Abnormal Uterine Bleeding

About 5 % of women between 30 and 49 yrs experience heavy menstrual bleeding which can be=

  • Menorrhagia -regular heavy periods
  • Heavy irregular bleeding
  • Bleeding between cycles
  • Bleeding after intercourse
  • Post-menopausal bleeding

Any irregular and abnormal bleeding must be investigated promptly. careful examination of cervix , pap smear , ultrasound and hysteroscopy may be needed to make a diagnosis .Treatment depends on the cause and could include hormonal treatment (oral contraceptive pills), or the hormonal IUD (e.g. Mirena). Surgical treatment options include hysteroscopic polypectomy or myomectomy, endometrial ablation, and or hysterectomy.

Uterine Fibroids

Uterine fibroids are benign arising from the smooth muscle cells of the uterus. Fibroids are present in up to 25 % of women in reproductive age . Signs and symptoms of fibroids can include very heavy periods, pelvic pain or pressure, urinary frequency, feeling a mass in the lower abdomen and infertility.

Diagnosis can be made from history, pelvic examination, blood work up and ultrasound scan of the pelvis.

Management depends on age and desire to retain the uterus and symptoms. If asymptomatic no treatment is needed. For symptomatic women medication, such as Tranexamic acid, oral contraceptives, or a progesterone containing IUD(Mirena) can be used.

If medical treatment is unsuccessful or unsuitable some will women need the fibroids to be removed (i.e. myomectomy) or the entire uterus removed (i.e. hysterectomy). Often this can be done by minimally invasive procedure (Hysteroscopy /Laparoscopy) resulting in less pain and shorter recovery time.

Ovarian Cysts

Many women develop ovarian cysts in their life time. Ovarian cysts are fluid filled structures which cause little or no discomfort and are generally harmless. Common symptoms include pelvic pain , pain with intercourse, pressure in lower abdomen, urinary and or bowel symptoms depending on the size .If the cyst is hormonally active, irregular vaginal bleeding may be present .Functional ovarian cysts include follicular cysts , corpus luteal cysts and Theca lutein cysts.

Diagnosis can be made from history, complete pelvic examination, blood work up and Imaging studies (pelvic ultrasound and or MRI).
The majority of cysts disappear without treatment within a few months. Symptomatic ovarian cysts need prompt evaluation and can be removed by minimally invasive surgery.

Vaginal Infections

Vaginitis is irritation or inflammation of the vagina resulting in discharge, irritation, itching and/or pain. This can be caused by changes in the normal balance of vaginal bacteria or due to infections. The most common types of vaginitis include: bacterial vaginosis, yeast infections(Thrush), and trichomoniasis. This leads to replacement of lactobacilli and increase in pH from a normal 4.5 to 7.

Symptoms can also be due to sexually transmitted infections, such as chlamydia, gonorrhoea, or herpes, Syphilis.

Evaluation of these symptoms is important and done by physical examination, vaginal swab cultures and or lab work. Annual STI testing is recommended for all sexually active women who have more than one partner in a year.

Treatment depends on the cause and may include antibiotics or antifungal medications. Please refrain from practice of vaginal douching, use of shower gels and antiseptic baths.
For confidential discussion regarding your issues please contact us .

Pelvic Pain

Dysmenorrhoea is pain occurring during menstruation. It may be primary or secondary dysmenorrhea. Chronic pelvic pain is defined as pelvic pain of at least 6 months duration, not associated with periods or sex and may be continuous or intermittent.

Causes of pelvic pain could be due to:

  • Endometriosis
  • Ovarian cysts
  • Adenomyosis
  • Fibroids
  • Muscle spasm
  • Pelvic venous congestion
  • Interstitial cystitis/bladder pain syndrome
  • Irritable Bowel Syndrome
  • Vulvodynia

Diagnosis is through careful and detailed history taking, thorough pelvic examination. And Investigations which may include pelvic ultrasound and sometimes diagnostic laparoscopy.

Management requires a holistic approach and may sometimes require a multidisciplinary input. Treatment may include NSAIDs, OCPills, and surgical (LUNA -Laparoscopic uterine nerve ablation -Cutting or destroying uterine nerves blocks pain signals from reaching tissues and organs. Dietary supplements such as Magnesium and Vitamin B1 may also be helpful.