GYNAECOLOGY CONDITIONS

Gynaecology Conditions

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1. Endometriosis: Endometriosis is a condition where the tissue that is present in the lining of the uterus occurs at other sites in the peritoneal cavity, which can be on the fallopian tubes, on the peritoneum, over uterosacral ligaments, and in the ovaries. When this occurs in the ovaries, these present as small cysts called “chocolate cysts” as they may have old blood collected in them, which is brownish in colour. This can be a very painful condition leading to symptoms such as pain in the lower abdomen, pain during sex and painful periods. This condition can be treated with surgery using laparoscopy which involves excising the endometriotic tissue or burning it with electrical diathermy.
    

2. Menopause: Menopause is the permanent cessation of periods diagnosed by absence of periods for more than 12 months. While most women experience only mild symptoms, severe menopausal symptoms such as hot flushes, night sweats, mood changes and low libido may need treatment with hormonal replacement therapy. If menopause occurs prematurely, women may need to be treated due to the risk of osteoporosis.
    

3. PID: Pelvic Inflammatory Disease may occur acutely with a sudden flare-up of symptoms such as fever, acute pelvic pain and/or vaginal discharge. This needs treatment with antibiotics and occasionally even may need hospitalization with intravenous antibiotics. A more common form of Pelvic Inflammatory Disease is chronic which may be asymptomatic, or present with chronic pelvic pain and/or vaginal discharge.
    

4. Dysfunctional Uterine Bleeding (DUB): Dysfunctional uterine bleeding is a condition which is characterised by heavy or irregular periods. It is a diagnosis of exclusion when all other known causes have been ruled out. It may need treatment with oral hormonal treatment/Mirena® IUS insertion or even surgical treatment with endometrial ablation or, rarely, a hysterectomy.
    

5. Adenomyosis: Adenomyosis is a condition where the glands that are present in the lining of the uterus occur deeper in the muscle of the uterus leading to heavy and painful periods. It is a form of endometriosis and can be treated with oral hormonal treatment/Mirena ®IUS insertion or surgical treatment depending on symptoms and patient preference.
    

6. Fibroids: Fibroids or uterine myomas are benign tumours of the muscle of the uterus and may be present in 30% women. They can be very small (less than 2-3 cm in diameter) and asymptomatic in which case they may not need any treatment. When symptomatic, they can cause menorrhagia (increased menstrual blood loss) and/or dysmenorrhea (period pains) with pressure symptoms if they are too big in size. Depending on their size, location and symptoms they may need surgical treatment with a myomectomy/endometrial ablation or a hysterectomy.
    

7. Ovarian cysts: Ovarian cysts are mostly benign in young women in the reproductive age group. Very small cysts up to 3-4 cm in diameter in these women may be functional cysts (follicular or luteal cysts) frequently arising from the site of ovulation. Mostly supportive or conservative management of these conditions is sufficient. However, sometimes they can cause pain or become persistent and may need surgical treatment. A similar condition can be benign tumours of the ovary presenting as cysts. These may be persistently noted or increase in size on sequential pelvic scans (unlike the functional cysts that spontaneously resolve) or may undergo torsion (twisting of the cyst on its own pedicle) which warrant surgical management. It is also important to differentiate these simple benign cysts from ovarian malignancies that occur mostly in the older age group but rarely occur in younger women. Checking for tumour markers by a blood test and performing a tertiary ultrasound scan examination are required to confirm the diagnosis.
    

8. Abnormal cervical screen results: In December 2017, the new Australian National Cervical Screening Program came into effect and HPV screen is the new primary screen test. The HPV test is similar in procedure to the previously known pap smear test. On the introduction of the program, the first test will be due in 2 years from the last test and then in 5 years if the test is normal. Due to the introduction of the new screening program, the referral for abnormal screening is likely to increase in the near future leading to an increase in the requirement of colposcopy assessment.
    

9. Cervical Intraepithelial Neoplasia (CIN): CIN is a condition that can be screened for by the presence of abnormal smear results. The screening tool has now been changed to the HPV test. However, the diagnosis of CIN will still need a confirmatory test with a colposcopy and a cervical biopsy. CIN can be divided into CIN 1, 2 and 3. CIN 1 falls under a low-grade squamous cell abnormality and is usually monitored by conservative management with annual colposcopy and HPV test. However, CIN 2-3 need treatment with “Large Loop Excision of Transformation Zone” (LLETZ) or known as “Loop Excision Electro-cauterisation Procedure” (LEEP). After treatment, there is a requirement of follow up with a colposcopy, cervical cytology and HPV test as a “test of cure”.
    

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