Owen J Owens
Consultant Gynaecologist

private gynecologist 92 harley street london

private gynaecologist pinehill hospital, hitchin, hertfordshire

 

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Mr Owen Owens MD MRCOG MRCPI - About womens gynecological health issues

Common Problems

Abnormal vaginal bleeding
This can be divided into pre-menopause and post menopause. In pre-menopause it can be due to polyps, occasionally fibroids and a polyp on the cervix or even a cervical erosion. In the majority of pre-menopausal women there is nothing sinister to find and cancer of the uterus (womb) and cervix are rare. A cervical smear is helpful is assessing the cervix. Abnormal bleeding can occur in younger women on the oral contraceptive pill (OCP) or even injectable forms such as Depoprovera and implants (Implanon). In post menopausal bleeding it can be due to a polyp, a low grade vaginal infection and rarely cancer of the uterus. 90% of women who bleed after the menopause will not have anything suspicious going on. However abnormal vaginal bleeding should be investigated in all women.

Adhesions
Adhesions are due to scar tissue formation following surgery or occasionally infection. Adhesions are usually diagnosed only by a procedure called a laparoscopy (see laparoscopy). Prior to performing a laparoscopy an ultrasound scan is usually performed to exclude any pelvic abnormality (see ultrasound). In younger women with possible adhesions then swabs are usually taken to exclude infection such as chlamydia or gonorrhoea.

Fibroids
Can affect up to 40% of women but only a small percentage of women will need to have surgery performed. Fibroids are common in some races such as African women. Fibroids can grow under the influence of the hormones from the ovary. They can stay within the muscle of the uterus (intramural), grow into the uterine cavity (sub-mucosal) or grow outwards (serosal). Occasionally fibroids can become pedunculated where thet grow by a stalk from the uterus.

HRT
This is known as hormone replacement therapy. It is used around or after the menopause as a substitute for the oestrogen produced by the ovary. HRT can be used on the skin (gel) or by applying a patch or alternatively using a tablet. Implants are rarely used nowadays as they are old fashioned. HRT risks include a slight increased risk of a deep vein thrombosis (clot) in the leg and if there is a family history of a thrombosis this has to be checked out before prescribing HRT. Blood pressure has to be checked in women on HRT. The risk of breast cancer with HRT is low about 3 women per 1000 if HRT is taken for more than 5 years.

Menopause
This means the women's last period. Normally a woman has to go 6 months without a period to say that she has gone through the menopause. The menopause usually happens between 48 and 52 years of age. Occasionally some women go through an early menopause or even a late menopause. Some of the symptoms of the menopause include hot flushes, night sweats, vaginal dryness, difficulty in concentrating.

Pre-mature menopause
Usually happens in women under the age of 45 years in women who have not had surgery.Treatment is only required depending on symptoms.

Ovarian Cysts
Cysts are common. They can be simple, complex or occasionally suspicious. An ultrasound scan is performed to confirm the cyst. If simple and less than 6 cm they can disappear, if complex a repeat scan after 4 - 6 weeks needs to be repeated and occasionally a blood test is performed (CA 125). Suspicious cysts can be due to benign conditions such as endometriosis (see later). In older women cancer of the ovary has to be excluded.

Pelvic pain
This is a commom condition. It can occur around a period or can be unrelated. Usually nothing sinister is found but a pelvic scan is performed to exclude any abnormality of the ovaries or uterus. Pelvic pain can occur with intercourse and again a scan is performed. Sometimes pelvic pain is associated with constipation.

Pelvic Reconstructive Surgery
This is performed in Centres of Excellence and may require the input of gynaecologist, plastic surgeon, bowel surgeon and a urological surgeon. Pelvic Reconstructive Surgery may be required in rare cases where a female is born without a vagina but the condition may not be recognised until a women fails to have a period. Otherwise it is performed occasionally in women who have had cervical cancer or radiotherapy and the disease has recurred.

Polycystic Ovarian Syndrome
This condition is commoner than expected. It can affect 1 in 5 women and is usually suspected if a woman has irregular periods every 6 weeks or less frequent. Sometimes it is intermittent. Women can be under weigt, normal weight or over weight with this condition. It is usually diagnosed with a pelvic scan and blood tests ( FSH and LH). The treatment is dependent on each women and their symptoms.

Post menopausal bleeding
This is bleeding after the menopause and unrelated to taking HRT. The majority of women with post menopausal bleeding (PMB) will not have anything sinister. A pelvic scan both abdominal and vaginal is required to make the diagnosis. If the lining of the womb is more than 5 mm in thickness a sample is taken from the lining of the womb (pipelle) or occasionally a procedure called a hysteroscopy is required to look into the womb either under sedation or a short general anaesthetic. Local anaesthetic can also be used in selected women.

Prolapse
This is when the pelvic structure that support the womb slacken usually after the menopause but is can happen before the menopause. The uterus can come down, the bladder at the front of the vagina or the rectum at the back of the vagina can bulge. The treatment options are either a ring pessary in women not suitable for surgery or surgery itself.

Vaginal discharge
This may be normal and mid cycle. May be due to infection so swabs need to be taken from the vagina or can be due to a cervical erosion where the neck of the womb or cervix is everted. A cervical erosion with no symptos does not require treatment.

Vaginoplasty
This is surgery performed on the vagina usually in young women with an absent or very short vagina. This operation is only performed in selected centres.

Laparoscopy
This is a diagnostic procedure performed under a general anaesthetic to assess the pelvic organs (uterus, ovaries and fallopian tubes).

Ultrasound scan
Performed both abdominally and vaginally to look at the size of the uterus and the ovaries. It is helpful in women who bleed after the menopause where the thickness of the lining of the womb is measured.

Spire Harpenden Hospital, Ambrose Lane, Harpenden, AL5 4BP Tel: 0800 585112
Spire Bushey Hospital, Heathbourne Road, Bushey Heath, WD23 1RD Tel: 01582 760045
Cobham Private Clinic, Luton & Dunstable NHS Trust, Lewsey Rd, Luton, LU4 0DZ Tel: 01582 718193
Luton & Dunstable NHS Trust, Lewsey Rd, Luton, LU4 0DZ Tel: 01582 497459