• Gut/ bowel disorders
• Allergies and intolerance
• Healthy eating education
• Weight management

Dietitians help people to eat healthy and balanced diets to improve their health and wellbeing and also to manage dietary related health conditions.

After significant weight loss, some people are left with loose or sagging skin that has lost its elasticity and doesn’t shrink back. Surgery to remove this excess skin includes tummy tuck, arm lift, thigh lift, and body lift procedures. These surgeries aim to improve comfort, hygiene, and body shape.

The surgery is usually done under general anaesthetic and involves cutting away the extra skin and tightening the remaining tissue. Recovery time varies but can take several weeks, and patients may need to wear compression garments to reduce swelling and support healing.

A small sample of breast tissue is removed and examined under a microscope to see if cancer is present.

Simple or Total: all breast tissue, skin and the nipple are surgically removed but the muscles lying under the breast and the lymph nodes are left in place.

Modified Radical: all breast tissue, skin and the nipple as well as some lymph tissue are surgically removed.

Partial: the breast lump and a portion of other breast tissue (up to one quarter of the breast) as well as lymph tissue are surgically removed.

Lumpectomy: the breast lump and surrounding tissue, as well as some lymph tissue, are surgically removed. When combined with radiation treatment, this is known as breast-conserving surgery.

General surgery covers breast diseases including breast cancer. These conditions are often initially dealt with in a specialised breast clinic which is able to perform a number of investigations (e.g. mammography, ultrasound, needle biopsy) during the initial outpatient clinic visit.

Surgery to increase breast size involves inserting silicone sacks (implants) filled with silicone gel or salt water (saline) under the chest muscle and skin.

The procedure involves making a cut (incision) in the armpit, under the breast or around the areola (the dark area around the nipple) from where the implant is inserted. The surgery is usually performed under general anaesthesia (you will sleep through it) and it will probably take 1–2 hours. You will probably be able to go home the day of the operation, but you will need to arrange for someone else to drive you.

You may need to take some medication for pain relief for 2-3 days and you should rest for a few days after the surgery. You will probably be able to return to work after 7-10 days. It will take several months for the scars to fade.

This is an operation that can lift and reshape sagging breasts. The procedure usually involves removing skin from an area below the nipple and reshaping the breast. The surgery is performed under general anaesthesia (you will sleep through it) and will take about 2 hours. You will probably stay in hospital overnight and will need to arrange for someone else to drive you home the next day.

Your breasts will be bruised and swollen for several days and you may need to take some medication for pain relief. You will need to wear a special support bra continuously for 3-4 weeks after surgery. You will probably be able to return to work after about 1 week. It will take several months for the scars to fade.

When a breast has been removed (mastectomy) because of cancer or other disease, it is possible in most cases to reconstruct a breast similar to a natural breast. A breast reconstruction can be performed as part of the breast removal operation or can be performed months or years later.

There are two methods of breast reconstruction: one involves using an implant; the other uses tissue taken from another part of your body. There may be medical reasons why one of these methods is more suitable for you or, in other cases, you may be given a choice.

Implants

A silicone sack filled with either silicone gel or saline (salt water) is inserted underneath the chest muscle and skin. Before being inserted, the skin will sometimes need to be stretched to the required breast size. This is done by placing an empty bag where the implant will finally go, and gradually filling it with saline over weeks or months. The bag is then replaced by the implant in an operation that will probably take 2-3 hours under general anaesthesia (you will sleep through it). You will probably stay in hospital for 2-5 days.

Flap reconstruction

A flap taken from another part of the body such as your back, stomach or buttocks, is used to reconstruct the breast. This is a more complicated operation than having an implant and may last up to 6 hours and require a 5- to 7-day stay in hospital.

Surgery to reduce breast size involves making a cut (incision) around the areola (the dark area around the nipple) straight downwards and along the crease beneath the breast. Glandular tissue, fat and skin are removed and the breast reshaped. The surgery is performed under general anaesthesia (you will sleep through it) and will take 2-4 hours.

You will probably stay in hospital 1-2 nights and will need to arrange for someone else to drive you home.

You may need to take some medication for pain relief for several days and you must wear a special support bra continuously for 2 weeks after surgery. You will probably be able to return to work after about 2 weeks. It will take several months for the scars to fade.

Breath testing is a simple, non-invasive way to check for problems in the digestive system. After drinking a special liquid, a patient breathes into a bag or machine at different times. The test measures gases like hydrogen or methane in the breath, which are made by bacteria in the gut. It helps doctors diagnose conditions like small intestinal bacterial overgrowth (SIBO), lactose intolerance, or how well the body digests certain sugars.

A PillCam is a small, capsule-shaped device with a built-in camera that patients swallow. As it moves through the digestive system, it takes thousands of pictures, helping doctors examine areas like the small intestine without the need for surgery. The images are sent to a recorder worn by the patient for approximately 8 hours and the device passes out of the body naturally in a bowel movement.

Carpal Tunnel Syndrome is caused by a pinched nerve in the wrist that causes tingling, numbness and pain in your hand.

Surgery to relieve carpal tunnel syndrome involves making an incision (cut) from the middle of the palm of your hand to your wrist. Tissue that is pressing on the nerve is then cut to release the pressure.

Coeliac disease is a condition caused by an allergy to gluten, a protein found in foods containing wheat, barley or rye. When someone with coeliac disease eats gluten, it damages the lining of their small intestine, making it harder for their body to absorb nutrients properly. This can cause symptoms like stomach pain, tiredness, diarrhoea, or skin rashes. The main treatment is following a strict gluten-free diet.

Laparoscopic: several small incisions (cuts) are made in the abdomen and a narrow tube with a tiny camera attached (laparoscope) is inserted. This allows the surgeon a view of the colon and, by inserting small surgical instruments through the other cuts, part or all of the colon can be removed.

Open: an abdominal incision is made and part or all of the colon is removed.

Colonoscopy is the examination of your colon (large bowel) using a colonoscope (long, flexible tube with a camera on the end). The colonoscope is passed into your rectum (bottom) and then moved slowly along the entire colon, while images from the camera are displayed on a television monitor.

The procedure takes from 10 minutes to an hour. Sometimes a small tissue sample (biopsy) will need to be taken during the procedure for later examination at a laboratory.

A colonoscopy may help diagnose conditions such as polyps (small growths of tissue projecting into the bowel), tumours, ulcerative colitis (inflammation of the colon) and diverticulitis (inflammation of sacs that form on the walls of the colon).

Colonoscopy may also be used to remove polyps in the colon.

Risks of a colonoscopy are rare but include: bleeding if a biopsy is performed; allergic reaction to the sedative; perforation (tearing) of the bowel wall.

What to expect

It is important that the bowel is completely empty before the procedure takes place. This means that you will only be able to have liquids on the day before, and will probably have to take some oral laxative medication (to make you go to the toilet more).

When you are ready for the procedure, you will be given medication (a sedative) to make you go into a light sleep. This will be given by an injection into a vein in your arm or hand.

The colonoscopy will usually take 15 – 30 minutes, but you will probably sleep for another 30 minutes. Because you have been sedated (given medication to make you sleep) it is important that you arrange for someone else to drive you home.

Some patients may experience discomfort after the procedure, due to air remaining in the colon.

An opening is made in the skin of the abdomen (stomach) to allow drainage of stools (faeces) from the colon into a collection bag on the outside. This may be temporary to allow time for healing of the colon or, if the entire colon has been removed, it may be permanent.

A colposcopy is a detailed examination of the cervix (entrance to the uterus) with a specially lit microscope (colposcope). As with a cervical smear, an instrument called a speculum is inserted into the vagina, and then the colposcope is inserted with its light directed on the cervix.

A specialist will perform a colposcopy if your cervical smear has shown abnormal or cancerous cells on the cervix. During the colposcopy further samples of tissue (biopsies) are usually removed and examined in the laboratory so the doctor can get a clearer idea of the extent of the abnormal cells.

The appearance of ears that are misshaped or protruding (‘bat ears’) can be improved surgically. This type of operation is often carried out in children.

Cuts (incisions) are made behind the ears through which the cartilage in the ear can be reshaped or removed. The surgery lasts 1-2 hours and can be performed under local anaesthetic (the area treated is numb but you are awake), allowing you to go home the same day. For children, the procedure would be performed under general anaesthetic (they sleep through it) and they will remain in hospital overnight. You will need to wear head bandages for about 1 week and will probably be able to return to normal daily routines after that.

Excess skin and/or fat can be surgically removed from your upper and/or lower eyelids to give your skin a less wrinkled and puffy appearance.

The procedure typically involves making a small cut (incision) in the fold of the eyelid (for the upper lid) or just below the eyelashes (for the lower lid) and removing any excess skin and/or fat. The surgery will take 1-3 hours and is performed under local anaesthetic (the area being treated is numb) together with a sedative to make you feel drowsy. You will be able to go home the same day. It is recommended that you have complete rest and keep eye pads on for a couple of days after surgery. You should be able to return to work within 1 week.

• Cosmetic injectables
• Non-surgical body sculpting & contouring

Cosmetic medicine services may include treatments such as cosmetic Botulinum Toxin injections, dermal filler, and laser skin therapy.

Surgery can be carried out to improve the appearance of your nose e.g. straightening it if it’s crooked or increasing or decreasing its size.

Small cuts (incisions) are made either on the inside or outside (in the creases) of the nose. Excess bone and/or cartilage is removed and the nose reshaped. The surgery takes about 2 hours and is performed under general anaesthetic (you sleep through it). You may be able to go home the same day or, in some cases, you may have to stay in hospital overnight. You will need to arrange for another person to drive you home. Your nose will be covered with a splint that you will have to wear for about 1 week. It will take about six weeks for the worst of the swelling to disappear.

Metal dilators are inserted through your vagina and used to widen the opening to the uterus. A curette (an instrument with a flat metal loop at one end) is then used to scrape the lining of the uterus.

This condition occurs when there is abnormal thickening of the deep tissue between the palm of your hand and your fingers. This thickening occurs very gradually and will start to make your fingers curl toward your palm.

If this condition gets to the stage where it significantly limits your hand function, surgery may be recommended. This usually involves removal of the thickened tissue, allowing you to straighten your fingers again.

Abnormalities of the endocrine system treated by general surgery include disorders of the pancreas and adrenal glands in the abdomen and the thyroid and parathyroid glands in the neck. These are often very complex conditions requiring extensive investigations. If surgery is required it is often quite complicated and will usually mean a stay in hospital for several days or even longer.

The endometrium is the name of the tissue that lines your uterus (womb). Endometriosis is a condition where tissue, like the endometrium, grows in other parts of the body. Usually these growths occur inside the stomach in places such as the ovaries, bowel, or a lining of the stomach called the peritoneum. Each month, as the endometrial lining of the uterus builds up with blood that will be lost during your period, these other growths of endometrial tissue get bigger and can bleed and cause inflammation and adhesions (internal scaring).

Some women with this condition do not have many symptoms, whereas others suffer severe pain and problems such as infertility and tiredness.

Treatment includes medication that will help control the pain and inflammation, and some women may need surgery to remove the tissue growths.

Endometriosis surgical treatment

Laparoscopic: an incision (cut) is made near your navel (tummy button) and a thin tube with a tiny camera attached (laparoscope) is inserted, allowing the surgeon a view of the internal organs. If endometriosis is being treated, small instruments are introduced through several small cuts in the lower abdomen and endometrial tissue is destroyed using an electric current or laser beam.

Abdominal (laparotomy): if endometriosis is very widespread, an incision is made in the abdomen, opening up the abdominal cavity so that the endometrial tissue can be removed.

In this procedure a thin, flexible tube with a camera and an ultrasound device at its tip is inserted through the mouth (or sometimes bottom). The tube is passed through the digestive tract and allows doctors to examine the lining of the tract as well as nearby organs, often to diagnose or stage cancers, evaluate abnormalities, or guide biopsies.

A face lift can include several different procedures such as a neck lift and/or a brow lift, all designed to reduce lines and wrinkles and lift sagging skin.

In a typical face lift, cuts (incisions) are made within the hairline in front of and around behind the ears. Tissue lying deep below the skin is repositioned, then the skin replaced and any excess is removed. The surgery varies in duration, but can take up to 4 or 6 hours if it is combined with other procedures. General anaesthesia (you sleep through the operation) is usually required, but in some cases you may be given a local anaesthetic and a sedative so the area being treated is numb and you feel drowsy but not asleep. In most cases, you will stay in hospital overnight following the procedure. It may take 2-3 weeks for the worst of the swelling to disappear and up to 1 year for the scars to fade.

A fibroscan is a type of ultrasound scan used to assess the health of the liver. It measures liver stiffness, which indicates the extent of liver damage.

Gallstones are formed if the gallbladder is not working properly, and the standard treatment is to remove the gallbladder (cholecystectomy). This procedure is usually performed using a laparoscopic (keyhole) approach.

Laparoscopic: several small incisions (cuts) are made in the abdomen (stomach) and a narrow tube with a tiny camera attached (laparoscope) is inserted. This allows the surgeon a view of the gallbladder and, by inserting small surgical instruments through the other cuts, the gallbladder can be removed.

Open: an abdominal incision is made and the gallbladder removed.

Partial: the diseased part of the stomach is removed and the remaining section is reattached to the oesophagus (food pipe) or small intestine.

Total: all of the stomach is removed and the oesophagus is attached directly to the small intestine.

Gastroscopy allows examination of the upper part of your digestive tract i.e. oesophagus (food pipe), stomach and duodenum (top section of the small intestine), by passing a gastroscope (long, flexible tube with a camera on the end) through your mouth and down your digestive tract. Images from the camera are displayed on a television monitor. Sometimes a small tissue sample (biopsy) will need to be taken during the procedure for later examination at a laboratory.

Gastroscopy may be used to diagnose peptic ulcers, tumours, gastritis etc.

Complications from this procedure are very rare but can occur. They include: bleeding if a biopsy is performed; allergic reaction to the sedative or throat spray; perforation (tearing) of the stomach with the instrument (this is a serious but extremely rare complication).

What to expect

All endoscopic procedures are viewed as a surgical procedure and generally the same preparation will apply. You will not be able to eat or drink anything for 6 hours before your gastroscopy. When you are ready for the procedure, the back of your throat will be sprayed with anaesthetic. You will also be offered medication (a sedative) to make you go into a light sleep. This will be given by an injection into a vein in your arm or hand.

The gastroscopy will take approximately 15 minutes, but you will probably sleep for another 30 minutes. You will spend some time in a recovery unit (probably 1-2 hours) to sleep off the sedative and to allow staff to monitor you (take blood pressure readings etc). Because you have been sedated (given medication to make you sleep) it is important that you arrange for someone else to drive you home.

If biopsies are taken for examination, your GP will be sent the results within 2-3 weeks.

Conditions of the gut dealt with by general surgery include disorders of the oesophagus, stomach, small bowel, large bowel and anus. These range from complex conditions such as ulceration or cancer in the bowel through to fairly minor conditions such as haemorrhoids. Many of the more major conditions such as bowel cancer will require surgery, or sometimes treatment with medication, chemotherapy or radiotherapy.

Haemorrhoids are a condition where the veins under the lining of the anus are congested and enlarged. Less severe haemorrhoids can be managed with simple treatments such as injection or banding which can be performed in the clinic while larger ones will require surgery.

GORD is caused by the backflow (reflux) of food and stomach acid into the oesophagus (the tube that connects the mouth to the stomach) from the stomach. This happens when the valve between the stomach and the lower end of the oesophagus is not working properly. The main symptom of GORD is heartburn (a burning feeling in the stomach and chest).

Read more about GORD on the Healthify website

Gynaecological cancer refers to cancer anywhere in a woman’s reproductive system or genital area. Cancers occur when the cells divide and grow in an uncontrolled way forming a lump, growth or tumour. Usually the cause of the cancer is unknown. There are a number of different treatments for gynaecological cancer and the doctor and specialist will work out which is best for each individual woman. Treatment may include surgery, chemotherapy and/or radiotherapy.

Ovarian Cancer

The most common symptom associated with ovarian cancer is abdominal pain. In most cases the cancer is found when a doctor feels a lump in the abdomen when doing an internal (vaginal) examination.

Endometrial Cancer

The endometrium is the lining of the uterus (womb). When a cancerous tumour grows in the endometrium the most common symptom is bleeding. This type of cancer is a lot more common in older women, after they have gone through menopause.

Cancer of the Vulva

The vulva is the area of the genitalia outside a woman’s body. Cancer of this region is very rare. The most common symptoms are bleeding, itching or a burning feeling in the vulval area.

Cervical Cancer

The cervix is at the entrance to the uterus (womb). Typical signs of cervical cancer include bleeding between periods and after sexual intercourse. In most cases the cancer can be diagnosed by a vaginal examination.

Haemorrhoids are a condition where the veins under the lining of the anus are congested and enlarged. Less severe haemorrhoids can be managed with simple treatments such as injection or banding which can be performed in the clinic while larger ones will require surgery.

Haemorrhoid removal:

Haemorrhoidectomy: each haemorrhoid or pile is tied off and then cut away.

Stapled Haemorrhoidectomy: a circular stapling device is used to pull the haemorrhoid tissue back into its normal position.

Problems with the appearance or function of the hand can be the result of injury, birth defects or degenerative conditions.

Transplantation

Fingers or hands that have been accidentally cut off can be reattached by very detailed surgery that is performed under a microscope (microsurgery) and involves reconnecting tendons, blood vessels and nerves.

Arthritis

Arthritis is a condition in which a joint and the surrounding tissue become swollen and painful. If surgery is necessary, it may involve replacement of the joint with an artificial joint or removal or repair of swollen or damaged tissue.

Birth Abnormalities

Surgery may sometimes be required for hand abnormalities that are present at birth such as too many or too few fingers, webbed fingers or joints that won’t bend.

Carpal Tunnel Syndrome

A pinched nerve in the wrist that causes tingling, numbness and pain in your hand may require surgery to make more room for the nerve. This operation is usually performed under local anaesthetic (the area being treated is numb but you are awake).

Injuries

Damage to tendons, nerves, joints and bones in the hand may require surgical repair. In some cases, tissue may be transferred from a healthy part of your body to the injured site (grafting).

A hernia exists where part of the abdominal wall is weakened, and the contents of the abdomen push through to the outside. This is most commonly seen in the groin area but can occur in other places. Surgical treatment is usually quite straightforward and involves returning the abdominal contents to the inside and then reinforcing the abdominal wall in some way.

Hiatus Hernia:

Laparoscopic: several small incisions (cuts) are made in the abdomen (stomach) and a narrow tube with a tiny camera attached (laparoscope) is inserted. Small instruments are inserted through the other cuts, allowing the surgeon to push the hernia (part of the stomach and lower oesophagus that is bulging into the chest) back into position in the abdominal cavity. The hiatus (opening) in the diaphragm (a sheet of muscle between the chest and stomach) is tightened and the stomach is stitched into place.

Open: an abdominal incision is made over the hernia and the hernia is pushed back into position in the abdominal cavity. The hiatus (opening in the diaphragm) is tightened and the stomach is stitched into place.

Fundoplication: during the above procedures, the top part of the stomach (fundus) may be secured in position by wrapping it around the oesophagus.

Inguinal Hernia:

Laparoscopic: several small incisions are made in the abdomen and a narrow tube with a tiny camera attached (laparoscope) is inserted. Small instruments are inserted through the other cuts, allowing the surgeon to push the hernia (part of the intestine that is bulging through the abdominal wall) back into its original position. The weakness in the abdominal wall is repaired.

Open: an abdominal incision is made and the hernia is pushed back into position. The weakness in the abdominal wall is repaired.

Umbilical Hernia:

An incision is made underneath the navel (tummy button) and the hernia (part of the intestine that is bulging through the abdominal wall) is pushed back into the abdominal cavity. The weakness in the abdominal wall is repaired.

Incisional Hernia:

Laparoscopic: several small incisions are made in the abdomen and a narrow tube with a tiny camera attached (laparoscope) is inserted. Small instruments are inserted through the other cuts, allowing the surgeon to push the hernia (part of the intestine that is bulging through the abdominal wall) back into its original position.

Open: an abdominal incision is made and the hernia is pushed back into position.

A hysterectomy is an operation to remove your uterus (womb). Some types of hysterectomies include the removal of other organs as well, and this will depend on the reason for the operation. A hysterectomy is a treatment for many different diseases and conditions and it can be done through the vagina or through a cut in the stomach.

A speculum is inserted into your vagina, as for a cervical smear, and a long, thin tube with a tiny camera attached (hysteroscope) is placed into the vagina and moved through into the uterus. This allows the surgeon to see inside the uterus and may, in some cases, show the reason for conditions such as infertility or pelvic pain. A hysteroscope may also be used to remove fibroids or polyps or to take a biopsy (small sample of tissue) for examination in the laboratory.

This is an operation where the cervix (entrance to the uterus) is dilated and a hysteroscope (small lighted mini telescope) is inserted into the uterus through the vagina and cervix so the specialist can see the inside of the uterus. If no cancer is present, a small spoon-like instrument with a long handle, called a curette, is inserted and the lining of the uterus is scraped off and sent to the laboratory for examination.

This procedure can be done under a general (you are asleep) or local (you are awake but the area being investigated is numb) anaesthetic.

When a person or couple has been unable to get pregnant after trying for a year or more. Read more about infertility on the Healthify website.

There are two types of IBD, ulcerative colitis and Crohn’s disease. In these conditions, the immune system attacks the lining of the colon causing inflammation and ulceration, bleeding and diarrhoea. In ulcerative colitis this only involves the large intestine, whereas in Crohn’s disease areas within the entire intestine can be involved. Both diseases are chronic (long term) with symptoms coming (relapse) and going (remission) over a number of years.

Symptoms depend on what part of the intestine is involved but include:

• abdominal pain
• diarrhoea with bleeding
• tiredness
• fevers
• infections around the anus (bottom)
• weight loss can occur if the condition has been present for some time.

Diagnosis is made when the symptoms, examination and blood tests suggest inflammatory bowel disease, infection is ruled out, and you undergo a colonoscopy with biopsy.

Treatment depends on the severity of the symptoms and what part of the intestine is affected. Medication is aimed at suppressing the immune system, which is harming the lining of the bowel. This is done via oral or intravenous medication as well as medication given as an enema (via the bottom). Other treatments include changes in the diet to optimise nutrition and health. Treatment in some cases requires surgery to remove affected parts of the bowel.

A range of medications such as iron, bisphosphonates (for bone conditions) and biologic treatments are delivered by intravenous infusion (given by injection into a vein through a drip).

IBS is a common condition that affects how the stomach and bowels work. People with IBS might get stomach pain, feel bloated, and have problems like diarrhoea (runny poo), constipation (hard poo), or both.

Read more about irritable bowel syndrome (IBS) on the Healthify website.

Labiaplasty is surgery to reduce the size of the labia minora, the folds of skin around the opening of the vagina. It may be performed for appearance reasons or to alleviate physical discomfort. The procedure is done under local or general anaesthetic.

Anterior: an incision (cut) is made in your navel (tummy button) and several small cuts in the abdomen (stomach). A thin telescopic instrument (laparoscope) and several small instruments are inserted into the cuts and used to tighten up the front wall of the vagina to repair a cystocele (bulging of the bladder into the vaginal wall).

Posterior: an incision is made in your navel and several small cuts in the abdomen. A laparoscope and several small instruments are inserted into the cuts and used to tighten up the back wall of the vagina to repair a rectocele (bulging of the rectum into the vaginal wall).

A surgical procedure can be performed to make your lips to appear fuller without having foreign material injected into them.

In this procedure, small cuts (incisions) are made on the inside of the lip and the tissue is reshaped. The surgery takes about 1 hour for the upper or lower lip and it is performed under local anaesthetic (the area is numb but you are awake). It will probably take 1-2 weeks for the swelling to disappear.

This procedure removes unwanted pockets of fat from under your skin in specific parts of the body such as the chin, neck, upper arms, stomach, hips and thighs. Liposuction should not be regarded as a means of general weight loss, but instead as a way to improve the shape of particular areas of your body.

A small cut (incision) is made, through which a narrow, hollow tube (cannula) is inserted. The tube is moved around to loosen the fat cells, which are then sucked out with a vacuum device. During the procedure you will lose a lot of fluid, so you will be given intravenous (injected straight into the vein) fluid to stop you becoming dehydrated. The procedure usually takes 1-3 hours and is carried out under local anaesthetic (the area being treated is numb but you are awake). You will probably be able to go home the same day but will need someone to drive you. However, if the procedure is more extensive and numerous areas are being treated at the same time, it may require general anaesthesia (you will sleep through it) and you may have to remain overnight in hospital. The area treated will be swollen and bruised after the surgery and you may need to take pain relief medication for several days. You will be given an elastic dressing or support garment that you may have to wear continuously for 2-3 weeks. You will probably be able to return to work after 1-2 weeks.

Menopause is also called the “change of life” and is the time when your periods will become irregular and stop. This is a natural process in all women and for most it will occur between the ages of 45 and 55 years.

Menopause is brought on by decreasing levels of the hormone oestrogen and this can cause a variety of symptoms, including hot flushes, night sweats, mood swings, sleeping problems, memory problems, depression and vaginal dryness. Some women do not notice any symptoms or they are very mild, whereas others experience more severe problems and should go to their doctor for advice.

There are many treatments available to reduce the symptoms associated with menopause and, in some cases, lifestyle changes can also help.

Menstruation is the medical name for your monthly period. This is when blood and tissue from the lining of the uterus (womb) is shed through the vagina and out of the body.

Menstruation starts at puberty and it is stimulated by hormones that make a girl’s body able to become pregnant. This usually happens anytime between the ages of 9 and 16 years. Menstruation will recur about every 28 days (the menstrual cycle), unless interrupted by pregnancy, and will stop at menopause, which occurs at about 50 years of age.

There are a number of problems that can occur with menstruation ranging from mild to severe. More than half of all women will have cramps (dysmenorrhoea) during the first day or two of their period. Other problems include very heavy or long periods (menorrhagia) or no periods (amenorrhoea).

Laparoscopic: an incision (cut) is made in your navel (tummy button) and several small cuts in the abdomen (stomach). A thin telescopic instrument (laparoscope) and several small instruments are inserted into the cuts and moved through into the uterus allowing the surgeon to view the fibroids. Small fibroids can then be removed either by introducing small surgical tools to cut them away or by vaporising them with a laser or electric current. For large fibroids, an incision is made across your abdomen and the fibroids are cut out of the uterus.

Hysteroscopic: a speculum is inserted into your vagina, as for a pap smear, and a long, thin tube with a tiny camera attached (hysteroscope) is placed into the vagina and moved through into the uterus. This allows the surgeon to see inside the uterus and remove the fibroids.

A group of procedures used to assess how well the oesophagus (the muscular tube that connects the throat to the stomach) is working. These tests help diagnose conditions such as reflux or swallowing disorders.

Common oesophageal tests include:

• Oesophageal manometry: measures the muscle contractions in the oesophagus.
• BRAVO pH testing: measures the acidity (pH) in the oesophagus.
• Oesophageal pH impedance study: measures acid levels in the oesophagus over 24 hours.

An oophorectomy is an operation to remove one or both ovaries. It is done for many reasons including ovarian cancer, ovarian cysts or to remove the source of the hormone oestrogen that is produced by the ovaries and can stimulate some cancers. If both ovaries are removed, your periods will stop and you will not be able to have children. Sometimes an oophorectomy is done together with a hysterectomy.

Several small incisions (cuts) are made in your abdomen (stomach) and a thin tube with a tiny camera attached (laparoscope) inserted, allowing the surgeon a view of your ovaries. Small instruments are inserted through the cuts and into the ovaries, where they remove the cysts.

An ovarian cyst is a fluid-filled sac or pouch in the ovary. In most cases, the cyst grows as a result of ovulation (when the egg is released from the ovary), and it will usually shrink over time. Sometimes, the ovarian cyst may cause pain.

The best way to check for an ovarian cyst is by ultrasound examination, and the treatment will depend on how troublesome the symptoms are. Sometimes it is best to leave the cyst alone and just check it regularly with ultrasound. In other cases it may need to be removed by laparoscopic surgery.

An incision (cut) is made in your navel (tummy button) and several small cuts in the abdomen (stomach). A thin telescopic instrument (laparoscope) is inserted through your navel, allowing the surgeon a view of the pelvic floor. Small instruments are inserted into the cuts that can lift the prolapsed or sagging organs back into position and reattach them.

Polycystic ovary syndrome (PCOS) is a hormonal disorder that can cause you to have a variety of symptoms, including no periods or irregular periods, increased hair growth on the face and body, acne (pimples) and increased bodyweight. PCOS is also one of the main causes of infertility in women. The ovaries of women with PCOS often contain many small cysts (fluid-filled sacs), but this does not seem to be the cause of the condition.

For women who have not reached menopause, the most common treatment is the birth control pill, which will regulate your periods. There are also other medicines that can help control the symptoms.

Laparoscopic: several small incisions (cuts) are made in the abdomen (stomach) and a narrow tube with a tiny camera attached (laparoscope) is inserted. This allows the surgeon to view the rectum and, by inserting small surgical instruments through the other cuts, part or all of the rectum can be removed.

Open: an abdominal incision is made and part or all of the rectum removed.

Laparoscopic: several small incisions (cuts) are made in your abdomen (stomach) and a thin tube with a tiny camera attached (laparoscope) inserted, allowing the surgeon a view of your fallopian tubes. Small surgical instruments are introduced through the other cuts and are used to remove part or all of the fallopian tube.

Abdominal (laparotomy): an incision is made in your abdomen and part or all of the fallopian tube is removed.

Scar appearance can be improved by various methods including a surgical procedure known as scar revision. This usually involves cutting out the old scar, closing the wound with stitches and, in some cases, moving the scar so that it is hidden by natural features of the body.

Scar revision is usually performed under local anaesthesia (the area around the scar is numbed by injecting a local anaesthetic). Sometimes you may also be given steroid injections at the time of surgery. Immediately following the procedure, you will need to remain at the clinic for about an hour, during which you will be encouraged to walk around. You may or may not have a dressing put on the wound and it is important to keep the area dry for 24 hours. Stitches may be removed in 1-2 weeks. You may need to take a few days off work after the surgery.

A long, narrow tube with a tiny camera attached (sigmoidoscope) is inserted into your anus and moved through your lower large intestine (bowel). This allows the surgeon a view of the lining of the lower large intestine (sigmoid colon). If necessary, a biopsy (small piece of tissue) may be taken for examination in the laboratory.

Shave Biopsy: the top layers of skin in the area being investigated are shaved off with a scalpel (surgical knife) for investigation under a microscope.

Punch Biopsy: a small cylindrical core of tissue is taken from the area being investigated for examination under a microscope.

Excision Biopsy: all of the lesion or area being investigated is cut out with a scalpel for examination under a microscope.

Incision Biopsy: part of the lesion is cut out with a scalpel for examination under a microscope.

New Zealand has a very high rate of skin cancer, when compared to other countries. The most common forms of skin cancer usually appear on areas of skin that have been over-exposed to the sun.

Risk factors for developing skin cancer are: prolonged exposure to the sun; people with fair skin; and possibly over-exposure to UV light from sun beds.

There are three main types of skin cancers: basal cell carcinoma, squamous cell carcinoma and malignant melanoma.

Basal Cell Carcinoma (BCC):

This is the most common type and is found on skin surfaces that are exposed to sun. A BCC remains localised and does not usually spread to other areas of the body. Sometimes BCCs can ulcerate and scab so it is important not to mistake it for a sore.

BCCs occur more commonly on the face, back of hands and back. They appear usually as small, red lumps that don’t heal and sometimes bleed or become itchy. They have the tendency to change in size and sometimes in colour.

Treatment:

Often a BCC can be diagnosed just by its appearance. In other cases it will be removed totally and sent for examination and diagnosis, or a biopsy may be taken and just a sample sent for diagnosis.

Removal of a BCC will require an appointment with a doctor or surgeon. It will be termed minor surgery and will require a local anaesthetic (numbing of the area) and possibly some stitches. A very small number of BCCs will require a general anaesthetic (you will sleep through the operation) for removal.

Squamous Cell Carcinoma (SCC):

This type of skin cancer also affects areas of the skin that have exposure to the sun. The most common area is the face, but an SCC can also affect other parts of the body and can spread to other parts of the body. The spreading (metastasising) can potentially be fatal if not successfully treated.

A SCC usually begins as a keratosis that looks like an area of thickened scaly skin, it may then develop into a raised, hard lump which enlarges. SCCs can sometimes be painful. Often the edges are irregular and it can appear wart like, the colour can be reddish brown. Sometimes it can appear like a recurring ulcer that does not heal.

All SCCs will need to be removed, because of their potential for spread. The removal and diagnosis is the same as for a BCC.

Malignant Melanoma:

This is the most serious form of skin cancer. It can spread to other parts of the body and people can die from this disease.

A melanoma usually starts as a pigmented growth on normal skin. They often, but not always, occur on areas that have high sun exposure. In some cases, a melanoma may develop from existing pigmented moles.

What to look for:

• an existing mole that changes colour (it may be black, dark blue or even red and white)
• the colour pigment may be uneven
• the edges of the mole/freckle may be irregular and have a spreading edge
• the surface of the mole/freckle may be flaky/crusted and raised
• sudden growth of an existing or new mole/freckle
• inflammation and or itchiness surrounding an existing or new mole/freckle.

Treatment:

It is important that any suspect moles or freckles are checked by a GP or a dermatologist. The sooner a melanoma is treated, there is less chance of it spreading.

A biopsy or removal will be carried out depending on the size of the cancer. Tissue samples will be sent for examination, as this will aid in diagnosis and help determine the type of treatment required. If the melanoma has spread more surgery may be required to take more of the affected skin. Samples from lymph nodes that are near to the cancer may be tested for spread, then chemotherapy or radiotherapy may be required to treat this spread.

Once a melanoma has been diagnosed, a patient may be referred to an oncologist (a doctor who specialises in cancer).

A melanoma that is in the early stages can be treated more successfully and cure rates are much higher than one that has spread.

There are three main types of skin cancers: basal cell carcinoma, squamous cell carcinoma and malignant melanoma. Basal cell and squamous cell carcinomas are generally slow growing and unlikely to spread to other parts of the body while melanoma is a serious skin cancer that can spread to other parts of the body and urgent removal is usually recommended.

Surgery involves removing the cancerous lesion and carefully reconstructing the area to achieve the best possible functional and cosmetic outcome. Plastic surgeons may use advanced techniques like skin grafts or local flaps to help the skin heal well and reduce scarring.

Skin conditions dealt with include lumps, tumours, cysts and other lesions of the skin and underlying tissues. These are often fairly simple conditions that can be dealt with by performing minor operations under local anaesthetic (the area of skin being treated is numbed). Often these procedures are performed as outpatient or day case procedures.

If the scar to be revised or skin lesion being removed is particularly large, a skin graft may be performed. This involves transferring skin from another, healthy part of the body (donor site) to the injured site (recipient site). While skin grafting can improve the function of a damaged area, some scarring will be left at both the donor and recipient sites. Skin grafting is likely to be performed under general anaesthesia (you will be asleep during the procedure) in a hospital. The wound may take weeks or months to heal and you may need to wear a support bandage for a similar period.

Skin lesions can be divided into two groups:

• Benign (non-cancerous): e.g. moles, cysts, warts, tags. These may be removed to prevent spreading (warts), stop discomfort if the lesion is being irritated by clothing/jewellery or to improve appearance.
• Malignant (cancerous): basal cell and squamous cell carcinomas are generally slow growing and unlikely to spread to other parts of the body. Melanoma is a serious skin cancer that can spread to other parts of the body. Urgent removal is recommended.

Surgery to remove skin lesions usually involves an office or outpatient visit, local anaesthesia (the area around the scar is numbed by injecting a local anaesthetic) and stitches. You may or may not have a dressing put on the wound and it is important to keep the area dry for 24 hours. Stitches may be removed in 1-2 weeks. You may need to take a few days off work after the surgery.

This procedure involves removing excess skin and fat from the stomach and tightening the muscles of the stomach wall. Cuts (incisions) are made across the lower stomach and around the tummy button and the muscles underneath are pulled together and stitched. The skin flap is stretched down and the excess skin removed. A new hole is made and the tummy button replaced. The surgery is performed under general anaesthesia (you will sleep through it) and will take 3-4 hours. You will probably have to stay in hospital for 2 days and will need to arrange for someone else to drive you home.

Your stomach will be swollen and painful at first and you may need to take medication for pain relief for several days. You will possibly have to wear a special support garment for 2-3 weeks after surgery. You will probably be able to return to work after about 2 weeks. It will take 9-12 months for the scar to lighten.