GP or gynaecologist: who should you see first?

A period that won't settle into a pattern. A pelvic ache you've been explaining away for weeks. A smear letter, a list of menopause symptoms, or a coil that's due. Search for help and you're offered a GP, a consultant, a menopause clinic, a coil appointment, a smear, a Well Woman MOT and A&E all at once.

In practice the choice is usually simpler than it looks. This guide sets out who to see for what, and when the right person is Dr Hikmat Naoum, Consultant Gynaecologist, GMC 3047637, at 117a Harley Street.

If you already know you want a specialist opinion, you can book a consultant gynaecology visit directly, with no referral needed. The consultation is £250, or £450 with an ultrasound in the same visit, and a follow-up is £200.

When should you call 999 or go to A&E?

Call 999 or go to A&E for a life-threatening emergency. That includes severe pain or heavy bleeding in pregnancy. NHS.uk also says to call 999 or go to A&E for pelvic pain that is severe, getting worse, or hurts when you move or touch the area, and if you feel faint, dizzy or lightheaded, have pain in the tip of your shoulder, have difficulty breathing, have heavy bleeding from the vagina, or suddenly feel confused.

If symptoms are urgent but not life-threatening, or you're unsure whether you need 999, NHS.uk points you to NHS 111, online or by phone. Our early-pregnancy appointment is a booked consultation for pregnancy-related concerns that can safely wait for an arranged time. It isn't an emergency early pregnancy unit (EPAU), so if pain or bleeding in pregnancy is happening now, call 999.

Which concern belongs with whom.

When is a GP the right place to start?

Often. NHS.uk says to see a GP if heavy periods are affecting your life, if you've had them for some time, or if you have severe pain during your periods. The same goes for bleeding between periods or after sex, heavy periods with other symptoms such as pain when peeing, pooing or having sex, and pelvic pain that comes and goes or won't go away. NHS.uk is clear that postmenopausal bleeding needs a GP visit even if it happened only once, even if it was only a small amount, and even if you're not sure it was blood.

A GP at our clinic can take your history, examine you where that helps, arrange blood tests in the same building if they'd change the plan, and decide whether a specialist, a smear or a menopause appointment is the next step. A GP consultation here is £150, and the GP can also write the letter you later bring to Dr Naoum. A cough, a urine infection, contraception other than a coil, or a medicine review are all best handled by a GP.

When is the menopause clinic the better fit?

For perimenopause and HRT. Dr Penny Sheehan, a GP with a menopause interest, GMC 6056535, consults on Mondays and Wednesdays at 117a Harley Street, and you can book without a referral. If your question is already about an HRT prescription or later monitoring, the HRT clinic handles that.

Hot flushes, night sweats, broken sleep, mood change and brain fog while your periods are still coming are menopause clinic territory. Heavy, irregular or postmenopausal bleeding, or pelvic pain, belong with consultant gynaecology instead. Any bleeding after the menopause should be checked promptly. Our guide on whether you need a blood test before a menopause appointment explains more.

What about coils, smears and screening?

Copper or hormonal coil fitting (£550 or £650), removal or replacement is booked through contraceptive services. Dr Naoum carries out those procedures personally, with a nursing chaperone, in the coil clinic. If you have pelvic pain, abnormal bleeding, a fertility question or a possible pregnancy, have that assessed in a gynaecology consultation before any coil is fitted. Our guide to choosing a coil appointment covers the options.

A private smear is its own service. It's a screening test, so pain or heavy bleeding needs a consultation rather than a smear alone.

A Well Woman MOT is planned screening for when you feel well. At Elite and Ultimate level it can include a gynaecology component, but it's still screening. If you have a current pelvic, menstrual, fertility or early-pregnancy concern, book the consultation that answers it.

When should you see a consultant gynaecologist?

When you have a pelvic, menstrual, fertility or early-pregnancy concern and want a consultant to take it on. People come to Dr Naoum with pelvic pain that has lasted weeks, heavy or irregular bleeding, bleeding between periods or after the menopause, difficulty conceiving, or a pregnancy-related concern that can wait for an arranged appointment. Our sister clinic offers the same kind of initial gynaecology consultation.

NICE guideline NG88 on heavy menstrual bleeding makes a point worth knowing: heavy bleeding has a major impact on quality of life, and treatment should aim to improve that rather than focusing only on measured blood loss. NICE suggests considering specialist care if treatment hasn't worked, if a woman declines medication, or if symptoms are severe, and specialist referral for fibroids of 3 cm or more in diameter. On the NHS, NHS.uk says a GP will usually refer you for tests or to a specialist if treatments don't work or a condition may be causing the bleeding. On Harley Street you can ask for that specialist opinion directly.

For postmenopausal bleeding, NHS.uk says a GP should refer you to hospital or a special postmenopausal bleeding clinic, and you shouldn't have to wait more than 2 weeks to see a specialist. That NHS two-week referral remains the public option. A consultant visit here, with examination and same-visit ultrasound when indicated, is one way to be seen promptly.

Fertility and recurrent miscarriage have dedicated assessments, so mention it when you book if that's your real question. Dr Naoum reviews difficulties conceiving, orders or interprets investigations, and refers on to specialist fertility services when that's the right next step. Couples can attend together. If you've already had an AMH test, our guide to what an AMH result tells you is worth reading before you come.

What happens at the consultation?

Dr Naoum takes a history, examines you when that would help, performs an ultrasound on site when it's indicated, and agrees a plan with you in the room. If an intimate examination would change the plan, a member of the nursing team is present as a chaperone. He explains each part as he goes, and you can ask him to pause. The scan happens in the same visit, so there's nothing extra to book online.

You leave with an explanation and a plan. That may include treatment here, a private smear booked as its own appointment, or referral to fertility, breast, menopause or another specialty. A clear scan is reassuring, though it can't promise that bleeding won't return. If breast or ovarian cancer runs in your family, our guide to BRCA testing in London explains how genetic testing works; the full BRCA1/2 panel is £662, including the £100 referral fee and a mini consultation.

Dr Naoum is on the GMC Specialist Register for obstetrics and gynaecology and was appointed Senior Consultant Gynaecologist at Oxford University NHS Trust in 2000. His specialist areas include diagnostic ultrasound, pain, abnormal bleeding, IUD procedures and HPV treatment. Medical Express Clinic has practised at 117a Harley Street since 1984 and is CQC-registered.

What should you bring?

Bring any referral letter, scans or smear reports you already have, a medication list, and the date of your last period if you know it. You don't need a referral to book, but if a letter exists, it's worth bringing. Appointments are arranged according to clinical need and current availability.