Common Gynaecological Disorders

OVARIAN CYSTS Different types of cysts can develop in the ovary. Follicles develop and resolve with each menstrual cycle. Some of them enlarge and persist. They can be asymptomatic and resolve spontaneously but the symptomatic , nonresolving or increasing, suspicious cysts warrants treatment. Some are associated with endometriosis (chocolate cysts). Cysts can suddenly cause pain if they twist, burst or bleed. Surgical removal is required for larger cysts, even if they are asymptomatic, chocolate cysts, and cysts which have suspicious features on ultrasound scan. Ovarian cancer often presents late in the course of the disease when the prognosis is poor.

FIBROID

Fibroids are lumps that develop in the womb. They are formed from muscle and fibrous tissue and can grow to be extremely large indeed. Some women are prone to fibroids especially if there is a family history. Numerous fibroids or a single large fibroid may impair fertility, and cause abdominal discomfort, pressure symptoms and bloating. They are a frequent cause of heavy periods. Fibroids can be detected on internal examination, and assessed by ultrasound scan. Fibroids inside the womb cavity itself can be removed using hysteroscopy. Those in the wall of the womb or on the outside of the womb can be removed during and operation called a myomectomy. Women who have finished their family and have heavy bleeding associated with fibroids may opt for a hysterectomy as the most appropriate treatment. Medical treatment is available, and in some cases the blood supply to a fibroid can be blocked by a technique called embolisation, which is carried out by specially trained Radiology Doctors and results in fibroid resolution without surgery. This technique is not suitable for patients who wish to become pregnant afterwards. Fibroids that are asymptomatic should be monitored annually by ultrasound. Fibroids which enlarge after the menopause require a hysterectomy.

INFECTION

Female tract infections manifest as change from normal clear odourless vaginal secretion to thick white-yellowgreen malodorous discharge with or without lower abdominal pain, itching or soreness. Here we can test for all vaginal and pelvic infections by smear preparation, treat these appropriately, and advise about the need to treat your partner.

VULVAL DISEASE

Certain skin conditions cause itchiness, pain and burning when they affect the labia and surrounding area. They are more common after the menopause when the skin thins and becomes more sensitive as a result of the drop in oestrogen levels. Ulceration can result from Herpes infection, and lumps can appear following infection with the wart virus.

BARTHOLIN CYS

It is a rapidly enlarging painful lump in the vulval area that may need surgery and antibiotic treatment. Skin tags can develop in the labia, and blocked hair follicles and boils may occur. Eczema and psoriasis can also affect the skin of the vulva.

MENOPAUSE

Menopause is defined as the absence of menstrual periods for 12 months. It is the time in a woman's life when the function of the ovaries ceases. The process of menopause does not occur overnight, but rather is a gradual process. This so-called perimenopausal transition period is a different experience for each woman.

• The average age of menopause is 51 years old, but menopause may occur as early as the 30s or as late as the 60s. There is no reliable lab test to predict when a woman will experience menopause.
• The age at which a woman starts having menstrual periods is not related to the age of menopause onset.
• Symptoms of menopause can include abnormal vaginal bleeding, hot flashes, vaginal and urinary symptoms, and mood changes.
• Complications that women may develop after menopause include osteoporosis and heart disease.
• Treatments for menopause are customized for each woman.
• Treatments are directed toward alleviating uncomfortable or distressing symptoms.