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Gynaecology

Below are the common gynaecological problems Dr Torode manages:

Abnormal Bleeding

It may be heavy periods, bleeding between periods, post coital bleeding or post menopausal bleeding. Heavy periods (menorrhagia) may be genetic or caused by conditions like polyps or fibroids. Polyps are small growths within the uterus and fibroids are fibrous lumps usually growing in the wall of the uterus. The diagnosis of the abnormal bleeding is arrived at often with the help of ultrasound or hysteroscopy and curettage. There are medical and surgical options for treatment. Medical treatment usually involves hormonal therapy while surgery may be endometrial ablation or hysterectomy. At endometrial ablation the lining of the uterus is cauterised during a Day Surgery procedure. Hysterectomy (removal of just the uterus not ovaries) can be done several different ways depending on the circumstances. Bleeding between periods or after the menopause usually involves finding the diagnosis by ultrasound, office endometrial biopsy or hysteroscopy (looking into the uterus) and D&C (scraping the lining of the uterus) which are done in a Day Hospital visit.

Pelvic Floor Prolapse

It occurs when the natural supports of the vagina and uterus are damaged to allow the vaginal walls or uterus to drop. When the front wall and bladder fall it is called a cystocoele and the patient may feel a lump or have frequency of urine. When the back wall falls there is often a rectocoele and the patient can feel a lump or have incomplete emptying of faeces. These conditions can be managed conservatively, sometimes with the help of a ring pessary but often require surgery which is usually done through the vagina.

Cervix Disease

It is recommended that all women who have been sexually active have a second-yearly pap smear. If a pap smear is significantly abnormal a colposcopy is done to look at the cervix through a microscope and sometimes a biopsy is taken. For the more severe forms of abnormality (CIN 2/3), a loop excision of the transformation zone of cervix (LLETZ) is often performed. This involves Day Surgery to shave off the abnormal cells.

Endometriosis

It is a condition where tissue like the lining of the uterus grows outside the uterus. It usually occurs around the outside of the uterus, on the bladder or in the ovaries (chocolate cysts). Endometriosis can cause period pain (dysmenorrhoea), intercourse pain (dyspareunia) or pain with defaecation (dyskesia). Sometimes it is associated with infertility. Usually the diagnosis is made by laparoscopy and the abnormally placed tissue removed at the time of the surgery. Often hormonal therapies are used to help control the symptoms.

Infertility

Difficulty in achieving a pregnancy can be a very distressing problem. Generally investigations are done to confirm ovulation, check semen analysis and to make sure fallopian tubes and uterus are normal. If, despite correcting any problems found, a pregnancy is not achieved assisted reproduction (usually IVF) is organised.

Urinary Problems

They are usually due to involuntary loss of urine either on coughing and sneezing (stress incontinence) or involve the feeling of frequency and urgency with incontinence (urge incontinence). Sometimes the diagnosis is made by history and examination but sometimes involve urodynamics testing. Generally stress incontinence is treated by surgery but frequency and urgency are treated medically. 

Menopause

Dr Torode has worked in the Menopause Clinic at Royal North Shore Hospital for over 20 years and is only too happy to discuss menopause treatments.

Gynaecology Links