DR RICHARD MURPHY
Top 10 reasons to see your gynaecologist
Reason 1: Heavy periods
Reason 2: Painful periods
Heavy and painful periods can be one and the same problem but some women only experience the pain and the discomfort without excessive bleeding. If you dread the pain associated with your periods, missing work, study, social activities or other normal day-to-day activities due to period pain there are very effective treatments available to help. Life should not just be about managing the pain.
Endometriosis and adenomyosis are common underlying conditions of painful periods. The management of these conditions means that your gynaecologist helps you reduce the symptoms and looks at the underlying causes that need attention. My role as your gynaecologist is to create clarity and to help you reduce the pain with the most suitable treatment or management plan.
Reason 3: Irregular periods
A common reason to speak to your gynaecologist is the irregularity of your cycle. A “normal” period cycle is regular and usually 28-30 days long. This can vary between 26-35 days. The average cycle length decreases with age from 25 until you reach menopause.
An irregular period can be associated with fertility problems, being a sign of infrequent or disordered ovulation. An irregular or very long cycle will also increase the risk of pre-malignant change in the endometrium and endometrial cancer.
Common causes of an irregular cycle include polycystic ovarian syndrome, thyroid problems, high prolactin and central disorders of the hypothalamus in the brain. I can help you diagnose why your periods are irregular and provide treatment so serious complications do not develop.
Reason 4: Pain during intercourse
If you experience pain during intercourse, the medical term for that is “Dyspareunia”.
It is common and there are a number of causes. “Superficial” pain occurs when there is pain with vaginal penetration. This can be with intercourse but also tampons. It is often caused by an overactive pelvic floor, where pelvic muscle contraction causes pain or discomfort.
A Women’s Health Physiotherapist has specialist training in the treatment of this condition. “Deep” pain is felt further inside the pelvis and can be a symptom of endometriosis, adhesions or other pelvic pathology. We may find clues to the cause with a good quality specialist gynecological ultrasound. Laparoscopic surgery is commonly used to diagnose and treat deep pelvic pain associated with intercourse.
Reason 5: Cervical screening test abnormalities
It’s important to note that since 2017 we no longer do the “Pap” test. Australia has moved to the Cervical Screening Test (CST) which screens for the presence of “high risk” Human Papillomavirus (HPV). We have known that certain viruses, when they persist in the body for a number of years, can cause the development of cancers. HPV causes almost all cervical, vaginal, vulval and anal cancers as well as a significant number of throat cancers.
"From the patient point of view, the CST and a Pap are the same, involving a speculum examination of the cervix and using a brush to collect cells from the cervix. The CST will tell whether you have a high-risk HPV strain and if so automatically look for cellular (“cytological”) abnormalities using the same sample."
If you have an abnormal CST your General Practitioner may recommend a Colposcopy. This involves a detailed examination of the cervix using a colposcope, a type of microscope. HPV related changes will be visible, allowing us to biopsy any abnormal areas, helping to guide treatment.
If a high-grade abnormality is found then a surgical procedure is usually recommended such as a Large Loop Excision of the Transformation Zone (LLETZ) or Loop Electrosurgical Excision (LEEP). Sometimes a more extensive Cone Biopsy may be needed. Treatment for premalignant cervical disease will always consider any future plans you may have for pregnancy.
Reason 6: Contraception
There is a huge range of options for contraception available, non-hormonal, hormonal and surgical. If you have complicated medical issues or have experienced side effects from contraception in the past we should still be able to find the right method for you and your partner. Non-hormonal options include condoms and the copper IUD. Hormonal contraceptives include the minipill, the combined (standard) pill, NuvaRing, Kyleena, Mirena, Depo-Provera and Implanon. Surgical options include vasectomy and tubal ligation.
Reason 7: Infertility
If you have been trying to fall pregnant for over 12 months, if you are 35 or over and not pregnant after 6 months, or if there is some specific reason you believe you may have difficulty conceiving, then please come and see me. We can explore your history, perform the appropriate investigations and discuss the options available to help you complete your desired family size.
Reason 8: Miscarriage
The loss of a wanted pregnancy can be devastating. The most common cause for first-trimester miscarriage is a chromosomal problem in the pregnancy which occurs shortly after fertilisation of the egg. I can help guide you through what is often a very difficult, confusing and stressful time.
Often a surgical curettage, “D+C”, is recommended to treat miscarriage. I often use medical treatment to treat miscarriage, helping to avoid hospitalisation, anaesthetic and surgery. If any treatment is needed to complete your miscarriage we can decide the best option for you.
Reason 9: Preconception counselling
If you have ongoing, chronic medical conditions or a history of major illness or disease in your past or in your family it is often helpful and reassuring to plan around these issues before pregnancy occurs. Optimising your general health, taking folic acid supplements for 3 months before you start trying, stopping smoking or any drug use are important.