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Gynaecology Services

Heavy Periods

Heavy periods can affect any age group but are more common in teenagers when they first start periods, and then in later reproductive years, typically in the 40-50 age group. The majority is related to hormonal causes, but we must exclude fibroids, polyps and more serious causes. A history, examination, scan and blood tests are usually required and the treatment is tailored to the individual. Miss Husain offers minimally invasive techniques such as Novasure to help older women with heavy periods who have completed their family.

Painful Periods

When periods first start they are painful and this settles with time. If periods start becoming painful again, and the pain is severe requiring painkillers, typically worse in the 1-2 weeks before the period starts, then this could indicate endometriosis. A history, examination and scan are usually required and the treatment is tailored to the individual.

Irregular Cycles

The cycles change with the age of the woman, being irregular at the extremes of reproductive life, such as teenagers and perimenopausal women. They can also be associated with polycystic ovary syndrome which is a common hormonal disorder affecting a range of ages. Irregular periods can be a feature of other hormone disorders, including early menopause. A history, examination, scan and blood tests are usually required and the treatment is tailored to the individual.

Pelvic Pain

Pelvic pain can be caused by any of the organs in the pelvis, and a diagnosis requires a detailed history from the patient, noting age , cyclical variation of the pain, association with intercourse as well as any bowel or urinary symptoms.

A relatively common cause, but poorly diagnosed cause is endometriosis. Although an internal examination and scan can be helpful in excluding pathology such as fibroids and ovarian cysts, endometriosis is diagnosed by performing a laparoscopy. This can be treated at the same time, as can ovarian cysts. Miss Husain will tailor the investigations according to your history, but will usually include an internal scan.

Painful Sex

There may be initial discomfort on the outside when a woman starts sexual activity but if intercourse is painful deep inside, this is one of the symptoms of endometriosis. A history, examination and scan is usually required and the treatment is tailored to the individual.

Endometriosis

This is a common condition affecting about 1 in 10 women in the UK. The womb lining which is normally present inside the womb is found outside the womb in the pelvis and this is affected by the ovarian hormones and hence the pain is cyclical initially. The cause is unknown but typically it causes painful periods, painful sex and about 30% women with infertility may have this condition.

A history, examination, scan and blood tests are done initially but only a laparoscopy can diagnose this condition. At laparoscopy, typical lesions will be seen which can be treated. The ovaries can be affected by this condition and these may affect fertility. Interestingly endometriosis can be present extensively and cause no symptoms or be present in only a minor degree and cause severe symptoms.

Fibroids

Fibroids occur in over 50 % of women of reproductive age group worldwide. They are non-cancerous growths of the smooth muscle cells of the uterine wall, containing various tissues including collagen. They start as tiny spots throughout the uterine wall. These then increase in size very slowly over many years, stimulated by ovarian hormones. The incidence increases with age up to the menopause.

Many women with fibroids do not have any problems but most women who do develop symptoms are between the ages of 30-50. The presence of symptoms depends on the fibroids’ size, position and condition. They are often found incidentally on a scan.

Fibroids can cause heavy prolonged periods, leading to iron-deficiency anaemia and tiredness. Because this occurs gradually many women do not notice until very late.

Fibroids can be multiple and are classified according to their position within the uterine wall. The majority are within the uterine wall (intramural) and cause general enlargement of the uterus or they can be growing on the outside wall of the uterus (subserosal). In this case the enlarged uterus or fibroid itself can cause pressure symptoms on the bladder or bowel, or pain with intercourse.

The fibroid can be growing from the inner wall into the cavity (submucosal); this type can cause problems with bleeding in between periods, and problems with fertility. Submucosal fibroids can be removed with a procedure called transcervical resection of fibroid at the time of a hysteroscopy.

The management of fibroids is tailored according to the woman’s age, symptoms, and reproductive plans and a mutually agreed decision made with the consultant and patient.

Polycystic Ovary Syndrome (PCOS)

This is a common hormonal disorder affecting approximately 10-15% women in the reproductive age group, depending on the population. The Rotterdam criteria are used to diagnose this condition which are essentially irregular periods, features of high male hormone level (excessive facial hair, acne) and/or polycystic appearance of the ovaries on scan. Some groups are affected more commonly; being of South Asian origin, overweight and with a family history of diabetes. Treatment is tailored to the individual, depending on whether pregnancy is desired or control of other symptoms.

PCOS should not be confused with ovarian cysts (see below).

Ovarian Cysts

Ovarian cysts can develop at any age, but are more common before the menopause. If they are large, or twist they can cause pain, pressure symptoms and can be associated with infertility.

The commonest cause is hormonal and this type of “simple” cyst usually improves on its own, if it is below a certain size and can be monitored with scans. Other cysts found in reproductive age group women are endometriotic cysts and dermoid cysts. Depending on the size and symptoms, these cysts need to be removed through keyhole surgery. This involves a general anesthetic and daycase operation and the tissue is analysed in the lab to confirm the type of cyst and that it is benign. Rarely some cysts can be cancerous; diagnostic methods guide us to suspect this prior to surgery and appropriate onward referral made as needed.

Fertility Problems

A full assessment for fertility is offered. Please see Fertility section and FAQs.

Pregnancy Planning / Preconception Care

Miss Husain provides advice on how to optimise your health for pregnancy, including if you have pre-existing medical conditions. Investigations will be arranged as needed for your particular situation.

Miscarriage

Assessment for suspected miscarriage is available including scan and blood tests.

If surgery is required this can be arranged at Spire Thames Valley Hospital.

Menopausal Problems

Miss Husain is happy to offer advice on common menopausal problems.

Well-Woman Checks

A full history is taken, BP, urine testing, BMI calculation, smear including HPV testing, Chlamydia screening, internal ultrasound scan and examination is conducted. If indicated a mammogram is also arranged.