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Gynaecology Clinic

The Clinic Aims and Services

The gynaecology clinic is led by a team of experienced leading London gynaecologists, specialising in different areas of gynaecology and obstetrics. The clinic aims to provides a complete one stop service for patients in a, professional and friendly environment.

The Services include: 

  • Cervical Smear Test (Pap test)   

  • Abnormal uterine bleeding (menorrhagia) 

  • Endometriosis

  • Fibroids

  • Menopause

  • Pelvic & Vaginal pain

  • Polycystic Ovaries (POCS)

  • Prolapse

  • Incontinence

  • Vulval problems

  • Painful Menstrual periods

Cervical smear test (Pap test)

Dyskaryosis is the medical term for describing abnormal cell changes. Dyskaryosis is not cancer and about 9 out of 10 cases revert back to normal on their own without treatment. Nearly all abnormal tests show no more than small changes in the cervical cells. It means that your smear test has done its job. Approximately 1 in every 12 cervical screening tests are reported abnormal, but in nearly all these cases it does mean that the person has cancer.

Depending on the degree of abnormality, it may be necessary to have a repeat cervical screening test or be referred to a Consultant Gynaecologist for a colposcopy. The urgency of referral depends on the result of the cervical screening test.

Abnormal smears are often caused by the Human Papilloma Virus (HPV or Wart virus). This is a very common infection and 60-70% women get it at some stage in life. Most women will shake it off through their immunity, but in some women it may linger on and cause abnormal smears.

The lining of the cervix is closely examined to check the cells for abnormalities by performing a Colposcopy using a magnifying instrument called a colposcope. 

Remember that it is rare for cervical cancer to be found on cervical screening. Cervical screening is designed to find early changes that could become cancer if left untreated.

Dysfunctional (abnormal) Uterine Bleeding / Heavy Periods (Menorrhagia)

Although heavy bleeding during the menstrual cycle is common, in most cases no cause will be found. In some cases the cause is a medical condition such as endometriosis or fibroids. In most cases treatment is effective through medication to reduce bleeding, or surgery.

It can be difficult to know if your bleeding is normal or heavy compared with other women. A heavy bleeding is generally blood loss of 60-80 ml or more, but it is difficult to measure how much blood you lose during a period.

The bleeding can be considered as heavy if you:

  • Pass large blood clots

  • Require frequent changes of tampons or sanitary towels

  • Require double sanitary protection (tampons and sanitary towels)

  • Bleed through to clothes or bedding

Dysfunctional uterine bleeding is diagnosed when heavy bleeding recurs each month, and interferes with your quality of life.

Dysfunctional uterine bleeding is where the womb and ovaries are normal, there is no obvious known cause of heavy bleeding, it is not a hormonal problem, and periods may be regular. This condition is more common in patients approaching the menopause or in someone who has only started their menstrual cycle 

Other, less common causes of heavy bleeding include:

  • Fibroids, which are non-cancerous tumours that grow in the muscle of the uterus

  • Endometriosis, where cells from the uterus lining grow in other parts of the body

  • Pelvic infection 

  • Polyps, masses in the inner lining of the uterus

  • Endometrial cancer (very rare cause)

  • Hormonal problems

  • Polycystic ovary syndrome

  • Anticoagulant medication such as warfarin

A vaginal examination of the cervix (neck of the womb) and examination of the size and shape of the uterus (womb) is carried out to diagnose the cause of heavy bleeding if the vaginal examination is normal and the patient is under 40 year old, the diagnosis is generally dysfunctional uterine bleeding. If the uterus is found to be large or abnormal, and/or they are over 45 years old, further diagnostic tests may be required

If other symptoms, such as irregular bleeding or pain during sex, are also present then further investigation is required. These may include:

  • Transvaginal Ultrasound, which can detect fibroids, polyps or structural changes in the uterus

  • Internal swabs to check for infection

  • Hysteroscopy (a thin telescope is passed into the uterus)

  • Endometrial sampling (biopsy of the uterine lining) to check for abnormalities

  • A blood test to check for anaemia, due to the heavy blood loss. 

Endometriosis

Endometriosis is a common condition where tissue from the lining of the womb, grows in other areas of the body, such as ovaries, vagina, bladder, fallopian tubes, rectum or bowel. 

The symptoms of endometriosis vary and some women may have no symptoms at all.

Most common symptoms include:

  • painful or heavy periods

  • pain during sex

  • pain in the lower back, pelvis or abdomen

  • bleeding between periods

  • fertility problems

The experience of pain varies between women. Most women with endometriosis get pain in the area between their hips and the tops of their legs. Some women have this all the time, while others only have pain during their periods, when they have sex or when they go to the toilet.

How severe the symptoms are depends largely on where in your body the endometriosis is. A small amount of tissue can be as painful as a large amount.

The diagnoses of Endometriosis made by an examination called a laparoscopy.

A laparoscopy, is undertaken with a general anaesthetic and a laparoscope (slender, tubular endoscope) is inserted through a small incision in your abdominal wall. The laparoscope has a tiny camera that transmits images to a video monitor for the Consultant to view the tissue of the endometrium.

The Consultant can then perform a biopsy for laboratory testing or insert other surgical instruments to treat the endometriosis. You can usually go home the same day after you have had a laparoscopy.

The treatment for endometriosis is influenced by several factors such as  

  • your age

  • your main symptom (pain, fertility problems)

  • if you are planning a pregnancy

  • if you have had any treatments previously

  • if you are anxious about surgery

Although there is no cure for endometriosis, the aim of treatment is to ease the symptoms so that the condition does not interfere with your daily life. Treatment can help to relieve pain, improve fertility, slow the growth of endometriosis, and prevent the disease from coming back.

The treatments for endometriosis is:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen act against the inflammation and help to ease pain and discomfort

  • Hormone treatments can limit or stop the production of oestrogen in your body. Removing exposure to oestrogen can reduce the endometriosis tissue and help to ease your symptoms

  • Surgery can remove or destroy the areas of endometriosis tissue. The type of surgery used will depend on where the tissue is and how extensive it is.

  • The surgery for endometriosis consists of:

  • Endometrial ablation: This is where the endometriosis tissue may be cut away, or be destroyed with heat from an electric current or a laser or by directing a beam of helium gas to destroy the tissue. This can usually be done by a laparoscopy. The Consultant Surgeon will make small cuts in your abdomen and then use the laparoscope to view inside your pelvis and remove the tissue.

  • Laparotomy surgery: This is an open surgery and a larger cut is made in the abdomen and may be suggested if endometriosis is severe and extensive.

  • A hysterectomy surgery: This is where the womb is removed and may be recommended if you have very severe symptoms.

In many women endometriosis can come back after surgery and in order to delay the return of the symptoms hormonal drugs after surgery is sometimes recommended.

Fibroids

Fibroids are benign tumours that develop within the uterus. About 1 in 5 women develop fibroids during their childbearing years and half of all women will have fibroids before they are 50.

The symptoms of fibroids are 

  • Heavy menstrual bleeding (menorrhagia)

  • Bleeding between periods

  • Periods lasting longer than normal

  • Pelvic cramping or pain with periods

  • Sensation of fullness or pressure in lower abdomen

  • Needing to urinate more often

  • Pain during intercourse

Fibroids often do not cause symptoms and are usually discovered during a routine gynaecological examination, diagnostic test or scan. To confirm diagnosis you may be asked to undergo:

  • Transvaginal ultrasound is a test used to look at a woman's reproductive organs, including the uterus, ovaries, and cervix

  • Hysteroscopy is a procedure used to examine the inside of the uterus (womb). It's carried out using a hysteroscope, which is a narrow tube with a telescope at the end. Images are sent to a computer in order to get a close-up of the womb

  • Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin. This procedure is also known as keyhole surgery or minimally invasive surgery.

  •  Biopsy is a sample of tissue taken from the body in order to examine it more closely. A doctor should recommend a biopsy when an initial test suggests an area of tissue in the body isn't normal. Doctors may call an area of abnormal tissue a lesion, a tumour, or a mass.

Treatments vary depending on your age, general health, the type of fibroids, and if you are pregnant or planning to get pregnant in the future. Some women may just need pelvic exams or ultrasounds every once in a while to monitor the fibroid growth.

Treatment for the symptoms of fibroids:

  • Birth control pills (oral contraceptives) help control heavy periods

  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for pain

  • Intrauterine devices (IUDs) release the hormones to reduce heavy bleeding and pain

  • Iron supplements treat anaemia caused by heavy periods

  • Short-term hormone therapy injections help to shrink the fibroids 

Surgery options for treating fibroids:

  • Hysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention.

  • If abnormalities are found at the time of the hysteroscopy, an operative hysteroscope with a channel to allow specialized instruments to enter the cavity is used to perform the surgery. Typical procedures include endometrial ablation, sub mucosal fibroid resection, and endometrial polypectomy.

  • Uterine Artery Embolisation (UAE), also known as Uterine Fibroid Embolisation (UFE), is an image-guided, minimally invasive procedure used to treat patients with symptomatic uterine fibroids.

  • An interventional radiologist, a specialist in performing these procedures, uses a high-definition x-ray camera to guide a catheter with a diameter of about 2 mm into the uterine arteries to deliver particles of an embolic material. The particles lodge in the small vessels supplying the fibroids reducing their blood supply and causing them to shrink.

  • Myomectomy is an operation to remove fibroids while preserving the uterus. For women who have fibroid symptoms and want to have children in the future, myomectomy is the best treatment option.

  • A myomectomy can be performed several different ways. Depending on the size, number and location of your fibroids, you may be eligible for an abdominal myomectomy, a laparoscopic myomectomy or a hysteroscopic myomectomy.

  • Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures

Menopause

A change in the balance of the body’s sex hormones is defined as Menopause. In the lead up to the menopause oestrogen levels decrease, causing the ovaries to stop producing an egg each month. Oestrogen is the female sex hormone that regulates a woman's periods. The fall in oestrogen also causes both physical and emotional symptoms including hot flushes, night sweats, mood swings, and vaginal dryness.

The average age for women to reach the menopause is 52 in the UK, although women can experience premature menopause e at 30 or 40. Menstruation can sometimes stop suddenly when reaching the menopause, but it is more likely that periods will become less frequent, with longer intervals in between each one before stopping altogether.

Most women do not need treatment for menopause, but treatments are available if symptoms are severe and interfere with quality of life. Hormone replacement therapy (HRT) is a common treatment for menopause, helping to relieve menopausal symptoms by replacing oestrogen. HRT is available in many forms including tablets, creams, gels, skin patches, or implants.

Pelvic & vaginal pain 

Possible causes of pelvic or vaginal pain include:

  • Ectopic pregnancy:  This is a life-threatening emergency that requires immediate treatment. It happens when an embryo begins growing outside of the uterus (usually in the fallopian tube). Symptoms include sharp pelvic pain or cramps, vaginal bleeding, nausea, and dizziness.

  • Ovarian cysts:  Normally a follicle houses the maturing egg during the menstrual cycle and releases the egg when you ovulate. Occasionally, a follicle doesn't open to release the egg or recloses after releasing the egg and swells with fluid, forming an ovarian cyst. This is usually harmless and goes away on its own. However, large cysts may cause pelvic pain, weight gain and frequent urination. Ovarian cysts can be identified with a pelvic examination or ultrasound.

  • Pelvic inflammatory disease (PID): This infection can cause permanent damage to the uterus, ovaries and fallopian tubes. It is the leading preventable cause of infertility in women. Symptoms include abdominal pain, fever, abnormal vaginal discharge, and pain during sex or urination. PID is treated with antibiotics or surgery in severe cases.

  • Premenstrual syndrome (PMS): As well as triggering mood swings and food cravings, PMS can also cause abdominal cramps, low back pain, headaches, tender breasts, and acne. Hormonal changes may be to blame. Stress, lack of exercise and some vitamin deficiencies may make the symptoms worse. Lifestyle changes and medication can often help.

  • Vulvodynia pain:  This affects the area around the opening of the vagina. It can be constant or recurring and is often described as a burning, stinging or throbbing sensation. Treatment options range from medication to physiotherapy.

 

Polycystic Ovarian Syndrome (PCOS)

In PCOS there is an imbalance between the pituitary gonadotropin luteinizing hormone (LH) and the follicle-stimulating hormone (FSH), resulting in a lack of ovulation and an increased testosterone production.

It is not known exactly what causes this imbalance but it is felt that it is probably a combination of genetic and environmental factors.

Many women with PCOS have a weight problem and there appears to be a relationship between PCOS and the body’s ability to make insulin.

Insulin is a hormone that regulates the change of sugar, starches and other food into energy for the body’s use or for storage. Many women with PCOS have insulin resistance, in which the body cannot use insulin efficiently. Since some women with PCOS make too much insulin, this leads to high circulating blood levels of insulin, called hyperinsulinemia.

It is believed that hyperinsulinemia is related to increased androgen levels and it is possible that the ovaries react by making too many androgens (male hormones). This can lead to acne, excessive hair growth, weight gain and ovulation problems as well as type 2 diabetes. In turn, obesity can increase insulin levels, causing PCOS to get worse.

PCOS is a very common problem in women of reproductive age that has both short-term effects upon reproductive function and longer term effects upon the risk of diabetes and cardiovascular disease.

PCOS is characterised by: 

  • Irregular periods, with cycle greater than 35 days, or lack of periods.

  • Signs of excess hair or acne

  • Appearance of the ovaries would be described as polycystic ovaries - what this means is that the ovaries contain at least 12 small follicles usually around the outer surface of the ovary.
    2 out of 3 of the above criteria are required for diagnosing the syndrome. Clinically one or more of the following symptoms may also be present:

  • Irregular ovulation or no ovulation

  • Infertility; difficulty in becoming pregnant

  • Recurrent miscarriages

  • Unwanted facial and/or body hair (hirsutism)

  • Oily skin, acne

  • Being overweight, rapid weight gain especially around the waist and abdomen (central obesity); or difficulty in losing weight.

Investigations to diagnose PCOS are:

  • Transvaginal Ultrasound (specific reporting on numbers of follicles is essential)

  • FSH/LH ratio (on day 3-5 of menses) or after progesterone challenge (avoid mid-cycle day 18-20 in women with cycles less than 35 days)

  • Male hormone (androgen) profile

  • Blood sugar testing (oral glucose tolerance ) if BMI >27

  • Thyroid function tests

  • Lipid profile (cholesterol, LDL and triglycerides)

Treatment for PCOS is 

Lifestyle change and change in diet are absolutely paramount. Prophylactic use of Metformin in women with impaired glucose tolerance, to prevent progression of diabetes, is gaining increasing acceptance. The effectiveness of Metformin, in relation to ovulation induction, has been evaluated and has not been found to be useful on its own.

For women with irregular cycles who would like to conceive, Clomiphene Citrate (CC) is the first choice therapy for women with PCOS (for patients with no previous PCOS treatments). In CC resistant women, a combination of CC plus Metformin could be tried before considering ovarian drilling as the final option 

In PCOS presenting symptoms are highly variable. Not all women with PCOS are infertile

The treatment of the condition is highly individualised and very much dependant on the presenting symptoms and needs of the woman in terms of fertility, cycle control, weight issues, and hyper androgenic symptoms.  

Prolapse 

Vaginal prolapse is a common and up to 11% of women will require surgery for prolapse in their lifetime.

The prolapse can be due to poor support of the anterior or posterior vaginal wall and/or uterus.

Classical symptoms include a feeling of a "lump" of dragging in the vagina and some women find it affects them emptying their bowels or bladder.

There are various treatment option which include:

  • physiotherapy, 

  • vaginal pessaries 

  • surgery

Urinary Incontinence

Urinary incontinence affects up to 30% of women and has marked effects on quality of life. Common symptoms include:

  • Frequency of urination during the day and night, 

  • Urgency (rushing to go), urgency with leakage (urge incontinence) and 

  • Leakage on coughing and exertion (stress incontinence).

Treatment can be effective and is often simple. Treatment options include physiotherapy, drugs and surgery.

Vulval Problems

Vulval problems consists of: 

  • Benign lumps, bumps and cysts:  These are common and a simple inspection should be enough for a Gynaecologist to reassure that they are not cancerous. If the lump is causing discomfort or is unsightly, a surgical excision can be performed under local anaesthesia.

  • Hypo-oestrogenic atrophy / Atrophic vaginitis: This condition is caused by a lack of oestrogen after the menopause, with soreness, bleeding and painful intercourse common symptoms. Diagnosis is made based on the appearance and by excluding infections using a swab test. The condition is treated with oestrogen, either as a tablet or cream.

  • Lichen Sclerosus: This is a chronic skin condition more common in the elderly. Itching and soreness are common and intercourse can be painful or impossible due to narrowing of the vaginal entrance. The symptoms often spread around the anal area and the skin usually has a whitened appearance. Diagnosis can usually be made from the appearances alone but sometimes it is necessary to take a biopsy. Treatment is with steroid ointments.

  • Vulval abscess: Vulval abscesses are fairly common and are the result of a cyst getting infected which can be very painful. In its early stages it may be possible to treat with antibiotics, but in most cases surgery will be required to drain the abscess.

  • Vulval cancer: This typically affects older women, with the symptom of a lump that is itchy, sore and which may bleed. Diagnosis is confirmed with a biopsy and treatment is by surgical excision, which may also involve removing lymph nodes in the groin.

Painful menstrual periods

During menstruation some discomfort, pain and cramping is normal, but medical advice should be taken if you experience symptoms of:  

  • Pelvic or vaginal pain when not menstruating

  • Painful menstrual periods lasting longer than 3 months

  • Cramping accompanied by diarrhoea and nausea

  • Passing of blood clots

Sudden cramping or pelvic pain could also be a sign of infection. An infection is serious and you should seek medical advice as soon as possible. Symptoms of infection include:

  • Severe pelvic pain

  • Sudden pain, especially if you may be pregnant

  • Fever

  • Foul-smelling vaginal discharge

 Causes for painful menstrual periods is not always known but some women are at a higher risk of painful periods if they have risk factors like: .

  • Family history of painful periods

  • Smoking

  • Being under 20 years old

  • Heavy bleeding with periods

  • Irregular periods

  • Not having had a baby

  • Experienced puberty early (before the age of 11)

Sometimes painful periods can be caused by an underlying medical condition such as:

  • Fibroids (noncancerous mass) in the uterus

  • Endometriosis, in which cells from the lining of the uterus grow in other parts of the body

  • Premenstrual syndrome (PMS)

  • Sexually transmitted infections (STIs)

  • Pelvic inflammatory disease (PID), an infection of the uterus, fallopian tubes, or ovaries often caused by sexually transmitted infections

  • Cervical stenosis, a rare condition in which the cervix is so small it slows menstrual flow

  • Adenomyosis, a rare condition in which the uterine lining grows into the muscular wall of the uterus

  • Intrauterine devices (IUDs) made of copper are associated with increased pain during menstruation

Until you are able to seek your doctor or Gynaecologist, you can try home treatments which have been known to relieve symptoms

  • Massaging your abdomen

  • Heating pad on your pelvic area or back

  • Regular physical exercise

  • Practicing relaxation techniques or yoga

  • Raising your legs or lying with your knees bent

  • Eating light, nutritious meals

  • Taking a warm bath

  • Taking an anti-inflammatory medication such as ibuprofen several days before your expected period

  • Taking vitamin B-6, vitamin B-1, vitamin E, omega-3 fatty acids, calcium, and magnesium supplements while reducing your intake of salt, alcohol, caffeine, and sugar to prevent bloating.

The medical treatment recommended by your doctor or Consultant, will depend on how severe the pain is and the underlying cause of your cramps. Medications include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)

  • Pain relievers, such as narcotics

  • Antidepressants

Surgery is an option if other treatment options have not been successful or your pain is caused by endometriosis or uterine fibroids. Surgery will be performed to remove any endometriosis implant, uterine fibroids, or cysts.

In very rare cases, a surgical removal of the uterus (hysterectomy) is an option if other treatments have not worked and pain is severe.

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