Gynaecology involves symptoms and conditions that affect the reproductive organs – as shown in the diagram.

These organs, and their function, can naturally change with age, pregnancy and childbirth in all women. However, sometimes symptoms can develop that may be troublesome and require specialist input.

This section provides information about some of the conditions that can occur, and in which Sanjay has particular expertise.

Menorrhagia is the term used to describe heavy periods. This is a common problem, experienced by up to 1 in 5 women at some time during their reproductive life. Periods are considered to be heavy when they interfere with your quality of life, with some women having to take time off work, not be able to continue exercising and needing to take a change of clothes when going out the house. Contrary to some common misconceptions, heavy periods are not inevitable with ageing and do not have to be tolerated.

The most common cause is a hormonal imbalance that results in the ovary not releasing an egg every month, hence the common association with ageing. However, fibroids and other conditions that alter the shape of the womb (uterus) can also be a cause.

We can assess your periods in a single visit. This will usually involve an internal examination and an internal pelvic ultrasound scan. We can then discuss a full range of treatment options with you. This may involve using a variety of hormonal and non-hormonal medications, simple surgery such as hysteroscopy and endometrial ablation, or more complex surgery such as laparoscopic hysterectomy or abdominal hysterectomy.

Whilst a period once a month is normal, bleeding more frequently is not. The additional bleeding can occur spontaneously, at any time in the cycle, known as inter-menstrual bleeding (IMB). It can also occur after intercourse, known as post-coital bleeding (PCB). If the bleeding occurs while you are taking hormonal contraception, it is known as breakthrough bleeding.

All forms of irregular bleeding are abnormal, and should be investigated. In the majority of cases, the bleeding will be due to a benign condition that does not have long term consequences once treated, for example a non-cancerous polyp. However, in some cases, it can be a sign of underlying cancer.

If you are bleeding too often, we can make a clinical assessment and perform an internal pelvic ultrasound scan at your first visit. We can then discuss appropriate treatment options with you.

Bleeding that happens more than 12 months after your last period is called post-menopausal bleeding (PMB). It should always be investigated urgently because it can be a sign of cancer. The first steps are an internal examination and an internal pelvic ultrasound scan, both of which can be performed at your first visit to the clinic. Sometimes a biopsy is also necessary.In most cases we find that the cause is not serious and can provide you with reassurance.

Fibroids are common, non-cancerous growths of the muscle of the womb. In many cases they do not cause any symptoms at all. However, when they enlarge in size, or multiple fibroids exist, they can start to cause symptoms. Women may experience heavy periods, pressure symptoms, bladder problems or a swelling in the abdomen.

We can identify fibroids on an internal and/or abdominal pelvic ultrasound scan at your first visit to the clinic. In some cases, we may also need to request a Magnetic Resonance Imaging (MRI) scan to establish the exact position of the fibroids.

The treatment options often depend on the size and position of the fibroids. We will discuss these with you in detail at your visit. We can then discuss appropriate treatment options with you, which may include hormonal medications or a surgical procedure.

An ovarian cyst is a fluid-filled sac that grows in an ovary. They are very common, and in most cases do not cause any symptoms. All women of reproductive age produce cysts in their ovaries, during the process of releasing an egg at ovulation. Once the egg is released, these cysts collapse and resolve spontaneously.

Cysts that do not resolve or cause persistent symptoms (usually pain and pressure) are considered abnormal growths. They can often get bigger if left untreated and may start to twist or burst, which leads to sudden severe pain. In a small group of patients, cysts can also be due to cancer.

An internal pelvic ultrasound scan can give a good impression about the origin of an ovarian cyst. This will often be combined with a blood test that measures a tumour marker that relates to ovaries. Using the scan and blood test results, we can then calculate a risk of cancer. Further advice, and recommended treatments, then depends on this risk.
If the scan and blood tests suggest that the cyst is not cancerous, they can be removed by keyhole surgery. Fortunately, the affected ovary can usually be preserved. Sanjay’s current record is a 22 litre cyst – the size of a triplet pregnancy!

Pelvic pain is a common reason to see a gynaecologist. There are many causes of pain, including endometriosis, ovarian cysts, irritable bowel syndrome and some bladder conditions. Occasionally, it is the result of scar tissue from previous surgery or infections.

It is very important for us to get a good description of the pain, and determine whether it is related to your periods. An internal pelvic ultrasound scan is also needed, to look at the uterus, tubes and ovaries. If the cause is not clear after the first assessment, the next step may be recommending a diagnostic laparoscopy. This is a short keyhole operation, under general anaesthetic, to enable a thorough assessment of your abdomen and pelvis. Pictures are taken during the procedure, which we can talk you through at your follow up visit.

If we think that the pain is not gynaecological, we will recommend other experts who may be able to help.

This is a condition that results when cells that line the womb (endometrium) are found outside the womb. When you have a period the endometrial cells outside your womb bleed, just like your womb does. Over time, this leads to scarring inside your tummy. It is therefore a common cause of pelvic pain and painful periods. It can run in families. The only way to confirm a diagnosis of endometriosis is through a diagnostic laparoscopy – a short keyhole procedure performed under general anaesthetic.

Sanjay is a national expert in the treatment of endometriosis. If you are found to have the condition, he will develop an individual treatment plan that takes into account the extent of your endometriosis, your desire for pregnancy and any previous treatments. If you have had previous treatments elsewhere, but still have pain, you may benefit from re-assessment. Sanjay is able to offer definitive treatment options that are known to have excellent success rates.

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