GYNAECOLOGY SERVICES IN MELBOURNE

There is no strict definition as to how heavy a woman’s periods must be, to be considered ‘heavy’. If you think your periods are too heavy, then they are! Many clinicians would consider the following as signs of heavy periods:

• Passing large clots (e.g. the size of a 50 cent piece or bigger)
• Experiencing episodes of flooding (gushes of blood, soaking through clothes or bed sheets)
• And / or having experienced iron-deficiency anaemia because of the heaviness of your periods.

Please read this blog for a more detailed discussion of heavy menstrual bleeding.

Again, there is no strict definition as to how painful your periods need to be, to be considered a problem. If your periods are too painful for you, they’re too painful! Signs that your periods may be considered too painful include:

• Having moderate period pain, despite taking regular over-the-counter pain relief
• Rating your period pain as 7/10 or worse
• Needing to take time off work or study because of your period pain
• And / or needing to change your social plans because of your period pain.

Please read this blog for a more detailed discussion about the investigation and management of painful periods.

Anatomically, the bony pelvis is the sink-shaped group of bones that connect your trunk with your legs. It supports and balances your trunk, and contains your bowels, bladder (where urine is stored), and internal sex organs (e.g. uterus, ovaries, and Fallopian tubes). Pain from these internal sex organs may be experienced as:

• Pain that is in the middle of your tummy, or on the left or right side
• Cramping / dull / sharp / stabbing and / or twisting in nature
• Cyclical (worse at particular times of your menstrual cycle), or non-cyclical (occurs at random times).

Pelvic pain can also be acute (occurring over a few minutes or hours), or chronic (which can last anywhere from six months to many years).

An ovarian cyst is a fluid-filled sac that forms within an ovary. There are various different types of cysts: some are a completely normal part of a woman’s menstrual cycle, while others are not.
Some cysts can simply be monitored using serial ultrasounds, and don’t need to be cut out (or ‘excised’). For other cysts, surgical excision is recommended, due to:

• Related symptoms (e.g. pelvic pain or pressure, abdominal distension)
• A wish by the patient to confirm the cyst is definitely benign (not cancerous), which can only be definitively confirmed by cutting out the cyst surgically, and asking the pathology doctors to look at the cyst under a microscope.

Endometriosis is a very common condition: it is thought to affect more than 11% of Australian women. There are many theories as to why endometriosis occurs, but we are yet to truly get to the bottom of it. The prevailing theory regarding what causes endometriosis is ‘retrograde menstruation’. When any woman has a period, the lining of the uterus sheds, and comes out of her vagina as blood. In some women, for some reason, some of this blood goes in the wrong direction: up through the Fallopian tubes and into her abdominal and pelvic cavity. These blood cells can then land on and stick to the outside of various pelvic structures: these can grow, and become endometriosis deposits (or nodules).

However, there is far more to this story. We know that endometriosis has a genetic component, as it seems to run in families, and daughters of mothers with endometriosis are more likely to suffer from it themselves. We know there is an inflammatory component, with release of all kinds of inflammatory markers in the pelvis, causing pain and potentially impacting on fertility.

By far the most common symptom of endometriosis is severe period pain. When severe, endometriosis can also cause: subfertility or infertility; cyclical bowel symptoms; blood in the urine during your period; and blood in your poo during your period.

Ultrasound (especially a so-called deeply-infiltrative endometriosis ultrasound) is very good at seeing moderate and severe endometriosis. However, the only way to diagnose mild endometriosis is to look around the pelvic organs with keyhole surgery.

The management of endometriosis essentially has two prongs, from the day of your first period (as a teenager) to the day of your last (when you go through menopause). The first prong is keyhole surgery, to look for and cut out all endometriosis deposits. The second prong is some kind of hormonal suppression, to slow the regrowth of the endometriosis. For example: the oral contraceptive pill, an intrauterine device, or injections to make your periods lighter.

Adenomyosis is a condition in which the cells that line the cavity of the uterus, grow too deeply, into the muscular layer of the uterus. This tissue then swells and bleeds when stimulated by cycling hormones, just like the cells that actually line the uterus. This swelling and bleeding within the muscle causes pain and heavy bleeding. Adenomyosis tends to get worse with age, and is a very common cause of both heavy and painful periods in women in their 40s and 50s.

To some extent, the symptoms of adenomyosis can be managed with medications. If this is not enough, surgical management may be needed. Unfortunately, there are no good surgical options that both treat adenomyosis, and retain a woman’s fertility. The only definitive management is hysterectomy (permanent surgical removal of the uterus, or womb).

Please read this blog for a more detailed discussion regarding the investigation and management of adenomyosis.

Fibroids are very common, non-cancerous growths within the muscle of the uterus. Fibroids tend to get worse with age, and are very common in women in their 30s – 50s. Fibroids can grow on the outside of the uterus, within the muscular walls, or inside the uterine cavity.

Depending on their location and size, they can cause various symptoms:

• If they are growing on the outside surface of the uterus, they may jut out and put pressure on the bladder, bowels, or abdominal wall. Hence, such fibroids may cause: decreased bladder capacity and needing to empty your bladder more often; constipation; and abdominal distension (or constant bloating).
• Fibroids that grow on the inside of the uterus may change the shape of the uterine cavity. Hence, they may cause: heavy periods; subfertility or infertility; recurrent miscarriage; premature labour and birth; and fetal malposition (e.g. breech position).
• Fibroids that are growing within the muscular walls of the uterus can cause a mix of all of the symptoms mentioned above.

There is little that can be done to prevent fibroids from occurring; some women are simply prone to develop them. Some medications (e.g. goserelin injections) can be used in the short-term to help shrink a woman’s fibroids somewhat. However, these medications are very strong, and can have irreversible side-effects if given for more than six months.

If causing troublesome symptoms, fibroids can be cut out surgically by various routes, depending on where they are located in relation to the muscle of the uterus.

Feel free to read our blogs related to fibroids by clicking on this link.

Polycystic Ovarian Syndrome (PCOS) is thought to affect approximately 10% of Australian women. Its symptoms and signs include:

• A long (and often irregular) menstrual cycle
• High levels of androgenic hormones, which may lead to male-pattern baldness on your head, and having unusually hairy arms, legs, back, chest, and / or face
• And / or having lots of small ovarian cysts seen at an ultrasound scan

Some of the health problems associated with PCOS include:

• Acne
• Difficulty losing weight
• Subfertility or infertility
• Sleep apnoea
• Diabetes
• Endometrial hyperplasia
• And high blood pressure.

Management of PCOS may include:

• Diet and exercise regimens to achieve and maintain a healthy body weight (please read this blog for more details)
• The contraceptive pill to ensure you have a period at least every three months
• Various techniques to remove unwanted excess hair
• Ovulation induction to help conceive
• And screening for diabetes and cardiovascular complications.

Feel free to read this blog for a more detailed discussion about PCOS.

For example:

• Cervical screening
• Colposcopy (using a special microscope to magnify views of the cervix) and cervical biopsy (if there are any suspicious areas on your cervix). Please read this blog for more information about colposcopy.
• And screening for, and management of, sexually transmitted diseases

Management of heavy and / or painful periods, ovarian cysts, fibroids, adenomyosis and endometriosis are all considered part of a general gynaecologist’s remit.

Menopause is the permanent cessation of menstrual periods, and (for most women) occurs in their late 40s to mid-50s. It is essentially due to the ovaries slowing down, and then shutting up shop all together. As ovarian function slows down, woman may experience various symptoms, such as:

• Hot flushes
• Disturbed sleep
• Muscle and joint aches
• Tender breasts
• Emotional changes
• And discomfort with penetrative sex

There are various ways to manage these symptoms, including: lifestyle changes; complementary therapies; non-hormonal options; bio-identical hormones; and hormone replacement therapy (also known as menopausal hormone therapy).

Dr Aekta Neel has a particular interest in the management of menopause, including discussions of the pros and cons of hormone replacement therapy.

Contraception is the use of a method or technique to avoid pregnancy, should penetrative sex occur. There are various forms of contraception, ranging from withdrawal, the ‘rhythm method’, condoms, contraceptive pills, and contraceptive implants (e.g. an intrauterine device, or a device under the skin of your upper arm), to permanent contraception (e.g. surgically removing the Fallopian tubes).

There are different benefits and risks for different types of contraception; some are more appropriate than others, depending on an individual patient’s circumstances. It’s important that you discuss your options with your clinician, to find the form of contraception that is more appropriate for you.

Please read this blog for a more detailed discussion regarding the contraceptive options available to you.

Broadly speaking, there are several different surgical approaches in gynaecological surgery:

• Vaginal surgery (which is performed through the vagina, without any scars in your tummy)
• Hysteroscopic surgery (which is performed using a video camera and instruments that are inserted through the vagina and cervix, into the uterine cavity)
• Laparoscopic (or keyhole) surgery, which involves making several small scars in your tummy
• And open (or abdominal) surgery, which involves making a larger scar in your tummy

These operations are all performed under a general anaesthetic, so you won’t feel or remember anything during the operation.

Depending on the extent of the surgery, your hospital stay may only be a few hours long; alternatively, it may mean that you need to be admitted for a few nights.

Common gynaecological operations include:

• Ovarian cystectomy (to remove an ovarian cyst)
• Hysterectomy (to remove the uterus +/- the cervix)
• Salpingectomy (to remove either / both Fallopian tubes)
• Oophorectomy (to remove either / both ovaries)
• Excision of endometriosis
• Myomectomy (to remove fibroids from the uterus)

If you are struggling to fall pregnant, it may be time that you (and potentially your partner, if you have one), undertake some investigations to try to work out how you can improve your chances. On a basic level, conceiving naturally involves:

• Ovaries that produce eggs
• At least one open Fallopian tube
• A ‘normal’ uterus
• And ‘normal’ sperm

Investigations are guided by these four factors. Management is focused on wherever the problems seems to lie.

Reproductive health supports individuals and couples to decide whether and when to have a child, and helps them to have a safe and satisfying sex life. It may involve:

• Contraception
• Management of sexually transmitted diseases
• And medical or surgical termination of pregnancy

During your consultation, your gynaecologist may request to examine you internally. This may include: a visual inspection; a cervical screening test and/or vaginal swabs; and manual palpation of the reproductive organs to assess for abnormalities.

Previously known as ‘Pap smears’, cervical screening tests (CSTs) are recommended for all Australian women aged between 25 and 74yo, at least every five years. If you have particular risk factors for cervical cancer, or have had abnormalities found on previous testing, a cervical screening test may be recommended as often as every year.

In 2023, the Australian government introduced self-collection of cervical screening tests: so you can take your own CST in a clinic such as Maven Centre! We can talk you through how to do this on the day.

A CST involves brushing the cervix to collect a sample of cells, to check for human papilloma virus (HPV), and other signs of precancerous changes on the cervix.

Signs and symptoms of gynaecological conditions vary, but may include: abnormal vaginal bleeding; pelvic pain; unusual discharge; itching; burning; changes in your menstrual cycle; pain during sex; or urinary symptoms. It is important to consult your gynaecologist if you experience any persistent or concerning symptoms.

Reasons to see a gynaecologist include:

• If your periods are too heavy
• If your periods are too painful
• If you have had an abnormal result on a cervical screening test
• If you have had an ultrasound showing endometriosis, adenomyosis, fibroids, and/or an ovarian cyst
• If you would like to optimise your sexual and reproductive health
• If your GP says you have pelvic organ prolapse
• If you are troubled by urinary incontinence (leakage)
• If you want to discuss your contraception options
• If your GP recommends that you do!

Please contact us for more information.

New patients will require a referral letter from a GP in order to see a Maven Centre gynaecologist. Contact us for more information on scheduling an appointment.

Yes, menstrual pain and discomfort are common gynaecological issues that we often help women to manage.

Some gynaecological conditions can affect fertility. For instance, conditions such as polycystic ovarian syndrome (PCOS), endometriosis, pelvic inflammatory disease (PID), and some uterine abnormalities may impact fertility. Consult Maven Centre’s gynaecologists if you have concerns about your fertility or are planning to conceive.