Common Conditions
What We Treat
Gynaecology treats many conditions affecting female sexual and reproductive organs. This is a small sample of some common conditions that a gynaecologist, like Dr Holbeach, can provide specialised care for.
Endometriosis
Endometriosis is a chronic condition caused by tissue that is similar to the lining of the uterus that is deposited outside of the uterus. Symptoms can include pain, bloating, abnormal bleeding, and subfertility.
Cysts
Cysts can occur on the ovaries, the fallopian tubes or in the vagina. Some cysts cause no symptoms and may spontaneously resolve with time. Others can cause pain or bloating and may require treatment.
- Ovarian CystsSome common benign ovarian cysts are functional cysts, dermoid cysts, cystadenomas, and endometriomas. Functional cysts may resolve spontaneously and require only surveillance. Dermoid cysts, cystadenomas, and endometriomas are less likely to resolve and may require surgical removal if large or causing symptoms, like pain.
- Vaginal CystsSome examples of vaginal cysts are Bartholin’s gland cyst, Gartner’s duct cyst, Skene’s gland cyst, and an inclusion cyst. Many will resolve spontaneously and do not need treatment. If they become bothersome, painful, or infected, they may need treatment.
- Bartholin’s Gland CystsA particularly common vaginal cyst is a Bartholin’s gland cyst is a lump in the vagina near the vaginal opening, It can occur on one side or both. They occur when the Bartholin’s gland duct is blocked and fluid accumulates causing the area to swell. Sometimes they resolve spontaneously. But they can also grow and become bothersome or infected.
Endometrial and cervical polyps
Polyps are usually benign growths located inside the uterus or on the cervix. They can cause abnormal bleeding, abnormal discharge, or subfertility. Small asymptomatic polyps may not require removal. Large polyps or polyps that cause symptoms will require removal.
Cervical dysplasia
Cervical dysplasia is a precancerous condition of the cervix. These abnormal cells are caused by HPV (human papilloma virus) infection, which is a common virus that most sexually active adults will come into contact with in their lives. Some HPV subtypes are more closely associated with these precancerous changes and cervical cancer than others.
Cervical screening involves testing for these HPV subtypes and, if they are present, looking at the cells of the cervix more closely. Specific advice about how to look at those cells and monitor depends on the HPV subtype.
Fibroids
Fibroids are benign growths in the uterus that grow under the influence of oestrogen. They can cause pain, pelvic pressure, heavy periods, enlarged abdomen, problems voiding urine, constipation, and subfertility.
Adenomyosis
Adenomyosis is a condition where the lining of the uterus grows into the muscular body of the uterus. This leads to the uterus grow larger and can cause painful periods, heavy periods, and subfertility.
Endometrial hyperplasia
Endometrial hyperplasia occurs when the lining of the uterus becomes thick and is a cause of abnormal uterine bleeding. For example, heavy bleeding, irregular bleeding, or postmenopausal bleeding. When the hyperplasia is described as ‘atypical’ this means that the cells have a precancerous appearance, and this requires treatment to prevent progression to endometrial cancer. Hyperplasia without atypical features is less likely to progress to cancer, but still requires treatment (usually progesterone and reducing risk factors for cancer).
Menopause & Perimenopause Symptoms
Perimenopause and menopause are periods of significant hormonal and life changes occurring often in midlife. Symptoms can include hot flushes and night sweats, insomnia, aches and pains, vaginal dryness, urinary symptoms, mood changes, and brain fog.
Some people experience menopause earlier than this. Premature ovarian insufficiency is a condition where, for several reasons, the ovaries become less functionally active and periods cease before the age of 40. Other people may experience menopause because their ovaries have been surgically removed to reduce the risk of some cancers.
There are now a range of options to manage perimenopause and menopause medically including hormonal and non-hormonal options.
How We Can Help
Seeing a gynaecologist for these conditions ensures that you receive specialised assessment and advice to help you make the right decision for you.
While many gynaecological conditions can be well managed by you and your GP, a gynaecologist can help you and your GP find the right path forward or provide an alternative perspective if needed. A gynaecologist can also advise about, and offer, surgical options.
If you think that you would like to discuss your options with a gynaecologist, please contact us today.
Frequently Asked Questions
How can I find out if I have endometriosis?
You can discuss your symptoms and medical history with your GP or gynaecologist. They will usually then perform an examination with your consent, and this may include some test like swabs for infection. Pelvic ultrasound is now very good at assessing stage 3 or 4 (moderate to severe) endometriosis, especially if it is done by an expert gynaecological ultrasound provider. They can involve bowel preparation to assess for bowel endometriosis. A specialised ultrasound that shows no evidence of endometriosis does not completely rule it out because there may be stage 1 or 2 disease, which ultrasound may not detect. In that, case we can be guided by your symptoms. Surgery is not required to confirm a diagnosis of endometriosis. There may however be other reasons to do surgery. Speak to a gynaecologist for advice specific to you and your goals.
I have been told I have an ovarian cyst, should I be worried?
Not all ovarian cysts are concerning. Some are part of ovarian function during the menstrual cycle. Not all cysts cause symptoms either. Cysts can become a problem if they are very large (>5cm) or cause symptoms or if they have suspicious features. A good quality ultrasound will be able to assess an ovarian cyst in sufficient detail to determine the size, type of cyst, and if there are concerning features. Blood tests can also be ordered to assess the risk of an ovarian cyst. Based on this assessment your GP may refer you to a gynaecologist for an opinion. Some (benign) cysts can be monitored with repeat ultrasound, some require surgical removal, and some require removal of the whole ovary. If it is considered likely to be a malignancy, then you may be referred to a gynae-oncologist.
I keep getting abnormal cervical screening tests, what does this mean?
An abnormal cervical screening test means that you have tested positive for a subtype of human papilloma virus (HPV) that has been associated with premalignant and malignant changes to the cervix. It can mean that you have abnormal cells on the cervical screening test, too. HPV is very common amongst sexually active adults. There are many subtypes of HPV and some of those subtypes are related to cervical cancer. It is those subtypes that the cervical screening tests for. If you test positive for high-risk subtypes (16 or 18) you will be referred to a gynaecologist who is trained to do colposcopy (special microscope and light). If you test positive for intermediate-risk subtypes (non 16 or 18) then it is usually repeated in a year and only if still positive will you be referred to a gynaecologist for colposcopy.
In general, it takes a long time for HPV to result in premalignant or malignant transformation. So, the recommendation is to watch closely, but not to treat the cervix unless there is a high-grade lesion.
I have fibroids, do they need to be removed?
No, fibroids do not need to be removed unless they are causing symptoms. If they are causing symptoms or impact on fertility, then they can be treated. Treatment options will depend on the symptoms, the location and size of the fibroids, and whether she has completed her family.
I don’t want to take hormones, what can I do?
If you do not want hormonal treatments, then you do not have to take hormonal treatments. Depending on your symptoms, your condition, and your goals, there may be other options that you would like to try instead. Hormonal treatments can have side effects for some people, however there is good evidence that they are effective to treat pain and bleeding. Have a conversation with your GP or contact us to discuss your options.