How I approach general gynaecology
Most gynaecological problems become clear through listening carefully, examining gently and, where it helps, scanning. At Parkside Hospital and the CRP Clinic I can perform an ultrasound scan during your consultation, so we can usually discuss what it shows at the same visit. I will explain what I have found, set out every reasonable option, including the option of doing nothing for now, and give you my recommendation. The decision is yours, and you will receive a detailed letter, usually emailed within 30 minutes of your appointment.
Heavy or painful periods
Heavy periods are periods that interfere with your daily life: needing to change protection every hour or two, flooding, passing clots or needing to plan around your period. Painful periods that stop you working or studying are not something you should have to put up with.
Common causes include fibroids, polyps, adenomyosis and endometriosis, and sometimes no structural cause is found. I start by asking about your bleeding and your general health, and usually suggest a blood test to check for anaemia (a low blood count). A scan, and sometimes a hysteroscopy (looking inside the womb with a slim telescope), helps to find the cause.
Treatment depends on the cause and on whether you hope to become pregnant. Options include non-hormonal medicines that reduce bleeding, hormonal treatments such as the hormonal coil or the contraceptive pill, removal of polyps or fibroids, endometrial ablation (a short procedure that destroys the lining of the womb; it is only for women who do not want a future pregnancy, because pregnancy afterwards is risky, and contraception is still needed) and, for some women, a keyhole hysterectomy.
You can read more on the fibroids, adenomyosis and endometriosis pages.
Ovarian cysts and endometrioma
Ovarian cysts are fluid-filled sacs on or in an ovary. Most are simple functional cysts that come and go with the menstrual cycle and disappear on their own. Others, such as dermoid cysts and endometriomas (cysts caused by endometriosis), do not resolve and sometimes need removing. A scan shows the size and appearance of a cyst, many simply need a repeat scan, and if a cyst does need removing I usually do this by keyhole surgery, preserving the healthy ovary. The ovarian cysts page explains this in detail.
Many small follicles on the ovaries can be one feature of polycystic ovary syndrome (PCOS), now renamed polyendocrine metabolic ovarian syndrome (PMOS) to reflect that it is a hormonal and metabolic condition. Follicles on a scan do not by themselves mean you have the condition: the diagnosis also depends on your periods, symptoms and blood tests. I can assess this and advise you, although its long-term care is often shared with your GP.
Sudden severe pelvic pain can mean a cyst has twisted or burst. That needs urgent assessment: go to your nearest emergency department or call 999.
Pelvic pain
Pelvic pain that lasts for six months or more has many possible causes, gynaecological and otherwise, and often more than one is involved: endometriosis, adenomyosis, adhesions, the bowel, the bladder, the muscles of the pelvic floor and the nerves. Long-standing pain can also change the way the nervous system processes pain, which is why treating it well often needs more than one approach.
I take a full history, examine you and usually scan you. Where endometriosis is suspected, I will discuss whether a laparoscopy would help. Treatment may include medication, hormonal treatment, surgery, pelvic floor physiotherapy and referral to a specialist pain service, and I will explain why I recommend each.
Prolapse
Prolapse means that the womb, the bladder or the bowel has dropped from its normal position, causing a feeling of heaviness or a bulge in the vagina, sometimes with bladder or bowel symptoms. It is common after childbirth and the menopause.
Many women are helped without surgery, through specialist pelvic floor physiotherapy or a vaginal pessary (a removable support). When surgery is the right choice, the options include vaginal repair and keyhole operations to support the womb or the top of the vagina. I will explain the benefits and risks of each, and you will have time to consider them.
Menopause and HRT
The menopause, and the years leading up to it (the perimenopause), can bring hot flushes and night sweats, poor sleep, low mood, anxiety, difficulty concentrating, joint pain, vaginal dryness and bladder symptoms. For some women these are mild; for others they affect every part of life.
I offer menopause consultations covering your symptoms, your personal and family history, and the options. HRT (hormone replacement therapy) is the most effective treatment for most menopausal symptoms, and for most women under 60 its benefits outweigh its risks. It comes in several forms, including tablets, patches, gels and sprays, and in local forms for vaginal symptoms. Non-hormonal treatments and lifestyle measures help too, and are particularly important if HRT is not suitable for you. I will help you weigh the benefits and risks for you personally, and I write to your GP so that any ongoing prescription continues smoothly.
PMS and PMDD
Premenstrual syndrome (PMS) is the name for physical and emotional symptoms in the days before a period that ease once it starts. Premenstrual dysphoric disorder (PMDD) is a severe form, in which mood symptoms such as depression, anxiety and irritability can be overwhelming.
Keeping a symptom diary over two or three cycles helps to confirm the pattern. Treatment ranges from lifestyle measures and psychological therapies to medicines and hormonal treatments that settle the cycle. For a small number of women with very severe symptoms that have not responded to other treatments, surgery is sometimes considered, after a trial of treatment that temporarily switches off the ovaries.
Postmenopausal bleeding
Assessment usually involves a transvaginal ultrasound scan to measure the thickness of the lining of the womb and, if needed, a hysteroscopy with a small sample of the lining, often at an outpatient appointment. The bleeding after the menopause page explains what to expect.
Hormonal coil fitting
The hormonal coil (an intrauterine system, or IUS) is a small T-shaped device placed in the womb, which releases a hormone that makes periods much lighter and provides contraception. It is also used to protect the lining of the womb as part of HRT. I fit hormonal coils, and can often do so at the same appointment as a scan, or with a hysteroscopy if that is also needed. You can choose inhaled pain relief if you would like it.
Gynaecological ultrasound
Ultrasound is a safe and quick way of looking at the womb and ovaries, and most women find it comfortable. A transvaginal scan, using a slim probe placed in the vagina, gives the clearest picture; an abdominal scan is an alternative. I perform and interpret scans myself at Parkside Hospital and the CRP Clinic, which means I can relate what the scan shows directly to your symptoms and discuss it with you at the same visit.
