Gynaecology Care

Amenorrhoea is a menstrual condition characterised by the absence of periods, while oligomenorrhoea is another menstrual condition consisting of infrequent periods. Amenorrhoea can be further categorised as primary or secondary. Primary amenorrhoea occurs when menstruation does not start during puberty, while secondary amenorrhoea is when menstrual periods that were once present and possibly regular become absent for six months or more in the absence of pregnancy, lactation, hormonal manipulation or ablation.

The causes of both primary and secondary amenorrhoea can be very different.

The symptoms of amenorrhoea may require a gynaecologist visit to review medical history and conduct a thorough physical examination, including a pelvic exam and pregnancy test. The cause of amenorrhoea can then be determined by arranging tests that include hormonal and imaging profiles.

You should see a doctor for a diagnosis if you experience any of the following:

• Suspect that you might be pregnant.
• Three or more missed periods in a row.
• Fewer than nine periods in a year.
• Changes in the pattern of your periods.
• Have not had your first menstrual period by the age of 16 or within two years of the onset of breast development or by the age of 14 in the absence of breast development.
• Other associated symptoms, such as heavy, irregular periods or acne.

Treatment for amenorrhoea and oligomenorrhoea depends on the cause. Your doctor will determine specific treatment(s) based on your age, overall health, medical history and the extent & cause of the condition.

Fibroids or uterine fibroids, also referred to as fibromas, myomas, leiomyomas, and uterine myomas, are abnormal growths of muscles or tissues that develop in or on the wall of the uterus. This abnormal growth is benign (noncancerous) and is often referred to as the most benign tumour in females.

There are different types of uterine fibroids, depending on their location and attachment:

• Intramural fibroids are embedded in the muscular wall of the uterus and are the most common type.
• Submucosal fibroids grow under the inner lining of the uterus.
• Subserosa fibroids grow under the outer surface lining of the uterus and can become quite large, extending into the pelvis.
• Pedunculated fibroids, the least common type, attach to the uterus with a stalk or stem and are often described as mushroom-like due to their shape.

While not all fibroids cause symptoms, those that do can lead to heavy menstrual bleeding, back pain, frequent urination, recurrent miscarriages, subfertility and discomfort during intercourse.

Diagnosis typically involves a pelvic exam by a gynaecologist to assess the condition, size and shape of the uterus.

Treatment for uterine fibroids varies based on factors such as size, number, location and associated symptoms. In cases with no symptoms, observation without treatment can be a reasonable option. Many individuals with fibroids never experience symptoms or complications.

Pelvic organ prolapse occurs when the muscles and tissues supporting the pelvic organs, including the uterus, bladder or rectum, weaken or loosen, resulting in one or more organs exerting pressure into the vagina. In severe cases, an organ may protrude onto another or outside the body.

Pelvic organ prolapse has various types that depend on the affected organ. Here are the most common:

• Cystocele: The bladder exerts pressure on the vagina.
• Rectocele: The rectum protrudes into the vagina.
• Uterine prolapse: The uterus bulges down into or out of the vagina.

Factors contributing to pelvic organ prolapse include pregnancy, childbirth, obesity, chronic coughing, constipation, pelvic organ cancers and hysterectomy. Genetics may also be a contributing factor.

If you suspect you have pelvic organ prolapse, consult your doctor. They will review your medical history and conduct a pelvic examination to assess your pelvic floor muscles and the degree of prolapse. This examination may be sufficient for a diagnosis.

Your doctor may also detect pelvic organ prolapse during a routine pelvic exam. If you do not have symptoms, then no further treatment is required.

The treatment of pelvic organ prolapse varies based on symptom severity and can involve several therapies:

• Behavioural treatments, like physiotherapy and Kegel exercises, to strengthen the core and pelvic floor muscles.
• Mechanical treatments, such as using a pessary for organ support.
• Surgical options for tissue repair or organ removal, such as hysterectomy.

Heavy periods, or menorrhagia, are prolonged or excessively heavy menstrual bleeding.
This condition can have various causes:

• Hormonal imbalances
• Uterine fibroids or polyps
• Adenomyosis (inflammatory tissue within the wall of the uterus)
• Thyroid disorders
• Bleeding disorders, including medication-related
• Abnormal lining of the womb, including hyperplasia and, less commonly, malignancy

Heavy menses can impact a person’s social life. They can also be associated with delayed fertility. While heavy periods themselves might not directly cause infertility, they can be a symptom of an underlying condition that could affect your fertility. For example, conditions like polycystic ovarian syndrome (PCOS) or endometriosis, which can cause heavy menstrual bleeding, are also associated with delayed fertility.

It is best to see a doctor if you experience heavy periods that significantly disturb your daily routine, such as soaking through one or more sanitary pads or tampons every hour for several consecutive hours, bleeding between periods, or if you have symptoms of anaemia such as fatigue, weakness or shortness of breath.

Diagnosing the cause of heavy periods often involves a thorough medical history, physical examination and sometimes additional tests, such as blood tests, ultrasound, MRI or a hysteroscopy (camera test) and biopsy of the uterine lining.

Treatment of heavy periods depends on the underlying cause and the patient's goals. It may include hormonal medications such as birth control pills, hormonal IUDs, NSAIDs to reduce bleeding and pain, tranexamic acid to reduce blood loss or surgical procedures such as endometrial ablation or hysterectomy in severe cases where fertility is not desired and less invasive options have failed.

Postmenopausal bleeding is any vaginal bleeding that occurs after a woman has gone through menopause, which is defined as 12 consecutive months without a menstrual period. While it's not uncommon for women to experience occasional spotting or light bleeding in the early stages of menopause, any bleeding that occurs a year or more after menopause should be evaluated by a healthcare professional.

Postmenopausal bleeding can be caused by various factors. These include:

• Endometrial atrophy: Thinning of the uterine lining due to hormonal changes during menopause can cause bleeding.
• Atrophic vaginitis: Thinning and inflammation of the lower genital tract.
• Polyps: Growths in the uterus or cervix that resembles skin tags and can lead to bleeding.
• Endometrial hyperplasia or cancer: Abnormal growth of the uterine lining or cancerous (malignant) changes can cause bleeding.

To diagnose the cause of postmenopausal bleeding, your doctor may perform a physical examination, pelvic ultrasound, hysteroscopy (camera test of the lining of the womb) and endometrial biopsy.

Treatment for postmenopausal bleeding depends on the underlying cause. It may include reassurance only, hormonal therapy and removal of the polyps in most of the benign causes.

It's important to see a doctor if you experience postmenopausal bleeding, as it can be a sign of a serious condition, such as endometrial cancer. Early diagnosis can help identify the cause and assist the doctor in treating you accordingly.