Gynaecology

Symptoms of Heavy Menstrual Bleeding
A clinical diagnosis of heavy menstrual bleeding (HMB) is made when blood loss is more than 80mls or lasts for more than 7 days. However HMB is generally described as bleeding that interferes with a woman’s quality of life. Significant blood loss would be indicated by a woman having to change her protection at night or flooding through double protection. Every year around 5% of the female population aged between 30 and 50 years consult their general practitioners with heavy menstrual bleeding or menorrhagia.

What investigations might be required?
You will be initially seen by the Consultant who will take a full history and perform an internal examination. You may then be referred for an ultrasound scan or possibly a hysteroscopy (a keyhole examination of the inside of the uterus). Please see the information section for further details on ultrasound scans and hysteroscopy. A blood test will be taken to assess whether you are anaemic or not.

What treatments are available?
Some women will be reassured if the investigations are normal and opt to have no treatment. For those wanting further help with their periods, the treatment options are detailed below. Women will be able to choose the therapy that is right for them after a full discussion with their Consultant.

Hormonal treatments
The Mirena™ system is inserted into the uterus like an intra-uterine device. It releases a hormone called levonorgestrel which reduces menstrual loss in up to 90% of women. It has the advantage that it is also an excellent contraceptive. Side-effects can be troublesome and consist of irregular bleeding lasting up to 6 months, breast tenderness, headaches, acne and mood changes.

The combined oral contraceptive pill (COCP). Again, this is a contraceptive, but also has possible side-effects of headaches, mood changes and weight gain. More rarely women can suffer a deep vein thrombosis on this treatment; for this reason women over the age of 35 years of age who smoke should not be prescribed the COCP.

Injectable or oral progestogens. These medications can cause irregular bleeding and other side-effects of weight gain, headaches and breast tenderness. They do not increase the risk of thrombosis however.

Gonadotrophin releasing hormone analogues are given by monthly injection or as a nasal spray. They make a woman menopausal for the length of the treatment and therefore can have the side-effects of hot sweats and flushes, vaginal dryness and joint aches. These symptoms can be offset by giving a small amount of hormone replacement therapy (HRT) at the same time.

Non-hormonal treatments
Tranexamic acid reduces the amount of blood lost by 50%. Possible side-effects are rare, but consist of nausea and headaches. This medication is generally given for 3 months and stopped at this point if no improvement has been seen. It can be used in conjunction with one of the hormonal methods outlined above.

Mefenamic acid is a non-steroidal anti-inflammatory drug which is especially useful if a woman has pain associated with her periods

Chronic pelvic pain is a common problem affecting women of any age. The pain can occur on a regular cycle or may only occur at certain times ie before and after eating, while urinating, during the menstrual period. Chronic pelvic pain can often disrupt a woman’s work, movements, sexual relationships, sleep and family duties and lead to long-term problems in a woman’s menstrual and clinical health. If pelvic pain lasts for more than 6 months then it is advisable that you consult your doctor to identify an underlying cause.

The causes of pelvic pain are varied. Chronic pelvic pain can lead to conditions such as endometriosis or fibroids. It may also be secondary to bowel, urinary or musculo-skeletal problems. Because there are varied causes of pelvic pain the process of identifying the underlying problem may be complex and time consuming. Preliminary tests required would include an ultrasound scan and if underlying gynaecological problems were suspected a laparoscopy in order to view the pelvic organs and determine whether there is a gynaecological cause for the problem.

What treatments are available?
Treatment options vary between the conservative, medical and surgical options.

Conservative treatments consist of pain relief and chronic pain management strategies. Many women find treatments such as aromatherapy and acupuncture very useful.

Medical treatments all aim to suppress the menstrual cycle and stop ovulation. Therefore, while they are useful in the treatment of pelvic pain, medical options have no place in the management of the infertile patient with endometriosis. The common medical therapies consist of the combined oral contraceptive pill (COCP), progestogens or Gonadotrophin-releasing hormone antagonists. There are a numbers of newer drugs that look promising which are still being assessed. Most of the different drugs have similar success rates with the choice of treatment largely being governed by the side-effects of the hormones. There is a relatively high recurrence rate of symptoms after treatment is stopped.

Surgery is usually performed laparoscopically. The aim of treatment is to remove all endometriotic deposits either by cutting them out or by ablating them with diathermy or laser. Surgical treatment doubles a woman’s fertility and removes pain in 75-80% of cases, although the disease can recur in 20% of women 5 years after the operation. In severe cases, a woman may need a hysterectomy or possibly bowel surgery. The infertile woman with advanced endometriosis may need IVF to become pregnant.

What is it?
Endometriosis is a condition in which cells similar to those lining the womb are found outside the womb in the pelvis. It is found in around 6% of women. The endometriotic deposits respond to a woman’s hormones causing inflammation and scarring in the pelvis.

What are the symptoms?
Symptoms of endometriosis can be very variable. The most common symptom of endometriosis is pelvic pain. Typically the pain starts before menstruation and stops some days after the period begins. However pain can occur at other times of the menstrual cycle and can become constant. Pains may be worse during sexual intercourse or with a full bladder or bowel.

Endometriosis can cause infertility; 30-40 % of women with the condition find it hard to get pregnant. What investigations might be required?

An internal examination can often detect signs of endometriosis. An ultrasound scan can detect ovarian endometriotic cysts, but will not be able to detect the typical small deposits in the pelvis.
The best technique for diagnosis is a laparoscopy (a keyhole examination of the pelvis).

What treatments are available?
Treatment options vary between the conservative, medical and surgical options.

Conservative treatments consist of pain relief and chronic pain management strategies. Many women find treatments such as aromatherapy and acupuncture very useful.

Medical treatments all aim to suppress the menstrual cycle and stop ovulation. Therefore, while they are useful in the treatment of pelvic pain, medical options have no place in the management of the infertile patient with endometriosis. The common medical therapies consist of the combined oral contraceptive pill (COCP), progestogens or Gonadotrophin-releasing hormone antagonists. There are a numbers of newer drugs that look promising which are still being assessed. Most of the different drugs have similar success rates with the choice of treatment largely being governed by the side-effects of the hormones. There is a relatively high recurrence rate of symptoms after treatment is stopped.

Surgery is usually performed laparoscopically. The aim of treatment is to remove all endometriotic deposits either by cutting them out or by ablating them with diathermy or laser. Surgical treatment doubles a woman’s fertility and removes pain in 75-80% of cases, although the disease can recur in 20% of women 5 years after the operation. In severe cases, a woman may need a hysterectomy or possibly bowel surgery. The infertile woman with advanced endometriosis may need IVF to become pregnant.

What is it?
This condition consists of several symptoms that occur in the days prior the start of a period, which then settle as the period starts. Mild forms of the syndrome are very common but the severe forms markedly affect a woman’s family and work life.

What are the symptoms?
There are many symptoms of PMS; the most common described are bloating, breast tenderness, mood changes, irritability and headaches. The exact cause of PMS is unknown, although many hormones have been implicated. It is known that the level of one the ‘happy’ receptors in the brain is lower pre-menstrually and that the change in the level of certain hormones is likely to trigger the symptoms.

What investigations might be required?
The most reliable way of diagnosing PMS is to complete a symptom chart for a couple of menstrual cycles. There are otherwise no scans or blood tests that can diagnose the condition.

What treatments are available?
General management techniques such as relaxation methods, exercise and other therapies such as reflexology, acupuncture and aromatherapy can all help. Dietary changes such as reducing intake of caffeine, alcohol, sugars and salt, eating regularly and consuming more fresh fruit and vegetables are useful.

No one medical treatment has been shown to be effective in all women. Many treatments are designed to suppress the normal ovarian cycle; others are aimed at increasing the ‘happy’ receptor level in the brain. Surgery is always a last resort and consists of removal of the ovaries with hormone replacement thereafter.

Treatment needs to be individualised after a full discussion of the options with your specialist.

Ovarian cysts are cavities within ovaries filled with fluid and are almost always benign. Cysts can occur from one month to the next. They may burst and thus disappear on their own. But if they have reached a certain size, they are unlikely to disappear naturally.

Most ovarian cysts produce no symptoms and women are unaware of their presence. However, if a cyst ruptures, twists, or if there is bleeding into the middle of the cyst, then one sided lower abdominal pain is common. If the cyst is large then it may cause pressure on the bladder or bowel.

Very occasionally, an ovarian cyst is actually the earliest form of ovarian cancer. However, this is extremely uncommon and mostly affects women over the age of 50.

Investigations
You will be initially seen by the Consultant who will take a full history and perform an internal examination. You may then be referred for an ultrasound. Please see the information section for further details on ultrasound scans. A blood test may be taken if a cyst is present and you are 50 years of age or above.

Treatment options
Some women will be reassured if the investigations are normal. If an ovarian cyst is confirmed and measures greater than 5cm your Consultant will likely discuss removal of the cyst using keyhole surgery (laparoscopy) if possible. If the cyst is smaller than 5cm and you have minimal symptoms it will be possible to observe the cyst with a further ultrasound scan 3-6 months later.

Sometimes it is necessary to remove the entire ovary, rather than just the cyst at the time of the operation. This will not affect a women’s normal hormone production or periods.

Fibroids are tissue growths that develop from the muscular wall of the uterus/womb. They can be found in the wall itself, under the external lining of the wall, or they can bulge into the cavity of the uterus/womb. They can grow and shrink under the influence of female hormones, usually becoming smaller after the menopause.

Fibroids can present in many ways depending on the number and site of the fibroids. Many women are unaware that they have fibroids because they do not have any symptoms. The most common symptoms of fibroids are heavy periods, painful periods or irregular periods. They may also cause discomfort through pressure on the bowel or the bladder since both these organs lie close to the uterus.

Investigations
You will be initially seen by the Consultant who will take a full history and perform an internal examination. You may then be referred for an ultrasound in order to determine the number, site and size of the fibroids. Please see the information section for further details on ultrasound scans.

Myomectomy
What is it?
This procedure is the removal of fibroids whilst leaving the uterus behind. The operation generally involves an incision in the abdominal wall (laparotomy). On some occasions it may be possible to remove fibroids with keyhole surgery.

The length of stay
The hospital stay after an abdominal operation is generally 4-6 days. The time taken to full recovery can take 6-8 weeks. Keyhole surgery has the advantage of a shorter hospital stay and quicker recovery.

Risks of the procedure
The main risks are bleeding and infection. The uterus has a very strong blood supply and hence removing fibroids can result in significant bleeding. Whilst precautions are undertaken to minimize any potential bleeding, on very rare occasions (1:200) a hysterectomy may have to be performed to prevent life-threatening blood loss. The risks of infection are reduced by giving antibiotics during and after the operation.

Other immediate risks of surgery include clots in the legs (Deep vein thrombosis, DVT), bruising of the wound and damage to bowel or bladder. Later risks include adhesions to the scars on the uterus which can cause abdominal pain in later years.

Fibroids can recur – the chances of this occurring are 10-20% over the 5-10 years after a myomectomy.

Surgical treatment for prolapse
If prolapse is causing medical problems or symptoms that bother you, it may be necessary to consider surgery. Your consultant will discuss surgery with you fully before you decide to go ahead. Other possible treatments include pessaries placed inside the vagina, or simply leaving things alone if things aren’t too bad.

Vaginal Repair
Prolapse surgery often involves a vaginal repair operation. Sometimes this also includes a vaginal hysterectomy (removal of the womb through the vagina). These operations are usually done through the vagina, all the stitches are inside the vagina and there is no scar on your tummy.

There are different sorts of repair operations but usually a ‘tuck’ is made in the wall of the vagina and sometimes the supporting fibres or ligaments are tightened up. The stitches used are usually dissolvable one’s and therefore don’t need to be removed after your operation. Sometimes the doctor will use a mesh or tissue to help support your vagina. This is more commonly used if your prolapse comes back after previous surgery.

Sacrospinous fixation
Sometimes to hold the vagina up more strongly, a stitch or two is put in deeper inside you. This stitch goes in to a strong ligament in the pelvis, (the sacrospinous ligament). This part of the operation aims to prevent your prolapse coming back and also helps to keep the normal length of your vagina if you are sexually active. There is a risk with this extra fixation stitch that damage can occur to blood vessels, bowel, urinary system or nerves. The stitch also makes the operating time longer.

Sacrocolpopexy
If the prolapse is complicated or has come back after surgery, it may be necessary to perform an operation through a cut in your tummy. The sacrocolpopexy, fixes your vagina to the bone at the back of your pelvis (the sacrum) to give stronger support. Material or mesh is often used and this helps to hold things in place. There is a small risk that this material can cut through into the vagina or get infected. Because the bowel and urinary systems are close by, there is a risk that they could be damaged in this operation. A further operation may then be needed to sort such problems out. Because the sacrocolpopexy is performed through a cut in your tummy, the operation usually takes longer to carry out and longer to recover from than surgery done through the vagina.

What sort of anaesthetic will I have?
Prolapse surgery may be carried out under a spinal anaesthetic so that you can be awake during the operation, but without pain or sensation below, or under a general anaesthetic (whilst you are asleep). The anaesthetist will discuss the anaesthetic before the operation. If you have any other medical problems, then these may require special attention before surgery.

What are the risks?
Sometimes the operation you have for prolapse will change from the original plan, either because of what the doctor finds or difficulties during the operation. In this case your doctor will do what he or she thinks is best for you at that time. This sometimes involves more extensive surgery than originally planned, sometimes less.

About a third of women who have prolapse surgery need more than one operation because the prolapse comes back or a different type of prolapse develops. For example, a prolapse of the womb can occur after an operation for prolapse of the vagina and vice versa.

Prolapse surgery usually improves or cures the symptom of ‘something coming down below’ or the lump in the vagina. Symptoms relating to the bowel or bladder such as constipation or incontinence are often not improved. Similarly problems with your sex life may not be improved with surgery.

If a mesh or extra tissue is used in a prolapse operation, there is a chance that this can get infected or cut through (erode). This may require a further operation to remove part of the mesh or repair any damage.

Occasionally, some new bowel or bladder symptoms occur after prolapse surgery, which may require further treatment in the future, including further surgery. Some women develop incontinence after prolapse surgery and some have problems emptying their bladder and need to use a catheter afterwards. This problem usually gets better with time.

There is a small risk of venous thrombosis (clots forming in your legs and lungs) with any pelvic surgery. To reduce this risk you will be given an injection every day and some anti-embolic stockings to wear.

How long will it take to recover?
You will be in hospital for 2 - 6 days depending on the type of operation you have and your general health and fitness. After this you will usually need to recover for 6 weeks, and must avoid heavy lifting and strenuous exercise for three months. You will be given further information with a booklet explaining what to expect following discharge home from hospital.

The vulva can be affected by generalised skin conditions such as psoriasis or allergic reactions. More specific vulval conditions consist of swellings of the Bartholin’s gland, vulval atrophy due to the menopause and thrush infections.

Vulval dystrophy is a chronic and recurrent condition, often presenting with itching, pain on intercourse or cracking of the skin. A biopsy under local anaesthetic is often required for diagnosis. Treatment is generally by a reducing course of strong steroid ointment.

Vulvodynia is a term given to a severe, chronic discomfort and or itching in the vulva that is not associated with infection of vulval dystrophy. This condition may well respond to tricyclic antidepressants. For more information please see www.vulvalpainsociety.org

Vulval ulcers or swellings should always be assessed by a specialist as they may be a sign of early cancer. Often a biopsy is required.

A woman is said to have reached the menopause once she has not had a period for one year. The time leading up to the menopause is known as the peri-menopause and is often associated with menstrual irregularities. The usual symptom of the peri-menopause is a change in your menstrual pattern. The periods may become more frequent or you may find that you skip a period. The menopause is also associated with hot flushes and night sweats, sleep disturbance, vaginal dryness or discomfort and urinary symptoms such as cystitis.

These menopausal symptoms are self-limiting and will eventually stop of their own accord. This usually takes between 2 and 5 years from the symptoms starting.

Diagnosing menopause
If you have any of these symptoms then you may well be experiencing the peri-menopause or menopause. Measuring the follicle stimulating hormone (FSH) in your blood in can help confirm the menopause. Treatment of the menopause hormone replacement therapy (HRT) is effective in treating several of the most common menopausal symptoms. HRT works by replacing oestrogen which naturally begins to fall in the approach to the menopause causing the menopausal symptoms.

In addition to relieving the menopausal symptoms HRT has also been shown to prevent osteoporosis (weak and brittle bones) and also reduces the risk of cancer of the large bowel.

Unfortunately HRT is associated with slightly increased risks of certain medical conditions which include breast cancer, cancer of the womb and ovaries, blood clots in the veins and coronary heart disease and stroke. These increased risks are very small and the benefits of the HRT often outweigh the small additional risks. We would suggest that you discuss this with the Doctor at your consultation so that you can make an informed decision whether HRT would be beneficial for you.

There are many forms of HRT available and your Doctor will help find the right HRT for you.

Sexually transmitted infections (STIs) are passed on through intimate sexual contact. Common STIs include Chlamydia, syphilis and gonorrhoea. They can be passed on during vaginal, anal and oral sexual intercourse as well as through genital contact with an infected partner.

Symptoms of STIs
Most STIs vary in their symptoms however common symptoms such as cystitis, a change in vaginal discharge, lower abdominal pain or the occurrence of small spots or lumps inside the vagina or on the vulva would be suggestive of an STI.

Diagnosing STIs
Most sexually transmitted infections are initially diagnosed on presentation of symptoms and then formally through blood, urine and vaginal swab tests.

Treating STIs
Most sexually transmitted disease can be treated using either a single dose or course of antibiotics. As STIs are easily passed on through sexual contact if you have a positive diagnosis it is important that your current or past sexual partners are notified and treated in order to reduce the risk of spreading and re-infection. Prevention is better than treatment and practising safe sex is the most effective way of preventing sexually transmitted infection. The male condom is the most effective method of preventing STIs.

Contraception allows you to control if and when you would like to have a baby. Some forms also provide protection against sexually transmitted infections.

There are several types of contraception which work in different ways. Barrier methods such as condoms create a physical barrier against sperm and would also provide protection against sexually transmitted infections (STIs). Women can also use hormonal methods of contraception such as the pill or contraceptive devices such the coil that is placed inside the womb.

No contraceptive device is 100% reliable and some have possible side effects. It is therefore important that before commencing the contraceptive you are assessed by your Doctor who will advise on which contraceptive would be the right choice for you based on your age, medical history and sexual lifestyle.

It is worth remembering that your contraceptive needs will change as you get older, after having children or if your sexual lifestyle changes. This can be discussed with your Doctor.

Miscarriage is common and occurs in 3 out of every 10 pregnancies. Most miscarriages occur in the first 12 weeks of pregnancy.

Symptoms
The most common symptom of miscarriage is vaginal bleeding. The amount of bleeding can vary from spotting to the passage of clots. There may also be associated lower abdominal cramping and pain in your back or pelvis. In this situation it would be advisable to contact your GP. Another feature of miscarriage is that the symptoms of pregnancy may stop unexpectedly. It is possible to experience no symptoms of miscarriage and the miscarriage is only picked up during a routine ultrasound scan performed to date your pregnancy.

Causes of miscarriage
About 50% of all early miscarriages happen because of a problem in the way the genetic material (chromosomes) combined when your egg and your partner’s sperm joined during fertilisation. There are many other causes of miscarriage too numerous to mention however maternal age, smoking and alcohol consumption all do increase miscarriage risk.

Diagnosis of miscarriage
A miscarriage is usually confirmed following an early pregnancy ultrasound scan. If your pregnancy is early in development (less than 7 weeks) a further ultrasound scan may be required 7-10 days alter to confirm the diagnosis. If your pregnancy at this time is suspected to be within your Fallopian tube (an ectopic pregnancy) then additional blood tests may be required in order to assist in the diagnosis.

Management of miscarriage
Unless your miscarriage is complete you may need treatment with either medicines or surgery to remove any pregnancy tissue from your womb. It is possible to let nature take its course (expectant management), however this can sometimes be associated with a higher chance of excessive bleeding. Your Doctor can discuss the options available to you so that an informed choice can be made.

What is it?
PMB is vaginal bleeding more than 12 months after the menopause. The concern is that it could originate from a growth inside the womb that could either be, or could become cancerous. For that reason women should always seek medical advice if such bleeding occurs; a woman will be seen in hospital within 2 weeks from referral.

What are the symptoms?
The bleeding could either be fresh or old in nature and variable in amount. Generally the loss is painless. It is possible to simply present with a persistent vaginal discharge.

What investigations might be required?
An internal examination will exclude a local cause of bleeding from the vulva, vagina or cervix. An ultrasound scan will visualise the uterus and ovaries. An important measurement is the thickness of the lining of the womb. If this is very thin, no further investigation may be required. However if the lining is thicker than expected, a hysteroscopy will be performed. This telescopic examination of the inside of the womb is generally performed in the out-patient department (OPD) and generally the investigation itself takes no more than a few minutes. It is usual to take a small biopsy of the lining at the end of the procedure. After 30 minutes and cup of tea a woman will be allowed home.

What treatments are available?
The results of the biopsy are usually available within the week. If the investigations are negative no further treatment is needed. If a polyp is found at hysteroscopy this will need removing either in the OPD or in main theatre under anaesthetic. If the biopsy finds a malignancy the patient will be referred into the oncology unit at the Royal Hallamshire Hospital for further treatment.

What is a hysteroscopy?
It is the examination of the inside of the womb using a fine telescope.

Where is it done?
It is performed in the Endoscopy Suite.

How is it performed?
A small telescope is inserted through the vagina and cervix into the cavity of the womb. Generally this is done without the need for a speculum or local anaesthetic. The surgeon then carefully inspects the lining of the womb; the images from a camera attached to the telescope are projected onto a TV screen so you can watch the pictures if you want.

How long does it take?
The look inside itself only takes a few minutes.

Will I find it painful?
You may experience some crampy period-like pains during the test, but these settle very quickly. It can be useful to take 2 paracetamol tablets one hour prior to your appointment.

Can I have a general anaesthetic?
Yes, if you prefer, you could have your hysteroscopy performed under general anaesthetic (GA) at a later date. It is important to remember that if, at any point, you find the procedure too uncomfortable, it will be stopped and arrangements will be made for you to be admitted for the procedure under GA.

The advantages of the outpatient setting are that you avoid the risks of an anaesthetic, recover quicker and get back to normal activities sooner. However, at all stages during your outpatient visit you are in control of the situation.

What other procedures may be performed?
It is likely that you will need a biopsy of the lining of the womb. This is performed by inserting a small sampler at the end of the procedure. This sampling only takes 10-20 seconds but can cause a cramp-like sensation, which again settles very quickly. It is possible that a polyp (an overgrowth of the lining of the womb) may be found. This can be removed at the time of the hysteroscopy. (see information section on ‘polyp removal’)

This procedure is a treatment for heavy menstrual periods. There are several methods available; all intend to remove permanently the lining of the womb. Approximately 40% of women who undergo this procedure will have minimal or no bleeding thereafter and another 50% will have lighter periods.

Roughly 10% of women will either require a repeat procedure or even a hysterectomy. The procedure is generally performed under a general anaesthetic as a day-case, but it can be done under local anaesthetic in selected cases. Complications are rare, but consist of the risks of infection, bleeding or rarely perforation of the uterus.

What is it?
A laparoscopy involves the insertion of a narrow telescope into the abdominal cavity through the tummy button. Further instruments may be inserted lower down in the bikini line. The procedure enables the surgeon to diagnose and treat many pelvic conditions. The operation is performed under a general anaesthetic.

What are the advantages?
The keyhole approach avoids the need for large incisions and is usually performed as a day case. Women get home faster and return to work and normal activities quicker.

What are the risks?
The usual surgical risks of bleeding, infection and deep vein thrombosis (DVT) are less than with open surgery, however no operation is risk-free. There is a 1:800 risk of damaging a blood vessel or organ inside the abdomen; this would require a larger incision on the abdomen to repair the injury. There is a less significant, but more common risk of infection in the small scars. This risk is lessened if the stitches are removed 5-7 days after the operation. This can be done at the hospital or by the local GP practice nurse.

How long will it take to recover?
Typically women are back to normal within a fortnight. It is important to remember that you should steadily improve after a laparoscopic procedure. If at any point you start experiencing more pain, develop a high temperature or suffer from vomiting or diarrhoea you should seek medical advice immediately.

Hysteroscopic sterilisation is a method of female sterilisation for women wanting permanent contraception. The procedure is performed in the out-patient clinic, usually without anaesthetic and involves the insertion of a small telescope (a hysteroscope) through the neck of the womb into the uterine cavity. Small devices are then placed into the entrance to the tubes; these devices block off the tubes over the next 3 months. Women are advised that they will need to use contraception for this time, when a scan or X-ray is performed to check the devices are in the correct place and the tubes are blocked.

Women are advised of the following before they undergo the procedure:
- The procedure is as at least as effective as laparoscopic sterilisation.
- The failure rate is 1:400.
- There is small (1:150) chance that the procedure cannot be performed successfully.
- Contraception needs to be used for the 3 months after the procedure until the check X-ray or ultrasound has been done.
- The procedure is completely irreversible.
- Certain treatments for abnormal uterine bleeding may not be feasible after this sterilisation procedure. However, effective alternatives are still available.

This procedure has been performed in Sheffield for 7 years and provides many advantages over the traditional laparoscopic or keyhole procedure. There is no need for a general anaesthetic and the risks and discomfort of a laparoscopy are avoided.

There are two techniques available, Essure and Adiana. Further information is available via the links below. For details of the cost of the procedure please contact us via the link.

A colposcopy is a detailed examination of the cervix. It is usually performed after an abnormal smear test in order to examine more closely the cells covering the cervix to determine if any of these cells have become cancerous and therefore need to be treated.

The colposcopy is performed in a similar manner to a cervical smear. The colposcopy is simply a large magnifying glass which is used to view your cervix from the outside. The procedure should not cause any pain or discomfort.

This operation is commonly performed for abnormal uterine bleeding, fibroids, pelvic inflammatory disease, endometriosis and cancer.

There are several ways to perform a hysterectomy: vaginal, abdominal or laparoscopic. The vaginal route avoids the need for an incision on the abdomen, but it is not always feasible to perform the operation this way. The laparoscopic option is associated with a quicker recovery and less post-operative discomfort. One type of laparoscopic hysterectomy, the laparoscopic sub-total hysterectomy (LASH) has the advantage of being a purely keyhole operation, but requires the cervix to be retained. Therefore cervical smears are still required.

The risks of hysterectomy procedure include the general surgical ones of infection, deep vein thrombosis or bleeding. More specifically, as the bladder is close to the womb, it may be damaged during the operation. However, such damage can be repaired and it is rare to have long-term problem from such a complication. There is a 15% chance of suffering a premature menopause after a hysterectomy as the blood supply to the ovaries can be affected even if they are retained at the time of surgery.