Gynaecology

In the past it was recommended that sexually active women have Pap smear tests every two years. The Pap smear test has been replaced by the new Cervical Screening Test, which looks for HPV virus. Women do not need to start having cervical screening tests until they turn 25. If you’re younger than 25, you are highly unlikely to have cervical cancer and have probably been vaccinated against HPV as part of the NIP.

HPV is a very common virus that is spread through skin-to-skin contact (which often occurs during sex). Almost every case of cervical cancer is caused by genital HPV. HPV doesn’t normally cause any symptoms and often goes away by itself. But some types of the HPV virus can remain in the body and eventually cause abnormal cells to develop. This can lead to cancer of the cervix, anus, vagina, vulva, penis or throat. There are 14 oncogenic types of HPV that the CST can detect. The CST specifically identifies HPV types 16 and 18 that cause 70% of all cervical cancers.

An abnormal Cervical Screening test sometimes requires a follow-up test. This may be either a repeat CST (for low-grade abnormalities) or further tests (for a high-grade abnormality).

Further tests may include:

• Colposcopy — a colposcope (an instrument that magnifies the cells of the cervix) gives your doctor a closer view of the extent and nature of the problem
• Biopsy — your doctor may take a small tissue sample from your cervix during the colposcopy and examine it in a laboratory.
• If a high-grade abnormality is confirmed with colposcopy and biopsy, your doctor will usually recommend treatment to remove the abnormal cells from your cervix. Technique for this can include:
  Wire-loop excision — the cells are gently scraped from the surface of your cervix using a loop of wire. Often performed under general anaesthetic.

Menstruation is bleeding from the vagina that happens about once a month, as a normal part of the menstrual cycle. It is also known as having a period.

During this cycle, your hormones make the lining of the uterus become thicker, getting ready in case of pregnancy. Hormones also cause an egg to be released from an ovary, which is known as ovulation.

If you don’t become pregnant, then your periods start about two weeks after ovulation. The lining of the uterus falls away and, along with some blood flows out through the vagina. Periods can be light or heavy, and the blood can range from bright red to dark brown. You might also notice small clots.

Some women get symptoms leading up to and during menstruation, such as:

• cramps or pains low in the abdomen
• bloating or swelling in the abdomen
• constipation before your period
• diarrhoea when your period starts
• acne
• tiredness
• mood changes

You should talk to your doctor if:

• you are 16 years or older and haven’t started to have periods
• your periods are getting heavier
• your periods get much closer together or further apart
• your periods have stopped and you’re not sure why
• you are bleeding in between periods or after intercourse
• you are bleeding after menopause
• you have severe period pain

You can also talk to your doctor if, for any reason, your periods are affecting your wellbeing or enjoyment of life.

Heavy periods (or menorrhagia) are hard to define, but if you feel you are using more tampons or sanitary towels than usual, or blood is leaking through to your clothes and bedding, this usually means your period is heavy. Heavy periods can also mean you need to change a pad overnight, you’re passing clots larger than a 50-cent piece, or you bleed for more than 7 to 8 days.

Heavy bleeding is sometimes caused by problems with the lining of your uterus (womb) or a hormonal disorder. Sometimes it can be due to your medications, or a medical illness. But in half of all women with heavy bleeding, no cause is ever found.

You should visit your doctor if heavy periods are disrupting your everyday life. Your doctor may want to investigate the possible causes of heavy bleeding to rule out any other health conditions which may be causing it. Conditions may be treated by medications, fitting prescribed devices or, in some cases, by surgery.

Endometriosis occurs when some of the tissue similar to the lining of the uterus (womb), called the endometrium, grows outside of the uterus. Endometriosis is a progressive, chronic condition. It is often painful but there are effective treatments that may relieve the symptoms of endometriosis.

Common symptoms include:

• heavy periods or irregular bleeding
• abdominal (tummy) or pelvic pain before and during a period, when having sex or going to the toilet
• bleeding between periods
• bleeding from the bladder or bowel, or changes in urination or bowel movements
• feeling bloated
• being tired and moody, especially around the time of your period
• not being able to get pregnant (infertility)

However, not everyone with endometriosis will experience symptoms.

To diagnose endometriosis, your doctor will probably ask about your symptoms and periods. You may need to have a laparoscopy, which is a type of surgery that allows doctors to look for endometriosis tissue in your abdomen.

Endometriosis can usually be treated with medicines or surgery. Medicines for endometriosis include hormone-based treatments like the pill or an implant or prescribed devices and pain relief medicine. Hormone treatments can reduce pain and reduce the growth of endometrial cells. However, they work only as long as you take them, so the endometriosis may come back.

Surgical treatment aims to remove as much of the endometriosis as possible. There are several options, including laparoscopic surgery where a small cut is made in your abdomen to allow examination and removal of the endometrial tissue. Surgery may also be combined with medicines. In very severe cases, a hysterectomy to remove the whole womb might be suggested.

Polycystic ovarian syndrome (PCOS) is a common hormonal condition that affects up to 1 in 5 girls and women in their reproductive years. It may cause disruptions to the menstrual cycle, skin and hair changes, as well as cysts on the ovaries.

It is one of the leading causes of infertility, yet many women don’t know they have it — up to 70% of women with PCOS remain undiagnosed.

PCOS can’t be cured, but if you have it you and your doctor can manage many of the symptoms . Women with PCOS can have a wide range of symptoms. Not every woman with PCOS will have every symptom, and each woman will have their own individual experience.

If you think you might have PCOS, it is important you see a doctor. An early diagnosis can help manage the symptoms of PCOS and reduce the potential long-term health risks.

PCOS symptoms include:

• excess hair growing on your face, chest, stomach or back (hirsutism)
• thinning hair or baldness (alopecia)
• irregular periods or no periods at all
• abnormal vaginal bleeding
• difficulty falling pregnant or not falling pregnant at all
• acne
• easy weight gain
• swollen belly
• mental health problems such as depression and anxiety

There are a number of different medical therapies to help manage PCOS symptoms, such as period problems, fertility, excess hair, acne and weight gain. These therapies include the oral contraceptive pill, symptom related drugs, hormone therapies, weight loss drugs, antidepressants and anti-anxiety drugs.

Menopause is defined as the final menstrual period. It occurs when there has been a change in a woman’s reproductive hormones and the ovaries no longer release any eggs.

Menopause can occur naturally and at the expected age, prematurely or early. Periods may stop unexpectedly due to primary ovarian insufficiency, or menopause can be caused by surgery, or because of treatment for cancer.

Perimenopause is the stage before natural menopause, and is when the ovaries are running out of eggs. It is often the time when women begin to experience the symptoms of menopause, such as hot flushes, vaginal changes and mood swings.

Management and treatment of menopausal symptoms depend on each individual woman, stage of life, relationships and general level of health and wellbeing. Healthy living, natural and complementary therapies, menopause hormone therapy, or MHT (formerly called hormone replacement therapy, or HRT) and some prescription medications can help relieve menopausal symptoms.

If you have had menopause because of treatment for cancer, or you have had premature or early menopause, it is helpful to understand what you can do for symptoms of menopause.

Serious gynaecological pathology in children and adolescents is rare. However, gynaecological symptoms are relatively common and it is important that all gynaecologists can make a correct assessment and plan appropriate management.

Looking after children and their families requires specific and sensitive skills and this is even more so when dealing with adolescent patients.

Menstrual disorders in adolescent girls are probably common although exact figures are not available as teenagers are reluctant to present due to embarrassment as well as lack of knowledge about what is normal.

Pain during menstruation may have a significant impact on schooling and examination performance. Earlier periods may be pain free and painful menstruation usually occurs on establishing regular ovulatory cycles. Pain is attributed to higher levels of prostaglandins and so anti-prostaglandin drugs can be helpful. Suppression of ovulation with the combined oral contraceptive pill is very effective in making periods less painful and lighter.

Whilst most girls respond to these treatments those who fail to do so need further evaluation.

Providing information, education and support around all family planning aspects.