Women experience problems related to their reproductive system throughout their lives. These range from the beginning of their menstruation right through and beyond the menopause. When symptoms cannot be explained or when your family doctor is concerned, then referral to a specialist gynaecologist is warranted.
The doctors at Northwest Women’s Health are experienced practitioners, sensitive to women’s needs and you can expect to be treated with dignity and respect. Privacy and a non-invasive environment will ensure your experience is pleasant and worthwhile. If an examination is required, we having nursing staff continually on hand to chaperone you and help the doctors.
Heavy periods are one of the commonest reasons women consult a gynaecologist. Menorrhagia is the medical word for heavy periods, and is regarded when pads or tampons are being changed too frequently, clots may be passed, and the patient may get up several times at night for fear of making a”mess” in the bed.
Couples trying to conceive may take up to 12 months to have success. Approximately 10% will not be pregnant after this time, and further investigation is warranted. Couples older than 35 years of age often come earlier than this and have tests after 6 months of trying.
The main purpose of the PAP smear is to detect precursors of Cervical Cancer. The aim is to find a condition called CIN (cervical intraepithelial Cancer) – this is 100% curable and when caught in this earlier phase, will virtually guarantee that cervical cancer will be avoided. Women should have regular PAP smears after the onset of intercourse, until the age of 70.
There are two very common conditions causing urinary incontinence in women. Stress Incontinence – accidents that happen with coughing, laughing or sneezing; and Overactive Bladder – where accidents happen in association with symptoms such as urgency, frequency and going quite a few times in the middle of the night (nocturia). At Northwest Women’s Health our doctors are experienced in sorting out the cause of the problem, thus making it much easier to fix!
The menopause causes a whole range of problems for women. The medical diagnosis of menopause can usually not be made for certain until the woman has had no periods for 12 months, in association with symptoms such as hot flushes, vaginal dryness, sleeplessness, mood changes and many others. The use of hormones causes many women much concern, but there are many aspects to the successful management of menopausal symptoms, one of which is HRT(hormone replacement therapy).
There is a vast choice of contraceptive agents for women. Choosing the right one for you may be simple, for others with complicating medical problems in the background, it can be quite a detailed process working out the safest and most effective method. A consultation with one of doctors will help you through this process.
These type of procedures typically involve 3 or 4 very small incisions in the abdomen, allowing the use of specialised instruments and a tiny camera. The entire abdomen, pelvis, uterus and ovaries can be seen on a high definition screen. A laparoscope is a fibre-optic telescope designed to allow the surgeon to visualise and examine the organs lying within the pelvic and abdominal cavities.
The operation is performed under general anaesthesia. A very small cut is made just below the navel through which the operating telescope (laparoscope) is inserted. When necessary, separate small incisions are made low down and at the sides of the abdomen to allow insertion of other fine instruments, e.g. grasping forceps, scissors, etc., and these will enable organs and tissue to be grasped, moved or cut as is required for your surgery. The incisions are closed and small dressings are often applied to cover these wounds.
This procedure can be used to investigate pelvic pain, potential causes of infertility, examination of cysts and tumours, to obtain biopsy samples and to investigate suspected ectopic pregnancy – amongst other things. From an operating perspective, common procedures include :
Treatment of ectopic pregnancy
Release/remove pelvic or abdominal adhesions
Surgically treat endometriosis
Excise or drain ovarian cysts
Remove fibroid (benign) tumours from the uterus
To enhance fertility eg: assisted reproductive techniques
To facilitate hysterectomy
Reconstruct the pelvic floor, treat prolapse and incontinence
No surgical procedure is entirely without risk, but this type of surgery attempts to minimise such risks. Anaesthesia itself has some slight risks and these are made worse by severe obesity or cigarette smoking. There is always a small chance that unforeseen circumstances may dictate that your procedure requires an open / traditional surgery approach but this is uncommon and occurs in about 1% of cases that are planned to proceed laparoscopically.
This is obviously entirely dependent on your individual recovery – however whilst traditional surgery patients are encouraged to refrain from driving for 2- 4 weeks, you may be able to drive in as little as a few days depending on your surgery and your rate of recovery. If in doubt, contact our staff for further advice.
Fibroids are benign tumours in the uterus which occur in 25% of women who are in the reproductive age group of 20 to 50 yrs. The symptoms are usually excessive bleeding during periods, heaviness, pelvic pain, and if large, a lump in the abdomen. There may also be pressure symptoms such as difficulty in passing urine and constipation. In Laparoscopic surgery for fibroid removal (myomectomy), the fibroid is separated from the uterus and removed. On average this would require one to two days in hospital.
Hysterectomy is the surgical removal of the uterus (womb). The common reasons are fibroids, heavy vaginal bleeding, prolapse, endometriosis and cancer of the uterus or cervix. In most cases, it is done through key hole surgery except in patients where the uterus is so big there is no space for the laparoscope and other instruments. In hysterectomy, the uterus and its supports are separated with special equipment, which reduce blood loss and time of surgery. The uterus is then removed usually through the vagina. After hysterectomy, a woman will no longer have her periods, and will not be able to fall pregnant.
Ovarian cysts are small fluid-filled sacs that develop in the ovaries. The cysts can be simple cysts that are commonly found among younger women and just need observation. Cysts are usually benign (non-cancerous cysts) and need close monitoring. Surgery is needed when there is a large sized cyst (greater than 5 – 6 cm) and when it doesn’t go away by itself, or keeps growing.. Some cysts may cause problems due to rupture, bleeding, or torsion. Symptoms of cysts are fullness in the abdomen, painful periods and abnormal bleeding, problems passing urine completely and pain with fever and vomiting. Laparoscopic surgery can be performed for most ovarian cysts, unless malignancy (cancer) is suspected.
Pelvic organ prolapse is a weakness or laxity in the supporting structures of the pelvic region. The bladder, rectal, or uterine tissue may bulge into the vagina and this is called pelvic organ prolapse. Pelvic organ prolapse is a very common condition, particularly among older women. It is estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. A Prolapsed Uterus refers to a uterus that has descended lower down into the vagina. Other types of pelvic organ prolapse are Cystocoele (bladder prolapse), Rectocele (rectal wall prolapse), and Enterocoele (prolapse of the small bowel). Finally there is Vaginal vault prolapse (prolapse following hysterectomy).
Ectopic pregnancy (EP) is where the pregnancy develops outside the uterus (womb), usually in one of the fallopian tubes. It is hence also known as a tubal pregnancy. However, this term is also used when the pregnancy grows in the ovaries or the abdomen (these are much rarer). EP happens in about 1 in 100 pregnancies. As the pregnancy grows, it causes pain and bleeding. If not recognized in time, the tube can rupture, causing internal bleeding. This is a medical emergency and can be fatal. The predisposing causes of ectopic pregnancy are pelvic infection, tubal endometriosis, previous abdominal surgeries and intra uterine contraceptives. In many cases there is no known underlying cause. The most common symptom is severe and persistent pain in one side of the lower abdomen. Many women describe it as an intense stabbing pain. Collapse preceded by feeling faint, dizziness, diarrhoea, vomiting and/or pain may occur. Treatment options for EP include observation, laparoscopy, laparotomy. For those who require intervention, the most common treatment is surgery. Under optimal conditions, a small incision can be made in the Fallopian tube and the ectopic pregnancy removed, leaving the Fallopian tube intact. In some instances, the location or extent of damage may require removal of a portion of the Fallopian tube or the entire tube.
Laparoscopy can be used to determine abnormalities of the uterus, fallopian tubes and ovaries. Defects such as scar tissue, endometriosis, fibroid tumours, congenital abnormalities and polycystic ovaries can be readily assessed at laparoscopy. In some women, the fallopian tubes are blocked. This can prevent the sperm and egg from coming together, causing infertility .With laparoscopy, some of the defects found can be corrected surgically.
Laparoscopic Sterilisation or Tubal ligation is also known as "tying the tubes“. This procedure involves obstructing the Fallopian tubes in order to prevent pregnancy. The fallopian tubes are on either side of the uterus and extend toward the ovaries. They receive eggs from the ovaries and transport them to the uterus. Once the fallopian tubes are closed, sperm can no longer reach the egg. Sterilisation can be performed using laparoscopy and normally requires only a day in hospital.