Gynaecology

Many women have cramps during a period. When the pains stop you getting on with your life, then you should seek help. Most women have no serious cause behind them, but a change in the type and severity of pain that you are experiencing might indicate a gynaecological problem such as endometriosis or fibroids. Heavier bleeding is often associated with more pain. Specific medical treatments are available for this.

Believe it or not, the average amount of blood lost with a period is just 40ml, but many women experience much heavier bleeding, that can be exhausting, painful, embarrassing and damned inconvenient. Some women can become anaemic when blood loss is excessive. Gynaecological conditions such as fibroids can make periods heavier. Specific treatment for these and the other hormonal causes can dramatically improve the quality of your life, so don’t just sit there, get it sorted!

You should consult a Gynaecologist if your period has not started by the time you are 16, or if you miss more than two periods. Obviously the most common reason why periods stop is when you are pregnant, but there are many other reasons why periods can be infrequent, such as hormone disturbance, menopause, stress and anorexia. Some contraceptives stop periods, which is completely safe, but always consult your Doctor if there is a change in the pattern of your period.

Periods normally come every 28-32 days. The most common cause of irregular periods in the UK is something called Polycystic Ovary disease (PCOD/PCOS). This refers to a hormone imbalance within the ovaries that can also be associated with excess body hair, acne and easy weight gain. You should see a Gynaecologist if you think you are affected.

Bleeding between periods or after sex may be caused by polyps inside the womb cavity, or by inflammation at the neck of the womb (cervix). It is also common in women taking the pill, when it is most likely if a pill is missed or if you have been ill. You should see a gynaecologist if you experience bleeding between periods.

The UK government guidelines recommend a smear test every 3 years from the age of 21 until the age of 65. It is prudent however the have an annual gynaecology check up. Miss Matthews performs smears that are analysed by computer and are therefore extremely accurate. The sensitivity of a smear test can be improved by also checking the smear test for the presence of a virus called HPV for little additional cost. The smear can also be used as a screening test for infections such as Chlamydia, Gonorrhoea and Herpes.

Miss Matthews provides all types of contraception and is can advise on appropriate methods for women of all ages.

A change in your normal vaginal discharge, especially if the normal odourless white discharge becomes thick, smelly or coloured, or if it is associated with discomfort or itch, can signify an infection. Miss Matthews can test for all vaginal and pelvic infections, treat these appropriately, and advise about the need to treat your partner. Discretion and confidentiality are of course assured.

Many different types of cysts can develop in the ovary. Most cause no symptoms, resolve spontaneously and are completely innocent. Large cysts in the ovary are less likely to go away themselves and may cause pelvic discomfort and irregular bleeding. Some are associated with endometriosis (chocolate cysts). Cysts can suddenly cause pain if they twist, burst or bleed. Surgical removal is required for larger cysts, even if they are asymptomatic, chocolate cysts, and cysts which have suspicious features on ultrasound scan. Ovarian cancer often presents late in the course of the disease when the prognosis is poor. A normal ovarian ultrasound scan virtually eliminates the risk of ovarian cancer and should be part of your annual gynaecological check-up, especially if there is a family history of cancer.

Endometriosis describes a condition where the cells that normally line the womb form deposits inside the tummy cavity lining (peritoneum). These deposits cause inflammation and scar tissue formation (adhesions). They can reduce fertility and cause significant pelvic pain, but sometimes they cause no symptoms at all. The diagnosis of endometriosis is made only by performing a laparoscopy. Miss Matthews routinely treats endometriosis surgically during the procedure if it is detected during a routine laparoscopy. Fertility improves following surgical treatment regardless of whether a patient has associated pain, and pain will significantly improve following surgery. Endometriosis affecting the ovaries can produce cysts called ‘chocolate cysts’ that contain old blood and should be surgically removed. Endometriosis affecting the muscle of the womb wall is called adenomyosis. It usually causes painful periods. The medical treatments for endometriosis are very successful in some patients and are often used immediately after surgery for a period of 6 months to a year, but all medical treatments are contraceptive and associated with significant side effects.

Fibroids are innocent lumps that develop in the womb. They are formed from muscle and fibrous tissue and can grow to be extremely large indeed. Some women are prone to fibroids especially if there is a family history. Numerous fibroids or a single large fibroid may impair fertility, and cause abdominal discomfort, pressure symptoms and bloating. They are a frequent cause of heavy periods. Fibroids can be detected on internal examination, and assessed by ultrasound scan. Fibroids inside the womb cavity itself can be removed using hysteroscopy. Those in the wall of the womb or on the outside of the womb can be removed during and operation called a myomectomy. Women who have finished their family and have heavy bleeding associated with fibroids may opt for a hysterectomy as the most appropriate treatment. Medical treatment is available, and in some cases the blood supply to a fibroid can be blocked by a technique called embolisation, which is carried out by specially trained Radiology Doctors and results in fibroid resolution without surgery. This technique is not suitable for patients who wish to become pregnant afterwards. Fibroids that are asymptomatic should be monitored annually by ultrasound. Fibroids which enlarge after the menopause require a hysterectomy.

Certain skin conditions cause itchiness, pain and burning when they affect the labia and surrounding area. They are more common after the menopause when the skin thins and becomes more sensitive as a result of the drop in oestrogen levels. Ulceration can result from Herpes infection, and lumps can appear following infection with the wart virus.

A Bartholins cyst causes a rapidly enlarging painful lump in the area that may need surgery and antibiotic treatment. Skin tags can develop in the labia, and blocked hair follicles and boils may occur. Eczema and psoriasis can also affect the skin of the vulva.

Miss Matthews is able to diagnose and treat all these conditions.

Gynaecological care is especially important around and after the menopause. Cervical and ovarian screening, bone density scans, mammography and appropriate hormone replacement therapy as required should all be monitored. Ladies wishing to have an individual tailored approach to HRT are referred to my colleague Miss Lynette Yong who specialises in bio-identical hormone replacement (lynette@sarajmatthews.com). Lynette also provides a cosmetic anti ageing service that includes botox injections, collagen fillers and liposuction. Both of us operate together in fat transfer operations, where fat is removed from the tummy and used to plump the labia, giving them a more youthful appearance.