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Retroverted uterus
The uterus is normally inclined up-wards and forwards. In about 1 in 10 women the uterus is titled backwards, lying close to the rectum. This condition is known as a retroverted uterus and is a harmless variation of the normal position. There is often no cause for condition, although if may occur after childbirth or because an ovarian cyst pushes the uterus backwards.
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A retroverted uterus usually causes no symptoms and does not affect fertility, pregnancy, or childbirth. However, you may feel pain during sexual intercourse or have low back-ache, especially during menstrual periods.
What might be done?
Your doctor may be able to feel that the uterus is retroverted during a pelvic examination. If an underlying disorder is though to be causing the condition, laparoscopy may be carried out to view the pelvis and abdominal cavity. Mild painkillers may relieve backache, and pain during intercourse may be relieved through trying a different sexual position. If there is an underlying cause, such as a cyst, this may be treated, allowing the uterus to return to its normal position.
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A retroverted uterus usually causes no symptoms and does not affect fertility, pregnancy, or childbirth. However, you may feel pain during sexual intercourse or have low back-ache, especially during menstrual periods.
What might be done?
Your doctor may be able to feel that the uterus is retroverted during a pelvic examination. If an underlying disorder is though to be causing the condition, laparoscopy may be carried out to view the pelvis and abdominal cavity. Mild painkillers may relieve backache, and pain during intercourse may be relieved through trying a different sexual position. If there is an underlying cause, such as a cyst, this may be treated, allowing the uterus to return to its normal position.
Uterine polyps
Uterine polyps are painless growths that are attached to the cervix or to the inside of the uterus. The polyps may occur singly or in groups and vary in length up to about 3 cm (1in). Polyps are usually harmless, but they may become cancerous in rare cases. Uterine polyps are common, especially in pre-menopausal women over the age of 30.
The reason why uterine polyps form is unknown, but they may develop on the cervix if it is already affected by a cervical erosion, in which the cells on the surface of the cervix are more delicate than usual. Polyps also sometimes form on the cervix following an infection of the area. Women who have not had children are more likely to develop uterine polyps.
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Symptoms of uterine polyps include a watery, bloodstained discharge from the vagina and bleeding after sexual intercourse, between periods, or after the menopause. Such bleeding may also be a sign of a more serious disorder, such as cancer of the cervix.
What might be done?
Your doctor will usually be able to see polyps on the cervix by looking at the cervix while holding your vagina open with an instrument called a speculum. If polyps in the uterus are suspected, further investigations will be arranged, such as ultrasound scanning or hysteroscopy, in which a viewing instrument is inserted through the cervix to view the inside of the uterus.
Treatment of polyps is usually quick and easy. Polyps on the cervix may be removed surgically during examination through the speculum, and uterine polyps can be removed during a hysteroscopy. Mild pain and slight vaginal bleeding are likely for a few days after surgery. Samples of tissue form the polyps are examined under a microscopy to make sure that there are no cancerous cells. Uterine polyps may recur after treatment, and then further surgery is usually required.
Removal of the polyp from the uterine cavity. Grasping forceps.
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The reason why uterine polyps form is unknown, but they may develop on the cervix if it is already affected by a cervical erosion, in which the cells on the surface of the cervix are more delicate than usual. Polyps also sometimes form on the cervix following an infection of the area. Women who have not had children are more likely to develop uterine polyps.
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Symptoms of uterine polyps include a watery, bloodstained discharge from the vagina and bleeding after sexual intercourse, between periods, or after the menopause. Such bleeding may also be a sign of a more serious disorder, such as cancer of the cervix.
What might be done?
Your doctor will usually be able to see polyps on the cervix by looking at the cervix while holding your vagina open with an instrument called a speculum. If polyps in the uterus are suspected, further investigations will be arranged, such as ultrasound scanning or hysteroscopy, in which a viewing instrument is inserted through the cervix to view the inside of the uterus.
Treatment of polyps is usually quick and easy. Polyps on the cervix may be removed surgically during examination through the speculum, and uterine polyps can be removed during a hysteroscopy. Mild pain and slight vaginal bleeding are likely for a few days after surgery. Samples of tissue form the polyps are examined under a microscopy to make sure that there are no cancerous cells. Uterine polyps may recur after treatment, and then further surgery is usually required.
Removal of the polyp from the uterine cavity. Grasping forceps.
Fibroids
Fibroids are abnormal growths in the uterus that consist of muscular and fibrous tissue. Fibroids are found in up to 1 in 3 women of childbearing age in the UK and are more common black women. Fibroids occur singly or in groups and may be as small as a pea or as big as a grapefruit. Small fibroids may not cause problems, but larger ones may affect menstruation or fertility.
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What are the causes?
The cause of fibroids is unknown, but they are thought to be related to an abnormal response by the uterus to the female sex hormone oestrogen. Fibroids do not occur before puberty, when the ovaries begin to increase oestrogen production, and they usually stop growing after the menopause. They also increase in size at times when there are increased levels of oestrogen in the body, such as during pregnancy and when taking the combined contraceptive pill or hormone replacement therapy.
What are the symptoms?
Most small fibroids do not cause symptoms, but the common symptoms of larger fibroids include:
- Prolonged menstrual bleeding.
- Abdominal pain during periods.
- Heavy bleeding during periods.
Heavy blood loss may lead to anaemia, cause pale skin and tiredness. Large fibroids may distort the uterus, which can often result in infertility or in recurrent miscarriages. During pregnancy, a large fibroid may cause the fetus to lie in an abnormal position. Fibroids may also press on the bladder, causing a need to pass urine often, or on the rectum, causing back pain. Rarely, a fibroid may become twisted, resulting in sudden pain in the lower abdomen.
How are they diagnosed?
The doctor will perform a pelvic examination. You may also have ultrasound scanning of the uterus or a hysteroscopy, in which a viewing instrument is inserted into the uterus through the cervix. A sample of the fibroid will be removed during the hysteroscopy to check that the growth is not cancerous. Sometimes, fibroids show up on X-rays that are taken for other reasons.
What is the treatment?
Small fibroids often do not need treatment but should be checked regularly by your doctor to make sure that they have not grown. If treatment is necessary, fibroids may be removed during a hysteroscopy if they are on an inner wall. Rarely, fibroids are treated using an in injection of a substance that blocks the blood vessels supplying them, causing the fibroids to shrink.
Large fibroids can be removed via an incision in the abdomen. Before having the surgery, you may be prescribed hormones that suppress the production of oestrogen so that the fibroids shrink. If you have persistent, large fibroids and do not want children, you may consider having a hysterectomy. Removal of fibroids usually results in regained fertility, but in about 1 in 10 women fibroids recur. Fibroids usually start to shrink after the menopause, when oestrogen levels in the body fall.
HYSTEROSCOPY
A hysteroscope is an instrument used to see inside the uterus and fallopian tubes. Hysteroscopy is used to diagnose disorders such as uterine polyps and can be performed under general or local anaesthesia in an outpatient clinic. Minor surgery, such as the removal fibroids, may also be carried out through the hysteroscope. The procedure usually lasts 15 minutes or less.
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What are the causes?
The cause of fibroids is unknown, but they are thought to be related to an abnormal response by the uterus to the female sex hormone oestrogen. Fibroids do not occur before puberty, when the ovaries begin to increase oestrogen production, and they usually stop growing after the menopause. They also increase in size at times when there are increased levels of oestrogen in the body, such as during pregnancy and when taking the combined contraceptive pill or hormone replacement therapy.
What are the symptoms?
Most small fibroids do not cause symptoms, but the common symptoms of larger fibroids include:
- Prolonged menstrual bleeding.
- Abdominal pain during periods.
- Heavy bleeding during periods.
Heavy blood loss may lead to anaemia, cause pale skin and tiredness. Large fibroids may distort the uterus, which can often result in infertility or in recurrent miscarriages. During pregnancy, a large fibroid may cause the fetus to lie in an abnormal position. Fibroids may also press on the bladder, causing a need to pass urine often, or on the rectum, causing back pain. Rarely, a fibroid may become twisted, resulting in sudden pain in the lower abdomen.
How are they diagnosed?
The doctor will perform a pelvic examination. You may also have ultrasound scanning of the uterus or a hysteroscopy, in which a viewing instrument is inserted into the uterus through the cervix. A sample of the fibroid will be removed during the hysteroscopy to check that the growth is not cancerous. Sometimes, fibroids show up on X-rays that are taken for other reasons.
What is the treatment?
Small fibroids often do not need treatment but should be checked regularly by your doctor to make sure that they have not grown. If treatment is necessary, fibroids may be removed during a hysteroscopy if they are on an inner wall. Rarely, fibroids are treated using an in injection of a substance that blocks the blood vessels supplying them, causing the fibroids to shrink.
Large fibroids can be removed via an incision in the abdomen. Before having the surgery, you may be prescribed hormones that suppress the production of oestrogen so that the fibroids shrink. If you have persistent, large fibroids and do not want children, you may consider having a hysterectomy. Removal of fibroids usually results in regained fertility, but in about 1 in 10 women fibroids recur. Fibroids usually start to shrink after the menopause, when oestrogen levels in the body fall.
HYSTEROSCOPY
A hysteroscope is an instrument used to see inside the uterus and fallopian tubes. Hysteroscopy is used to diagnose disorders such as uterine polyps and can be performed under general or local anaesthesia in an outpatient clinic. Minor surgery, such as the removal fibroids, may also be carried out through the hysteroscope. The procedure usually lasts 15 minutes or less.
Cancer of the ovary
Cancer of the ovary is the fifth most common type of cancer in women and causes about 4,300 deaths each year in the UK, more than any other cancer of the reproductive tract. This high death rate is usually explained by the fact that symptoms do not develop until late in the progress of the disease, which delays the diagnosis and treatment.
The cause of cancer of the ovary is not known, but the tumour sometimes develops from an ovarian cyst. There seem to be hormonal and genetic risk factors for developing the disease. Women who have never had children or have had a late menopause are more likely to develop cancer of the ovary. Women with a close relative who developed ovarian cancer before the age of 50 are also at greater risk.
What are the symptoms?
Ovarian cancer rarely produces symptoms in the early stages, although there may be symptoms similar to those of an ovarian cyst, such as irregular periods. In most cases, symptoms occur only if the cancer has spread to other organs and may include:
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- Pain in the lower abdomen.
- Swelling in the abdomen caused by excess fluid.
- Frequent need to pass urine.
- Rarely, abnormal vaginal bleeding.
There may also be general symptoms of cancer, such as loss of weight, nausea, and vomiting. Left untreated, the cancer may spread to other organs in the body, such as the liver or lungs.
How is it diagnosed?
If a close relative has had cancer of the ovary, you should consult your about screening for this type of cancer. Screening may detect cancerous changes before symptoms develop and allows treatment to be given in the early stages of the disease. You may be offered ultrasound scanning (through the vagina to look for a tumour or blood tests to look for a specific protein that is produced by this cancer. Otherwise, if your doctor suspects cancer of the ovary, he or she will examine your abdomen for the presence of swellings or lumps. You may have an ultrasound scan of your ovaries and a laparoscopy. Other tests that may be carried out include a chest X-ray and CT scanning of the lungs or liver to see if the disease has spread.
What is the treatment?
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If cancer of the ovary is diagnosed in a woman who wishes to have children, usually only the affected ovary and fallopian tube are removed. If the cancer has spread to other parts of the reproductive tract or the woman does not wish to have children, a total hysterectomy may be performed, in which the uterus and both the fallopian tubes and ovaries are removed. Surgery is followed by chemotherapy to kill any remaining cancer cells. If the caner has spread to other organs in the body, radiotherapy may also be given. After treatment, blood tests and physical examinations are carried out regularly to check for recurrence.
What is the prognosis?
A complete recovery from cancer of the ovary is possible only if the condition is diagnosed and treated while in the early stages. However, the disease has spread in up to 3 in 4 women by the time of diagnosis. In these women, chemotherapy can prevent further spread of the cancer, sometimes for years, but it can rarely eliminate the cancer completely.
Read more…
The cause of cancer of the ovary is not known, but the tumour sometimes develops from an ovarian cyst. There seem to be hormonal and genetic risk factors for developing the disease. Women who have never had children or have had a late menopause are more likely to develop cancer of the ovary. Women with a close relative who developed ovarian cancer before the age of 50 are also at greater risk.
What are the symptoms?
Ovarian cancer rarely produces symptoms in the early stages, although there may be symptoms similar to those of an ovarian cyst, such as irregular periods. In most cases, symptoms occur only if the cancer has spread to other organs and may include:
- Pain in the lower abdomen.
- Swelling in the abdomen caused by excess fluid.
- Frequent need to pass urine.
- Rarely, abnormal vaginal bleeding.
There may also be general symptoms of cancer, such as loss of weight, nausea, and vomiting. Left untreated, the cancer may spread to other organs in the body, such as the liver or lungs.
How is it diagnosed?
If a close relative has had cancer of the ovary, you should consult your about screening for this type of cancer. Screening may detect cancerous changes before symptoms develop and allows treatment to be given in the early stages of the disease. You may be offered ultrasound scanning (through the vagina to look for a tumour or blood tests to look for a specific protein that is produced by this cancer. Otherwise, if your doctor suspects cancer of the ovary, he or she will examine your abdomen for the presence of swellings or lumps. You may have an ultrasound scan of your ovaries and a laparoscopy. Other tests that may be carried out include a chest X-ray and CT scanning of the lungs or liver to see if the disease has spread.
What is the treatment?
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If cancer of the ovary is diagnosed in a woman who wishes to have children, usually only the affected ovary and fallopian tube are removed. If the cancer has spread to other parts of the reproductive tract or the woman does not wish to have children, a total hysterectomy may be performed, in which the uterus and both the fallopian tubes and ovaries are removed. Surgery is followed by chemotherapy to kill any remaining cancer cells. If the caner has spread to other organs in the body, radiotherapy may also be given. After treatment, blood tests and physical examinations are carried out regularly to check for recurrence.
What is the prognosis?
A complete recovery from cancer of the ovary is possible only if the condition is diagnosed and treated while in the early stages. However, the disease has spread in up to 3 in 4 women by the time of diagnosis. In these women, chemotherapy can prevent further spread of the cancer, sometimes for years, but it can rarely eliminate the cancer completely.
Polycystic ovary syndrome
In polycystic ovary syndrome, both of the ovaries become enlarged with multiple, fluid-filled cysts. The condition is thought to be caused by an imbalance of sex hormones, sometimes by a relative excess of luteinizing hormone, produced by the pituitary gland, and of the male sex hormone testosterone. This imbalance may prevent ovulation (egg release), thus reducing fertility, and sometimes leads to the excessive growth of body hair.
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This syndrome is the most common female reproductive disorder, affecting about 1 in 20 women of childbearing age in the UK. The condition sometimes runs in families.
What are the symptoms?
The symptoms of polycystic ovary syndrome are variable. The condition may go unnoticed until a woman is tested for infertility. Symptoms include:
- Infrequent or absent periods.
- Obesity.
- Excessive hair growth.
Women with polycystic ovary syndrome have an increased risk of developing resistance to the action of the hormone insulin and this resistance may lead to diabetes mellitus. Women who are affected by the condition are also more likely to develop hypertension, coronary artery disease, and myocardial infraction.
What might be done?
If your doctor suspects that you have polycystic ovary syndrome, he or she will take blood samples to measure your levels of sex hormones and see if you have an imbalance. You may also have ultrasound scanning to look for ovarian cysts.
Treatment depends on the severity of your symptoms and whether you want to conceive. Infertility can be treated with drugs, such as clomiphene. If you do not want to have children, abnormal periods can be treated with a combined oral contraceptive pill.
To treat insulin resistance and reduce your risk of developing diabetes mellitus, your doctor may prescribe drugs such as melformin, which may also help to make
Read more…
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This syndrome is the most common female reproductive disorder, affecting about 1 in 20 women of childbearing age in the UK. The condition sometimes runs in families.
What are the symptoms?
The symptoms of polycystic ovary syndrome are variable. The condition may go unnoticed until a woman is tested for infertility. Symptoms include:
- Infrequent or absent periods.
- Obesity.
- Excessive hair growth.
Women with polycystic ovary syndrome have an increased risk of developing resistance to the action of the hormone insulin and this resistance may lead to diabetes mellitus. Women who are affected by the condition are also more likely to develop hypertension, coronary artery disease, and myocardial infraction.
What might be done?
If your doctor suspects that you have polycystic ovary syndrome, he or she will take blood samples to measure your levels of sex hormones and see if you have an imbalance. You may also have ultrasound scanning to look for ovarian cysts.
Treatment depends on the severity of your symptoms and whether you want to conceive. Infertility can be treated with drugs, such as clomiphene. If you do not want to have children, abnormal periods can be treated with a combined oral contraceptive pill.
To treat insulin resistance and reduce your risk of developing diabetes mellitus, your doctor may prescribe drugs such as melformin, which may also help to make
Ovarian cysts
Ovarian cysts are fluid-filled sacs that grow on or in the ovaries. Most ovarian cysts are noncancerous and not harmful, but a cyst may sometimes become cancerous. Cancerous cysts are more likely to develop in women over the age of 40.
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What are the types?
There are many types of ovarian cyst. The most common type is a follicular cyst, in which one of the follicles, where eggs develop, grows and fills with fluid. This type of ovarian cyst may grow to 5 cm (2 in) in diameter and usually occurs singly. Multiple small cysts that develop in the ovaries are thought to be caused by a hormonal disorder, and this condition is known as polycystic ovary syndrome.
Less commonly, cysts may form in the corpus luteum, the yellow tissue that develops from a follicle after the release of an egg. These cysts fill with blood and can grow to 3 cm.
A dermoid cyst is a cyst that contains cells that are normally found elsewhere in the body, such as skin and hair cells. A cystadenoma is a cyst that grows from one type of cell in the ovary. In rare cases, a single cystadenoma can fill the entire abdominal cavity.
What are the symptoms?
Most ovarian cysts do not cause symptoms, but when there are symptoms, they may include:
- Discomfort in the abdomen.
- Pain during sexual intercourse.
- Irregular periods, which sometimes have heavy blood loss.
- Postmenopausal bleeding.
Large cysts can put pressure on the bladder, leading to urinary retention or a frequent need to pass urine.
Are there complications?
If an ovarian cyst ruptures or becomes twisted, severe abdominal pain, nausea, and fever may develop. Cysts may grow so large that the abdomen is distended. In rare cases, a cyst producing the sex hormone oestrogen may develop before puberty, which leads to early sexual development. Some ovarian produce male sex hormones, which can cause the development of male characteristics, such as growth of facial hair.
What might be done?
Sometimes, ovarian cysts are only discovered when a pelvic examination is carried out during a routine checkup. If you have symptoms of a cyst, your doctor will perform a pelvic examination.
You may also be sent for ultrasound scanning or for a laparoscopy to confirm the diagnosis and the size and position of the cyst. You may also have blood tests to see if a cyst is cancerous.
Ovarian cysts may disappear without treatment, although the size of a cyst may be monitored with regular ultrasound scans. Large or persistent cysts may be drained or removed. If there is a chance that the cyst is cancerous, it will be removed, leaving the ovary and fallopian tube if possible. Ovarian cysts may recur if the ovary is not removed.
Read more…
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What are the types?
There are many types of ovarian cyst. The most common type is a follicular cyst, in which one of the follicles, where eggs develop, grows and fills with fluid. This type of ovarian cyst may grow to 5 cm (2 in) in diameter and usually occurs singly. Multiple small cysts that develop in the ovaries are thought to be caused by a hormonal disorder, and this condition is known as polycystic ovary syndrome.
Less commonly, cysts may form in the corpus luteum, the yellow tissue that develops from a follicle after the release of an egg. These cysts fill with blood and can grow to 3 cm.
A dermoid cyst is a cyst that contains cells that are normally found elsewhere in the body, such as skin and hair cells. A cystadenoma is a cyst that grows from one type of cell in the ovary. In rare cases, a single cystadenoma can fill the entire abdominal cavity.
What are the symptoms?
Most ovarian cysts do not cause symptoms, but when there are symptoms, they may include:
- Discomfort in the abdomen.
- Pain during sexual intercourse.
- Irregular periods, which sometimes have heavy blood loss.
- Postmenopausal bleeding.
Large cysts can put pressure on the bladder, leading to urinary retention or a frequent need to pass urine.
Are there complications?
If an ovarian cyst ruptures or becomes twisted, severe abdominal pain, nausea, and fever may develop. Cysts may grow so large that the abdomen is distended. In rare cases, a cyst producing the sex hormone oestrogen may develop before puberty, which leads to early sexual development. Some ovarian produce male sex hormones, which can cause the development of male characteristics, such as growth of facial hair.
What might be done?
Sometimes, ovarian cysts are only discovered when a pelvic examination is carried out during a routine checkup. If you have symptoms of a cyst, your doctor will perform a pelvic examination.
You may also be sent for ultrasound scanning or for a laparoscopy to confirm the diagnosis and the size and position of the cyst. You may also have blood tests to see if a cyst is cancerous.
Ovarian cysts may disappear without treatment, although the size of a cyst may be monitored with regular ultrasound scans. Large or persistent cysts may be drained or removed. If there is a chance that the cyst is cancerous, it will be removed, leaving the ovary and fallopian tube if possible. Ovarian cysts may recur if the ovary is not removed.
Endometriosis
The lining of the uterus, known as the endometrium, is normally shed once a month during menstruation and the regrows. In endometriosis, some pieces of the lining become attached to organs in the pelvic cavity, such as the ovaries and the lower intestine. The misplaced pieces of lining react to the hormones of menstrual cycle and bleed during periods. The blood cannot leave the body through the vagina and causes irritation of the surrounding tissues, leading to pain in the abdomen and eventually scarring. Irritation of the ovaries may lead to painful cysts.
Endometriosis is a common condition, affecting as many as 1 in 5 women of childbearing age. Women who do not have children until they are in their 30s and those who remain childless are more likely to develop the condition. Severe endometriosis can often cause problems with fertility.
The exact cause of endometriosis is not known, but there are many theories. One theory is that fragments of endometrium shed during menstruation do not leave the body in the usual way through the vagina. Instead, they travel along the fallopian tubes, from where they may pass into the pelvic cavity and become attached to the surfaces of nearly organs.
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What are the symptoms?
Endometriosis may not produce symptoms. If symptoms do develop, their severity varies from woman to woman. Symptoms may also vary depending on which organs are affected by the condition. They may include:
- Pain in the lower abdomen, which usually becomes more severe just before and during menstrual periods.
- Irregular periods or very heavy menstrual bleeding.
- Pain during sexual intercourse.
- Lower abdominal pain on urination.
If the endometrium grows on the lower intestine, you may develop diarrhoea or constipation, pain during bowel movements, and in rare cases, bleeding from the rectum during menstruation.
What might be done?
In women who do not have symptoms, endometriosis may only be suspected following investigations for infertility. To help make a diagnosis, your doctor will carry out a pelvic examination. The diagnosis may be confirmed with a laparoscopy (left), in which the organs in the pelvic and abdominal cavities are examined using a viewing instrument.
There are many different treatments for endometriosis, and the one chosen depends on your age, which organs are affected, the severity of symptoms, and whether you wish to have children in the future. You may be offered hormonal or surgical treatment. In mild cases, treatment may not be necessary.
If your symptoms are troublesome, your doctor may prescribe one of several different hormonal treatments that stop menstruation for several months. These drugs may include the synthetic hormone gonadorelin, gonadorelin analogues, and danazol, all of which suppress production of the female sex hormone oestrogen and have the effect of stopping menstruation. Alternatively, you may be given the combined oral contraceptive pill. This treatment is usually given for approximately 6 – 12 months, during which time the endometriosis should improve. If the condition does recur, it is usually milder than before.
Small fragments of endometrial tissue that do not respond to a period of hormonal treatment may be destroyed by laser surgery during a laparoscopy. However, endometriosis sometimes recurs after this treatment, and further operations may be necessary.
If you have severe endometriosis and you do not plan to have children or have gone through the menopause, your doctor may recommend that you have a hysterectomy to remove the uterus. Both ovaries will also be removed, together with other areas that are affected by endometriosis. If the ovaries are removed before you have reached the menopause naturally, you will develop menopausal symptoms. To alleviate these symptoms, your doctor will probably recommend hormone replacement therapy.
What is the prognosis?
Although treatment is usually successful, endometriosis may recur until the menopause occurs and the menstrual cycle ends. Endometriosis is unlikely to recur if the ovaries are removed.
LAPAROSCOPY
During laparoscopy, a rigid viewing instrument called a laparoscope is used to view the inside of the pelvis and the abdomen through small abdominal incisions. Laparoscopy may be used to look for disorders of the female reproductive organs, such as endometriosis, and to investigate other abdominal disorders, such as Appendicitis. Some types of surgery, such as female sterilization, may also be carried out during the procedure. Laparoscopy is always performed under general anaesthesia. Recovery is faster than after normal surgery due to the smaller incisions.
FEMALE STERILIZATION
Sterilization, by a method known as tubal ligation, is a permanent means of contraception for women who do not want any more children or for whom pregnancy would be harmful. The operation can be performed through two small incisions in the abdomen (laparoscopic sterilization) or single incision in the pubic area (minilaparotomy). The operation seals the fallopian tubes, usually by using clips or by cutting and typing them, so that sperm cannot travel through the tubes to fertilize eggs.
Read more…
Endometriosis is a common condition, affecting as many as 1 in 5 women of childbearing age. Women who do not have children until they are in their 30s and those who remain childless are more likely to develop the condition. Severe endometriosis can often cause problems with fertility.
The exact cause of endometriosis is not known, but there are many theories. One theory is that fragments of endometrium shed during menstruation do not leave the body in the usual way through the vagina. Instead, they travel along the fallopian tubes, from where they may pass into the pelvic cavity and become attached to the surfaces of nearly organs.
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What are the symptoms?
Endometriosis may not produce symptoms. If symptoms do develop, their severity varies from woman to woman. Symptoms may also vary depending on which organs are affected by the condition. They may include:
- Pain in the lower abdomen, which usually becomes more severe just before and during menstrual periods.
- Irregular periods or very heavy menstrual bleeding.
- Pain during sexual intercourse.
- Lower abdominal pain on urination.
If the endometrium grows on the lower intestine, you may develop diarrhoea or constipation, pain during bowel movements, and in rare cases, bleeding from the rectum during menstruation.
What might be done?
In women who do not have symptoms, endometriosis may only be suspected following investigations for infertility. To help make a diagnosis, your doctor will carry out a pelvic examination. The diagnosis may be confirmed with a laparoscopy (left), in which the organs in the pelvic and abdominal cavities are examined using a viewing instrument.
There are many different treatments for endometriosis, and the one chosen depends on your age, which organs are affected, the severity of symptoms, and whether you wish to have children in the future. You may be offered hormonal or surgical treatment. In mild cases, treatment may not be necessary.
If your symptoms are troublesome, your doctor may prescribe one of several different hormonal treatments that stop menstruation for several months. These drugs may include the synthetic hormone gonadorelin, gonadorelin analogues, and danazol, all of which suppress production of the female sex hormone oestrogen and have the effect of stopping menstruation. Alternatively, you may be given the combined oral contraceptive pill. This treatment is usually given for approximately 6 – 12 months, during which time the endometriosis should improve. If the condition does recur, it is usually milder than before.
Small fragments of endometrial tissue that do not respond to a period of hormonal treatment may be destroyed by laser surgery during a laparoscopy. However, endometriosis sometimes recurs after this treatment, and further operations may be necessary.
If you have severe endometriosis and you do not plan to have children or have gone through the menopause, your doctor may recommend that you have a hysterectomy to remove the uterus. Both ovaries will also be removed, together with other areas that are affected by endometriosis. If the ovaries are removed before you have reached the menopause naturally, you will develop menopausal symptoms. To alleviate these symptoms, your doctor will probably recommend hormone replacement therapy.
What is the prognosis?
Although treatment is usually successful, endometriosis may recur until the menopause occurs and the menstrual cycle ends. Endometriosis is unlikely to recur if the ovaries are removed.
LAPAROSCOPY
During laparoscopy, a rigid viewing instrument called a laparoscope is used to view the inside of the pelvis and the abdomen through small abdominal incisions. Laparoscopy may be used to look for disorders of the female reproductive organs, such as endometriosis, and to investigate other abdominal disorders, such as Appendicitis. Some types of surgery, such as female sterilization, may also be carried out during the procedure. Laparoscopy is always performed under general anaesthesia. Recovery is faster than after normal surgery due to the smaller incisions.
FEMALE STERILIZATION
Sterilization, by a method known as tubal ligation, is a permanent means of contraception for women who do not want any more children or for whom pregnancy would be harmful. The operation can be performed through two small incisions in the abdomen (laparoscopic sterilization) or single incision in the pubic area (minilaparotomy). The operation seals the fallopian tubes, usually by using clips or by cutting and typing them, so that sperm cannot travel through the tubes to fertilize eggs.
Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is a common cause of pain in the pelvic region in women. In this condition, some of the female reproductive organs become inflamed, usually as a result of an infection. Young and sexually active women are most likely to be affected. PID may have no obvious symptoms, and some women are unaware that they have had the condition until, years later, they are investigated for infertility.
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PID is usually caused by a sexually transmitted infection (STI), such as gonorrhoea or chlarmydial infection. PID may also be caused by an infection developing after a termination of pregnancy or after childbirth. In rare cases, tuberculosis can develop in the pelvis.
The infection spreads upwards from the vagina to the uterus and fallopian tube. The ovaries may also be affected. An intra-uterine contraceptive device (IUD)makes this spread of infection more likely. If you think you may have an infection, tests will usually be performed so that you can be treated before PID develops. When PID is discovered during investigations for infertility, the original cause may remain unknown.
What are the symptoms?
PID may have no obvious symptoms, especially when caused by Chlamydia. If there are symptoms, they may include:
- Pain in the pelvic region.
- Fever.
- An abnormal vaginal discharge.
- Heavy or prolonged periods.
- Pain during sexual intercourse.
- Tiredness.
If PID develops suddenly, you may have severe pain, nausea, and vomiting, and urgent hospital attention is required.
If the condition is not treated, the fallopian tubes may be damaged. The infection may also spread to other organs in the pelvis and the abdomen.
What might be done?
If your doctor suspects that you have PID, he or she will carry out a pelvic examination. Swabs may be taken from both the cervix and the vagina to identify the organisms causing the infection. Ultrasound scanning of the pelvis may also be performed. If you have severe symptoms, you will be admitted to hospital, and a laparoscopy may be performed to view the abdominal and pelvic cavities.
Your doctor will probably prescribe antibiotics, which will be given intravenously if you are in hospital. You may also be given painkillers.
You should not have sexual intercourse until your recovery is complete. Your sexual partner should have tests to look for sexually transmitted infections and should be treated (if necessary to prevent a reinfection). If you use an IUD, you may be advised to change to a different method of contraception.
If PID is detected and treated early, you should make a complete recovery. If PID is not treated, damage to the fallopian tubes can increase the risk of having an ectopic pregnancy or may lead to infertility.
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PID is usually caused by a sexually transmitted infection (STI), such as gonorrhoea or chlarmydial infection. PID may also be caused by an infection developing after a termination of pregnancy or after childbirth. In rare cases, tuberculosis can develop in the pelvis.
The infection spreads upwards from the vagina to the uterus and fallopian tube. The ovaries may also be affected. An intra-uterine contraceptive device (IUD)makes this spread of infection more likely. If you think you may have an infection, tests will usually be performed so that you can be treated before PID develops. When PID is discovered during investigations for infertility, the original cause may remain unknown.
What are the symptoms?
PID may have no obvious symptoms, especially when caused by Chlamydia. If there are symptoms, they may include:
- Pain in the pelvic region.
- Fever.
- An abnormal vaginal discharge.
- Heavy or prolonged periods.
- Pain during sexual intercourse.
- Tiredness.
If PID develops suddenly, you may have severe pain, nausea, and vomiting, and urgent hospital attention is required.
If the condition is not treated, the fallopian tubes may be damaged. The infection may also spread to other organs in the pelvis and the abdomen.
What might be done?
If your doctor suspects that you have PID, he or she will carry out a pelvic examination. Swabs may be taken from both the cervix and the vagina to identify the organisms causing the infection. Ultrasound scanning of the pelvis may also be performed. If you have severe symptoms, you will be admitted to hospital, and a laparoscopy may be performed to view the abdominal and pelvic cavities.
Your doctor will probably prescribe antibiotics, which will be given intravenously if you are in hospital. You may also be given painkillers.
You should not have sexual intercourse until your recovery is complete. Your sexual partner should have tests to look for sexually transmitted infections and should be treated (if necessary to prevent a reinfection). If you use an IUD, you may be advised to change to a different method of contraception.
If PID is detected and treated early, you should make a complete recovery. If PID is not treated, damage to the fallopian tubes can increase the risk of having an ectopic pregnancy or may lead to infertility.
Virilization
Normally, low levels of male sex hormones are present in females and are produced by the adrenal glands and the ovaries. However, if the production of these hormones increases significantly, various male characteristics begin to develop, a condition called virilization.
Virilization most commonly occurs in adulthood, causing symptoms such as deepening of the voice, excessive hair growth on the face and body known as hirsutism, and thinning of the hair on the temples and crown. These symptoms often cause psychological distress. Rarely, the condition is present at birth, virilization is usually due to a genetic disorder that causes abnormal hormones levels.
What are the causes?
When virilization develops later in life, the possible causes induce abnormalities of the ovaries, such as certain types of ovarian cysts, cancer of the ovary, and polycystic ovary syndrome. Hormone levels can also be increased by adrenal tumours and the use of certain male hormone supplements by athletes.
What are the symptoms?
Symptoms appear gradually as male sex hormone levels rise. They include:
- Excessive growth of hair on the face and body.
- Less regular or absent menstruation.
- Reduction in breast size or in rare cases failure of the breasts to develop.
- Enlargement of the clitoris.
- Irreversible enlargement of the larynx (Adam’s apple), causing the voice to become deeper.
- Thinning of the hair around the temples and crown.
The hormonal imbalance may lead to increased muscles development, producing a male body shape.
What may be done?
Your doctor will examine you and may arrange tests to determine the cause of your symptoms. These tests include blood tests to measure hormone levels, MRI or CT scanning to look for an adrenal tumour, and ultra-sound scanning to check the ovaries. Treatment of the cause, such as removal of a tumour, should reverse some of the changes. If no cause is found, oral contraceptives may be given to suppress hormone production by the ovaries and reduce male sex hormone levels. You may be given advice on how to manage excessive hair, perhaps by using electrolysis or waxing. Counseling is often helpful.
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Virilization most commonly occurs in adulthood, causing symptoms such as deepening of the voice, excessive hair growth on the face and body known as hirsutism, and thinning of the hair on the temples and crown. These symptoms often cause psychological distress. Rarely, the condition is present at birth, virilization is usually due to a genetic disorder that causes abnormal hormones levels.
What are the causes?
When virilization develops later in life, the possible causes induce abnormalities of the ovaries, such as certain types of ovarian cysts, cancer of the ovary, and polycystic ovary syndrome. Hormone levels can also be increased by adrenal tumours and the use of certain male hormone supplements by athletes.
What are the symptoms?
Symptoms appear gradually as male sex hormone levels rise. They include:
- Excessive growth of hair on the face and body.
- Less regular or absent menstruation.
- Reduction in breast size or in rare cases failure of the breasts to develop.
- Enlargement of the clitoris.
- Irreversible enlargement of the larynx (Adam’s apple), causing the voice to become deeper.
- Thinning of the hair around the temples and crown.
The hormonal imbalance may lead to increased muscles development, producing a male body shape.
What may be done?
Your doctor will examine you and may arrange tests to determine the cause of your symptoms. These tests include blood tests to measure hormone levels, MRI or CT scanning to look for an adrenal tumour, and ultra-sound scanning to check the ovaries. Treatment of the cause, such as removal of a tumour, should reverse some of the changes. If no cause is found, oral contraceptives may be given to suppress hormone production by the ovaries and reduce male sex hormone levels. You may be given advice on how to manage excessive hair, perhaps by using electrolysis or waxing. Counseling is often helpful.
Abnormal puberty in females
Puberty is the period during which sexual development occurs. In girls, puberty is characterized by a growth spurt, hair growth in the armpits and pubic region, the development of the breasts and reproductive organs, and the onset of menstruation. Although there is some variation in the age of onset of puberty, girls tend to start this process between the age of 10 and 14. Puberty may be considered abnormal if it starts either earlier than normal (precocious) or later (delayed).
Early puberty occurs if a girl develops breasts before the age of 8 or if menstruation starts before the age of 10. In extreme cases, puberty may begin at the age of 4.
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Puberty is delayed if menstruation has not started by the age of 16 or breast development is absent at the age of 14.
Early puberty is rare and may be due to a hormone disorder. Delayed puberty is more common. Although there may be an underlying cause of delayed puberty. Many girls who have not menstruated by the age of 16 are simply late developers, a tendency that often runs in families.
Abnormal puberty can be disturbing for a girl and her family because physical and sexual development will not coincide with that of her peers. Medical advice should be sought as soon as abnormal puberty is suspected.
What are the causes?
Puberty in girls is controlled by female sex hormones produced by the ovaries. The production of these hormones is controlled by hormones from the pituitary gland in the brain and from the hypothalamus (the part of the brain that regulates the pituitary gland). Disorders of any of these organs may lead to an abnormally early or late puberty.
Early puberty may be due to a disorder that causes a premature rise in sex hormones. For example, ovarian cyst developing in childhood may produce sex hormones, causing early sexual development. A tumour of the hypothalamus or damage to the pituitary gland as the result of head injury or an infection such as meningitis may also cause early puberty.
Delayed puberty may be caused by certain chromosome disorders, such as Turner’s syndrome, or less commonly by a pituitary tumour. Excessive weight or exercise may create a temporary hormonal imbalance that can lead to delayed puberty.
In many cases of abnormal puberty, no underlying cause is found.
What might be done?
The doctor will carry out an examination to determine whether puberty has started or how far it has progressed. A blood sample may be taken to measure hormone levels or check for a chromosomal abnormality. The doctor may also arrange for MRI or CT scanning of the brain to look for a pituitary tumour, or ultrasound scanning of the ovaries to check for cysts.
If there is an underlying condition, it will be treated. For example, an ovarian cyst will be surgically emoved. Hormonal treatment may be prescribed to suspend precocious puberty or to promote sexual development if puberty is delayed. In some cases, delayed puberty is associated with infertility, and further evaluation and treatment may be required in the future if a woman who has had a delayed puberty wants to have chidren.
Sometimes, puberty is simply late, and treatment is not necessary. Gaining weight and reducing strenuous activity may help if delayed puberty has been caused by weight loss or exercise.
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Early puberty occurs if a girl develops breasts before the age of 8 or if menstruation starts before the age of 10. In extreme cases, puberty may begin at the age of 4.
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Puberty is delayed if menstruation has not started by the age of 16 or breast development is absent at the age of 14.
Early puberty is rare and may be due to a hormone disorder. Delayed puberty is more common. Although there may be an underlying cause of delayed puberty. Many girls who have not menstruated by the age of 16 are simply late developers, a tendency that often runs in families.
Abnormal puberty can be disturbing for a girl and her family because physical and sexual development will not coincide with that of her peers. Medical advice should be sought as soon as abnormal puberty is suspected.
What are the causes?
Puberty in girls is controlled by female sex hormones produced by the ovaries. The production of these hormones is controlled by hormones from the pituitary gland in the brain and from the hypothalamus (the part of the brain that regulates the pituitary gland). Disorders of any of these organs may lead to an abnormally early or late puberty.
Early puberty may be due to a disorder that causes a premature rise in sex hormones. For example, ovarian cyst developing in childhood may produce sex hormones, causing early sexual development. A tumour of the hypothalamus or damage to the pituitary gland as the result of head injury or an infection such as meningitis may also cause early puberty.
Delayed puberty may be caused by certain chromosome disorders, such as Turner’s syndrome, or less commonly by a pituitary tumour. Excessive weight or exercise may create a temporary hormonal imbalance that can lead to delayed puberty.
In many cases of abnormal puberty, no underlying cause is found.
What might be done?
The doctor will carry out an examination to determine whether puberty has started or how far it has progressed. A blood sample may be taken to measure hormone levels or check for a chromosomal abnormality. The doctor may also arrange for MRI or CT scanning of the brain to look for a pituitary tumour, or ultrasound scanning of the ovaries to check for cysts.
If there is an underlying condition, it will be treated. For example, an ovarian cyst will be surgically emoved. Hormonal treatment may be prescribed to suspend precocious puberty or to promote sexual development if puberty is delayed. In some cases, delayed puberty is associated with infertility, and further evaluation and treatment may be required in the future if a woman who has had a delayed puberty wants to have chidren.
Sometimes, puberty is simply late, and treatment is not necessary. Gaining weight and reducing strenuous activity may help if delayed puberty has been caused by weight loss or exercise.
Hypogonadism in females
Female sex hormones control sexual development and the menstrual cycle. Underactivity of the ovaries, known as hypogonadism, leads to low levels of these hormones in the body. A decline in hormone levels occurs naturally during the menopause, but at other times it may indicate an underlying disorder. Hypogonadism may cause distressing symptoms but is often treatable.
What are the types?
There are two types of hypogonadism: primary and secondary. Either type can occur at any age. Primary hypogonadism is often caused by a disorder or failure of the ovaries, which may result from a chromosomal abnormality such as Turner’s syndrome. It may also be caused by the surgical removal of the ovaries. In most cases, primary hypogonadism occurs as a natural consequence of the menopause.
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Secondary hypogonadism is caused by an abnormality of the pituitary gland or of the hypothalamus (a part of the brain) that leads to underproduction of the hormones that stimulate the ovaries to function.
This abnormality may be due to a disorder such as a pituitary tumour or, rarely, to damage to the pituitary gland or the hypothalamus as a result of a head injury or an infection such as viral encephalitis. Sometimes, it results from excessive exercise or sudden weight loss.
What are the symptoms?
The symptoms depend on the age at which hypogonadism develops and the amount of sex hormones produced. If the onset occurs before puberty, hypogonadism causes abnormal puberty in females. If the onset occurs after puberty, symptoms may include:
- Reduced or absent menstruation.
- Reduced fertility.
- Hot flushed, excessive sweating, and anxiety, together with other symptoms associated with the menopause.
- Rarely, the pubic hair may recede and the breasts may become smaller.
There may also be other symptoms, depending on the underlying cause.
What might be done?
Your doctor may arrange for you to have blood tests to measure your hormone levels. You may also have CT scanning of the brain to look for a pituitary abnormality or ultrasound scanning of the ovaries.
The treatment depends on the cause. For example, a pituitary tumous may be removed by surgery. If the condition is due to weight loss, gaining weight may help. In some cases, hormone treatment may be prescribed to induce puberty. Hormone replacement therapy may be recommended for menopausal women to help to relieve symptoms of the menopause and protect against diseases associated with low levels of sex hormones, such as osteoporosis and coronary artery disease.
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What are the types?
There are two types of hypogonadism: primary and secondary. Either type can occur at any age. Primary hypogonadism is often caused by a disorder or failure of the ovaries, which may result from a chromosomal abnormality such as Turner’s syndrome. It may also be caused by the surgical removal of the ovaries. In most cases, primary hypogonadism occurs as a natural consequence of the menopause.
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Secondary hypogonadism is caused by an abnormality of the pituitary gland or of the hypothalamus (a part of the brain) that leads to underproduction of the hormones that stimulate the ovaries to function.
This abnormality may be due to a disorder such as a pituitary tumour or, rarely, to damage to the pituitary gland or the hypothalamus as a result of a head injury or an infection such as viral encephalitis. Sometimes, it results from excessive exercise or sudden weight loss.
What are the symptoms?
The symptoms depend on the age at which hypogonadism develops and the amount of sex hormones produced. If the onset occurs before puberty, hypogonadism causes abnormal puberty in females. If the onset occurs after puberty, symptoms may include:
- Reduced or absent menstruation.
- Reduced fertility.
- Hot flushed, excessive sweating, and anxiety, together with other symptoms associated with the menopause.
- Rarely, the pubic hair may recede and the breasts may become smaller.
There may also be other symptoms, depending on the underlying cause.
What might be done?
Your doctor may arrange for you to have blood tests to measure your hormone levels. You may also have CT scanning of the brain to look for a pituitary abnormality or ultrasound scanning of the ovaries.
The treatment depends on the cause. For example, a pituitary tumous may be removed by surgery. If the condition is due to weight loss, gaining weight may help. In some cases, hormone treatment may be prescribed to induce puberty. Hormone replacement therapy may be recommended for menopausal women to help to relieve symptoms of the menopause and protect against diseases associated with low levels of sex hormones, such as osteoporosis and coronary artery disease.
Postmenopausal bleeding
Menstrual bleeding should cease at the menopause. Postmenopausal bleeding is normal only with certain forms of hormone replacement therapy that cause withdrawal bleeding once a month. Other postmenopausal bleedings may be a sign of a serious disorder, such as cancer of the reproductive tract, and should be investigated by a doctor. Postmenopausal bleeding may range from light spotting to a heavier flow of blood and is usually painless.
What are the causes?
Postmenopausal bleeding can be a symptom of several disorders of the vulva, vagina, cervix, and uterus. The most common and least serious cause of such bleeding is atrophic vaginitis, in which the vagina becomes inflamed due to low levels of oestrogen after the menopause.
Postmenopausal bleeding could be caused by a disorder of the cervix, such as cervical erosion or cancer of the cervix. In these disorders, bleeding from the cervix may be more likely to occur after sexual intercourse. Postmenopausal bleeding may also be the result of a thickened endometrium (the lining of the uterus) or cancerous or non-cancerous growths in the uterus. Cancer of the vulva and vagina may also lead to postmenopausal bleeding, although both of these disorders are very rare.
What might be done?
Your doctor will examine the vagina and cervix to look for abnormalities. If abnormal areas are seen in the vagina, a small sample of tissue may be taken for examination under a microscope. Your doctor may also perform a cervical smear test to check for abnormal cells in the cervix. In some cases, a sample of endometrial tissue may be taken for analysis.
Ultrasound scanning may be carried out to image the uterus and to measure the thickness of the lining. The inside of your uterus may also be examined.
The treatment for postmenopausal bleeding varies depending on the underlying cause. Oestrogen creams that are applied to the vagina may be prescribed to relieve atrophic vaginitis. Surgery may be necessary to remove cancerous growths. Surgery may also be carried out to treat disorders of the cervix and uterus, such as cervical polyps or a thickened endometrium. Postmenopausal bleeding should cease once the underlying disorder has been treated.
ENDOMETRIAL SAMPLING
During endometrial sampling a small sample of tissue is removed from the endometrium (the lining of the uterus) to investigate symptoms such as heavy vaginal bleeding and to rule out cancer of the uterus. The sample is examined under a microscope for abnormalities. The procedure may be slightly uncomfortable but usually lasts for only a few minutes and does not require anaesthesia.
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What are the causes?
Postmenopausal bleeding can be a symptom of several disorders of the vulva, vagina, cervix, and uterus. The most common and least serious cause of such bleeding is atrophic vaginitis, in which the vagina becomes inflamed due to low levels of oestrogen after the menopause.
Postmenopausal bleeding could be caused by a disorder of the cervix, such as cervical erosion or cancer of the cervix. In these disorders, bleeding from the cervix may be more likely to occur after sexual intercourse. Postmenopausal bleeding may also be the result of a thickened endometrium (the lining of the uterus) or cancerous or non-cancerous growths in the uterus. Cancer of the vulva and vagina may also lead to postmenopausal bleeding, although both of these disorders are very rare.
What might be done?
Your doctor will examine the vagina and cervix to look for abnormalities. If abnormal areas are seen in the vagina, a small sample of tissue may be taken for examination under a microscope. Your doctor may also perform a cervical smear test to check for abnormal cells in the cervix. In some cases, a sample of endometrial tissue may be taken for analysis.
Ultrasound scanning may be carried out to image the uterus and to measure the thickness of the lining. The inside of your uterus may also be examined.
The treatment for postmenopausal bleeding varies depending on the underlying cause. Oestrogen creams that are applied to the vagina may be prescribed to relieve atrophic vaginitis. Surgery may be necessary to remove cancerous growths. Surgery may also be carried out to treat disorders of the cervix and uterus, such as cervical polyps or a thickened endometrium. Postmenopausal bleeding should cease once the underlying disorder has been treated.
ENDOMETRIAL SAMPLING
During endometrial sampling a small sample of tissue is removed from the endometrium (the lining of the uterus) to investigate symptoms such as heavy vaginal bleeding and to rule out cancer of the uterus. The sample is examined under a microscope for abnormalities. The procedure may be slightly uncomfortable but usually lasts for only a few minutes and does not require anaesthesia.
Menopausal problems
The menopause, the time at which a woman stops menstruating, is a normal consequence of the aging process. More than 8 in 10 women feel well throughout the menopause or experience only mild symptoms, but some women have severe problems that affect their lifestyle.
The onset of the menopause usually occurs between the age of 45 and 55, although some women develop symptoms before or after this time. Smoking can lower the age at which the menopause takes place. A woman is generally considered to be menopausal if she has not had a period for at least 6 months and there is no other underlying cause. The tendency to have either an early or late menopause can run in families.
What are the causes?
As women age, their ovaries gradually become less active and produce smaller amounts of the sex hormone oestrogen. The menopause occurs as a result of this reduction in oestrogen levels. As levels of oestrogen in the body decline, the pituitary gland begins to secrete more follicle-stimulate hormone (FSH) to try to stimulate the ovaries. Most of the symptoms associated with the menopause are a consequence of the reduced levels of oestrogen or increased levels of FSH. These tend to be more severe when the menopause takes place prematurely or abruptly. A sudden menopause can be brought about by surgical removal of the ovaries or anticancer treatments that can damage the ovaries, such as chemotherapy and radiotherapy.
What are the symptoms?
Menopausal symptoms may begin up to 5 years before menstruation finally stops and usually last for a year or two. Many women find that one of the first signs of the menopause is, irregularity in their menstrual cycle. Menstrual bleeding may also become heavier. Increased levels of FSH in the body cause many of the other common symptoms that can occur during the menopause. These include:
- Hot flushes, in which the head, chest, and arms become red and feel hot, lasting from a couple of minutes to as long as an hour.
- Heavy sweating, which is often especially troublesome at night.
- Feelings of anxiety, panic, or depression, which may be made worse if the menopause coincides with a stressful life event such as the departure of adult children from the home.
The longer-term effects of a decline in oestrogen levels include:
- Drying of the skin, which encourages the formation of wrinkles.
- Vaginal dryness and discomfort during sexual intercourse as a result of thinning of the lining of the vagina.
- Urinary infections that occur due to thinning of the lining of the urethra (the passage leading from the bladder to the outside of the body).
The decline in oestrogen levels following the menopause may also increase your risk of developing certain long-term conditions, such as coronary artery disease and age-related thinning of the bones.
What may be done?
Hormone replacement therapy, commonly known as HRT, may help to relieve many of the symptoms that occur at the menopause by boosting the levels of oestrogen in the body and reducing the production of FSH. Your doctor may prescribe HRT as pills, implants under the skin, or skin patches. To achieve maximum benefit, HRT is usually given for at least 5 years. However, long-term use may carry certain risks, which you should discuss with your doctor.
Alternative treatments are available in the form of oestrogen creams, which help to control vaginal dryness and discomfort, and the drug clonidine, which can be used to relieve hot flushes. Some women find complementary therapies, such as homeopathy, helpful.
The process of the menopause normally lasts between 1 and 5 years, after which symptoms usually disappear.
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The onset of the menopause usually occurs between the age of 45 and 55, although some women develop symptoms before or after this time. Smoking can lower the age at which the menopause takes place. A woman is generally considered to be menopausal if she has not had a period for at least 6 months and there is no other underlying cause. The tendency to have either an early or late menopause can run in families.
What are the causes?
As women age, their ovaries gradually become less active and produce smaller amounts of the sex hormone oestrogen. The menopause occurs as a result of this reduction in oestrogen levels. As levels of oestrogen in the body decline, the pituitary gland begins to secrete more follicle-stimulate hormone (FSH) to try to stimulate the ovaries. Most of the symptoms associated with the menopause are a consequence of the reduced levels of oestrogen or increased levels of FSH. These tend to be more severe when the menopause takes place prematurely or abruptly. A sudden menopause can be brought about by surgical removal of the ovaries or anticancer treatments that can damage the ovaries, such as chemotherapy and radiotherapy.
What are the symptoms?
Menopausal symptoms may begin up to 5 years before menstruation finally stops and usually last for a year or two. Many women find that one of the first signs of the menopause is, irregularity in their menstrual cycle. Menstrual bleeding may also become heavier. Increased levels of FSH in the body cause many of the other common symptoms that can occur during the menopause. These include:
- Hot flushes, in which the head, chest, and arms become red and feel hot, lasting from a couple of minutes to as long as an hour.
- Heavy sweating, which is often especially troublesome at night.
- Feelings of anxiety, panic, or depression, which may be made worse if the menopause coincides with a stressful life event such as the departure of adult children from the home.
The longer-term effects of a decline in oestrogen levels include:
- Drying of the skin, which encourages the formation of wrinkles.
- Vaginal dryness and discomfort during sexual intercourse as a result of thinning of the lining of the vagina.
- Urinary infections that occur due to thinning of the lining of the urethra (the passage leading from the bladder to the outside of the body).
The decline in oestrogen levels following the menopause may also increase your risk of developing certain long-term conditions, such as coronary artery disease and age-related thinning of the bones.
What may be done?
Hormone replacement therapy, commonly known as HRT, may help to relieve many of the symptoms that occur at the menopause by boosting the levels of oestrogen in the body and reducing the production of FSH. Your doctor may prescribe HRT as pills, implants under the skin, or skin patches. To achieve maximum benefit, HRT is usually given for at least 5 years. However, long-term use may carry certain risks, which you should discuss with your doctor.
Alternative treatments are available in the form of oestrogen creams, which help to control vaginal dryness and discomfort, and the drug clonidine, which can be used to relieve hot flushes. Some women find complementary therapies, such as homeopathy, helpful.
The process of the menopause normally lasts between 1 and 5 years, after which symptoms usually disappear.
Abnormal vaginal bleeding
What are the causes?
Light bleeding between periods, known as spotting, is common in the first few menstrual cycles after starting oral contraceptives or changing to a different type of pill. Spotting is usually brought on by the body adjusting to changes in hormone levels, but this type of bleeding is also associated with using an intra-uterine contraceptive device (IUD).
Abnormal bleeding, especially within a few hours of sexual intercourse, may indicate a disorder of the cervix, such as cervical erosion or cancer of the cervix. In older women, sex may damage the walls of the vagina, which become thinner and more fragile after the menopause, causing bleeding.
Abnormal vaginal bleeding that is not associated with sexual intercourse or contraception may be caused by a disorder such as endometriosis or uterine polyps. Loss of blood from the uterus can also occur in early pregnancy and could indicate a miscarriage. Various disorders of the female reproductive organs may cause post-menopausal bleeding, such as cancer of the uterus.
If you notice abnormal bleeding, you should see your doctor immediately so that the cause can be investigated.
What might be done?
Your doctor may be able to make a diagnosis based on the timing of the bleeding and a physical examination. You may also need to have tests, such as a cervical smear test to check for disorders of the cervix, ultrasound scanning to look for at the uterus, or endoscopy to view the inside of the uterus.
The treatment for abnormal vaginal bleeding depends on the cause. Spotting caused by oral contraceptives may be prevented by changing the dose or type of pill. Hormone treatments can be used to restore the elasticity of fragile vaginal walls in older women. Surgery may be required to treat more serious underlying disorders. In most cases, abnormal vaginal bleeding disappears once the cause has been successfully treated.
Premenstrual syndrome
The cause of PMS is disrupted, but it is thought that the symptoms are triggered by the action of the female sex hormones oestrogen and progesterone before menstruation. Stress may make the symptoms worse, as may excessive consumption of chocolate and caffeine containing drinks, such as coffee and cola. A women is more likely to have severe symptoms of PMS if close relatives have experienced similar problems, although no specific genetic factors have as yet been identified.
What are the symptoms?
The symptoms of PMS vary between women, and some women find that the symptoms also differ from month to month. Symptoms may appear just a few hours before a period begins, but they can start up to 14 days beforehand. In most affected women, the symptoms disappear by the time menstruation has finished or a few days afterwards.
The symptoms of PMS may include:
- Tenderness or generalized lumpiness of the breasts.
- A feeling of bloating caused by the retention of fluid.
- Mood changes, including feelings of tension, irritability, depression, anxiety, and tiredness.
- Difficulty concentrating and making everyday decisions.
- Headaches, including migraine.
- Backache and muscle stiffness.
- Disruption of normal sleep patterns.
- Unusual food cravings.
Less commonly, nausea, vomiting, cold sweats, dizziness, and hot flushes may also be experienced.
What may be done?
The diagnosis of PMS is usually easily made from the timing of your symptoms. Your doctor may ask you to keep a record of symptoms to confirm that they are related to menstruation.
There are a number of self-help measures you can take to try to prevent PMS. If there are not effective or your symptoms are severe, you should seek medical advice. Certain painkillers, such as ibuprofen, can help to relieve headaches and muscle stiffness. If you experience mood swings, your doctor may prescribe antidepressant drugs, which may be more effective if taken throughout the menstrual cycle. Diuretic drugs may help to relieve fluid retention. Your doctor may also prescribe treatment with the hormone progesterone. No treatment is consistently successful, but the symptoms can usually be relieved.
PREVENTING PREMENSTRUAL SYNDROME
The following self-help measures may help either to prevent or to relieve premenstrual syndrome. If these measures do not help and you have persistent symptoms, visit your doctor for advice.
- Relax as much as possible and try to avoid stress.
- Try taking up a light, relaxing exercise, such as yoga.
- Take warm baths.
- Eat little and often, making sure your diet includes plenty of carbohydrates and fibre.
- Try to reduce your salt intake.
- Avoid eating excessive amounts of chocolate.
- Avoid drinks containing large amounts of caffeine, such as coffee, tea, and cola.
- A vitamin B6 supplement may be helpful, although very high doses can be harmful.
- Evening primrose oil capsules are often effective, especially in relieving breast tenderness.
Dysmenorrhoea
Up to three-quarters of women have period pain, also known as dysmenorrhoea, at some time. In about a fifth of these women, the pain is severe and can seriously disrupt normal activities. Pain is usually experienced in the 24 hours before menstruation or over the first 1 or 2 days of the period.
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What are the types?
There are two types of dysmenorrhoea; primary, which has no obvious cause; and secondary, which is the result of a disorder of the reproductive organs.
Primary dysmenorrhoea. This form of dysmenorrhoea usually appears in the early teens and is associated with the hormones involved in the monthly release of eggs from the ovaries. Periods often become painful about 1 -2 years after the start of menstruation, when ovulation begins. A rise in the level of hormone-like substances called prostaglandins in the body occurs some days after ovulation and makes the muscles of the uterus contract. This contraction interferes with the blood supply to the uterus and causes period pain. This type of menstrual pain tends to lessen after the age of 25, often disappearing by the age of 30, and it usually becomes less severe after childbirth, probably because the blood supply to the uterus increases.
Women with close female relatives who have had primary dysmenorrhoea are more likely to develop it, suggesting that genetic factors are involved.
Secondary dysmenorrhoea. Painful periods in women who have not experienced menstrual pain before or have only had mild pain is called secondary dysmenorrhoea. This type of period pain usually affects women between the ages of 20 and 40. The cause is often endometriosis, in which fragments of the tissue that normally lines the uterus become attached to other organs in the pelvis, or a disorder of the uterus, such as a fibroids. A persistent infection of the reproductive organs and use of an intra-uterine contraceptive device (IUD) may also cause painful periods.
What are the symptoms?
The symptoms of dysmenorrhoea begin either just before or at the start of menstruation and are worst when bleeding is heaviest. The pain may be described as either or both of the following:
- Cramping lower abdominal pain that comes in waves, radiating to the lower back and down the legs.
- Dragging pain in the pelvis.
This pain may be accompanied by any of the symptoms of premenstrual syndrome (right), such as headache.
What can I do?
Taking certain over-the-counter painkillers, such as ibuprofen, may help to alleviate the discomfort. Relaxing in a hot bath and applying a source of heat, such as a hot-water bottle, to your abdomen may also provide pain relief. However, consult your doctor if you are experiencing period pain for the first time or if the pain becomes severe.
What might the doctor do?
Your doctor will probably examine you, especially if you have secondary dysmenorrhoea. Various tests may be carried out, including a cervical swab to look for infection, ultrasound scanning of the lower abdomen, or examination of the uterus with an instrument called a hysteroscope.
Treatment depends on the type of dysmenorroea. If you have primary dysmenorrhoea, your doctor may prescribe a nonsteroidal anti-inflammatory drug or an anti-spasmodic drug to reduce cramping pain. In some cases, your doctor may prescribe oral contraceptive pills, which relieve period pain by preventing ovulation and can also decrease menstrual blood loss. Once ovulation has been suppressed, primary dysmenorrhoea should improve, but the pain may recur at any time if you stop treatment. Secondary dysmenorrhoea usually disappears once the underlying condition is treated.
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What are the types?
There are two types of dysmenorrhoea; primary, which has no obvious cause; and secondary, which is the result of a disorder of the reproductive organs.
Primary dysmenorrhoea. This form of dysmenorrhoea usually appears in the early teens and is associated with the hormones involved in the monthly release of eggs from the ovaries. Periods often become painful about 1 -2 years after the start of menstruation, when ovulation begins. A rise in the level of hormone-like substances called prostaglandins in the body occurs some days after ovulation and makes the muscles of the uterus contract. This contraction interferes with the blood supply to the uterus and causes period pain. This type of menstrual pain tends to lessen after the age of 25, often disappearing by the age of 30, and it usually becomes less severe after childbirth, probably because the blood supply to the uterus increases.
Women with close female relatives who have had primary dysmenorrhoea are more likely to develop it, suggesting that genetic factors are involved.
Secondary dysmenorrhoea. Painful periods in women who have not experienced menstrual pain before or have only had mild pain is called secondary dysmenorrhoea. This type of period pain usually affects women between the ages of 20 and 40. The cause is often endometriosis, in which fragments of the tissue that normally lines the uterus become attached to other organs in the pelvis, or a disorder of the uterus, such as a fibroids. A persistent infection of the reproductive organs and use of an intra-uterine contraceptive device (IUD) may also cause painful periods.
What are the symptoms?
The symptoms of dysmenorrhoea begin either just before or at the start of menstruation and are worst when bleeding is heaviest. The pain may be described as either or both of the following:
- Cramping lower abdominal pain that comes in waves, radiating to the lower back and down the legs.
- Dragging pain in the pelvis.
This pain may be accompanied by any of the symptoms of premenstrual syndrome (right), such as headache.
What can I do?
Taking certain over-the-counter painkillers, such as ibuprofen, may help to alleviate the discomfort. Relaxing in a hot bath and applying a source of heat, such as a hot-water bottle, to your abdomen may also provide pain relief. However, consult your doctor if you are experiencing period pain for the first time or if the pain becomes severe.
What might the doctor do?
Your doctor will probably examine you, especially if you have secondary dysmenorrhoea. Various tests may be carried out, including a cervical swab to look for infection, ultrasound scanning of the lower abdomen, or examination of the uterus with an instrument called a hysteroscope.
Treatment depends on the type of dysmenorroea. If you have primary dysmenorrhoea, your doctor may prescribe a nonsteroidal anti-inflammatory drug or an anti-spasmodic drug to reduce cramping pain. In some cases, your doctor may prescribe oral contraceptive pills, which relieve period pain by preventing ovulation and can also decrease menstrual blood loss. Once ovulation has been suppressed, primary dysmenorrhoea should improve, but the pain may recur at any time if you stop treatment. Secondary dysmenorrhoea usually disappears once the underlying condition is treated.
Menorrhagia
What are the causes?
Heavy or prolonged menstrual bleeding can be a symptom of various disorders of the uterus, such as fibroids, uterine polyps, or cancer of the uterus. Menorrhagia is also a well-known side effect of using an intra-uterine contraceptive device (IUD). A single heavy period that is late may be a miscarriage. Menorrhagia may also be caused by a hormonal disorder, such as hypothyroidism. The condition occurs more commonly in women who are overweight.
Sometimes, the cause is not clear. If your periods have always been heavy, there is probably no need for concern. However, you should consult your doctor if the problem affects your lifestyle.
How is it diagnosed?
Your doctor will examine you and may arrange for blood tests to measure your hormone levels and to look for signs of anaemia. Further investigations, such as ultrasound scanning to look for fibroids or polyps in the uterus, may be necessary. You may also have a hysteroscopy, in which a viewing in instrument is passed through the cervix to examine the uterus. A small sample of the endometrium (the lining of the uterus) may be taken for analysis.
What is the treatment?
Treatment depends on the cause, your age, and the severity of the bleeding. Any underlying disorder will be treated. If no cause is found, drugs may initially be given to reduce blood loss. You may want to consider changing your method of contraception if you use an IUD. If you are overweight, losing weight may help.
If initial treatments do not help or if menorrhagia is severe, you may require laser surgery to remove the endometrium or an operation to remove the uterus. These procedures are irreversible and are only offered to women who do not want to have children in the future. Laser removal of the endometrium is a minor procedure, but it carries a small risk that problems will recur if any endometrial tissue remains. A hysterectomy is a major operation but ensures that menorrhagia will not recur.
Amenorrhoea
There are two types of amenorrhoea: primary and secondary. If a girl has not started to menstruate by the age of 16, she is said to have primary amenorrhoea. Once menstruation has become established during puberty, it is normal for periods to stop during pregnancy, for a few months following childbirth, while breast-feeding, temporarily after ceasing to take oral contraceptive pills, and permanently at the menopause. If menstruation stops at any other time for at least 3 months, the condition is known as secondary amenorrhoea.
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What are the causes?
Amenorrhoea is often caused by a disturbance in the female sex hormones, which may be brought on by factors such as stress or depression. Excessive exercise and extreme or sudden weight loss may also lead to such hormonal disturbances and are common causes of amenorrhoea in athletes, gymnasts, and ballet dancers. Hormonal changes may lead to primary or secondary amenorrhoea, depending on when they occur.
Primary amenorrhoea is a characteristic feature of delayed puberty and may be caused by a chromosomal abnormality. The failure of menstruation to start at puberty may also be due to a condition in which the hymen (the thin membrane over the vagina) has no opening and menstrual blood cannot leave the body. In rare cases, the uterus is absent from birth, and therefore no menstruation can occur.
Secondary amenorrhoea may be due to a pituitary gland disorder, such as a pituitary tumour. Some women have a premature menopause, in which periods cease before the age of 33. Other possible causes include disorders of the ovaries, such as polycystic ovary syndrome, and treatments such as radiotherapy and chemotherapy, which can result in damage to the ovaries.
What might be done?
Treatment is not needed if amenorrhoea lasts for only a few months after stopping oral contraceptive pills or occurs during pregnancy or breast-feeding. Menstruation normally resumes within a few months of giving birth if you are not breast-feeding or within a month of stopping breast-feeding. After the menopause, amenorrhoea will be permanent.
Amenorrhoea that occurs at any other time should be investigated. Your doctor will examine you and may perform a pregnancy test. You may also need to have blood tests to measure hormone levels, ultrasound scanning of the ovaries and uterus, and CT scanning of the pituitary gland.
Treatment of the underlying disorder induces menstruation in most cases. If the cause cannot be treated, hormonal treatment may be used to start menstruation. If periods are absent due to stress, weight loss, or excessive exercise, they should occur if the problem is overcome.
Read more…
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What are the causes?
Amenorrhoea is often caused by a disturbance in the female sex hormones, which may be brought on by factors such as stress or depression. Excessive exercise and extreme or sudden weight loss may also lead to such hormonal disturbances and are common causes of amenorrhoea in athletes, gymnasts, and ballet dancers. Hormonal changes may lead to primary or secondary amenorrhoea, depending on when they occur.
Primary amenorrhoea is a characteristic feature of delayed puberty and may be caused by a chromosomal abnormality. The failure of menstruation to start at puberty may also be due to a condition in which the hymen (the thin membrane over the vagina) has no opening and menstrual blood cannot leave the body. In rare cases, the uterus is absent from birth, and therefore no menstruation can occur.
Secondary amenorrhoea may be due to a pituitary gland disorder, such as a pituitary tumour. Some women have a premature menopause, in which periods cease before the age of 33. Other possible causes include disorders of the ovaries, such as polycystic ovary syndrome, and treatments such as radiotherapy and chemotherapy, which can result in damage to the ovaries.
What might be done?
Treatment is not needed if amenorrhoea lasts for only a few months after stopping oral contraceptive pills or occurs during pregnancy or breast-feeding. Menstruation normally resumes within a few months of giving birth if you are not breast-feeding or within a month of stopping breast-feeding. After the menopause, amenorrhoea will be permanent.
Amenorrhoea that occurs at any other time should be investigated. Your doctor will examine you and may perform a pregnancy test. You may also need to have blood tests to measure hormone levels, ultrasound scanning of the ovaries and uterus, and CT scanning of the pituitary gland.
Treatment of the underlying disorder induces menstruation in most cases. If the cause cannot be treated, hormonal treatment may be used to start menstruation. If periods are absent due to stress, weight loss, or excessive exercise, they should occur if the problem is overcome.
Irregular periods
Periods start at puberty and continue until the menopause. The average menstrual cycle lasts 28 days, but periods may occur as often as every 24 days or as infrequently as every 35 days. After puberty, most women develop a regular menstrual cycle with a relatively consistent length of time between periods. In some women, however, periods remain irregular. Menstrual bleeding normally lasts between 2 and 7 days, with the average length of bleeding being 5 days.
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What are the causes?
Variations in the length of the menstrual cycle are usually the result of a temporary hormonal imbalance. Fluctuations in hormone levels during puberty mean that periods are often irregular when they first start, and wide variations in a woman’s normal pattern of bleeding are common in the first few months following childbirth and with the approach of the menopause.
Hormonal imbalances at other times may be caused by factors such as stress, depression, and severe or long-term illness. Excessive exercise and extreme loss of weight are also common causes of hormonal disturbance that can cause menstruation to become irregular.
Occasionally, irregular menstruation may be a symptom of a disorder of the ovaries or of the uterus. For example, polycystic ovary syndrome, in which there is an imbalance of the sex hormones, or endometriosis, in which fragments of the tissue that normally lines the uterus are displaced and become attached to other organs in the pelvis, may disrupt periods.
In some cases, an unsuspected pregnancy produces irregular bleeding that could easily be mistaken for a period. A single, late, heavy period may be due to a miscarriage. If you have a late period that is accompanied by severe abdominal pain, you should seek medical attention urgently because it may be due to an ectopic pregnancy. In some cases, the cause of irregular menstruation is unknown.
What might be done?
Irregular periods due to the normal hormonal changes that follow puberty or childbirth usually become more regular with time. In women who are approaching the menopause, irregular periods will eventually cease altogether. In all these cases, treatment is not usually necessary. However, if the problem persists and interferes with a woman’s lifestyle, drugs may be given to regulate menstruation. These drugs include oral contraceptives for younger women and hormone replacement therapy for women near menopause. Irregular menstruation that is due to extreme weight loss, excessive exercise, stress, or depression should become more regular once these problems have been overcome.
If there is no obvious cause for your irregular periods and no apparent pattern to menstrual bleeding, your doctor may arrange for you to have tests to look for underlying disorder. These may include a pregnancy test, blood tests to measure hormone levels, and ultrasound scanning of the pelvic region to look at the ovaries and uterus. If an underlying disorder is discovered, treatment of that disorder should regulate periods in most cases.
Read more…
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What are the causes?
Variations in the length of the menstrual cycle are usually the result of a temporary hormonal imbalance. Fluctuations in hormone levels during puberty mean that periods are often irregular when they first start, and wide variations in a woman’s normal pattern of bleeding are common in the first few months following childbirth and with the approach of the menopause.
Hormonal imbalances at other times may be caused by factors such as stress, depression, and severe or long-term illness. Excessive exercise and extreme loss of weight are also common causes of hormonal disturbance that can cause menstruation to become irregular.
Occasionally, irregular menstruation may be a symptom of a disorder of the ovaries or of the uterus. For example, polycystic ovary syndrome, in which there is an imbalance of the sex hormones, or endometriosis, in which fragments of the tissue that normally lines the uterus are displaced and become attached to other organs in the pelvis, may disrupt periods.
In some cases, an unsuspected pregnancy produces irregular bleeding that could easily be mistaken for a period. A single, late, heavy period may be due to a miscarriage. If you have a late period that is accompanied by severe abdominal pain, you should seek medical attention urgently because it may be due to an ectopic pregnancy. In some cases, the cause of irregular menstruation is unknown.
What might be done?
Irregular periods due to the normal hormonal changes that follow puberty or childbirth usually become more regular with time. In women who are approaching the menopause, irregular periods will eventually cease altogether. In all these cases, treatment is not usually necessary. However, if the problem persists and interferes with a woman’s lifestyle, drugs may be given to regulate menstruation. These drugs include oral contraceptives for younger women and hormone replacement therapy for women near menopause. Irregular menstruation that is due to extreme weight loss, excessive exercise, stress, or depression should become more regular once these problems have been overcome.
If there is no obvious cause for your irregular periods and no apparent pattern to menstrual bleeding, your doctor may arrange for you to have tests to look for underlying disorder. These may include a pregnancy test, blood tests to measure hormone levels, and ultrasound scanning of the pelvic region to look at the ovaries and uterus. If an underlying disorder is discovered, treatment of that disorder should regulate periods in most cases.
