Gynaecological conditions commonly treated

Pap Smear

Pap smears are essential for all sexually active women over the age of 18. They can be uncomfortable but should not be too painful.

They should be conducted every two years and can save lives by detecting pre cancer lesions on the cervix (neck of the womb).

Abnormalities on pap smears are most often caused by a common virus called HPV (Human Pappiloma Virus). This is a very common virus and most people come in contact with it once they become sexually active. Most women can naturally drive out the virus from their body with a strong immune system over the course of a few years.

Pap smears will be reported as:

  • negative (normal)
  • HPV or low grade abnormalities
  • high grade abnormalities

A low grade abnormality will likely be monitored with a follow up pap smear 6 and 12 months down the track.

A high grade abnormality means you will need a colposcopy.

A colposcopy is when a special light is used to look at the cervix. It mostly uses the same medical instruments as a pap smear but takes a bit longer. Sometimes you will need to have a biopsy (little pinch of tissue taken from the cervix) at the time of colposcopy.

Mirena & IUD insertion

IUDs or coils are small devices that sit in your womb and prevent you from getting pregnant.

There are 2 types of IUDs that are used in Australia - the copper IUD and the Mirena. They are both very effective contraceptives. They are both long term and reversible.

The copper IUD has no hormone in it. It makes the inside of the womb not able to hold a pregnancy.

The mirena has a small amount of a progesterone like hormone in it. This means that the mirena not only prevents pregnancies but it also makes your periods very light.

The mirena also helps relive some of the symptoms of endometriosis.

Contraception

There are many options for contraception

The best method depends on what stage of life you are at, and other variable factors such as lifestyle, budget and existing medical conditions.

Each method or device has it's own benefits and limitations and these are best discussed with Dr Myers.

Some contraception methods to consider include:

  • Condoms
  • The Pill
  • Nuvaring
  • Implants
  • IUD's
  • Permanent
  • Natural

Fibroids

Fibroids are non-cancerous overgrowths within the muscle of the womb.

They can occur anywhere in the wall of the womb. Fibroids are quite common and can be small and cause no symptoms at all. At times, fibroids can cause a number of symptoms:

  • heavy periods
  • 'pressure’ symptoms from the fibroids pressing on the structures that are close to the uterus like the bladder and the bowel
  • a lump in your pelvic area
  • pain
  • interfering with pregnancy and fertility

Treatment of fibroids is based on the symptoms they cause. Some women may choose to do nothing, in this case the fibroids may be monitored with ultrasound.

If you do need treatment there are a number of options. These include surgical removal of the fibroid (a myomectomy or a hysteroscopic resection) or a hysterectomy.

There are some non surgical ablative treatments which can involve MRI or CT scans.

Endometriosis

Endometriosis is a common condition and it is also chronic

Endometrium is the name we give to cells that line the inside of the uterus (womb).

For various reasons, in some women this tissue moves to other parts of the body. Most commonly it moves to the outside of the bladder and bowel and the ovaries. This is called ‘endometriosis’.

Being a chronic condition, means that our treatments for fibroids are often aimed at relieving the symptoms rather than completely curing the condition.

The most common symptoms of endometriosis are:

  • pelvic pain
  • pain during sex
  • pain moving bowels (or with the bladder)
  • pelvic pain when not menstruating
  • back pain
  • infertility

If you have any of the symptoms of endometriosis the first step will be a history and examination, usually followed by an ultrasound of the pelvis. Depending on the findings, it may be recommended that you have laparoscopic surgery to identify the cause of your pain or to diagnose endometriosis.

The treatments for endometriosis include surgery and medicine and most women have a combination of these treatments.

The medical options include pain killers and hormonal treatments like the pill, hormonal IUD (Mirena) and implanon.

The surgical options range from key hole surgery to remove the endometriosis to a hysterectomy for women who have completed their families and cannot control the pain any other way.

Menstrual Difficulties

Difficultiies with menstruation include a number of problems

Some of these problems occur more frequently at certain stages of life.

The most common problems are :

  • Amenorrhea – No menstrual periods after the age of 16 years or absence of menstrual periods for 3 consecutive months and is not pregnant
  • Dysmenorrhoea – Painful menstruation periods
  • Menorrhagia – Excessive bleeding which lasts for 8 to 10 days
  • Oligomenorrhoea – Irregular menstrual periods or getting periods frequently

The treatment depends on the cause of your problems and the symptoms.

These are best discussed with Dr Myers

Post Menopausal Bleeding

After menopause women should get no further vaginal bleeding

If they do it needs to be investigated.

There are a number of different causes and most of them are not serious but your doctor must do some tests to make sure you do not have pre-cancer in the uterus.

The first test will include checking that your pap smear tests are up to date and organising an ultrasound. Sometimes you will require a hysteroscopy to examine a sample of the lining of the womb.

This is generally undertaken with a general anaesthetic and invokes a little camera being placed inside your womb.

Ovarian Cysts

Ovarian cysts are a common finding on ultrasounds of the pelvis

It is normal for women who are ovulating to get cysts on their ovaries that go away without treatment.

There are several causes of ovarian cysts, including:

  • normal ovulation cysts
  • endometriosis
  • dermoids - benign cysts
  • in rare cases, cancer

If a cysts is found on an ultrasound, you must have it followed up. The follow up will generally include repeating the scan and running blood tests.

If there are any concerns then surgery may be recommended.

Polycystic Ovarian Syndrome

Polycystic ovarian syndrome is a hormonal condition.

It causes a woman’s ovaries to be generally bigger than average.

Polycystic means the ovaries have many cysts or follicles that rarely grow to maturity or produce eggs capable of being fertilised. Up to a third of women may have polycystic ovaries seen on an ultrasound, but they do not all have Polycystic ovarian syndrome.

Polycystic Ovary Syndrome (PCOS) is relatively common, especially in infertile women. It affects 12 to 18 per cent of women of reproductive age.

It cause your periods to be irregular and for you to have too much testosterone (male hormone) in your body. Women with PCOS often have to work very hard to control their weight.

Almost 70 per cent of cases of PCOS remain undiagnosed.

Infertility

Infertility or subfertility is diagnosed after trying for a baby for 12 months

This means having regular sex over a 12 month period and not getting pregnant.

There are a number of causes for infertility.

When coming for an infertility appointment it is important for both partners to be present and for you to bring all recent medical results.

The investigations will include:

  • ultrasounds
  • blood tests
  • sperm tests

Urinary Incontinence

Incontinence is a leakage of urine

It is very common as women get older.

There are a number of effective treatments available, including:

  • lifestyle changes
  • medications
  • physiotherapy
  • surgery

Prolapse

Prolapse is very common in older women

A prolapse is when the tissues of the vagina and uterus fall down or slip from their usual positions

There can be prolapse of the vagina in which organs and structures next to the vagina prolapse into the weakened walls of the vagina or of the uterus in which the uterus with damaged supports slips down.

The main cause of prolapse is the weak muscles, tissues, and ligaments that support the vagina and its surrounding tissues and organs.

The factors that can cause vaginal prolapse include:

  • frequent lifting of heavy objects
  • chronic cough
  • severe constipation
  • menopause
  • childbirth
  • previous surgeries in the pelvic area
  • advanced age
  • hysterectomy
  • obesity

Women with prolapse may have different symptoms based on the type of prolapse. The signs and symptoms include:

  • difficulty in passing urine and emptying bowel
  • enlarged and wide vaginal opening
  • vaginal lump
  • the protrusion of tissues at the front and back wall of the vagina

There are a number of treatments for prolapse.

Sometimes surgery is recommended. This is often done through the vagina but can sometimes also be done laparoscopically.

The best approach depends on your activity level, the type and severity of prolapse and what previous surgery you have had. It is also possible to deal with prolapse without surgery. This can include pelvic floor exercises, vaginal creams and vaginal pessaries (silicon devices inserted into the vagina to help with support).

Colposcopy

A colposcopy is usually recommended to patients following an abnormality on a pap smear.

Colposcopy is similar to a pap smear in that it looks at the cervix for any abnormalities.

A test for HPV is commonly done at the same time.

The colposcopy allows the Doctor to see any abnormalities that need investigation or monitoring.

It is a procedure that happens in the rooms on the day of consultation.

Hysterectomy

A hysterectomy is the surgical removal of a woman's womb (uterus)

Depending on the reason for the hysterectomy, a surgeon may choose to remove all or only part of the uterus.

A woman may have a hysterectomy for different reasons, including:

  • Uterine fibroids that cause pain, bleeding, or other problems
  • Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal
  • Cancer of the uterus, cervix, or ovaries
  • Endometriosis
  • Abnormal vaginal bleeding
  • Chronic pelvic pain
  • Adenomyosis, or a thickening in the muscle layer of the womb

Hysterectomy for non-cancerous reasons is usually considered only after all other treatment approaches have been considered and discussed.

Laparoscopic Hysterectomy

Laparoscopic hysterectomy surgery is done with surgical instruments including a telescope

The surgeon puts these tools through small incisions in the abdomen

A laparoscopic hysterectomy leaves several very small scars on the abdomen.

The operation is performed under a general anaesthetic. The operation usually takes about 90 minutes.

Laparoscopic hysterectomy may have a quicker recovery and fewer complications than abdominal hysterectomy.

If you have any gynaecological health concerns, please contact Dr Clare Myers to make an appointment for a consultation

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  • 900 - 500
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