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Knowledge Base

Frequently Asked
Questions

Expert answers to common questions about pregnancy, women's health, and gynaecological care — from Dr. Amon Siveregi and the team.

Topics

Pregnancy in South Africa

8 FAQs
When should I attend my first antenatal visit?

You should attend your first antenatal visit as soon as you confirm your pregnancy, ideally between 8–10 weeks. This booking visit is crucial for:

  • Establishing gestational age and due date
  • Comprehensive blood tests (iron levels, blood group, HIV, syphilis, hepatitis B, rubella immunity)
  • Initial counselling and health assessment
  • First trimester screening bloods
  • Creating your personalised care plan

Early attendance ensures optimal monitoring and early detection of any potential concerns.

Which pregnancy supplements should I take during pregnancy?

We recommend prenatal supplements that contain iron and folic acid among other essential nutrients. Popular options include:

  • Preg-Omega Plus
  • Pregnavit M
  • DS24

These supplements support fetal development, prevent neural tube defects, and maintain maternal health. Always inform your doctor of all medications (including herbal) you are taking so they can advise on the best supplement for your specific needs.

What foods should I avoid during pregnancy?

To protect you and your baby, avoid these dangerous foods:

  • Uncooked meat, fish, and chicken — risk of bacterial contamination
  • Unpasteurised dairy products — listeria risk
  • Shark, swordfish, or tiefish — high mercury levels
  • Excessive fish intake — limit to ±2 helpings per week

Ensure all foods are adequately washed and properly cooked. Maintain good food hygiene at all times. Also avoid alcohol completely and limit caffeine to 1 cup per day.

Is it safe to exercise while pregnant?

Yes, exercise is safe and beneficial during pregnancy. We recommend:

  • Preferred activities: Water exercises (reduces swelling, good balance, even heat distribution), walking, pilates, and rowing
  • Avoid: High impact exercise, extreme sports, mountain biking
  • Intensity: Use the "talk test" — you should still be able to talk while exercising
  • Duration: 30 minutes per session
  • Frequency: 5–7 times a week

Always listen to your body and consult your doctor before starting any new exercise routine.

When will I start feeling my baby move?

Most women begin to feel fetal movements (quickening) between 18–22 weeks of pregnancy. First-time mothers may notice movements slightly later (around 20–22 weeks), while women who have been pregnant before may feel them earlier (around 16–18 weeks).

Initially, movements may feel like gentle flutters or bubbles. As your baby grows, movements become more distinct kicks and rolls. From 28 weeks onwards, you should monitor fetal movements daily and report any reduced or absent movements to your doctor immediately.

What warning signs in pregnancy require urgent medical attention?

Contact your doctor or proceed to the nearest hospital immediately if you experience any of these danger signs:

  • Severe headache — persistent or intense
  • Abdominal pain — severe or persistent
  • Reduced or absent fetal movements
  • Vaginal bleeding — any amount
  • Rupture of membranes — drainage of liquor (water breaking)
  • Shortness of breath — sudden or severe
  • Chest pain
  • Severe vomiting — for more than 2 days, at least 3 times a day

Never hesitate to seek medical attention — it's always better to be safe.

Can I continue working and travelling during pregnancy?

Working: Yes, you can continue working during pregnancy if your pregnancy is uncomplicated and your job is not hazardous. Ensure you take regular breaks, stay hydrated, and avoid prolonged standing.

Travelling:

  • Air travel: Most airlines allow flying up to 28 weeks. After 28 weeks, a doctor's letter is required permitting local flights up to 37 weeks
  • Car travel: Permitted with adequate hydration and regular leg stretching
  • Avoid: Malaria, zika virus, and yellow fever areas

Always consult your doctor before planning any travel during pregnancy.

What are my options for pain relief during labour and delivery?

Several pain relief options are available during labour:

  • Non-pharmacological: Breathing techniques, water immersion (birthing pool), massage, movement and positioning, TENS machine
  • Pharmacological: Entonox (gas and air), pethidine or other opioids, epidural anaesthesia (most effective method)
  • Regional anaesthesia: Spinal block for caesarean sections

We discuss your preferences during antenatal visits and create a birth plan. The available options may depend on your labour progress, medical conditions, and the facility where you deliver. Our team will guide you through the best options for your situation.

Polycystic Ovary Syndrome (PCOS)

2 FAQs
Can PCOS affect my fertility and chances of getting pregnant?

Yes, PCOS can affect fertility, but many women with PCOS do conceive successfully. PCOS often causes:

  • Irregular or absent ovulation — making it harder to predict fertile windows
  • Hormonal imbalances — elevated androgens can interfere with egg development
  • Insulin resistance — can affect reproductive hormones

However, with proper management — including lifestyle changes, ovulation induction medications, and fertility treatments — most women with PCOS can achieve pregnancy. We offer comprehensive fertility assessments and personalised treatment plans to optimise your chances of conception.

What lifestyle changes can help manage PCOS symptoms?

Lifestyle modifications are the cornerstone of PCOS management:

  • Weight management: Even 5–10% weight loss can restore ovulation and improve symptoms
  • Balanced diet: Low glycaemic index foods, high fibre, lean proteins, healthy fats
  • Regular exercise: 150 minutes per week of moderate activity improves insulin sensitivity
  • Stress reduction: Yoga, meditation, adequate sleep
  • Avoid smoking and limit alcohol

These changes not only manage PCOS symptoms but also reduce long-term risks of type 2 diabetes, cardiovascular disease, and endometrial cancer associated with PCOS.

Endometriosis Management

4 FAQs
What is endometriosis and what symptoms does it cause?

Endometriosis is a condition where tissue similar to the uterine lining (endometrium) grows outside the uterus, commonly on the ovaries, fallopian tubes, pelvic lining, and other pelvic structures.

Common symptoms include:

  • Pelvic pain — especially during menstruation (dysmenorrhea)
  • Pain during intercourse (dyspareunia)
  • Pain with bowel movements or urination — especially during periods
  • Heavy menstrual bleeding
  • Infertility — difficulty getting pregnant
  • Fatigue, diarrhoea, constipation, bloating — especially during periods

Symptom severity doesn't always correlate with the extent of the disease — some women with mild endometriosis have severe pain, while others with advanced disease have little pain.

Can endometriosis cause infertility?

Yes, endometriosis is a leading cause of infertility. Approximately 30–50% of women with endometriosis experience difficulty conceiving. Endometriosis can affect fertility through:

  • Anatomical distortion — scar tissue and adhesions can block fallopian tubes or distort pelvic anatomy
  • Inflammation — creates a hostile environment for eggs, sperm, and embryos
  • Ovarian dysfunction — endometriomas (chocolate cysts) can damage ovarian tissue and reduce egg quality
  • Implantation issues — may affect the uterine lining's ability to accept an embryo

However, many women with endometriosis do conceive naturally or with fertility treatment. We offer comprehensive fertility assessments and tailored treatment options including laparoscopic surgery, ovulation induction, IUI, or IVF depending on your specific situation.

How is endometriosis diagnosed?

Endometriosis diagnosis involves a combination of approaches:

  • Clinical assessment: Detailed history of symptoms, pelvic examination
  • Imaging: Transvaginal ultrasound can detect endometriomas and deep infiltrating endometriosis; MRI may be used for complex cases
  • Laparoscopy: The gold standard for diagnosis — a minimally invasive surgical procedure that allows direct visualization of endometriotic lesions. Biopsy confirmation may be obtained

Unfortunately, diagnosis is often delayed by 7–10 years on average. If you have chronic pelvic pain, painful periods, or infertility, early consultation with a specialist is important.

What treatment options are available for endometriosis?

Treatment is individualised based on symptoms, disease severity, age, and fertility goals:

  • Pain management: NSAIDs (anti-inflammatory medications), hormonal therapies (combined oral contraceptives, progestins, GnRH agonists)
  • Surgical treatment: Laparoscopic excision or ablation of endometriotic lesions — preferred for moderate to severe disease, infertility, or when medical treatment fails
  • Fertility treatment: Ovulation induction, IUI, or IVF depending on the severity and other fertility factors
  • Multidisciplinary approach: Pain specialists, physiotherapists, psychologists for chronic pain management

Dr. Siveregi specialises in advanced laparoscopic surgery for endometriosis, offering minimally invasive techniques with faster recovery and excellent outcomes.

Hysterectomy Information

3 FAQs
What are the different types of hysterectomy?

There are several types of hysterectomy, classified by what is removed and the surgical approach:

By extent of surgery:

  • Total hysterectomy: Removal of the entire uterus and cervix (most common)
  • Subtotal/supracervical hysterectomy: Removal of the uterus but cervix is left in place
  • Radical hysterectomy: Removal of uterus, cervix, upper vagina, and parametrium (for cancer)
  • With or without salpingo-oophorectomy: Removal of fallopian tubes and/or ovaries

By surgical approach:

  • Abdominal hysterectomy: Through an incision in the abdomen
  • Vaginal hysterectomy: Through the vagina (no external incision)
  • Laparoscopic hysterectomy: Minimally invasive, through small keyhole incisions
  • Robotic-assisted laparoscopic: Enhanced precision for complex cases

Dr. Siveregi specialises in minimally invasive laparoscopic hysterectomy, offering faster recovery and less scarring.

How long does recovery take after a hysterectomy?

Recovery time depends on the surgical approach:

  • Laparoscopic/vaginal hysterectomy: 2–4 weeks for normal activities
  • Abdominal hysterectomy: 4–6 weeks for normal activities

General recovery guidelines:

  • Hospital stay: 1–3 days (laparoscopic), 2–4 days (abdominal)
  • Avoid heavy lifting (>5kg) for 6 weeks
  • No sexual intercourse for 6 weeks
  • No driving for 2–4 weeks (until you can perform emergency stops comfortably)
  • Gradual return to work: 2–6 weeks depending on job demands
  • Full recovery: 3–6 months

We provide detailed post-operative instructions and schedule follow-up appointments to monitor your recovery.

Will I go into menopause after a hysterectomy?

It depends on whether your ovaries are removed:

  • If ovaries are preserved: You will NOT go into immediate menopause. You will stop having periods and cannot become pregnant, but your ovaries continue to produce hormones. However, some women experience menopause slightly earlier (1–2 years) than they would have naturally
  • If ovaries are removed (bilateral oophorectomy): You will experience immediate surgical menopause, regardless of age. Symptoms may be more sudden and severe than natural menopause

Key points:

  • A hysterectomy alone does not cause hormonal changes
  • If you're premenopausal and ovaries are removed, hormone replacement therapy (HRT) may be recommended
  • We discuss ovary preservation vs. removal based on your age, medical conditions, and cancer risk
  • Even after hysterectomy, cervical screening (pap smears) may still be needed depending on the reason for surgery

Menopause Support

5 FAQs
What are the first signs and symptoms of menopause?

Menopause typically occurs between ages 45–55 (average 51 in South Africa). The transition (perimenopause) can start several years earlier. Early signs include:

  • Menstrual changes: Irregular periods, heavier or lighter bleeding, skipped periods
  • Hot flushes: Sudden feeling of heat, often with sweating and flushing
  • Night sweats: Disruptive sweating during sleep
  • Sleep disturbances: Insomnia, waking frequently
  • Mood changes: Irritability, anxiety, low mood
  • Vaginal changes: Dryness, discomfort during intercourse
  • Other symptoms: Fatigue, joint pain, difficulty concentrating, decreased libido, urinary changes

Menopause is confirmed after 12 consecutive months without a period. Symptoms vary widely — some women have mild symptoms, others experience significant impact on quality of life.

How long do menopausal symptoms usually last?

The duration varies significantly between women:

  • Perimenopause: The transitional phase lasts an average of 4 years (range: a few months to 10 years)
  • Vasomotor symptoms (hot flushes/night sweats): Typically last 7–10 years, but can persist for decades in some women
  • Most intense symptoms: Usually occur in the first 2–5 years after the final period
  • Gradual improvement: Most symptoms gradually decrease over time

However, some symptoms like vaginal dryness and urinary changes may persist or worsen without treatment. The good news is that effective treatments are available to manage symptoms at any stage.

Is hormone replacement therapy (HRT) safe?

For most women, HRT is safe and highly effective when used appropriately. The safety profile depends on several factors:

Benefits:

  • Most effective treatment for hot flushes and night sweats (85–90% success rate)
  • Prevents bone loss and reduces fracture risk
  • May reduce cardiovascular disease risk if started early (within 10 years of menopause or before age 60)
  • Improves quality of life, mood, sleep, and sexual function

Risks (small and depend on type, dose, and duration):

  • Slightly increased risk of breast cancer with combined HRT (oestrogen + progestogen) after 5+ years of use
  • Slightly increased risk of blood clots with oral HRT (transdermal patches/gels have lower risk)
  • Increased risk if started late (>10 years after menopause or after age 60)

Key points:

  • HRT is contraindicated in women with breast cancer, unexplained vaginal bleeding, active blood clots, or severe liver disease
  • We use the lowest effective dose for the shortest duration needed
  • Regular reviews (annually) to reassess benefits vs. risks
  • Non-hormonal alternatives are available if HRT is not suitable

The decision to use HRT should be individualised based on your symptoms, medical history, and personal preferences. We'll discuss all options thoroughly.

What can I do to manage hot flushes and night sweats?

Lifestyle modifications:

  • Identify and avoid triggers (spicy foods, caffeine, alcohol, stress, warm environments)
  • Dress in layers, wear breathable fabrics (cotton, linen)
  • Keep bedroom cool, use lightweight bedding
  • Regular exercise (but not close to bedtime)
  • Weight management — overweight women experience more severe symptoms
  • Stress reduction techniques (yoga, meditation, deep breathing)
  • Stay hydrated, limit caffeine and alcohol

Medical treatments:

  • HRT: Most effective treatment (85–90% success)
  • Non-hormonal medications: Certain antidepressants (SSRIs/SNRIs), gabapentin, clonidine
  • Newer treatments: Fezolinetant (neurokinin 3 receptor antagonist) — non-hormonal option

Complementary therapies: Some women find relief with black cohosh, soy isoflavones, or acupuncture, though evidence is mixed.

We'll work with you to find the most appropriate management strategy for your symptoms and preferences.

How can menopause affect my bone and heart health?

Menopause significantly impacts bone and cardiovascular health due to declining oestrogen levels:

Bone health:

  • Rapid bone loss occurs in the first 5–10 years after menopause (up to 20% bone density loss)
  • Increased risk of osteoporosis and fractures (hip, spine, wrist)
  • Prevention: adequate calcium (1000–1200mg/day) and vitamin D, weight-bearing exercise, avoid smoking and excessive alcohol
  • Bone density scan (DEXA) may be recommended to assess fracture risk
  • Treatments available if osteoporosis is diagnosed

Heart health:

  • Before menopause, women have lower cardiovascular risk than men of the same age
  • After menopause, risk increases to equal that of men
  • Oestrogen has protective effects on blood vessels and cholesterol levels
  • Increased risk of hypertension, high cholesterol, diabetes, and metabolic syndrome
  • Prevention: heart-healthy diet, regular exercise, weight management, blood pressure and cholesterol monitoring, smoking cessation

We offer comprehensive menopause assessments including bone density scans, cardiovascular risk assessment, and personalised prevention strategies to protect your long-term health.

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Questions?

Dr. Siveregi and the team are here to provide personalised care and answer your specific concerns.

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