Abnormal vaginal bleeding & heavy periods

Abnormal bleeding may represent heavy bleeding (menorrhagia), bleeding between periods (intermenstrual bleeding), bleeding after sex (post coital bleeding), irregular bleeding or bleeding after menopause (post-menopausal bleeding).

Heavy bleeding is not only inconvenient and expensive to manage, but can be accompanied by pain and discomfort. Irregular or heavy bleeding can also indicate underlying issues and should be investigated by an expert gynaecologist.

The initial investigation usually involves an ultrasound of the pelvis and a clinical examination by the gynaecologist. Hormone blood tests may be recommended.Sometimes hysteroscopy (a very small telescope being inserted vaginally) is required to diagnose and treat the conditions causing the abnormal bleeding. In a minority of cases, laparoscopy may also be required to ensure that the causes of the heavy bleeding are fully investigated.

Uterine fibroids

Fibroids are benign growths of the muscle layer of the uterus. They occur in 40% of women and can have no symptoms, however they can cause pain and discomfort. 

Uterine fibroid symptoms:

• Pelvic pain
• Pain with intercourse
• Pelvic pressure symptoms
• Heavy periods
• Interference with normal bladder and bowel function
• Abdominal distension
• Infertility
• Recurrent miscarriage
  

Treatment

Fibroids are normally diagnosed by ultrasound, which also provides information on which method of treatment is required, or whether no treatment is needed.

Treatment of fibroids may be by hysteroscopic, laparoscopic or open surgery depending on size, number and location.  A myomectomy means removal of the fibroids by surgery – another option sometimes recommended is a hysterectomy. Occasionally non-surgical treatments are an option. 

Tubal Ligation

Known as ‘tying your tubes’, tubal ligation provides sterilisation by sealing a woman’s fallopian tubes so that eggs cannot reach the uterus. Laparoscopic tubal ligations are the least invasive surgical method and allow for quick recovery times.

Laparoscopic tubal ligation is a minimally invasive surgical technique, under general anaesthetic, that involves inserting a laparoscope (camera) usually through a small incision through the umbilicus (belly button) to view the abdomen and pelvis.  Usually only 1 further small incision just above the pubic hair line is required to insert an instrument to place clips on the tubes. 

Surgery takes 30 – 45 minutes, followed by a recovery time in the hospital of around 4 hours. Patients are normally able to go home the same day.

Ovarian cysts

Ovarian cysts are often physiological, which means they naturally occur and often resolve themselves, however sometimes cysts require surgical removal, either because of pain or other symptoms, or to eliminate the risk of further complications or malignancy.

Ovarian cysts symptoms:

• Pelvic pain
• Irregular bleeding
• Pressure symptoms
• Abdominal swelling or bloating
• Pain with intercourse
• Urinary frequency or discomfort
• Changes in bowel function
  

Treatment

Diagnosis of cysts involves a combination of discussion, a physical exam, ultrasound and sometimes a blood test. Once Phill has the results of the investigation, he will discuss your options with you. 

Depending on the type of ovarian cyst diagnosed, treatment may range from a check up 6-8 weeks later to see if the cysts have resolved, to laparoscopic surgery to remove the cysts. Normally the ovary is not removed unless the cysts are cancerous (malignant). 

Laparoscopic surgery for the removal of cysts is a minimally invasive surgical technique, performed under general anaesthetic. The surgery involves inserting a laparoscope (camera) usually through a small incision through the umbilicus (belly button) to view the abdomen and pelvis.  2-3 further incisions are required in the lower abdomen to insert instruments in order to treat the cyst, which is then usually deflated and removed through the umbilicus.. This procedure takes 1-1.5 hours, followed by a hospital stay of one night and ideally 7-10 days’ rest.

Adhesions

Adhesions are areas of scar tissue that form between organs, often sticking organs together.  They are usually the result of infection, inflammation (sometimes caused by endometriosis) or previous surgery.

Adhesion symptoms:

• Pain
• Infertility

However, many adhesions are asymptomatic, which means you won’t notice them.

Treatment

Laparoscopic surgery is a favoured treatment for diagnosis and division of adhesions due to being least invasion and offering swift recovery times. This is a minimally invasive surgical technique, under general anaesthetic, that involves inserting a laparoscope (camera) usually through a small incision through the umbilicus (belly button) to view the abdomen and pelvis.  2-3 further incisions are usually required in the lower abdomen to insert instruments in order to divide or excise the scar tissue so there is no longer adhsion between the surfaces.  Laparoscopic surgery for the diagnosis and treatment of adhesions takes 1-2 hours, usually followed by a hospital stay of one night and ideally 7-10 days’ rest.

Prolapse

Fibroids are benign growths of the muscle layer of the uterus. They occur in 40% of women and can have no symptoms, however they can cause pain and discomfort. 

Prolapse symptoms:

• Awareness of a lump protruding from the vagina• A downward dragging sensation• Back aches
• Bladder symptoms (incontinence, difficulty passing urine, incomplete emptying, urgency)
• Bowel symptoms (constipation, incomplete emptying)
• Difficulty keeping a tampon in place
• Problems with intercourse
  

TREATMENT

Not all prolapse requires treatment, and if prolapse treatment is recommended, surgery is not always necessary.  Physiotherapy is always important and non-surgical options such as vaginal pessaries are sometimes an option. If prolapse surgery is required, this is performed vaginally. Repairs to the pelvic floor may be made during a hysterectomy which is being performed for other reasons. Some prolapse surgery patients can develop recurrent prolapse – this affects up to 25% of women. 

As with all gynaecological conditions, discussing your options thoroughly with a knowledgeable gynaecologist is essential.

VASECTOMY REVERSAL

Phill performs vasectomy reversals using the most effective technique available; with a general anaesthetic and an operating microscope (microsurgical).

RESULTS

The biggest study to date* showed these pregnancy success rates after vasectomy reversals: The age and gynaecological history of the potential mother is extremely important to the chance of success. In some cases it may be better to proceed directly to IVF and ICSI rather than performing a vasectomy reversal, and with his fertility expertise, Phill is in an ideal position to give advice on this.

*Belker AM, Thomas AJ, Jr, Fuchs EF, Konnak JW, Sharlip ID. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy study group. J Urol. 1991;145:505–11.    

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REVERSAL OF FEMALE TUBAL STERILISATION

Phill will be able to advise you on the method that will give the best rate of conception. Get in touch, and we can discuss your options.

SURGERY

Phill is an expert in laparoscopic hysterectomy, which is a less painful, less invasive surgical method for hysterectomies and offers fast recovery times. This is a minimally invasive surgical technique, under general anaesthetic, that involves inserting a laparoscope (a very small camera) usually through a small incision through the belly button to view the abdomen and pelvis.  Three further incisions are required in the lower abdomen to insert instruments in order to disconnect the uterus, which is then removed vaginally. Endometriosis can be removed during the same procedure if required. This procedure takes approximately 1.5-2 hours, followed by a hospital stay of 2-3 days and ideally 3 weeks’ rest. Vaginal hysterectomy can be an option for women who have heavy periods and experience symptoms of prolapse as repairs can be made to the pelvic floor at the same time. This procedure takes 1-2 hours, followed by a hospital stay of 2-3 days and ideally 3 weeks’ rest. During an abdominal hysterectomy the uterus is removed through the abdomen. This surgery can be required for women with large fibroids in the uterus. This procedure takes 1-2 hours, followed by a hospital stay of 3-5 days and ideally 4-6 weeks’ rest. Phill will speak with you about your options and the best hysterectomy procedure for your situation during your personal consultation. Make a time to talk with Phill.

SYMPTOMS

The types of symptoms women with endometriosis may experience include:

•  Period pain
• Pelvic pain at times unrelated to periods
• Mid-cycle pain (particularly when it occurs predominantly on one side)
• Pain or discomfort with sex
• Bladder symptoms such as frequency or painful urination
• Pain with bowel motions, particularly during a period
• Infertility
• Spotting before full menstrual flow (premenstrual spotting)
• Heavy periods
• Pain that is not controlled by hormonal contraception
• Irritable bowel syndrome

TREATMENT

Endometriosis treatment involves laparoscopic surgical excision. This is a minimally invasive surgery, which is performed under general anaesthetic. A laparoscope (a tiny camera) is inserted, usually through a small incision in the belly button so the surgeon can view the abdomen and pelvis.  2-3 further incisions are usually required in the lower abdomen to insert instruments in order to remove the endometriosis. Surgery for endometrosis diagnosis and removal generally takes one or two hours, and most women need one night in hospital. Within 4-5 days after endometriosis surgery patients can generally resume normal activity such as lifting, driving, walking, and most are ready to return to work after 7-10 days’ rest. Treatment may also involve non-surgical adjuncts such as hormonal contraceptive pills, Mirena IUS or other pain medications.

SURGERY SUCCESS RATES

Over eighty percent of women with endometriosis appropriately treated at initial surgery do not require further treatment for the disease. 10-20% have recurring symptoms of endometriosis, however only some of these women will require further surgical treatment to improve their symptoms. Endometriosis can be removed in 95% of initial surgeries, and surgical risks and complications are low. Five percent of women are diagnosed with ‘severe endometriosis’ which involves the bowel wall/rectum and the ovaries. If severe endometriosis is diagnosed at an initial surgery, Phill will discuss your options with you thoroughly and a second operation may be recommended. Endometriosis pain can take up to three months to resolve as the nerves affected by endometriosis are affected by the removal operation and need to repair.