About our gynaecology service

Our Consultant Gynaecologists and are here to advise you on any aspect of women's health from fertility issues, contraception, gynaecological problems or difficulties associated with the menopause.

Nursing staff are specially trained and have together spent many years caring for women of all ages.

At The Wellington, we offer women a ‘one stop’ clinic, where we can assess your medical history, address any particular worries or concerns, offer blood pressure checks, cervical smears, trans vaginal ultrasound scans, blood tests and swabs, STI screens and urine tests , all in one place.

Cervical smear tests

Most women between the ages of 25 and 65 should have regular smear tests (at least every three years). A smear is a sample of cells taken from the cervix. It is examined under the microscope to detect any abnormal cells. If any abnormal cells are detected, these women will then be referred for a colposcopy examination.

A smear test is a rough guide as to what abnormal cells may be present on the cervix, but a colposcopy together with a biopsy is the way of accurately determining the situation. Many women will find that following a colposcopy examination their cervix is found to be entirely normal.

Another group of women will find that their cervix contains mildly abnormal cells and it is usually possible to monitor these cells without requiring further treatment. Some women will find the abnormal cells detected by their smear test and colposcopy are so called ‘pre-cancerous cells’. These are cells which may turn into cancer over a period of time, if they are left untreated. It is this group of patients who require treatment, usually under local anaesthetic to remove the abnormal cells.

Colposcopy to Cervix

Colposcopy or colcoscopy is a diagnostic procedure in which a colposcope is utilised to examine an illuminated, magnified view of the cervix, the tissue of the vagina, and vulva. Many premalignant lesions and malignant lesions in these areas have discernible characteristics which can be detected with a thorough colposcopic examination.

Coil insertion

This procedure, performed by a gynaecologist, using an intrauterine device made up of a plastic or metal coil, spiral or other shape (about 25mm long), is inserted into the cavity of the uterus to prevent conception or pregnancy. Its exact mode of action is unknown but it is thought to interfere with implantation of the embryo.

 

 

Endometriosis 

Endometriosis is an extremely common condition which can affect women in a variety of ways. It occurs when the cells which normally line the uterus (endometrium) are found in other parts of the pelvis. The cells behave exactly the same as they do when they line the uterus and therefore each month they grow and at the time of a period then they bleed. Bleeding inside the pelvis can often cause pain. Therefore, most patients with endometriosis initially have problems with pain at the time of their periods. After many months and years of this internal bleeding, scar tissue may form, together with cysts on the ovaries. Women with severe endometriosis may have pain at any time of their menstral cycle and may have adhesions in the pelvis which cause problems. In addition to the pain which is caused by Endometriosis, this condition can also cause problems with fertility.

Most patients have the diagnosis of Endometriosis confirmed by a laparoscopy operation. At this laparoscopy then mild to moderate Endometriosis can be treated with the laser or another similar ablation method. This is a very effective way of treating early Endometriosis. A variety of hormonal treatments may be useful in controlling the symptoms of Endometriosis. Common hormonal treatments include the oral contraceptive pill, the mirena IUS, progesterone treatments, danasol and GnRH hormone injections.

Adenomyosis

 Also referred to as “uterine endometriosis,” this is a benign disease confined to the uterine muscle. 

Amenorrhoea

Amenorrhoea is the absence of a menstrual period in a woman of reproductive age.

Fibroids

What are Uterine Fibroids?

Uterine fibroids are the most common benign (non-cancerous) pelvic tumour in women. They are also called leiomyomas or myomas. Fibroids are caused by an over growth of the muscle of the uterus. They are often round or oval in shape with a firm consistency. They may be single or multiple and can arise in different layers of the uterus.

The main types of fibroids are:

  • Intramural: the most common type of fibroid, which develop in the muscle wall of the womb 
  • Subserosal: fibroids that develop outside the wall of the womb into the pelvis and can become very large
  • Submucosal: fibroids that develop in the muscle layer beneath the womb's inner lining and grow into the cavity of the womb

Fibroids grow in the presence of the hormone oestrogen, but following the menopause the majority of fibroids shrink. Fibroids only need to be treated if they are causing problems. Their size can vary between microscopic up to the size of a football. African and afro-Caribbean women have more than three times the incidence of symptomatic fibroids compared with Caucasian women.

What are the Symptoms?

Although the majority of women experience no symptoms, fibroids can be associated with significant symptoms that impair quality of life and interfere with fertility. The most common symptoms are:

  • Heavy, prolonged menstrual periods sometimes with clots (menorrhagia). This can result in anaemia with dizziness and easy tiredness
  • Pressure on the bladder causing urinary frequency and urgency
  • Pelvic pain and swelling in the abdomen
  • Back or leg pain. Fibroids can press on nerves that supply the pelvis 
  • Painful intercourse (dyspareunia)
  • Pressure on the bowel, leading to constipation and bloating 
  • Fertility problems and occasionally miscarriage 

Diagnosis

Initial diagnosis is confirmed with a transvaginal ultrasound scan and/or MRI. The radiological examination identifies the type, number, size and location of fibroids. Also, the ultrasound or MRI excludes other possible causes of symptoms such as endometriosis, ovarian cysts, ovarian cancer or endometrial cancer.

What treatments are available?

Medication

There are different forms of medication available which help control symptoms. 

  • Levonorgestrel intrauterine system (LNG-IUS) is a small plastic devise that is placed in the womb and slowly releases the progestogen hormone levonorgestrel. It stops your womb lining growing quickly, so it's thinner and your bleeding becomes lighter. 
  • LNG-IUS also acts as a contraceptive, but doesn't affect your chances of getting pregnant after you stop using it. 

Tranexamic Acid

  • This works by stopping the small blood vessels in the womb lining bleeding, reducing blood loss by about 50%.
  • Tranexamic acid tablets aren't a form of contraception and will not affect your chances of becoming pregnant. 

Anti-inflammatory medicines (NSAIDS)

  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and mefenamic acid, can be taken three times a day from the first day of your period until bleeding stops or reduces to manageable levels. 
  • NSAIDs work by reducing your body's production of a hormone-like substance called prostaglandin, which is linked to heavy periods.

The contraceptive pill

  • The contraceptive pill is a popular method of contraception that stops an egg being released from the ovaries to prevent pregnancy. 
  • As well as making bleeding lighter, some contraceptive pills can help reduce period pain. 

Oral progestogen

  • Oral progestogen is synthetic (man-made) progesterone (one of the female sex hormones) that can help reduce heavy periods. 
  • Oral progestogen works by preventing the womb lining growing quickly. It's not a form of contraception, but it can reduce your chances of conceiving while you're taking it.

Injected progestogen

  • Progestogen is also available as an injection to treat heavy periods. It works by preventing the lining of your womb growing quickly.

Gonadotropin releasing hormone analogues (GnRHas)

  • If you're still experiencing symptoms related to fibroids despite treatment with the above medications, your GP can refer you to a gynaecologist. They may prescribe medication called gonadotropin releasing hormone analogues (GnRHas) to help shrink your fibroids.
  • GnRHas are hormones that are given by injection. They work by affecting the pituitary gland which stops the ovaries producing oestrogen and help shrink the fibroid 
  • GnRHas stop your menstrual cycle (period), but aren't a form of contraception. They don't affect your chances of becoming pregnant after you stop using them. 
  • GnRHas can cause a number of menopause-like side effects, including:

                 - hot flushes
                 - increased sweating
                 - muscle stiffness
                 - vaginal dryness

  • Because of this, GnRHas is only prescribed on a short-term basis (a maximum of six months at a time). Your fibroids may grow back to their original size after treatment is stopped.

Ulipristal Acetate

  • This is a new method of treating fibroids with moderate to severe symptoms. It’s only recommended for women over 18 years of age.
  • The treatment involves taking one tablet orally (by mouth) once a day, with a course of treatment lasting up to three months. During this time you shouldn't bleed and your fibroids will shrink.
  • After the initial course of treatment, you’ll wait to see what your next two periods are like while not taking treatment. If they're still heavy, another three month course of ulipristal acetate may be recommended. 
  • If successful, the need for surgery may be avoided altogether.

Surgical treatment

Surgery to remove your fibroids may be considered if your symptoms are particularly severe and medication has been ineffective. There are several different procedures that can be used to treat fibroids.

Hysterectomy

A hysterectomy is a surgical procedure to remove the womb. It's the most effective way of preventing fibroids coming back. A hysterectomy may be recommended if you have large fibroids or severe bleeding and you don't wish to have any more children.

There are a number of different ways a hysterectomy can be carried out, including through the vagina, through a single larger incision in the abdomen, or through a number of small incisions (laparoscopically). The type of hysterectomy performed will depend on a number of factors, including size of the fibroids.

Myomectomy

A myomectomy is surgery to remove the fibroids from the wall of your womb. It may be considered as an alternative to a hysterectomy if you still would like to have children. However, a myomectomy isn't suitable for all types of fibroid. Your consultant can tell you whether the procedure is suitable for you based on factors such as the size, number and position of your fibroids.
Depending on the size and position of your fibroids, a myomectomy may be performed laparoscopically or through a single larger incision (open surgery).

Uterine Artery Embolisation (UAE)

This is a minimally invasive treatment designed to preserve the uterus and your fertility. UAE is carried out by a radiologist (a specialist doctor who interprets X-rays and scans). It involves blocking the blood vessels that supply the fibroids, causing them to shrink.
During the procedure, a special solution is injected through a small tube (catheter), which is guided by X-ray through a blood vessel in your leg. It's carried out under local anaesthetic, so you'll be awake but the area being treated will be numbed.

What are the benefits of UFE?

  • Fibroid embolisation usually requires a short overnight stay in hospital
  • Quick recovery. The majority of women resume light activities in 3-5 days and almost all women are able to return to normal activities within 7 to 10 days.
  • On average, 90 percent of women who had the procedure experience significant or total relief of heavy bleeding
  • 85 percent of treated patients have significant pain relief. A similar percentage of patients experienced significant improvement in their urinary symptoms.
  • The embolisation is suitable for multiple fibroids as well as large fibroids.
  • Recurrence rate of treated fibroids is very low

Are there any risks?

UAE is considered to be very safe however most women will experience moderate pain for several hours after the procedure. This feels like a severe period pain but can be managed well with medication.

Like all surgical procedures, UAE comes with a small risk of infection (1%) which would be diagnosed promptly and then treated with a course of antibiotics. Vaginal discharge for a few weeks can also be experienced by some women.

Endometriosis - please see Menstral disorders section

Ovarian Cysts

An ovarian cyst is a fluid-filled sac that develops on a woman’s ovary. They are very common and do not usually cause any symptoms. Most ovarian cysts occur as part of the normal workings of the ovaries. These cysts are generally harmless and disappear without treatment in a few months.

Signs and symptoms

An ovarian cyst will usually only cause symptoms if it is very large, blocks the blood supply to the ovaries or ruptures (bursts). In these cases, you may notice:

  • pelvic pain – this can range from a dull, heavy sensation to a sudden, severe and sharp pain 
  • pain during intercourse (dyspareunia)
  • difficulty emptying your bowels 
  • urinary frequency 
  • heavy periods, irregular periods or lighter periods than normal 
  • bloating and a swollen tummy 
  • feeling very full after only eating a little 
  • difficulty getting pregnant (although fertility is unaffected in most women with ovarian cysts – see below)

Diagnosis

Ovarian cysts are diagnosed by a transvaginal ultrasound scan. If a cyst is identified during the ultrasound scan, you may need to have this monitored with a repeat ultrasound scan in a few weeks. If there is any concern that your cyst could be cancerous, your consultant will perform a blood test (CA125) to look for high levels of chemicals that can indicate ovarian cancer.

However, having raised levels of these chemicals doesn't necessarily mean you have cancer, as high levels can also be caused by non-cancerous conditions such as endometriosis, a pelvic infection, fibroids or even being on your period.
Due to the slightly increased risk of ovarian cancer in post-menopausal women, women who have been through the menopause may be advised to have ultrasound scans and blood tests every four months for a year.

Treatment

If you have a large or persistent cyst, or cysts that are causing symptoms they will usually need to be surgically removed. Your consultant will also recommend surgery if there are concerns that the cyst could be cancerous or could become cancerous.

Laparoscopy

Most cysts can be removed laparoscopically. This is a minimally invasive approach where small incisions are made in your abdomen, allowing the surgeon to access your ovaries. The surgeon then removes the cyst through the small cuts in your skin. After the cyst has been removed, the cuts will be closed using dissolvable stitches.

A laparoscopy is preferred because it causes less pain and has a quicker recovery time. Most women are able to go home on the same day or the following day.

Laparotomy

If your cyst is particularly large, or there is a chance it could be cancerous, a laparotomy may be recommended. During a laparotomy, a single, larger cut is made in your tummy to give the surgeon better access to the cyst.
The whole cyst and ovary may be removed and sent to a laboratory to check whether it's cancerous. Stitches or staples will be used to close the incision.

Fibroids - please see Menstral disorders section

Asherman's Syndrome - information to follow

Chronic Pelvic Pain - information to follow

Menopause

All women will experience the menopause. Natural menopause takes place when the ovaries become unable to produce the hormones oestrogen and progesterone. Menopause can also occur when the ovaries are damaged by specific treatment such as chemotherapy or radiotherapy, or when the ovaries are removed, often at the time of a hysterectomy.

Ovaries naturally fail to produce oestrogen and progesterone when they have few remaining egg cells; the maximum number of egg cells in the ovaries is present before birth, with a reduced number already at birth, gradual reduction from puberty, and a rapid decline from 40 onwards. The average age of the natural menopause is 51 years, but can occur much earlier or later. The resulting low, and changing levels of ovarian hormones, particularly oestrogen, are thought to be the cause of menopausal symptoms and later consequences in many women.

Menopause means the last menstrual period. Periods stop because the low levels of oestrogen and progesterone do not stimulate the lining of the womb (endometrium) in the normal cycle. Hormone levels can fluctuate for several years before eventually becoming so low that the endometrium stays thin and does not bleed. Perimenopause is the stage from the beginning of menopausal symptoms to the post menopause.

The term climacteric refers to the time in which the hormone levels are changing; up to the periods stopping; reducing and changing hormone levels can cause early menopausal symptoms. At this stage, there may still be enough hormones produced to stimulate the lining of the womb (endometrium) to produce monthly periods (menstruation).

Post menopause is the time following the last period, and is usually defined as more than 12 months with no periods in someone with intact ovaries, or immediately following surgery if the ovaries have been removed.
Menopause occurring before the age of 45 is called early menopause and before the age of 40 is premature menopause. Generally, women having an early or premature menopause are advised to take HRT until approximately the average age of the menopause, for both symptom control and bone protective effect.

Diagnosis

A simple blood test can be performed to determine whether women’s ovaries have stopped working.

Symptoms

Hot flushes and night sweats are very common at the time of the menopause. These can occur at any time and can be debilitating. Mood swings, irritability and loss of concentration are also recognised symptoms of the menopause. In addition, the skin of the vagina and the supporting tissues of the pelvis become thinner and weaker at the time of the menopause and very often cause some discomfort and minor infections. Women often describe a decrease in libido (sex drive) as well.

Long term complications

Osteoporosis is the commonest long term complication of the menopause. A lack of oestrogen causes the bones to thin slowly. This process is called osteoporosis and over many years increases the chances of a bone fracture. Severe cases of osteoporosis can result in spinal problems and a decrease in height or in hip fractures with minimal trauma. The instance of coronary heart disease and strokes is much lower in women before the age of the menopause. However, after the menopause, the incidents of coronary heart disease increase significantly.

Treatment

Diet, lifestyle and exercise can significantly help manage symptoms. A healthy, balanced diet, minimising caffeine and alcohol and regular exercise can be very helpful. In addition to this, Hormone Replacement Therapy (HRT) will reduce symptoms and protect you from the longer term health issues discussed. HRT comes in many different forms and can be taken by tablet, a skin patch, an absorbable gel or sometimes by inserting a small implant. Your consultant will discuss with you the best option which can be tailored to suit your individual needs. This is based on different factors such as: medical and family history, age and severity of symptoms.

Most women have some worries and anxiety in early pregnancy, even when there haven’t been problems like pain or bleeding. Your body is undergoing very big changes even in the early weeks and that includes changes in lots of hormone levels which can influence how you feel. You will probably also be worried about whether your baby is OK and whether the tests you decide to have will all be normal. You should be assured that these feelings affect nearly all women at some point.

Bleeding

This is a worrying time for you and your partner, but 1 in 10 women experience bleeding in early pregnancy. Although this is often not caused by anything serious, it could be a warning sign of a miscarriage.

Pregnancy loss

Miscarriage (like ectopic and molar pregnancy) can be a very unhappy and upsetting experience, for women and their partners. For many people, even a very early miscarriage means the loss of their baby and all the hopes and plans they had for their future. Approximately 10 to 15% of pregnancies result in a miscarriage. The majority of patients develop bleeding and sometimes pain in the early stages of pregnancy. The commonest time of miscarriage is between 7 and 12 weeks from the last period.

Approximately 50% of miscarriages are caused by chromosomal abnormalities. This means that the pregnancy was developing abnormally and was never going to develop into a fully grown baby. Most chromosomal abnormalities are spontaneous or sporadic. They are not usually caused by something inherited. Either the growth of cells in the early stage of pregnancy has not occurred perfectly or an egg which did not consist of a perfect complement of chromosomes is fertilised. Many people describe the consequence of miscarriage as being nature's way of dealing with an abnormally growing pregnancy.

The majority of miscarriages can be diagnosed with a single ultrasound scan. Some miscarriages are best treated with surgical evacuation of the tissue left inside the uterus, whilst other miscarriages are best treated conservatively, allowing the products of conception to pass spontaneously.

Ectopic Pregnancy

An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes (these tubes connect the ovaries to the womb). If an egg gets stuck in them, it won't develop into a baby and your health may be at risk if the pregnancy continues. The danger of ectopic pregnancies is when the growth of the pregnancy tissue causes an expansion and rupture of the fallopian tube resulting in sudden and severe bleeding. Most women with an ectopic pregnancy complain of pain and bleeding in the early stages of pregnancy and the commonest time for presentation is 6 to 8 weeks after the last period.

Unfortunately, it's not possible to save the pregnancy. It usually has to be removed using medicine or an operation. In the UK, around 1 in every 80-90 pregnancies is ectopic. This is around 12,000 pregnancies a year.

Sometimes the diagnosis is obvious, but most of the time further investigations will be required in order to make the diagnosis. An ultrasound scan is performed to exclude an intrauterine pregnancy. If on ultrasound a pregnancy is seen inside the uterus then the chances of an ectopic pregnancy are very small. Sometimes an ultrasound scan can actually see an ectopic pregnancy. Sometimes the ultrasound scan gives clues, such as having fluid in the pouch of Douglas. There are occasions where a blood test such as a B-LCG level or a progesterone level can be performed and this gives extra information about the likelihood of an ectopic pregnancy.

If there is any suspicion of rupture of the ectopic pregnancy then surgery is appropriate. The diagnosis and treatment is usually possible by performing a laparoscopy. Medical treatment is sometimes appropriate and usually the drug methotrexate is used. Following this type of treatment, monitoring of blood levels of B-LCG may be necessary to ensure the treatment’s success.

Molar Preganancies - Information will follow, please speak to your doctor if you have any concerns 

Problems with the bladder can affect women of all ages, although the risk of developing these types of concerns increases after pregnancy, childbirth and the menopause. Urinary incontinence can severely impact your quality of life and personal relationships. However, there are many effective treatment options available to you.

Stress urinary incontinence (SUI)

SUI is the leaking of urine with various types of exertion such as; coughing, sneezing, lifting and exercises. The treatment for SUI initially involves lifestyles changes and improving the pelvic floor muscles through exercises. However, surgery is an option should your symptoms not resolve. This involves strengthening the ligaments that support the neck of the bladder to prevent leakage.


Urge Urinary Incontinence (UUI)


Urgency is a sudden need to pass urine without warning which very often cannot be put off. This might mean that you may not make it to the toilet in time and you may leak, this is known as urge urinary incontinence (UUI).
There are many different treatments for urge incontinence which can be very successful. These include lifestyle techniques, bladder retraining and medications to help inhibit bladder contractions. Botox injections into the bladder can also be effective in relaxing the bladder muscle, helping urgency and allowing the bladder to hold more urine. This is done through a telescope under local or general anaesthetic.

Pelvic Organ Prolapse (POP)


Prolapse is a condition where the muscles and ligaments supporting a woman's pelvic organs weaken, causing one or more of the pelvic organs to descend and create a bulge into, or protruding out of the vagina. Women most commonly develop pelvic organ prolapse after childbirth, a hysterectomy or after the menopause.
In different women, prolapse may involve one or a combination of: the front wall of the vagina (including the bladder), the back wall of the vagina (including the bowel) or the cervix and uterus (womb). It can cause discomfort and women often describe a ‘dragging’ sensation or ‘heaviness’. POP can also affect the function of your bladder and bowel.

Treatments depend on the severity of symptoms and type of prolapse you have. If the symptoms are mild lifestyle modifications, pelvic floor muscle strengthening or a vaginal ring pessary may help. If the prolapse is very bothersome, surgical repair may be offered. Your consultant will recommend the most appropriate surgical treatment based on a number of factors including: previous surgical history, your age, severity of symptoms and your general health.


Urodynamics Test


Urodynamics is an investigation designed to show what happens to your bladder during filling and emptying. It recreates your bladder symptoms, enabling us to accurately diagnose the cause and offer you the best treatment tailored to your particular problem. It may also be carried out prior to prolapse, continence and other gynaecological surgery, even if you do not have any problems with your bladder.

In addition to our consultant gynaecologists we also have a dedicated nurse-led urodynamics clinic run by our Clinical Nurse Specialist, Sacha Newman. This is held at The Platinum Medical centre twice a week. If you would like to find out any more about urodynamics please call Sacha on: 0207 483 5285.


Urinary Tract Infections


Urinary Tract Infections (UTIs) are common in the female population. The commonest time to experience a urinary infection is when you become sexually active, in pregnancy and during or after the menopause. The main symptom is pain on passing urine and sometimes blood is seen in the urine. A urine sample can be sent to the laboratory to check for infection and a reliable result can be obtained. This urine sample can determine which particular antibiotics are best used to treat this urine infection. It is important to treat a urinary tract infection early because, if left untreated, it can spread up the urinary tract and affect the kidneys


Vulval Conditions


A number of distressing conditions affect the lower genital tract in women. Vulval disease is often poorly managed as the multitude of conditions affecting this area range from dermatological to neurological diagnoses.


Broadly there are three groups of vulval conditions:


• Skin conditions called dermatoses, the commonest being Lichen Sclerosis
• Premalignant conditions such as Vulval Intraepithelial Neoplasia (VIN)
• Vulval pain conditions, such as vulvodynia, many of which can be precipitated by other conditions


The commonest presenting symptoms for women with vulval disease are either itching (pruritus), a noticeable skin change (either a swelling or split) and pain. Vulval pain can be continually present or affect sexual function but often is intractable.

Sexually Transmitted Infections (STI)

A STI is any kind of bacterial or viral infection that can be passed on through unprotected sexual contact. It doesn’t matter how many times you’ve had sex or how many partners you’ve had - any woman can get a STI.

Signs and symptoms

STIs don’t always have noticeable symptoms so after having unprotected sex, it can be easy to be in denial and just hope you’ll be ok. But you should always get yourself checked out as soon as possible so that you don’t pass anything on or cause yourself long-term harm. You may also need to consider emergency contraception to protect yourself from pregnancy.

If you do develop symptoms, they can include:

  • Unusual green, yellow or smelly discharge from the vagina or penis
  • Heavier periods or bleeding in-between periods
  • Pain or a burning feeling when urinating
  • Rashes, itching, burning, tingling around the genitals or anus
  • Blisters or lumps around the genitals or anus
  • Black powder or tiny white dots in your underwear
  • Pain during sex (in women)
  • Lower abdominal pain in women

Other Infections

There are other types of infections that are not sexually transmitted including

  • Thrush
  • Urinary tract infection (UTI)
  • Vaginitis
  • Urethritis 

Screening and Treatment

If you suspect an infection of any sort we have a variety of screening and treatment options available. Our consultants or clinical nurse specialist would be happy to talk to you about these.

Pelvic Inflammatory Disease (PID)

PID is an infection of the female upper genital tract, including the womb, fallopian tubes and ovaries. PID is a common condition, although it's not clear how many women are affected in the UK. It mostly affects sexually active women aged 15 to 24.

The fallopian tubes can become scarred and narrowed if they're affected by PID and make it difficult for eggs to pass from the ovaries into the womb. This can increase your chances of having an ectopic pregnancy (a pregnancy in the fallopian tubes instead of the womb) in the future and can make some women infertile.

Symptoms

PID often doesn't cause any obvious symptoms. Most women have mild symptoms that may include one or more of the following:

  • pain around the pelvis or lower abdomen (tummy)
  • discomfort or pain during sex that's felt deep inside the pelvis 
  • pain during urination 
  • bleeding between periods and after sex 
  • heavy periods 
  • painful periods 
  • unusual vaginal discharge, especially if it's yellow or green 

Treatment

If diagnosed at an early stage, PID can be treated with a course of antibiotics, which usually lasts for 14 days. You'll be given a mixture of antibiotics to cover the most likely infections, and often an injection as well as tablets. It's important to complete the whole course and avoid having sexual intercourse during this time to help ensure the infection clears.

Women who have had delayed treatment or had repeated episodes of PID are most at risk. However, most women treated for PID are still able to get pregnant without any problems.

Contraception

There are many methods of contraception to choose from. Your consultant can help you choose a contraception that suits you.
Some of the things you might want to think about are:

  • Whether you (or a partner) want to become pregnant fairly soon, many years away or not at all
  • How you (and a partner) want contraception to suit your lifestyle
  • Whether you (or a partner) want to use the method every day, every time you have sex or less

There are three main types of gynaecological cancer:

  • Cervical Cancer
  • Endometrial Cancer
  • Ovarian Cancer

With increasing awareness of these diseases and their symptoms and earlier diagnosis and treatment, there are better outcomes now than ever before.

Our service has a number of senior gynaecology cancer specialists who are able to take advantage of the latest advances in cancer diagnosis and treatment including fertility sparing surgery for younger women.

Cervical Cancer

The incidence of cervical cancer is decreasing in the UK as a result of regular cervical screening. The incidence has fallen since 1989 when systematic screening was introduced and this disease now affects 2000 women in England and Wales each year. It mainly affects women in the 30 to 65 year old age group.

A considerable amount is known about how cervical cancer develops. The process is usually quite a long one covering many years. Initially, a women is infected with certain types of the human papiloma virus (HPV). It is very common to be infected with HPV and a vast majority of women have no problems subsequently. Their body fights the infection and eradicates it and they become immune to further infections. However, there is a group of women who are not able to adequately fight HPV and they then develop pre cancerous cells on the cervix, these cells can usually be detected by cervical smears and it is these abnormalities that screening is designed to detect.

These pre cancerous cells are called cervical intraepithelial neoplasia (CIN). CIN can be present for many years before developing into anything more severe. In fact, the vast majority of patients with CIN would not develop cervical cancer if they went untreated. However, if the CIN is undetected, usually for many years, then this can progress in about 30% of women to develop into invasive cancer of the cervix.

Other factors such as young age at the time of first intercourse, multiple sexual partners, smoking and the oral contraceptive pill have been associated with an increased chance of developing cervical cancer. However, the majority of women developing cervical cancer do not necessarily have any of these other possible risk factors.

Pathology

Approximately 85% of cervical cancers develop from the cells that are on the surface of the cervix. This results in a squamous cell cancer. The other 15% of cervical cancers develop from the columnar epithelium which lines the inside of the cervix resulting in an adeno carcinoma of the cervix. Squamous cell carcinomas and adeno carcinomas are treated in exactly the same way.

Presentation

A significant number of patients with cervical cancer will be detected during their routine cervical smear test. However, patients may present with abnormal irregular bleeding, especially after intercourse, or bleeding after the menopause. They may notice a smelly vaginal discharge or occasionally present with pain. On examination, a very small cervical cancer may not be visible to the naked eye, it may only be seen with a colposcopy examination or by taking a biopsy. The international organisation which classifies cervical cancers (FIGO) state that anyone with a cervical cancer should have an examination under anaesthetic, an examination of their bladder, an examination of the bowel (if necessary) and a scan of their chest and kidneys. All of these investigations can be utilised to determine exactly how large the tumour is and whether the tumour has spread to the surrounding tissues or to the lymph nodes of the pelvis. All patients will have an MRI scan which is the most accurate way of looking at the tumour.

Treatment

Early cervical cancers can be treated with surgery. If the tumour is microscopic then it may be possible to remove it with a cone shaped biopsy of the cervix. Tumours that are smaller than 4cm and confined to the cervix will usually be treated with a radical hysterectomy. This is an operation which removes the uterus and the tissue to the side of the uterus which is called the parametrium. It also removes the upper one third of the vagina and the pelvic lymph nodes. It may or may not be necessary to remove the ovaries at the same time. A small tumour of the cervix which does not spread to the lymph nodes, which is treated by a radical hysterectomy stands a 95% chance of being cured.

Larger tumours of the cervix are usually treated with a combination of chemotherapy and radiotherapy. This treatment is just as effective as surgery in curing early stage cervical cancer. Radiotherapy is usually a five week course of external beam radiotherapy together with a further dose of internal radiotherapy at the end. A small dose of cisplatin chemotherapy is usually given at the beginning, half way through, and at the end of this treatment.

Follow-up

Once treatment is completed then patients are usually required to attend for follow-up examinations every three months for two years in the first instance. The chances of recurrent disease are very much decreased after two years.

Endometrial Cancer

Endometrial cancer tends to affect patients who have gone through the menopause, particularly those in the 65 to 75 year old age group. It is more common in patients who are overweight or who have diabetes or high blood pressure. It is more common in women who have had no children and less common in women who have been on the oral contraceptive pill. It is a disease which is more common in the Western world and has one of the highest incidences in the United States. Approximately 3000 women per year will develop endometrial cancer in England and Wales.

Pathology

The majority of endometrial cancers arise from the columnar epithelium which lines the uterine cavity (endometrium). Over 85% of the tumours are adeno carcinomas and this histological sub type carries the best prognosis.

Presentation

The vast majority of patients will present with an episode of vaginal bleeding after the menopause. Any episode of bleeding after the menopause requires investigation. Patients should undergo an abdominal and vaginal examination and a cervical smear should be taken. The lining of the uterus should be sampled. Sometimes this is possible in the outpatient department and sometimes the patient needs to come into hospital and have a hysteroscopy examination. All patients with post menopausal bleeding would have an ultrasound scan to look at the thickness of the lining of the uterus and to look at the ovaries. Any patient who has endometrial cancer diagnosed should have an MRI scan to look as closely as possible at the tumour. This scan is used to determine how deeply the tumour invades into the muscle layer of the uterus (myometrium).

Treatment

Over 80% of women who develop endometrial cancer will present whilst that tumour is still confined to the uterus. Therefore, the correct treatment in almost all cases of endometrial cancer is to perform a hysterectomy operation. This can be performed either through an incision in the abdomen or very often through keyhole surgery. The keyhole surgery approach is particularly advantageous in the obese patients because it allows them to recover so much quicker. It may be necessary to remove some lymph nodes from the pelvis at the same time as the hysterectomy, but this is not a common procedure.

Approximately 40% of patients with endometrial cancer will be offered Radiotherapy treatment of the pelvis following their hysterectomy. The Radiotherapy is thought to decrease the chances of cancer recurrence. The need for Radiotherapy is determined by examination of the tumour and uterus under the microscope.

Generally speaking the prognosis from endometrial cancer is very good because the majority of patients present relatively early. Most patients are seen and examined at follow-up three monthly for the first two years and six monthly for two years after that. Their doctor may decide to take a smear from the top of the vagina as it is often the top of the vagina which is the commonest site for disease recurrence.

Ovarian Cancer

Ovarian cancer is the most common gynaecological cancer in women in the UK. If affects between 4,000 and 5,000 women every year. Unfortunately many of those women present when the disease is quite advanced and therefore the prognosis from ovarian cancer is often quite poor.

There is an increased chance of developing ovarian cancer in women who have had no children, a late menopause and sometimes in the event of a family history of ovarian cancer. There is a decreased chance of developing ovarian cancer in women who have been on the oral contraceptive pill and those who have already had hysterectomies with conservation of ovaries. Smoking appears to have no affect on the incidence of ovarian cancer.

Presentation

Patients with ovarian cancer tend to present in a number of different ways. Some will find a mass in the abdomen which is causing swelling. Some will find fluid in their abdomen, which is also caused swelling and many will find a decreased appetite and a change in bowel habit. Some will have their ovarian cancer discovered coincidentally.

Quite a number of patients with ovarian cancer are actually referred by their GP to other specialists such as bowel surgeons and gastroenterologists because their symptoms can be so confusing. On examination a mass may be found in the abdomen, which arises from the pelvis. An ultrasound scan can usually characterise this matter and other scans such as MRI scan and CT scan may also be used to help in the diagnosis.

A blood test can be done to look for a CA125 level. If this is raised it increases the suspicion of an ovarian cyst being due to an ovarian cancer.

Treatment

Most patients with ovarian cancer will require a combination of surgery and chemotherapy. It is most common to perform the surgery first to remove the cancer and to take samples from any areas inside the abdomen where the cancer may have spread. Ideally, all the areas of cancer are removed at the time of surgery, but this is not always possible.

The surgical treatment is usually followed by chemotherapy. There are a combination of chemotherapeutic agents, which are used for the treatment of ovarian cancer, but the commonest is carbo platin and taxol. This is usually given on a three weekly basis for six cycles in total. The debate about which patients benefit most from which types of chemotherapy can often be quite complex and would be a discussion outside the scope of this summary.

Follow-up

Most patients with ovarian cancer will be carefully followed-up. They should see their doctor every three months for the first two years and some of those patients will benefit from having a blood test on a regular basis to look at the CA125 level. If the cancer recurs then the majority of patients would be suitable to receive a second type of chemotherapy, but this would depend on the individual circumstances.

Hereditary Ovarian Cancer

The majority of cases of ovarian cancer happen by chance, but up to 20 per cent will be inherited. Mutations in at least nine genes can cause an increased risk of ovarian cancer. The Wellington Hospital work with Genetic Counsellors to help support patients if this is an inherited form of cancer. Click here for more information  

A lack of fertility or concerns about a lack of fertility is something that worries a larger number of couples. It has been shown that if a couple are having regular unprotected sexual intercourse, then there is an 80% chance of conception after 12 months and a 90% chance of conception after 18 months. It is therefore very common to wait for a year or more before investigating the couple who are trying to conceive.

There are three main causes of infertility. A woman needs to produce eggs regularly and at the right time of her menstrual cycle, the man needs to produce sperm of the right quality and quantity, and the two need to be able to meet and therefore the women's fallopian tubes need to be open and undamaged.

About 25% of infertility is due to a lack of eggs, about 25% is due to a problem with the sperm, about 25% is due to tubal problems and in the final 25% the reason for infertility is never discovered (so called unexplained infertility).

Ovulation

The vast majority of healthy women between the ages of 15 and 40 will ovulate regularly. A regular menstrual cycle, especially if it is approximately 28 days, gives a strong indication that the women is ovulating. In addition, the mucus produced by the cervix is often very thin and runny at the time of ovulation and some women can detect this. Some women experience short but sharp pains in the pelvis at the time of ovulation, which is normal. Ovulation usually occurs 14 days before the first day of a period (therefore in a 28 day cycle it occurs 14 days after the first day of the period as well). A simple blood test measuring the progesterone level one week before a period is due is usually sufficient to confirm ovulation. Alternatively, a series of ultrasound scans starting at the beginning of the cycle can show the progress of an egg being produced.

Male Factor

A man is expected to produce at least 20 million sperm per millilitre of semen. Those sperm need to be of good quality. A past history of surgery on the testes or certain infections such as mumps or orchiditis can cause a decrease in sperm production. A semen analysis involves collecting a sample of the ejaculate and analysing it under the microscope.

Tubal Factors

A patient who has had previous surgery in the pelvis or previous infection in the pelvis, may be at risk of having damage to the fallopian tubes. Damage to the fallopian tubes can also be caused by endometriosis. There are two commonly used tests to investigate the patency of the fallopian tubes.

A hysterosalpingogram is an investigation done in the X-Ray department where a dye is inserted through the cervix and X-Rays are taken showing the progress of the dye up through the uterus and out through the fallopian tubes. An alternative investigation is to perform a laparoscopy, which is a minor operation done under general anaesthetic (see laparoscopy). Dye can be inserted through the cervix and into the uterus and tubes and can been seen spilling out of the ends of the tubes under direct vision through the laparoscope.

Doctors

Browse doctors for this speciality, and find out more about their skills

Miss Rashna Chenoy Consultant Gynaecologist
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Miss Rashna Chenoy
Miss Marcellina Coker Consultant Gynaecologist
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Miss Marcellina Coker
Mr Ian Currie Consultant Gynaecologist
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Mr Ian Currie
Mr Ellis Downes Consultant Obstetrician and Gynaecologist
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Mr Ellis Downes
Mr Demetrios L Economides Consultant Obstetrician and Gynaecologist
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Mr Demetrios L Economides
Mr Alan J Farthing Consultant Gynaecologist
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Mr Alan J Farthing
Mr Ruwan Fernando Consultant Obstetrician and Gynaecologist
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Mr Ruwan Fernando
Ms Christina Fotopoulou Consultant Gynaecologist
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Ms Christina Fotopoulou
Ms Sadaf Ghaem-Maghami Consultant Gynaecologist
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Ms Sadaf Ghaem-Maghami
Mr Andrew Hextall Consultant Gynaecologist
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Mr Andrew Hextall
Mrs Joanne Susan Hockey Consultant Gynaecologist
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Mrs Joanne Susan Hockey
Miss Sarah Hussain Consultant Gynaecologist
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Miss Sarah Hussain
Mr Joseph Iskaros Consultant Obstetrician and Gynaecologist
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Mr Joseph Iskaros
Mr Ahmed Ismail Consultant Gynaecologist
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Mr Ahmed Ismail
Professor Vikram Khullar Consultant Gynaecologist
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Professor Vikram Khullar
Dr Maria Kyrgiou Consultant & Senior Lecturer Gynaecologist
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Dr Maria Kyrgiou
Mr Craig Leitch Consultant Gynaecologist
Obstetrics & Gynaecology
Mr Craig Leitch
Mr Gidon Lieberman Consultant Gynaecologist
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Mr Gidon Lieberman
Mr Peter Mason Consultant Obstetrician
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Mr Peter Mason
Mr Angus McIndoe Consultant Gynaecologist
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Mr Angus McIndoe
Mr Tariq Miskry Consultant Obstetrician and Gynaecologist
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Mr Tariq Miskry
Mr Michael Morcos Consultant Gynaecologist
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Mr Michael Morcos
Mr Nicholas H Morris Consultant Gynaecologist
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Mr Nicholas H Morris
Dr Reeba Oliver Consultant Obstetrician and Gynaecologist
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Dr Reeba Oliver
Mr Narendra Pisal Consultant Gynaecologist
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Mr Narendra Pisal
Miss Kankipati Shanti Raju Consultant Gynaecologist
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Miss Kankipati Shanti Raju
Professor Wendy M Reid Consultant Gynaecologist
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Professor Wendy M Reid
Mr Robert E Richardson Consultant Gynaecologist
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Mr Robert E Richardson
Mr Paul Serhal Consultant Gynaecologist
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Mr Paul Serhal
Miss Amina Shafik Consultant Gynaecologist
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Miss Amina Shafik
Mr John Smith Consultant Gynaecologist
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Mr John Smith
Mrs Patricia Wilson Consultant Gynaecologist
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Mrs Patricia Wilson
Mr Joseph Yazbek Consultant Gynaecologist
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Mr Joseph Yazbek
20160309-RWMG-HCA-0024.jpg Sacha Newman Clinical Nurse Specialist - Gynaecology

Sacha is an experienced and compassionate practitioner specialising in women’s health for over 8 years. She is used to working autonomously and always places woman at the centre of care, striving to meet each individual patient’s needs in a sensitive and relaxed environment.

Sachas my main area of expertise is urogynaecological and pelvic floor disorders, alongside an extensive knowledge of a wide range of other common gynaecological conditions.