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Gynaecological issues

hot water_bottle_woman_18_05_12Your lady bits can be a worry at times, but don’t be too shy to ask for help.

At some point in your life it is likely that you will suffer from a gynaecological problem – something that affects your reproductive organs – and there’s really no need to feel embarrassed about what might be going on down below. Taking off your knickers may cause you to blush but your doctor will have seen it all before – and won’t bat an eyelid. Most GPs are sensitive to a patient’s needs and your doc should offer you a diagnosis, reassurance and treatment options, too.


This is a condition where pieces of the endometrium, the lining inside the womb (uterus) are found elsewhere in the body, usually the pelvic cavity. During your period your hormones stimulate the endometrium, causing it to grow, then break down and bleed. This internal bleeding, unlike a period, has no way of leaving the body, which leads to inflammation, pain and the formation of scar tissue. Endometrial tissue can also be found in the ovary, where it can form cysts, called ‘chocolate cysts’ because of their appearance.

What are the symptoms?
These vary from non-existent to severe and include painful, heavy or irregular periods, experiencing pain during or after sex, infertility and fatigue. Diagnosis is achieved through a procedure called a laparoscopy, a keyhole technique where a small telescope with a light and usually a camera on the end, is inserted into your pelvis via your belly button while under a general anaesthetic.

What causes it?
Endometriosis most commonly occurs in women between the ages of 25 and 40. Its cause is still unclear to doctors, but it is thought to be down to the failure of endometrial tissue to leave the body during menstruation. Instead it travels up the fallopian tubes and into the pelvic cavity, where it sticks to and grows on the pelvic organs.

Treating it
There is no definite cure for endometriosis but there are several treatments that can help ease the symptoms. Most women usually take a certain type of painkiller when the pain becomes very intense. Hormone therapy, primarily in the form of the contraceptive pill or coil, is a popular treatment for the condition. This helps to reduce or stop the production of the hormone oestrogen, which in turn stops the endometrium growing. Surgery is another option. What is known as conservative surgery aims to remove the stray deposits of endometrial fragments by cutting them out, or using heat, a laser or an electric current to remove them. More radical surgery includes having a total or sub-total hysterectomy but this is considered a last resort. For more details go to

Polycystic ovary syndrome (PCOS)

The term comes from the appearance of the ovaries in some women with the disorder – large and studded with numerous cysts (polycystic). And the ovaries never grow to full development to produce an egg capable of being fertilised. Women with PCOS rarely ovulate and are less fertile.

What are the symptoms?
Women with polycystic ovary syndrome usually have at least some of the many signs and symptoms associated with PCOS, including: absent or infrequent periods – occurring every five to six weeks or down to once or twice a year, excessive hair growth on the face and forearms, lower legs and abdomen. Some women may also suffer from mild to severe adult acne and become overweight or obese.

What causes it?
While it is not known if women are born with this condition, research suggests a link to excess insulin, which is thought to increase the production of male hormones by your ovaries. Studies also indicate that genetic factors may play a role in PCOS. Women raise their risk if they are overweight, too.

Treating it
Most symptoms and health risks can be managed without any medical intervention, through maintaining a healthy lifestyle. Prescribed drugs include clomiphene, which stimulates ovarian function, gonadotropin injections which directly stimulate the ovarian follicles to grow or metformin, which improves the uptake of sugars into cells by insulin and boosts the ovulation rate. Ovarian diathermy is a surgical option that uses heat to alter ovarian function; for 80% of women it brings back ovulation. For more details, go to


These are tumours that grow in the uterus (womb) and are categorised by where they grow. They are benign, which means they are not cancerous, and are made up of muscle fibre. Fibroids can be as small as a pea and can grow as large as a melon. It is estimated that between 20-50% of women have, or will have, fibroids at some time in their lives. They are rare in women under the age of 20, most common in women in their 30s and 40s and usually tend to shrink down after the menopause.

What are the symptoms?
As many as 75% of women have no symptoms of fibroids at all, while others have symptoms ranging from bleeding and pain to incontinence.

What causes them?
Although the cause of fibroids is unknown, they seem to be influenced by oestrogen. This would explain why they appear during a woman’s middle years (when oestrogen levels are high) and stop growing after the menopause (when levels drop). They occur up to nine times more often in black women than in white women. Women who weigh over 70kg (11st ) may be more likely to have fibroids, – thought to be due to higher levels of oestrogen in heavier women.

Treating them
If you don’t have any symptoms then you won’t need treatment. If you do have symptoms you may be offered a group of drugs, called GnRH analogues, that reduce oestrogen levels in your body and, as a result, will cause fibroids to shrink. Studies have shown that when taken for six months, GnRH analogues can reduce the size of fibroids by up to 50%. They also stop menstrual bleeding and pelvic pain. The main surgical treatments are myomectomy (removing any fibroids individually), hysterectomy (removing the womb entirely) or undergoing uterine artery embolisation (blocking the blood supply to the fibroids). Magnetic resonance imaging (MRI) is also used but is still undergoing trials. For more details, go to


Stress incontinence occurs when your bladder is put under pressure, for example when you cough, sneeze, laugh or exercise. Urge incontinence is when you have a sudden very urgent need to dash to the toilet.

What are the symptoms?
The main symptom is a loss of bladder control that causes you to pass urine when you are not intending to.

What causes it?
Stress incontinence occurs when the muscles of your pelvic floor weaken, and can no longer keep your urethra closed. Weakening is caused by pregnancy and childbirth, menopause, or old age. Urge incontinence is usually as a result of infections and conditions that affect the nervous system like multiple sclerosis and Parkinson’s.

Treating it
Reducing your caffeine intake, changing the amount you drink, (reducing it if it is too much, or increasing it if it is too little) and losing weight if you are obese can ease symptoms. Strengthening your pelvic floor by exercising the muscles also helps but if symptoms persist you may need surgery. For more details, go to

Abnormal smear test

An irregular test result will be positive if there is a common virus called the human papillomavirus (HPV) or ‘wart virus’ present in the body. It is a sexually transmitted virus, which the majority of women get rid of without treatment within two years. However, it can lead to pre-cancer and, if not treated, to cervical cancer. Cervical screening detects the condition at a pre-cancerous stage. All women between the ages of 25 and 50 should have a smear test every three years.

What are the symptoms?
Even if the results of the smear test show an abnormal result, there will be no symptoms experienced beforehand.

What causes it?
The virus is only present if a woman is sexually active and is more likely to be present in women who have multiple partners.

Treating it
Once diagnosed you will be given a colposcopy at an outpatient appointment. A colposcope – a low powered microscope – is used to examine your cervix to assess the extent and severity of any problem and to determine treatment. The abnormal cells may be removed using laser ablation or cold coagulation treatments, where a hot probe is used to burn away the problematic cells. The most common option is a treatment called loop diathermy, where a thin wire circle cuts through and removes the abnormal area. For women who have cancer, surgery is the main option in localised cases. Chemo may be used for more extensive disease. For more details, go to

Heavy periods
Excessive blood loss during your cycle should not be ignored…

Also called menorrhagia, heavy periods are when a woman loses an excessive amount of blood for more than eight days a month, during several consecutive periods.

Experiencing heavy bleeding does not necessarily indicate that there is anything seriously wrong but, on an emotional and physical level, it can be debilitating. Heavy menstrual bleeding is considered to be 60-80ml or more in each cycle – the average amount lost is 30-40ml. You can usually tell if your period is heavier than normal if you are using more tampons or pads, you experience flooding that seeps through to your clothes or bedding and you need to use tampons and towels together. If you do suffer from heavy periods, then you could also find yourself feeling tired, extra irritable, experiencing pain and at risk of developing anaemia.

It is important to speak to your GP about your symptoms, as there are a variety of solutions available. They can prescribe hormone tablets, medication to reduce blood loss, or an intrauterine device (IUD). If your symptoms persist, endometrial ablation (where the lining of the uterus is destroyed or removed using laser, radiofrequency waves, microwaves or heated water) is an option, as well as surgery, with a full hysterectomy (complete removal of the womb) being the most drastic, but effective option.

This article was first published in at home with Lorraine Kelly in April 2012. [Read the digital edition here]

Photograph: Getty Images

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