Owen Owens MD MRCOG MRCPI - About womens gynecological health issues
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.
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.
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.
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.
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.
Usually happens in women under the age of 45 years in
women who have not had surgery.Treatment is only required depending on symptoms.
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.
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
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.
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.
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
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.
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.
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.
is a diagnostic procedure performed under a general anaesthetic to assess the
pelvic organs (uterus, ovaries and fallopian tubes).
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