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Conditions
Here you can find more information on a range of common conditions. If you do not see a specific condition listed, please contact Yorkshire Gynaecology to enquire as to whether we can help.
Please note - the following section contains general medical information only. It should not be treated as advice and you should not rely on it as an alternative to seeking a professional medical opinion.
INCONTINENCE
Urinary incontinence is the involuntary leaking of urine. It is a very common condition and has been estimated to affect up to 50% of woman. It can greatly impact upon a person's quality of life both at home and at work.
Risk factors include obesity, previous pregnancies and vaginal delivery increasing age and family history. Certain medications and urinary tract infections can also cause incontinence.
The major types of incontinence are:
Stress incontinence - leakage when pressure increases in the abdomen, such as coughing, lifting, laughing, sneezing. The volume of urine lost can be small or large.
Urge incontinence - the frequent feeling of the need to pass urine and not being able to make it to the bathroom in time.
Mixed incontinence - this is a combination of both stress and urge incontinence.
Overflow incontinence - loss of urine without any warning signs. This is often due to issues with the bladder muscle being underactive or due to something obstructing the passage of urine out of the bladder (e.g. pelvic prolapse, fibroids or previous surgery). Symptoms can involve difficulty in starting to pass urine, slow flow, multiple visits to the toilet in a short period of time, getting up often at night and a sense of incomplete emptying.
Investigations may include an examination, urodynamic studies, ultrasound scanning and cystoscopy (using a scope to look inside the bladder).
Initial treatments can include lifestyle advice, bladder retraining and pelvic floor exercises. Drug therapy may be prescribed in order to try and help regain bladder control. For some patients, a surgical procedure may be suggested.
PELVIC FLOOR
PROBLEMS
The pelvic floor is the name given to a series of muscles and ligaments which help support the organs within the pelvis and hold them in the correct position. Weakening of any of these structures can lead to a 'prolapse'. This can result in a bulge within the vagina.
This is a very common condition. Symptoms may include the sensation of a bulge or dragging feeling, back ache, discomfort during intercourse, problems passing urine and constipation. Sometimes the prolapse can be pushed back.
Risk factors include number of past pregnancies, vaginal delivery, increasing age and menopause, obesity, previous surgery (e.g. hysterectomy), constipation, recurrent heavy lifting and genetic disorders.
Investigations will include an examination, possible bladder studies and imaging.
Initial treatments may involve changes in lifestyle (such as stopping smoking, avoiding heavy lifting, weight loss and a high fibre diet to tackle constipation). Pelvic floor exercises and/or pessary devices can be used to offer more support and help relieve symptoms. Surgery can also be an option to help resolve the prolapse and strengthen the pelvic floor.
MENSTRUAL
DISORDERS
For some women, periods (menstruation) occur monthly without any concern. However for others, there can be a large number of physical/emotional symptoms associated with them, which can greatly affect quality of life.
Abnormal Uterine Bleeding
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Heavy periods - Hormone imbalances, fibroids, polyps and other medical conditions can all cause heavier menstruation. Bleeding can also become heavier when approaching the menopause. Note - any bleeding after the menopause always requires investigation.
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Absence of periods - this can be caused by hormone imbalances, drugs, excessive exercise, pregnancy and weight loss.
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Bleeding between periods and after intercourse.
Painful Periods
This is the most common menstrual disorder. Abdominal pain and cramps can be associated with normal periods, but for some this can be intense and persistent. The pain is due to contractions of the uterus and may be felt in the lower back. It can be associated with nausea, vomiting and diarrhoea. Other causes include fibroids, adenomyosis or endometriosis.
Investigations for menstrual disorders may include blood tests, an examination and ultrasound scanning. A procedure called 'hysteroscopy' may be recommended - a scope is used to look inside the uterus and search for any abnormalities. Samples of the uterus lining (endometrium) can be taken for examination.
Treatments available depend on the cause of your symptoms. These may include lifestyle advice, medications/implants/mirena coils and surgical options - for example hysteroscopic surgery, endometrial ablation, hysterectomy and radiological procedures.
FIBROIDS & CYSTS
Fibroids are benign tumours that develop from the muscle layers in the uterus. Their growth is influenced by sex hormones. Consequently women of a reproductive age or those on hormone-replacement-therapy are more likely to develop them. Fibroids can cause abnormal uterine bleeding, pain and pressure type symptoms. They may also have effects on fertility and influence pregnancy outcomes. Their management depends on the type of symptoms being experienced, size of the fibroid(s), their location and fertility desires.
In many cases they cause no symptoms and are identified incidentally.
Investigations will include an examination, possible blood tests and imaging (usually ultrasound scanning and/or MRI). Camera tests (hysteroscopy/laparoscopy) may also be required to look inside the uterus and/or pelvis.
Treatments can involve simple monitoring of the fibroids, drugs to try and reduce their size (such as hormonal therapies and others) and/or surgery. Sometimes a hysterectomy (removal of the uterus) can be the best option to treat fibroids. Other options include myomectomy (surgical removal of a fibroid) and embolisation (interventional radiology to block off their blood supply).
Ovarian cysts are fluid filled collections which are attached to an ovary. Often they cause no symptoms and the majority are harmless. For some woman they can cause pain, pressure symptoms and bloating. Sometimes the cyst can burst, bleed or twist the ovary (torsion).
They are usually found on ultrasound scanning and often their size and makeup influences treatment. Some can be simply monitored. For others, medication can be suggested to try and reduce their size. Surgery can also be suggested to remove the cyst(s) - usually laparoscopic surgery.
ENDOMETRIOSIS
Endometriosis is a common condition where the endometrium (lining of the womb) is found growing outside of the uterus. Sites can include the ovaries, pelvic ligaments, the surface of the uterus, bladder, fallopian tubes, bowel or abdominal wall.
Patients can experience pelvic pain, painful periods, pain during intercourse and issues with fertility. Endometriosis usually affects women of childbearing age and is less common for those who have gone through the menopause.
In order to diagnose endometriosis patients often need a 'laparoscopy' - a surgical procedure to look inside the abdomen with a camera.
Treatments include drugs for pain relief and hormonal therapies. Surgical treatment of endometriosis can be performed during laparoscopy.
MENOPAUSE
& HRT
The menopause is the time where a woman stops having periods and can no longer become pregnant naturally. It is a normal part of ageing and usually occurs between the ages of 45-55. The average age is 51. The menopause is associated with a decline in the amount of oestrogen within the body.
Common symptoms associated with 'going through the menopause' include irregular periods, hot flushes, night sweats, vaginal dryness, bladder problems, insomnia, mood swings, reduced libido, difficulties in concentrating and memory retention. These symptoms may occur some years before the final period.
Investigations may include an examination, blood tests and scans.
Hormone replacement therapy (HRT) can be offered to those with troublesome symptoms.
FERTILITY &
MISCARRIAGE
There are both female and male factors that influence fertility. Causes of sub-fertility can be investigated and appropriate advice given.
Miscarriage is a term used to describe the loss of a pregnancy before 23 weeks and is a very emotional and difficult time for a patient and their family. The main signs of miscarriage are vaginal bleeding and abdominal pain. There are many causes of miscarriage and these include problems with the developing foetus and placenta, infection, maternal medical conditions and abnormalities of the uterus.
Recurrent miscarriage may require additional investigations. These can include blood tests, scans and genetic profiling.