Menstrual Problems and Heavy Periods
Period problems are a very common issue throughout a woman’s reproductive life, particularly in the perimenopausal years from 40 onwards. Severity is subjective but if your menstrual cycle impacts on normal daily activities in any significant way, then it is worth considering investigation and treatment. Up to 30% of the female population between the ages of 30 and 50 will be affected at some stage by abnormal bleeding, but in the vast majority of cases there is no serious underlying problem, and the cause is usually a simple hormonal or dysfunctional issue. Investigations nowadays are very streamlined, and can often be carried out on a one-stop basis to avoid delay. These include basic blood tests and pelvic ultrasound scan usually followed by diagnostic tests such as a hysteroscopy and biopsy of the endometrium (womb lining). Treatments nowadays are generally conservative and a hysterectomy is very rarely required, except as the final option. Most problems can be managed with minimal access techniques including removal of any polyps or fibroids, Mirena coil insertion and endometrial ablation to remove the endometrium. There is an ever-increasing trend for such treatments such to be undertaken in outpatients under local anaesthetic, to minimise any disruption to home life and work, and avoid the need for unecessary general anaesthesia.
For those patients requiring hysterectomy, modern surgical and anaesthetic techniques usually mean that the inpatient stay is in the region of 24 – 36 hours, with a reasonably quick return to normal activities afterwards. The most appropriate route of hysterectomy (abdominal, vaginal or laparoscopic) is tailored to suit individual patient needs.
There are several exciting new developments in this field, including the Myosure device for quicker and safer resection of fibroids and polyps, Novasure Radiofrequency Endometrial Ablation, and Minitouch Microwave Endometrial Ablation, all of which are available to patients under my care.
Hormonal Disorders Including PCOS and PMS
Hormonal disorders are another very common area where women experience difficulty throughout their reproductive lives. It is estimated that more than 40% of women will suffer from PMS of varying degrees of severity. PCOS (Polycystic Ovary Syndrome) is also becoming increasingly common affecting as many as 1 in 5 women. Treatment is offered once the appropriate diagnostic tests have been undertaken, which usually involves blood tests and pelvic ultrasound imaging. There are well-proven treatment regimes for both conditions, which work well in conjunction with holistic care, including dietary advice which is available from both Anita Ralph, Medical Herbalist, and Katie Peck, Dietitian. There is ample scientific evidence that PMS responds well to herbal interventions, and many patients have had successful treatment for this condition in the Integrated Gynaecology Clinic, featured on the website.
Some useful links:
Verity Polycystic Ovary Syndrome website:
The National Association for Premenstrual Syndrome website:
Pelvic pain is a very common condition which can be due to a variety of underlying problems including endometriosis, infection, adhesions, ovarian pathology and pelvic venous congestion. Occasionally pain can also be due to other organs such as the appendix, bowel or gall bladder. Investigations are usually more straightforward than most patients imagine, and include blood tests, ultrasound imaging, together with MRI/CT scans in selected cases. In some cases patients will also require a diagnostic laparoscopy to fully evaluate the problem and help with ongoing management. Depending on the underlying condition, an operative laparoscopy may be carried out at the same time to treat the problem, thus avoiding the need for repeated surgical procedures. Modern laparoscopic surgery and day case anaesthetic techniques have revolutionised the management of pelvic pain, so there is no need to suffer in silence when effective treatment is readily available.
Vulval Disorders including Pain
Vulval pain can be due to wide range of conditions, both functional and organic. Common causes include infections (such as thrush), benign skin conditions such as lichen sclerosus, lichen planus and eczema, as well as functional problems such as vestibulodynia (vulval pain). Expert diagnosis and treatment can be very beneficial in many of these conditions and sufferers can be reassured that there is a wide range of treatments available which can help alleviate symptoms rapidly and effectively.
Where required, collaborative help is also available; patients have the option to be seen in the Integrated Gynaecology Clinic where they will also have access to the expertise of Anita Ralph, a Medical Herbalist. Many conditions, including chronic thrush, can be helped enormously by tried and tested herbal remedies. In other situations, the advice of a Consultant Dermatologist maybe required and this is readily available.
Very few patients require surgery, although in some cases a biopsy may be taken under local anaesthetic to help aid diagnosis.
I offer labial reduction surgery or labiaplasty, where patients are concerned about labial appearance or experiencing discomfort. Very few insurance companies will cover this type of surgery nowadays, and most patients opt to self-fund treatment. Judith will be happy to give details on request.
Benign Ovarian Problems
Ovarian problems can be quite common, ranging from medical conditions such as Polycystic Ovary Syndrome (PCOS) to ovarian cysts, which may require surgical management. Patients can be reassured that virtually all of these conditions are benign and many cysts/lesions will resolve spontaneously, without the need for surgical intervention. Often ultrasound scan monitoring is all that is required, along with supportive or hormonal therapies. In the vast majority of cases where surgery is indicated, it can be undertaken laparoscopically, with minimal inpatient stay and a quick return to normal activities.
Early Pregnancy and Miscarriage
Early pregnancy can be a stressful time, particularly for women who are pregnant for the first time. Many minor problems and ailments can seem magnified during this sensitive period,and it can be very helpful to obtain advice from a specialist, which will hopefully prove reassuring and remove unnecessary anxiety.
For those women unfortunate enough to suffer miscarriage, which affects in the region of 1 in 3 pregnancies, advice is also on hand. Emergency appointments can be scheduled and surgical management of miscarriage (SMM) is available on an urgent/emergency basis at various private hospitals. It is hoped that medical management of miscarriage (MMM) will soon be available as well.
Paediatric and Adolescent Gynaecology
I offer gynaecological consultations for babies, children and adolescent girls, in conjunction with my paediatric colleagues, where necessary.
Problems in this category can include: vulval/labial fusion, chronic discharge, vulval pain/discomfort and menstrual disorders, including amenorrhoea (absence of periods). Surgery is rarely indicated and most conditions can be managed conservatively in the outpatient setting.
Well Woman Screening
I can offer a wide range of Well Woman Screening programmes including the following:
- HPV screening and vaccination
- Cervical smear test
- Ovarian screening including examination, transvaginal ultrasound scan and CA 125 monitoring
- Breast awareness checks and mammography
- Menopause and HRT screening including bone densitometry
This is just a sample of the various screening checks available and these can be individualised according to each patient’s needs. Please contact Judith Holdstock for further information.
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