t mean you should rush into parenthood if you’re not ready. It’s okay to want other things in your life sorted before starting a family, such as financial security or finding a partner. It’s also important to remember that everyone is different and there may be other medical factors that affect someone’s fertility.

If you have questions about delaying pregnancy, egg freezing, or whether you would benefit from investigations into your fertility, I recommend seeing your GP.

Perinatal anxiety and depression affects up to 1 in 5 women.  If left untreated, it can affect bonding with your baby, shorten breastfeeding duration, affect your relationship with your partner, and increase the risk of depression in the future.

If you had perinatal anxiety or depression with one pregnancy, you may not have it with another. However, you are at a higher risk of it reoccurring. Other risk factors include a family history of mood disorders, trauma or disappointment with the birth experience, limited social support, financial or relationship concerns, and previous abuse.

We know that counselling – such as cognitive behavioural therapy and interpersonal and group therapy – is effective. Other things that can help include addressing stressors, allowing time for self-care (e.g., is there someone who can care for the baby while you exercise or have some down time?), optimising sleep and diet, and staying connected. Medication may also be considered in consultation with your doctor.

Admitting that you’re struggling during or after pregnancy can be hard, but you’re not alone. If you have concerns about your mood, please see your GP. You can also get support from PANDA and The Gidget Foundation.

I get this question a lot from patients and the short answer is that there is no test that can 100% show you can have children. In fact, it’s not uncommon for couples being assessed for infertility to have completely normal testing – meaning that no cause for their difficulties is found.  

However, some tests can show if falling pregnant could be more difficult, which is useful when planning for pregnancy or if you’re considering egg freezing.

The first step is seeing a GP or fertility specialist. They may ask about things like medical conditions, sexually transmitted infections, family history, acne or excess hair growth, and what your periods are like. Hormone blood tests can then be used to check for conditions like polycystic ovarian syndrome and thyroid disorders, or could show whether you have lower than expected egg reserve. Other investigations like a pelvic ultrasound or semen analysis for your partner may also be recommended.

Whilst you can do these tests anytime, you should see your GP if you’ve been trying to conceive for more than a year without success, or after 6 months if you’re over 35.

No it does not. But let's delve into the why.

Breasts and nipples come in all different shapes and sizes. The size of your breast is determined by how much fatty tissue you have but your milk production relies on the alveoli. Milk is produced in the alveoli and with the right techniques in increasing the supply once your baby arrives, you should be producing enough milk for your baby, or babies!

One of the most important signs to look for throughout your pregnancy, are breast changes. The size of your breasts should increase during the first trimester, both the nipples and areola will become larger and darker in colour. These will help your baby in attaching, your body is amazing! It is important to discuss any changes with your Midwife or GP and they will easily assess if this is normal for your stage of pregnancy. Similarly, if you haven’t seen any breast changes, this is just as important for them to know.

Hand expressing from 37 weeks can also be beneficial for both you and your baby. This can help to initiate the lactation process before baby arrives and decrease anxiety around initial milk production.

Your partner plays an equally important role when it comes to conception. Factors that can influence male fertility include alcohol, smoking, weight and a poor diet. When it comes to alcohol, it's advised that men cease drinking alcohol at least three months prior to attempting to conceive, since alcohol can diminish sperm quality and consequently the likelihood of falling pregnant. If your partner smokes, it’s also recommended to stop before trying. Furthermore, achieving a healthy weight is beneficial, as being overweight can adversely affect sperm production. We recommend your partner follow a mediterranean diet style due to its association with better semen quality. Additionally, taking a Male Prenatal can help to increase sperm motility.

The brain definitely changes during pregnancy and after having a baby. Parts of the brain shrink (this isn’t necessarily a bad thing, it may just be a sign of the brain becoming more efficient) and older women who have had children have less signs of aging on brain imaging. We also know that the changes that happen help nurture our relationship with our baby, helping us to recognise their non-verbal cues and be more vigilant about potential threats.

After giving birth, most women report issues with “Mum brain” or “baby brain”, such as forgetting words, or making errors like putting milk in a cupboard instead of the fridge. Interestingly, when tested under lab conditions, a lot of the concerns about memory and attention etc aren’t reproduceable. This suggests that other factors, such as the hormonal changes after giving birth, stress, sleep deprivation and mental load, could be contributing to the symptoms of “Mum brain”.

Whatever the cause, most of these issues tend to get better with time. For some it may be a few months, for others it may be longer – particularly if they have ongoing stressors or sleep deprivation, or depression.

Weight does factor into your fertility, as being both overweight and underweight can impact regular menstrual cycles and ovulation. This is because the fat in your body plays a big role in hormone regulation. In saying that, there are many things you can do to support a healthy weight like ensuring you are eating a healthy balanced diet, staying active and maintaining a good sleep routine. If you’re not sure where to start, using the Australian Guide to Healthy Eating can be a great way to learn about how many serves of each core food group you need to get per day to achieve a healthy balance of nutrients.

When it comes to exercise, the general guidelines recommend doing at least 150 minutes of moderate intensity exercise per week (just over 20 minutes a day).

Managing your pregnancy initially comes with much excitement and the common question of ‘when do you tell your loved ones the exciting news?’. The answer is, when you feel comfortable. And this can differ for each couple.

During the first 12 weeks the incidence of miscarriage is at its highest and one of the main reasons couples tend to keep their pregnancy news a secret initially. With the rate of miscarriage in Australia currently at 1 in 4, the discussion of miscarriage in the public eye is becoming more common.

In trying to decide which approach to take, ask yourself, would you be comfortable telling your loved ones about a potential miscarriage? This can help to guide you in the right direction and think about those people you may lean on for support throughout your pregnancy.

It is also important to remember this pregnancy journey, albeit wonderful, can come with many changes in emotions. Reach out to your healthcare provider who can help to link any other services for support throughout your pregnancy.

When pregnant it is really important to look after your nutrition for you and your baby. Generally speaking, key nutrients we focus on in pregnancy are iron, folate, iodine, calcium and vitamin D. However, whether you need to take a supplement is dependent on your nutritional status. Therefore, it’s essential you talk to your doctor or pharmacist before taking any supplements when planning to conceive, during pregnancy, and throughout postpartum to ensure you’re meeting your individual requirements and for your safety.

The World Health Organisation defines infertility as the inability to conceive after a 12-month period of unprotected intercourse or the inability to carry pregnancies to live births.

Hyperfertility (or super-fertility) is a relatively new concept and could be a potential cause of infertility. The idea is that some people have a uterus that is particularly receptive to implantation of a fertilised egg, regardless of the quality of that egg. They therefore fall pregnant easily and quickly, regardless of whether the pregnancy can result in a live birth.

We know that most early pregnancy loss is due to genetic problems with a baby. It is speculated that hyperfertile people may therefore be more prone to pregnancy loss or miscarriage.

Hyperfertility is still the subject of research and there are many other causes of infertility. If you have concerns about your fertility, or have had two or more pregnancy losses, please speak to your GP about seeing a fertility specialist. Whilst a cause for infertility is not always found, some causes can be treated, or assisted reproductive technology (e.g., IVF) may be an option.

Pregnancy loss is so common (affecting up to 31% of pregnancies in some studies) but it can be very hard to talk about and therefore, it's difficult to know what’s normal in terms of recovery.

Physically, the body recovers within a few weeks. It is usually advised to wait until you have a period before trying again. Periods can return as soon as two weeks after a miscarriage so it’s important to use contraception until you’re ready.

Most early pregnancy losses are due to genetic problems affecting the baby, so unless you have a condition that may impact on future pregnancies (or a history of recurrent pregnancy loss), you can try again whenever you feel ready. If there were aspects of your health you were working on before falling pregnant, such as quitting smoking, reducing alcohol intake or increasing your physical activity, this is a good opportunity to continue with those things. Unless you have a long break from trying, I recommend continuing your prenatal vitamins.

The time people take to grieve is variable and may impact on when you feel ready to try again. If you’re struggling with your emotional recovery, I'd recommend reaching out to your GP for next steps. Support can also be found through organisations like The Pink Elephants Support Network, The Gidget Foundation and Bears of Hope.

When trying to fall pregnant, you want to ensure your body is in it’s best health to not only support conception, but also a healthy pregnancy and baby. The first step would be to stop drinking alcohol as it’s recommended to stop drinking at least 3 months before trying to conceive. This is because it can impact your fertility and increase the risk of harm to baby.

The next step is to ensure you’re eating a healthy balanced diet. I recommend trying to follow the principles of the Mediterranean diet, which is high in vegetables, fruit, legumes, wholegrain carbs, nuts and seeds, healthy fats such as olive oil and moderate in intakes of fish, other meat and dairy products. It's also low in red and processed meats. Compared to a Western diet, the Mediterranean diet is richer in vitamins, minerals, antioxidants, healthy fats such as Omega-3 and lower in saturated fats. This helps to ensure you’re nourishing your body and reducing inflammation to support your fertility.

Although different to miscarriages, ectopic pregnancies occur when the fertilised egg develops and starts to grow outside of the uterus. Unfortunately it is not possible to save the pregnancy, which can be very sad and distressing. It is very important for you and your partner to seek specialist support services, which can be referred by your GP or Midwife. These can include bereavement services provided by a health professional who specialises in loss, perinatal social workers who can help to manage returning to work and also how to tell your loved ones.

You may also be wondering how this may affect subsequent pregnancies, and although ectopic pregnancies are usually a once off, it is important to receive the correct guidance on conceiving in the future.

You may want to refer to one of the many online resources which can help to understand the range of emotions you are feeling after an ectopic pregnancy such as The Pink Elephants Support Network,  and Red Nose Grief and Loss Support.

A lot of changes happen to the body after having a baby. Some of these happen quickly, such as hot flushes and breast engorgement. Some take longer and last for months, such as hair loss. One thing you probably haven’t heard many people chat about over coffee is postpartum discharge or bleeding.

Postpartum bleeding can sometimes come as a bit of shock when you’ve been blissfully period-free during your pregnancy. However, it’s normal. It’s just the lining of the uterus that helped support the placenta being shed. Initially, it looks red or red-brown (lochia rubra), then it slowly becomes more watery and pinkish (lochia serosa).  

The amount of discharge is about 200 to 500mL, and it lasts about four to six weeks. If it hasn’t stopped after six weeks, you should see your GP or obstetrician to exclude complications like an infection or leftover placenta.

There’s no need to treat lochia – you can deal with it like you would a period using pads or period underwear. It’s best to avoid tampons during this time to avoid the risk of infection. If you have concerns about your bleeding, please see your GP.

Without contraception, about 80 in 100 women of reproductive age who have regular intercourse will get pregnant in a year. Regular intercourse is usually defined as having intercourse every two or three days throughout the month. However, if you’re actively trying to conceive, you can improve your chances by timing when you have sex.

Once released by an ovary, an egg only survives for about 24 hours, which isn’t very long at all! Sperm, on the other hand, can live up to 5 days. It’s therefore best to time intercourse so that the sperm is ready and waiting for the egg when it is released.

Roughly speaking, if you have a 28-day cycle, ovulation (the release of an egg) happens around 2 weeks prior to the next period. I usually recommend having regular unprotected sex in the week leading up to ovulation. You can have sex every day if you’d like, but it’s also fine to have sex every two to three days.

If you’re not sure when you're ovulating, tracking your cycle with a calendar or app can be helpful. You may also notice changes around the time of ovulation, such as more slippery or stretchy vaginal discharge, abdominal pain, or a small increase in your resting body temperature. Ovulation kits are also available. These detect luteinizing hormone (LH) in your urine – this hormone rapidly increases about 24 to 36 hours before ovulation.

If you have irregular periods, or aren’t sure if you’re ovulating, I recommend seeing your GP. It’s also worth checking in with your GP if your periods are regular and you haven’t fallen pregnant after 12 months despite having regular intercourse (or after 6 months if you’re over 35).

Many people start the pill young, when pregnancy planning or fertility isn’t usually a big concern. As people get older, however, they may start to worry about the long-term effects of the pill. Fortunately, the pill has been around long enough now that we know it is safe for many people to use in the long term. It also does not affect fertility.

Your ability to fall pregnant after stopping the combined pill normally goes back to your usual level within a couple of months; however, some people fall pregnant very quickly – so it’s good to be prepared to fall pregnant as soon as you stop the pill. For example, I recommend starting a prenatal vitamin three months prior to stopping contraception and actively trying.

It’s also useful to monitor your periods with a period tracker when you stop the pill. If your periods haven’t returned (or aren’t regular) within three months, I recommend seeing your GP to exclude conditions such as a thyroid disorder or polycystic ovarian syndrome.

You’ve just had a baby and the main things you’re worried about are sore nipples or sterilising bottles, sleep deprivation, and finding time to eat and shower. The last thing you’re thinking about is your period; however, it’s good to know what to expect – particularly because you can fall pregnant before your first period. So make sure you have a plan for contraception after giving birth!

If you’re not exclusively breastfeeding, your period can return as soon as four to six weeks after giving birth, with most people having them back by three months. This is different from the usual bleeding after giving birth (lochia), which usually lasts up to 6 weeks.

If you breastfeed, it may be many months (or years) before your periods return. This is because prolactin (the hormone needed for breastfeeding) can stop ovulation – the release of an egg — and therefore delay your period.

Periods may also change after a baby in terms of how heavy or painful they are or, if you’re using hormonal contraception. If you have concerns about your period, or if there is a significant delay in your period returning, I recommend seeing your GP.