Frequently asked questions: gynaecology

When must I have a hysterectomy?

Hysterectomy is not done commonly these days and most women end up keeping their uteruses until menopause.  The reason for this is that we have better hormonal ways to treat pain and bleeding.  Hysterectomy is only reserved for patients with prolapse (hanging out of the uterus) and patients who cannot use or have side effects of the hormonal therapy.  There are also patients for whom the hormonal treatment does not work.

How regular would I have to go for a papsmear?

Your initial papsmear should be a year after becoming sexually active.  You should follow up with a smear 1 year after that and if both are normal you can do it every second year.  If you do a HPV virus test with your papsmear, and it is negative, you can extend your intervals to 4 yearly.

Do I have to take hormone replacement?

This is a very individual situation and depends on your risk profile, your severity of symptoms and your risk of osteoporosis.

Patients who has mild symptoms which they can cope with and good bone density can probably go without hormone replacement.

Other factors taken into consideration is breast cancer and thrombosis risk.

Why do I have menstrual cramps?

Women who have menstrual cramps tend to have more prostaglandin hormone released during menstruation.  Prostaglandin is the pain hormone of the body.  About 10 to 20% of women with severe menstrual cramps can have endometriosis, but this can only be confirmed with laparoscopy.  If the endometriosis is very severe it can sometimes be seen on ultrasound.

Will I be able to fall pregnant?

About 1 in 7 couples struggle to fall pregnant and this is usually 40% a female reason, 40% a male reason and in 20% of cases the reason is unknown.  It is difficult and expensive to do all the tests which is needed to see if you will be able to fall pregnant.   This  would be a sperm test, a test of your tubal patency, and a test for ovulation. Ultrasound and exam in the rooms can only exclude uterine growths and ovarian cysts but cannot confirm fertility.

If you have a regular menstruation and you are younger than 33, you should give yourself a year to fall pregnant before seeing a gynaecologist.  If you have an irregular menstruation of if you are over 33, you should see a gynaecologist after 6 months

What are the danger signs that I should look out for?

The 3 types of gynaecological cancers are cervical, ovarian and endometrial cancers.  Ovarian and endometrial cancers are very scarce in women below the age of 45 but cervical cancer can appear in any woman who is sexually active.  Danger signs of cervical cancer is bleeding after intercourse, but this may only  happen at a late stage so it is better to go for regular screening (papsmear) to avoid this cancer.  You can also go for a hpv vaccination which is very effective to avoid this type of cancer.

Postmenopousal bleeding is a symptom that must always be investigated.  Although there is a benign cause of this in 90% of cases, 10% of patients will have endometrial cancer.

Ovarian cancer is a very difficult cancer to diagnose early and it usually only gives symptoms when it is already far progressed.  Symptoms would then be abdominal distention and lower abdominal pains.  It is therefore necessary to go for yearly vaginal sonars after the age of 45 to try to diagnose this cancer at an early stage.  Even more so you should go for regular check-ups if you have a family history of breast, prostate or ovarian cancer.

Breast cancer presents with a painless lump in the breast which persists and get bigger.  It is more common after 50 but even young patients from 30 years onwards can get it.  Lumps which come and go are usually benign.  Please do self examination every month after menstruation and preferably you should go for mammograms every 2 years after 40 and every year after 50.  If you have any close family history you should start you mammograms 5 years before the family member was diagnosed.

What are the signs of sexually transmitted diseases?

Genital ulceration, swelling of inguinal glands, genital warts and foul smelling discharges can be associated with std’s although there are other causes of this as well.  If you are worried a gynaecologist can do a full array of tests to exclude std.  Condoms can protect agains most std’s but not all as some are caused by skin to skin contact.